Biomechanical evaluation of patellar tendon repair using Krackow suture technique.

BACKGROUND: Patellar tendon rupture is a potentially devastating injury. Surgical repair is the primary treatment recommended for the patients with patellar tendon ruptures. Given the tendon properties, the suture technique is critical for proper tissue repair. Providing adequate loading during early mobilization is essential to prevent tendon suture repair failure. Therefore, the current study evaluated the mechanical characteristics of various applied loadings on patellar tendon repair using Krackow suture via a porcine model. METHODS: Twelve fresh porcine hindlimbs with patellar tendon rupture were repaired by Krackow method using synthetic and non-absorbable No. 5 Ethibond sutures. Loadings of 100 and 200 N were applied during the cyclic loading test. A three-dimensional optical motion capture system was used to record the gap formation at the initial, 50th, 100th, 150th, 200th, 250th, 500th, 750th, and 1000th cycle. After cyclic loading, the specimen was loaded to failure under displacement control at a rate of 1 mm/s. RESULTS: Suture breakage was the primary failure mode in both loading conditions. After 1000 cyclic loadings of 100 N, the ultimate failure strength was 243.6 ± 25.8 N. However, the specimens tested under 200 N of loading failed before reaching 200 cycles. Under the 100 N loading, the largest gap deformation (1.89 ± 0.23 mm) and residual deformation (0.213 ± 0.183 mm) were found in the initial cycle. The average cumulative displacement was 5.13 mm from the initial cycle to the 100th cycle and 4.5 mm from the 250th to the 1000th cycle. CONCLUSIONS: Our findings can serve as reference values for further comparisons with various repair techniques or materials. This study suggests that the initially applied load after patellar tendon repair is an important risk factor of re-rupture.

Arthroscopic excision of wrist ganglions: does trans-cystic or cystic-sparing portal technique affect clinical outcomes?

INTRODUCTION: The preliminary results of arthroscopic wrist ganglionectomy were contradictory. The approach used for the arthroscopic excision of wrist ganglions may play an important role. We analyzed two surgical approaches for arthroscopic excision of wrist ganglions. MATERIALS AND METHODS: Between April 2009 and October 2014, 49 patients with wrist ganglions who underwent arthroscopic excision in our institute were retrospectively classified into two treatment groups, namely the trans-cystic portal technique (TCP) and cyst-sparing portal technique (CSP). The visual analog scale (VAS), Mayo wrist scores, and disabilities of the arm, shoulder, and hand (DASH) scores were measured for clinical assessment. Recurrence, residual pain, and complications were evaluated at follow-up. RESULTS: No significant differences were found between the groups in terms of demographic data, and preoperative clinical assessment, as well as with regard to postoperative VAS score (p = 0.898), Mayo wrist score (p = 0.526), DASH score (p = 0.870), recurrence (p = 0.491), residual pain (p = 0.690), and complications (p = 0.352). Recurrence was found in 2 of the 47 patients and they were both in the CSP group. At the final follow-up, residual pain was found in four patients in the TCP group and three in the CSP group. CONCLUSIONS: For performing arthroscopic resection of wrist ganglions, both techniques are safe regarding the complication rates. In recurrence rate, no significant difference was found between the two groups, but no recurrence was observed when the TCP technique was used.

One-year mortality and Periprosthetic infection rates after Total knee Arthroplasty in Cancer patients: a population-based cohort study.

BACKGROUND: Knowledge on periprosthetic infection and mortality rate following total knee arthroplasty (TKA) is essential for justifying this treatment in patients with cancer; however, relevant data from population-based studies are lacking. Therefore, we examined 1-year periprosthetic infection, mortality, and 5-year relative survival rates in cancer patients who underwent TKA. METHODS: This is a population-based cohort study based on analysis of the Taiwan National Health Insurance Research Database. We enrolled a total of 2294 cancer patients and 131,849 patients without cancer (control group) who underwent TKA between January 1, 1997, and December 31, 2011. All patients were followed until death, infection, withdrawal from the National Health Insurance, or December 31, 2012. RESULTS: The periprosthetic knee joint infection rate in cancer patients (1.73%) was not significantly higher than that in the control group (1.87%). However, the 1-year mortality rate was significantly higher (p < 0.05) in the cancer group (4.10%) than in the control group (1.66%). The overall 5-year survival rate was 93.10% as compared with those without cancers. CONCLUSION: Low periprosthetic knee joint infection rates and high 5-year relative survival rates indicate the feasibility of TKA in cancer patients. However, the surgeon should take into account a higher mortality rate in the first year following TKA.

