Journal of Joint Surgery and Research最新文献_第2页

Post-operative change in lower limb length in inverted V-shaped high tibial osteotomy with a large correction angle is larger than that with a small correction angle

Journal of Joint Surgery and Research

Pub Date : 2024-12-07 DOI: 10.1016/j.jjoisr.2024.11.003

Seiju Hayashi, Kei Kato, Satoshi Miyazaki, Kazuki Yunokawa

Purpose

Although inverted V-shaped high tibial osteotomy (iVHTO) is a good option for severe varus deformity requiring a valgus correction angle >15°, it is still unclear whether its several clinical advantages can be applied to varus deformities requiring a valgus correction angle ≤15°. Moreover, no previous studies have revealed why the application of iVHTO was limited to a correction angle >15°. This study aimed to compare post-operative anatomical changes and to determine any applicability of iVHTO for a valgus correction angle ≤15° using three-dimensional (3D) bone models.

Methods

Differences in post-operative anatomical alignment changes between iVHTO with >15° of correction (L-iVHTO group) and iVHTO with ≤15° of correction (S-iVHTO group) were examined. A total of 37 knees (18 L-iVHTO and 19 S-iVHTO) in 27 patients were enrolled. Pre- and post-operative 3D computed tomography bone models were reconstructed using a ZedHTO system. Post-operative anatomical changes (Δ) in posterior tibial slope (PTS), medial proximal tibial angle (MPTA), knee rotation angle (KRA), tibial torsion angle (TTA), patella tilting angle (PTA), Caton–Deschamps index (CDI), tibia length (TL), and lower leg length (LLL) were compared.

Results

ΔLLL in the L-iVHTO group (1.8 ± 5.6 mm) was significantly larger than that in the S-iVHTO group (−1.7 ± 4.8 mm; p < 0.01). No significant differences were observed among the groups in ΔMPTA, ΔPTS at the medial and lateral tibial plateau, ΔKRA, ΔTTA, ΔPTA, ΔCDI, and ΔTL.

Conclusions

Since the characteristics of hemi-open-wedge HTO (OWHTO) and hemi-closed-wedge HTO (CWHTO) might be expressed in iVHTO depending on the correction angle, surgeons should be aware pre-operatively that L-iVHTO will lengthen the LLL and S-iVHTO will shorten the LLL post-operatively.

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引用次数: 0

Hip fracture and cancer: descriptive epidemiological study demonstrating a paradigm shift in common orthopedic trauma 髋部骨折和癌症：描述性流行病学研究证明了普通骨科创伤的范式转变

Journal of Joint Surgery and Research

Pub Date : 2024-11-29 DOI: 10.1016/j.jjoisr.2024.11.002

Juri Teramoto , Yasuhiro Homma , Taiji Watari , Koju Hayashi , Tomonori Baba , Nobuhiko Hasegawa , Daisuke Kubota , Tatsuya Takagi , Muneaki Ishijima

Purpose

Despite the increase both in patients with cancer and those with proximal femoral fractures (PFFs), details of the characteristics of non-pathological PFFs in patients undergoing cancer treatment are unknown. The purpose of this retrospective study was to investigate the characteristics and issues of patients with active cancer who have non-pathological PFFs.

Methods

This was a retrospective, observational, descriptive epidemiological study. A total of 376 patients were admitted to Juntendo University hospital with a diagnosis of PFF. Six of these patients had metastasis-related pathological fractures and were excluded from this study. The remaining 370 patients comprised 100 men and 270 women.

Results

The mean patient age was 78.6 ± 11.2 years. Fractures included 141 trochanteric femoral fractures and 229 femoral neck fractures. Of these, 39 (10.5%) of the patients had active cancer, 55 (14.9%) has a history of past cancer, and 276 (74.6%) had no cancer. Among the 39 patients with active cancer, 13 (33.3%) received glucocorticoids; furthermore, 10 (76.9%) of these 13 patients were not receiving medications to prevent osteoporosis. Lastly, 9 of the 39 falls were hospitalization-related, but 6 (66.7%) of these 9 patients did not undergo rehabilitation during hospitalization.

Conclusions

Approximately one in ten patients with PFF in this study were undergoing cancer treatment. Moreover, one in four patients with PFF were cancer-related. Therefore, orthopedic surgeons should have basic knowledge about cancer management in hip fracture.

