Socioeconomic and Other Risk Factors for Retear after Arthroscopic Surgery for Nontraumatic Rotator Cuff Tear.

Background and Objectives: Few studies have investigated the socioeconomic factors associated with retear after rotator cuff repair. This study aimed to identify the risk factors, including socioeconomic factors, for rotator cuff retear in patients who underwent arthroscopic rotator cuff repair. Materials and Methods: This retrospective study included 723 patients diagnosed with full-thickness rotator cuff tears who underwent arthroscopic rotator cuff repair from March 2010 to March 2021. The outcome variable was rotator cuff retear observed on postoperative magnetic resonance imaging or ultrasonography. Sex, age, obesity, diabetes, symptom duration, and tear size were the independent variables. Socioeconomic variables included occupation, educational level, type of medical insurance, and area of residence. We compared patients with and without retear and estimated the effects of the independent factors on retear risk. Results: The mean age of the patients, symptom duration, and tear size were 62.4 ± 8.0 years, 1.8 ± 1.7 years, and 21.8 ± 12.5 mm, respectively. The age, type of medical insurance, diabetes, tear size, and symptom duration differed significantly between patients with and without retearing (p < 0.05). Age, occupation, type of medical insurance, diabetes, initial tear size, and symptom duration significantly affected the risk of retear. Patients who performed manual labor had a significantly higher retear rate (p = 0.005; OR, 1.95; 95% CI, 1.23-3.11). The highest retear risk was seen in patients with Medicaid insurance (p < 0.001; OR, 4.34; 95% CI, 2.09-9.02). Conclusions: Age, initial tear size, and symptom duration significantly affect retear risk after arthroscopic rotator cuff repair. Occupation and type of medical insurance were also risk factors for retear. Socioeconomically vulnerable patients may be at a greater risk of retear. Proactive efforts are required to expand early access to medical care.

High conversion rate to total hip arthroplasty after hemiarthroplasty in young patients with a minimum 10 years follow-up.

BACKGROUND: This study aimed to evaluate the follow-up results of bipolar hemiarthroplasty (BHA) for more than 10 years in patients aged < 60 years and to analyze the risk factors for acetabular erosion after BHA. METHODS: This retrospective study included 114 patients who underwent BHA were followed-up for at least 10 years. The mean age was 54.1 years, and the mean follow-up duration was 13.8 years. The patients were divided into two groups according to the presence of acetabular erosion, and the preoperative parameters were compared between the two groups. Moreover, the risk factors related to acetabular erosion after BHA were analyzed using statistical comparisons. RESULTS: Reoperation was performed in 44 of the 114 patients (38.6 %). The survival rate when the end point was reoperation related to acetabular erosion was found to be significantly time-dependent: 73.2 % at 5 years, 48.8 % at 10 years, and 25.9 % at 15 years. The acetabular erosion group showed significantly younger age at the time of surgery, higher body mass index (BMI), more avascular necrosis of the femoral head, and smaller prosthetic femoral head. The final multivariate logistic regression analysis showed that young age at the time of surgery were independent risk factors for acetabular erosion after BHA in patients aged < 60 years. CONCLUSIONS: The minimum 10-year follow-up outcomes of BHA in patients aged < 60 years showed a relatively high conversion rate to total hip arthroplasty. When considering BHA in younger patients, more careful decisions should be made with respect to patient's choice, keeping in mind that long-term survival cannot be guaranteed.

Joint Space Width Increases Medially and Decreases Laterally at Different Time Points After Medial Open-Wedge High Tibial Osteotomy.