Acupoint catgut embedding attenuates fibromyalgia pain through attenuation of TRPV1 signaling pathway in mouse.

Objectives: Chronic pain is considered as pain lasting for more than three months and has emerged as a global health problem affecting individuals and society. Chronic extensive pain is the main syndrome upsetting individuals with fibromyalgia (FM), accompanied by anxiety, obesity, sleep disturbances, and depression, Transient receptor potential vanilloid 1 (TRPV1) has been reported to transduce inflammatory and pain signals to the brain. Materials and Methods: Acupoint catgut embedding (ACE) is a novel acupuncture technique that provides continuous effects and convenience. ACE was performed at the bilateral ST36 acupoint. Results: We demonstrated similar pain levels among all groups at baseline. After cold stress, chronic mechanical or thermal nociception was induced (D14: mechanical: 1.85 ± 0.13 g; thermal: 4.85 ± 0.26 s) and reversed in ACE-treated mice (D14: mechanical: 3.99 ± 0.16 g; thermal: 7.42 ± 0.45 s) as well as Trpv1-/- group (Day 14, mechanical: 4.25 ± 0.2 g; thermal: 7.91 ± 0.21 s) mice. Inflammatory mediators were augmented in FM individuals and were abridged after ACE management and TRPV1 gene loss. TRPV1 and its linked mediators were increased in the thalamus (THA), somatosensory cortex (SSC), medial prefrontal cortex (mPFC), and anterior cingulate cortex (ACC) in FM mice. The up-regulation of these mediators was diminished in ACE and Trpv1-/- groups. Conclusion: We suggest that chronic pain can be modulated by ACE or Trpv1-/-. ACE-induced analgesia via TRPV1 signaling pathways may be beneficial targets for FM treatment.

Nanotechnology in the regulation of stem cell behavior.

Stem cells are known for their potential to repair damaged tissues. The adhesion, growth and differentiation of stem cells are likely controlled by the surrounding microenvironment which contains both chemical and physical cues. Physical cues in the microenvironment, for example, nanotopography, were shown to play important roles in stem cell fate decisions. Thus, controlling stem cell behavior by nanoscale topography has become an important issue in stem cell biology. Nanotechnology has emerged as a new exciting field and research from this field has greatly advanced. Nanotechnology allows the manipulation of sophisticated surfaces/scaffolds which can mimic the cellular environment for regulating cellular behaviors. Thus, we summarize recent studies on nanotechnology with applications to stem cell biology, including the regulation of stem cell adhesion, growth, differentiation, tracking and imaging. Understanding the interactions of nanomaterials with stem cells may provide the knowledge to apply to cell-scaffold combinations in tissue engineering and regenerative medicine.

Long-Term Use of Immunosuppressive Agents Increased the Risk of Fractures in Patients with Autoimmune Diseases: An 18-Year Population-Based Cohort Study.

The risk of fractures is higher in patients with autoimmune diseases, but it is not clear whether the use of immunosuppressive agents can further increase this risk. To investigate this issue, a retrospective study was conducted using data from Taiwan's National Health Insurance Research Database. Patients diagnosed with autoimmune diseases between 2000 and 2014, including psoriatic arthritis, rheumatoid arthritis, ankylosing spondylitis, and systemic lupus erythematosus, were included in the study. A control group of patients without autoimmune diseases was selected from the same database during the same period. Patients with autoimmune diseases were divided into two sub-cohorts based on their use of immunosuppressive agents. This study found the risk of fractures was 1.14 times higher in patients with autoimmune diseases than in those without. Moreover, we found that patients in the immunosuppressant sub-cohort had a higher risk of fractures compared to those in the non-immunosuppressant sub-cohort. The adjusted sub-distribution hazard ratio for shoulder fractures was 1.27 (95% CI = 1.01-1.58), for spine fractures was 1.43 (95% CI = 1.26-1.62), for wrist fractures was 0.95 (95% CI = 0.75-1.22), and for hip fractures was 1.67 (95% CI = 1.38-2.03). In conclusion, the long-term use of immunosuppressive agents in patients with autoimmune diseases may increase the risk of fractures.

