Publications by authors named "Yaniv Warschawski"

28 Publications

  • Page 1 of 1

Mid-term clinical and radiographic outcomes of porous-coated metaphyseal sleeves used in revision total knee arthroplasty.

Knee Surg Relat Res 2021 May 4;33(1):16. Epub 2021 May 4.

Orthopedic Department, affiliated to the Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center, Ichilov Hospital, Tel Aviv University, 6 Weizman St, 6423906, Tel Aviv, Israel.

Background: The management of bone defects remains one of the major challenges surgeons are faced with in revision total knee arthroplasty (RTKA). Large and uncontained bone defects are traditionally managed with metaphyseal sleeves that facilitate osseointegration and have reported construct stability. While many studies have presented excellent short-term outcomes using metaphyseal sleeves, less is known on their performance in the longer term. The purpose of this study was to present our mid-term results of the metaphyseal sleeves used in patients undergoing RTKA.

Materials And Methods: Between January 2007 and January 2015, 30 patients underwent RTKA with the use of a CCKMB prosthesis combined with an osteointegrative sleeve. The main indications for RTKA were instability in 40% of the cases (n = 12), aseptic loosening in 30% (n = 9), infection in 26.7% (n = 8), and "other" in 3.3% (n = 1). The minimal follow-up time was 5 years and the mean follow-up time was 82.4 months (SD = 22.6). Clinical outcomes were assessed by Knee Society scores (KSS), range of motion and rate of re-operation.

Results: The mean Knee Society score increased significantly from 72.1 preoperatively to 90.0 postoperatively (p < 0.001). The cumulative incidence of re-operation in our study was 13.3% (n = 4). Our study reported no cases of aseptic loosening or mobile-bearing spin-out. Knee flexion to 90° and more was impossible in seven cases (23.3%) preoperatively and in one case (3.3%) postoperatively.

Conclusion: Porous-coated metaphyseal sleeves demonstrated excellent rates of survivorship and radiographic ingrowth in the mid-term setting. However, further studies are required to assess their outcomes in the long-term.
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http://dx.doi.org/10.1186/s43019-021-00103-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8097806PMC
May 2021

Good clinical and radiological outcomes of the varus-valgus constrained mobile-bearing implant in revision total knee arthroplasty.

Int Orthop 2021 05 17;45(5):1199-1204. Epub 2021 Mar 17.

Orthopedic Department, Tel Aviv Sourasky Medical Center, Ichilov Hospital, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman St., 6423906, Tel Aviv, Israel.

Purpose: Knee instability is one of the most common indications for having to undergo revision total knee arthroplasty (RTKA) and can be prevented with adequate implant selection and good surgical technique. Varus-valgus constrained implants (VVC) are indicated for cases of RTKA with absent ligament function in order to provide the necessary stability. While mobile-bearing articulations are thought to decrease the risk of aseptic loosening in comparison to their fixed-bearing counterparts, there is limited data on their outcomes. The purpose of our study is to present the clinical and radiological outcomes for patients undergoing an RTKA procedure with the mobile-bearing VVC implant.

Methods: Between January 2008 to January 2018, 93 patients underwent RTKA with the use of varus-valgus mobile-bearing (VVCMB) prosthesis. The main indications for RTKA were instability 38.7% (n = 36), aseptic loosening 31.2% (n = 29), infection in 26.9% (n = 25), and other 3.3%. The mean follow-up time was 56 months. Clinical outcomes were assessed by knee society scores, range of motion, and rate of re-operation.

Results: The mean knee society score increased significantly from 65.52 pre-operatively to 89.65 post-operatively (p < 0.001). The five year cumulative incidence of re-operation in our study was 7.53% (n = 7). Our study reported no cases of aseptic loosening or mobile-bearing spin-out. The number of flexion contractures decreased from n = 23 (24.7%) pre-operatively to n = 11 (11.8%) post-operatively (p < 0.05).

Conclusion: The VVC mobile-bearing prosthesis demonstrated good clinical outcomes and mid-term survivorship in patients undergoing RTKA. Additional follow-up is required in the long term.
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http://dx.doi.org/10.1007/s00264-021-05003-7DOI Listing
May 2021

Dynamic locking plate vs. cannulated cancellous screw for displaced intracapsular hip fracture: A comparative study.

J Orthop 2021 Mar-Apr;24:15-18. Epub 2021 Feb 12.

Orthopedic Department, Tel Aviv Sourasky Medical Center, Ichilov Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Introduction: There is no consensus regarding the optimal device for displaced intracapsular hip fractures. This retrospective study compared two techniques (1) cannulated cancellous screw (CCS), and (2) Targon Femoral Neck (TFN) plate.

Materials And Methods: Data regarding gender, operational data, complications, pain, Quality of life and function scores were retrieved.

Results: 103 patients were included, 42 were treated using CCS, compared to 61 treated using TFN. Operative time shorter for CCS (p = 0.019). Complication rates were not different (p > 0.05).

Conclusion: As CCS method take shorter operating time and reduced costs, CCS should be used for the treatment of displaced ICHF.
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http://dx.doi.org/10.1016/j.jor.2021.02.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7902286PMC
February 2021

Expandable Proximal Femoral Nail versus Gamma Proximal Femoral Nail for the treatment of hip reverse oblique fractures.

Arch Orthop Trauma Surg 2021 Jan 8. Epub 2021 Jan 8.

Department of Orthopaedic Surgery, Medical Center, Affiliated with the Faculty of Health and Science and Ben Gurion University, Ha-Refu'a St 7, 7747629, Ashdod, Israel.

Background: Reverse oblique intertrochanteric fractures are classified by the AO/OTA as 31A3 and account for 2-23% of all trochanteric fractures. The Gamma 3-Proximal Femoral Nail (GPFN) and the Expendable Proximal Femoral Nail (EPFN) are among the various devises used to treat this fracture. The aim of this study was to compare outcomes and complication rates in patients with AO/OTA 31A1-3 fractures, treated by either a GPFN or an EPFN.

Patients And Methods: A total of 67 patients (40 in the GPFN group and 27 in the EPFN group, average age 78.8 years) were treated in our institution between July 2008 and February 2016. Data on postoperative radiological variables, including peg location and tip-apex distance (TAD), as well as orthopedic complications, such as union rate, surgical wound infection and cut-outs rates were also recorded, along with the incidence of non-orthopedic complications and more surgical data. Functional results were evaluated and quantified using the Modified Harris Hip Score (MHHS) and by the Short Form 12 Mental Health Composite questionnaire (SF-12 MHC) in order to assess the quality of life.

