EFORT Open Rev. 2025 Jan 3;10(1):57-63. doi: 10.1530/EOR-24-0110. Print 2025 Jan 1.

ABSTRACT

Esophageal perforation is a rare but serious complication that can occur post-cervical spine surgery. This case report presents the clinical course, diagnostic challenges and management strategies of a patient who had a late-diagnosis esophageal perforation after anterior cervical spine surgery (ACSS). A woman in her 50s underwent ACSS for cervical spondylosis. Three months postoperatively, she experienced persistent right neck and shoulder pain. Despite multiple consultations, an esophageal perforation was only diagnosed 10 years later when a neck mass ruptured, discharging food debris. Surgical management included removing the anterior cervical plate and reconstruction with a sternocleidomastoid muscle flap. Postoperatively, she faced wound complications, and the perforation failed to heal despite multiple debridement and stent placements. Ultimately, complete excision of the diverticulum, repair of the perforation and muscle flap reconstruction led to her recovery, with no recurrence over an 8-year follow-up. We reviewed the literature on cases with esophageal perforation occurring more than 10 years after anterior cervical surgery and summarized the treatment experiences. This case underscores the diagnostic challenges and delayed presentation of esophageal perforation post-ACSS. Early recognition and multidisciplinary management are essential. In cases of late perforation, hardware removal, diverticulum excision and a muscle flap are critical to achieving successful closure of the esophageal lesion, preventing recurrence and ensuring comprehensive repair. Addressing esophageal diverticula during perforation treatment is crucial to prevent recurrence and ensure thorough repair. This highlights the need for high clinical suspicion and a coordinated surgical approach to improve patient outcomes.

PMID:40071924 | PMC:PMC11728875 | DOI:10.1530/EOR-24-0110

EFORT Open Rev. 2025 Jan 3;10(1):28-36. doi: 10.1530/EOR-2024-0070. Print 2025 Jan 1.

ABSTRACT

PURPOSE: A staged bilateral total knee arthroplasty (BTKA) procedure is considered when a patient is not deemed suitable for simultaneous BTKA due to concerns about the risk of mortality and complications. However, no network meta-analysis has been conducted to compare simultaneous vs staged BTKA procedures with different intervals in terms of postoperative mortality and overall complication rates.

METHODS: Four databases - Medline, Embase, Cochrane Library and Web of Science - were searched from inception to December 19, 2023, for studies comparing patients who underwent staged BTKA with different intervals and simultaneous BTKA. The primary outcome domains were 1-year mortality and 90-day overall complications. Secondary outcomes included neurological, cardiovascular, pulmonary, infectious and venous thromboembolic complications within 90 days.

RESULTS: Fifteen observational studies were included. Staged BTKA with intervals between 6 weeks and 3 months (odds ratio (OR): 0.69, 95% CI: 0.53-0.91), between 3 and 6 months (OR: 0.67, 95% CI: 0.53-0.84) and longer than 6 months (OR: 0.67, 95% CI: 0.55-0.83) exhibited a lower mortality risk compared to simultaneous BTKA. Staged BTKA with an interval shorter than 6 weeks and longer than 6 months exhibited a higher risk of pulmonary (OR: 1.24, 95% CI: 1.03-1.49; OR: 1.64, 95% CI: 1.10-2.44) and infectious complications (OR: 1.50, 95% CI: 1.15-1.96; OR: 1.52, 95% CI: 1.14-2.02) compared to simultaneous BTKA. An interval between 3 and 6 months ranked best in outcomes of 1-year mortality (P score = 0.7849) and 90-day complications (P score = 0.7077).

CONCLUSIONS: Staged BKTA with an interval of more than 6 weeks but less than 6 months is associated with a lower risk of postoperative mortality and complications. However, these results should be interpreted with caution due to potential biases inherent in the inclusion of nonrandomized studies.

LEVEL OF EVIDENCE: II.

PMID:40071914 | PMC:PMC11728876 | DOI:10.1530/EOR-2024-0070

EFORT Open Rev. 2025 Jan 3;10(1):37-47. doi: 10.1530/EOR-2023-0209. Print 2025 Jan 1.

ABSTRACT

Knee osteoarthritis (OA) is a common chronic condition that leads to joint pain and disability among older adults. An interprofessional collaborative approach has nowadays been widely advocated in knee OA management although little is known about the characteristics of care, roles and responsibilities of healthcare providers and how they collaborate as a team to optimise treatment outcomes. The Donabedian structure-process-outcome framework was used in the review. Six databases were searched from February 2013 to March 2023. A total of 26 articles that met our inclusion criteria were reported. All studies (n = 26) identified the physiotherapist as a critical member of the interprofessional team. Several studies (n = 5) have offered training to healthcare providers in the management of knee OA. The intervention components in most studies included disease-based education (n = 21) and exercise therapy (n = 16). A comprehensive understanding of the existing interprofessional knee OA care in this review could potentially assist the government and healthcare organisations in developing interprofessional practice guidelines and designing intervention programmes that maximise their benefits.

PMID:40071912 | PMC:PMC11728870 | DOI:10.1530/EOR-2023-0209