Radiographic and clinical results of posterior dynamic stabilization for the treatment of multisegment degenerative disc disease with a minimum follow-up of 3 years.

BACKGROUND: This study aims to compare radiographic and clinical outcomes of Dynesys and posterior lumbar interbody fusion (PLIF) for the treatment of multisegment disease. METHODS: Thirty-five consecutive patients who received Dynesys implantation at three levels from L1 to S1 from November 2006 to July 2007 were studied. A retrospective analysis of the medical records of 25 patients with the same indications who received 3-level PLIF (L1-S1) was also conducted. Radiographic and clinical outcomes between the groups were compared. All patients included in the analysis completed 3-year follow-up. Dynesys stabilization resulted in higher preservation of motion at the operative levels, as well as total range of motion from L1 to S1. A decrease of anterior disc height was seen in the Dynesys group and an increase was seen in the PLIF group. An increase in posterior disc height was noted in both groups; however, was greater in the PLIF group at 3 years. RESULTS: The Dynesys group showed a greater improvement in Oswestry Disability Index and visual analogue scale back pain scores at 3 years postoperatively. There were no differences in complications between the two groups. CONCLUSION: In conclusion, Dynesys is an acceptable alternative to PLIF for the treatment of multisegment lumbar disease.

Incidence and risk factors of vertebral body collapse after posterior instrumented spinal fusion in elderly patients: An observational study.

This study investigates the incidence and risk factors of new vertebral body collapse (VC) after posterior instrumented spinal fusion in patients older than 70 years. This retrospective study analyzed the data of elderly patients who underwent posterior instrumented spinal fusion in the thoracolumbar spine between January 2013 and December 2017. The 2 subsamples comprised of patients who had experienced vertebral compression fracture (VCF) before the index spinal surgery (group 1, n = 324) and those who had not (group 2, n = 1040). We recorded and analyzed their baseline characteristics, their underlying comorbidities, and the details of their current instrumented spinal fusion. The incidences of new VC and screw loosening were recorded. In groups 1 and 2, the incidences of new VC were 31.8% and 22.7%, respectively, and those of new VC with screw loosening were 25.6% and 33%, respectively. The risk factor was upper screw level at the thoracolumbar junction (hazard ratio [HR] = 2.181, 95% confidence interval [CI]: 1.135-4.190) with previous VCF. The risk factors were age ≥ 80 years (HR = 1.782, 95% CI: 1.132-2.805), instrumented levels > 4 (HR = 1.774, 95% CI: 1.292-2.437), and peptic ulcer (HR = 20.219, 95% CI: 2.262-180.731) without previous VCF. Clinicians should closely monitor new VC after posterior instrumented spinal fusion in elderly patients with previous VCF with upper screw level at the thoracolumbar junction and in patients without previous VCF aged ≥ 80 years, with instrumented levels > 4 and peptic ulcer.

Using Deep Neural Network Approach for Multiple-Class Assessment of Digital Mammography.

According to the Health Promotion Administration in the Ministry of Health and Welfare statistics in Taiwan, over ten thousand women have breast cancer every year. Mammography is widely used to detect breast cancer. However, it is limited by the operator's technique, the cooperation of the subjects, and the subjective interpretation by the physician. It results in inconsistent identification. Therefore, this study explores the use of a deep neural network algorithm for the classification of mammography images. In the experimental design, a retrospective study was used to collect imaging data from actual clinical cases. The mammography images were collected and classified according to the breast image reporting and data-analyzing system (BI-RADS). In terms of model building, a fully convolutional dense connection network (FC-DCN) is used for the network backbone. All the images were obtained through image preprocessing, a data augmentation method, and transfer learning technology to build a mammography image classification model. The research results show the model's accuracy, sensitivity, and specificity were 86.37%, 100%, and 72.73%, respectively. Based on the FC-DCN model framework, it can effectively reduce the number of training parameters and successfully obtain a reasonable image classification model for mammography.

Risk factors for unplanned return to the operating room within 24 hours: A 9-year single-center observational study.

