Uğur Yüzügüldü, Enes Keleş, Harun Yasin Tüzün
et al.
Abstract Background This study aims to comprehensively examine the distal femoral valgus cut angle (VCA) utilized during total knee arthroplasty (TKA) in the Turkish population and identify the radiological and demographic factors influencing this critical surgical parameter. Methods A retrospective analysis was performed on 193 lower extremity orthoradiographs from 120 patients diagnosed with end-stage knee osteoarthritis between January 2020 and December 2023. Key radiological variables assessed included VCA, mechanical femorotibial angle (MTFA), neck-shaft angle (NSA), medial offset (MO), and lateral distal femoral angle (LDFA). Results The mean VCA was 6.48 ± 0.83 degrees, with no statistically significant differences observed between genders (p = 0.755). A moderate negative correlation was identified between VCA and NSA (r = − 0.423, p < 0.001), while weak to moderate positive correlations were observed between VCA and both MO (r = 0.337, p < 0.001) and LDFA (r = 0.307, p = 0.002). No significant associations were found between VCA and the other evaluated parameters. Conclusions The results highlight the necessity of personalized assessment of VCA during TKA to optimize radiological outcomes, as opposed to a standardized approach. In the Turkish population, VCA is primarily influenced by NSA, MO, and LDFA, with coronal plane deformities showing no significant effect. This study emphasizes the importance of considering patient-specific anatomical variations during preoperative planning.
Orthopedic surgery, Diseases of the musculoskeletal system
This paper computes the Jones polynomial and the invariants obstructing cosmetic surgery which are derived from it for two infinite families of knots, proving they satisfy the Purely Cosmetic Surgery Conjecture. Both the method of computation and the method for generating families of knots extend.
The emerging field of quantum resource estimation is aimed at providing estimates of the hardware requirements (`quantum resources') needed to execute a useful, fault-tolerant quantum computation. Given that quantum computers are intended to compete with supercomputers, useful quantum computations are likely to involve the use of millions of qubits and error correction clock cycles. The compilation and benchmarking of these circuits depends on placement and routing algorithms, which are infeasible to construct at scale by hand. We offer a compiler that transforms a quantum circuit into a sequence of lattice surgery operations. The compiler manages memory in terms of surface code patches and costs the space-time volume and cycle counts of the input circuits. These compiled lattice surgery objects are then recursively repurposed as gates for larger scale compilations. Our code is available on GitHub under a permissive software license and we welcome community contributions.
Noriaki Yokogawa, Takeshi Sasagawa, Hiroyuki Hayashi
et al.
Introduction: Cervical spinal cord injury (CSCI) without major bone injury is increasing among older adults, particularly in aging societies like Japan. The optimal treatment strategies remain unclear, with conservative therapy often preferred, especially for older patients. However, surgery is frequently necessary due to poor improvement or progression of paralysis during conservative treatment. This study investigated the characteristics and outcomes of older patients with CSCI without major bone injury who transitioned from conservative treatment to surgery.
Methods: This nationwide, retrospective study examined data from patients aged 65 years with CSCI without major bone injury. The patients were categorized into 3 groups: conservative treatment, planned surgery, and those who switched from conservative treatment to surgery. The study aimed to identify the risk factors for conservative therapy failure that necessitate surgical intervention and to compare the outcomes between patients who had planned surgery and those who required surgery after conservative management failed.
Results: Among 615 patients, 422 (68.6%) received conservative treatment, 193 (31.4%) had planned surgery, and 116 (18.9%) transitioned from conservative to surgical treatment. Transition to surgery was mainly due to poor improvement or progression of neurological deficits. Significant risk factors for transitioning to surgery included younger age, presence of ossification of the posterior longitudinal ligament, and spinal cord signal changes on magnetic resonance imaging. Comparative analysis showed no significant differences in neurological outcomes between patients who had surgery as planned and those who required surgery after failed conservative treatment.
Conclusions: A significant proportion of older patients with CSCI without major bone injury who were initially managed conservatively eventually required surgery due to insufficient neurological improvement. The outcomes of patients who transitioned to surgery were similar to those who had surgery as initially planned, indicating that careful monitoring of conservative treatment followed by surgery, if necessary, may be an effective approach.
Chennur SMS Mazhar, Satish Koti, Raghavendra Raju RP
et al.
