Assessment of Physical Performance and Early Treatment Outcomes after Implantation of Modular Prostheses of Femoral and Tibial Shaft.

BACKGROUND: Tumours of bone diaphyses often require resection followed by bone reconstruction. The use of modular pro-sthe-ses permits early limb loading and rapid improvement in physical performance. The aim of this study was to evaluate the func-tioning of patients and early treatment outcomes after the implantation of modular prostheses. The analysis covered the correlation between the extent of resection, physical performance and the number of perioperative complications. MATERIAL AND METHODS: 10 patients (5 women and 5 men) with diaphyseal tumours who had modular prostheses implanted were treated at the Orthopaedic Oncology Department in Brzozów between 2014 and 2018. The mean age of the patients was 51.1 years (range: 26-63 years). Functional outcomes were assessed using the MSTS and the Karnofsky scoring system. A VAS was used to evaluate pain intensity. the extent of resection was also analysed, considering bone length and tumour weight. RESULTS: The mean tumour weight was 374g (150-700g). The length of the implants varied from 10 to 25 cm. The mean dura-tion of hospitalisation was 16 days (14-19 days). At 3 months following the surgery, the intensity of pain had decreased from a mean of 6.8 points to 4.2 points (a decrease of 26% from the pre-operative baseline). The MSTS showed improvement of functional performance from a mean of 10.8 points (36%) to 22.9 points (76%). The Karnofsky scores demonstrated an increase in physical performance from 47 to 67 points (20 points on average). Superficial infection of the wound developed in 1 patient. CONCLUSIONS: 1. The treatment of diaphyseal tumours with modular prostheses produces good functional outcomes. 2. The extent of the resection and the size of the implant have an effect on the post-operative physical performance of the patients. 3. Pre-operative evaluation of the weight of the tumour may be helpful in predicting the patient's post-operative functional status. 4. Phy-sical perfor-mance is better after the resection of femoral vs tibial tumours.

Enhanced recovery program for minimally invasive and vaginal urogynecologic surgery.

INTRODUCTION AND HYPOTHESIS: Enhanced recovery protocols (ERPs) are evidenced-based interventions designed to standardize perioperative care and expedite recovery to baseline functional status after surgery. There remains a paucity of data addressing the effect of ERPs on pelvic reconstructive surgery patients. METHODS: An ERP was implemented at our institution including: patient counseling, carbohydrate loading, avoidance of opioids, goal-directed fluid resuscitation, immediate postoperative feeding and early ambulation. Patients undergoing elective pelvic reconstructive surgery before and after implementation of the ERP were identified in this cohort study. RESULTS: One hundred eighteen patients underwent pelvic reconstructive surgery within the ERP compared with 76 historic controls. Reductions were seen in length of hospital stay (29.9 vs. 27.9 h, p = 0.04), total morphine equivalents (37.4 vs. 19.4 mg, p < 0.01) and total intravenous fluids administered (2.7 l vs. 1.5 l, p < 0.0001). Hospital discharges before noon doubled (32.9 vs. 60.2%, p < 0.01). More patients in the ERP group ambulated on the day of surgery (17.1 vs. 73.7%, p < 0.01) and ambulated at least two times the day following surgery (34.2 vs. 72.9%, p < 0.01). No differences were seen in average pain scores (highest pain score 7.39 vs. 7.37, p = 0.95), hospital readmissions (3.9 vs. 3.4%, p = 0.84), or postoperative complications (6.58 vs. 8.47%, p = 0.79). Patient satisfaction significantly improved. ERP was not associated with an increase in 30-day total hospital costs. CONCLUSIONS: Implementation of ERP for pelvic reconstructive surgery patients was associated with a reduced length of hospital stay, improved patient satisfaction, and decreased administration of intravenous fluids and opioids without an increase in complications, readmissions, or hospital costs.

Anatomic assessment of femoral tunnel by transtibial drilling technique in double-bundle anterior cruciate ligament reconstruction: an in vivo study.

