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The purpose of this study was to compare short-term clinical outcomes between total hip arthroplasty (THA) and total knee arthroplasty (TKA) patient cohorts, adjusting for confounding variables including age, sex, body mass index, operative time, length of stay, and preoperative Western Ontario and McMaster Universities and 12-Item Short-Form Health Survey. A total of 349 patients who met inclusion and exclusion criteria created 2 cohorts: THA, 194, and TKA, 155, for statistical analysis via multiple regression and analysis of covariance measures. Outcome measures included Western Ontario and McMaster Universities and 12-Item Short-Form Health Survey data, collected prospectively at baseline and 2 years of follow-up. The current study showed that baseline characteristics of TKA patients have more factors with negative effect on postoperative outcome than THA. However, despite controlling for the possible confounding effect of these variables, THA patients experienced a significantly better functional outcome than TKA patients.

Intraarticular hip disease is commonly acknowledged as a cause of ipsilateral knee pain. However, this is based primarily on observational rather than high-quality evidence-based studies, and it is unclear whether ipsilateral knee pain improves when hip disease has been treated.We asked whether (1) hip disease was associated with preoperative ipsilateral knee pain and (2) ipsilateral knee pain would improve after hip arthroplasty.We retrospectively assessed knee pain in 255 patients who underwent hip arthroplasties between 2006 and 2008. The WOMAC pain score of each joint was the primary outcome measure, which was obtained prospectively before surgery and at 3 months and 1 year postoperatively. Of the 255 patients, 245 (96%) had followup data obtained at 3 months or 1 year.Preoperatively, ipsilateral knee pain was observed more frequently than contralateral knee pain (55% versus 18%). Preoperative ipsilateral knee pain scores were worse than contralateral knee pain scores (mean, 80 versus 95). Ipsilateral knee pain improved at 3 months and 1 year. When compared with the scores for contralateral knee pain at 3 months (95) and 1 year (96), there were no differences between knees.Our observations suggest hip disease is associated with ipsilateral knee pain and that it improves after hip arthroplasty. This should be considered during preoperative evaluation for patients with hip and knee pain.Level III, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

The purposes of this study were to evaluate the accuracy and reliability of preoperative templating on conventional radiographs (CRs) for metal-on-metal hip resurfacing and to determine the factors affecting the accuracy. Four observers templated 80 CRs on 2 separate occasions in a blinded fashion. Eight independent variables were evaluated to investigate their effect on the accuracy of templating. The overall accuracy of templating within one size of the actual component was 80.6% for the femoral component and 98.5% for the acetabular component. Overall, the intraobserver and interobserver reliability was fair to substantial (κ = 0.22-0.61). Using multiple regression analysis, surgical time was the only factor that affected the accuracy of predicting the size of the acetabular component (P = .019). We conclude that CR templating for metal-on-metal hip resurfacing is a useful method for preoperative planning of the sizes of the respective implants and that surgeon experience does play a significant role in the accuracy of predicting component size during templating.

The purpose of this study was to investigate factors affecting the short-term outcome of primary total hip arthroplasty (THA) and develop a multivariate regression equation to predict the short-term outcome of primary THA. Prospectively collected data for 101 primary THAs performed at a single institution were used in this study. Twelve independent variables were analyzed via correlation and multivariate regression analyses. Correlation analyses showed that three variables significantly influenced Western Ontario and McMaster Universities Osteoarthritis (WOMAC) physical function (PF) score at minimum follow-up of 1 year: preoperative WOMAC PF score (P < .0001), sex (GN, P = .0159), and the presence of preoperative comorbidities (CMB, P = .0246). Multivariate regression analysis yielded the following equation: Outcome = PF0.45 - GN9 + CMB8 + 62, which can be used to predict the general short-term outcome of primary THA.

