Postoperative change in patellofemoral alignment following closing-wedge distal femoral osteotomy performed for valgus osteoarthritic knees

Purpose@#To evaluate the postoperative change in patellar position after medial closed distal femoral osteotomy (DFO) performed for valgus osteoarthritic knees. @*Methods@#The study included 21 consecutive knees in 20 patients undergoing DFO. A minimum of 2-year followup data was obtained for all subjects with a mean follow-up period of 42 months (range 31–59 months). The patellar position was evaluated on plain radiographs preoperatively, 1-year postoperatively, and 2-year postoperatively. For patellar height, the modified Insall–Salvati Index (mISI), modified Caton–Deschamps Index (mCDI) and modified Blackburne–Peel Index (mBPI) were measured on the standing lateral radiographs.Patellofemoral alignment on the axial plane was assessed on skyline views with 30° flexion based on the measurements for lateral patellar tilt (LPT) and lateral patellar shift (LPS). Measured values at pre- and postoperative phases were statistically compared using a two-way analysis of variance. @*Results@#All indices including mISI, mCDI, mBPI, LPT and LPS showed no statistically significant postoperative changes. @*Conclusion@#Medial closed-wedge DFO performed for valgus osteoarthritic knees did not significantly influence patellofemoral alignment either on the sagittal or axial plane. Therefore, to highlight the clinical relevance of our findings, medial closed-wedge DFO for the valgus knee does not adversely affect the patellofemoral joint.Level of evidence: Level IV, case series.

Effect of Teriparatide on Subsequent Vertebral Fractures after Instrumented Fusion Surgery for Osteoporotic Vertebral Fractures with Neurological Deficits

STUDY DESIGN: Retrospective case review. PURPOSE: To assess the incidence and effect of teriparatide (TP) on subsequent vertebral fractures following a long-instrumented fusion surgery for osteoporotic vertebral fractures (OVFs). OVERVIEW OF LITERATURE: TP treatment may be a useful strategy for patients with OVFs treated with a long-instrumented surgery. METHODS: Overall, 47 patients who underwent long-instrumented fusion surgery (≥3 levels) for OVFs with neurological deficits between 2010 and 2013 were enrolled. The mean age of the subjects was 76 years; the study population comprised 20 males and 27 females. The mean follow-up duration was 23 months. The average of fused vertebrae was 4.9. TP was used for 19 patients who comprised the TP group. The incidence of subsequent VFs was estimated with Kaplan–Meier analyses and compared between the TP and non-TP groups using the log-rank test. Risk factors were evaluated using a Cox proportional hazards model. RESULTS: A total of 38% (18/47 cases) of the subjects were identified with subsequent VFs. There were no significant differences in the age, sex, fused levels, presence of prevalent fractures, and correction loss of the two groups. The occurrence of subsequent VFs was lower in the TP group than in the non-TP group (16% vs. 54%, p=0.014). The log-rank test revealed that the TP treatment significantly reduced the risk of subsequent VFs (p=0.048). A Cox proportional hazards model revealed that preoperative TP treatment is only a protective factor of subsequent VFs after instrumented fusion surgery for OVFs (hazard ratio, 0.281; p=0.047). CONCLUSIONS: In this retrospective study, pre- and postoperative TP treatment significantly reduced the incidence of subsequent VFs after instrumented fusion surgery for OVFs. A prospective randomized study is warranted to determine the efficacy of TP treatments.

The Effect of Concomitant Arthroscopic Lateral Retinacular Release on Postoperative Patellar Position and Orientation in Open Wedge High Tibial Osteotomy

PURPOSE: The purpose of this study was to evaluate the effect of concomitant arthroscopic lateral release (LR) in open wedge high tibial osteotomy (OWHTO) by comparing the pre- and postoperative radiological parameters of patellar position and orientation. MATERIALS AND METHODS: The study was comprised of 19 knees undergoing OWHTO and concomitant LR and 18 knees undergoing OWHTO alone. Radiological parameters for patellar position and orientation included the Caton-Deschamps index (CDI), Blackburne-Peel index (BPI), patellar tilting angle (PTA), patellar lateral shift (PLS), and patellofemoral distance (PFD), which were evaluated in the preoperative period and at one year after surgery. RESULTS: Patellar height was significantly reduced after surgery as indicated by the decrease in BPI (p=0.03) in the OWHTO/LR group, and decrease in CDI (p=0.03) and BPI (p=0.04) in the OWHTO alone group. PTA and PLS were significantly reduced after the combined OWHTO/LR procedure (p=0.04 and p=0.04, respectively). By contrast, no significant changes were detected when isolated OWHTO was performed. CONCLUSIONS: OWHTO induced a postoperative decrease in patellar height in both groups. Regarding the change in patellofemoral alignment, concomitant LR in OWHTO significantly decreased lateral patellar tilt and shift, while no significant difference in those parameters were noted in the OWHTO alone knees.

