A Novel Approach for Correcting Limb Length Discrepancy in Total Hip Arthroplasty.

INTRODUCTION: This study aimed to evaluate the accuracy of the suture technique, along with the utilization of a spirit-level device which is an instrument designed to indicate whether a surface is horizontal or vertical, in comparison to the conventional supraacetabular pin method and caliper measurement for correcting leg length discrepancy (LLD) during total hip arthroplasty (THA). Materials and methods: Consecutive patients who underwent unilateral primary THA between January 2021 and March 2023 were included in the study. The exclusion criteria were severe flexion and adduction contracture that could affect the accuracy of measurements, a history of lower extremity surgery, the presence of lower extremity deformity, and the absence of postoperative full-length radiographs. Patients were allocated into two groups based on the technique employed for correcting LLD during THA. Group 1 (n=62) consisted of patients evaluated using the suture technique with a spirit-level device, while group 2 (n=75) comprised patients who underwent the supraacetabular pin method with caliper measurement. The distance between the inter-teardrop line and the tip of the lesser trochanter was measured for both hips to assess LLD. RESULTS: The mean preoperative LLD was similar between groups, which was 11.6 ± 9.1 mm in group 1 and 9.5 ± 9.8 mm in group 2 (p=0.191). Postoperatively, group 1 had a significantly lower LLD compared to group 2 (p<0.001). CONCLUSION: According to the results obtained from this study, the use of a suture technique in conjunction with a spirit-level device to achieve a consistent leg position is an effective method for correcting LLD during THA.

Exploring Actual and Presumed Links between Accurately Inferring Contents of Other People's Minds and Prosocial Outcomes.

The term "empathic accuracy" has been applied to people's ability to infer the contents of other people's minds-that is, other people's varying feelings and/or thoughts over the course of a social interaction. However, despite the ease of intuitively linking this skill to competence in helping professions such as counseling, the "empathic" prefix in its name may have contributed to overestimating its association with prosocial traits and behaviors. Accuracy in reading others' thoughts and feelings, like many other skills, can be used toward prosocial-but also malevolent or morally neutral-ends. Prosocial intentions can direct attention towards other people's thoughts and feelings, which may, in turn, increase accuracy in inferring those thoughts and feelings, but attention to others' thoughts and feelings does not necessarily heighten prosocial intentions, let alone outcomes.

Intraoperative Neurophysiological Monitoring in Total Hip Arthroplasty for Crowe Types 3 and 4 Hips.

Background: Crowe types 3 and 4 dysplastic hips usually need total hip arthroplasty (THA) with femoral shortening osteotomy (FSO) to facilitate reduction, equalize limb length, and decrease the traction stress in nerves. The frequency of peripheral nerve palsy after primary THA has been reported to range from 0.08% to 3.7%. Apart from direct trauma to the nerve, the excessive extension of the extremity is also reported as a common cause of nerve damage. The current study aimed to evaluate the outcomes of intraoperative neurophysiological monitoring (IONM) in THA for Crowe types 3 and 4 hips. Methods: The data of patients who underwent primary THA with IONM were retrospectively reviewed using our medical records. Patients with Crowe types 3 and 4 dysplastic hips were included in the study. Motor-evoked potentials and somatosensory-evoked potentials were assessed intraoperatively. Preoperative dislocation height and postoperative trochanter minor differences were measured using preoperative and postoperative radiographs. Results: Twenty-three hips of 19 patients (4 bilateral THAs) with a mean age of 45 years participated in the study. Ten hips (43%) were classified as Crowe type 4, whereas 13 hips (57%) were Crowe type 3. The mean preoperative dislocation height was 41.6 mm (range, 15-100 mm). Postoperatively, only 6 patients had a difference between trochanter minor levels with a mean of 8.5 mm (range, 3-17 mm). Three patients underwent a subtrochanteric FSO to achieve reduction. Postoperatively, no patient had any motor and sensory nerve dysfunction. Conclusions: According to the results acquired from this study, no nerve palsy was observed after THA for Crowe types 3 and 4 hips, and subtrochanteric FSO was not performed in all Crowe type 3 hips and 70% of Crowe type 4 hips with the aid of IONM.

A comparison of robotic-assisted and manual techniques in restricted kinematically aligned total knee arthroplasty: coronal alignment improvement with no significant clinical differences.

PURPOSE: The purpose of this study was to compare radiographic and clinical outcomes of robotic-assisted and conventional manual techniques in restricted kinematically aligned TKA. METHODS: Patients who underwent either manual or robotic-assisted restricted kinematically aligned TKA between 2019 and 2020 were included in this retrospective comparative study. Radiographic outcomes comprised coronal plane measurements performed through standing full-length anteroposterior radiographs. The Knee Injury and Osteoarthritis Outcome Score (KOOS), Oxford score, Visual Analog Scale pain and satisfaction score, and Forgotten Joint Score were used to determine the clinical outcome. The continuous data were compared by Student's t test according to the Kolmogorov‒Smirnov normality test. RESULTS: The manual group consisted of 46 patients (38 females, eight males) with a mean age of 68.1 years, and the robotic group consisted of 70 patients (58 females, 12 males) with a mean age of 65.7 years (n.s.). Preoperatively, no significant difference was observed between groups concerning demographic characteristics, radiographic measurements, and clinical scores except for the symptom and pain domains of the KOOS score, which was significantly worse in the manual group (p = 0.011 and 0.035, respectively). At the postoperative 2-year follow-up, we observed significant differences between groups with respect to the mean HKA angle, mMPTA, and mLDFA (p = 0.034, 0.041, and 0.005, respectively). A comparison of clinical scores at the postoperative 2-year follow-up demonstrated no significant differences between groups. CONCLUSION: The current study demonstrated that using robotic-assisted technique for restricted kinematically aligned total knee arthroplasty (TKA) resulted in significantly better outcomes compared to the conventional manual technique in achieving normal ranges of lower extremity coronal alignment measurements. While the robotic-assisted group demonstrated better clinical scores, there was no statistically significant difference in clinical outcomes between the robotic-assisted group and the control group at the two-year follow-up. Concerning clinical relevance, the restoration of original anatomy and coronal alignment, a crucial concern in restricted kinematically aligned TKA, may be better achieved by the robotic-assisted technique. LEVEL OF EVIDENCE: Level III (Retrospective cohort study).