Results: The total prevalence of postoperative orthopedic complications including postoperative infection showed a significant difference with a p-value of 0.016 in favor of the EPFN group. Nonetheless, the frequency of revision did not differ between the two groups, being 0.134. The main orthopedic complication in both groups was head cut-out of the GPFN lag screw and the EPFN expendable peg, which was 20% and 7.4%, respectively, and required a revision surgery using a long nail or total hip replacement (THR). However, the average TAD did not significantly differ between groups which might be due to a relatively low cohort to reach a significant difference. Nonunion rate of 5% occurred solely in the GPFN group, with similar results of intraoperative open reduction between both groups. The EPFN group achieved better scores in both questionnaires (p = 0.027 and p = 0.046, respectively). Both the MHHS and SF-12 MCS values significantly differed between groups, with the EPFN group achieving better scores than the GPFN group in both questionnaires (p = 0.027 and p < 0.05, respectively).

Conclusions: According to this study, the EPFN yields better results in comparison with the GPFN, with relatively less complications rate, for the treatment of unstable reverse oblique pertrochanteric fracture. In light of this results, we conclude that the EPFN might be as good as GPFN for the treatment of reverse oblique intertrochanteric fractures.

Level Of Evidence: Level III retrospective study. The local institutional review board of the Tel Aviv Medical Center approved this study and all the surgeries were done exclusively in this institution.
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http://dx.doi.org/10.1007/s00402-020-03726-7DOI Listing
January 2021

Tranexamic acid in non-elective primary total hip arthroplasty.

Injury 2021 Jun 14;52(6):1544-1548. Epub 2020 Oct 14.

Division of Orthopedics, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel-Aviv, 6423906 Israel.

Purpose: Blood loss during and following elective total hip arthroplasty (THA) can be substantial and may require allogeneic blood transfusions which carries significant risks and morbidity for patients. Intraoperative use of tranexamic acid (TXA) has been proven to reduce the need for allogeneic blood transfusion in elective THA patients. Data regarding TXA efficacy in reducing blood loss in trauma patients undergoing non-elective primary THA is sparse, and its routine use is not well established.

Methods: This is a retrospective analysis of a consecutive cohort of patients who underwent non-elective primary THA in a tertiary medical center between January 1st 2011- December 31st 2019. The cohort was divided into two groups; one received perioperative TXA treatment while the other did not. Blood loss, blood product administration, peri and postoperative complications, readmissions and 1-year mortality were compared between groups.

Results: A total of 419 patients (146 males, 273 females) who underwent THA were included in this study. The "TXA" group consisted 315 patients compared to 104 patients in the "no TXA" group. TXA use reduced postoperative bleeding, as indicated by changes in hemoglobin levels before and after surgery (ΔHb= -2.75 gr/dL vs. ΔHb= -3.34 gr/dL, p<0.001) and by administration of allogeneic blood transfusions (7.0% vs. 16.3%, p = 0.004).

Conclusion: Similar to the known effect of TXA in elective THA patients, the use of TXA treatment in patients undergoing non-elective THA led to a significant reduction in postoperative blood loss and in the proportion of patients requiring allogeneic blood transfusions.
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http://dx.doi.org/10.1016/j.injury.2020.10.056DOI Listing
June 2021

Is continuation of anti-platelet treatment safe for elective total hip arthroplasty patients?

Arch Orthop Trauma Surg 2020 Dec 11;140(12):2101-2107. Epub 2020 Oct 11.

Adult Reconstruction Unit, Division of Orthopedics, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.

Introduction: Acetylsalicylic acid (aspirin) is a commonly prescribed medication, especially in the age group of individuals who undergo elective total hip arthroplasty (THA). Preoperative discontinuation of aspirin is believed to reduce intraoperative bleeding and other complications, but it may increase the risk of perioperative cardiovascular events. In this study we have sought to evaluate the safety of continuous aspirin treatment in patients undergoing elective THA.

Materials And Methods: This is a retrospective analysis of a consecutive cohort who underwent elective THA in a tertiary medical center between 2011 and 2018. The cohort was divided into two groups-one that received continuous preoperative aspirin treatment and one that did not. Blood loss, peri- and postoperative complications, readmissions, and short- and long-term mortality were compared between groups.

Results: Out of 757 consecutive patients (293 males, 464 females) who underwent elective primary THA, 552 were in the "non-aspirin" group and 205 were in the "aspirin" group and were not treated preoperative with other medication affecting hemostasis. Perioperative continuation of aspirin treatment did not significantly increase perioperative bleeding, as indicated by changes in hemoglobin levels (P = 0.72). There were no significant differences in short- and long-term mortality (P = 0.47 and P = 0.4, respectively) or other perioperative complications, such as readmission (P = 0.78), deep or superficial infection (P = 1 and P = 0.47, respectively), and cardiovascular events (none in both groups).

Conclusion: Peri-operative continuation of aspirin treatment in patients undergoing elective primary THA did not increase perioperative complications or mortality compared to the non-aspirin-treated patients. The protective effects of aspirin from postoperative thrombotic and cardiovascular events are well documented. The current findings dispute the need to preoperatively withhold aspirin treatment in patients undergoing elective primary THA.
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http://dx.doi.org/10.1007/s00402-020-03629-7DOI Listing
December 2020

The Effect of Femoral Head Size, Neck Length, and Offset on Dislocation Rates of Constrained Acetabular Liners.

J Arthroplasty 2021 01 31;36(1):345-348. Epub 2020 Jul 31.

Division of Orthopedic Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.

Background: Constrained acetabular liners (CALs) are used in both primary and revision total hip arthroplasty in cases where stability and abductor deficiency are of concern. The efficacy of CALs has been shown to be design dependent. There is clear evidence that the use of small head sizes and shorter offset in unconstrained total hip arthroplasty is associated with higher rates of dislocation. To our knowledge, no such study has assessed the effect of femoral head size, neck length, and offset for CALs.

Methods: We performed a retrospective study assessing the outcomes of CALs with minimum 2-year follow-up. A Kaplan-Meier survivorship analysis was conducted for all patients and for patients revised for instability. A binomial regression analysis was performed to assess for variables significantly associated with CAL failure.

Results: A total of 285 CALs in 281 patients were identified with a mean follow-up of 5.7 years. Ten-year Kaplan-Meier survival analyses were as follows: all indication 91.9% vs instability 85.5% (P = .15). Increasing neck length was associated with lower rates of failure (odds ratio, 0.81; P = .042). Femoral head size, offset, and abductor reconstruction were not significantly associated with CAL failure.