Nonossifying fibromas (NOFs) usually occur in the metaphysis of long bones of children and adolescents. These are benign fibrous proliferations and can simulate primary neoplasms of bone. Hence, it is important to recognize the clinical, radiological, and histopathological characteristics of this lesion. Here we are presenting a case of NOF in a 16-year-old female who presented to us with left forearm pain and swelling. Following radiological evaluation, there was a pathological fracture in the ulna with a metadiaphyseal lytic lesion. An open biopsy was done. The histopathological examination confirmed it to be NOF of ulna.
Vikas Warikoo, Jebin Aron, Abhijeet Salunke
et al.
Introduction: Currently, there is no consensus whether timing, fracture displacement & union of pathological fractures affects outcomes in patients with osteosarcoma of the extremities. Material and methods: A systematic review was conducted to assess the impact of fracture timing, displacement, and union on oncologic outcomes in osteosarcoma patients. The review included a total of 417 patients, 117 of whom had pathological fractures. The prevalence of pathological fractures in osteosarcoma was found to be 28 %. Results: Among the patients with fractures, 68 % had fractures at presentation, while 32 % developed fractures during treatment. In this study, 31 % of the fractures were displaced, while 69 % were undisplaced. Adequate surgical margins were achieved in 91 % of cases with pathological fractures. However, no statistically significant correlation was found between the timing of fracture development, fracture displacement, or fracture union with local recurrence or mortality rates. Conclusion: This systematic review found no significant association between the timing of fracture development, fracture displacement, or fracture union with local recurrence or mortality outcomes in osteosarcoma patients. Further research is needed to investigate the role of factors such as tumor size and hematoma in oncologic outcomes. The timing of fracture and other relevant fracture characteristics are may be the subject of evaluation in further trials.
The Cyclic Surgery Theorem and Moser's work on surgeries on torus knots imply that for any non-trivial knot in $S^3$, there are at most two integer surgeries that produce a lens space. This paper investigates how many positive integer surgeries on a given knot in $S^3$ can produce a manifold rational homology cobordant to a lens space. Tools include Greene and McCoy's work on changemaker lattices which come from Heegaard Floer $d$-invariants, and Aceto-Celoria-Park's work on rational cobordisms and integral homology which is based on Lisca's work on lens spaces.
In ``Knots in lattice homology", Ozsváth, Stipsicz, and Szabó showed that knot lattice homology satisfies a surgery formula similar to the one relating knot Floer homology and Heegaard Floer homology, and in previous work, I showed that knot lattice homology is the persistent homology of a doubly filtered space. Here I provide an iterable version of the surgery formula that, provided the initial knot lattice space with flip map, produces a space isomorphic as a doubly-filtered space to the corresponding knot lattice space for the dual knot with the corresponding flip map. If we include the involutive data for the original knot and ambient three-manifold, we can also produce the corresponding involutive data on the new knot lattice space without assuming that the original three-manifold is an $L$-space. I construct $\infty$-categories where these operations are functorial. Finally, I use the surgery formula to compute some examples of knot lattice spaces including for the regular fiber of $Σ(2,3,7)$ and for a knot in a three-manifold that is not given by an almost rational graph.
Lindsay M. Clarke, Resa M. Jones, Shivayogi V. Hiremath
et al.
(1) Background: Despite evidence of increased rates of sports injury during the years surrounding peak growth in adolescents, little is known regarding the relationship between adolescent growth and gait stability. The aim of this study was to gain a better understanding of how chronological age and height relate to gait stability in both male and female adolescents. (2) Methods: Participants (N = 67; females: <i>n</i> = 34, ages 8.7–15.9 years; males: <i>n</i> = 33, ages 10.0–16.7 years) completed two trials of treadmill walking at varying speeds: the preferred walking speed and 30% above and below. Trials were separated by a bout of fatiguing exercises. HarmonicRatios of the trunk, calculated from acceleration signals taken during walking, were used to quantify gait stability. Data were separated by sex and relationships between height and chronological age, and HarmonicRatios were assessed using multiple linear regression. (3) Results: Females’ HarmonicRatios improved with chronological age both before and after fatigue. Males’ HarmonicRatios increased with chronological age before fatigue; however, this effect was eliminated post-fatigue. Females’ height was negatively associated with HarmonicRatios post-fatigue. Males’ height was positively associated with HarmonicRatios pre-fatigue. (4) Conclusions: The study findings suggest sex differences in the effects of fatigue on gait stability during adolescence. In both sexes, HarmonicRatios increased with chronological age. These improvements were eliminated for males and altered for females with fatigue. The results of this study indicate the need for the reevaluation of sports progression based on chronological age in adolescents.
