DOS BULLETIN - Dansk Ortopædisk Selskab
DOS BULLETIN - Dansk Ortopædisk Selskab DOS BULLETIN - Dansk Ortopædisk Selskab
2010-378_DOS nr. 3 2010 29/09/10 10:08 Side 134 A prospective randomized trail between Transforaminal (TLIF) and instrumented posterolateral fusion (PLF) A one year follow- up Kristian Høy, Bent Niederman, Peter Helmig Aarhus University Hospital, Orthopedic Department E Background: Circumfentrical fusion is superior to PLF concerning functional outcome, fusionrate and saggital balance, Christensen 2002, Videbaeck 2006.Need of anterior support was questioned 2007 Ekman, comparing PLIF/PLF. In 2009 Neumann compared TLIF to PLF,outcome was significantly in favor of TLIF. Purpose: The aim of the present study was to show whether these benefits also could be found in a Transforaminal interbody fusion group (TLIF) compared to a normal posterolateral fusion group (PLF). Since TLIF theoretical implicate the benefits of 360 degrees fusion, by less invasive surgery, and thereby less morbidity. Methods: During 01.11.2003-.01.11.2008 100 pt`s were prospectively randomized to either Transforaminal instrumented fusion or Postero lateral instrumented fusion. The TLIF group was operated using TSRH(Medtronic)and Implex (Zimmer) and allograft. The PLF group was operated using TSRH (Medtronic) and allograft. Inclusions criteria were patients with segmental instability due to disc degeneration, former disc herniation, spondylolisthesis less than grade 2. All patients functional outcome was registered prospectively, and after one year using Dallas Pain questionnaire (DPQ), SF-36, and Low Back pain questionnaire. Findings: Sex ratio 40 men and 58, women. 51 patients had TLIF and 47 PLF. Mean age TLIF/PLF was 49/45. No statistic difference in outcome between the two groups at one year could be detected, concerning, daily activity, work leisure, Anxiety/depression, social interest. No statistical difference could be seen between groups concerning Back pain or Leg pain. Boths groups had significant improvement in functional outcome, back pain, and leg pain after one year compared to preoperative. Daily activities p > 0.0002/0.00001, Back pain > 0.00001/0.00001, Leg pain > 0.0007/0.0002. Operation time in the TLIF group was significant higher p < 0.00001, mean 228 min TLIF group, 180. min PLF group The blood loss was significantly higher in the TLIF group compared to the PLF group p > 0.0011 mean 776 ml (TLIF), 437 ml (PLF). No difference in radiological fusion after one year. Patients satisfaction after 1 year was, 75 percent overall,, 78 % (TLIF), 73 %(PLF). Conclusion: Spinal fusions significant improve patient`s Functional outcome, Back Pain and Leg pain after one year. No statistical significance difference in functional outcome, Back or Leg pain could be found between Transforaminal group and Posterolateral fusion group after one year. 134
2010-378_DOS nr. 3 2010 29/09/10 10:08 Side 135 Can “high flex” be achieved and does it matter in total knee arthroplasty? A randomized, controlled trial Morten Grove Thomsen, Henrik Husted, Kristian Otte, Anders Troelsen Dept. of Orthopedics, University Hospital of Hvidovre, Denmark Background: Pain free range of motion (ROM) is a cornerstone in successful total knee arthroplasty (TKA). The achievement of a high degree of knee flexion is thought to improve the activity in daily living and possibly the patient satisfaction. Purpose: The purpose was to compare ROM, patient satisfaction, pain, “feel” of the knee, and activities of daily living between a standard posterior cruciate- retaining TKA and a “high flex” posterior-stabilized TKA. Methods: The study is a randomized, single-blinded, controlled trial in which patients undergoing one-stage bilateral TKA randomly had a standard AGC (Biomet®) cruciate-retaining TKA in one knee and a Highflex LPS (Zimmer®) posterior-stabilized TKA in the contra lateral knee. At follow-up 6 weeks, 3, 6 and 12 months postoperatively, the ROM, satisfaction, pain, “feel” of the knee, and the abilities in daily activities