Citations

Abstract Background: Prior studies have evaluated the efficacy of subchondroplasty for the management of subchondral cysts of the knee, yet few studies to date evaluate minimum 2-year outcomes following subchondroplasty of the acetabulum. Purpose: The purpose of this study was to evaluate minimum two-year outcomes following arthroscopic subchondroplasty for the treatment of acetabular subchondral cysts and to identify variables associated with total hip arthroplasty (THA) conversion following subchondroplasty. Study Design: Cases Series, Level of Evidence IV. Methods: A retrospective review of prospectively maintained data was performed on patients who underwent primary hip arthroscopy May 2019 to September 2021 by a single surgeon. Consecutive patients who underwent subchondroplasty for acetabular subchondral cysts with minimum two-year follow-up were identified. Demographics, magnetic resonance imaging (MRI), intraoperative findings, and clinical outcomes were evaluated. Cross-sectional area of the subchondral cysts was measured on MRI. Clinical outcomes included Hip Outcome Score–Activities of Daily Living (HOS-ADL), HOS–Sports Subscale (HOS-SS), international Hip Outcome Score-12 (iHOT-12), and visual analog scale for pain (VAS-Pain). Conversion to THA was recorded. The patients who converted to THA were compared to those who did not. Continuous variables associated with THA conversion were analyzed with receiver operating characteristic (ROC) curves to identify thresholds associated with THA conversion. Results: Twenty-nine patients underwent subchondroplasty for acetabular subchondral cysts with minimum two-year follow up (age: 48.2±11.1 years, body mass index: 29.9±6.6kg/m2, 52.0% female). The THA-free survivorship rate was 62.1%. Patients who achieved THA-free survivorship had smaller subchondral cysts (88.5±59.2 mm2 vs. 147.1±54.8, P=0.013) and a lower prevalence of high-grade femoral head chondral defects (16.7% vs. 54.5%, P=0.048) compared to patients who converted to THA. ROC analysis identified patients with a subchondral cyst <133 mm2 were 21.3 times more likely to achieve THA-free survivorship (P=0.001). The THA-free survivors demonstrated significant improvements across all measured PROs (P≤0.015). Conclusions: Subchondroplasty for acetabular subchondral cysts demonstrated a 62.1% THA-free survivorship at minimum 2-year follow-up, with survivors demonstrating significantly improved PROs. Patients with cysts <133 mm2 were 21.3 times more likely to achieve THA-free survivorship than patients with larger cysts. Keywords: Hip, Acetabulum, Subchondral Cysts, Subchondroplasty

Abstract Background: Osteochondral allograft and autograft transplantation for femoral head defects have emerged as promising treatments for concomitant cartilage and subchondral bone injuries in young patients. The purpose of this study was to evaluate the clinical and radiological outcomes of patients who underwent osteochondral allograft or autograft transplantation for femoral head defects and access any risk factors that may lead to conversion to THA. Methods: All patients who underwent osteochondral allograft or autograft transplantation for femoral head defects were analyzed. All patients had symptomatic femoral head osteochondral defects identifiable on advanced imaging such as computed tomography or magnetic resonance imaging. Clinical outcomes were assessed at final follow-up with the modified Harris Hip Score (mHHS), Hip Outcome Score – Activities of Daily Living (HOS-ADL), Hip Outcome Score – Sport-Specific Subscale (HOS-SSS), and International Hip Outcome Tool (iHOT-12). Additionally, patients were assessed radiographically preoperatively and at a final postoperative visit using anterior-posterior and lateral radiographs for osteoarthritis using Tönnis grading. Results: A total of 27 patients were included in this study (19 osteochondral allograft transplantation, 8 osteochondral autograft transplantation). The overall mean follow-up was 4.7 years. The average mHHS, HOS-ADL, HOS-SSS, and iHOT-12 for the allograft cohort were 86.7, 92.8, 81.4, and 79.0, respectively, while for the autograft cohort it was 87.6, 92.7, 83.1, and 82.0, respectively. For the allograft cohort, there were a total of 5 reoperations (26.3%) consisting of 4 THA at a mean of 1.9 years and 1 trochanteric osteotomy nonunion at 0.7 year. For the remaining allograft patients who did not undergo treatment failure, only one (6.7%) had radiographic osteoarthritis progression. None of the patients in the autograft cohort underwent THA. Overall, conversion to THA was 14.8%. Conclusion: Osteochondral allograft and autograft transplantation for femoral head defects demonstrated overall favorable clinical outcomes and conversion to THA at mean 5-year follow-up and should be considered for patients with focal femoral head defects.

