Publications by authors named "Octavian Andronic"

24 Publications

  • Page 1 of 1

Outcomes of Hip Arthroscopy in Patients with Femoroacetabular Impingement and Concomitant Tönnis Grade II Osteoarthritis or Greater: Protocol for a Systematic Review.

Int J Surg Protoc 2021 Mar 16;25(1):1-6. Epub 2021 Mar 16.

Young Adult Hip Service, Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge, United Kingdom.

Introduction: Outcomes of hip arthroscopy for femoroacetabular impingement and concomitant moderate- to advanced hip osteoarthritis (Tönnis Grade II or greater) is still a matter of debate as findings in the literature are controversial. This study aims to investigate whether hip arthroscopy is effective in treating patients with femoroacetabular impingement and Tönnis hip osteoarthritis Grade II or greater.

Methods And Analysis: The protocol follows the PRISMA-P guidelines. The systematic review is registered in the International Prospective Register for Systematic Reviews and Meta-analysis (PROSPERO) under the registration number: CRD42020210936. The search will include multiple databases: MEDLINE, EMBASE, Web of Science Core Collection and Cochrane library. The screening and selection process will be performed by two independent researchers based on predefined criteria. All studies published in English or German from inception to 1 of December 2020 that investigated outcomes of hip arthroscopy in patients with Tönnis grade II or greater of hip osteoarthritis will be considered eligible. The risk of bias and quality of articles will be assessed using the MINORS tool. Methodological inconsistency and heterogeneity will be explored using the I test. This assessment will be used to provide recommendations using the GRADE system.

Ethics And Dissemination: Separate ethical approval is not required. This study will be a comprehensive and rigorous systematic review on all published articles reporting on outcomes of hip arthroscopy for femoroacetabular impingement and concomitant hip osteoarthritis Tönnis Grade II or greater. It will explore patient reported outcomes as well as radiological outcomes, complications, rates of revision surgery and rates of conversion to total hip replacement (THR). Results of the current review will be published in a peer-reviewed scientific journal and disseminated on research platforms according to copyright rules and rights.

Highlights: Hip arthroscopy is used to treat femoroacetabular impingement and is effective in patients that have concomitant hip osteoarthritis Tönnis Grade 0 or 1.Outcomes of hip arthroscopy in patients with femoroacetabular impingement and in moderate to advanced osteoarthritis - Tönnis Grade 2 or greater, is a matter of debate.The purpose of the current systematic review is to elucidate, stratify and critical appraise the current evidence on outcomes in this patient subpopulation.
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http://dx.doi.org/10.29337/ijsp.26DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8114840PMC
March 2021

Lack of Conclusive Evidence of the Benefit of Biologic Augmentation in Core Decompression for Nontraumatic Osteonecrosis of the Femoral Head: A Systematic Review.

Arthroscopy 2021 May 5. Epub 2021 May 5.

Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland.

Purpose: To assess whether biologic augmentation in addition to core decompression (CD), compared with CD alone, improves clinical and radiographic outcomes in the treatment of nontraumatic osteonecrosis of the femoral head (ONFH). Our hypothesis was that biologic augmentation would reduce the progression of osteonecrosis and therefore also the rate of conversion to total hip arthroplasty (THA).

Methods: A systematic review was performed in accordance with the Preferred Reporting Items of Systematic Reviews and Meta-analysis (PRISMA) statement. Six databases were searched: Central, MEDLINE, Embase, Scopus, AMED, and Web of Science. Studies comparing outcomes of CD versus CD plus biologic augmentation (with or without structural augmentation), with a reported minimum level of evidence of III and ≥24 months of follow-up, were eligible. Procedural success was conceptualized as (1) avoidance of conversion to THA and (2) absence of radiographic disease progression. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal checklists. A quantitative analysis of heterogeneity was undertaken.

Results: We included studies reporting on 560 hips in 484 patients. Biologic augmentation consisted of bone marrow stem cells in 10 studies, bone morphogenic protein in 2, and platelet-rich plasma in 1. Three studies used additional structural augmentation. The median maximum follow-up time was 45 months. Only 4 studies reported improvement in all clinical scores in the augmentation group. Seven studies observed a reduction in the rate of radiographic progression, and only 5 found reduced rates of conversion to THA when using augmentation. A high risk of bias and marked heterogeneity was found, with uncertainty about the study designs implemented, analytical approaches, and quality of reporting.

Conclusion: Current evidence is inconclusive regarding the benefit of biologic augmentation in CD for nontraumatic ONFH, because of inconsistent results with substantial heterogeneity and high risk of bias.

Level Of Evidence: III, systematic review of level I, II, and III studies.
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http://dx.doi.org/10.1016/j.arthro.2021.04.062DOI Listing
May 2021

Flexor hallucis longus hypertrophy secondary to Achilles tendon tendinopathy: an MRI-based case-control study.

Eur J Orthop Surg Traumatol 2021 Feb 8. Epub 2021 Feb 8.

Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.

Purpose: The purpose of this study was to outline an indirect sign of advanced Achilles tendinopathy on magnetic resonance imaging (MRI), based on the hypothesis that these patients would present with secondary hypertrophy of the flexor hallucis longus muscle (FHL).

