Osteoarthritis causes a number of physical ailments, which result in the deterioration of a persons’ general health and reduction of their ability to move freely. This cross-sectional study was designed to assess the impact of physical ailments in the course of knee osteoarthritis (KOA) on the quality of life (QoL) of patients in early old age. An anonymous survey was conducted by the use of the recognized research tools: Western Ontario scale and McMaster Osteoarthritis Index (WOMAC), The Index of Severity for Knee Disease (ISK) and World Health Organization Quality of Life—BEFF (WHOQOL-BREF). The study involved 300 people aged between 60 and 75 years old, including 150 patients diagnosed with gonarthrosis and 150 people without lower limb complaints. The significant intensification of the symptoms of knee osteoarthritis was associated with a worse assessment of health (p < 0.001), overall quality of life (p < 0.001) and in the following domains: physical (p < 0.001), mental (p < 0.001) and environmental (p < 0.001) in a group of patients with KOA. These findings suggest that taking measures to reduce knee pain and improve function may have an impact on improving the overall quality of the life of people in their early old age.

Background: The objective of the study was evaluation of the clinical and radiologic outcomes and complications following the minimally invasive chevron procedure employing the Akin osteotomy with percutaneous transosseous suture as compared to screw fixation. Methods: Between 2018 and 2019, the authors performed 103 minimally invasive chevron (MIC) with Akin osteotomies. In 54 patients, the Akin osteotomy was performed with screw stabilization (group A), and in 49 with percutaneous transosseous suture (group B). Preoperatively and 1 year later, the authors employed anteroposterior and lateral weightbearing radiographs of the feet to evaluate interphalangeal angle (IPA), distal phalangeal articular angle (DPAA), proximal phalangeal articular angle (PPAA), intermetatarsal angle (IMA), hallux valgus angle (HVA), and functional result using the American Orthopaedic Foot & Ankle Society (AOFAS) hallux-metatarsophalangeal-interphalangeal scale. Furthermore, all additional procedures and complications were recorded. Results: Both groups demonstrated a statistically significant decrease of the value of HVA (group A: from 34.1° to 14.0°, group B: from 33.6° to 13.0°), DPAA (group A: from 12.1° to 4.0°, group B: from 11.5° to 3.4°), PPAA (group A: from 4.6° to 1.7°, group B: from 4.3° to 1.5°), IMA (group A: from 15.1° to 8.0°, group B: from 14.7° to 7.5°) and IPA (group A: from 14.1° to 6.3°, group B: from 12.9° to 5.1°). Functional improvement as measured using the AOFAS scale was achieved in both groups (group A: from 42 to 90 points, group B: from 40 to 89 points). No cases of bone nonunion or delayed union and permanent damage to the medial dorsal cutaneous nerve were seen. Two group B patients underwent conversion of the fixation of the Akin osteotomy to screws, 3 patients had their MICA screws and 1 Akin screw removed in the outpatient setting. Conclusion: The minimally invasive chevron osteotomy with transosseous suture stabilization of the Akin osteotomy was a safe method with good functional results that were comparable to the outcomes achieved when using screw fixation. Level of Evidence: Level III, retrospective comparative study.

Background: The main goal of the study was to evaluate the costs, clinical and radiologic results, and complications of hallux valgus surgery using scarf osteotomy, depending on the type of fixation (with or without screws). Methods: We evaluated 169 patients who underwent scarf osteotomy between January 2013 and August 2016. The patients were separated into 3 groups depending on the type of stabilization: A, 2 screws (50 patients); B, modified with 1 screw (55 patients); C, modified without implant (64 patients). We assessed duration of surgery, additional procedures, pre- and postoperative hallux valgus angle (HVA) and intermetatarsal angle (IMA) on anteroposterior and lateral foot weightbearing radiographs, the American Orthopaedic Foot & Ankle Society (AOFAS) hallux-metatarsophalangeal-interphalangeal scale for the clinical assessment preoperatively and at the 12-month follow-up. We recorded all the complications and compared the costs between the groups. Results: Both the average HVA (A: from 33.7 to 12.6 degrees, B: 35.0 to 13.2 degrees, C: 34.7 to 12.4 degrees) and IMA (A: from 14.9 to 7.5 degrees, B: 15.2 to 6.9 degrees, C: 15.5 to 7.8 degrees) decreased in all groups without significant intergroup differences. The average AOFAS score improved in all the groups (A: from 40 to 88 points, B: 38 to 89 points, C: 42 to 91 points). A similar complication rate was observed (A: 9%, B: 10%, C: 11%). In group C, we noted a shorter time of surgery, and the procedure was the most cost-effective. Conclusion: Scarf osteotomy without implant stabilization was faster and cost-effective and gave comparable results. It was technically demanding and required patient compliance. Level of Evidence: Level III, retrospective comparative study.

