Journal of Joint Surgery and Research最新文献

Autologous protein solution injections in end-stage hip and knee osteoarthritis: comparison of rates of conversion to arthroplasty 自体蛋白溶液注射治疗终末期髋关节和膝关节骨性关节炎：转换率的比较

Journal of Joint Surgery and Research

Pub Date : 2026-01-21 DOI: 10.1016/j.jjoisr.2025.12.008

Ayano Kuwasawa , Junya Itou , Kotaro Nihei , Ken Okazaki

Purpose

This study evaluated the efficacy of autologous protein solution (APS) injections in patients with end-stage osteoarthritis of the hip (HOA) or knee (KOA). Given the limited evidence for APS in HOA, the focus was on comparing the rates of conversion to arthroplasty between the two joints after APS therapy. Therefore, the primary aim of this study was to compare conversion rates to arthroplasty, while the secondary aim was to evaluate response rates based on short-term patient-reported outcomes. Additionally, given the anticipated differences in patient backgrounds between KOA and HOA groups, a supplementary analysis was conducted using propensity score matching (PSM).

Methods

Patients with Kellgren–Lawrence grade 4 HOA or KOA who received APS injections at a single institution between 2018 and 2023 were retrospectively reviewed. PSM was used to adjust for age, sex, body mass index, and follow-up duration. Arthroplasty-free survival was assessed using the Kaplan–Meier method. Clinical efficacy was evaluated with the OMERACT-OARSI criteria, using the Knee Injury and Osteoarthritis Outcome Score for KOA and the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire for HOA.

Results

Of 704 cases treated, 16 hips and 183 knees met the inclusion criteria; 15 hips and 15 knees were matched for analysis. Kaplan–Meier curve analysis revealed a significantly higher 2 year rate of conversion to arthroplasty for HOA (75.0% vs. 36.6%; p < 0.0001). However, there was no significant difference in the 6 month OMERACT-OARSI response rate (HOA 54.2%, KOA 40.0%; p = 0.38).

Conclusion

APS provided short-term symptom relief in both HOA and KOA but failed to delay arthroplasty in most HOA cases. Anatomical and biomechanical factors may influence long-term efficacy.

目的评价自体蛋白溶液（APS）注射治疗终末期髋关节（HOA）或膝关节（KOA）骨性关节炎的疗效。鉴于APS治疗HOA的证据有限，本研究的重点是比较APS治疗后两个关节间转到关节置换术的比率。因此，本研究的主要目的是比较关节置换术的转换率，而次要目的是根据患者报告的短期结果评估缓解率。此外，考虑到KOA组和HOA组之间患者背景的预期差异，使用倾向评分匹配（PSM）进行了补充分析。方法回顾性分析2018年至2023年在同一机构接受APS注射的kelglen - lawrence 4级HOA或KOA患者。PSM用于调整年龄、性别、体重指数和随访时间。采用Kaplan-Meier法评估无关节置换生存期。临床疗效评估采用OMERACT-OARSI标准，KOA采用膝关节损伤和骨关节炎结局评分，HOA采用日本骨科协会髋关节疾病评估问卷。结果704例患者中，16髋、183膝符合纳入标准；15个髋部和15个膝关节进行匹配分析。Kaplan-Meier曲线分析显示，HOA的2年转换率明显更高（75.0% vs. 36.6%; p < 0.0001）。然而，6个月的OMERACT-OARSI缓解率无显著差异（HOA 54.2%, KOA 40.0%; p = 0.38）。结论aps对HOA和KOA均有短期缓解作用，但对大多数HOA患者均不能延迟关节置换术。解剖和生物力学因素可能影响长期疗效。

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引用次数: 0

Robotic-assisted total hip arthroplasty 机器人辅助全髋关节置换术

Journal of Joint Surgery and Research

Pub Date : 2026-01-19 DOI: 10.1016/j.jjoisr.2025.12.006

Faraz A. Asim , K. Keely Boyle , Antonia F. Chen

Purpose

The aim of the review was to outline the evolution of navigation and robotic-assisted systems in total hip arthroplasty (THA), describe major classification schemes and current platforms, and summarize evidence on their clinical performance and limitations.