PURPOSE: To evaluate the serial changes in the joint space width (JSW) of the medial and lateral compartments after medial open-wedge high tibial osteotomy (MOWHTO) and its associated factors. METHODS: The medial and lateral weight-bearing JSWs were measured on serial radiographs and analyzed preoperatively and postoperatively within 2 weeks, as well as at 3 months, 6 months, 1 year, and 2 years. Associations between the medial and lateral JSWs and age, body mass index, mechanical axis, correction angle, lateral distal femoral angle, medial proximal tibial angle, joint line convergence angle (JLCA), JLCA on stress radiographs, and arthroscopic cartilage status were examined. Clinical outcome was measured according to the Knee Society objective and functional scores. RESULTS: Seventy-one patients who underwent MOWHTO with locking-plate fixation were analyzed. The respective mean medial and lateral JSWs on serial radiographs were as follows: 3.08 mm and 5.14 mm preoperatively, 3.10 mm and 4.63 mm postoperatively, 3.37 mm and 4.57 mm at 3 months, 3.40 mm and 4.59 mm at 6 months, 3.44 mm and 4.57 mm at 1 year, and 3.42 mm and 4.64 mm at 2 years. At 3 months, the medial JSW increased (P < .001), whereas the lateral JSW decreased immediately (P < .001). JSW showed no significant differences at other time points. Preoperative and postoperative JLCAs and medial femoral and tibial cartilage grades were associated with medial JSW changes (P = .021). However, no significant parameters were associated with decreases in the lateral JSW (P > .05). The postoperative Knee Society objective and functional scores improved and were maintained. CONCLUSIONS: After MOWHTO, the medial JSW increased at 3 months postoperatively and the lateral JSW decreased immediately. The preoperative and postoperative JLCAs and the medial femoral and tibial cartilage grades were associated with the change in the medial JSW. However, no significant parameters were associated with the decrease in the lateral JSW. LEVEL OF EVIDENCE: Level IV, case series of therapeutic study.

Comparison of Surgical Outcomes Between Standard and Elevated-Rim Highly Cross-Linked Polyethylene Acetabular Liners in Primary Total Hip Arthroplasty With Minimum 15-Year Follow-Up: Single-Center, Retrospective Cohort Study.

BACKGROUND: The aims of the present study are to (1) conduct the longest-to-date follow-up wear analysis of the highly cross-linked polyethylene acetabular liners, (2) assess the incidence of femoral and acetabular osteolysis, and (3) compare the surgical outcomes between standard and elevated-rim acetabular liners in primary total hip arthroplasty (THA). METHODS: In this retrospective cohort study, we evaluated 112 primary THAs performed by a single experienced arthroplasty surgeon at our institution between March 2000 and December 2003. Patients were classified based on the type of acetabular liner used: standard or elevated-rim liner. For evaluation of surgical outcomes, the following data were collected: acetabular cup position (anteversion and inclination), wear rate (linear and volumetric), presence of osteolysis, history of reoperation (all-cause and wear-related), complications (deep joint infection, dislocation, and periprosthetic fracture), and Harris hip score at last follow-up. RESULTS: Linear and volumetric wear rates were 0.028 mm/y (0.000-0.145 mm/y) and 11.641 mm3/y (0.000-70.000 mm3/y) in the standard group and 0.026 mm/y (0.000-0.094mm/y) and 9.706 mm3/y (0.000-33.000 mm3/y) in the elevated-rim group, respectively. These rates were not significantly different between groups. One case of osteolysis was confirmed in the standard group, whereas no osteolysis was observed in the elevated-rim group. CONCLUSION: We suggest that elevated-rim highly cross-linked polyethylene acetabular liners might be a good implant option that can be used safely.

Effect of a synthetic osteoconductive bone graft substitute with zeta potential control (geneX®ds) in the treatment of intertrochanteric fracture: A single center experience of 115 consecutive proximal femoral nail antirotations.

INTRODUCTION: Although various clinical applications of geneX®ds have been reported, no study has reported the clinical application of geneX®ds in osteoporotic hip fracture. The present study aimed to identify the clinical effect of the application of geneX®ds in elderly patients with intertrochanteric fracture treated using proximal femoral nail antirotation (PFNA). MATERIALS AND METHODS: From March 2014 to October 2017, 233 patients with intertrochanteric fracture (65 men and 168 women) were enrolled in this study. All patients received surgical treatment using PFNA. Patients were classified into two groups: those in whom geneX®ds which is synthetic osteoconductive bone graft substitute with the unique property of Zeta Potential Control (ZPC®), was use, and those in whom it was not. We compared the preoperative details and surgical outcomes, including radiologic outcome (postoperative reduction, tip apex distance, sliding distance of the helical blade, union, and union time) and clinical outcomes (Harris Hip Score and the walking ability at the last follow-up) between the groups. RESULTS: In patients with unstable fracture who achieved anatomical or extramedullary type of reduction, the average sliding distance at 1, 3, and 12 months was 4.9 mm, 7.5 mmm and 8.1 mm in the geneX®ds group and 7.5 mm, 10.8 mm, and 12.1 mm in the no geneX®ds group, respectively. There were significant differences in the sliding distance at 1, 3, and 12 months between these two groups. CONCLUSION: The use of this synthetic osteoconductive bone graft substitute with zeta potential control may have positive effect on the controlled sliding of the helical blade and the healing of intertrochanteric fracture.

