Cross-link augmentation enhances CFR-PEEK short fixation in lumbar metastasis stabilization.

Introduction: Spinal stability plays a crucial role in the success of the surgical treatment of lumbar vertebral metastasis and, in current practice, less invasive approaches such as short constructs have been considered. Concurrently, carbon fiber-reinforced (CFR) poly-ether-ether-ketone (PEEK) fixation devices are expanding in oncologic spinal surgery thanks to their radiotransparency and valid mechanical properties. This study attempts to provide an exhaustive biomechanical comparison of different CFR-PEEK surgical stabilizations through a highly reproducible experimental setup. Methods: A Sawbones biomimetic phantom (T12-S1) was tested in flexion, extension, lateral bending, and axial rotation. An hemisome lesion on L3 vertebral body was mimicked and different pedicle screw posterior fixations were realized with implants from CarboFix Orthopedics Ltd: a long construct involving two spinal levels above and below the lesion, and a short construct involving only the levels adjacent to L3, with and without the addition of a transverse rod-rod cross-link; to provide additional insights on its long-term applicability, the event of a pedicle screw loosening was also accounted. Results: Short construct reduced the overloading onset caused by long stabilization. Particularly, the segmental motion contribution less deviated from the physiologic pattern and also the long-chain stiffness was reduced with respect to the prevalent long construct. The use of the cross-link enhanced the short stabilization by making it significantly stiffer in lateral bending and axial rotation, and by limiting mobiliza-tion in case of pedicle screw loosening. Discussion: The present study proved in vitro the biomechanical benefits of cross-link augmentation in short CFR-PEEK fixation, demonstrating it to be a potential alternative to standard long fixation in the surgical management of lumbar metastasis.

Soft tissue sarcomas of the buttock: A systematic review and meta-analysis.

BACKGROUND: Soft tissue sarcomas of the buttock (BSTS) are historically associated with a poor prognosis. The literature includes retrospective studies with small sample size. It is difficult to estimate the rate of local recurrence (LR), distant metastasis (DM) and overall survival (OS). A systematic review and meta-analysis was deployed to summarize the available information on BSTS patients that underwent surgical treatment. METHODS: The PubMed, EMBASE, Scopus and Google Scholar databases were reviewed for eligible studies following PRISMA guidelines. INCLUSION CRITERIA: (1) primary BSTS confirmed by pathological biopsy (2) indication for surgical treatment (3) reporting either the rate of LR, DM, or OS at 5-year (4) articles published up to December 2021 (5) english language. The Methodological Index for Non-Randomized Studies (MINORS) was applied for the quality appraisal. RESULTS: Six eligible studies with 216 BSTS patients were identified. Most patients underwent surgical resection, associated with radiation therapy. The most represented histological types were liposarcoma (n = 43, 19,9%), rhabdomyosarcoma (n = 27, 12.5%), and undifferentiated pleomorphic sarcoma (n = 23, 10.6%). High-grade tumor rates ranged from 37% to 88.2%, marginal resection rates from 20.3% to 50%, LR rates from 0% to 62.5%, DM rates from 37.5% to 62.5%. The pooled 5-year OS from 1941 to 2002 was 41% (IC95%: 33%-49%). The average MINORS score was 9.3 (range: 6 to 11). CONCLUSIONS: Surgical resection of BSTS had on average dissatisfactory outcomes, and the 5-year overall survival was poor, with high rates of local recurrence and distant metastasis. An effort to collect new data with a higher level of evidence is warranted.

Validation process of Toronto Exremity Salvage Score in Italian: A quality of life measure for patients with extremity bone and soft tissue tumors.