Methods

This review traces the development of computer-assisted and robotic-assisted technologies in THA, highlights key system classifications and representative platforms, and synthesizes published data on accuracy, outcomes, and workflow considerations.

Results

Navigation and robotic-assisted systems were developed to reduce variability in component placement through pre-operative planning, intra-operative guidance, and real-time feedback. Evidence demonstrates that robotic-assisted THA improves the accuracy of component orientation and limb length restoration compared with manual techniques, while long-term functional outcomes and cost effectiveness remain similar.

Conclusions

Robotic-assisted THA provides measurable improvements in technical accuracy and reproducibility. However, further prospective studies with robust methodology are needed to clarify its long-term clinical and economic value.

目的概述全髋关节置换术中导航和机器人辅助系统的发展，描述主要分类方案和当前平台，并总结其临床表现和局限性的证据。本文回顾了人工髋关节手术中计算机辅助和机器人辅助技术的发展，重点介绍了关键的系统分类和代表性平台，并综合了有关准确性、结果和工作流程考虑因素的已发表数据。结果通过术前计划、术中指导和实时反馈，开发了导航和机器人辅助系统，以减少组件放置的可变性。有证据表明，与人工技术相比，机器人辅助THA提高了部件定位和肢体长度恢复的准确性，而长期功能结果和成本效益保持相似。结论机器人辅助THA在技术准确性和可重复性方面有显著提高。然而，需要进一步的前瞻性研究和可靠的方法来阐明其长期临床和经济价值。

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引用次数: 0

Kinematic alignment in total knee arthroplasty: principles, outcomes, and evolving perspectives 全膝关节置换术中的运动学对齐：原则、结果和不断发展的观点

Journal of Joint Surgery and Research

Pub Date : 2026-01-16 DOI: 10.1016/j.jjoisr.2025.12.005

Manabu Akagawa , Loïc Villet , Ciara Harman , Charles Rivière

Purpose

Mechanical alignment (MA) has traditionally guided total knee arthroplasty (TKA), seeking neutral limb alignment for all patients. However, this uniform method disregards anatomical diversity and leaves up to 20% of patients dissatisfied. Kinematic alignment (KA) was introduced to address these limitations by restoring each patient's native pre-arthritic knee alignment.

Methods

A literature review conducted in April 2025 examined the rationale, biomechanics, clinical outcomes, implant considerations, and future directions of KA-TKA.

Results

KA replicates the knee's natural joint lines and ligament balance, avoiding the soft tissue and kinematic distortions inherent to MA. Biomechanical studies show that KA better reproduces native knee kinematics and more physiological gait patterns. Clinical evidence, including randomized trials and meta-analyses, demonstrates that KA provides superior joint perception, greater patient satisfaction, and comparable implant survivorship relative to MA. Long-term data extending beyond 10 years indicate that component positioning and prosthetic limb alignment have a negligible influence on implant loosening or revision rates. Implant selection also plays a key role, with medial pivot designs and posterior cruciate ligament retention further enhancing (i.e. symbiotic effect) the kinematic and clinical benefits of KA.

Conclusions

KA represents a validated, patient-specific alternative to the long-standing MA paradigm. By aligning prosthetic components to each patient's anatomy rather than enforcing a neutral axis, KA enhances TKA performance without compromising implant durability. Future research should focus on refining three-dimensional assessment tools and implant designs to optimize the reproducibility and longevity of KA-TKA.

机械对齐（MA）传统上指导全膝关节置换术（TKA），为所有患者寻求中立肢体对齐。然而，这种统一的方法忽视了解剖学的多样性，导致多达20%的患者不满意。运动学对齐（KA）的引入是为了解决这些限制，通过恢复每个患者的原生关节炎前的膝关节对齐。方法于2025年4月进行了一篇文献综述，探讨了KA-TKA的原理、生物力学、临床结果、种植注意事项和未来发展方向。结果ska复制了膝关节的自然关节线和韧带平衡，避免了MA固有的软组织和运动学扭曲。生物力学研究表明，KA更好地再现了膝关节的运动学和更生理的步态模式。包括随机试验和荟萃分析在内的临床证据表明，与MA相比，KA提供了更好的关节感知，更高的患者满意度和相当的种植体存活率。超过10年的长期数据表明，组件定位和假肢对齐对种植体松动或翻修率的影响可以忽略不计。植入物的选择也起着关键作用，内侧枢轴设计和后交叉韧带保留进一步增强了KA的运动学和临床益处（即共生效应）。结论ska代表了长期存在的MA模式的一种经过验证的、患者特异性的替代方案。通过将假体部件对准每个患者的解剖结构，而不是强制一个中性轴，KA增强了TKA的性能，而不影响植入物的耐用性。未来的研究应着眼于完善三维评估工具和种植体设计，以优化KA-TKA的重复性和寿命。