Abstract Introduction: Labral injury at the time of open and arthroscopic hip preservation surgery for symptomatic femoroacetabular impingement (FAI) is managed with debridement versus refixation by the treating surgeon based on tear pattern, tissue quality, and hip morphology. While refixation has been favored based on mid-term outcomes in some series, differences in the long-term patient reported outcomes (PROMS) have not been defined in well-designed and matched prospective series. Methods: This study consisted of a prospective, multi-center cohort that underwent primary surgical treatment for symptomatic FAI. Patients were included if they underwent corrective osteoplasty and a labral refixation or a labral debridement procedure. Using a ratio of 1:1, hips with labral refixation and labral debridement were matched by age, sex, and surgical approach. Postoperative assessments were conducted at a minimum 8 years after surgery using PROMS and assessment of reoperations. Results: A total of 237 hips (n=188 labral refixation, n=49 labral debridement) met the inclusion criteria for the current study. 48 hips from the labral refixation and 48 hips from debridement groups with mean follow-up of 10.3±1.7 years and 10.6±2.1 years respectively were included. No significant differences were observed in the femoral head, acetabular cartilage grade, or labral grade between the groups. The mHHS improved 19.8±19.6 and 23.4±16.8 from baseline to the final follow-up in the labral refixation and debridement groups, respectively (p=0.43). There were no significant differences in PROMS between the labral refixation and debridement groups. Overall, 66% and 76% of the labral refixation and debridement groups achieved the MCID for the mHHS respectively (p=0.30). There were more revision surgeries with labral refixation than with debridement (10.4% vs. 2.1%, p=0.09), but more conversions to total hip replacement in the labral debridement group (8.3% vs. 4.2%, p=0.38), but neither of these differences were statistically significant. Discussion: Both labral refixation and debridement are effective with durable improvement in PROMS at a mean of 10 years in a prospective cohort of patients treated surgically for symptomatic FAI. No significant differences in baseline or final PROMS were observed, and similar rates of revision and conversion to hip replacement were observed in the debridement and refixation groups.

Summary Introduction Peroral plication of the esophagus (POPE) can reduce sump size and improve symptoms in end-stage achalasia. However, its long-term efficacy and safety are unknown. Methods Patients with end-stage achalasia who underwent POPE at our institution (2016–2024) were identified. Data were abstracted for patient demographics, procedural details, and clinical and radiographic outcomes. Results Twelve patients underwent POPE. The technical success rate was 100%, with mean procedural time of 57 minutes and without adverse events. Symptomatic improvement occurred in 75% of patients (mean follow-up of 15 months), while 86% had radiographic improvement in sump size. Repeat POPE in 6 (50%) patients a mean of 2.6 years after index POPE and a third POPE in four (33%) patients a mean of 3.1 years later was performed, with similar technical success rates and outcomes to the index POPE. Conclusions POPE is a safe and repeatable long-term therapeutic option in end-stage achalasia.

Purpose of review Pain during cesarean delivery (PDCD) has been overlooked and underreported and is associated with a traumatic birth experience and long-term morbidity. We review the studies reporting on PDCD and summarize available guidance providing roadmaps for anesthesiologists caring for patients during cesarean delivery. Recent findings PDCD is a patient-reported outcome and should not be defined by interventions mitigating insufficient neuraxial anesthesia, such as supplemental analgesic medication or general anesthesia. Depending on the cohorts studied and definitions used, current reported rates of PDCD range between 2 and 36%. Preoperative patient counseling, risk stratification, and testing of neuraxial block are mitigating strategies; ultimately, if pain occurs, it should be managed skillfully applying shared decision-making with a supportive follow-up to reduce psychological trauma. Statements from three international organizations offer guidance to prevent and treat PDCD. Summary This review provides strategies to mitigate the occurrence of PDCD, with targeted approaches to better prevent and manage PDCD.