BACKGROUND AND OBJECTIVES: Limb salvage surgery remains the standard treatment in bone and soft tissue tumors. Toronto Extremity Salvage Score (TESS) is the most used quality of life measure. Our objective was to perform cross-cultural adaptation and validation in Italian, testing test-retest reliability, construct validity, and responsiveness. METHODS: We interviewed patients already treated for content validity. A total of 124 patients completed TESS and other questionnaires presurgery, at 3 months, 3 months + 2 weeks, and 6 months follow-up. We calculated intraclass correlation coefficients (ICCs) for reliability, associations with Pearson's r, and change over time with paired T tests. RESULTS: A new item regarding touch-screen devices was added to the upper extremity (UE) questionnaire. ICC resulted of 0.99 for lower extremity (LE) and 0.98 for UE patients, Pearson's r between TESS and Musculoskeletal Tumor Society was .66 and .64, EuroQol-5D-5L r was .62 and .61, and r between TESS and short form-36 physical function subscale was .76 and .71 for LE and UE groups, respectively. Paired T test results were statistically significant to detect change over time (0.03, 0.04, and 0.04 for LE groups and 0.03, 0.01, and 0.04 for UE groups). CONCLUSION: The Italian version of TESS can be used for the bone and soft tissue sarcoma population in clinical trials in Italy and with Italian speaking patients abroad to ensure patients' perspectives for efficacy and efficiency of treatments.

Patient-centered boundary mechanisms to foster intercultural partnerships in health care: a case study in Guatemala.

BACKGROUND: Up to one half of the population in Africa, Asia and Latin America has little access to high-quality biomedical services and relies on traditional health systems. Medical pluralism is thus in many developing countries the rule rather than the exception, which is why the World Health Organization is calling for intercultural partnerships to improve health care in these regions. They are, however, challenging due to disparate knowledge systems and lack of trust that hamper understanding and collaboration. We developed a collaborative, patient-centered boundary mechanism to overcome these challenges and to foster intercultural partnerships in health care. To assess its impact on the quality of intercultural patient care in a medically pluralistic developing country, we conducted and evaluated a case study. METHODS: The case study took place in Guatemala, since previous efforts to initiate intercultural medical partnerships in this country were hampered by intense historical and societal conflicts. It was designed by a team from ETH Zurich's Transdisciplinarity Lab, the National Cancer Institute of Guatemala, two traditional Councils of Elders and 25 Mayan healers from the Kaqchikel and Q'eqchi' linguistic groups. It was implemented from January 2014 to July 2015. Scientists and traditional political authorities collaborated to facilitate workshops, comparative diagnoses and patient referrals, which were conducted jointly by biomedical and traditional practitioners. The traditional medical practices were thoroughly documented, as were the health-seeking pathways of patients, and the overall impact was evaluated. RESULTS: The boundary mechanism was successful in discerning barriers of access for indigenous patients in the biomedical health system, and in building trust between doctors and healers. Learning outcomes included a reduction of stereotypical attitudes towards traditional healers, improved biomedical procedures due to enhanced self-reflection of doctors, and improved traditional health care due to refined diagnoses and adapted treatment strategies. In individual cases, the beneficial effects of traditional treatments were remarkable, and the doctors continued to collaborate with healers after the study was completed. Comparison of the two linguistic groups illustrated that the outcomes are highly context-dependent. CONCLUSIONS: If well adapted to local context, patient-centered boundary mechanisms can enable intercultural partnerships by creating access, building trust and fostering mutual learning, even in circumstances as complex as those in Guatemala. Creating multilateral patient-centered boundary mechanisms is thus a promising approach to improve health care in medically pluralistic developing countries.

Intra- and inter-observer reliability of ten major histological scoring systems used for the evaluation of in vivo cartilage repair.