Methods: MRI scans of Achilles tendon were analyzed retrospectively in two cohorts. The study group consisted of consecutive patients presenting with clinical signs of Achilles tendinopathy and no previous surgeries, while the control group were patients that had an MRI due to other reasons and no signs of tendinopathy. Two parameters from two muscle bellies were measured and compared on axial MRI scans 4-5 cm above the ankle joint line at the level of greatest thickness: area and diameter of the triceps surae (TS) and of the FHL muscle. Ratios (FHL/TS) were calculated for area (Ar) and diameter (Dm) measurements. Interobserver agreement was analyzed. A receiver operating characteristic (ROC) curve was created for both ratios to assess potential cutoff points to differentiate between the groups.

Results: A total of 60 patients for each study group were included. Both ratios Ar(FHL/TS) and Dm(FHL/TS) showed significant higher values in the tendinopathy group (p < 0.001). There were strong to very strong intraclass correlation coefficients (ICC = 0.75-0.93). A diameter ratio Dm (FHL/TS) of 2.0 or higher had a sensitivity of 49% and specificity of 90% for concomitant Achilles tendinopathy.

Conclusion: In our patient cohort, FHL hypertrophy was observed in patients with Achilles tendinopathy as a possible compensatory mechanism. Measuring a diameter ratio Dm(FHL/TS) of 2.0 or higher on an axial MRI, may be indicative as an indirect sign of functional deterioration of the Achilles tendon.
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http://dx.doi.org/10.1007/s00590-021-02891-8DOI Listing
February 2021

Clinical and Functional Outcomes of Peroneus Longus to Brevis Tendon Transfer.

Foot Ankle Int 2021 Jun 15;42(6):699-705. Epub 2021 Jan 15.

University Center for Prevention and Sports Medicine, Balgrist University Hospital, Zurich, Switzerland.

Background: Peroneal tendon lesions can cause debilitating pain, but operative treatment remains controversial. Some studies recommend peroneal tenodesis or transfer if more than half of the tendon is affected. However, clinical outcomes and inversion/eversion motion after peroneal transfer have not been investigated yet.

Methods: Patients who underwent distal peroneus longus to brevis transfer for major peroneus brevis tendon tears with a minimum follow-up of 2 years were included. Clinical outcome parameters included the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score, the German Foot Function Index (FFI-D), and Karlsson-Peterson score. Functional outcome was tested with a standardized active range-of-motion (ROM) and isokinetic strength measurement protocol, including concentric and eccentric eversion and inversion tests.

Results: Of total 23 eligible patients, 14 (61%) were available for follow-up. Clinical outcome scores were good with AOFAS 86 ± 16 points, FFI-D pain 26% and FFI-D disability 26%, and Karlsson-Peterson score 78 ± 23 points. There was no difference in strength in comparison to the contralateral foot (all > .05). Isokinetic strength was 16.3 ± 4.9 Nm (108% of contralateral side) and 18.8 ± 4.5 Nm (101%) at concentric 30 deg/s and eccentric 30 deg/s eversion tests, as well as 15.7 ± 5.2 Nm (102%) and 18.7 ± 3.3 Nm (103%) at concentric 30 deg/s and eccentric 30 deg/s inversion tests, respectively. There was no difference in ROM compared to the contralateral side (eversion/inversion 14.5-0-18.7 vs 14.1-0-16.1 degrees).

Conclusion: Peroneus longus to brevis transfer is a viable option for treating severe peroneus brevis tendon tears and does not compromise measurable strength or ROM in inversion or eversion in comparison to the contralateral ankle joint.

Level Of Evidence: Level IV, prospective case series.
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http://dx.doi.org/10.1177/1071100720982592DOI Listing
June 2021

Implications for diagnosis and treatment of peri-spinal implant infections from experiences in periprosthetic joint infections-a literature comparison and review.

J Spine Surg 2020 Dec;6(4):800-813

Center for Musculoskeletal Surgery, Charité - Universitaetsmedizin Berlin, Berlin, Germany.

Both, periprosthetic joint infection (PJI) and peri-spinal implant infection (PSII) are serious complications occurring in arthroplasty and spine instrumentation with absolute numbers expected to rise in the next years. The currently existing literature data describing the characteristics of PSII are limited when compared to PJI studies. However, both PJI and PSII exhibit similarities concerning pathogenesis, symptoms, diagnosis, treatment and prognosis. This literature review aims at comparing PJI and PSII and to develop implications for diagnosis and treatment of PSII from existing studies about PJI. The review was performed on the basis of a structured PubMed, Cochrane Library, and Medline analysis and existing guidelines, with 99 references being included. The results indicate that specific terms like re-infection should be defined in the context of PSII based on existing definitions of PJI, that biofilm studies and studies analyzing different prosthesis surfaces in arthroplasty could be used for PSII, and that histopathology as an additional standard tool in PSII diagnosis might be helpful. In addition, the development of a standardized algorithm-based treatment system with antibiotic protocols, including long term suppression, for PSII similar to the ones existing for PJI is necessary.
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http://dx.doi.org/10.21037/jss-20-12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7797793PMC
December 2020

Arthroscopic repair of posterosuperior rotator cuff tears with bioabsorbable patch augmentation: a magnetic resonance-controlled case series with 1-year follow-up.

