ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS

RISK FACTORS OF RECURRENCE LUMBAR DISC HERNIATION AFTER PRIMARY ENDOSCOPIC TRANSFORAMINAL DISCECTOMY. PART 2

2026-03-27T13:09:42+02:00

Recurrence of lumbar disc herniation (LDH) after primary endoscopic transforaminal discectomy (PETD) is diagnosed in 3.8–15 % of cases. Objective. To study preoperative radiographic and MRI signs that potentiate LDH recurrence after PETD. Methods The study material consisted of articles identifying radiographic and MRI risk factors for recurrent LDH after PETD between 2015 and 2025 in the PubMed, Google Scholar, and Medline databases. The study method was a systematic review of relevant literature sources. Results. The level of LDH does not influence the incidence of rLDH, although some authors consider the presence of a disc herniation in the upper lumbar spine as a risk factor for recurrence. rLDH is significantly more frequently recorded with primary disc protrusion; in cases of migrated disc herniation, the risk of rLDH significantly increases with large intracanal displacement of disc material extending beyond the inferior margin of the superior or inferior vertebral pedicle. The use of PETD for resection of central disc herniations most often results in recurrent LDH (compared to foraminal, extraforaminal, and migratory) due to technical errors. A study of disc height index dynamics in the pre- and postoperative periods and the degree of Modic type endplate degeneration showed that the less severe the degenerative processes in the prolapsed intervertebral disc, the higher the risk of herniation recurrence after PETD. Conclusions. Recurrence disc herniation after PETD is significantly more common in cases of primary protrusion and significantly increases with large annular defects (≥ 6 mm). rLDH is significantly more common in discs with moderate degenerative changes, with a disc height index of approximately 0.37 ± 0.09 and Modic type 1

Cryosurgical Management of Extraskeletal Myxoid Chondrosarcoma: A Case Report with Long-term Functional Outcomes

2026-03-27T12:36:05+02:00

Introduction. Extraskeletal myxoid chondrosarcoma (EMC) is a rare soft-tissue sarcoma with a substantial risk of local recurrence and distant metastasis. Liquid-nitrogen cryosurgery may serve as an adjunct during limb-salvage procedures, including bone recycling. Objective. To report a juxta-articular EMC of the knee treated with wide excision, liquid-nitrogen cryosurgery of resected bone segments, and reconstruction with total knee replacement (TKR), and to present functional follow-up outcomes. Methods. A wide excision was performed via a medial parapatellar approach with osteotomy of the patella and proximal tibia. Resected bone was treated with liquid nitrogen (15 minutes) followed by stepwise thawing, then reattached; reconstruction included TKR and internal fixation. Follow-up assessed union, recurrence/metastasis (MRI/CT), and function (MSTS). Results. Surgical margins were negative. Union was achieved within 1 year. No local recurrence or progression of lung lesions was detected during 1–3 years of follow-up. Function was preserved (ROM 0–90°) with MSTS 90 % (1 year), 97 % (2 years), and 93 % (3 years), without reported complications. Conclusions. Cryosurgery with bone recycling can be a useful adjunct for limb-salvage surgery in knee EMC, enabling reconstruction with favorable functional outcomes in early to mid-term follow-up.

CLINICAL CASE OF USING TRICALCIUM PHOSPHATE-BASED BONE CEMENT REINFORCED WITH HYDROXYAPATITE

2026-03-27T12:53:13+02:00

The study and implementation of biomaterials for reconstructive orthopedic interventions remain a key focus of modern biomaterials science. Calcium phosphate ceramics are notable for their high biocompatibility, osteoconductive properties, and biodegradability. Developing materials capable of adapting to the shape of bone defects is particularly relevant. Objective. To evaluate the effectiveness of a metastable tricalcium phosphate cement reinforced with needle-shaped hydroxyapatite crystals for filling cavity defects in the acetabulum during total hip arthroplasty. Methods. A clinical case of a 52-year-old patient with stage IV coxarthrosis and acetabular cystic defects is presented. Following marginal cyst resection, the cement was applied to the cavity prior to implantation of an uncemented acetabular cup. Postoperative follow-up was performed on days 7 and 30 using radiography and multislice CT. Results. The postoperative course was uneventful. On day 7, the cavity was fully filled with cement; by day 30, multiple bone trabeculae had formed within the material, with density similar to native bone. Prosthesis fixation remained stable, without cement migration or aseptic demarcation. Conclusions. The use of calcium phosphate cement with a paste-like consistency reinforced with needleshaped hydroxyapatite crystals allows complete defect filling, promotes bone-cement complex formation, and provides stable prosthesis fixation in the early postoperative period. Further studies with longer follow-up are required to assess long-term outcomes and material resorption.