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引用次数: 0

Proximal femoral periprosthetic fractures: A review of current concepts 股骨近端假体周围骨折：当前概念的回顾

Journal of Joint Surgery and Research

Pub Date : 2026-01-13 DOI: 10.1016/j.jjoisr.2025.12.004

Dylan Green, Humza Osmani, James Li, Vishal Senthilkumar, Andreas Fontalis, Fares S. Haddad

Purpose

Periprosthetic femoral fractures (PFFs) are a serious complication of total hip arthroplasty (THA) and are expected to become more frequent as older patients live longer with osteoporotic bone and well-fixed implants. This review summarizes recent evidence to support rational prevention and management.

Methods

A narrative review of contemporary clinical, registry, and biomechanical studies on proximal femoral PFFs was performed, focusing on epidemiology and risk factors, femoral stem design and biomechanics, classification, treatment of Vancouver B fractures, and peri-operative optimization.

Results

Registry and cohort studies show that PFFs occur mainly in frail older patients, with 1 year mortality similar to that after fragility hip fracture. Early post-operative fracture risk is consistently higher after uncemented than cemented THA, while composite beam cemented stems and collared cementless stems appear to reduce risk compared with polished taper slip and collarless designs. Short stems and hip resurfacing have theoretical advantages for proximal load transfer but have not shown consistent protection against PFF. Conventional Vancouver and Unified Classification System schemes are less reliable around polished taper slip stems; interface based concepts that focus on cement–bone integrity may better guide management. For selected Vancouver B2 and B3 fractures, especially in physiologically high-risk patients, open reduction and internal fixation can achieve outcomes comparable with revision when the cement–bone interface is intact. Early surgery in orthogeriatric pathways appears important.

Conclusion

A design-specific, physiology-led approach combining implant selection, interface-based classification, selective fixation, and peri-operative optimization is central to improving outcomes in PFF.

目的：股骨假体周围骨折（pff）是全髋关节置换术（THA）的一个严重并发症，随着骨质疏松性骨和固定良好的假体的老年患者寿命延长，pff的发生率有望增加。本文综述了支持合理预防和管理的最新证据。方法回顾当代股骨近端pff的临床、登记和生物力学研究，重点关注流行病学和危险因素、股骨干设计和生物力学、温哥华B型骨折的分类、治疗和围手术期优化。结果注册和队列研究表明，pff主要发生在体弱的老年患者中，其1年死亡率与脆性髋部骨折后相似。非骨水泥THA术后早期骨折风险始终高于骨水泥THA，而复合梁骨水泥支架和无骨水泥支架与抛光锥形滑脱和无骨水泥支架设计相比，风险更低。短茎和髋关节表面置换在近端负荷转移方面具有理论上的优势，但对PFF的保护作用并不一致。传统的温哥华和统一分类系统方案在抛光锥形滑杆周围不太可靠；基于界面的概念关注骨水泥的完整性可以更好地指导管理。对于选定的温哥华B2和B3骨折，特别是生理性高风险患者，在水泥-骨界面完好的情况下，切开复位内固定可以达到与翻修相当的效果。早期手术治疗正老年病通路显得很重要。结论：结合植入物选择、基于界面的分类、选择性固定和围手术期优化，设计特异性、生理导向的方法是改善PFF预后的核心。

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引用次数: 0

Mechanical alignment can still be an optimal target in total knee arthroplasty for severe varus knee 机械对齐仍然是严重膝内翻全膝关节置换术的最佳目标

Journal of Joint Surgery and Research

Pub Date : 2026-01-06 DOI: 10.1016/j.jjoisr.2025.12.002

Shuichi Matsuda, Kohei Nisthitani, Shinichi Kuriyama

Purpose

The aim of this review was to investigate which alignment strategy provides the most appropriate target in total knee arthroplasty (TKA) for severe varus deformity, taking into account age-related skeletal changes, ligament balance, and implant longevity.