JSES Int 2020 Dec 9;4(4):860-868. Epub 2020 Sep 9.

Department of Orthopaedics and Traumatology, Waid City Hospital, Zürich, Switzerland.

Background: Among many advances in the treatment of rotator cuff tears, arthroscopic augmentation techniques with patches of various biological and synthetic graft materials have been introduced to reinforce the repair. However, structural and functional outcomes after patch augmentation vary, and reinforcing the tendon healing remains a challenge. The aim of this study was to evaluate clinical and radiologic outcomes 1 year after arthroscopic posterosuperior (PS) rotator cuff repair with bioabsorbable patch augmentation.

Methods: From October 2014 to December 2017, all patients with PS rotator cuff tears undergoing arthroscopic repair with patch augmentation using a resorbable, biologically derived poly-4-hydroxybutyrate patch (Biofiber; Wright, Memphis, TN, USA) were enrolled in this study. Only full-thickness PS lesions with ≥1 of the following tear patterns were augmented with a patch and were the subject of this study: large U- and L-shaped tear, transtendinous tear, delamination, and fraying of the bursal layer. Patients were examined preoperatively and at 1 year postoperatively with a standardized examination protocol and magnetic resonance imaging (MRI).

Results: Sixteen patients were included in this study; 1 patient was lost to follow-up. One patient only underwent clinical follow-up. We detected 1 repair failure (6.7%) with dislocation of the lateral-row anchors on computed tomography scanning at 3 months postoperatively. MRI was performed in 14 patients after 1 year; in all of them, the cuff repair was intact. The Sugaya tendon integrity score was 1.7 ± 0.9. The Constant-Murley score improved from 44 to 89 points ( < .001). Muscular strength improved in the supraspinatus (from 2.6 to 4.8), infraspinatus (from 3.2 to 4.9), and subscapularis (from 4 to 4.9) (all < .001). Overall, patient satisfaction was high (3.6 ± 0.6).

Discussion: This small-sized case series is the first to prospectively assess clinical and radiologic outcomes after patch augmentation of PS rotator cuff tears using bioabsorbable poly-4-hydroxybutyrate patches. Good to excellent structural and functional outcomes were observed with a low retear rate (6.7%) and good tendon integrity on 1-year postoperative MRI, and the graft did not cause any complications. The use of bioabsorbable patches could be beneficial when unfavorable PS tear patterns are encountered in which a stable repair of the full tendon thickness at its insertion is otherwise difficult to reach.
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http://dx.doi.org/10.1016/j.jseint.2020.07.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7738590PMC
December 2020

What are the outcomes of core decompression without augmentation in patients with nontraumatic osteonecrosis of the femoral head?

Int Orthop 2021 03 4;45(3):605-613. Epub 2020 Sep 4.

Young Adult Hip Service, Department of Trauma and Orthopaedics, Addenbrooke's - Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK.

Purpose: Core decompression (CD) of the femoral head is performed to preserve the hip in avascular necrosis (AVN). The outcome following this procedure differs based on the medical centre and the technique. Also, the time to total hip replacement (THR) and the percentage of patients subsequently undergoing a THR are controversial.

Methods: A systematic review was performed following PRISMA guidelines. The search included CENTRAL, MEDLINE, EMBASE, Scopus, AMED and Web of Science Core Collection databases. Studies reporting the outcome of CD for AVN were assessed. Studies using additional implants, vascularized grafts or any type of augmentation were excluded. Quality assessment was performed using the Joanna Briggs Institute Critical Appraisal Checklist (JBI CAC) tool.

Trial Registration: International prospective register of systematic reviews (PROSPERO) - CRD42018100596 .

Results: A total of 49 studies describing 2540 hips were included. The mean weighted follow-up time was 75.1 months and the mean age at surgery was 39 years. Twenty-four of 37 studies reported improvement in all outcome scores, whilst 9/37 studies report only partial improvement post-operatively. Four studies (4/37) described poor clinical outcomes following intervention. Data was pooled from 20 studies, including 1134 hips with a weighted mean follow-up of 56 months. The percentage of hips undergoing THR averaged 38%. The time to THR had a weighted mean of 26 months after CD.

Conclusion: Pooled results from 1134 hips and of these nearly 80% with early stage of osteonecrosis, showed that approximately 38% of patients underwent a total hip replacement at an average of 26 months following core decompression without augmentation.
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http://dx.doi.org/10.1007/s00264-020-04790-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7892522PMC
March 2021

Factors affecting outcome in the treatment of streptococcal periprosthetic joint infections: results from a single-centre retrospective cohort study.

Int Orthop 2021 01 27;45(1):57-63. Epub 2020 Aug 27.

Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.

Purpose: To report and analyse factors affecting the outcome of streptococcal periprosthetic joint infections (PJIs).

Methods: A retrospective analysis of consecutive streptococcal PJIs was performed. Musculoskeletal Infection Society 2013 criteria were used. Outcome was compared with a prospective PJI cohort from the same institution.