EVALUATION OF THE QUALITY OF REHABILITATION OF PATIENTS WITH PATELLAR TENDINOPATHY USING A ROBOTIC ORTHOSIS

2026-03-27T11:48:14+02:00

Objective. To analyze the results of treatment using a robotic orthosis during the rehabilitation of patients following arthroscopy who developed pain in the anterior compartment of the knee joint (KJ), using clinical and instrumental assessments of their condition. Methods. We reviewed the medical records of 120 patients with anterior knee pain syndrome (46 women aged (28.6 ± 7) years and 74 men aged (38.2 ± 8) years). Patients underwent rehabilitation in a robotic orthosis with various body weight support settings ranging from 65% to 10%. A multivariate analysis of clinical indicators was performed, including pain levels on the Visual Analog Scale (VAS) and the Anterior Knee Pain Scale (AKPS). Joint functional characteristics were assessed using the Knee Society Score (KSS). Results. The functional status of 60 patients was analyzed. Six weeks after surgery, the mean VAS score was 3.8 ± 0.3 in group 1 and 1.8 ± 0.4 in group 2; the difference 2.00, t ≈ 30.99, p < 0.001; for KSS (part 1) in group 1 — 68 ± 6.5; in group 2 — 83 ± 2.3; difference −15.00, t ≈ −16.85, p < 0.001; for KSS (part 2), the means were 72 ± 4.8 versus 80 ± 3.2; difference –8.00, t ≈ −10.74, p <0.001, indicating better function in group 2. The AKPS score was 64 ± 5.8 in group 1 and 76 ± 3.8 in group 2; difference −12.00, t ≈ −13.40, p < 0.001. After 3 months, the VAS score in group 1 was 2.2 ± 0.6, and in group 2 — 1.2 ± 0.4; difference 1.00, t ≈ 10.74, p < 0.001; for KSS (part 1) 78 ± 4.7 vs. 90 ± 2.2; difference −12.00, t ≈ −17.92, p < 0.001; for KSS (part 2) — 80 ± 3.8 vs. 90 ± 1.8; difference −10.00, t ≈ −18.42, p < 0.001; AKPS after 3 months was 76 ± 1.6 in group 1 and 89 ± 2.0 in group 2; difference −13.00, t ≈ −39.34, p < 0.001. Conclusions. All confidence intervals for the differences do not include 0, so the differences are statistically significant; the effect sizes are large, indicating a clinically important advantage of using a robotic orthosis for pain reduction and improvement of upper limb function.

USE OF VIRTUAL REALITY EYEGLASSES AS AN ADDITIONAL METHOD IN REHABILITATION AFTER UPPER LIMB INJURY

2026-03-27T12:15:34+02:00

Over the past two decades, there has been a significant increase in the use of immersive technologies in rehabilitation. VR technologies allow for the simulation of motor tasks in a safe gaming digital environment, which contributes to better integration of the patient into the rehabilitation process, activates the neuromuscular system and reduces psychoemotional stress during the restoration of motor functions. While traditional methods involving simple, repetitive movements can be exhausting for patients and make them less motivated to continue treatment. Objective. Examined the effectiveness of using VR technology as an auxiliary method of rehabilitation in patients with traumatic injuries of the upper limbs after a blast injury. Materials. The effectiveness of using VR technology as an auxiliary rehabilitation method in patients with traumatic injuries of the upper extremities after a blast injury was analyzed. Results. The study included a case series of 4 military personnel with traumatic injuries of the upper limbs resulting from a blast injury. The rehabilitation program included standard physical therapy and physiotherapy methods in combination with training in a virtual environment using virtual reality glasses with the VR Vitalis program. Patients performed tasks aimed at improving coordination, strength and amplitude of movements in the shoulder, elbow and radiocarpal joints, considering the need for movement restoration. The dynamics of the range of motion was assessed using goniometry, muscle strength using dynamometry, and the level of motivation for classes was assessed using a survey. Conclusion. It was found that the use of VR technologies as an additional method to traditional rehabilitation contributed to a noticeable improvement in the indicators of functional recovery of upper limb movements. Positive dynamics were recorded not only in physical indicators, but also in the psycho-emotional state. All participants reported increased motivation and better involvement in the treatment process.