Methods

Relevant radiographic, biomechanical, intra-operative, and clinical studies were reviewed to clarify how age-related deformity, soft tissue conditions, and post-operative alignment influence outcomes in varus knees undergoing TKA.

Result

Radiographic analyses show that lower limb deformity progresses with aging and osteoarthritis, making it difficult to identify the constitutional alignment based on pre-operative morphology. Intra-operative findings reveal that the medial structures are not necessarily contracted, whereas lateral laxity increases with varus severity. Biomechanical simulations indicate that varus alignment exceeding 6° results in a marked increase in medial contact stress, and clinical studies report inferior outcomes and a higher risk of tibial loosening in such cases. Reconstruction in neutral mechanical alignment without excessive medial release provides stable kinematics and satisfactory clinical outcomes, even in severe varus knees.

Conclusions

In patients with advanced varus deformity, aiming to reproduce the native alignment is neither practical nor beneficial because of age-related skeletal changes and altered ligament balance. Mechanical alignment within 3° of neutral, achieved without excessive medial release, remains a reasonable and safe target that minimizes implant stress and ensures long-term stability. Alignment beyond 6° varus should be avoided.

目的：本综述的目的是在考虑到与年龄相关的骨骼变化、韧带平衡和植入物寿命的情况下，研究在全膝关节置换术（TKA）治疗严重内翻畸形时，哪种对齐策略提供最合适的目标。方法回顾相关的影像学、生物力学、术中和临床研究，以阐明年龄相关的畸形、软组织状况和术后对齐如何影响膝关节内翻行全膝关节置换术的结果。结果影像学分析显示，下肢畸形随着年龄的增长和骨关节炎的发展而发展，使得术前形态学难以识别下肢的体质排列。术中发现内侧结构不一定收缩，而外侧松弛随着内翻的严重程度而增加。生物力学模拟表明，内翻对准超过6°会导致内侧接触应力显著增加，临床研究报告在这种情况下预后较差，胫骨松动的风险更高。无过度内侧松脱的中性机械对齐重建提供了稳定的运动学和令人满意的临床结果，即使是严重的膝内翻。结论在晚期内翻畸形患者中，由于年龄相关的骨骼变化和韧带平衡的改变，旨在重现自然对齐既不现实也无益。在无过度内侧松解的情况下，中性点3°内的机械对准仍然是合理和安全的目标，可以最大限度地减少种植体应力并确保长期稳定性。应避免对准超过6°内翻。

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引用次数: 0

Multi-region anterior knee pain is associated with poorer subjective athletic performance following anterior cruciate ligament reconstruction: an exploratory cross-sectional study 多区域前膝关节疼痛与前交叉韧带重建后较差的主观运动表现相关：一项探索性横断面研究

Journal of Joint Surgery and Research

Pub Date : 2026-01-05 DOI: 10.1016/j.jjoisr.2025.12.003

Shunsuke Ohji , Jun-ya Aizawa , Kenji Hirohata , Takehiro Ohmi , Tomoko Kawasaki , Sho Mitomo , Hideyuki Koga , Kazuyoshi Yagishita

Purpose

Anterior knee pain (AKP) is a common complication after anterior cruciate ligament (ACL) reconstruction and may affect post-operative functional outcomes. However, the relationship between the AKP region and patient-reported outcome measures (PROMs) remains unclear. The aim of this study was to examine whether multi-region AKP is associated with poorer PROMs than single region or no AKP following ACL reconstruction.