Results: The most common isolated streptococcal species was Streptococcus dysgalactiae (9/22, 41%) among 22 patients included. Surgical treatment consisted of DAIR (debridement, antibiotics, irrigation and retention) in 12 (55%), one-stage revision arthroplasty in one (4%), two-stage revision arthroplasty in eight (37%) and implant removal in one (4%) patient. An infection free-outcome was achieved in 15 cases (68%), whilst seven (32%) patients failed initial revision and relapsed with the same pathogen, from which six were treated with DAIR and one with one-stage revision arthroplasty. No failures were observed in patients who received a two-stage revision. Failure rates did not differ in the cases treated with rifampin (1/5) from those without 6/17 (p = 0.55). There was no correlation between the length of antibiotic treatment and relapse (p = 0.723). In all failures, a persistent distant infection focus was identified at the time of relapse. Compared with our prospective PJI cohort, relapse rates were significantly higher 32% vs 12% (p < 0.05).

Conclusion: No correlation with the use of rifampin or length of antibiotic treatment was found. No failures were observed in patients who received a two-stage revision, which may be the surgical treatment of choice. A distant persisting infection focus could be the reason for PJI relapse with recurrent hematogenous seeding in the joint.
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http://dx.doi.org/10.1007/s00264-020-04722-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7801309PMC
January 2021

Limited improvement and high rate of complication in patients undergoing reverse total shoulder arthroplasty for previous native shoulder infection.

J Shoulder Elbow Surg 2021 Jan 9;30(1):34-39. Epub 2020 Jun 9.

Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland.

Background: The outcomes of reverse total shoulder arthroplasty (RTSA) surgery for the sequelae of former septic native joint shoulder arthritis are unknown but might be inferior to patients without prior bacterial arthritis.

Methods: We performed a single-center case-control study embedded in our prospective RTSA cohort. We matched all patients with prior infections in a 1:1 ratio with patients who underwent RTSA for other indications. The matching variables were indication for surgery, age, sex, dominant/nondominant shoulder, and body mass index. We evaluated outcomes by Constant score and active function.

Results: Among 1249 patients in the RTSA cohort, 14 were operated for sequelae of previous native shoulder joint infections. Although both groups significantly improved from preoperative to postoperative values, the outcome of postinfectious patients was clearly inferior in comparison with the control group (absolute [38 ± 17 vs. 75 ± 8, P < .01], relative Constant score [47 ± 19 vs. 88 ± 9, P < .01], Constant pain score [11.0 ± 3.1 vs. 14.3 ± 1.3, P < .01], subjective shoulder value [43 ± 26 vs. 85 ± 10, P < .01], abduction [70 ± 43 vs. 148 ± 29°, P = .001], and elevation [82 ± 49° to 131 ± 16°, P = .02]). Moreover, in the postinfectious group, overall surgical complications occurred in 36%, with the need for revision in 21%. There was, however, no recurrence of infection in any of the patients' shoulders.

Conclusion: RTSA for end-stage postinfectious joint disease is associated with a high number of complications and reoperations. Clinical outcomes are inferior to those without past infection.
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http://dx.doi.org/10.1016/j.jse.2020.04.048DOI Listing
January 2021

The Effect of Patellar Positioning on Femoral Component Rotation when Performing Flexion Gap Balancing Using a Tensioning Device for Total Knee Arthroplasty.

J Knee Surg 2020 Jul 14. Epub 2020 Jul 14.

Department of Orthopaedic Surgery, University Hospital Balgrist, Zurich, ZH, Switzerland.

There is an increasing interest in new devices such as tensiometers for flexion gap balancing during total knee arthroplasty (TKA). The purpose of this study was to determine the influence of patella positioning during flexion gap balancing on femoral component rotation. We prospectively evaluated 32 consecutive knees in 31 patients who underwent primary TKA for degenerative osteoarthritis and where soft tissue balancing was performed using the same tensiometer. Preoperative measurements included valgus/varus deformation, mechanical axis, epicondylar axis, and tibial slope. Intraoperatively, measurement of femoral component rotation in 90 degrees of knee flexion was conducted in three different positions of the patella: (1) patella reduced, (2) patella dislocated but not everted, and (3) patella dislocated and everted. The femoral component had significantly higher rotation when the patella was reduced compared with a dislocated patella (4.9 ± 2.1 degrees vs. 4.2 ± 2.2 degrees;  = 0.006) and compared with a dislocated and everted patella (4.9 ± 2.1 degrees vs. 4.1 ± 2.3 degrees;  = 0.006). Varus knees ( = 22) demonstrated significantly increased femoral component rotation if the patella was reduced (5.3 ± 2.2 degrees) compared with dislocated patella without eversion (4.7 ± 2.3 degrees;  = 0.037) and with eversion (4.4 ± 2.5 degrees;  = 0.019). As such, the measurement of the mediolateral flexion gap stability with a laterally dislocated patella leads to a statistically significant overestimation of the lateral ligament stability and an underestimation of the external rotation positioning of the femoral component of approximately 1 degree, which is aggravated in varus knees. This is a Level II, prospective consecutive series study.
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http://dx.doi.org/10.1055/s-0040-1713896DOI Listing
July 2020

Mal-angulation of femoral rotational osteotomies causes more postoperative sagittal mechanical leg axis deviation in supracondylar than in subtrochanteric procedures.

J Exp Orthop 2020 Jul 1;7(1):46. Epub 2020 Jul 1.

Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland.