目的：尽管癌症患者和股骨近端骨折（pff）的发生率均有所增加，但接受癌症治疗的患者非病理性pff的详细特征尚不清楚。本回顾性研究的目的是探讨有非病理性pff的活动性癌症患者的特点和问题。方法回顾性、观察性、描述性流行病学研究。共有376名诊断为PFF的患者被送入俊天大学医院。其中6例患者有转移相关的病理性骨折，被排除在本研究之外。其余370名患者包括100名男性和270名女性。结果患者平均年龄78.6±11.2岁。其中股骨粗隆骨折141例，股骨颈骨折229例。其中39例（10.5%）患者有活动性癌症，55例（14.9%）患者有既往癌症病史，276例（74.6%）患者无癌症。39例活动性肿瘤患者中，13例（33.3%）接受糖皮质激素治疗；此外，这13例患者中有10例（76.9%）未接受预防骨质疏松的药物治疗。最后，39例跌倒中有9例与住院有关，但这9例患者中有6例（66.7%）在住院期间没有接受康复治疗。在本研究中，大约十分之一的PFF患者正在接受癌症治疗。此外，四分之一的PFF患者与癌症有关。因此，骨科医生应掌握髋部骨折肿瘤处理的基本知识。

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引用次数: 0

Determining the most effective osteoporosis drug for bone mineral density loss in proximal area after total hip arthroplasty: A network meta-analysis 确定治疗全髋关节置换术后近端区域骨矿物质密度损失的最有效骨质疏松症药物：网络荟萃分析

Journal of Joint Surgery and Research

Pub Date : 2024-11-26 DOI: 10.1016/j.jjoisr.2024.11.001

Akira Morita , Emi Kamono , Tadashi Oyama , Hyonmin Choe , Yutaka Inaba , Naomi Kobayashi

Purpose

The aim of this study was to compare and rank the efficacy of different drugs for bone mineral density (BMD) loss prevention at 1 year after total hip arthroplasty (THA) using a network meta-analysis (NMA) of randomized controlled trials (RCTs).

Methods

A literature search was conducted based on the PRISMA statement. The searched databases included MEDLINE (through PubMed), Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing & Allied Health Literature (CINAHL). Only RCTs exploring the efficacy of currently available osteoporosis drugs in preventing periprosthetic BMD loss were included. A multivariate random-effects NMA was conducted to combine direct and indirect comparisons of agents using a frequentist consistency model. Regarding the efficacy rank, the frequentist analog to the surface under the cumulative ranking (SUCRA) probabilities, called the P-score, was used.

Result

In total, 17 RCTs were extracted. According to the pairwise mean difference (95% confidence interval) in BMD change, the efficacy of teriparatide was highest in both zones 1 and 7. From the predicted treatment rankings for BMD changes, teriparatide was ranked as the best intervention in zone 1 (P-score = 0.8844) and zone 7 (P-score = 0.9044)

Conclusions

The results suggest that teriparatide, zoledronic acid, alendronate, and etidronate may be options for the prevention of periprosthetic BMD loss in zones 1 and 7 at 1 year after THA.

目的本研究旨在通过对随机对照试验 (RCT) 进行网络荟萃分析 (NMA)，对不同药物在全髋关节置换术 (THA) 术后 1 年预防骨矿物质密度 (BMD) 降低的疗效进行比较和排序。方法根据 PRISMA 声明进行文献检索。检索的数据库包括 MEDLINE（通过 PubMed）、Cochrane Central Register of Controlled Trials 和 Cumulative Index to Nursing & Allied Health Literature (CINAHL)。仅纳入了探讨现有骨质疏松症药物在预防假体周围 BMD 损失方面疗效的 RCT。采用频数一致性模型进行了多变量随机效应 NMA，将药物的直接和间接比较结合起来。在疗效等级方面，采用了类似于累积等级（SUCRA）概率表面的频数模型，即 P-score。根据 BMD 变化的成对平均差（95% 置信区间），特立帕肽在 1 区和 7 区的疗效最高。结论结果表明，特立帕肽、唑来膦酸、阿仑膦酸盐和依替膦酸盐可能是在 THA 术后 1 年预防 1 区和 7 区假体周围 BMD 损失的选择。

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引用次数: 0

Accurate acetabular cup placement using a smartphone-based digital alignment guide in total hip arthroplasty 在全髋关节置换术中使用基于智能手机的数字校准指南精确放置髋臼杯

Journal of Joint Surgery and Research

Pub Date : 2024-11-22 DOI: 10.1016/j.jjoisr.2024.10.002

Yuki Teranishi , Yusuke Okanoue , Junpei Dan , Dai Ohira , Masahiko Ikeuchi

Purpose

Successful total hip arthroplasty (THA) requires accurate positioning of the acetabular cup. Although computed tomography (CT)-based navigation technology enables more accurate placement, most navigation systems are bulky, expensive, and often inaccessible due to cost and complexity. The purpose of this study was to introduce a smartphone-based digital cup alignment guide to improve placement accuracy and provide a cost-effective and accessible solution for THA.