Conclusion: Larger head size has not been demonstrated to lead to lower failure in CALs. Increasing neck length was associated with lower failure rate. Surgeons should be cautious when attempting to ream to larger acetabular shell sizes for the purpose of using larger heads with CALs. Increasing neck length may instead be targeted intraoperatively.
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http://dx.doi.org/10.1016/j.arth.2020.07.067DOI Listing
January 2021

Revision Hip Arthroplasty Using a Porous-coated or Taper ZMR Implant: Minimum 10-year Follow-up of Implant Survivorship.

J Am Acad Orthop Surg 2021 Jan;29(1):e41-e50

Mount Sinai Hospital, Division of Orthopaedics - Joseph and Wolf Lebovic Health Complex, Toronto, Ontario, Canada.

Introduction: The Zimmer Modular Revision hip (ZMR) system is available in two stem options, a porous-coated cylindrical (PCM) and a taper (TM) stem. Several concerns have been reported regarding modular implants. Specifically, because of early junctional fractures, the ZMR system was redesigned with a wider modular interface. As such, we designed a study assessing long-term ZMR survivorship and functional and radiographic outcomes.

Methods And Materials: A search of our institutional research database was performed. A minimum 10-year follow-up was selected. The following two cohorts were created: PCM and TM stems. The Kaplan-Meier survival analysis was performed, and causes of stem failure requiring revision surgery were collected. Functional outcomes as per the Harris Hip Score and radiographic stem stability were assessed as per the Engh classification.

Results: A total of 146 patients meeting the inclusion criteria were available for follow-up (PCM = 68, TM = 78). The mean follow-up was 13.4 years clinically and 11.1 years radiographically for the PCM cohort. Similarly, the TM cohort had a follow-up of 11.1 years clinically and 10.5 years radiographically. The Kaplan-Meier survivorships were 87.1% and 87.8% at 15 years for the PCM and TM cohorts, respectively. The most common cause of failure requiring revision surgery overall was aseptic loosening (PCM = 1.4%, TM = 5.6%). The mean postoperative Harris Hip Score was as follows: PCM = 71.2 and TM = 64.7. Engh type I or II stem ingrowth was as follows: PCM = 85% and TM = 68%.

Discussion: Good survivorship using the ZMR stem system can be expected at up to 15 years. Aseptic loosening remains the most commonly encountered problem for both PCM and TM stems. Previously identified modular junctional weakness seem to have been addressed.
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http://dx.doi.org/10.5435/JAAOS-D-19-00512DOI Listing
January 2021

Effects of surgeon experience and patient characteristics on accuracy of digital pre-operative planning in total hip arthroplasty.

Int Orthop 2020 10 22;44(10):1951-1956. Epub 2020 Jul 22.

Adult Reconstruction Unit, Division of Orthopedics, Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center,, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel.

Background: The effect of surgeon experience on accuracy of digital pre-operative planning for total hip arthroplasty (THA) remains unclear. The aims of our study were to compare pre-operative planning accuracy between fellow-trained orthopaedic surgeons and residents and to explore whether surgery indication effects the prediction accuracy.

Methods: We prospectively reviewed 101 patients who underwent pre-operative digital templating for THA in our center from January 2019 to January 2020 with King Mark device. Extracted data included baseline characteristics and indication for primary arthroplasty. Pre-operative digital templating was performed separately by both a fellow-trained surgeon and a resident. Accuracy of each group was compared with the implanted components.

Results: The overall adequate pre-operative planning of the acetabular cup (exact or +/-1 size match) by the fellow-trained group was higher compared with the resident's group (77.2 and 64.3% respectively, p = 0.037), whereas the overall adequate pre-operative planning of the femoral stem (exact or +/-1 size match) was higher in the resident's group compared with the fellow-trained group (83.2 and 61.4% respectively, p < =0.001). The fellow-trained group showed better pre-operative planning of complex cases (developmental dysplasia of the hip and avascular necrosis of femoral head) than the resident's group.

Conclusions: The experience of the planner does not significantly affect the accuracy of correctly predicting component sizes. However, in complex cases, fellow-trained surgeons should assist residents in digital pre-operative templating for THA.
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http://dx.doi.org/10.1007/s00264-020-04733-4DOI Listing
October 2020

Management Options and Outcomes for Patients with Femoral Fractures with Post-Polio Syndrome of the Lower Extremity: A Critical Analysis Review.

JBJS Rev 2020 06;8(6):e0146

Division of Orthopaedics, Joseph and Wolf Lebovic Health Complex, Mount Sinai Hospital, Toronto, Ontario, Canada.

Post-polio syndrome is characterized by a late functional deterioration (usually after >=15 years from the initial infection) in patients with a history of paralytic poliomyelitis infection, and it is defined by the March of Dimes criteria. Patients with post-polio syndrome are at increased risk for falls and associated hip and femoral fractures as a result of lower bone mineral density, decreased lean muscle mass, and musculoskeletal deformities. Current evidence suggests that treatment modalities for femoral fractures should emphasize fixation that allows early progressive weight-bearing and ambulation to optimize functional outcomes. Good results after hip arthroplasty have been described with both cemented and uncemented implants in patients who have been treated for osteoarthritis, but there has been little evidence guiding hip fracture management. Anatomic challenges that are encountered are osteoporotic bone, a valgus neck-shaft angle, increased femoral anteversion, and a small femoral canal diameter. Intramedullary nailing of hip and femoral fractures can be challenging due to the small femoral canal diameter that frequently is encountered. Alternative methods of fixation have shown promising results. These include the use of sliding hip screws for hip fracture management and fixed-angle locking plates for hip and femoral fracture management.
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http://dx.doi.org/10.2106/JBJS.RVW.19.00146DOI Listing
June 2020

Revision total knee arthroplasty for patellar dislocation in patients with malrotated TKA components.

Arch Orthop Trauma Surg 2020 Jun 5;140(6):777-783. Epub 2020 May 5.

Division of Orthopaedic Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.

Purpose: Patellar dislocation is a serious complication leading to patient morbidity following total knee arthroplasty (TKA). The cause can be multifactorial. Extensor mechanism imbalance may be present and result from technical errors such as malrotation of the implants. We sought to understand the reasons for post-arthroplasty patellar dislocation and the clinical outcomes of patients in whom it occurs.

Methods: This is a retrospective cohort study assessing the outcomes of revision surgery for patellar dislocation in patients with component malrotation in both primary and revision TKAs. Patient demographics, dislocation etiology, presurgical deformity, intraoperation component position, complications, reoperation, and Knee Society Scores (KSS) were collected.