Diagnostic strategy for elderly patients with isolated greater trochanter fractures on plain radiographs.

BACKGROUND: Isolated greater trochanter (GT) fractures are relatively rare and few studies have assessed the appropriate diagnostic and therapeutic strategies for these fractures. When initial plain radiographs show an isolated GT fracture, underestimation of occult intertrochanteric extension may result in displacement of a previously non-displaced fracture. This study examined the clinical results and value of different diagnostic strategies in elderly patients with isolated GT fractures on plain radiographs. METHODS: Between January 2010 and January 2015, 30 patients with initial plain radiographs showing isolated GT fractures were examined using MRI, bone scanning and/or CT for suspected occult intertrochanteric extension. We assessed the sensitivity, specificity, and positive and negative predictive value of each test. In addition, we noted the location of the fracture or soft-tissue injury on MRI in addition to treatment results. RESULTS: All 30 patients had osteoporosis and fractures caused by minor trauma. MRI revealed isolated GT fractures in nine patients and occult intertrochanteric fractures in 21 patients. Using the MRI-based diagnosis as a reference, the results showed that plain radiographs, bone scans, and CT scans can be used for supplementary examination but they are not appropriate as confirmatory tests for these fractures. However, in patients with both isolated GT fractures seen on plain radiographs and increased uptake in only the GT area on bone scans, MRI revealed isolated GT fractures. The fractures were treated surgically in 20 patients and conservatively in 10 patients with satisfactory clinical results. CONCLUSIONS: We confirmed that MRI-based examination is useful in all symptomatic elderly patients whose plain radiographic findings reveal isolated GT fractures. However, we suggest that there is a need to establish a diagnostic strategy through increased understanding of the available diagnostic methods. We believe that surgical treatment should be considered in patients with occult intertrochanteric fractures that are detected on MRI.

Subtle elbow instability associated with lateral epicondylitis.

BACKGROUND: In lateral epicondylitis, even in the absence of apparent instability, subtle instability can be found under anesthesia. We wanted to ascertain the following: (1) how many elbows surgically treated with lateral epicondylitis showed subtle instability during examination under anesthesia (EUA), (2) how effective magnetic resonance imaging (MRI) was in predicting subtle instability, and (3) if any difference existed in preoperative clinical data between elbows with and without subtle instability during EUA. METHODS: One hundred and twenty-two elbows (117 patients) diagnosed with intractable lateral epicondylitis underwent surgical treatment. No elbow showed apparent instability with conventional physical examination. Under general anesthesia, the elbows were examined for subtle instability via fluoroscopy and divided into unstable and stable groups. Potential prognostic factors and functional scores were assessed retrospectively. The MRIs were reviewed again by two radiologists. RESULTS: Seventeen elbows (unstable group, 13.9%) had subtle instability in EUA, while 105 elbows (stable group, 86.1%) did not. Lateral collateral ligament (LCL) complex injury was noted in the MRIs of 28 elbows. Fifteen elbows showed subtle instability among 28 elbows with abnormal MRI (positive predictive value, 53.6%), while 81 elbows did not show subtle instability among 82 elbows with normal MRI (negative predictive value, 98.7%). The preoperative visual analog scale score was higher in the unstable group than in the stable group (p < 0.001), and a history of multiple corticosteroid injections (≥3) was related to subtle instability in EUA (p = 0.042). Other factors showed no significant differences between both groups. CONCLUSIONS: Subtle instability resulting from LCL complex injury was noted in elbows with lateral epicondylitis. This could be visualized with fluoroscopic EUA, and preoperative MRI could be used to exclude subtle instability. Surgeons should consider checking for subtle instability, especially when patients have a history of multiple corticosteroid injections (≥3) or severe pain and MRI indicates instability.

Prediction of the Irreparability of Rotator Cuff Tears.