PURPOSE: In the last two decades, many surgical techniques have been described for articular cartilage repair. Reliable histological scoring systems are fundamental tools to evaluate new procedures. Several histological scoring systems have been described, and these can be divided in elementary and comprehensive scores, according to the number of sub-items. The aim of this study was to test the inter- and intra-observer reliability of ten main scores used for the histological evaluation of in vivo cartilage repair. The authors tested the starting hypothesis that elementary scores would show superior intra- and inter-observer reliability compared with comprehensive scores. METHODS: Fifty histological sections obtained from the trochlea of New Zealand Rabbit and stained with Safranin-O fast green were used. The histological sections were analysed by 4 observers: 2 experienced in cartilage histology and 2 inexperienced. Histological evaluations were performed at time 1 and time 2, separated by a 30-day interval. The following scores were used: Mankin, O'Driscoll, Pineda, Wakitani, Fortier, Selleres, ICRS, ICRSII, Oswestry (OsScore) and modified O'Driscoll. Intra- and inter-observer reliability were evaluated for each score. In addition, the pavement-ceiling effect and the Bland-Altman Coefficient of Repeatability were then evaluated for each sub-item of every score. RESULTS: Intra-observer reliability was high for all observers in every score, even though the reliability was significantly lower for non-expert observers compared with expert counterparts. In terms of Coefficient of Repeatability, some scores performed better (O'Driscoll, Modified O'Driscoll and ICRSII) than others (Fortier, Seller). Inter-observer reliability was high for all observers in every score, but significantly lower for non-expert compared with expert observers. CONCLUSIONS: In expert hands, all the scores showed high intra- and inter-observer reliability, independently of the complexity. Although every score has advantages and disadvantages, ICRSII, O'Driscoll and Modified O'Driscoll scores should be preferred for the evaluation of in vivo cartilage repair in animal models.

No early tibial tray loosening after surface cementing technique in mobile-bearing TKA.

Controversy still exists regarding which cementation technique of the tibial component is preferable. Full cementation showed excellent long-term outcomes, and surface cementation with fixed-bearing designs provided excellent mid-term results. Concerns have been expressed about possible rotary forces to the tibial rotating platform, when the tibial stem remains cementless, with the risk of early loosening. The purpose of this study was to evaluate the rate of early loosening and radiolucency lines in 70 consecutive unidirectional rotating platform, posterior stabilized, total knee arthroplasties, using surface cementation. Multivariate analysis was performed to identify any correlations between early loosening or radiolucency lines and clinically relevant covariates: age, sex, BMI, follow-up time, cement penetration, radiolucencies, tibial slope, femoral flexion, frontal alignment, pre-operative and post-operative Knee Scores. The tibial plateau was divided into four zones in antero-posterior view and into two zones in lateral view, and the cement penetration was evaluated in each zone. The mean follow-up was 43 months (SD 14), and the average patients' age was 73 (SD 7). The Knee Score averaged 91 (SD 8) and the Function score 86 (SD 17) at last follow-up visit. The cement penetration was >2 mm in all zones. No early loosening was detected, but in five asymptomatic patients (7%) radiolucency was noted around the tibial stem. The presence of radiolucent lines was not correlated with any of the covariates. The rate of early loosening and radiolucency lines with mobile tibial tray and surface cementation is comparable to other studies using different cementation techniques or surface cementation combined with fixed platform total knee arthroplasties.

Long-term results of cementless anatomic total hip replacement in dysplastic hips.

This perspective study analyzes the long-term outcomes of cementless anatomic total hip arthroplasty (THA) in patients with developmental dysplasia of the hip (DDH). Between 1990 and 2004, 100 ABG total hip prosthesis were implanted in 87 patients with DDH. The average follow-up was 9 years (range 4-18 years). The mean Harris Hip Score was 87.13 (SD = 14.6) at the last follow-up. Radiographic analysis showed good results for the stems, while in 38% of the hips we recorded periacetabular bone resorption. Mean linear polyethylene wear was 0.23 mm/year. Ten revisions have been performed, survival rate was 99% for the stems and 90% for the cups. Cementless THA with hemispherical cup and anatomical stem is recommended when possible for patients with DDH although high rates of polyethylene wear and subsequent osteolysis have been the limiting factor in the long-term success of this implant.

Accessory soleus in the athletes: literature review and case report of a massive muscle in a soccer player.

Accessory soleus is a rare congenital anatomical variant, which may manifest in the second/third decade of life as an exertional ankle pain and swelling or as an asymptomatic postero-medial mass. The incidence of this condition ranges from 0.7 to 5.5%. Many treatment options have been described in literature, including conservative treatment, excision, fasciotomy, release and closure of blood supply. We report a symptomatic massive accessory soleus (17 x 5 x 4 cm) in an 18-year-old male semi-professional soccer player. Excision of the accessory soleus was performed. The patient went back to the game 3 months after surgery. The literature review stated that either fasciotomy or excision of the muscle produce good results in the athletes.