OBJECTIVE: To evaluate the anatomy of femoral tunnels created by simulated transtibial technique in double-bundle anterior cruciate ligament (ACL) reconstruction. METHODS: Two tibial tunnels, anteromedial (AM) and posterolateral (PL), were drilled 45?and 55?to tibial plateau respectively. On the femoral side, the AM and PL tunnels were drilled through anteriomedial portal. After the four tunnels were established, the shaft of a reamer was introduced into the joint through tibial tunnel and reached against the lateral wall of intercondylar notch. The position that the reamer shaft can reach was marked and recorded. RESULTS: Neither femoral AM nor PL tunnel opening can be fully or partially reached by the reamer shaft through the tibial AM tunnel in all cases. The evaluation through the tibial PL tunnel showed that only in 8 of 50 cases (16%) the femoral AM tunnel opening and in 4 cases (8%) the PL opening can be fully reached. On the other hand, in 12 cases (24%) the femoral AM tunnel opening and in 10 cases (20%) the PL opening can be partially reached by the shafts through the tibial PL tunnel. CONCLUSION: The result strongly suggests that transtibial technique is not well competent for femoral tunnel drilling in anatomic double-bundle ACL reconstruction as we have hypothesized.

The psychological assessment of candidates for reconstructive hand transplantation.

Standardized psychological assessment of candidates for reconstructive hand transplantation (RHT) is a new approach in transplantation medicine. Currently, international guidelines and standardized criteria for the evaluation are not established. Patients suffering from the loss of a hand or an upper extremity have to cope with multiple challenges. For a selected group of patients, RHT represents an option for restoring natural function and for regaining daily living independence. The identification of at-risk patients and those requiring ongoing counseling due to poor coping or limited psychological resources are the primary focus of the psychological assessment. We have developed the 'Innsbruck Psychological Screening Program for Reconstructive Transplantation (iRT-PSP)' which utilizes a semi-structured interview and standardized psychological screening procedures and continuous follow-up ratings. Between January 2011 and October 2011, four candidates were evaluated using the iRT-PSP. Psychological impairments including social withdrawal, embarrassment, reduced self-esteem, and a depressive coping style were identified and poor quality of life was reported. The motivation for transplantation was diverse, depending on many factors such as bi- or unilateral impairment, native or accidental loss of hand, and social integration.

Aerodynamic and acoustic assessment in children following airway reconstruction: an assessment of feasibility.

OBJECTIVE: The purpose of this study was to examine the feasibility of conducting aerodynamic and acoustic assessment in children following airway reconstruction. Underlying etiologies, co-morbidities and age related factors can present challenges for meaningful instrumental data collection in this population. METHODS: A chart review of 100 children who were seen for a complete voice evaluation at the Center for Pediatric Voice Disorders at the Cincinnati Children's Hospital Medical Center was conducted. Children who completed full or partial aerodynamic and acoustic protocols were identified. Data regarding the ability to participate in the assessment was tabulated, and vowel samples taken from the acoustic data were subjected to signal type classifications (e.g., Type I, II, III). RESULTS: Fifty-three children met the inclusion/exclusion criteria of the chart review. Of those children, 58% (n=31/53) were able to complete the full acoustic and aerodynamic protocols without any modification. In regards to the aerodynamic protocol alone, 64% (n=34/53) could complete protocol. In regards to the acoustic protocol alone, 75% (n=40/53) could complete the entire acoustic protocol without any modification. There were 32% (n=17) who provided a Type I acoustic signal which was appropriate for measurement of F(0). There was a significant correlation between age and ability to complete the protocol for both the aerodynamic (p=.007) and acoustic (p=.004) protocols. CONCLUSIONS: This study demonstrated that a majority of children were capable of completing aerodynamic and acoustic protocols. A significant proportion of children in this study had severe dysphonia, precluding the ability to extract fundamental frequency. Although aerodynamic and acoustic measures are feasible for many patients in this population, the severity of dysphonias observed in these patients causes the use of these measures to be limited in some cases for documenting behavioral and surgical outcomes measures.