Methods

This exploratory cross-sectional study included 35 athletes who returned to sport following primary unilateral ACL reconstruction [median age 20.0 years (interquartile range 5.0 years); mean ± standard deviation time since surgery 11.8 ± 2.3 months]. Knee pain locations were identified using a photographic knee pain map and were classified into five categories: no AKP, medial, central, lateral, and multi-region. Post-operative subjective athletic performance (PoSAP) intensity and the Anterior Cruciate Ligament–Return to Sport after Injury (ACL-RSI) scale were used as PROMs. Differences in patient-reported outcomes across the five pain location groups were analyzed using the Kruskal–Wallis test and Dunn's post hoc test.

Result

Dunn's test showed that the multi-region pain group had significantly lower PoSAP scores than the no AKP group (adjusted p = 0.029; r = 0.589). However, the Kruskal–Wallis test revealed no significant differences in ACL-RSI scores among the groups with different AKP locations.

Conclusions

Individuals with AKP affecting multiple regions perceive poorer post-operative athletic performance after ACL reconstruction than those without AKP. These findings underscore the importance of assessing whether AKP has affected multiple regions, in addition to pain intensity, when evaluating post-operative recovery.

目的膝关节前侧疼痛（AKP）是前交叉韧带（ACL）重建术后常见的并发症，并可能影响术后功能预后。然而，AKP区域与患者报告的结果测量（PROMs）之间的关系尚不清楚。本研究的目的是研究在ACL重建后，与单区域AKP或无AKP相比，多区域AKP是否与较差的prom相关。方法：本探索性横断面研究纳入35名单侧前交叉韧带重建后重返运动的运动员[中位年龄20.0岁（四分位数间距5.0岁）；术后平均±标准差时间（11.8±2.3个月）。膝关节疼痛位置通过膝关节疼痛图确定，并分为五类：无AKP、内侧、中央、外侧和多区域。采用术后主观运动表现（PoSAP）强度和前十字韧带-损伤后运动恢复（ACL-RSI）量表作为PROMs。使用Kruskal-Wallis测试和Dunn事后测试分析了五个疼痛定位组患者报告结果的差异。结果经dunn检验，多区疼痛组PoSAP评分明显低于无AKP组（p = 0.029, r = 0.589）。然而，Kruskal-Wallis测试显示，不同AKP位置组的ACL-RSI评分没有显著差异。结论有AKP影响多个区域的患者在ACL重建术后运动表现较差。这些发现强调了在评估术后恢复时，除了疼痛强度外，评估AKP是否影响多个区域的重要性。

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引用次数: 0

How I perform total knee arthroplasty: functional alignment in practice 我如何进行全膝关节置换术：在实践中的功能对齐

Journal of Joint Surgery and Research

Pub Date : 2025-12-29 DOI: 10.1016/j.jjoisr.2025.11.004

Simon W. Young

Background

Alignment has traditionally been central to total knee arthroplasty (TKA). Mechanical alignment (MA) offers reproducibility and long-term durability, whereas kinematic alignment (KA) seeks to restore native anatomy. Functional alignment (FA) has recently emerged, integrating alignment and ligament balance within defined boundaries. This review summarizes the evolution of alignment philosophy and describes the uthor's current robotic-assisted FA technique.

Methods

Key technical domains—alignment, balancing, and boundaries—are outlined. Evidence from a series of randomized controlled trials (RCTs) comparing MA, KA, and FA is summarized, with a detailed description of the FA technique including initial kinematic positioning, boundary definition, virtual gap assessment, algorithm-guided optimization, and robotic execution.

Results

RCTs comparing KA and MA demonstrate no significant differences in functional outcomes at 2, 5, or 10 years. In contrast, FA provides equivalent overall outcomes to MA, but with fewer soft tissue releases and improvements in specific patient subgroups, particularly those with greater pre-operative deformity or constitutional asymmetry. While alignment and balance influence stability and mechanical loading, their effect on patient-reported outcomes appears limited once acceptable thresholds are met. Patient selection, expectation management, pain sensitization, and surgical technique remain major determinants of satisfaction.

Conclusions

FA represents a pragmatic convergence of mechanical and kinematic philosophies, using technology to individualize alignment and balance targets within safe boundaries. FA provides a balanced, reproducible approach, although outcomes in TKA depend on more than alignment alone.