PURPOSE: To determine the influence of preoperative factors on reparability of rotator cuff tears (RCTs) and yield a predictive model for predicting irreparability preoperatively. METHODS: Among patients with full-thickness RCTs, the reparable group underwent arthroscopic rotator cuff repairs for reparable RCTs whereas the irreparable group underwent alternative surgical procedures for irreparable RCTs. We analyzed age, sex, chronic pseudoparalysis (CPP), mediolateral and anteroposterior tear sizes, acromiohumeral distance (AHD), tangent sign, fatty infiltration (FI) (group 1, Goutallier stage 0 or 1; and group 2, Goutallier stage 2, 3, or 4), and tendon involvement (TI) (type 1, supraspinatus; type 2, supraspinatus and subscapularis; type 3, supraspinatus and infraspinatus; and type 4, all 3 tendons). RESULTS: The irreparability rate was 12.5%. Between the reparable (663 patients) and irreparable (95 patients) groups, significant differences were found in age (58.8 ± 8.3 years vs 65.6 ± 8.0 years, P < .001); female sex (46.9% vs 63.2%, P = .014); CPP (6.5% vs 36.8%, P < .001); mediolateral tear size (23.7 ± 12.1 mm vs 47.4 ± 9.1 mm, P < .001); anteroposterior tear size (17.9 ± 11.5 mm vs 43.4 ± 16.2 mm, P < .001); AHD (9.0 ± 1.7 mm vs 5.8 ± 1.6 mm, P < .001); tangent sign (2.9% vs 61.1%, P < .001); group 2 FI of the subscapularis (6.9% vs 20.0%, P < .001), supraspinatus (12.1% vs 58.9%, P < .001), infraspinatus (26.8% vs 69.5%, P < .001), and teres minor (4.2% vs 10.5%, P = .008); and type 1, 2, 3, and 4 TI (88.1%, 6.2%, 5.4%, and 0.3%, respectively, vs 29.5%, 21.1%, 28.4%, and 21.1%, respectively; P < .001). Multiple logistic regression analysis showed CPP, mediolateral tear size, AHD, tangent sign, group 2 FI of the supraspinatus, and type 4 TI were significant independent predictors of irreparability, with odds ratios of 3.539 (P = .007), 1.087 (P < .001), 0.624 (P < .001), 6.141 (P < .001), 2.233 (P = .034), and 12.350 (P = .016), respectively. These factors yielded a predictive model for irreparability as follows: Logit P = 1.264 × CPP + 0.084 × Mediolateral tear size - 0.472 × AHD + 0.804 × Group 2 FI of supraspinatus + 1.815 × Tangent sign + 2.514 × Type 4 TI - 3.460. CONCLUSIONS: The irreparability of RCTs is strongly associated with CPP, mediolateral tear size, AHD, tangent sign, group 2 FI of the supraspinatus, and type 4 TI and can be preoperatively calculated using the predictive equation. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Open reduction and internal fixation of comminuted patellar fractures with headless compression screws and wiring technique.

BACKGROUND: Management of a displaced comminuted patellar fractures is challenging, and various surgical fixation methods have been suggested. However, issues of loss of reduction and breakage of fixatives have not yet been resolved. In the current study, we describe a new technique for exposure and stabilization of comminuted patellar fractures and evaluate the clinical and radiologic outcomes of this new treatment. MATERIALS AND METHODS: Thirteen patellar fractures with articular comminution, which were treated by headless compression screws with additional separate vertical wiring were enrolled in this study. Loose articular fragments were fixed with headless compression screws under direct visual reduction of the articular surface, which was facilitated by the superior everting of the patella. Radiographs of the knee were obtained at routine follow-up to assess fracture healing and widening of articular step-off. Clinical outcomes including range of motion, quadriceps circumference, visual analog scale (VAS) related pain score, Lysholm, and Bostman grading scales were measured at the last follow-up. RESULTS: All the fractures healed at a mean of 15 weeks. No patient had loss of reduction, evidence of implant migration, or metallic failure. Articular step-off larger than 2 mm was not seen in any of the cases. The average range of motion arc was 134.2° (range, 120°-145°), and the mean Lysholm and Bostman scores were 94.4 (range, 84-100 points) and 28.7 (range, 25-30 points), respectively. Thigh muscle wasting was observed in four patients (33.3%), but no patient had >1.5 cm difference in thigh circumference girth between the injured and uninjured lower limbs. The average VAS-related pain score was 0.4. CONCLUSIONS: Articular fixations with headless compression screws under direct visual reduction of the articular surface resulted in good clinical outcomes and were considered clinically effective for comminuted patellar fractures.

Clinical and radiologic outcomes after arthroscopic rotator cuff repair: Single-row versus Speed-Bridge technique.