Results: Twenty patients (21 knees) were identified. The average time from primary arthroplasty to onset of dislocation was 33.6 months (SD 44.4), and the average time from dislocation to revision was 3.38 months (SD 2.81). Seventeen knees (80.9%) had internal rotation of the tibial component and seven knees (33.3%) had combined internal rotation of both the femoral and tibial components. Fifteen knees (71.4%) were treated with a condylar constrained implant at the time of revision, and five knees were converted to a hinged prosthesis. The average follow-up time was 56 months. During this time, one patient (4.54%) had a recurrent dislocation episode, requiring further surgery. At final follow up, the mean KSS was 86.2.

Conclusion: Revision TKA following patellar dislocation for patients with malrotated components was associated with high success rates. After revision surgery, patients had a low recurrence of patellar dislocation, low complication rates, and excellent functional outcomes.
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http://dx.doi.org/10.1007/s00402-020-03468-6DOI Listing
June 2020

Total hip arthroplasty in patients with fibrous dysplasia: a modern update.

Can J Surg 2020 05 1;63(3):E202-E207. Epub 2020 May 1.

From the Division of Orthopaedic Surgery, Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex, Toronto, Ont.

Background: Fibrous dysplasia (FD) results from an abnormality in lamellar bone formation and most frequently involves the proximal femur. This can lead to the development of osteoarthritis requiring total hip arthroplasty (THA). Such cases are challenging, and there is a lack of information guiding best management. As such, we devised a study assessing the outcomes and complications in patients with FD undergoing THA with modern implant technology, and we outlined our preferred surgical technique.

Methods: A search of our institutional arthroplasty database was performed to identify patients who underwent THA for FD between January 2001 and July 2018 at Mount Sinai Hospital in Toronto, Canada. Data regarding implants used and the use of allograft material or metal augments or both were obtained. Complications and revision requirements were noted. Radiographic and clinical leg length discrepancies were assessed.

Results: A total of 10 hips in 9 patients who underwent THA for FD were identified. Mean follow-up time was 6.0 years (range 0.5 to 10.3 yr). The majority of patients underwent THA using uncemented femoral and acetabular components with large femoral heads on highly cross-linked polyethylene liners. Most cases (80% of hips) required allograft to the proximal femur. A single complication requiring revision was noted. In 90% of hip surgeries, the patient required transfusion of packed red blood cells. Mean radiographic and clinical leg length discrepancies were 0.9 cm (range -2.4 to 2.4 cm) and 0.9 cm (range -4 to 0 cm), respectively.

Conclusion: Contrary to previous reports, low complication and revision rates were observed with cementless components and routine use of allograft material. The challenging nature of such cases warrants use of an experienced arthroplasty treatment team.
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http://dx.doi.org/10.1503/cjs.007219DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7828999PMC
May 2020

The Effect of Polyethylene Liner Thickness on Patient Outcomes and Failure After Primary Total Knee Arthroplasty.

J Arthroplasty 2020 08 14;35(8):2072-2075. Epub 2020 Mar 14.

Division of Orthopaedics - Joseph and Wolf Lebovic Health Complex, Mount Sinai Hospital, Toronto, Ontario, Canada.

Background: The effect of using thicker liners in primary total knee arthroplasty (TKA) on functional outcomes and aseptic failure rates remains largely unknown. As such, we devised a multicenter study to assess both the clinical outcomes and survivorship of thick vs thin liners after primary TKA.

Methods: A search of our institutional databases was performed for patients having undergone bilateral (simultaneous or staged) primary TKA with similar preoperative and surgical characteristics between both sides. Two cohorts were created: thick liners and thin liners. Outcomes collected were as follows: change in Knee Society Score (ΔKSS), change in range of motion, and aseptic revision. Ad hoc power analysis was performed for ΔKSS (⍺ = 0.05; power = 80%). Differences between cohorts were assessed.

Results: About 195 TKAs were identified for each cohort. ΔKSS and change in range of motion in the thin vs thick cohorts were similar: 51.4 vs 51.6 (P = .86) and 11.1° vs 10.0° (P = .66), respectively. No difference in aseptic revision rates were observed between thin and thick cohorts: all cause (4.1%, 3.1%; P = .59), aseptic loosening (0.5%, 0.5%; P = 1.0), instability (0.5%, 0.5%; P = 1.0), all-cause revision for stiffness (3.1%, 2.1%; P = .52), manipulation under anesthesia (2.1%, 2.1%; P = 1.0), and liner exchange (0.5%, 0%; P = .32).

Conclusion: The results of this study suggest that both rates of revision surgery and clinical outcomes are similar for TKAs performed with thick and thin liners. Preoperative factors are likely to play an important role in liner thickness selection, and emphasis should be placed on ensuring sound surgical technique.
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http://dx.doi.org/10.1016/j.arth.2020.03.017DOI Listing
August 2020

The effect of patient institutional transfer during the interstage period of two-stage treatment for prosthetic knee infection.

Bone Joint J 2019 Sep;101-B(9):1087-1092

Division of Orthopaedics, Mount Sinai Hospital, Toronto, Canada.

Aims: The aim of this study was to assess the effects of transferring patients to a specialized arthroplasty centre between the first and second stages (interstage) of prosthetic joint infection (PJI) of the knee.

Patients And Methods: A search of our institutional database was performed to identify patients having undergone two-stage revision total knee arthroplasty (TKA) for PJI. Two cohorts were created: continuous care (CC) and transferred care (TC). Baseline characteristics and outcomes were collected and compared between cohorts.

Results: A total of 137 patients were identified: 105 in the CC cohort (56 men, 49 women; mean age 67.9) and 32 in the TC cohort (17 men, 15 women; mean age 67.8 years). PJI organism virulence was greater in the CC cohort (36.2% 15.6%; p = 0.030). TC patients had a higher rate of persisting or recurrent infection (53.6% 13.4%; p < 0.001), soft-tissue complications (31.3 14.3%; p = 0.030), and reduced requirement for porous metal augments (78.1% 94.3%; p = 0.006). Repeat first stage debridement after transfer led to greater need for plastic surgical procedures (58.3% 0.0%; p < 0.001).

Conclusion: Patient transfer during the interstage of treatment for infected TKA leads to poorer outcomes compared with patients receiving all their treatment at a specialized arthroplasty centre. Cite this article: 2019;101-B:1087-1092.
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http://dx.doi.org/10.1302/0301-620X.101B9.BJJ-2019-0279.R1DOI Listing
September 2019

Impact of Hip Antibiotic Spacer Dislocation on Final Implant Position and Outcomes.

J Arthroplasty 2019 Sep 30;34(9):2107-2110. Epub 2019 Apr 30.