ABSTRACT: The purpose of the retrospective case-control study was to identify the causes of and risk factors for unplanned return to the operating room (uROR) within 24 hours in surgical patients.We examined 275 cases of 24-hour uROR in our hospital from January 2010 to December 2018. The reasons for 24-hour uROR were classified into several categories. Controls were randomly matched to cases in a 1:1 ratio with the selection criteria set for the same surgeon and operation code in the same corresponding year.The mortality rate was significantly higher in patients with 24-hour uROR (11.63% vs 5.23%). Bleeding was the most common etiology (172/275; 62.55%) and technical error (14.5%) also contributed to 24-hour uROR. The clinical factors that led to bleeding included a history of liver disease (P = .032), smoking (P = .002), low platelet count in preoperative screening (P = .012), and preoperative administration of antiplatelet or anticoagulant agents (P = .014).Clinicians should recognize the risk factors for bleeding and minimize errors to avoid the increase in patient morbidity and mortality that is associated with 24-hour uROR.Level of Evidence: Level IV.

Combination of long- and short-axis alar sacroplasty techniques under fluoroscopic guidance for osteoporotic sacral insufficiency fracture.

BACKGROUND: Sacral insufficiency fracture (SIF) is rarer than osteoporotic vertebral compression fracture that occurs at other levels of the thoracolumbar spine. Percutaneous sacroplasty can effectively relieve pain and improve mobility. Several sacroplasty-based techniques have been reported to date. Sacroplasty is often performed with computed tomography-guided cannula placement, which is time intensive and results in greater radiation exposure than that resulting from fluoroscopy. Herein, we report our preliminary experience with a combination of long- and short-axis alar sacroplasty techniques under fluoroscopic guidance for osteoporotic SIFs. METHODS: We retrospectively reviewed 44 consecutive patients with symptomatic osteoporotic SIFs who underwent alar sacroplasty between January 2013 and February 2020. The study group comprised 19 patients who underwent a combination of long- and short-axis alar sacroplasty techniques under fluoroscopic guidance. The control group comprised the remaining 25 patients who underwent short-axis alar sacroplasty under fluoroscopic guidance. Visual analog scale (VAS) scores, operation times, injected cement volumes, and postoperative complications were recorded. RESULTS: The VAS score for pain decreased in both groups; however, no significant difference was noted between the study and control groups in injected cement volume (3.55 ± 0.96 vs 2.94 ± 0.89 mL). The operation time was longer in the study group than in the control group (32 ± 7.1 vs 28.04 ± 4.99 min; P = 0.046). No major complications were noted. CONCLUSION: A combination of long- and short-axis alar sacroplasty techniques can be effectively performed under fluoroscopic guidance for osteoporotic SIFs.

Long-term total hip arthroplasty rates in patients with acetabular and pelvic fractures after surgery: A population-based cohort study.

BACKGROUND/OBJECTIVE: Osteoarthritis typically develops after surgery for traumatic fractures of the acetabulum and may result in total hip arthroplasty (THA). We conducted a population-based retrospective study to investigate the incidence of THA after treatment of acetabular, pelvic, and combined acetabular and pelvic fractures with open reduction-internal fixation surgery compared with that in the control group. DESIGN: A retrospective population-based cohort study. SETTING: Data were gathered from the Taiwan National Health Insurance Research Database. PARTICIPANTS: We enrolled 3041 patients with acetabular fractures, 5618 with pelvic fractures, and 733 with combined pelvic and acetabular fractures between January 1, 1997, and December 31, 2013, totaling 9392 individuals. The control group comprised 664,349 individuals. Study participants were followed up for the occurrence of THA until death or the end of the study period. RESULTS: The THA rates after surgical intervention were 17.82%, 7.28%, and 18.01% in patients with acetabular, pelvic, and combined acetabular and pelvic fractures, respectively. Moreover, they were significantly higher for the acetabular fracture, pelvic fracture, and combined-fracture groups (adjusted hazard ratios [aHRs] = 58.42, 21.68, and 62.04, respectively) than for the control group (p < 0.0001) and significantly higher for the acetabular fracture and combined-fracture groups than for the pelvic fracture group (aHRs = 2.59 and 2.68, respectively; p < 0.0001). CONCLUSION: The incidence rates of THA after surgical intervention in the pelvic fracture, acetabular fracture, and combined-fracture groups were significantly higher than that of the control group.

Effects of Injected Antiosteoporotic Medication Versus Oral Bisphosphonates on Rates of Repeated Vertebroplasty or Kyphoplasty.