Numerous adolescents diagnosed with adolescent idiopathic scoliosis (AIS) often manifest symptoms indicative of functional gastrointestinal disorders (FGIDs). However, the precise connection between FGIDs and AIS remains unclear. The study involved adolescents drawn from sample datasets provided by the Korean Health Insurance Review and Assessment Service spanning from 2012 to 2016, with a median dataset size of 1,446,632 patients. The AIS group consisted of individuals aged 10 to 19 with diagnostic codes for AIS, while the control group consisted of those without AIS diagnostic codes. The median prevalence of FGIDs in adolescents with AIS from 2012 to 2016 was 24%. When accounting for confounding factors, the analysis revealed that adolescents with AIS were consistently more prone to experiencing FGIDs each year (2012: adjusted odds ratio (aOR), 1.21 [95% confidence interval (CI), 1.10–1.35], <i>p</i> < 0.001; 2013: aOR, 1.31 [95% CI, 1.18–1.46], <i>p</i> < 0.001; 2014: aOR, 1.24 [95% CI, 1.12–1.38], <i>p</i> < 0.001; 2015: aOR, 1.34 [95% CI, 1.21–1.49], <i>p</i> < 0.001; and 2016: aOR, 1.35 [95% CI, 1.21–1.50], <i>p</i> < 0.001). These findings suggest that AIS is correlated with an elevated likelihood of FGIDs, indicating that AIS may function as a potential risk factor for these gastrointestinal issues. Consequently, it is recommended to provide counseling to adolescents with AIS, alerting them to the heightened probability of experiencing chronic gastrointestinal symptoms.
Adam I. Edelstein, Alexander D. Orsi, Christopher Plaskos
et al.
Abstract Background The coronal plane alignment of the knee (CPAK) classification was first developed using long leg radiographs (LLR) and has since been reported using image-based and imageless robotic total knee arthroplasty (TKA) systems. However, the correspondence between imageless robotics and LLR-derived CPAK parameters has yet to be investigated. This study therefore examined the differences in CPAK parameters determined with LLR and imageless robotic navigation using either generic or optimized cartilage wear assumptions. Methods Medial proximal tibial angle (MPTA) and lateral distal femoral angle (LDFA) were determined from the intraoperative registration data of 61 imageless robotic TKAs using either a generic 2 mm literature-based wear assumption (Navlit) or an optimized wear assumption (Navopt) found using an error minimization algorithm. MPTA and LDFA were also measured from preoperative LLR by two observers and intraclass correlation coefficients (ICCs) were calculated. MPTA, LDFA, joint line obliquity (JLO), and arithmetic hip-knee-ankle angle (aHKA) were compared between the robotic and the average LLR measurements over the two observers. Results ICCs between observers for LLR were over 0.95 for MPTA, LDFA, JLO, and aHKA, indicating excellent agreement. Mean CPAK differences were not significant between LLR and Navlit (all differences within 0.6°, P > 0.1) or Navopt (all within 0.1°, P > 0.83). Mean absolute errors (MAE) between LLR and Navlit were: LDFA = 1.4°, MPTA = 2.0°, JLO = 2.1°, and aHKA = 2.7°. Compared to LLR, the generic wear classified 88% and the optimized wear classified 94% of knees within one CPAK group. Bland–Altman comparisons reported good agreement for LLR vs. Navlit and Navopt, with > 95% and > 91.8% of measurements within the limits of agreement across all CPAK parameters, respectively. Conclusions Imageless robotic navigation data can be used to calculate CPAK parameters for arthritic knees undergoing TKA with good agreement to LLR. Generic wear assumptions determined MPTA and LDFA with MAE within 2° and optimizing wear assumptions showed negligible improvement.