Thoracic ossification of ligamentum flavum (OLF) caused by skeletal fluorosis is rare. Only six patients had been reported in the English literature. This study reports findings from the first clinical series of this disease. This was a retrospective study of patients with thoracic OLF due to skeletal fluorosis who underwent surgical management at the authors' hospital between 1993 and 2003. Diagnosis of skeletal fluorosis was made based on the epidemic history, clinical symptoms, radiographic findings, and urinalysis. En bloc laminectomy decompression of the involved thoracic levels was performed in all cases. Cervical open door decompression or lumbar laminectomy decompression was performed if relevant stenosis was present. Neurological status was evaluated preoperatively, at the third day postoperatively, and at the end point of follow-up using the Japanese Orthopaedic Association (JOA) scoring system of motor function of the lower extremities. A total of 23 cases were enrolled, 16 (69.6%) males and 7 (30.4%) females, age ranging from 42 to 72 years (mean 54.8 years). All patients came from a high-fluoride area, and 22 (95.7%) had dental fluorosis. Medical imaging showed OLF together with ossification of many ligaments and interosseous membranes, including interosseous membranes of the forearm (18/23 patients 78.3%), leg (14/23 patients 60.9%), and ribs (11/23 patients 47.8%). OLF was classified into five types based on MRI findings: localized (4/23 patients 17.4%), continued (12/23 patients 52.2%), skip (3/23 patients 13.0%), combining with anterior pressure (2/23 patients 8.7%), and combining with cervical and/or lumbar stenosis (2/23 patients, 8.7%). Urinalysis showed a markedly high urinary fluoride level in 14 of 23 patients (60.9%). Patients were followed up for an average duration of 4 years, 5 months. Paired t-test showed that the JOA score was slightly but nonsignificantly increased relative to preoperative measurement 3 days after surgery (P = 0.0829) and significantly increased at the end of follow-up (P = 0.0001). In conclusion, Fluorosis can cause ossification of thoracic ligamentum flavum, as well as other ligaments. Comparing with other OLF series, a larger number of spinal segments were involved. The diagnosis of skeletal fluorosis was made by the epidemic history, clinical symptom, imaging study findings, and urinalysis. En bloc laminectomy decompression was an effective method.

Hyoid bone fractures secondary to blunt trauma other than strangulation are rare. Only 27 cases have been reported in the literature. They have few, if any, complications, such as dysphagia, hypoxia, cardiorespiratory collapse, laceration of the pharynx, mandibular fracture, thyroid cartilage fracture, and facial fracture. No report of hyoid bone fracture associated with spinal column injury was reported in the English literature. The authors reported a 46-year-old male patient who complained of neck pain and odynophagia after a traffic accident. After systemic examination and cervical CT scan, the diagnosis of hyoid bone fracture at the right great horn and atlantoaxial subluxation was made. The patient was observed in ICU for 48 hours. A nasogastric tube was inserted for feeding. Fifteen milligrams of dexamethasone was given once a day for 3 days to reduce the swelling and pain. We performed a cutaneous traction for the subluxation and carefully watched the hyoid bone and the patient's respiration. No lethal complications occurred. Two weeks later, the patient was allowed to ambulate with cervical collar protection and to resume oral intake. Three months later, he was asymptomatic. This case, with hyoid fracture and atlantoaxial subluxation, is the only case reported in the literature. The importance of hyoid fracture, however, rests not with the rarity of it, but with the lethal potential of missing diagnosis. Nonsurgical management may be effective in most of the cases.

Few studies about how heterotopic ossification (HO) affects functional outcome after metal-on-metal total hip resurfacing (MOMHR) have been reported. The purpose of this study was to evaluate the incidence and clinical significance of HO after MOMHR. We retrospectively reviewed 122 consecutive patients, who underwent MOMHR from June 2006 to October 2008, with adequate follow-up information. All patients had four weeks of aspirin (325 mg twice a day) for DVT prophylaxis and two weeks of celecoxib (400 mg once a day) for pain control. All data were collected prospectively including radiographs and functional scores preoperatively, at three months and at one year postoperatively. An independent musculoskeletal radiologist, using the Brooker classification, reviewed radiographs. Unbalanced ANOVA analyses were performed to evaluate the effect of HO on outcome. The overall incidence of HO at three months was 62.1% (grade 1:39.8%, grade 2:20.4%, grade 3:1.9%) and 75% at one year (grade 1: 41.7%, grade 2: 27.8%, grade 3: 5.5%). There were no significant differences in the functional status scores among Brooker grade 0 to 3 groups at three months and one year follow-up. The incidence of HO after MOMHR was 62.1% at three months and 75% at one year despite a post-operative regimen of aspirin and celecoxib. We found no evidence that predominantly Brooker grade 1 or 2 HO affected the clinical outcome at three months or one year when compared across all Brooker classes of patients.