背景：在全膝关节置换术（TKA）中，传统上对齐一直是核心。机械对准（MA）提供再现性和长期耐用性，而运动学对准（KA）旨在恢复原始解剖结构。功能对齐（FA）最近出现，整合对齐和韧带平衡在明确的界限。这篇综述总结了对齐哲学的发展，并描述了作者目前的机器人辅助FA技术。方法概述了关键技术领域——对齐、平衡和边界。本文总结了一系列比较MA、KA和FA的随机对照试验（RCTs）的证据，并详细描述了FA技术，包括初始运动学定位、边界定义、虚拟间隙评估、算法引导优化和机器人执行。结果比较KA和MA的随机对照试验显示，2年、5年或10年的功能结局无显著差异。相比之下，FA提供了与MA相同的总体结果，但在特定的患者亚组中，特别是那些术前畸形或体质不对称较大的患者，软组织释放和改善较少。虽然对准和平衡影响稳定性和机械负荷，但一旦达到可接受的阈值，它们对患者报告的结果的影响似乎有限。患者选择、期望管理、疼痛敏感和手术技术仍然是满意度的主要决定因素。sfa代表了机械和运动学哲学的实用融合，使用技术在安全边界内个性化对齐和平衡目标。FA提供了一种平衡的、可重复的方法，尽管TKA的结果不仅仅取决于对齐。

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引用次数: 0

Hip–spine relationship in total hip arthroplasty: Concepts, clinical relevance, and future perspectives 全髋关节置换术中髋-脊柱关系：概念、临床相关性和未来展望

Journal of Joint Surgery and Research

Pub Date : 2025-12-27 DOI: 10.1016/j.jjoisr.2025.11.005

Hidetoshi Hamada , Keisuke Uemura , Nobuhiko Sugano

Purpose and Methods

Dislocation remains a leading cause of revision in total hip arthroplasty (THA). While Lewinnek's “safe zone” for acetabular component placement has historically guided surgical orientation, dislocations still occur within this range, highlighting its limitations. Recent research has emphasized the importance of spinopelvic dynamics, particularly the relationship between pelvic tilt and spinal alignment, in influencing functional component orientation and dislocation risk.

Result

Patients with spinal stiffness, prior fusion, or spinopelvic imbalance are at higher risk for instability after THA. Several spinopelvic classification systems have been developed to stratify risk and guide implant positioning. However, these systems often rely on static imaging and fail to capture post-operative or age-related changes in spinopelvic mobility. Furthermore, they do not account for femoral motion or multidirectional impingement. Virtual range of motion (VROM) simulation offers a dynamic, patient-specific alternative by modeling critical movements, such as flexion, extension, and rotation, relative to the functional pelvic plane. This enables pre-operative planning of impingement-free zones tailored to individual pelvic and femoral alignment. Even in patients with altered spinopelvic dynamics, implants planned within these parameters may achieve stability without depending solely on sagittal spinopelvic classification.

Conclusion

Although spinopelvic classification systems contribute valuable insights, their clinical utility is limited by post-operative variability and omission of femoral alignment. Patient-specific, VROM-based planning may offer clinical relevant implant orientation, improving THA stability and outcomes through individualized functional alignment strategies.

目的和方法脱位仍然是全髋关节置换术（THA）翻修的主要原因。虽然Lewinnek髋臼假体放置的“安全区”历来指导手术定位，但脱位仍然发生在该范围内，突出了其局限性。最近的研究强调了脊柱骨盆动力学的重要性，特别是骨盆倾斜和脊柱对齐之间的关系，在影响功能部件取向和脱位风险方面。结果脊柱僵硬、既往融合或脊柱骨盆不平衡的患者THA后发生不稳定的风险较高。一些脊柱-骨盆分类系统已被开发用于风险分层和指导植入物定位。然而，这些系统通常依赖于静态成像，无法捕捉到术后或年龄相关的脊柱骨盆活动能力变化。此外，它们没有考虑到股骨运动或多向撞击。虚拟活动范围（VROM）模拟提供了一个动态的，患者特定的替代方案，通过建模关键运动，如屈曲，伸展和旋转，相对于功能盆腔平面。这使得术前规划适合个人骨盆和股骨对齐的无撞击区成为可能。即使在脊柱骨盆动力学改变的患者中，在这些参数范围内计划的植入物也可以实现稳定性，而不依赖于脊柱骨盆矢状面分类。结论尽管脊柱骨盆分类系统提供了有价值的见解，但其临床应用受到术后变异性和股骨对齐遗漏的限制。患者特异性的、基于vrom的计划可以提供临床相关的种植体定位，通过个性化的功能对齐策略提高THA的稳定性和预后。