were assessed. The study group consisted of 33 patients (mean age: 67.2 yrs). The knees had comparable preoperative ROM. Findings: At 1-year follow-up we found a significantly higher degree of knee flexion of 7°, both active and passive, in the “high-flex” group (p= 0.001). The “high-flex” LPS TKA showed a mean active flexion of 121° (range: 105°-140°) and passive flexion of 127° (range: 107°-146°). In both groups the median VAS pain score was 0, the median VAS satisfaction score was 9, and the median VAS score of the patient “feel” of the knee was 9 at 1-year follow-up. Further, there were no significant differences between the groups in the performance of daily activities. Conclusion: The “high-flex” TKA showed increased knee flexion, but no significant differences in patient related outcomes were found. This suggests little clinical relevance of the difference in knee flexion as pain free ROM and high patient satisfaction were achieved with both TKA’s. 135
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2010-378_<strong>DOS</strong> nr. 3 2010 29/09/10 10:08 Side 134<br />
A prospective randomized trail between Transforaminal<br />
(TLIF) and instrumented posterolateral fusion<br />
(PLF)<br />
A one year follow- up<br />
Kristian Høy, Bent Niederman, Peter Helmig<br />
Aarhus University Hospital, Orthopedic Department E<br />
Background: Circumfentrical fusion is superior to PLF concerning functional<br />
outcome, fusionrate and saggital balance, Christensen 2002, Videbaeck<br />
2006.Need of anterior support was questioned 2007 Ekman, comparing<br />
PLIF/PLF. In 2009 Neumann compared TLIF to PLF,outcome was significantly<br />
in favor of TLIF.<br />
Purpose: The aim of the present study was to show whether these benefits also<br />
could be found in a Transforaminal interbody fusion group (TLIF) compared to a<br />
normal posterolateral fusion group (PLF). Since TLIF theoretical implicate the<br />
benefits of 360 degrees fusion, by less invasive surgery, and thereby less morbidity.<br />
Methods: During 01.11.2003-.01.11.2008 100 pt`s were prospectively randomized<br />
to either Transforaminal instrumented fusion or Postero lateral instrumented<br />
fusion. The TLIF group was operated using TSRH(Medtronic)and Implex (Zimmer)<br />
and allograft. The PLF group was operated using TSRH (Medtronic) and<br />
allograft. Inclusions criteria were patients with segmental instability due to disc<br />
degeneration, former disc herniation, spondylolisthesis less than grade 2. All<br />
patients functional outcome was registered prospectively, and after one year using<br />
Dallas Pain questionnaire (DPQ), SF-36, and Low Back pain questionnaire.<br />
Findings: Sex ratio 40 men and 58, women. 51 patients had TLIF and 47 PLF.<br />
Mean age TLIF/PLF was 49/45. No statistic difference in outcome between the<br />
two groups at one year could be detected, concerning, daily activity, work leisure,<br />
Anxiety/depression, social interest. No statistical difference could be seen<br />
between groups concerning Back pain or Leg pain. Boths groups had significant<br />
improvement in functional outcome, back pain, and leg pain after one year compared<br />
to preoperative. Daily activities p > 0.0002/0.00001, Back pain ><br />
0.00001/0.00001, Leg pain > 0.0007/0.0002. Operation time in the TLIF group<br />
was significant higher p < 0.00001, mean 228 min TLIF group, 180. min PLF<br />
group The blood loss was significantly higher in the TLIF group compared to the<br />
PLF group p > 0.0011 mean 776 ml (TLIF), 437 ml (PLF). No difference in radiological<br />
fusion after one year. Patients satisfaction after 1 year was, 75 percent<br />
overall,, 78 % (TLIF), 73 %(PLF).<br />
Conclusion: Spinal fusions significant improve patient`s Functional outcome,<br />
Back Pain and Leg pain after one year. No statistical significance difference in<br />
functional outcome, Back or Leg pain could be found between Transforaminal<br />
group and Posterolateral fusion group after one year.<br />
134