Purpose: The aim of the study was to assess whether administration of a single dose of methylprednisolone in the group patients above 65 years of age will be effective in complex analgesic management after total hip arthroplasty (THA). Methods: Seventy-seven patients above 65 years old were double-blind randomized into two: the study and controls groups. Pre-operatively, the study group received as a single dose of 125 mg intravenous methylprednisolone, while the others saline solution as placebo. Peri-operatively, all the patients were administered opioid and nonopioid analgesic agents. We measured the levels of inflammatory markers (leukocytosis, C-reactive protein—CRP), pain intensity level (visual analog scale—VAS; numerical rating scale—NRS), the life parameters, and noted complications. Results: Following administration of methylprednisolone were significantly lower levels of CRP on all the four post-operative days; leukocytosis on the second day; the VAS/NRS score at rest after six, 12, and 18 hours post-operatively, diminished the dose of parenteral opioid preparations (oxycodone hydrochloride), the duration of analgesia by peripheral nerve block was significantly higher as compared with the placebo group (p < 0.000001). No infectious complications were noted; there was one patient who developed post-operative delirium. Conclusion: A single dose of methylprednisolone significantly reduces the level of post-operative pain at rest on the day of THA in the group patients above 65 years of age, decreases the dose of opioid analgesic agents, and significantly decreases the level of inflammatory markers, without infectious processes.

BACKGROUND Assessment of the potential utility of deep learning with subsequent image analysis to automate the measurement of hallux valgus and intermetatarsal angles from radiographs to serve as a preoperative aid in establishing hallux valgus severity for clinical decision-making. AIM To investigate the accuracy of automated measurements of angles of hallux valgus from radiographs for further integration with the preoperative planning process. METHODS The data comprises 265 consecutive digital anteroposterior weightbearing foot radiographs. 181 radiographs were utilized for training (161) and validating (20) a U-Net neural network to achieve a mean Sørensen–Dice index > 97% on bone segmentation. 84 test radiographs were used for manual (computer assisted) and automated measurements of hallux valgus severity determined by hallux valgus (HVA) and intermetatarsal angles (IMA). The reliability of manual and computer-based measurements was calculated using the interclass correlation coefficient (ICC) and standard error of measurement (SEM). Inter- and intraobserver reliability coefficients were also compared. An operative treatment recommendation was then applied to compare results between automated and manual angle measurements. RESULTS Very high reliability was achieved for HVA and IMA between the manual measurements of three independent clinicians. For HVA, the ICC between manual measurements was 0.96-0.99. For IMA, ICC was 0.78-0.95. Comparing manual against automated computer measurement, the reliability was high as well. For HVA, absolute agreement ICC and consistency ICC were 0.97, and SEM was 0.32. For IMA, absolute agreement ICC was 0.75, consistency ICC was 0.89, and SEM was 0.21. Additionally, a strong correlation (0.80) was observed between our approach and traditional clinical adjudication for preoperative planning of hallux valgus, according to an operative treatment algorithm proposed by EFORT. CONCLUSION The proposed automated, artificial intelligence assisted determination of hallux valgus angles based on deep learning holds great potential as an accurate and efficient tool, with comparable accuracy to manual measurements by expert clinicians. Our approach can be effectively implemented in clinical practice to determine the angles of hallux valgus from radiographs, classify the deformity severity, streamline preoperative decision-making prior to corrective surgery.

Objective: To report the effect of weightbearing x-ray imaging on clinical decisions in hallux valgus. Weightbearing (WB) x-ray is standard imaging for symptomatic hallux valgus (HV). In our clinical practice, often patients are presenting with non-weightbearing (NWB) x-rays. Repeated imaging requires additional radiation, justified only if expected to benefit patient’s treatment. In this study, the influence of WB status on radiological HV parameters and on clinical decisions was analyzed.Methods: In the dataset of WB and NWB x-rays, the hallux valgus (HVA) and intermetatarsal angle (IMA) were measured and differences analyzed. Clinical decisions for 10 x-ray pairs were studied among 40 respondents.Results: The WB and NWB HVA difference ranged − 16 to 16° (p < 0.001) and IMA − 3.4 to 5.8° (p < 0.001). In only 45% of cases, the decisions based on NWB and WB imaging were consistent (kappa (95% CI) = 30.0 (23.7–36.3)).Conclusions: Clinical decisions based on WB and NWB radiographs vary significantly. NWB films overestimate early and underestimate advanced HV deformity. Repeating radiographs is justified in patients presenting with NWB radiographs of symptomatic HV.