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引用次数: 0

Evaluation of the reliability and relationship with physical examination of a novel ultrasound index, the “concave sign,” for symptomatic hip labral tears 评估一种新型超声指标“凹征”对症状性髋关节唇裂的可靠性及其与体格检查的关系

Journal of Joint Surgery and Research

Pub Date : 2025-12-22 DOI: 10.1016/j.jjoisr.2025.12.001

Hiroki Yamamoto , Michihisa Aoyama , Miwa Kojima , Takao Sugiyama , Shoichi Nishikino

Purpose

This study aimed to evaluate the reliability of a novel ultrasound index, the “concave sign,” obtained by ultrasound observation, and to evaluate its association with physical examination.

Methods

Forty patients diagnosed with symptomatic hip labral tears who were undergoing conservative treatment were enrolled. Ultrasonography was used to observe the concave deformity (concave sign) of the joint capsule on the labral surface during gluteus minimus contraction. The reliability of the presence of the concave sign was examined using the κ coefficient, and the association between the concave sign and the anterior impingement test (AIT) as well as the flexion–abduction–external rotation (FABER) test was analyzed using Fisher's exact test.

Results

The intra-rater reliability for detecting the concave sign was κ = 0.81, and the inter-rater reliability was κ = 0.90. Among those with a positive concave sign, 95.7% were positive for the AIT and 87.0% were positive for the FABER test; a significant association was observed for both tests (p < 0.01 and p < 0.05, respectively).

Conclusion

This investigation indicated that the concave sign is a reliable ultrasound index for detecting adhesion-like pathology of the hip labrum and joint capsule and demonstrated its clinical utility as an adjunct to physical examination.

目的评价超声观察获得的一种新型超声指标“凹征”的可靠性，并评价其与体格检查的相关性。方法选取40例经诊断为症状性髋关节唇裂并接受保守治疗的患者。超声观察臀小肌收缩时关节囊在唇面凹形畸形（凹征）。采用κ系数检验凹征存在的可靠性，采用Fisher精确检验分析凹征与前撞击试验（AIT）和屈曲-外展-外旋试验（FABER）之间的相关性。结果检测凹符号的评分内信度为κ = 0.81，评分间信度为κ = 0.90。在凹号为阳性的患者中，AIT阳性率为95.7%，FABER阳性率为87.0%；两项试验均观察到显著相关性（分别为p <； 0.01和p <； 0.05）。结论凹征是诊断髋关节唇、关节囊粘连样病变的可靠超声指标，可作为体格检查的辅助手段。

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引用次数: 0

Chronological changes in lower leg swelling up to one year after total knee arthroplasty: A prospective case series 全膝关节置换术后一年内下肢肿胀的时间变化：前瞻性病例系列

Journal of Joint Surgery and Research

Pub Date : 2025-12-11 DOI: 10.1016/j.jjoisr.2025.10.004

Kohei Nishitani , Shinichi Kuriyama , Shinichiro Nakamura , Hiromu Ito , Shuichi Matsuda

Purpose

Lower leg swelling is a common complication following total knee arthroplasty (TKA). However, the long-term natural course of post-operative swelling remains unclear. This study aimed to evaluate chronological changes in calf circumference and to identify swelling patterns after TKA.

Methods

Patients with osteoarthritis who underwent unilateral TKA between 2020 and 2021 were included. Calf circumference on the operated side was measured on the day of surgery, at discharge (2–3 weeks post-operatively), and at 1.5, 3, 6, and 12 months after surgery. The minimum detectable change (MDC) of calf circumference was calculated to define a detectable change in swelling. Chronological changes were analyzed using Friedman's test, and factors associated with increased calf circumference were evaluated using multiple linear regression.