Mount Sinai Hospital, Division of Orthopaedics, Joseph and Wolf Lebovic Health Complex, Toronto, ON, Canada.

Background: Dislocation of dynamic antibiotic hip spacers during the treatment of periprosthetic joint infection is a well-described complication. Unfortunately, the repercussions of such events after reimplantation of the definitive prosthesis remain largely unknown. As such, we devised a study comparing the perioperative and postoperative outcomes of patients having undergone reimplantation with and without spacer dislocation.

Methods: A search of our institutional database was performed. Two retrospective cohorts were created: dislocated and nondislocated hip spacers. The radiographic and clinical outcomes for each cohort were collected.

Results: The two retrospective cohorts contained 24 patients for the dislocated group and 66 for the nondislocated group. Continuous variables noted to be significantly different between the dislocated and nondislocated groups were as follows: clinical leg-length discrepancy (1.35 cm vs 0.41 cm, P = .027), acetabular center of rotation (1.34 cm vs 0.60 cm, P = .011), total packed red blood cell transfusions (4.05 vs 2.37, P = .019), operative time (177.4 min vs 147.3 min, P = .002), and hospital length of stay (7.79 days vs 5.89 days, P = .018). Categorical variables noted to be significantly different were requirement for complex acetabular reconstruction (58.3% vs 13.7%, P < .001), requirement of constrained liners (62.5% vs 37.3%, P = .040), and dislocation after second stage (20.8% vs 6.1%, P = .039).

Conclusion: Dislocation of dynamic hip spacers leads to inferior clinical results and perioperative outcomes after reimplantation of the definitive prosthesis. Additionally, complex acetabular reconstruction is often required. As such, every effort should be made to prevent hip spacer dislocation.
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http://dx.doi.org/10.1016/j.arth.2019.04.051DOI Listing
September 2019

Correlation between preoperative imaging parameters and postoperative basic kinematics-based functional outcome in patients with tibial plateau fractures.

Clin Biomech (Bristol, Avon) 2019 05 16;65:87-91. Epub 2019 Apr 16.

Division of Orthopedics, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.

Background: Functional scores and radiographs are often used to assess function and predict development of osteoarthritis in patients with multi-fragmentary tibial plateau fractures (TPFs). Locomotion, which is the primary goal of fracture treatment, is rarely assessed. The objective of this study was to assess functional ability of patients after TPF fixation using spatio-temporal gait analysis (STGA), and to compare STGA variables with self-reported functional scores and preoperative fracture characteristics.

Methods: Preoperative CT scans of 21 patients with complete articular multi-fragmentary TPFs were evaluated for number of fragments, maximum gap between the fragments and maximum articular depression. All patients underwent STGA (velocity, cadence, step length of the affected and the unaffected leg, single-limb support by the affected and the unaffected leg, and double-leg support) and filled the Knee Society Score and the Short Form-12 questionnaires on average 3 years (SD = 1.56, range, 2-5.8) post-injury.

Findings: Step length and single-limb support time of the affected leg were shorter compared to the unaffected leg (p = 0.02 and p = 0.007, respectively). Number of fracture fragments correlated with cadence (R = -0.461, p = 0.04) and velocity (R = -0.447, p = 0.04).

Interpretation: Given that both higher fracture comminution and deformity on the one hand and the above gait parameter alterations on the other hand are associated with knee osteoarthritis, STGA may be used for routine postoperative evaluation of patients after TPF fixation.
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http://dx.doi.org/10.1016/j.clinbiomech.2019.04.009DOI Listing
May 2019

Relatively High Complication and Revision Rates of the Mayo Metaphysical Conservative Femoral Stem in Young Patients.

Orthopedics 2018 Jul 9;41(4):e516-e522. Epub 2018 May 9.

The Mayo metaphysical conservative femoral stem (Zimmer, Warsaw, Indiana) is a wedge-shaped implant designed to transfer loads proximally, reduce femoral destruction, and enable the preservation of bone stock in the proximal femur. Thus, it is a potentially preferred prosthesis for active, non-elderly patients who may require additional future surgeries. This retrospective case study analyzed the outcomes of consecutive patients who underwent total hip replacements with this stem between May 2001 and February 2013. All patients underwent clinical assessment, radiological evaluation for the presence and development of radiolucent lines, and functional assessment (numerical analog scale, Harris hip score, and Short Form-12 questionnaire). Ninety-five hips (79 patients) were available for analysis. The patients' mean age was 43 years (range, 18-64 years), and the mean follow-up was 97 months (range, 26.9-166 months). The postoperative clinical assessments and functional assessments revealed significant improvements. Sixteen patients (20.3%) had 18 orthopedic complications, the most common of which were an intraoperative femoral fracture and implant dislocation requiring revision surgeries in 10 hips (10.5%). Radiological analysis revealed evidence of femoral remodeling in 64 (67.4%) implants, spot welds (neocortex) in 35 (36.8%), and osteolysis in 3 (3.2%). These results suggest that the conservative hip femoral implant has an unacceptable complication rate for non-elderly patients. [Orthopedics. 2018; 41(4):e516-e522.].
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http://dx.doi.org/10.3928/01477447-20180503-01DOI Listing
July 2018

Financial impact and effect on the outcome of preoperative tests for at-risk older hip fracture patients.

Geriatr Gerontol Int 2018 Jun 7;18(6):937-942. Epub 2018 Mar 7.

Orthopedic Division, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

Aim: Older patients with proximal femoral fractures often undergo preoperative tests due to coexisting morbidities. Our aim was to evaluate these tests and their impact on patient outcome and medical expenses.

Methods: This retrospective study includes data on head computed tomography, carotid ultrasound, echocardiography and pulmonary functional tests calculated according to the type of surgery (osteosynthesis or hip arthroplasty) carried out on 2798 patients. Time-to-surgery, test repeated postoperatively, American Society of Anesthesiology Physical Status score, additional procedures, hospitalization time, 30-day mortality and associated medical expenses were evaluated.

Results: A total of 921 preoperative tests were carried out in 780 (28%) patients, and 375 postoperative tests were carried out in 329 (12%) patients (P < 0.001). A total of 23 procedures were carried out after surgery, none related to the originally carried out tests. Significant group differences were found for American Society of Anesthesiology Physical Status score, days to surgery, hospitalization time (days) and mortality rates. The medical expenses of these tests were 1.3% of the average income per case, and 0.6% of the average study group income.