We compared clinical outcome between the Speed- Bridge technique and single-row techniques in patients with full-thickness rotator cuff tears and figured out the patterns of retear by computed tomography (CT) arthrogram and ultrasonography follow-up. In total 209 patients with full-thickness rotator cuff tears who underwent arthroscopic rotator cuff repair and were followed up for at least 2-year were enrolled retrospectively (group 1: single-row repair, group 2: Speed-Bridge repair). Pre- and postoperative data were reviewed to assess clinical and radiologic outcomes. There were no significant differences in clinical outcome between the 2 groups. The retear rates of medium and large-sized rotator cuff tear groups were higher in group 1 than in group 2 (p < 0.05). There was no significant difference in the medial row failure rate between the 2 groups. Present study showed that the knotless suture Bridge technique may be a considerable alternative method for treating full-thickness rotator cuff-tears. Level of evidence: Level III, Retrospective comparative study.

Estrogen receptor gene polymorphism in patients with degenerative lumbar scoliosis.

OBJECTIVE: To examine the association between development of degenerative lumbar scoliosis (DLS) and sex hormones. METHODS: We investigated the association between DLS and estrogen receptor alpha (ERα) gene polymorphisms in 184 patients with a diagnosis of DLS, by determining the presences of the Pvu II and Xba I polymorphisms, measuring bone mineral densities at the lumbar spine (LSBMD) and femoral neck (FNBMD), and by investigating biochemical markers of bone turnover and comparing these results with those of 220 healthy normal controls. RESULTS: Genotype frequencies in DLS patients and controls revealed a significant difference for the Pvu II polymorphism only (p = 0.0287). No significant difference was found between the DLS and control groups with respect to the Xba I polymorphism, bone mineral density (BMD), or biochemical markers. Furthermore, no significant association was observed between the Pvu II polymorphism and BMD, lumbar scoliosis, lateral listhesis, or biochemical markers in patients with DLS. CONCLUSION: These results suggest that the ERα Pvu II polymorphism influences the prevalence of DLS.

Glenoid rim fracture through anchor points after arthroscopic Bankart repair for shoulder instability.

PURPOSE: We studied the incidence of postoperative glenoid rim fractures and analysed the relationships of glenoid rim fracture with osteolysis, fracture pattern, number of anchors and postoperative activity after arthroscopic Bankart repair with suture anchor fixation. METHODS: Among 570 patients of the Bankart repair group, nine patients who had undergone revision arthroscopy for glenoid rim fracture after initial Bankart repair with at least two years post-revision follow-up were enrolled. Mean age was 28.8 years (range, 18-49 years), and mean follow-up was 36.4 months (range, 25-64 months). The mean time from Bankart repair to failure of initial surgery following trauma was 27.3 months (range, four to-84 months). Initial suture anchors were made of bioabsorbable composites (poly-D-L-lactic acid, PDLLA) without ceramic osteo-filler (seven cases) and metals (two cases). PDLLA without ceramic osteo-filler suture anchors were used for revision surgery. We reviewed 570 patients for relationship between osteolysis and glenoid rim fracture. RESULTS: Five patients including three and two with bioabsorbable and metal suture anchors, respectively, experienced glenoid rim fracture at more than two years postoperatively. Osteolysis around initial suture anchors groups showed higher glenoid rim fracture incidence compared with the control group (odd ratio =4.186 [95 % CI, 1.108-15.818]; p = 0.037). CONCLUSIONS: Osteolysis related to insertion of metal or PLDDA suture anchors may lead to glenoid rim fracture. Remnant metal or bioabsorbable suture anchors without ceramic composite could be a stress riser at two years postoperatively.

BMP2 increases adipogenic differentiation in the presence of dexamethasone, which is inhibited by the treatment of TNF-α in human adipose tissue-derived stromal cells.