PURPOSE: Vertebral compression fractures can recur within a few years after percutaneous vertebroplasty (PVP) or kyphoplasty. METHODS: We conducted a population-based study using data from the Taiwan National Health Insurance Research Database to investigate the efficacy of various antiosteoporotic treatments in reducing the prevalence rate of repeated PVP or kyphoplasty in patients hospitalized from January 1, 1997, to December 31, 2004. We included patients with vertebral compression fractures after PVP or kyphoplasty who received oral bisphosphonates (OB group; n = 6141) or injected drug therapies (injection group; n = 4308). FINDINGS: The incidence rate of repeated PVP or kyphoplasty was significantly lower in the I/Z/D (denosumab monotherapy or ibandronate or zoledronate with or without denosumab) group than in the OB group (crude subdistribution hazard ratio [sHR], 0.79; 95% CI, 0.70-0.90; P < 0.05; adjusted sHR, 0.77; 95% CI, 0.68-0.87; P < 0.0001). The analysis revealed a significantly lower incidence rate of repeated PVP or kyphoplasty in the I/Z group compared with that in the OB group (crude sHR, 0.82; 95% CI, 0.72-0.94; P = 0.0038; adjusted sHR, 0.80; 95% CI, 0.70-0.91; P = 0.0011). The denosumab group also exhibited a significantly lower incidence rate of repeated PVP or kyphoplasty than did the OB group (crude sHR, 0.61; 95% CI, 0.46-0.80; P = 0.0005; adjusted sHR, 0.58; 95% CI, 0.44-0.77; P = 0.0001). Although the teriparatide group had higher fracture frequency than did the OB group, the analysis revealed no significant difference between the OB and teriparatide groups with respect to the incidence rate of repeated PVP or kyphoplasty (adjusted sHR, 1.08; 95% CI, 0.92-1.26; P = 0. 3747). IMPLICATIONS: Injected antiosteoporotic medication was associated with lower rates of repeated vertebroplasty and kyphoplasty than was OB application.

High 2-year mortality and recurrent infection rates after surgical treatment for primary septic arthritis of the hip in adult patients: An observational study.

Primary septic arthritis of the hip is rare and potentially devastating in adults. Its optimal surgical treatment and clinical outcomes remain unclear.In this retrospective cohort study, we investigated mortality and reinfection rates after surgery of patients with septic hip arthritis. We reviewed patients treated for primary septic hip joints from October 2005 to December 2016. A total of 51 adult patients were identified, and 38 among them had destructive hip joints. A poor postoperative outcome was defined as mortality or recurrent infection within 2 years of surgery.After surgery, 7 (13.7%) patients died within 1 year and 5 (9.8%) patients developed a recurrent hip infection within 2 years. Therefore, poor outcomes occurred in 22% (n = 11) of the study cohort. Among the 38 patients with a destructive hip joint, 7 (18.4%) died within 1 year after surgery and 4 (10.5%) developed a recurrent hip infection within 2 years of surgery. Correlative infections other than infected hip joint and liver cirrhosis were identified as risk factors for poor outcomes.In conclusion, clinical physicians treating adult primary septic hip joints should be cognizant of the high failure rate of surgical treatment. In addition, the high mortality rate should be considered during the discussion of surgical treatment with these patients and their families.

Perioperative acute myocardial infarction rate in chronic renal disease patients undergoing orthopedic surgery: Is there any difference between dialyzed and nondialyzed patients?

BACKGROUND: The incidence of acute myocardial infarction (AMI) in healthy patients undergoing noncardiac surgery is <1%. When patients with chronic kidney disease (CKD) undergo orthopedic surgery, AMI incidence can be expected to be relatively high. However, data on a population-wide scale is lacking. OBJECTIVE: To investigate AMI incidence in patients with CKD (with and without dialysis) undergoing orthopedic surgery. DESIGN: A population-based study covering the period from January 1, 1997, to December 31, 2011. SETTING: Data from the Taiwan National Health Insurance Research Database. PARTICIPANTS: Participants were 219,195 patients with CKD who underwent surgery between January 1, 1997, and December 31, 2011. RESULTS: AMI occurred in 2,708 participants (1.24%). The AMI incidence rate in the dialyzed group was 1.52%, which was higher than that in the nondialyzed group after propensity score matching. Dialysis (odds ratio [OR]: 1.79; 95% confidence interval [CI]: 1.62-1.98), male (OR: 1.42; 95% CI: 1.28-1.57), diabetes mellitus (OR: 1.61; 95% CI: 1.44-1.80), hyperlipidemia (OR: 1.88; 95% CI: 1.68-2.11), old myocardial infarction (OR: 18.87; 95% CI: 16.26-1.21.90), and cerebral vascular disease (CVA) (OR: 1.29; 95% CI: 1.30-1.47) were all associated with AMI in the patients with CKD. CONCLUSIONS: The AMI risk was higher in the patients with CKD undergoing orthopedic surgery than in the general population, and the dialyzed group had a higher risk of AMI than did the nondialyzed group.