Relationship between Pain and Muscle Activities of the Knee Joint during Walking in Patients with Severe Knee Osteoarthritis / The Japanese Journal of Rehabilitation Medicine

Objective：To investigate the relationship between clinical assessment of pain and muscle activity during walking in patients with severe knee osteoarthritis (OA)．Methods：Eleven patients diagnosed as having severe knee OA (13 knees) were evaluated with electromyography and numerical rating scale (NRS) of pain during walking. Electromyography was recorded from the vastus medialis (VM), semitendinosus (ST), vastus lateralis (VL), and biceps femoris (BF) muscles. Co-contraction indexes (CCIs) for the extensor and flexor muscles of the knee joint were calculated as follows：using the VM and ST data for CCI at the medial aspect of the knee and the VL and BF data for CCI at the lateral aspect. Spearman's rank correlation coefficients between the average individual muscle activities or CCI and pain were calculated.Results：During the terminal stance of walking, NRS significantly correlated with the activation patterns of BF (r ＝－0.61, p＜0.05), the CCI of VL-BF (r ＝－0.582, p＜0.05), and the CCI of VM-ST (r ＝－0.596, p＜0.05)．Conclusion：This study suggests that pain severity is reflected in increasing CCI at the medial and lateral aspects during the terminal stance phase in severe knee OA.

A sewing needle in contact with the cervical dura mater and vertebral artery: A case report.

RATIONALE: Although cervical foreign bodies have been previously reported, the report of a needle in the cervical spinal cord is rare. Herein, we report a rare case of a sewing needle in contact with the cervical dura mater and vertebral artery. PATIENTS CONCERNS: A 47-year-old man presented with discomfort in the posterior region of his neck. Approximately 2 years before admission, he suffered a stiff neck and had stabbed the posterior region of his neck with a sewing needle. The sewing needle had deeply entered his neck, and he left it alone because it could not be identified or removed. On examination, the patient had a full range of neck motion, but was experiencing discomfort. Cervical spine radiographs revealed a metal foreign body oriented from between the C2 and C3 spinous processes to the anterior cervical spine. DIAGNOSIS: Computed tomography (CT) myelogram and CT angiogram revealed that the sewing needle was penetrating into the foramen transversarium and was in contact with the cervical dura mater and the right vertebral artery. INTERVENTIONS: The sewing needle was removed under general anesthesia. OUTCOMES: Cerebrospinal fluid leakage occurred immediately after removal of the needle. Symptoms of discomfort disappeared without any complications. LESSONS: This is the first report of a sewing needle that entered the cervical spinal canal while avoiding the cervical spine and the vertebral artery. Although no symptoms occurred for nearly 2 years, surgical removal of a foreign body near the cervical spinal cord and vertebral artery should be performed as soon as possible, before the occurrence of symptoms.

Prognostic Factors of Surgical Outcome after Spinous Process-Splitting Laminectomy for Lumbar Spinal Stenosis

STUDY DESIGN: A retrospective case review. PURPOSE: To assess the clinical and radiographic outcomes and identify the predictive factors associated with poor clinical outcomes after lumbar spinous process-splitting laminectomy (LSPSL) for lumbar spinal stenosis (LSS). OVERVIEW OF LITERATURE: LSPSL is an effective surgical treatment for LSS. Special care should be taken in patients with degenerative lumbar scoliosis (DLS). METHODS: A consecutive retrospective case review of patients undergoing LSPSL for LSS with a minimum 2-year follow-up was performed. Mild DLS and mild degenerative spondylolisthesis (DS) were included in the study. The Japanese Orthopedic Association (JOA) score and recovery rate were reviewed. Poor clinical outcome was defined as a recovery rate or =5 mm was found in 8 of 24 patients (33%) in the DS group. A progression of curvature > or =5degrees was found in 5 of 14 patients (36%) in the DLS group. The progression of scoliosis and slippage did not influence the clinical outcome. CONCLUSIONS: The clinical and radiographic outcomes of LSPSL for LSS were favorable. Pre-existing DLS was significantly associated with poor clinical outcome.