BACKGROUND/AIMS: The aim of this study was to analyze the effect of BMP2 on osteogenic differentiation of human adipose tissue-derived stromal cells (hADSCs). METHODS: Cultured cells were differentiated into osteogenic lineage in the presence of BMP2. Gene expressions were determined by real time PCR. RESULTS: BMP2 increased (2/8) or inhibited (6/8) osteogenic differentiation according to hADSCs batches. Regardless of the BMP2 action on osteogenic differentiation, BMP2 induced lipid droplet formation under an osteogenic differentiation condition in all batches of hADSCs, not hBMSCs, to be tested, which was confirmed by analysis of adipogenesis related genes expression. hADSCs expressed various BMP receptors. BMP2 increased expression of BMP2-responsive genes such as DLX3 and ID2, and induced SMAD1 phosphorylation in hADSCs and hBMSCs. BMP2 increased osteogenic differentiation of hADSCs in osteogenic medium in which dexamethasone was omitted. The addition of BMP2 in the control culture media containing dexamethasone alone lead to formation of lipid droplets and increased C/EBP-α expression in hADSCs. In the presence of TNF-α, BMP2 stimulated osteogenic differentiation of hADSCs even in hADSCs batches in which treatment of BMP2 alone inhibited osteogenic differentiation. CONCLUSION: These data indicate that the control of osteogenesis and adipogenesis in hADSCs is closely related, and that hADSCs have preferential commitment to adipogenic lineages.

Analysis of sagittal balance of ankylosing spondylitis using spinopelvic parameters.

STUDY DESIGN: Prospective study. OBJECTIVE: To analyze sagittal spinopelvic parameters in ankylosing spondylitis (AS) patients. SUMMARY OF BACKGROUND DATA: There are little data on the relationship between the sagittal spinopelvic parameters and AS. METHODS: The study and control groups comprised 90 AS patients and 40 controls. Participants were classified into 3 groups: normal (n=40), sagittal balance (n=58), and sagittal imbalance (n=32) groups. All underwent lateral radiograph of the whole spine including hip joints. The radiographic parameters were sacral slope, pelvic tilting, pelvic incidence, overhang of S1, thoracic kyphosis, lumbar lordosis, and C7 plumbline. Statistical analysis was performed to identify significant differences between the 2 groups. Correlations between radiological parameters and symptoms were sought. RESULTS: AS patients and controls were found to be significantly different in terms of sagittal balance, sacral slope, pelvic tilt, pelvic incidence, S1 overhang, and lumbar lordosis. However, no significant difference was observed between these 2 groups for thoracic kyphosis (P>0.05). Of the 90 AS patients, 32 patients (5 women and 27 men) were assigned to the sagittal imbalance group and 58 (12 women and 46 men) to the sagittal balance group. There was a significant difference in all sagittal parameters and visual analogue scale (VAS) score between these 2 groups. Correlation analysis revealed significant relationships between sagittal parameters in AS. However, there was no association between sacral slope and S1 overhang, and between pelvic incidence and VAS score. Stepwise logistic regression analysis revealed that pelvic tilt contributed significantly to sagittal balance. CONCLUSIONS: AS patients and normal controls were found to be significantly different in terms of sagittal spinopelvic parameters. Significant relationships were found between sagittal spinopelvic parameters in AS patients. Pelvic tilt was a significant parameter in determination of sagittal balance in AS patient. Furthermore, VAS scores were significantly related to sagittal spinal parameters which were closely related with pelvic orientation in AS patients.

Correlation between clinical outcomes and spinopelvic parameters in osteoporosis.

INTRODUCTION: Little data is available on the relationship between sagittal spinopelvic parameters and health related quality of life (HRQOL) in osteoporotic patients. The aim of this study was to identify relationships between spinopelvic parameters and HRQOL in osteoporosis. MATERIAL AND METHODS: The patient and control groups comprised 138 osteoporotic patients and 40 controls. All underwent anteroposterior and lateral radiography of the whole spine, including hip joints, and completed clinical questionnaires. The radiographic parameters examined were; sacral slope, pelvic tilt, pelvic incidence, thoracic kyphosis, lumbar lordosis, and sagittal vertical axis. Lumbar spinal bone mineral density (LSBMD) and femoral neck BMD (FNBMD) of the non-dominant proximal femur were measured. A Visual Analogue Scale (VAS: 0-10) was used to assess back pain, and the Oswestry disability index (ODI) questionnaire and the Scoliosis Research Society (SRS-22) questionnaire to evaluate QOL. Statistical analysis was performed to identify significant differences between the patient and control groups. In addition, correlations between radiological parameters and clinical questionnaires were sought. RESULTS: Patients and controls were found to differ significantly in terms of sagittal vertical axis, sacral slope, pelvic tilt, lumbar lordosis, and thoracic kyphosis. However, no significant intergroup difference was observed for pelvic incidence (P > 0.05). Correlation analysis revealed significant relationships between radiographic parameters and clinical outcomes. Multiple regression analysis was performed to identify predictors of clinical outcome, and the results obtained revealed that sagittal vertical axis, sacral slope, and FNBMD significantly predicted VAS, ODI, and SRS-22 scores and that LSBMD predicted SRS-22 scores. CONCLUSIONS: Osteoporotic patients and controls were found to be significantly different in terms of sagittal spinopelvic parameters. Correlation analysis revealed significant relationships between radiographic parameters and clinical outcome variables. In particular, sagittal vertical axis, sacral slope, and FNBMD significantly predicted clinical outcomes in osteoporotic patients.