Short-term and long-term revision rates after lumbar spine discectomy versus laminectomy: a population-based cohort study.

BACKGROUND/OBJECTIVE: Degenerative diseases of the lumbar spine were managed with discectomy or laminectomy. This study aimed to compare these two surgical treatments in the postoperative revision rates. DESIGN: A population-based cohort study from analysis of a healthcare database. SETTING: Data were gathered from the Taiwan National Health Insurance Research Database (NHIRD). PARTICIPANTS: We enrolled 16 048 patients (4450 women and 11 598 men) with a mean age of 40.34 years who underwent lumbar discectomy or laminectomy for the first time between 1 January 1997 and 31 December 2007. All patients were followed up for 5 years or until death. RESULTS: Revision rate within 3 months of the index surgery was significantly higher in patients who underwent discectomy (2.75%) than in those who underwent laminectomy (1.18%; p<0.0001). This difference persisted over the first year following the index surgery (3.38% vs 2.57%). One year afterwards, the revision rates were similar between the discectomy (9.75%) and laminectomy (9.69%) groups. The final spinal fusion surgery rates were also similar between the groups (11.25% vs 12.08%). CONCLUSION: The revision rate after lumbar discectomy was higher than that after laminectomy within 1 year of the index surgery. However, differences were not identified between patient groups for the two procedures with respect to long-term revision rates and the proportion of patients who required final spinal fusion surgery.

Prosthetic Joint Infection Following Invasive Dental Procedures and Antibiotic Prophylaxis in Patients With Hip or Knee Arthroplasty.

OBJECTIVES We aimed to clarify whether invasive dental treatment is associated with increased risk of prosthetic joint infection (PJI) and whether prophylactic antibiotics may lower the infection risk remain unclear. DESIGN Retrospective cohort study. PARTICIPANTS All Taiwanese residents (N=255,568) who underwent total knee or hip arthroplasty between January 1, 1997, and November 30, 2009, were screened. METHODS The dental cohort consisted of 57,066 patients who received dental treatment and were individually matched 1:1 with the nondental cohort by age, sex, propensity score, and index date. The dental cohort was further divided by the use or nonuse of prophylactic antibiotics. The antibiotic and nonantibiotic subcohorts comprised 6,513 matched pairs. RESULTS PJI occurred in 328 patients (0.57%) in the dental subcohort and 348 patients (0.61%) in the nondental subcohort, with no between-cohort difference in the 1-year cumulative incidence (0.6% in both, P=.3). Multivariate-adjusted Cox regression revealed no association between dental procedures and PJI. Furthermore, PJI occurred in 13 patients (0.2%) in the antibiotic subcohort and 12 patients (0.18%) in the nonantibiotic subcohorts (P=.8). Multivariate-adjusted analyses confirmed that there was no association between the incidence of PJI and prophylactic antibiotics. CONCLUSIONS The risk of PJI is not increased following dental procedure in patients with hip or knee replacement and is unaffected by antibiotic prophylaxis. Infect Control Hosp Epidemiol. 2017;38:154-161.

Use of corticosteroids is not associated with repeated vertebroplasty or kyphoplasty within one year after the surgery in patient older than 50 years.

OBJECTIVE: The aim of this study was to investigate whether corticosteroid use increases the incidence of repeated PVP or kyphoplasty patients older than 50 years. METHODS: This study enrolled the data of 2,753 eligible patients from the Taiwan National Health Insurance Research Database who were exposed to systemic corticosteroids for at least 3 months during the first year preceding the first PVP or kyphoplasty. These steroid users were matched 1:1 in age, sex, and the index date of surgery with non-user controls during the enrollment period. All patients were followed for 1 year after the first PVP or kyphoplasty. The incidence of repeated PVP or kyphoplasty was compared between the steroid users and controls. A Cox proportional hazards model was developed to account for multiple confounding factors. RESULTS: The number of patients receiving repeated PVP or kyphoplasty was 233 (8.46%) and 205 (7.45%) in the corticosteroid and control groups, respectively. The Cox proportional hazards model revealed no association between corticosteroid use and repeated PVP or kyphoplasty. CONCLUSIONS: Systemic corticosteroid use for longer than 3 months is not associated with repeated PVP or kyphoplasty within one year of surgery in patient older than 50 years old. LEVEL OF EVIDENCE: Level III, Therapeutic study.