Lev Nikolaevich Ankin

2026-03-27T13:28:43+02:00

On January 23, 2026, Lev Mykolayovych Ankin, professor, doctor of medical sciences, military doctor, prominent Ukrainian orthopedic traumatologist, and scientist, passed away.

APPLICATION OF SURGICAL TECHNOLOGIES FOR THE TREATMENT OF VICTIMS WITH LONG BONE DEFECTS DUE TO MODERN COMBAT TRAUMA. MESSAGE 2. INDUCED MEMBRANE TECHNOLOGY (MASQUELET TECHNIQUE)

2026-03-25T22:39:39+02:00

Combat trauma, which, unfortunately, is now widespread in Ukraine as a result of the Ukrainian-Russian war, causes severe traumatic injuries to both military personnel and civilians. Objective. To provide a complete description of the indications for the use of induced membrane technology (Masquelet technology) in victims with long bone defects resulting from combat trauma. Methods. This study is based on an analysis of 51 cases of the use of the Masquelet technique in victims with long bone defects due to combat injuries. Connection criteria: the use of this particular technology is effective according to absolute or conditionally absolute indications, it was effective Masquelet.Results. It was established that the Masquelet technology was mainly used in victims with long bone defects aged 31–40 years (52.94 %). In addition, the Masquelet technology was most often used on the lower limb 64.70 %. There is a pattern in the use of the Masquelet technology depending on the localization of the long bone defect: in the proximal part of both the upper and lower limbs, this technology was used more often. The Masquelet technology was mainly used in victims with long bone defects measuring 5.0–9.99 cm (45.10 %). At the same time, the Masquelet technology was not used for long bone defects larger than 15 cm. Conclusions. The use of Masquelet technology is appropriate in victims with defects of long bones due to combat trauma in young and middle age, which is due to the age-dependent nature of bone tissue repair processes. There is an obvious dependence of the effectiveness and feasibility of using the induced membrane technology on the size of the defect. The most appropriate application is with a defect size of 5.0–9.99 cm and cavitary defects, regardless of the localization of the defect. It is also necessary to take into account the results of a comprehensive analysis of clinical-epidemiological and clinicalanatomical features.

WOUND DRAINAGE AFTER TOTAL KNEE ARTHROPLASTY, COMPARATIVE ANALYSIS

2026-03-26T13:41:28+02:00

Diseases and injuries of the knee occupy a significant place in the structure of orthopedic pathology. The main method of knee arthritis of the III–IV degree is total knee arthroplasty (TKA). Purpose. To analyze the postoperative period after TKA without wound drainage. Methods. For the study, a homogeneous group of 140 patients was selected, their age ranged from 45 to 78 years, the diagnosis was knee arthritis of the III–IV degree. Patients were divided into 2 groups: study group — the wound was not drained (73 people), comparison group — the wound was drained (67). Results. Blood loss during surgery was comparable in both groups and ranged from 80 to 340 ml, with an average of (217.59 ± 76.19) ml in the study group and (195.6 ± 67.97) ml in the comparison group. No statistically significant difference was f ound i n b oth g roups ( p > 0 .05, p = 0 .16277). A c omparative analysis of the course of the postoperative period revealed a shorter treatment period in the study group. Refusal to drain the postoperative wound under conditions of stable hemostasis contributed to a faster recovery of hemoglobin and erythrocyte indices. ESR and CRP levels showed a tendency towards a faster reduction in inflammation in the study group. The postoperative management used did not show any differences in the healing time of the postoperative wound. The low intensity of postoperative pain according to VAS in the study group allowed to reduce the use of analgesics and shorten the patient's hospital stay by 2 days. Therefore, TKA without drainage of the postoperative wound can be considered as the method of choice. Conclusion. TKA without drainage of the wound after surgery did not cause an increase in postoperative complications in our series of operations. In addition, it reduced pain syndrome and, according to laboratory data, reduced the indicators of the inflammatory process.