Purpose: Alteration of the postoperative frontal mechanical leg axis is a known problem in femoral rotational osteotomies. However, the maintenance of the sagittal mechanical leg axis seems also important. Goal of this study was to investigate the impact of femoral rotational osteotomies on the sagittal mechanical leg axis and to identify the degree of mal-angulation of the osteotomy planes that alter the postoperative sagittal alignment relevantly.

Methods: Using 3D bone models of two patients with a pathologic femoral torsion (42° antetorsion and 6° retrotorsion), subtrochanteric and supracondylar rotational osteotomies were simulated first with an osteotomy plane perpendicular to the mechanical femoral axis (baseline osteotomy plane), second with predefined mal-angulated osteotomy planes. Subsequently, five different degrees of rotation were applied and the postoperative deviations of the sagittal mechanical leg axes were analyzed.

Results: Using the baseline osteotomy plane, the sagittal mechanical leg axis changed by 0.4° ± 0.5° over both models. Using the mal-angulated osteotomy planes, maximum deviation of the sagittal mechanical leg axis of 4.0° ± 1.2° and 11.0° ± 2.0° was observed for subtrochanteric and for supracondylar procedures, respectively. Relevant changes of more than 2° were already observed with mal-angulation of 10° in the frontal plane and 15° of rotation in supracondylar procedures.

Conclusion: Relevant changes of the postoperative sagittal mechanical leg axis could be observed with just slight mal-angulation of the osteotomy planes, in particular in supracondylar procedures and in cases with higher degrees of rotation. However, osteotomies perpendicular to the femoral mechanical axis showed no relevant alterations.
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http://dx.doi.org/10.1186/s40634-020-00262-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7326744PMC
July 2020

What are the outcomes of core decompression in patients with avascular necrosis? Protocol for a systematic review.

F1000Res 2020 31;9:71. Epub 2020 Jan 31.

Young Adult Hip Service, Department of Trauma and Orthopaedics, Addenbrooke's - Cambridge University Hospital, Cambridge, CB2 0QQ, UK.

 Core decompression is a hip preserving surgical procedure that is used to treat avascular necrosis (AVN) of the femoral head. The eventual clinical and radiological outcome following this procedure is varied in literature. Also, the time to a total hip replacement (THR) from the index procedure and the percentage of patients subsequently undergoing a THR is controversial. Furthermore, there are multiple surgical methods along with multiple augmentation techniques and various classification and staging systems described. The purpose of this systematic review, therefore, is to analyse the outcomes following decompression only, excluding any augmentation techniques for non-traumatic AVN of the femoral head. This protocol is being developed in line with the PRISMA-P guidelines. The search strategy includes articles from Medline, Embase, Google Scholar, CINHAL and Cochrane library. The review and screening will be done by two independent reviewers. Review articles, editorials and correspondences will be excluded. Articles including patients with sickle cell disease and with core decompression where augmentation is used will be excluded. The risk of bias and quality of articles will be assessed using the Joanna Briggs Institute Critical Appraisal Checklist for the different study designs included. This study will be a comprehensive review on all published articles having patients with AVN of the femoral head and undergoing core decompression surgery only. The systematic review will then define the outcomes of the core decompression surgery based on clinical and radiological outcomes. Each outcome will include the different stages within it and finally, the total mean time to THR will be calculated. This will then be followed by assessing the cumulative confidence in evidence from all the data collected using the GRADE tool.    This systematic review is registered in the International Prospective Register for Systematic Reviews and Meta-analysis (PROSPERO) under the registration number:  CRD42018100596.
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http://dx.doi.org/10.12688/f1000research.22167.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7101011PMC
February 2021

Modifications of the pirogoff amputation technique in adults: A retrospective analysis of 123 cases.

J Orthop 2020 Mar-Apr;18:5-12. Epub 2019 Nov 1.

Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.

Background: The Pirogoff amputation (1854) was initially developed to provide full-weight-bearing stumps and therefore allow a short ambulation without prosthesis. Modifications of the original technique including Boyd (1939) and the "Modified Pirogoff" were developed, which further reduced complications and improved the outcome. However, the current evidence regarding the techniques is scarce. The functional outcome, survivorship and complication rates are unknown. It was the purpose of this study to expand the knowledge with a retrospective case series and ultimately summarize and analyze the data with a systematic review.

Methods: A retrospective study of the Boyd procedures from our institution between 1999 and 2018 was performed. Outcome was determined based on the PLUS-M Score (Prosthetic Limb Users Survey of Mobility). Survivorship (absence of more proximal amputation), postoperative leg-length discrepancy, time to early fusion and time to mobilization were also evaluated. Finally, in the second part of the study, the results were integrated in a systematic review, which followed the Preferred Reporting Items of Systematic Reviews and Meta-analysis (PRISMA) guidelines. The quality of all the studies were then assessed using the Joanna Briggs Institute Critical Appraisal Checklist (JBI CAC).

Results: A total of 123 procedures including 115 patients, with an average follow-up of 45 months (range, 10-300 months) could be included. A very good or good function could be achieved in 85 (69%) patients. The mean survivorship was 82.1% (range 46%-100%). In four studies, including our series, all patients remained with a functional stump at the latest follow-up. The calculated average leg-length discrepancy was 2.5 cm.