To track the short-term neck narrowing changes in Birmingham metal-on-metal hip resurfacing (MOMHR) patients.Since 2001, the Center for Hip and Knee Replacement started a registry to prospectively collect data on hip and knee replacement patients. From June 2006 to October 2008, 139 MOMHR were performed at our center by two participate surgeons using Birmingham MOMHR prosthesis (Smith Nephew, United States). It is standard of care for patients to obtain low, anteriorposterior (LAP) pelvis radiographs immediately after MOMHR procedure and then at 3 mo, 1 year and 2 year follow up office visits. Inclusion criteria for the present study included patients who came back for follow up office visit at above mentioned time points and got LAP radiographs. Exclusion criteria include patients who missed more than two follow up time points and those with poor-quality X-rays. Two orthopaedic residency trained research fellows reviewed the X-rays independently at 4 time points, i.e., immediate after surgery, 3 mo, 1 year and 2 year. Neck-to-prosthesis ratio (NPR) was used as main outcome measure. Twenty cases were used as subjects to identify the reliability between two observers. An intraclass correlation coefficient at 0.8 was considered as satisfied. A paired t-test was used to evaluate the significant difference between different time points with P0.05 considered to be statistically significant.The mean NPRs were 0.852 ± 0.056, 0.839 ± 0.052, 0.835 ± 0.051, 0.83 ± 0.04 immediately, 3 mo, 1 year and 2 years post-operatively respectively. At 3 mo, NPR was significantly different from immediate postoperative X-ray (P0.001). There was no difference between 3 mo and 1 year (P = 0.14) and 2 years (P = 0.53). Femoral neck narrowing (FNN) exceeding 10% of the diameter of the neck was observed in only 4 patients (5.6%) at two years follow up. None of these patients developed a femoral neck fracture (FNF).Femoral neck narrowing after MOMHR occurred as early as 3 mo postoperatively, and stabilized thereafter. Excessive FNN was not common in patients within the first two years of surgery and was not correlated with risk of FNF.

To identify factors that affect patient response rates to preoperative functional surveys in hip and knee arthroplasty patients.From May 2008 to March 2009, 247 patients were scheduled more than 4 wk in advance for hip or knee arthroplasty by one of two participating surgeons at our center. A personalized questionnaire comprised of the Short Form 12 (SF-12) and Western Ontario and McMaster Universities (WOMAC) Index was mailed to patients at random time points ranging from 7 to 101 d prior to surgery. Nine independent factors were documented prospectively, including age, gender, ethnicity, marital status, type of surgery, surgeon, days prior to surgery (DPS) of survey mailing, WOMAC score and SF-12 score. The date of the completed survey receipt was also documented. For non-responders, the surveys were completed with the research team at the hospital upon admission. Multivariate regression and χ(2) analysis were performed with Statistical Analysis Software software.DPS was the only factor that affected patient response. Mailing surveys 26 d to 31 d prior to surgery dates led to a peak response rate of 80% that was significantly higher (P0.023) than response rates for patients who were mailed their surveys ≤ 16 d (62.5%), 17 d to 25 d (70%) or ≥ 32 d prior to surgery (55%). No other factors, including preoperative WOMAC and SF-12 scores, significantly influenced response behavior.The DPS was independently the most significant predictor of response rates for pre-operative functional data among patients scheduled for hip and knee arthroplasty.

Total knee arthroplasty (TKA) can lead to substantial blood loss. To avoid the high costs of autologous blood predonation programs and efficiently allocate limited blood resources, we sought to identify preoperative and intraoperative factors associated with allogeneic blood transfusion (AllTx) after primary TKA and, subsequently, develop a model to predict patients who will require AllTx. We analyzed 31 independent variables in 644 primary unilateral TKAs without autologous blood predonation for requirement of AllTx. Seventy-one procedures (11.0%) required AllTx. Age, comorbid anemia, preoperative hemoglobin concentration, and surgical time were significant predictors for requiring AllTx. When applied to an independent cohort, our model for predicting the need for AllTx after TKA was 90% sensitive and 52.5% specific.