Corticosteroid Is Associated with Both Hip Fracture and Fracture-Unrelated Arthropathy.

OBJECTIVE: We aimed to investigate whether and how corticosteroid use was associated with serious hip arthropathy. METHODS AND MATERIALS: This population-based cohort study analyzed the Taiwan National Health Insurance Research Database and screened the one-million random sample from the entire population for eligibility. The steroid cohort consisted of 21,995 individuals who had used systemic corticosteroid for a minimum of 6 months between January 1, 1997 and December 31, 2006. They were matched 1:1 in propensity score on the index calendar date with controls who never used steroid. All participants were followed up until occurrence of serious hip arthropathy that required arthroplasty, withdrawal from the national health insurance, or the end of 2011. Surgical indication was classified as fracture-related and -unrelated. The cumulative incidence of hip arthroplasty was estimated by the Kaplan Meier method. The association with steroid exposure was explored by the Cox proportional hazard model. RESULTS: Cumulative incidences of hip arthroplasty after 12 years of follow-up were 2.96% (95% confidence interval [CI], 2.73-3.2%) and 1.34% (95% CI, 1.2-1.51%) in the steroid users and non-users, respectively (P<0.0001). The difference was evident in fracture-related arthroplasty with 1.89% (95% CI, 1.71-2.09%) versus 1.10% (95% CI, 0.97-1.25%), but more pronounced in fracture-unrelated surgery, 1.09% (95% CI, 0.95-1.24%) versus 0.24% (95% CI, 0.19-0.32%). Multivariate-adjusted Cox regression analysis confirmed steroid use was independently associated with both fracture-related (adjusted hazard ratio [HR], 1.65; 95% CI, 1.43-1.91) and unrelated arthroplasty (adjusted HR, 4.21; 95% CI, 3.2-5.53). Moreover, the risk for fracture-unrelated arthropathy rose with steroid dosage, as the adjusted HR increased from 3.30 (95% CI, 2.44-4.46) in the low-dose subgroup, 4.54 (95% CI, 3.05-6.77) in intermediate-dose users, to 6.54 (95% CI, 4.74-9.02) in the high-dose counterpart (Ptrend<0.0001). CONCLUSIONS: Corticosteroid use is associated with long-term risk of hip arthroplasty, particularly for fracture-unrelated arthropathy.

Osteoporotic sacral insufficiency fracture: An easily neglected disease in elderly patients.

Sacral insufficiency fractures (SIFs) are easily neglected by clinical physicians.The incidence of SIFs remains unclear in patients with symptomatic osteoporotic compression fractures of the lumbar-sacral area.This retrospective study was conducted by reviewing the medical records and radiological reports and by reading magnetic resonance (MR) images from August 2013 to July 2016. We identified 1233 cases with symptomatic vertebral compression fractures for which surgical interventions were performed. A total of 1144 cases were eligible for this study. Neglected diagnoses by radiologists and clinical physicians were calculated, respectively.The MR imaging (MRI) findings of SIFs were divided into the body (S1, S2, S3, and S4 levels) and alar areas (unilateral, bilateral, transverse, and none).A total of 34 (3.00%) cases with SIFs were identified through MRI. A significant difference was observed between 19 (6.53%) patients aged >80 years and 15 (1.76%) aged <80 years (P < .0001). Eight (23.53%) and 26 (76.47%) cases of SIFs were neglected by radiologists and clinical physicians, respectively. The S2 and S3 levels were the predominantly involved area (23/34; 67.65%). Furthermore, the bilateral alar area was the most commonly involved (19/34; 55.88%), as observed in coronal views of MRI.While treating other levels of osteoporotic compression fractures, radiologists and clinical physicians should be aware of SIFs, particularly when the patients are aged >80 years. The coronal oblique MR images of the thoracolumbar region should be carefully read to avoid neglecting SIFs.