Effect of Meniscal Tear Patterns and Preoperative Cartilage Status on Joint Space Width After Medial Opening-Wedge High Tibial Osteotomy.

BACKGROUND: Medial opening-wedge high tibial osteotomy (MOWHTO) is performed to treat young adults with medial compartment knee osteoarthritis associated with varus deformity. However, factors influencing joint space width (JSW) vary according to the type of medial meniscal tear and have not yet been completely elucidated. PURPOSE: To examine changes in JSW according to the type of medial meniscal tear after MOWHTO and analyze the influencing factors. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: This study was conducted on 134 patients who underwent MOWHTO for medial osteoarthritis and were followed up for >2 years. The patients were classified into 3 groups based on medial meniscal status: intact, nonroot tear, and root tear. The authors then measured the JSW preoperatively and at 3 months, 6 months, 1 year, and >2 years postoperatively; analyzed whether the change in JSW varied according to meniscal status; and determined the association of these changes with the preoperative cartilage grade of the medial femoral condyle (MFC) and medial tibial plateau (MTP). International Knee Documentation Committee (IKDC) scores were used to evaluate clinical function. RESULTS: Of the 134 patients, the medial meniscus was intact in 29 patients, a nonroot tear was observed in 58 patients, and a root tear was observed in 47 patients. Postoperatively, JSW increased for all groups, but the timing of the increase varied between the groups (P < .001). JSW increased the most 6 months postoperatively in the intact group and 3 months postoperatively in the nonroot tear and root tear groups (P < .001). Additionally, the increase in JSW was the greatest in the root tear group. Preoperatively, MFC and MTP cartilage status differed among the groups; MTP status did not affect the JSW, but MFC status did (P < .001). The IKDC score increased from the preoperative to postoperative time point in all groups, but there was no significant difference between groups. CONCLUSION: The authors observed that the amount and timing of increase in JSW were dependent on the pattern of medial meniscal tear observed when MOWHTO was performed. In addition, the cartilage grade of MFC before surgery was associated with changes in JSW. The IKDC score was not significantly different between groups. However, a longer follow-up period is needed to analyze the correlation with the meniscal tear pattern and JSW.

Radiographic measurement reliability of lumbar lordosis in ankylosing spondylitis.

INTRODUCTION: Intraobserver and interobserver reliabilities of the several different methods to measure lumbar lordosis have been reported. However, it has not been studied sofar in patients with ankylosing spondylitis (AS). MATERIALS AND METHODS: We evaluated the inter and intraobserver reliabilities of six specific measures of global lumbar lordosis in patients with AS. Ninety-one consecutive patients with AS who met the most recently modified New York criteria were enrolled and underwent anteroposterior and lateral radiographs of whole spine. The radiographs were divided into non-ankylosis (no bony bridge in the lumbar spine), incomplete ankylosis (lumbar spines were partially connected by bony bridge) and complete ankylosis groups to evaluate the reliability of the Cobb L1-S1, Cobb L1-L5, centroid, posterior tangent L1-S1, posterior tangent L1-L5, and TRALL methods. RESULTS: The radiographs were composed of 39 non-ankylosis, 27 incomplete ankylosis and 25 complete ankylosis. Intra- and inter-class correlation coefficients (ICCs) of all six methods were generally high. The ICCs were all ≥0.77 (excellent) for the six radiographic methods in the combined group. However, a comparison of the ICCs, 95 % confidence intervals and mean absolute difference (MAD) between groups with varying degrees of ankylosis showed that the reliability of the lordosis measurements decreased in proportion to the severity of ankylosis. The Cobb L1-S1, Cobb L1-L5 and posterior tangent L1-S1 method demonstrated higher ICCs for both inter and intraobserver comparisons and the other methods showed lower ICCs in all groups. The intraobserver MAD was similar in the Cobb L1-S1 and Cobb L1-L5 (2.7°-4.3°), but the other methods showed higher intraobserver MAD. Interobserver MAD of Cobb L1-L5 only showed low in all group. CONCLUSION: These results are the first to provide a reliability analysis of different global lumbar lordosis measurement methods in AS. The findings in this study demonstrated that the Cobb L1-L5 method is reliable for measuring the global lumbar lordosis in AS.