Conclusions: Non-routine preoperative tests prolong time-to-surgery, increased hospitalization time and contribute to 30-day mortality. No postoperative procedure was related to preoperative test findings. The financial cost for these tests does not burden the medical expenses per procedure. Geriatr Gerontol Int 2018; 18: 937-942.
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http://dx.doi.org/10.1111/ggi.13295DOI Listing
June 2018

Anti-inflammatory Prophylaxis Prevents Heterotopic Ossification in Contralateral Side Hip Arthroscopy: A Case Report.

J Orthop Case Rep 2017 Jan-Feb;7(1):20-23

Department of Orthopaedics, Tel-Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Introduction: Heterotopic ossification (HO) after hip surgery is the formation of bone in non-skeletal tissue, usually between the muscle and the joint capsule. HO after hip surgery may be associated with clinical sequelae such as pain, impingement and decreased range of motion, compromising surgical outcomes.

Case Report: A 20-year-old basketball player presented with a 2-year duration of the left groin pain after a basketball-related injury. Due to continued disability and failure of conservative management the patient underwent hip arthroscopy. No HO prophylaxis was given. Follow-up radiographs at 3 months after left hip arthroscopy showed Grade 3 HO on the left side. On the 2 post-operative visit, the patient complained of contralateral (right-sided) hip pain. Due to continued symptoms on the right side and failure to respond to conservative management the patient underwent right hip arthroscopy. HO prophylaxis was initiated with non-steroidal anti-inflammatory medications (NSAIDs) treatment (Etodolac) 600 mg/day for 14 days. Follow-up radiographs at 3 months after the right hip arthroscopy showed no HO.

Conclusion: This case demonstrates the efficacy of HO prophylaxis in a single patient. Routine HO prophylaxis with NSAIDs should be considered for patients undergoing hip arthroscopy with osteoplasty. A minimum of 9 weeks post-operative follow-up is recommended to assess the radiographic presence of HO.
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http://dx.doi.org/10.13107/jocr.2250-0685.670DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5458690PMC
June 2017

Preemptive Analgesia in Hip Arthroscopy: A Randomized Controlled Trial of Preemptive Periacetabular or Intra-articular Bupivacaine in Addition to Postoperative Intra-articular Bupivacaine.

Arthroscopy 2017 Jan 8;33(1):118-124. Epub 2016 Oct 8.

Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Israel; Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel.

Purpose: To evaluate and compare the efficacy of intra-articular and periacetabular blocks for postoperative pain control after hip arthroscopy.

Methods: Forty-two consecutive patients scheduled for hip arthroscopy were randomized into 2 postoperative pain control groups. One group received preemptive intra-articular 20 mL of bupivacaine 0.5% injection, and the second group received preemptive periacetabular 20 mL of bupivacaine 0.5% injection. Before closure all patients received an additional dose of 20 mL of bupivacaine 0.5% intra-articularly. Data were compared with respect to postoperative pain with visual analog scale (VAS) and analgesic consumption, documented in a pain diary for 2 weeks after surgery.

Results: Twenty-one patients were treated with intra-articular injection, and 21 patients with peri-acetabular injection. There were no significant differences with regards to patient demographics or surgical procedures. VAS scores recorded during the first 30 minutes postoperatively and 18 hours after surgery were significantly lower in the periacetabular group compared with in the intra-articular group (0.667 ± 1.49 vs 2.11 ± 2.29; P < .045 and 2.62 ± 2.2 vs 4.79 ± 2.6; P < .009). There were no differences between the groups with regard to analgesic consumption.

Conclusions: Periacetabular injection of bupivacaine 0.5% was superior to intra-articular injection in pain reduction after hip arthroscopy at 30 minutes and 18 hours postoperatively. However, total analgesic consumption over the first 2 postoperative weeks and VAS pain measurements were not significantly affected.

Level Of Evidence: Level I, randomized controlled trial.
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http://dx.doi.org/10.1016/j.arthro.2016.07.026DOI Listing
January 2017

The medial border of the tibial tuberosity as an auxiliary tool for tibial component rotational alignment during total knee arthroplasty (TKA).

Knee Surg Sports Traumatol Arthrosc 2017 Jun 26;25(6):1736-1742. Epub 2016 Mar 26.

Mount Sinai Hospital, 600 University Avenue, Toronto, ON, M5G 1X5, Canada.

Purpose: The objective of this study was to quantify the amount of ensuing internal rotation of the tibial component when positioned along the medial border of the tibial tubercle, thus establishing a reproducible intraoperative reference for tibial component rotational alignment during total knee arthroplasty (TKA).

Methods: The angle formed from the tibial geometric centre to the intersection of both lines from the middle of the tibial tuberosity and its medial border was measured in 50 patients. The geometric centre was determined on an axial CT slice at 10 mm below the lateral tibial plateau and transposed to a slice at the level of the most prominent part of the tibial tuberosity. Similar measurements were taken in 25 patients after TKA, in order to simulate the intraoperative appearance of the tibia after making its proximal resection.

Results: This angle was found to be similar (n.s.) in normal and post-TKA tibiae [median 20.4° (range 15°-24°) vs. 20.7° (range 16°-25°), respectively]. In 89.3 % of the patients, the angle ranged from 17° to 24°. No statistical difference (p n.s.) was found between women and men in both normal [median -20.7° (range 16°-25°) vs. 19.9° (range 15°-24°)] and post-TKA tibiae [median 21.4° (range 19°-24°) vs. 20° (range 16°-25°)].

Conclusion: This study found that in 90 % of the patients, the medial border of the tibial tuberosity is internally rotated 17°-24° in relation to the line connecting the middle of the tuberosity to the tibial geometric centre. Since this anatomical landmark may be more easily identifiable intraoperatively than the commonly used "medial 1/3", it can provide a better quantitative reference point and help surgeons achieve a more accurate tibial implant rotational position.

Level Of Evidence: Cohort and case control studies, Level III.
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http://dx.doi.org/10.1007/s00167-016-4072-7DOI Listing
June 2017

Selective COX-2 Inhibitors Significantly Reduce the Occurrence of Heterotopic Ossification After Hip Arthroscopic Surgery.

Am J Sports Med 2016 Mar 22;44(3):677-81. Epub 2015 Dec 22.

Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Background: Heterotopic ossification (HO) after hip arthroscopic surgery is a common complication and may be associated with clinical sequelae such as pain, impingement, and decreased range of motion. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used medications for reducing or preventing HO.

Hypothesis/purpose: The purpose of this study was to evaluate the effectiveness of short-term selective cyclooxygenase-2 (COX-2) inhibitors used for HO prophylaxis after hip arthroscopic surgery. The hypothesis was that postoperative HO prophylaxis with 600 mg etodolac once daily for 2 weeks would significantly reduce the incidence of HO after hip arthroscopic surgery when compared with no prophylaxis.