Conclusion: The "Modified Pirogoff" and Boyd amputation techniques can achieve favourable long-term functional outcome in cases of irreparable foot conditions such as osteomyelitis or trauma. Patency of the posterior tibial artery is an indispensable condition to elect for these surgical techniques. Presence of neuropathy does not preclude this amputation level. With proper patient selection, a maximal survivorship of the stump with treatable minor complications can be achieved.Level of Evidence: IV.
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http://dx.doi.org/10.1016/j.jor.2019.10.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7067983PMC
November 2019

Applicability of augmented reality in orthopedic surgery - A systematic review.

BMC Musculoskelet Disord 2020 Feb 15;21(1):103. Epub 2020 Feb 15.

Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland.

Background: Computer-assisted solutions are changing surgical practice continuously. One of the most disruptive technologies among the computer-integrated surgical techniques is Augmented Reality (AR). While Augmented Reality is increasingly used in several medical specialties, its potential benefit in orthopedic surgery is not yet clear. The purpose of this article is to provide a systematic review of the current state of knowledge and the applicability of AR in orthopedic surgery.

Methods: A systematic review of the current literature was performed to find the state of knowledge and applicability of AR in Orthopedic surgery. A systematic search of the following three databases was performed: "PubMed", "Cochrane Library" and "Web of Science". The systematic review followed the Preferred Reporting Items on Systematic Reviews and Meta-analysis (PRISMA) guidelines and it has been published and registered in the international prospective register of systematic reviews (PROSPERO).

Results: 31 studies and reports are included and classified into the following categories: Instrument / Implant Placement, Osteotomies, Tumor Surgery, Trauma, and Surgical Training and Education. Quality assessment could be performed in 18 studies. Among the clinical studies, there were six case series with an average score of 90% and one case report, which scored 81% according to the Joanna Briggs Institute Critical Appraisal Checklist (JBI CAC). The 11 cadaveric studies scored 81% according to the QUACS scale (Quality Appraisal for Cadaveric Studies).

Conclusion: This manuscript provides 1) a summary of the current state of knowledge and research of Augmented Reality in orthopedic surgery presented in the literature, and 2) a discussion by the authors presenting the key remarks required for seamless integration of Augmented Reality in the future surgical practice.

Trial Registration: PROSPERO registration number: CRD42019128569.
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http://dx.doi.org/10.1186/s12891-020-3110-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7023780PMC
February 2020

Post-thyroidectomy Hypocalcemia - Risk Factors and Management.

Chirurgia (Bucur) 2019 Sept-Oct;114(5):564-570

The complications of thyroidectomy vary from hypocalcemia and recurrent laryngeal nerve lesions to injury of vocal folds, local hematoma, cysts, granuloma. Post-operative hypocalcemia has an incidence of 1.2-40%. Permanent hyoparathyroidism is registered in 3% of cases. This is a brief narrative review focusing on the levels of calcium after performing a thyroidectomy and the need of calcium supplements under these circumstances. This complication, even it seems rather harmless at first, in fact it represents an important contributor to hospitalization delay and, especially for severe forms, to poor quality of life, including the risk of life threatening episodes. Devascularisation of parathyroid glands in addition to injury or dissection causes hypoparathyroidism. Hypocalcemia risk differs with sex (females have a higher risk), lymph node dissection (it increases the risk), it differs with type of thyroidectomy (larger dissections have a higher risk; also the intervention for recurrent goitre and second intervention for post-operatory bleeding increase the risk of hypocalcemia; while Basedow disease is probably at higher risk than multinodular goitre among benign conditions) and the duration of procedure. Pre-operatory low calcium, parathormon (PTH), 25-hydroxivitamin D increases the risk. The calcium drop rate matters as well: a decrease of 1 mg/dL calcium over 12 hours after surgery is independently correlated with the risk of symptomatic hypocalcemia. Early post-operatory PTH and calcium are best predictors for the need of oral calcium supplements. Routine post-operatory calcium and vitamin D supplementation statistically significant decreases the risk of developing transitory hypocalcemia and acute complications compare to calcium alone supplements or no supplements. In cases of hypoparathyroidism calcitriol is preferred.
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http://dx.doi.org/10.21614/chirurgia.114.5.564DOI Listing
November 2019

Biomarkers associated with idiopathic frozen shoulder: a systematic review.

Connect Tissue Res 2020 11 7;61(6):509-516. Epub 2019 Aug 7.

Department of Orthopaedics, Balgrist University Hospital, University of Zurich , Zurich, Switzerland.