DEFINITION OF THE KNEE PHENOTYPE IN THE UKRAINIAN POPULATION BASED ON THE CPAK CLASSIFICATION

2026-03-26T14:07:37+02:00

Native coronal alignment of the knee joint demonstrates marked individual variability, which influences total knee arthroplasty planning and functional outcomes. The CPAK classification allows systematization of these anatomical variations based on the parameters aHKA and JLO. Although CPAK phenotypes have been described in several populations, data regarding the Ukrainian population have so far been lacking. Objective. To determine the characteristics of native lower-limb alignment and CPAK phenotypes of the knee joint in the Ukrainian population. Methods. A total of 500 full-length standing radiographs of the lower limbs were analyzed: 300 in the healthy group and 200 in the group with Kellgren-Lawrence grade III–IV osteoarthritis. LDFA and MPTA were measured, aHKA and JLO were calculated in accordance with CPAK principles, and knees were subsequently classified within the 3×3 CPAK matrix. Results. In the healthy group, the most common CPAK phenotypes were type II (24.7 %), type I (21.7 %), and type V (21.0 %). Neutral aHKA was observed in 47.3 %, varus in 39.3 %, and valgus in 13.3 %. The most frequent JLO orientation was apex distal (50.3 %). In sex-specific subgroups, type II predominated in males (28 %) and type V in females (25 %). In the osteoarthritis group, varus aHKA values predominated (58 %), with CPAK phenotypes I (35.5 %), IV (22 %), and II (19.5 %) being most common. Conclusions. This study describes for the first time the distribution of CPAK phenotypes of the knee joint in the Ukrainian population. Among healthy individuals, CPAK phenotypes I, II, and V were most prevalent, with neutral alignment observed in 47 %. In patients with grade III–IV osteoarthritis, a marked shift toward varus alignment was noted, with varus phenotypes accounting for 58 %, whereas neutral phenotypes were observed in only 34 %. These findings reflect population specific patterns of native coronal knee alignment and may serve as a basis for further research into the clinical relevance of CPAK phenotypes and their impact on outcomes of total knee arthroplasty.

MRI CLASSIFICATION OF ROTATOR CUFF ARTHROPATHY

2026-03-26T14:44:16+02:00

There are several classifications of rotator cuff arthropathy, which are predominantly based on the X-ray examination of patients. The aim of the study was to develop an MRI classification of rotator cuff arthropathy of the shoulder joint. Methods. We included to the study MRI examinations of 91 patients with rotator cuff arthropathy. Presence of acromion acetabularization, deterioration of the shoulder joint articular cartilage, fatty degeneration of the rotator cuff muscles (except teres minor muscle) according to the Goutallier classification, global fatty degeneration index (GFDI) were determined on MRI. Results. After analyzing the above-mentioned criteria, we divided all patients into 4 groups depending on the stage of the disease. We compared the distribution of patients into groups according to the Hamada X-ray classification and according to the proposed MRI classification and made sure of the reproducibility of the data. Conclusion: After comparing Hamada's classification and our classification, we found that the first stage according to Hamada's classification corresponds to the first stage of our MRI classification, the second stage corresponds to the second and third stages of MRI classification, the third, fourth and fifth stages according to Hamada's classification correspond to the fourth stage of our MRI classification. The MRI classification of rotator arthropathy of the shoulder joint presented by us has advantages over the Hamada classification and other radiological classifications, since it takes into account not only the migration of the humeral head and the presence of omarthrosis, but also answers the question of the condition of the rotator cuff muscles, which allows us to determine the rational tactics of surgical treatment in this group of patients.

Functional outcomes of reverse total shoulder arthroplasty in acute proximal humeral fractures versus post-traumatic sequelae