To evaluate the clinical feature, operative method and prognosis of thoracic ossification of ligamentum flavum caused by skeletal fluorosis. All the patients with thoracic OLF, who underwent surgical management in the authors' hospital from 1993–2003, were retrospectively studied. The diagnosis of skeletal fluorosis was made by the epidemic history, clinical symptoms, radiographic findings, and urinalysis. En bloc laminectomy decompression of the involved thoracic levels was performed in all cases. Cervical open door decompression or lumbar laminectomy decompression was performed if relevant stenosis existed. The neurological statuses were evaluated with the Japanese Orthopaedic Association (JOA) scoring system preoperatively and at the end point of follow up. Also, the recovery rate was calculated. 23 cases have been enrolled in this study. Imaging study findings showed all the cases have ossification of ligamentum flavum together with ossification of many other ligaments and interosseous membranes, i.e. interosseous membranes of the forearm in 18 of 23 (78.3%), of the leg in 14 of 23 (60.1%) and of the ribs in 11 of 23 (47.8%). Urinalysis showed markedly increased urinary fluoride in 14 of 23 patients (60.9%). All the patients were followed up from 12 months to 9 years and 3 months, with an average of 4 years and 5 months. The JOA score increased significantly at the end of follow up (P = 0.0001). The recovery rate was 51.83 ± 32.36%. Multiple regression analysis revealed that the preoperative JOA score was an important predictor of surgical outcome (p = 0.0022, r = 0.60628). ANOVA analysis showed that patients with acute onset or too long duration had worse surgical result (P = 0.0003). Fluorosis can cause ossification of thoracic ligamentum flavum, as well as other ligaments. En bloc laminectomy decompression was an effective method. Preoperative JOA score was the most important predictor of surgical outcome. Patients with acute onset or too long duration had worse surgical outcome.

AIM: To determine whether there is a functional difference between patients who actively follow-up in the office (OFU) and those who are non-compliant with office follow-up visits (NFU). METHODS: We reviewed a consecutive group of 588 patients, who had undergone total joint arthroplasty (TJA), for compliance and functional outcomes at one to two years post-operatively. All patients were given verbal instructions by the primary surgeon to return at one year for routine follow-up visits. Patients that were compliant with the instructions at one year were placed in the OFU cohort, while those who were non-compliant were placed in the NFU cohort. Survey mailings and telephone interviews were utilized to obtain complete follow-up for the cohort. A χ2 test and an unpaired t test were used for comparison of baseline characteristics. Analysis of covariance was used to compare the mean clinical outcomes after controlling for confounding variables. RESULTS: Complete follow-up data was collected on 554 of the 588 total patients (93%), with 75.5% of patients assigned to the OFU cohort and 24.5% assigned to the NFU cohort. We found significant differences between the cohorts with the OFU group having a higher mean age (P = 0.026) and a greater proportion of females (P = 0.041). No significant differences were found in either the SF12 or WOMAC scores at baseline or at 12 mo postoperative. CONCLUSION: Patients who are compliant to routine follow-up visits at one to two years post-operation do not experience better patient reported outcomes than those that are non-compliant. Additionally, after TJA, older women are more likely to be compliant in following surgeon instructions with regard to follow-up office care.

Purpose To evaluate the clinical feature, operative method and prognosis of thoracic ossification of ligamentum flavum caused by skeletal fluorosis. Methods All the patients with thoracic OLF, who underwent surgical management in the authors' hospital from 1993–2003, were retrospectively studied. The diagnosis of skeletal fluorosis was made by the epidemic history, clinical symptoms, radiographic findings, and urinalysis. En bloc laminectomy decompression of the involved thoracic levels was performed in all cases. Cervical open door decompression or lumbar laminectomy decompression was performed if relevant stenosis existed. The neurological statuses were evaluated with the Japanese Orthopaedic Association (JOA) scoring system preoperatively and at the end point of follow up. Also, the recovery rate was calculated. Results 23 cases have been enrolled in this study. Imaging study findings showed all the cases have ossification of ligamentum flavum together with ossification of many other ligaments and interosseous membranes, i.e. interosseous membranes of the forearm in 18 of 23 (78.3%), of the leg in 14 of 23 (60.1%) and of the ribs in 11 of 23 (47.8%). Urinalysis showed markedly increased urinary fluoride in 14 of 23 patients (60.9%). All the patients were followed up from 12 months to 9 years and 3 months, with an average of 4 years and 5 months. The JOA score increased significantly at the end of follow up (P = 0.0001). The recovery rate was 51.83 ± 32.36%. Multiple regression analysis revealed that the preoperative JOA score was an important predictor of surgical outcome (p = 0.0022, r = 0.60628). ANOVA analysis showed that patients with acute onset or too long duration had worse surgical result (P = 0.0003). Conclusion Fluorosis can cause ossification of thoracic ligamentum flavum, as well as other ligaments. En bloc laminectomy decompression was an effective method. Preoperative JOA score was the most important predictor of surgical outcome. Patients with acute onset or too long duration had worse surgical outcome.