Abstract Background There are many classification systems for atlantoaxial dislocation (AAD). Among these systems, the definitions of irreducible AAD remain vague, and its treatments are not unified. Objective To explore the surgical strategies and efficacy for the treatment of os odontoideum (OO) with AAD. Methods The clinical data of 56 OO patients with AAD who underwent surgery from January 2017 to June 2021 were retrospectively analyzed. AAD was classified into four types, Type I and type II were treated with posterior fixation and fusion. Type III received posterior fixation and fusion after irreducible dislocations were converted to reducible dislocations by translateral mass release or transoral release. Type IV required transoral release for conversion into reducible dislocations before posterior fixation and fusion. The operation time, blood loss, and complications were recorded. The preoperative and postoperative neurological function changes were assessed using the Japanese Orthopedic Association (JOA) score. Postoperative fusion status was assessed by X-ray. Results There were 40 cases of type I-II, 14 cases of type III, and two cases of type IV AAD. The operation times of single posterior fixation and fusion, combined translateral mass release and combined transoral release were 130.52 ± 37.12 min, 151.11 ± 16.91 min and 188.57 ± 44.13 min, the blood loss were 162.63 ± 58.27 mL, 235.56 ± 59.94 mL, 414.29 ± 33.91 mL, respectively. One patient with type III died, one with type III underwent revision surgery due to infection, and three patients with type I had further neurological deterioration after operation. fifty-five patients were followed up for 12–24 months. The follow-up results showed that enough decompression was achieved and that fixation and fusion were effective. The JOA score increased from 9.58 ± 1.84 points preoperative to 13.09 ± 2.68 points at 3 months after operation, 14.07 ± 2.83 points at 6 months and 14.25 ± 2.34 at 12 months after operation, all significant differences compared with preoperative results (P < 0.05). Conclusion OO patients with irreducible AAD can be treated by translateral mass release or transoral release combined with posterior fixation and fusion, while some of those with bony fusion can be treated by transoral release combined with posterior fixation and fusion.
Orthopedic surgery, Diseases of the musculoskeletal system
Abstract Background Systemic vancomycin administration pre-operatively for the infection prophylaxis of spinal implant surgery remains unsatisfactory. This study aimed to explore the efficacy and dosage of local use of vancomycin powder (VP) in preventing surgical site infections after spinal implant surgery in a rat model. Methods Systemic vancomycin (SV; intraperitoneal injection, 88 mg/kg) or intraoperative intra-wound VP (VP0.5: 44 mg/kg, VP1.0: 88 mg/kg, VP2.0: 176 mg/kg) was applied after spinal implant surgery and methicillin-resistant S. aureus (MRSA; ATCC BAA-1026) inoculation in rats. General status, blood inflammatory biomarkers, microbiological and histopathological evaluation were performed during 2 weeks post-surgery. Results No post-surgical deaths, wound complications and obvious signs of vancomycin adverse effects were observed. Bacterial counts, blood and tissue inflammation were reduced in the VP groups compared with the SV group. VP2.0 group showed better outcomes in weight gain and tissue inflammation than the VP0.5 and VP1.0 group. Microbial counts indicated that no bacteria survived in the VP2.0 group, whereas MRSA was detected in VP0.5 and VP1.0 groups. Conclusions Intra-wound VP may be more effective than systemic administration in preventing infection caused by MRSA (ATCC BAA-1026) after spinal implant surgery in a rat model.
Orthopedic surgery, Diseases of the musculoskeletal system
Sukij Laohajaroensombat, Suwimol Prusmetikul, Sasivimol Rattanasiri
et al.
Abstract Background Platelet-rich plasma (PRP) injection for ankle osteoarthritis (OA) treatment showed contradictory results. This review was aimed to pool individual studies which assessed the efficacy of PRP for ankle OA treatment. Methods This study was conducted following the preferred report items of systematic review and meta-analysis guideline. PubMed and Scopus were searched up to January 2023. Meta-analysis, or individual randomised controlled trial (RCT), or observational studies were included if they involved ankle OA with aged ≥ 18 years, compared before–after receiving PRP, or PRP with other treatments, and reported visual analog scale (VAS) or functional outcomes. Selection of eligible studies and data extraction were independently performed by two authors. Heterogeneity test using Cochrane Q test and the I 2-statistic were assessed. Standardised (SMD) or unstandardised mean difference (USMD) and 95% confidence interval (CI) were estimated and pooled across studies. Results Three studies from meta-analysis and two individual studies were included, which consisted of one RCT and four before–after studies with 184 ankle OAs and 132 PRP. The average age was 50.8–59.3 years, and 25–60% of PRP injected cases were male. The number of primary ankle OA was accounted to 0–100%. When compared to before treatment, PRP significantly reduced VAS and functional score at 12 weeks with pooled USMD of − 2.80, 95% CI − 3.91, − 2.68; p < 0.001 (Q = 82.91, p < 0.001; I 2 96.38%), and pooled SMD of 1.73, 95% CI 1.37, 2.09; p < 0.001 (Q = 4.87, p = 0.18; I 2 38.44%), respectively. Conclusion PRP may beneficially improve pain and functional scores for ankle OA in a short-term period. Its magnitude of improvement seems to be similar to placebo effects from the previous RCT. A large-scale RCT with proper whole blood and PRP preparation processes is required to prove treatment effects. Trial registration PROSPERO number CRD42022297503.