The benefits of otoplasty for children: further evidence to satisfy the modern NHS.

SUMMARY OBJECTIVES: To take standards from, and revalidate an existing study which addressed the psychological and social outcomes following otoplasty in children [Bradbury E, Hewison J, Timmons M. Psychological and social outcome of prominent ear correction in children. Br J Plast Surg 1992;45:97-100]. The psychosocial experiences of children undergoing otoplasty at the University Hospital of North Staffordshire were retrospectively examined and compared to the cohort in the existing study. METHODS: Retrospective questionnaires were sent to all children aged 5-16 (n=101) who were on the hospital records having undergone otoplasty between 1999 and 2003, investigating social experiences, and experience of surgery. RESULTS: This study found: 97% reported an increase in happiness; 92% reported an increase in self-confidence; 79% noted improved social experience; 100% reported bullying reduced or stopped. The Wilcoxon Rank Sum Test confirmed the statistical validity of these findings (P<0.001). The existing study found: 63% of children reported increase in happiness and confidence; 13% noted improved social experiences; 53% noted bullying had stopped entirely. CONCLUSIONS: Otoplasty is an effective procedure in alleviating psychosocial distress in the vast majority of children that undergo the operation, and hence this study supports the continued availability of otoplasty on the NHS for children with prominent ears.

Functional assessment and muscle strength before and after reconstruction of chronic anterior cruciate ligament lesions.

PURPOSE: The goal of this study was to evaluate strength and functional capacity before and after anterior cruciate ligament (ACL) reconstruction to determine the influences of preoperative strength deficit, graft type, and gender, as well as their clinical relevance in predicting postsurgical recovery and determining the postoperative rehabilitation program. METHODS: This was a retrospective review of prospectively collected uniform data from a group of 191 patients undergoing ACL reconstruction. We assessed functional capabilities and strength of the quadriceps and hamstring at 60 degrees/s and 180 degrees/s by use of a Cybex II dynamometer (Lumex, Ronkonkoma, NY) before and 6, 9, and 12 months after surgery. RESULTS: There was a preoperative quadriceps strength deficit and a decreased limb symmetry index in patients with an ACL deficiency. This strength deficit increased postoperatively, with the highest measured deficit occurring at 6 months postoperatively and a clear improvement from 6 to 12 months. Functional assessment showed identical development. There was a statistically significant relation between an increased quadriceps strength deficit preoperatively and poor early postoperative functional performance. For the bone-patellar tendon-bone (BPTB) group, there was an increased quadriceps strength deficit compared with the semitendinosus and gracilis tendon (STG) group, and the STG group had an increased hamstring strength deficit on postoperative testing. The postoperative hamstring strength deficit is significantly increased in female patients. CONCLUSIONS: All of these data suggest that quadriceps strength deficit is related to the ACL injury and is increased by ACL reconstruction. Even 1 year after ACL reconstruction, a quadriceps strength deficit of almost 20% persists. Flexion strength is within the normal range before and after surgery. These results are influenced by graft choice, with a higher quadriceps strength deficit for BPTB grafts. STG grafts induce a higher hamstring strength deficit compared with BPTB grafts. Functional assessment is improved at 9 and 12 months postoperatively compared with preoperatively regardless of graft type. However, an increased preoperative quadriceps strength deficit results in a lower limb symmetry index at 6 and 9 months postoperatively. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Comparison of radial forearm with fibula and scapula osteocutaneous free flaps for oromandibular reconstruction.

