Monthly Archives: March 2014

Short term improvements only for shoulder revision repair surgery

Orthopedic Surgery

Long-term outcomes of revision arthroscopic rotator cuff repair surgery is not as successful as in a first-time surgery, according to researchers from the Orthopaedic Research Institute in Sydney, Australia, who presented their work at the American Orthopaedic Society for Sports Medicine’s (AOSSM) Specialty Day.

“According to our results, patients with revision arthroscopic rotator cuff surgery had gained short term (six months post operatively) functional and clinical improvements. However, these gains pretty much disappeared by two years following surgery,” said lead researcher, Aminudin Mohamed Shamsudin, MD, M.Medicine (Ortho) from the Orthopaedic Research Institute in Sydney, Australia.

Shamsudin and his team analyzed and followed-up with 360 arthroscopic rotator cuff surgery patients where they compared the functional and clinical outcomes of 310 primary cases with that of 50 revision cases. The revision group patients were older with a mean age of 63 while the primary group patients had a mean age of 60. The primary group also had a larger rotator cuff tear on average. Two years after surgery the primary group reported less pain at rest, during sleep and with overhead activity compared to the revision group. At two years, the primary group also had better forward flexion, abduction, internal rotation and strength compared to the revision group. The re-tear rate for the primary rotator cuff repair was 16 percent at six months and 21 percent at two years. The re-tear rate for the revision rotator cuff repair was 28 percent at six months and 40 percent at two years. The increase in re-tear rate in the revision group at two years was associated with increased pain, impaired overhead function and less overall satisfaction with shoulder function.

“Further studies are needed to identify ways to improve long-term outcomes following revision arthroscopic rotator cuff surgery. However, our results do highlight the long-term success of primary rotator cuff surgery and may help patients understand the realistic expectation of the outcomes of revision arthroscopic rotator cuff surgeries,” said Shamsudin.

http://www.medicalnewstoday.com/releases/274116.php

Picture courtesy of shoulderarthritis.blogspot.com

 

 

After hip fracture surgery, new MRI can ‘see through’ metal screws

Orthopedic Surgery_March

People who sustain the most common type of hip fracture, known as a femoral neck fracture, are at increased risk of complications. A special type of MRI developed at Hospital for Special Surgery in collaboration with GE Healthcare can show a detailed image following fracture repair, without the distortion caused by metal surgical screws that are problematic in standard MRIs.

Each year, more than 340,000 people suffer a broken hip in the United States. The femoral neck, the area just below the ball of the hip’s ball-and-socket joint, is the most common site of fracture, accounting for 45 to 53 percent of cases. People with this type of injury are at high risk of complications because the blood supply to the fractured portion of the bone is often disrupted. The concern is that the decreased blood supply will lead to non-healing or the death of bone cells, known as osteonecrosis.

Researchers at Hospital for Special Surgery developed a specially sequenced, contrast-enhanced MRI to identify potential problems so doctors can intervene early and prevent further damage to the joint.

“This new MRI greatly improves the visualization of bone and soft tissue when there is metal in a joint, such as the screws used to repair a hip fracture,” explained Hollis G. Potter, M.D., Chairman of the Department of Radiology and Imaging at HSS.

A study on this subject, titled “Femoral Head Osteonecrosis Following Anatomic Stable Fixation of Femoral Neck Fractures: An in-vivo MRI Study” was presented at the annual meeting of the American Academy of Orthopaedic Surgeons (AAOS) in New Orleans.

The Department of Radiology and Imaging at HSS is known internationally as a premier center for world class musculoskeletal clinical and research imaging. “Imaging is a vital component of the integrated care system provided by HSS,” said Dr. Potter. “Our team is constantly optimizing the ability to image the earliest signs of a musculoskeletal condition, disease progression and/or healing.”

Despite advances in surgical hardware and techniques, femoral neck fractures remain a significant clinical challenge. The primary complications arising from femoral neck fractures are non-union and osteonecrosis, which occurs when the blood supply to the bone is disrupted. This causes bone cells to die, which can destroy the joint and lead to arthritis.

With respect to femoral neck hip fractures, this is the first MRI that can “see through” surgical screws to detect early signs of osteonecrosis, so that interventions can be initiated before there is further damage, such as collapse of the bone or osteoarthritis.

In the study, patients had an MRI known as a “multi-acquisition variable-resonance image combination,” or MAVRIC MRI, three months and 12 months after surgery. “The MAVRIC MRI provided us with information that could not be ascertained from x-rays or a standard MRI,” Dr. Potter explained. “A special 3-D fast spin echo technique minimized distortion caused by metal screws used to repair the fracture, facilitating assessment of the hip joint and any potential problems concerning osteonecrosis or non-union.”

MRI revealed decreased blood flow to the injured area and osteonecrosis in 80 percent of patients in the superomedial quadrant of the femoral head. However, despite these findings, patients demonstrated excellent radiographic and functional outcomes. Researchers attributed this to a surgical technique that entailed stabilizing the broken bones with screws and restoring the fracture to the correct alignment and normal anatomical position.

http://www.medicalnewstoday.com/releases/273870.php

Picture courtesy to www.radiopaedia.org