2026-03-26T15:03:21+02:00

Proximal humeral fractures account for 4–6 % of all fractures and are the third most prevalent fracture pattern in the elderly. Reverse total shoulder arthroplasty (RTSA) is a frequently utilized surgical procedure for treating this fracture. Aim. To improve the functional outcome and quality of life of patients with acute proximal humeral fractures and post-traumatic sequelae using reverse total shoulder arthroplasty. Subjects and Methods. This comparative study was conducted on a total of 20 patients with 3- or 4-part proximal humeral fractures aged more than 55 years, 10 patients were suffering from acute fractures (group I) and 10 patients with post-traumatic sequelae (group II). All patients were evaluated preoperatively and followed up postoperatively at 6 weeks, 3 months, 6 months and one year for functional outcomes. Radiological, clinical and functional outcomes were assessed by a goniometric range of motion (ROM), Constant-Murley score, and the Arabic version of the Quick DASH score. The rate of postoperative complications and the need for revision surgery were also reported. Results. In group I, the DASH and VAS score declined from 88.30 (± 8.23) and 5.90 (± 1.28) in the 6th weeks after surgery down to 34.30 (± 11.55) and 0.70 (± 0.48), respectively after 1 year. The Constant score increased from 14.70 (± 5.67) to 67.30 (± 14.98). All scores showed almost similar improvements in all three parameters in group II. Moreover, similar improvements in the deltoid muscle power, function and ranges of motion were reported in patients of both groups. Conclusion. Reverse shoulder arthroplasty provides favorable post-operative outcomes among elderly patients with 3-part and 4-part fractures of the proximal humerus. Indication for RTSA will not be affected by whether patients are presenting with acute or post-traumatic sequelae fractures. Level of evidence: Therapeutic study level III.

RADIOGRAPHIC MORPHOMETRIC PREDICTION OF NEW VERTEBRAL COMPRESSION FRACTURES AFTER VERTEBROPLASTY

2026-03-26T17:37:54+02:00

New vertebral compression fractures (NVCF) following percutaneous vertebroplasty (PVP) remain a clinical challenge. Methods. A retrospective cohort study (2023–2025) was conducted at the Institute of Spine and Joint Pathology, Ukraine, involving 26 patients (24 females, 2 males; mean age (69.04 ± 2.04) years) with osteoporotic vertebral compression fractures treated with PVP. Morphometric parameters of 99 vertebrae w ere a ssessed o n d igital r adiographs ( frontal/sagittal, RadiAnt DICOM Viewer, precision 0.1 mm / 0.1°): anterior (ha), middle (hm), posterior (hp) heights, relative compression (%), wedge index, local kyphotic angle, thoracic kyphosis, lumbar lordosis, and scoliosis. Results. NVCF occurred in 46.2 % of cases (45 fractures in 12 patients). Significant differences between NVCF and non-NVCF groups were observed for ha compression (20.69 ± 1.16 mm vs. 23.89 ± 0.78 mm, p = 0.0338), hm (17.84 ± 1 mm vs. 21.31 ± 0.61 mm, p = 0.0021), hp (26.97 ± 0.81 mm vs. 29.61 ± 0.51 mm, p = 0.0073), lumbar lordosis (44,4° ± 1,52° v s. 3 8.28° ± 1.46°, p = 0.01), a nd s coliosis (7.53° ± 0.56° vs. 5.90° ± 0.48°, p = 0.022). The linear discriminant functions model, based on hm (canonical correlation = –0.863) and relative Ha compression (canonical correlation = 0.139), achieved Wilks’ Λ = 0.8 (χ² = 15.77, p = 0.000376), classification accuracy of 76.25 % (sensitivity 76.9 %, specificity 75.9 %), a nd A UC = 0 ,754 ± 0 ,058. A djusted f unction: F = 6,07 – 0,28×hm (mm) –0,035×Ha (%); F > 0 indicates NVCF risk. Other parameters were excluded due to low discriminatory power or collinearity. Conclusion. This two-parameter model, using hm and relative Ha compression, offers moderate predictive accuracy for NVCF post-PVP. Its simplicity suits resource-limited Ukrainian clinics. External validation and inclusion of confounders (e. g., BMD, therapy) are required for broader adoption.

RECOMMENDATIONS FOR PREVENTING POSTOPERATIVE COMPLICATIONS OF TRANSPEDICULAR SCREW FIXATION IN PATIENTS WITH SPINAL DISORDERS