Study Design: Cohort study; Level of evidence, 3.

Methods: Between July 2010 and April 2014, a total of 263 consecutive patients underwent hip arthroscopic surgery, performed by a single surgeon, for various pathological abnormalities at 1 medical center. The initial 163 patients received no postoperative NSAID prophylaxis for HO, and the subsequent 100 patients received 600 mg etodolac once daily for 2 weeks postoperatively. Prophylaxis compliance data, gastrointestinal side effects, and postoperative radiographs for HO were monitored.

Results: A total of 100 control patients and 63 study patients met the inclusion criteria. The mean follow-up period was 12.88 months. No significant differences were observed in terms of age, sex, follow-up, or procedures performed. No gastrointestinal bleeding was observed. Radiographic findings of HO were present in 36 of 100 control patients with 17, 15, and 4 classified as having Brooker grades 1, 2, and 3, respectively. No patients in the study group presented with HO, and a significant difference in the HO rate between groups was observed (P < .0001).

Conclusion: HO after hip arthroscopic surgery is a relatively common complication, with a rate of 19% for Brooker grade ≥2 in the patients who did not receive NSAID prophylaxis. No HO was found in the patients who received short-term COX-2 inhibitor prophylaxis. The short-term administration of 600 mg etodolac once daily for 2 weeks was found to be safe and effective in preventing HO in patients undergoing hip arthroscopic surgery. HO prophylaxis protocols based on short-term etodolac treatment may be considered after hip arthroscopic surgery.
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http://dx.doi.org/10.1177/0363546515618623DOI Listing
March 2016

Pathological findings in patients with low anterior inferior iliac spine impingement.

Surg Radiol Anat 2016 Jul 30;38(5):569-75. Epub 2015 Nov 30.

Department of Orthopedic Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Purpose: Femoroacetabular impingement (FAI) has been well described in recent years as one of the major causes of hip pain potentially leading to acetabular labral tears and cartilage damage, which may in turn lead to the development of early degenerative changes. More recently, extra-articular patterns of impingement such as the anterior inferior iliac spine (AIIS)/subspine hip impingement have gained focus as a cause of hip pain and limitation in terminal hip flexion and internal rotation. The purpose of this study was to evaluate the prevalence of low AIIS in patients undergoing hip arthroscopy and to characterize the concomitant intra-articular lesions.

Methods: Between November 2011 and April 2013, 100 consecutive patients underwent hip arthroscopy for various diagnoses by a single surgeon. After intra-operative diagnosis of low AIIS was made, a comprehensive review of the patients' records, preoperative radiographs, and intra-operative findings was conducted to document the existence and location of labral and chondral lesions.

Results: Twenty-one (21 %) patients had low AIIS. There were 13 males (mean age 38.4 years) and eight females (mean age 35.5 years). Eight patients had pre-operative radiographic evidence of low AIIS. All patients had a labral tear anteriorly, at the level of the AIIS; 17 had chondrolabral disruption and 17 had chondral lesions in zone two (antero-superior); and four patients had lesion in zones two and three.

Conclusions: Low AIIS is a common intra-operative finding in hip arthroscopy patients. Characteristic labral and chondral lesions are routinely found in a predictable location that effaces the low AIIS. Level of Evidence-Level IV, Case Series.
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http://dx.doi.org/10.1007/s00276-015-1591-8DOI Listing
July 2016

Dynamic locking plate vs. simple cannulated screws for nondisplaced intracapsular hip fracture: A comparative study.

Injury 2016 Feb 30;47(2):424-7. Epub 2015 Oct 30.

Division of Orthopedic Surgery, Tel Aviv Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address:

Introduction: Intracapsular hip fractures (ICHF) are a common cause of morbidity and mortality and pose a great economic burden on the health care systems. Appropriate surgical treatment requires balancing optimal outcomes with the cost of treatment to the health care system. While in elderly patients with displaced ICHF arthroplasty became the standard of care, the internal fixation method for conserving the femoral head in younger patients or in nondisplaced ICHF is still in debate. We compared a dynamic locking plate with the standard cancellous cannulated screws (CCS) for treatment of nondisplaced ICHF.

Methods: All patients treated with internal fixation for nondisplaced ICHF between July 2009 and December 2012 at our level one trauma center were included in this study. Patients treated with Targon FN (Aesculap) implants and CCS (Synthes) were compared. Charts were reviewed for demographics, intraoperative data and peri/post operative complications retrospectively. Radiographical analysis, pain (VAS), quality of life (SF12) and function (MHHS) data were prospectively gathered.

Results: One hundred and fifteen non-displaced ICHFs were treated with internal fixation, 81 with CCS and 34 with Targon FN implant; the mean follow-up was 19 and 28 months, respectively. Group fracture characteristics (Garden/Powel classification), and demographics, excluding age, were not significantly different. Post-operative revision rates of the Targon FN and CCS groups, perioperative complications were not statistically different (p>0.05). Quality of life (SF-12), function (Modified Harris Hip Score) and Visual Analogue Scale (VAS) pain scores were not statistical different.

Conclusions: Complication rates and clinical outcomes for the treatment of nondisplaced ICHF with Targon FN and SCC showed no significant differences. Based on this evidence in consideration of the substantial cost differential between the Targon FN and SCC we suggest SCC for treatment of nondisplaced ICHF.

Level Of Evidence: III.
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http://dx.doi.org/10.1016/j.injury.2015.10.054DOI Listing
February 2016

Expandable proximal femoral nail versus gamma proximal femoral nail for the treatment of AO/OTA 31A1-3 fractures.

Injury 2016 Feb 28;47(2):419-23. Epub 2015 Oct 28.

Division of Orthopedic Surgery. Tel Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Introduction: The gamma-proximal femoral nail (GPFN) and the expandable proximal femoral nail (EPFN) are two commonly used intramedullary devices for the treatment of AO 31A1-3 proximal femur fractures. The aim of this study was to compare outcomes and complication rates in patients treated by both devices.

Patients And Methods: A total of 299 patients (149 in the GPFN group and 150 in the EPFN group, average age 83.6 years) were treated for AO 31A1-3 proximal femur fractures in our institution between July 2008 and February 2013. Time from presentation to surgery, level of experience of the surgeon, operative time, amount of blood loss and number of blood transfusions were recorded. Postoperative radiological variables, including peg/screw location, tip to apex distance and orthopaedic complications, as, malunion, nonunion, surgical wound infection rates, cutouts, periprosthetic fractures and the incidence of non-orthopaedic complications. Functional results were estimated using the modified Harris Hip Score, and quality of life was queried by the SF-36 questionnaire.

