Pediatric Scoliosis Surgery-A Comprehensive Analysis of Treatment-Specific Variables and Trends in Latvia.

Background and Objectives: There are currently no data available regarding pediatric scoliosis surgery in Latvia. The aim of this article is to present treatment specific variables, investigate their interrelation, and identify predictors for the length of stay after surgical pediatric scoliosis correction. Materials and Methods: This retrospective study included all surgical pediatric scoliosis corrections in Latvia for the years 2012 to 2016. Analyzed parameters were chosen to portray the patients' demographics, pathology, as well as treatment specific variables. Descriptive, inferential, and linear regression statistics were calculated. Results: A total of 69 cases, 74% female and 26% male, were identified. The diagnostic subgroups consisted of 62% idiopathic (IDI) and 38% non-idiopathic (non-IDI) scoliosis cases. Non-IDI cases had significantly increased operation time, hospital stay, Cobb angle before surgery, and instrumented levels, while IDI cases showed significantly higher Cobb angle percentage correction. For all operated cases, the operation time and the hospital stay decreased significantly over the investigated time period. Early post-operative complications (PCs) occurred in 15.9% of the cases and were associated with increased hospital stay, instrumented levels, and Cobb angle before surgery. The linear regression analysis revealed that operation time and the presence of PCs were significant predictors for the length of the hospital stay. Conclusions: This is the first study to provide comprehensive insight into pediatric scoliosis surgery since its establishment in Latvia. Our regression model offers clinically applicable predictors and further underlines the significance of the operation length on the hospital stay. These results build the foundation for international comparison and facilitate improvement in the field.

Extracellular Vesicle Isolation and Characterization from Periprosthetic Joint Synovial Fluid in Revision Total Joint Arthroplasty.

Extracellular vesicles (EVs) comprise an as yet insufficiently investigated intercellular communication pathway in the field of revision total joint arthroplasty (RTJA). This study examined whether periprosthetic joint synovial fluid contains EVs, developed a protocol for their isolation and characterized them with respect to quantity, size, surface markers as well as documented their differences between aseptic implant failure (AIF) and periprosthetic joint infection (PJI). EV isolation was accomplished using ultracentrifugation, electron microscopy (EM) and nanoparticle tracking analysis evaluated EV presence as well as particle size and quantity. EV surface markers were studied by a bead-based multiplex analysis. Using our protocol, EM confirmed the presence of EVs in periprosthetic joint synovial fluid. Higher EV particle concentrations and decreased particle sizes were apparent for PJI. Multiplex analysis confirmed EV-typical surface epitopes and revealed upregulated CD44 and HLA-DR/DP/DQ for AIF, as well as increased CD40 and CD105. Our protocol achieved isolation of EVs from periprosthetic joint synovial fluid, confirmed by EM and multiplex analysis. Characterization was documented with respect to size, concentration and epitope surface signature. Our results indicate various differences between PJI and AIF EVs. This pilot study enables new research approaches and rising diagnostic opportunities in the field of RTJA.

An Overview of the Current State of Pediatric Scoliosis Management.

Historically pediatric scoliosis represents a condition deeply rooted within the origins of orthopedic surgery. Today only a few subspecialized surgeons treat pediatric scoliosis patients. In severe cases surgery can hold progression of and correct pathologic spinal curvature. The goal of this article is to provide an overview of the current state of pediatric scoliosis management. It aims to increase the attention of general physicians and orthopedic surgeons to a niched but rather frequently encountered pediatric pathology to facilitate early recognition and diagnosis. A thorough research of literature was conducted to summarize the different scoliosis types, their etiology and presentation. Classification, normal human growth phases and curve progression risk have been further elaborated. Finally, current treatment options with their benefits, shortcomings and complications were laid out and discussed. Among the etiological groups a focus was put on idiopathic scoliosis, in particular adolescent idiopathic scoliosis as the most frequently encountered subtype.