2026-03-26T18:10:22+02:00

Innovations in spinal surgery have improved technical precision and perioperative efficiency, however, the issue of postoperative complications arising from the use of transpedicular screw fixation (TF) remains a concern. Objective. To develop an algorithmic protocol for reducing the likelihood of postoperative complications in patients undergoing transpedicular screw fixation. Methods. An analysis was conducted of the surgical outcomes o f 2 ,760 p atients w ith d egenerative d iseases, i njuries and deformities of the spine, with radiographic assessment of transpedicular screw (TS) placement, both with and without the use of a 3D navigation system. The patients’ laboratory parameters and the results of 62 intraoperative neurophysiological monitoring sessions were studied. Results. An algorithmic scheme was developed to prevent the development of TS complications and improve the quality of care for patients with spinal disorders: preoperative strategic comprehensive planning, intraoperative monitoring and techniques for precise TS placement, postoperative follow-up, prevention complications. An algorithm for action has been defined in cases of suspicion of an incorrectly placed screw or deterioration in neurological status. The core of the prediction and assessment of the likelihood of postoperative complications is an algorithmized scheme for laboratory examination of patients. Its suitability was verified during the surgical treatment of 30 patients. Conclusions. The algorithm-based protocol developed enables a structured assessment of the risk of complications, the planning of surgical treatment taking into account modern technologies, the monitoring of all critical points, the implementation of an individualized approach for each patient, and the integration of spinal navigation and neuromonitoring of the surgical process, which will minimize complications and have a positive impact on patients’condition, the length of their hospital stay, and the qualityof treatment outcomes.

STIMULATION OF PERIOSTEAL BONE FORMATION WITH PLATELET-RICH PLASMA IN A RAT MODEL OF FEMORAL ATROPHIC NON-UNION

2026-03-26T20:28:50+02:00

Objective. To investigate the effect of local injection of platelet rich plasma (PRP) on periosteal bone formation in a rat model of femoral atrophic non-union. Methods. The study was conducted on 11 rats. Atrophic non-union was modelled by performing a mid-shaft femoral osteotomy with intramedullary Kirschner wire fixation, followed by periosteal stripping (2 mm) at both ends of the osteotomized bone and their separation with a silicone spacer. On day 7 post-surgery, 5 animals received a local PRP injection into the injury zone. Radiography was performed at weeks 2 and 4. After 8 weeks, euthanasia was performed, and the operated femurs were harvested for histological analysis. Results. In the atrophic non-union model, a loose connective tissue capsule of varying thickness without signs of inflammation was found around the spacer in all rats. Acellular areas were identified within the cortex. The structure of the periosteum and endosteum near the osteotomy site was disrupted. In 5 out of 6 animals, no signs of bone formation were observed near the spacer from either the periosteal or endosteal zones. Following PRP injection, a higher density of capillary-type vessels was observed within the capsule. Areas of cartilage with hypertrophic chondrocytes were identified, indicating endochondral ossification. In 4 rats, formed bone tissue was recorded on the fragments, predominantly on one side, in both periosteal and endosteal zones. The bone tissue was cancellous in the periosteal zone and woven bone in the endosteal zone. Conclusion. Local PRP injection into the injury zone on day 7 in a rat model of femoral atrophic non-union with previously disrupted periosteum positively affects periosteal bone formation at the fragment ends.

CHANGES IN CEREBRAL OXYGENATION AT DIFFERENT BEACH CHAIR POSITION ANGLES AS A PREDICTOR OF EARLY POSTOPERATIVE NEUROCOGNITIVE DISORDERS

2026-03-26T21:07:16+02:00

The beach chair position during shoulder surgery may lead to reduced cerebral oxygenation due to the hydrostatic gradient and anesthesia-induced vasodilation. Increasing the tilt angle potentially elevates the risk of cerebral hypoxia and early postoperative cognitive impairment. Objective. To investigate the effect of body tilt angle in the beach chair position on cerebral oxygenation parameters and the risk of early postoperative cognitive impairment. Methods. In this prospective randomized study, 75 ASA I–II patients undergoing shoulder surgery were assigned to a beach chair position at either 80° (n = 35) or 60° (n = 40). Regional cerebral oxygen saturation (rSO2) was monitored using near-infrared spectroscopy (NIRS), along with hemodynamic parameters and BIS. Cognitive function was assessed using the MMSE preoperatively and 24 hours postoperatively. Quality of recovery was evaluated using the QoR-15 questionnaire, and discharge readiness using the Modified Aldrete score. Statistical analysis was performed using Student’s t-test. Results. After positioning, mean rSO2 was lower in the 80° group (71.9 ± 6.6 %) compared with the 60° group (83.3 ± 5.3 %; p < 0.001), with no significant differences in mean arterial pressure. At 24 hours, MMSE scores were lower in the 80° group (25.1 ± 1.5 vs 28.1 ± 1.3; p < 0.001). This group also demonstrated poorer QoR-15 scores and longer extubation time (p <0.001). Conclusions. A tilt angle of 80° is associated with greater reductions in rSO2 and worse early cognitive outcomes.