Results: The GPFN and the EPFN fixation methods were similar in terms of functional outcomes, complication rates and quality of life assessments. More patients (107 vs. 73) from the GPFN group were operated within 48 h from presentation (44.8 h vs. 49.9 h for the EPFN group, p=0.351), and their surgery duration and hospitalisation were significantly longer (18.5 days vs. 26 days, respectively, p<0.001). The GPFN patients were frequently operated by junior surgeons: 90% (135) while 50.6% (76) of the EPFN operations were performed by senior doctors. Other intraoperative measures were similar between groups. Cutout was the most common complication affecting 6.7% of the GPFN group and 3.3% of the EPFN group (p=0.182).

Conclusions: Good clinical outcomes and low complication rates in the GPFN and the EPFN groups indicate essentially equivalent safety and reliability on the part of both devices for the treatment of proximal femoral fractures.
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http://dx.doi.org/10.1016/j.injury.2015.10.013DOI Listing
February 2016

Gait characteristics and quality of life perception of patients following tibial plateau fracture.

Arch Orthop Trauma Surg 2015 Nov 19;135(11):1541-6. Epub 2015 Sep 19.

Department of Orthopedic Surgery, Sourasky Medical Center, Weizmann St 10, Tel-Aviv, Israel.

Introduction: The purpose of the current study was to evaluate the long-term functional outcome as measured by gait patterns and quality of life assessment of patients with high-energy tibial plateau fracture compared to matched controls.

Materials And Methods: Thirty-eight patients were evaluated in a case-controlled comparison. Twenty-two patients with tibial plateau fracture were evaluated after 3.1 (1.63) years (sd) from injury. Patients underwent a computerized spatiotemporal gait test and completed the SF-12 health survey. 16 healthy subjects, matched for age and gender served as a control group. The main outcome measures for this study were spatiotemporal gait characteristics, physical quality of life and mental quality of life.

Results: Significant differences were found in all gait parameters between patients with tibial plateau fracture and healthy controls. Patients with tibial plateau fracture walked slower by 18% compared to the control group (p < 0.001), had slower cadence by 8% compared (p = 0.002) to the control group and had shorter step length in the involved leg by 11% and in the uninvolved leg by 12% compared to the control group (p = 0.006 and p = 0.003, respectively). Patients with tibial plateau fracture also showed shorter single limb support (SLS) in the involved leg by 12% compared to the uninvolved leg and 5% in the uninvolved leg compared to the control group (p < 0.001 and p = 0.017, respectively). Significant differences were found in the Short Form (SF)-12 scores. Physical Health Score of patients with tibial plateau fracture was 65% lower compared to healthy controls (p < 0.001), and Mental Health Score of the patients was 40% lower compared to healthy controls (p < 0.001). Finally, significant correlations were found between SF-12 and gait patterns.

Conclusion: Long-term deviations in gait and quality of life exist in patients following tibial plateau fracture. Patients following tibial plateau fracture present altered spatiotemporal gait patterns compared to healthy controls, as well as self-reported quality of life.
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http://dx.doi.org/10.1007/s00402-015-2325-4DOI Listing
November 2015

Capsular closure does not affect development of heterotopic ossification after hip arthroscopy.

Arthroscopy 2015 Feb 8;31(2):225-30. Epub 2014 Nov 8.

Department of Orthopedics, Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.

Purpose: The purpose of this study was to evaluate the role of capsular closure after hip arthroscopy in reduction of the incidence of heterotopic ossification (HO).

Methods: One hundred (50 study group, 50 control group) consecutive hip arthroscopy procedures with radiographic follow-up of more than 9 weeks were included in the study. The study group consisted of 50 patients in whom capsular closure with 2 No. 1 polydioxanone (PDS) sutures was performed, and a control group consisted of 50 patients in whom the capsule remained open after capsulotomy. HO was assessed by radiographs using the Brooker classification. Statistical analysis of the data was carried out with the χ-square or Fisher exact test and Student t test, when appropriate, at a significance level of .05.

Results: Thirty-six (36%) patients had radiographic evidence of postoperative HO (14 patients in the capsular closure group). No significant difference was found regarding sex, side of operation, age, or HO rate between the study and the control groups (P = .778, P = .123, P = .744, and P = .144, respectively). Furthermore, no significant difference was found in the rate of HO with potential clinical significance (Brooker classification > I) between the control and study groups (P = .764).

Conclusions: Capsular closure did not seem to alter the rate of HO when compared with a control group of patients in whom the capsulotomy was not repaired.

Level Of Evidence: Level III, retrospective comparative study.
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http://dx.doi.org/10.1016/j.arthro.2014.08.026DOI Listing
February 2015

Clinical characteristics of children with 2009 pandemic H1N1 influenza virus infections.

Pediatr Int 2011 Aug;53(4):426-30

Department of Pediatrics B North, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.

Background: Further understanding of the clinical manifestations, hospital course and treatment options of the 2009 pandemic H1N1 influenza virus (H1N1) is needed in preparation for future outbreaks.

Methods: Seventy-three children with polymerase-chain-reaction-confirmed infections with H1N1 treated in a tertiary care medical center in Israel were included in the study. Clinical data were extracted from medical records, and analyzed by hospitalization status or the presence of underlying chronic medical conditions.

Results: Prevalent symptoms were fever, cough and shortness of breath, with additional findings of conjunctivitis, seizures, chills, dizziness, purpuric rash and chest pain. Hospitalized patients were more likely to have shortness of breath (OR 26.7, 95%CI: 3.5-1150), abnormal lung auscultation (OR 11.6, 95%CI: 2.8-67), abnormal X-ray (OR 3.3, 95%CI: 1.1-9.6), and a chronic illness (OR 5.4, 95%CI: 1.8-17), compared with non-hospitalized ones. Disease manifestations were similar between children with or without chronic diseases. Only two (2.7%) children required intensive care, and no deaths were recorded. A high rate (18%) of thrombocytopenia was found. One child had rapid symptom resolution after intravenous immunoglobulin treatment.

Conclusion: H1N1 infection follows a mild course, even in the presence of severe underlying diseases. Abnormal respiratory findings and the presence of a chronic disease probably contributed to the decision to hospitalize patients. A rapid resolution of H1N1 symptoms after intravenous immunoglobulin treatment warrants further study, and could be a possible therapeutic option for severe cases.
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http://dx.doi.org/10.1111/j.1442-200X.2010.03271.xDOI Listing
August 2011
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