Dear sir, Kuh et al. [1] treated 19 thoracic OLF patients from 1998 to 2002, and retrospectively reviewed the patients age, sex, symptom duration, involved disease level, preoperative clinical features, neurological findings, radiological findings, the other combined spinal diseases and the surgical outcomes. The authors classified the OLF into three types: unilateral, bilateral and bridge type. In their series, there was no relationship between OLF type and the surgical outcome statistically, but the unilateral types and the single lesion of thoracic OLF was thought to be a relatively favorable factor to the surgical outcome. In the past 12 years, 74 cases of OLF underwent en-bloc decompression in our hospital. We performed CT scan in every case. However, we found the CT shape of the ossified ligaments changing according to the different scan planes. We found different types on different planes in one patient (Fig. 1). We think that this may be the reason for no relationship between OLF type and the surgical outcome. We wonder whether the authors also found these phenomena, and how they classified the patients in those cases. Fig. 1 Different CT scan plane showed different type of ossification in one patient. According to the authors typing system, a the plane through pedicle showed bilateral type ossification, b the plane through the intervertebral disc showed bridge type ossification ...

Osteoma is a common benign tumor. It occurs dominantly at the skull bone. Outside skull osteoma is rare, and primary intra-canal osteoma is extremely rare. To the author’s knowledge, only 14 cases of osteomas of the spine had been reported, in which only seven cases were in English literature. The authors reported two rare cases of intra-canal osteoma of the upper cervical spine with cord compression. Included are pertinent history, physical examination, rontgenographic evaluation before and after operation, surgical interventions, pathological study, and outcome. The available literature is also reviewed. On systemic examination and rontgenographic study, these two cases were found to have bone tumor in the upper cervical canal. Surgical interventions were performed, one with an en bloc excision, the other with a subtotal excision. The pathological study demonstrated a diagnosis of osteoma. After a follow-up with 20 and 15 months, the clinical symptoms of both cases significantly improved.

In this paper, we first introduce the definition of quantum information optics and expound the essential distinction between quantum and classical information optics. Secondly, the five great subjects on the research of quantum information optics are summarized. Finally, the recent experimental progress on the preparation (or generation) of quantum states (or quantum information) in some semiconductor devices and materials are introduced and reviewed in detail.© (1996) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

Object The authors evaluated different surgical methods used to treat thoracic ossification of the ligamentum flavum (OLF). Methods Data obtained in 40 patients who underwent posterior decompression for thoracic myelopathy caused by thoracic OLF were studied retrospectively. There were 32 men and eight women. All patients underwent posterior decompression in which laminoplasty was performed or laminectomy combined with lateral fusion. Every surgical specimen was stained with H & E, and scanning electron microscopy was performed in 20 cases. The mean follow-up period was 28 months. Postoperative outcomes were evaluated using a recovery scale based on the Japanese Orthopaedic Association classification. There were a total of 168 ossified segments in this series, 77.4% of which were located in the lower thoracic spine. Marginal osteophyte formation was found in 36 patients; in 32 of the 36 patients, these marginal osteophytes were located at the intervertebral space either higher or lower than the ossified segment. Scanning electron microscopy showed elastic fiber breakdown, proliferation of collagenous fibers, calcification, and OLF in the same microscopy region. Laminoplasty was performed in four patients. In three cases surgery resulted in unchanged or worse outcome (increased kyphotic deformity in two), and in one it resulted in good outcome. Laminectomy combined with lateral fusion was performed in 36 patients, in 30 cases of which it resulted in a good or fair outcome, and increased kyphotic deformity in only one. Of these 36 laminectomy-treated patients, an en bloc laminectomy-treated procedure was performed in 16 patients; in 11 of the 12 patients with lateral or diffuse-type lesions the surgery resulted in a good or fair outcome. En bloc laminectomy, however, seems ineffective in the treatment of patients with thickened, nodular-type thoracic OLF, as the procedure resulted in worse outcome in two of the four patients. The authors have thus developed a new modality of laminectomy that they have termed “separating laminectomy,” which they performed in 16 patients with thickened, nodular-type OLF; in 13 cases it resulted in a good or fair outcome, and in only one case did it result in a worse outcome. Conclusions The pathogenesis of thoracic OLF is mainly due to the localized mechanical stress on the ligament. Laminectomy combined with lateral fusion is the treatment of choice for thoracic OLF; furthermore, in terms of the configuration of the ossified lesion, en bloc laminectomy is suitable for the treatment of lateral-type and diffuse-type OLF, and the separating laminectomy is suitable for the thickened, nodular-type OLF.