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Background: For a substantial part of patients with chronic low back pain, the origin is located in the sacroiliac joint (SIJ). Minimally invasive sacroiliac joint fusion (MISJF) is increasingly being implemented as a treatment option in SIJ dysfunction. Despite remaining controversy, evidence continues to increase. This study evaluates the clinical results and safety of MISJF in a double-center consecutive case series in patients with SIJ dysfunction over a one-year observation period. Methods: SIJ complaints were diagnosed after history taking, physical examination and least a 50% reduction of SIJ pain 30–60 min following image-guided injection. Primary outcome measures were patient reported outcome measurements (PROMs), consisting of Visual Analogue Scale (VAS) pain score and EuroQol 5-dimensions 3-levels (EQ-5D-3L). Patients' perspectives on the effects of surgery were collected through questionnaires. Secondary outcome measures were implant positioning and (serious) adverse events ((S)AE's). Results: A total of 29 patients were included. In 44.8% of patients, SIJ dysfunction was of postpartum origin. The mean VAS-pain score improved from 7.83 (± 1.71) to 4.97 (± 2.63) postoperatively (p < 0.001). EQ-5D-3L score improved from 0.266 (± 0.129) to 0.499 (± 0.260) postoperatively (p < 0.001). Opioid consumption decreased from 44.8 to 24.1% postoperatively (p = 0.026). In 13.7% of patients, an (S)AE occurred. Conclusion: MISJF appears to be an effective and safe procedure in this cohort. Statistically significant and clinically relevant improvements in pain and quality of life were observed one-year postoperatively. Future studies should focus on the long-term outcomes to further evaluate the safety and effectiveness of MISJF. [ABSTRACT FROM AUTHOR]

Aims: One of the instruments in the orthopaedic surgeon's armamentarium to face the challenges associated with periprosthetic fracture around the stem of a hip replacement is the tapered, fluted, modular, titanium (TFMT) stem. Our aim was to study its clinical and radiological outcomes. Patients and Methods: During the period 2010–2016 86 patients (55 females; median age 78.2 years; mean BMI 26.3 kg/m2; median ASA classification 2) underwent 87 revisions for a Vancouver B periprosthetic fracture using a Stryker Restoration Cone-Conical stem. Results: After a median follow-up of 2.9 years no stem had to be revised and no case of stem fracture was found. Dislocation was the most common complication and occurred in 18% of patients. Other major complications were deep infection (n = 4), subsidence >5 mm (n = 7), and nonunion (n = 5). 3-month and 1-year mortality was 10% and 15% respectively and was strongly correlated with age, deep infection, and ASA classification. The median EQ-5D health state index at final follow-up was 0.78 and all patients were ambulatory. Conclusions: The complication most commonly encountered was dislocation and can likely be prevented by the use of large heads, adequate reduction and fixation of the trochanteric area and restoration of the native anatomy. Contrary to previous concerns, fracture and subsidence of these modular stems do not appear to be a significant problem in this geriatric population. [ABSTRACT FROM AUTHOR]

Purpose: Physical functioning is a multidimensional construct covering perceived functioning, functional capacity and actual physical activity. Currently, the assessment of physical functioning in low back pain (LBP) patients has been limited to only one or two of these aspects. This study evaluates physical functioning of LBP patients by assessing the three individual aspects using questionnaires and ambulant sensor-based measurements.Methods: Actual physical activity, functional capacity and perceived functioning were measured in 26 patients undergoing patient specific treatment before, direct and 3–4 weeks after the first treatment using, respectively, sensor-based activity monitoring, sensor-based motion analysis test and the Oswestry questionnaire. Patients were compared to a healthy control group.Results: Perceived functioning and functional capacity, but not actual physical activity is impaired in pre-treatment LBP patients. After treatment, patients improved in perceived physical functioning and functional capacity approaching healthy levels, however only slight (p > 0.05) improvements in actual physical activity were found. Moreover, only few and weak correlations were found between the different aspects of physical functioning.Conclusion: Perceived functioning, actual physical activity and functional capacity are three independent outcome dimensions, being complementary but not redundant. Especially, perceived functioning and physical capacity need attention when evaluating LBP patients during rehabilitation.Implications for RehabilitationPerceived physical functioning and physical capacity are negatively affected by low back pain and improve after treatment.Low back pain patients perform their daily activity independent of pain and complaints.Inertia sensor-based motion analysis can objectify treatment effects showing low back pain patients their progress in rehabilitation.New interventions can be justified with inertia sensor technology in low back pain patients. [ABSTRACT FROM PUBLISHER]

Introduction: External spinal orthoses are commonly used in treating spinal disorders. The purpose of a spinal orthosis is to relieve pain and reduce spinal motion. Despite the widespread use of spinal orthoses, evidence of their efficacy is lacking, and there is no literature comparing different types of orthoses with regard to objective measurements of the immobilization effect on the thoracolumbar spine. Aim: The aim of this study was to evaluate and compare movement reduction and comfort of four types of thoracolumbar orthoses on the normal motion using inertia sensor-based motion analysis (IMA). Methods: Ten healthy volunteers were asked to perform five tasks of daily living without an orthosis and with four different types of orthoses. Motion analysis was performed using IMA. Comfort and subjective immobilization were analyzed by a questionnaire. Results: All gait parameters were comparable in the different conditions. During the sit-to-stand (STS) test, the maximum angular bending rate was significantly impaired by all orthoses compared with the unbraced condition. During the block-step test, significant differences were found in pelvic obliquity for braced conditions. The bending angle was significantly reduced during the flexion and extension test for all orthoses. Wearing an orthosis showed significantly larger pelvic obliquity during latero-flexion compared with the unbraced condition. In a subjective analysis using the questionnaire, the bandage scored best, and the Jewett scored worst in comfort and movement restriction. Conclusions: All orthoses influence spinal movement during several daily tasks as was shown by IMA. The most rigid orthoses provided the most movement restriction, but simultaneously scored worse in comfort. The choice for a certain brace should be based on individual patient characteristics and diagnosis because of the experienced differences in impairment and comfort. [ABSTRACT FROM AUTHOR]