INTRODUCTION: Current guidelines recommend endoscopic surveillance of Barrett's esophagus (BE) but do not account for competing mortality unrelated to esophageal cancer (EC). We conducted a systematic review and meta-analysis to estimate EC and non-EC mortality risk in BE patients. METHODS: We searched multiple databases for studies reporting mortality in BE. We included population-based studies providing standardized mortality ratio (SMR). The primary outcome was SMR from all causes and EC and non-EC etiologies. SMR was calculated by dividing the observed mortality over the expected mortality. Logarithmic form of SMRs was pooled using random-effects model. RESULTS: Our search yielded 2,826 articles, of which 7 studies (n = 34,454) were included. All-cause mortality was elevated in BE patients compared with population controls (pooled SMR 1.24, 95% confident interval [CI] 1.01–1.53) driven in part by increased EC mortality risk (SMR 8.98, 95 CI 5.12–15.77). The mortality risk was still increased but attenuated after excluding EC mortality (SMR 1.21, 95% CI 1–1.46). There was no increased mortality risk of non-EC malignancies (SMR 1.22, 95% CI 0.82–1.82) or mortality due to noncancer etiologies (SMR 1.13, 95% CI 0.90–1.43). Death due to cardiovascular diseases was higher in BE (SMR 1.16, 95% CI 1.02–1.33). BE patients were 10 times more likely to die from noncancer etiologies than EC (risk ratio 10.71, 95% CI 5.98–19.16). Subgroup analysis of studies that excluded prevalent EC at baseline (3 studies) also showed increased all-cause (SMR 1.12, 95% CI 1.07–1.18) and EC mortality (SMR 4.7, 95% CI 3.58–6.17) among BE patients. DISCUSSION: BE patients exhibit a higher all-cause mortality, driven in part by risk of EC mortality. A personalized approach to surveillance, mitigating risk of EC while recognizing the broader mortality risks, is warranted.

Abstract Background: Acute coronary syndrome (ACS) remains a major cause of mortality worldwide, with India reporting approximately three million cases annually. This study aims to assess the demographics, risk factors, and treatment patterns of ACS patients in Central India while exploring challenges related to pre-hospital delays and financial constraints. Materials and Methods: A cross-sectional, questionnaire-based study was conducted at a tertiary care hospital. Data from patients with ACS were collected through face-to-face interviews using a self-designed, semi-structured, open-ended questionnaire. Results: Among the 90 participants, 86.6% were diagnosed with an acute ST-segment elevation myocardial infarction (STEMI), with a male predominance (81.1%). Common risk factors included smoking, diabetes, hypertension, and a history of cardiovascular events. The primary reasons for delays in seeking medical care were a lack of recognition of symptom severity (37%), prolonged travel times (21%), and unavailability of suitable transportation (21%). Chest pain was the most frequently reported initial symptom (73.3%), with symptom onset occurring most often in the morning (43.3%). Males were more likely to experience anterior wall MI, while females predominantly presented with inferior or posterior wall MI. Emergency medical service (EMS) utilization was low, with most patients relying on personal vehicles for transportation. Additionally, rural patients required at least one additional hospital visit before reaching the tertiary care center compared to their urban counterparts. Thrombolysis was the primary treatment modality, administered to 76.67% of participants, with an average door-to-needle time of 78 ± 63 min. Conclusion: Multiple hospital referrals and inadequate EMS utilization hinder optimal ACS management. This study underscores the need for a streamlined referral process, enhanced EMS infrastructure, reduced door-to-needle time, and targeted interventions to mitigate financial barriers to ACS care in India.