Association between estrogen receptor gene polymorphism and back pain intensity in female patients with degenerative lumbar spondylolisthesis.

STUDY DESIGN: Prospective study. OBJECTIVE: To examine the possible association of estrogen receptor α (ERα) polymorphisms and pain intensity in symptomatic female degenerative spondylolisthesis (DS) patients. SUMMARY OF BACKGROUND DATA: DS has been associated with a significant sex effect. Thus, several studies about the association between the ER gene and osteoarthritis have been reported. However, whether estrogen is associated with pain sensitivity is inconsistent in the existing literatures from both human and animal studies. METHODS: The PvuII and XbaI polymorphisms, bone mineral density at the lumbar spine (LSBMD) and at the femoral neck (FNBMD), pain intensity at the leg and lower back, and radiologic and anthropometric findings were analyzed in 192 patients with DS. RESULTS: There was a significant association between XbaI polymorphism and the visual analog scale score of back pain. The back pain visual analog scale in patients with a GG genotype was significantly higher than in patients with the AG (P<0.05) or the AA (P<0.05) genotypes. In addition, the presence of the CG haplotype was found to be associated with back pain intensity in the haplotype analysis of the PvuII and the XbaI polymorphisms of ERα. CONCLUSIONS: These results suggest that the ERα gene polymorphism using XbaI restriction enzyme influences the perception of back pain in patients with DS.

Hip arthroplasty for patients with chronic renal failure on dialysis.

An increasing number of chronic renal failure patients are experiencing hip joint disorders. This study aimed to analyze the outcomes of hip arthroplasty in chronic renal failure patients undergoing dialysis. Of 2364 hips that underwent hip arthroplasty during 2003-2017, 37 were retrospectively examined. Radiological and clinical outcomes of hip arthroplasty, and development of local and general complications during follow-up and their associations with dialysis duration were analyzed. The mean patient age, follow-up duration, and bone mineral density T-score were 60.6 years, 36.6 months, and - 2.62, respectively. Osteoporosis was noted in 20 cases. Most patients who underwent total hip arthroplasty with a cementless acetabular cup implant exhibited excellent radiological outcomes. There were no changes in femoral stem alignment, subsidence, osteolysis, and loosening. Thirty-three patients had an excellent or good Harris hip score. Complications developed in 18 patients within 1 year postoperatively. General complications developed in 12 patients at > 1 year postoperatively; no patient experienced local complications. In conclusion, hip arthroplasty for chronic renal failure patients on dialysis yielded excellent radiological and satisfactory clinical outcomes but may be associated with postoperative complications. Careful preoperative treatment planning and overall postoperative management are required to reduce the complication risk.

Component Asymmetry in Bilateral Cementless Total Hip Arthroplasty.

Background: This study investigated the results of component asymmetry (CA) in bilateral cementless total hip arthroplasty (THA). Methods: This study included 300 patients, who underwent bilateral cementless THA between April 2000 and December 2017. They were divided into the component symmetry (CS) and CA groups; CA group was sub-classified into acetabular component asymmetry (ACA) and femoral component asymmetry (FCA). Radiologic and clinical outcomes of the CA group were compared with those of the CS group. Results: The incidence of CA was 25.7% (77/300 patients), including 55 patients with ACA, 34 patients with FCA, and 12 with both components asymmetric. The mean time interval between operations in the CA group was significantly longer than that in the CS group (p < 0.001). The mean differences in horizontal and vertical distances from teardrop to the center of rotation of the acetabular component between both hips in the ACA group were significantly larger than those in the CS group (p = 0.033 and p < 0.001, respectively). The mean femoral component alignment angle difference between both hips was significantly larger in the FCA group than in the CS group (p < 0.001). The mean Harris Hip Score at last follow-up of the CA group was similar to that of the CS group. Conclusions: CA in patients undergoing bilateral cementless THA was not rare, especially with a longer time interval between operations. Regardless of CA, when stable fixation of the components was achieved, satisfactory radiologic and clinical outcomes were obtained.