: The pathophysiology of idiopathic frozen shoulder (FS) remains poorly described. There is a lack of differentiation between idiopathic and secondary cause. The aim of this systematic review was to summarize the evidence regarding the pathophysiology of idiopathic FS on a molecular level and emphasize the clinical relevance. : A database search of Medline, EMBASE and Cochrane Central Register of Controlled Trials from inception to April 2018 was performed. Participants who underwent previous injections or surgeries were excluded. A thorough selection and quality assessment process using the Cochrane Risk of Bias assessment tool and the Joanna Briggs Institute Critical Appraisal Checklist was conducted by two reviewers independently. : A total of 15 studies analyzing 333 study subjects were included. Twelve studies evaluated capsular tissue and three studies investigated blood samples. The tissue samples revealed increased expression of various inflammatory cytokines including interleukins, cyclooxygenase and tumor necrosis factor. Several types of acid-sensing ion channels (ASIC1 and ASIC3) were associated with disturbed neurogenesis and melatonin-regulated pain mechanism. The blood samples showed prevalence of specific interleukin and metalloproteinase genotypes. A decreased matrix metalloproteinase/tissue inhibitor of metalloproteinase ratio was found both in tissue and blood. : The findings indicate an abnormal local neurogenesis with possible regulation through melatonin. The disturbance in remodeling of the extracellular matrix and in collagen translation, together with a persistent inflammation and an impaired healing, all interact in the process that leads to persistent fibrosis. There is global fibroplasia with localized anterior capsule contracture.
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http://dx.doi.org/10.1080/03008207.2019.1648445DOI Listing
November 2020

Low Anterior Resection - Emergency Versus Elective Surgery in Rectal Cancer Treatement - Comparative Analysis.

Chirurgia (Bucur) 2019 Mar-Apr;114(2):216-221

Rectal cancer is a public health problem, being one of the most prevalent neoplastic localizations. The current surgical management of this pathology includes low anterior resection with colorectal anastomosis. The presentation as an emergency of these patients and the need for immediate intervention make it impossible to follow the necessary multimodal management. The present study proposes a comparative assessment of a series of cases where the intervention was elective, respectively emergency. This is a retrospective, observational, descriptive, unicentric study, that took place between 1st of January 2010 and 31st of December 2018 in the 3rd Department of General Surgery of the University Emergency Hospital Bucharest. We included in the study patients with the discharge diagnosis of rectal neoplasm who underwent curative surgical treatment consisting of low anterior resection performed in compliance with oncological safety principles. Conclusion: The emergency nature of the surgery influences whether or not a R0 type resection is obtained due to lack of adequate preoperative assessment (stadialization) and the presence or absence of neoadjuvant treatment rather than a technical defect.
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http://dx.doi.org/10.21614/chirurgia.114.2.216DOI Listing
July 2019

non-arthroplasty iliopsoas impingement in athletes: a narrative literature review.

Hip Int 2019 Sep 3;29(5):460-467. Epub 2019 Apr 3.

2 Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge, UK.

Introduction: Iliopsoas impingement occurs secondary to a tight iliopsoas tendon that causes impingement during movement. This review presents current aspects regarding the diagnosis of iliopsoas impingement and also exposes the readers to the possible anatomic and clinical variations together with the available treatment options.

Methods: We conducted a narrative literature review with regard to non-arthroplasty iliopsoas impingement.

Results: Iliopsoas impingement is characterised by a distinct pattern of labral pathology, with anteriorly localised labral damage, that does not extend to the anterosuperior portion of the acetabulum. Anterior groin pain and intermittent catching, snapping or popping of the hip are common symptoms. Non-specific focal tenderness is often found over the iliopsoas tendon at the level of the anterior aspect of the joint. The 'C-sign' and Impingment test are usually positive. Dynamic ultrasonography is also useful for confirming the diagnosis. Initial management of painful iliopsoas impingement should be conservative. When patients continue to have pain, an ultrasound-guided injection can provide relief and predict the response to the surgical release. For patients who have recurrent pain after local injection of steroids, arthroscopic release has shown to achieve effective results.

Conclusions: Although different treatment options for iliopsoas impingement are emerging, the current standard of therapy is conservative followed by an arthroscopic tenotomy if necessary. Young adult hip surgeons should always keep this differential in mind in a patient presenting with groin pain and mechanical symptoms.
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http://dx.doi.org/10.1177/1120700019831945DOI Listing
September 2019

Appendiceal Mass - Dilemmas Regarding Extension of the Resection.

Chirurgia (Bucur) 2019 Jan-Feb;114(1):126-130

Starting from a typical case, we try to highlight the main critical elements, both in the diagnostic algorithm and in the therapeutic one. We hereby present a 54-year old patient, known with hepatic steatosis and renal microlithiasis, which undergoes an ultrasonography in ambulatory, on the background of unsystematised abdominal discomfort; the ultrasound reveals the presence of a tumoral mass in the right iliac fossa.
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http://dx.doi.org/10.21614/chirurgia.114.1.126DOI Listing
June 2019

Predictive Factors for Intraabdominal Hypertension after Incisional Hernia Repair.

Chirurgia (Bucur) 2019 Jan-Feb;114(1):12-17

The purpose of our research is to synthesize the risk factors quoted in the literature which predispose to intra-abdominal hypertension occurrence following surgical repair of incisional hernias. We used for our research the Web of Science, Scopus and PubMed research platforms and we used the following search formula: (Intra-abdominal hypertension OR intra-abdominal pressure OR abdominal compartment syndrome) AND risk factors AND incisional hernia. The results were filtered according to the following criteria: language (English), publish year ( 2000) and access (in extenso). In this context, we chose to classify the risk factors for IAP increase in the following categories: (1) those related body habitus and anthropometry; (2) those associated with the presence of comorbidities; (3) those related to the defect of the abdominal wall; (4) those associated with the surgical management. Among the most important risk factors we mention: elevated BMI, chronic obstructive pulmonary disease, large incisional hernias with loss of domain, surgical technique used, prolonged surgeries and repeated attempts to close the defect.
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http://dx.doi.org/10.21614/chirurgia.114.1.12DOI Listing
June 2019

Long-term results of reverse total shoulder arthroplasty for rotator cuff dysfunction: a systematic review of longitudinal outcomes.