Volumetric Analysis of Subacromial Space After Superior Capsular Reconstruction for Irreparable Rotator Cuff Tears.

Purpose: Subacromial volume measurement on magnetic resonance images is relatively new. It has been shown that decreased subacromial volume increases after surgical repair of full-thickness rotator cuff tears. There is no study examining subacromial volume changes after superior capsular reconstruction (SCR). The purpose of this study was to compare subacromial volume changes on magnetic resonance images (MRI) after superior capsular reconstruction performed for primary irreparable rotator cuff tears. Methods: Patients who underwent an SCR procedure between 2017 and 2019 with a minimum 2-year postoperative follow-up were included in this retrospective study. Subacromial volume was measured on MRI using software. The preoperative and postoperative acromiohumeral distance, Constant Scores, graft thickness, and Hamada grades of the patients were evaluated. Results: A total of 18 patients with a mean age of 59.7 years (range: 49-74 years) underwent an SCR for massive irreparable cuff tear. The mean preoperative subacromial volume was 3.54 ± 0.39 cm3 (range 2.88-4.36 cm3), which increased to 4.46 ± 0.39 cm3 (range 3.75-5.32 cm3) postoperatively (p = < 0.001). The increase in subacromial volume and acromiohumeral distance did not correlate with Constant scores and graft thickness. We observed a significantly higher subacromial volume increase among Hamada grade 1 patients, compared to those with Hamada grade 2 (p = 0.011). Conclusions: We observed that subacromial volume significantly increased after superior capsular reconstruction. However, the increase in subacromial volume did not correlate with clinical scores, acromiohumeral distance changes, or graft thickness.Level of evidence: Level III - Retrospective Cohort Study.

Preliminary outcomes of kinematically aligned robot-assisted total knee arthroplasty with patient-specific cartilage thickness measurement.

This study aimed to assess the preliminary outcomes of kinematically aligned robot-assisted total knee arthroplasty (TKA) with patient-specific cartilage thickness measurement. Patients who underwent kinematically aligned robot-assisted TKA were included in this study. Robot-assisted total knee arthroplasties were performed by NAVIO Surgical System (Smith & Nephew, Memphis, USA), an image-free handheld robotic system. The kinematic alignment technique was performed according to our intraoperative cartilage thickness measurement technique. Hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), joint-line orientation angle (JLOA), and joint-line convergence angle (JLCA) were measured through standing full-length anteroposterior radiographs. Knee Injury and Osteoarthritis Outcome Score, Oxford score, VAS pain and satisfaction score, and Forgotten Joint Score were used to assess clinical outcomes. A total of 142 knees of 109 patients (92 females and 17 males) were evaluated in this study. There was a significant correction in HKA, JLCA, and mMPTA postoperatively (p ≤0.001, < 0.001, and 0.029, respectively). We observed no significant change in mLDFA and JLOA measurements. All clinical scores significantly increased at the latest follow-up. Our results demonstrated that kinematically aligned robot-assisted TKA with patient-specific cartilage thickness measurement demonstrated no significant change in mLDFA and JLOA, as expected; however, significantly corrected the deformity in HKA, mMPTA, and JLCA measurements.

It Is Hard to Read Minds without Words: Cues to Use to Achieve Empathic Accuracy.

When faced with the task of trying to "read" a stranger's thoughts, what cues can perceivers use? We explore two predictors of empathic accuracy (the ability to accurately infer another person's thoughts): use of stereotypes about the target's group, and use of the target's own words. A sample of 326 White American undergraduate students were asked to infer the dynamic thoughts of Middle Eastern male targets, using Ickes' (Ickes et al. 1990) empathic accuracy paradigm. We predicted use of stereotypes would reduce empathic accuracy because the stereotypes would be negative and inaccurate. However, more stereotypical inferences about the target's thoughts actually predicted greater empathic accuracy, a pattern in line with past work on the role of stereotypes in empathic accuracy (Lewis et al. 2012), perhaps because the stereotypes of Middle Easterners (collected from a sample of 60 participants drawn from the same population) were less negative than expected. In addition, perceivers who inferred that the targets were thinking thoughts that more closely matched what the target was saying out loud were more empathically accurate. Despite the fact that words can be used intentionally to obscure what a target is thinking, they appear to be a useful cue to empathic accuracy, even in tricky contexts that cross cultural lines.