Results

A total of 104 patients (mean age 76.2 years) were enrolled. The MDC was calculated as 1.59 cm. The median calf circumference increased significantly at 1.5 months post-operatively (31.0 cm) compared with the pre-operative value (30.0 cm), then gradually decreased to baseline level. A detectable increase in swelling was observed in 31% of patients at 1.5 months. A greater increase in calf circumference at 1.5 months was associated with lower pre-operative calf circumference (β = −0.35; p < 0.001) and higher body mass index (β = 0.14; p = 0.02).

Conclusions

Calf circumference increased significantly at 1.5 months after TKA, and one-third of patients showed a detectable increase in swelling. These findings help clarify the time course of lower leg swelling and may guide patient education and post-operative monitoring.

目的：下肢肿胀是全膝关节置换术（TKA）后常见的并发症。然而，术后肿胀的长期自然过程仍不清楚。这项研究旨在评估小腿围的时间变化，并确定TKA后的肿胀模式。方法纳入2020年至2021年期间接受单侧TKA的骨关节炎患者。在手术当天、出院时（术后2-3周）以及术后1.5、3、6和12个月测量手术侧小腿围。计算小腿围的最小可检测变化（MDC）来定义肿胀的可检测变化。使用Friedman’s检验分析时间变化，并使用多元线性回归评估与小腿围增加相关的因素。结果共纳入104例患者，平均年龄76.2岁。MDC计算为1.59厘米。与术前（30.0 cm）相比，术后1.5个月中位小腿围明显增加（31.0 cm），然后逐渐下降到基线水平。在1.5个月时，31%的患者肿胀明显增加。1.5个月时小腿围增加较多，术前小腿围较低（β = - 0.35; p < 0.001），体重指数较高（β = 0.14; p = 0.02）。结论TKA术后1.5个月皮肤周长明显增加，1 / 3患者肿胀明显增加。这些发现有助于明确下肢肿胀的时间过程，并可指导患者教育和术后监测。

{"title":"Chronological changes in lower leg swelling up to one year after total knee arthroplasty: A prospective case series","authors":"Kohei Nishitani , Shinichi Kuriyama , Shinichiro Nakamura , Hiromu Ito , Shuichi Matsuda","doi":"10.1016/j.jjoisr.2025.10.004","DOIUrl":"10.1016/j.jjoisr.2025.10.004","url":null,"abstract":"<div><h3>Purpose</h3><div>Lower leg swelling is a common complication following total knee arthroplasty (TKA). However, the long-term natural course of post-operative swelling remains unclear. This study aimed to evaluate chronological changes in calf circumference and to identify swelling patterns after TKA.</div></div><div><h3>Methods</h3><div>Patients with osteoarthritis who underwent unilateral TKA between 2020 and 2021 were included. Calf circumference on the operated side was measured on the day of surgery, at discharge (2–3 weeks post-operatively), and at 1.5, 3, 6, and 12 months after surgery. The minimum detectable change (MDC) of calf circumference was calculated to define a detectable change in swelling. Chronological changes were analyzed using Friedman's test, and factors associated with increased calf circumference were evaluated using multiple linear regression.</div></div><div><h3>Results</h3><div>A total of 104 patients (mean age 76.2 years) were enrolled. The MDC was calculated as 1.59 cm. The median calf circumference increased significantly at 1.5 months post-operatively (31.0 cm) compared with the pre-operative value (30.0 cm), then gradually decreased to baseline level. A detectable increase in swelling was observed in 31% of patients at 1.5 months. A greater increase in calf circumference at 1.5 months was associated with lower pre-operative calf circumference (β = −0.35; <em>p</em> < 0.001) and higher body mass index (β = 0.14; <em>p</em> = 0.02).</div></div><div><h3>Conclusions</h3><div>Calf circumference increased significantly at 1.5 months after TKA, and one-third of patients showed a detectable increase in swelling. These findings help clarify the time course of lower leg swelling and may guide patient education and post-operative monitoring.</div></div>","PeriodicalId":100795,"journal":{"name":"Journal of Joint Surgery and Research","volume":"4 1","pages":"Pages 33-38"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145748198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0