J Shoulder Elbow Surg 2019 Apr 21;28(4):774-781. Epub 2019 Jan 21.

Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.

Background: The aim of this systematic review was to evaluate the longitudinal evolution of midterm to long-term results of reverse total shoulder arthroplasty (RTSA) for patients with massive irreparable rotator cuff tears (miRCT).

Methods: Databases were scanned for studies of RTSA for miRCT. Studies with a minimum Level IV of evidence were considered eligible. Studies were included if they reported a minimum of 5 years of follow-up and excluded if they reported RTSA combined with tendon transfers or as revision arthroplasty. Data were grouped based on results after 5 to 7 years, 7 to 10 years, and 10 to 20 years of follow-up.

Results: Eight studies with a total of 365 shoulders were included. After a mean follow-up of 9.5 years (range, 5-20 years), the preoperative absolute and relative Constant scores were significantly improved from 24 to 59 points (P = .004) and from 33% to 74% (P = .009). The preoperative Subjective Shoulder Value improved from 23% to 72% (P = .049). Active anterior elevation and abduction also improved significantly (P = .004 and P = .014, respectively), but active external rotation remained unchanged (P = .855). None of the clinical scores or active ranges of motion significantly deteriorated up to 20 years after the operation (P > .05). After 10 years, 42% of the RTSAs showed grade III or IV inferior scapular notching.

Conclusion: Pooled long-term results of RTSA for miRCT show significant improvement of overhead function and of objective and subjective outcome scores up to 20 years after surgery. Shoulder function and outcome scores also showed no significant deterioration between 5 and 20 years of follow-up. Longer follow-up will be needed to determine ultimate longevity.
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http://dx.doi.org/10.1016/j.jse.2018.10.005DOI Listing
April 2019

Particularities in the Evolution of Mortality by Traumatic Events in the Last 30 Years.

Chirurgia (Bucur) 2017 Nov-Dec;112(6):690-695

We present a retrospective descriptive study targeting the mortality in the European Union's countries during the past 30 years. Data was collected from the WHO (World Health Organization) database of global mortality. The aim of this study was the identification of particularities in the evolution of trauma-related mortality in before-mentioned countries. The results showed patterns of mortality related to socio-geographical conditions at different times in history and a general trend towards its decrease. Age was also an important factor to take into consideration. To conclude, we would like to point out the lack of studies and available research in trauma-related fields and also to underline their necessity and utility, especially in the pediatric department.
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http://dx.doi.org/10.21614/chirurgia.112.6.690DOI Listing
April 2018

Lateral unicompartmental knee replacement: a systematic review of reasons for failure.

Int Orthop 2018 08 13;42(8):1827-1833. Epub 2017 Oct 13.

Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland.

Purpose: Currently, individual studies lack the power to successively illustrate different failure modes; therefore, we undertook a systematic review to examine lateral unicompartmental knee replacement (lat UKR) failure modes. Furthermore, we compared early with midterm and late failures and fixed-bearing with mobile-bearing implants.

Methods: A search using the databases of PubMed, EMBASE, Cochrane, and annual registries was performed to search for failed lat UKRs. Studies were included when they reported more than four failures, described failure modes and were minimum level IV studies. Data was analysed based on overall failure modes, fixed- vs. mobile bearing and early (<5 years) vs. midterm (5-10 years) vs. late failures (>10 years).

Results: Fourteen cohort studies and two registry-based studies were included. A total of 336 overall failures, 87 time-dependent failures, and 175 implant-specific failures were identified. The main overall causes of failure were osteoarthritis (OA) progression (30%) and aseptic loosening (22%). These were followed by less common causes such as instability (7%), unexplained pain (5%), infection (5%), polyethylene wear (5%), and bearing dislocation (5%). Bearing dislocation was the most common early failure (29%) and also the most common failure among mobile-bearing implants (27%). In midterm and late failures, OA progression had the highest rates (59% and 78% respectively) and was also the most common type of failure in fixed-bearing implants (44%).

Conclusions: Progression of OA and aseptic loosening are the major overall failure modes in lat UKR. Bearing dislocation was the main failure mode in early years and in mobile-bearing implants, whereas OA progression caused most failures in late years and in fixed-bearing implants.

Level Of Evidence: Systematic Review of minimum level IV studies.
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http://dx.doi.org/10.1007/s00264-017-3662-4DOI Listing
August 2018

Tendencies on Traditional Metrics.

Chirurgia (Bucur) 2017 Mar-Apr;112(2):117-123

Technological evolution dynamics has led to the exponential increase of the quantity of information published in all the scientific domains. In this context, there has been necessary to develop an objective method of reviewing the journals, articles and respectively the researchers. This paper represents a review of the evolution of traditional metrics based on citations.
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http://dx.doi.org/10.21614/chirurgia.112.2.117DOI Listing
July 2017