Orthopedic surgery, Diseases of the musculoskeletal system
Orsola Capovilla-Searle, Noémie Legout, Maÿlis Limouzineau
et al.
Given an immersed, Maslov-$0$, exact Lagrangian filling of a Legendrian knot, if the filling has a vanishing index and action double point, then through Lagrangian surgery it is possible to obtain a new immersed, Maslov-$0$, exact Lagrangian filling with one less double point and with genus increased by one. We show that it is not always possible to reverse the Lagrangian surgery: not every immersed, Maslov-$0$, exact Lagrangian filling with genus $g \geq 1$ and $p$ double points can be obtained from such a Lagrangian surgery on a filling of genus $g-1$ with $p+1$ double points. To show this, we establish the connection between the existence of an immersed, Maslov-$0$, exact Lagrangian filling of a Legendrian $Λ$ that has $p$ double points with action $0$ and the existence of an embedded, Maslov-$0$, exact Lagrangian cobordism from $p$ copies of a Hopf link to $Λ$. We then prove that a count of augmentations provides an obstruction to the existence of embedded, Maslov-$0$, exact Lagrangian cobordisms between Legendrian links.
Fault-tolerant quantum computers, with error correction implemented using topological codes, will most likely require lattice surgery protocols in order to implement a universal gate set. Timelike failures during lattice surgery protocols can result in logical failures during the execution of an algorithm. In addition to the spacelike distance of the topological code used to protect the qubits from errors, there is also the timelike distance which is given by the number of syndrome measurement rounds during a lattice surgery protocol. As such, a larger timelike distance requirement will result in the slowdown of an algorithm's runtime. Temporal encoding of lattice surgery (TELS) is a technique which can be used to reduce the number of syndrome measurement rounds that are required during a lattice surgery protocol. This is done by measuring an over-complete set of mutually commuting multi-qubit Pauli operators (referred to as a parallelizable Pauli set) which form codewords of a classical error correcting code. The results of the over-complete set of Pauli measurements can then be used to detect and possibly correct timelike lattice surgery failures. In this work, we introduce an improved TELS protocol and subsequently augment it with the ability to correct low-weight classical errors, resulting in greater speedups in algorithm runtimes. We also explore large families of classical error correcting codes for a wide range of parallelizable Pauli set sizes. We also apply TELS to magic state distillation protocols in the context of biased noise, where logical qubits are encoded in asymmetric surface codes. Using optimized layouts, we show improvements in the space-time cost of our magic state factories compared to previous protocols. Such improvements are achieved using computations performed in the Clifford frame.
Kristen Hendricks, Jennifer Hom, Matthew Stoffregen
et al.
We prove an involutive analog of the dual knot surgery formula of Eftekhary and Hedden-Levine. We also compute a small model for the local equivalence class of the involutive dual knot complex.
The surgery theorem of Wraith states that positive Ricci curvature is preserved under surgery if certain metric and dimensional conditions are satisfied. We generalize this theorem as follows: Instead of attaching a product of a sphere and a disc, we glue a sphere bundle over a manifold with a so-called core metric, a type of metric which was recently introduced by Burdick to construct metrics of positive Ricci curvature on connected sums. As applications we construct core metrics on 2-sphere bundles, where the base admits a core metric, and obtain new examples of 6-manifolds with metrics of positive Ricci curvature.
Anthony Conway, Diarmuid Crowley, Mark Powell
et al.
For every $k \geq 2$ we construct infinitely many $4k$-dimensional manifolds that are all stably diffeomorphic but pairwise not homotopy equivalent. Each of these manifolds has hyperbolic intersection form and is stably parallelisable. In fact we construct infinitely many such infinite sets. To achieve this we prove a realisation result for appropriate subsets of Kreck's modified surgery monoid $\ell_{2q+1}(\mathbb{Z}[π])$, analogous to Wall's realisation of the odd-dimensional surgery obstruction $L$-group $L_{2q+1}^s(\mathbb{Z}[π])$.