Hip arthroscopy appears to be a safe and efficacious treatment for labral tears and FAI in older patients who do not have significant underlying degenerative changes. However, in this population, there is a significant proportion of patients who eventually require hip arthroplasty. Outcomes may be affected by type of treatment (ie, labral debridement vs repair). Additional high-quality studies are needed to understand how these factors affect outcomes.
Study Design Retrospective review.
Objective To compare clinical outcomes after transforaminal lumbar interbody fusion (TLIF) in patients with and patients without osteoporosis.
Methods We reviewed all patients with 6-month postoperative radiographs and computed tomography (CT) scans for evaluation of the interbody cage. CT Hounsfield unit (HU) measurements of the instrumented vertebral body were used to determine whether patients had osteoporosis. Radiographs and CT scans were evaluated for evidence of implant subsidence, migration, interbody fusion, iatrogenic fracture, or loosening of posterior pedicle screw fixation. Medical records were reviewed for persistence of symptoms or recurrence of symptoms.
Results The final data analysis included 18 (20.5%) patients with osteoporosis and 70 (79.5%) patients without osteoporosis. Males comprised 50% of patients with osteoporosis, and 64.3% of patients without osteoporosis. The mean age was significantly higher in the osteoporotic group (65.2 years) versus the nonosteoporotic group (56.9 years; p < 0.0001). We found significantly higher rates of subsidence (72.2 versus 45.7%, p = 0.05) and iatrogenic fractures (16.7% versus 1.4%, p = 0.03) in the osteoporotic group. In addition, the osteoporotic group had significantly higher radiographic complication rates compared with the nonosteoporotic group (77.8 versus 48.6%, p = 0.03). There was no difference between groups for revision surgery (16.6 versus 14.3%, p = 0.78) or postoperative symptoms (44.4% versus 50.0%, p = 0.69).
Conclusions Our data demonstrated significantly increased rates of cage subsidence, iatrogenic fracture, and overall radiographic complications in patients with osteoporosis. However, these radiographic complications did not predispose patients with osteoporosis to an increased risk of surgical revision or worse clinical outcomes.
Osteomyelitis and septic arthritis of the hand and wrist require prompt recognition and early treatment to minimize adverse sequelae. A rational treatment approach assesses the pathogenesis, microbiology, medical and surgical treatment options. Direct inoculation is the most common cause of septic arthritis or osteomyelitis, with Staphylococcus aureus the most frequent offending pathogen. The increasing incidence of community and hospital-acquired methicillin resistant Staphylococcus aureus (MRSA) requires special consideration and should be considered early in the treatment of hand infections. Open surgical debridement of the bone or joint is the preferred treatment. In the radiocarpal joint, arthroscopic irrigation and debridement is an effective treatment method with a shorter period of hospitalization and equivalent results in the intermediate term.Long-term parenteral and oral antibiotics combined with a short period of splint immobilization are integral in the postoperative period. Despite early and aggressive treatment, stiffness, recurrent infection, pain and deformity may persist.
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