OBJECTIVE: To compare our experience with the osteocutaneous radial forearm free flap (group 1) (n = 108) with other commonly used osteocutaneous free flaps (group 2) (n = 56) such as the fibula and scapula in single-stage oromandibular reconstruction. DESIGN: Retrospective case review. SETTING: Tertiary-care academic medical center. PATIENTS: One hundred sixty-three consecutive patients who underwent 164 mandibular reconstructions with osteocutaneous free flaps. MAIN OUTCOME MEASURES: Assessment of preoperative and intraoperative variables for both groups. We compared recipient-site complication rate, intensive care unit stay, total hospital stay, and postoperative function. RESULTS: The most common donor site used was the radius (n = 108 [66%]), followed by the fibula (n = 36 [22%]) and scapula (n = 20 [12%]). Mean follow-up was 29 months (range, 1-116 months). Group 2 patients had larger soft tissue and/or bony defects. Surgical and medical complication rates and major donor site morbidity in group 1 were similar or better when compared with those in group 2. The lengths of the intensive care unit (4 vs 7 days; P = .009) and hospital stays (13 vs 15 days; P = .06) were shorter in group 1. Although the microvascular success rate was similar in both groups, the local wound complication rate was significantly better for group 1. The difference for the length of intensive care unit stay was statistically significant and potentially amounts to more than 6000 dollars of savings. Functional outcomes, including the ability to tolerate oral diet, tracheostomy presence, and dental rehabilitation, were similar between the groups. CONCLUSIONS: The primary site long-term morbidity, donor site morbidity, and postoperative function of osteocutaneous radial forearm free flaps are comparable to those of other commonly used osteocutaneous free flaps such as the fibula and scapula when used in single-stage oromandibular reconstruction.

[Phonation reconstruction and function assessment after total and near-total laryngectomy].

BACKGROUND & OBJECTIVE: Total laryngectomy is a common surgery pattern for treating laryngeal and hypopharyngeal cancer, but patients will lost phonation function after operation. This study was to retrospectively analyze usage of modified Amatsu, and modified Pearson operation in treating laryngeal and hypopharyngeal cancers, and to analyze phonation function by subjective and objective assessment. METHODS: Clinical data of 69 patients with laryngeal or hypopharyngeal cancer treated by total or near-total laryngectomy (modified Amatsu or modified Pearson operation) in our department from 1996 to 2003 were retrospectively analyzed. Phonation function of 69 patients was evaluated by acoustic analysis and Jiyan classification method, and compared with phonation quality of patients received vertical hemilaryngectomy (VHL) and healthy people. RESULTS: No patient appeared obvious aspiration. Four cases with post-operative radiotherapy all regained phonation function. The 3-year survival rate was 88% (22/25); 5-year survival rate was 80% (4/5). Results of acoustic assessment, and Jiyan classification method indicated that phonation function of patients received modified Amatsu or modified Pearson operation could meet daily requirements. CONCLUSIONS: Modified Amatsu and modified Pearson operations can be learnt and applied easily for phonation reconstruction after laryngectomy. They may be optional surgery patterns, especially modified Pearson operation.

Rehabilitation for limb salvage patients: kinesiological parameters and psychological assessment.

Osteosarcoma is the most frequently occurring primary malignant tumor of bone, especially in adolescence. Treatment involves either limb salvage surgery or amputation with neoadjuvant chemotherapy. This review article discusses the current treatment modalities for osteosarcoma and also compares the gait patterns and psychosocial profiles of patients treated with either limb salvage surgery or amputation for osteosarcoma. Contemporary orthopedic literature on therapeutic options for osteosarcoma patients is reviewed. Background information on the basic principles of kinesiology, with emphasis on studies of gait pattern differences among patients treated with limb salvage versus amputation, is presented. Finally, several studies of the psychologic profiles of patients after these two procedures for osteosarcoma are reviewed. Trends in contemporary orthopedic literature suggest that functional outcomes, in terms of kinesiologic parameters, are comparable for patients treated with either limb salvage or amputation. Both sets of patients reported quality-of-life problems, including difficulty retaining health insurance and finding appropriate employment, social isolation, and poor self-esteem. The management of patients with osteosarcoma includes not only an individualized surgical plan for each patient but also includes awareness of the patients' psychologic and social needs after surgery.