Methods

A smartphone application for acetabular cup placement in THA using built-in gyroscope and accelerometer sensors was developed. The application calculates and displays the cup inclination angle to ensure surgical accuracy. A prospective study was conducted to verify and validate the new guide by assessing the difference between the target pre-operative planned angles and the post-operative placement angles in 87 patients. Differences between the displayed intra-operative angles and the post-operative placement angles were compared between the new guide and CT-based navigation in 20 of the 87 cases.

Results

The post-operative cup inclination and anteversion angles were 40.4 ± 2.9° (range 35–47°) and 13.7 ± 4.4° (range 5–27°). Differences between the intra-operative target and post-operative cup inclination and anteversion angles were 1.8 ± 1.9° (range 0–7°) and 2.8 ± 2.5° (range 0–10°), respectively. The application demonstrated no significant difference in cup inclination and anteversion angle accuracy compared with CT-based navigation.

Conclusions

The smartphone-based guide provides a practical alternative for cup placement in THA, especially in settings where CT-based navigation is not available. Challenges include the need to manage intra-operative pelvic alignment and rotational errors, which suggest room for improvement. However, it is a cost-effective and accessible tool that can improve the accuracy of acetabular cup placement in THA.

目的成功的全髋关节置换术（THA）需要准确定位髋臼杯。虽然基于计算机断层扫描（CT）的导航技术可以实现更精确的定位，但大多数导航系统体积庞大、价格昂贵，而且由于成本和复杂性往往无法使用。本研究的目的是引入一种基于智能手机的数字髋臼杯对位指南，以提高置放的准确性，并为 THA 提供一种经济有效且易于使用的解决方案。方法开发了一种智能手机应用程序，用于在 THA 中使用内置陀螺仪和加速计传感器进行髋臼杯置放。该应用程序计算并显示髋臼杯的倾斜角度，以确保手术的准确性。一项前瞻性研究通过评估 87 名患者的术前目标计划角度和术后置入角度之间的差异，验证并确认了新指南。结果术后髋臼杯倾斜角和内翻角分别为 40.4 ± 2.9°（范围 35-47°）和 13.7 ± 4.4°（范围 5-27°）。术中目标角度与术后髋臼杯倾角和内翻角的差异分别为 1.8 ± 1.9°（范围 0-7°）和 2.8 ± 2.5°（范围 0-10°）。与基于 CT 的导航相比，该应用在髋臼杯倾角和内翻角的准确性方面没有明显差异。面临的挑战包括需要管理术中骨盆对齐和旋转误差，这表明还有改进的余地。不过，它是一种成本效益高且易于使用的工具，可以提高 THA 中髋臼杯置入的准确性。

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引用次数: 0

Meniscus tears in the setting of anterior cruciate ligament injury 前十字韧带损伤时的半月板撕裂

Journal of Joint Surgery and Research

Pub Date : 2024-11-14 DOI: 10.1016/j.jjoisr.2024.10.003

Koji Nukuto , Efstathios Konstantinou , Anja Maximiliane Wackerle , Jaren C. Lagreca , Camila Grandberg , Yunseo Linda Park , Brooke Collins , Volker Musahl

Purpose

Meniscus tears in the setting of anterior cruciate ligament (ACL) injury can affect post-operative outcomes and stability when not treated correctly. To reduce post-operative osteoarthritis and to improve outcomes, accurate diagnosis and treatment options must be selected. The purpose of this review was to review recent evidence regarding biomechanics and diagnosis of meniscus injury as well as treatment options for meniscus tears, which are often complicated by ACL injuries.

Methods

Studies and topics on concomitant meniscus tears in the presence of ACL injury were searched.

Results

Various risk factors have been identified for meniscus tears associated with ACL injuries. As some meniscus tears are difficult to identify on magnetic resonance imaging (MRI), arthroscopic diagnosis of meniscal pathology plays a crucial role. Indications for meniscectomy should be limited due to subsequent exacerbation of post-operative instability and contribution to osteoarthritic changes. Although meniscal repair is the standard treatment for bucket handle tears, ramp lesions, lateral meniscus posterior root tears, and lateral meniscus oblique radial tears, non-operative treatment may be also effective to a certain extent for stable meniscal tears. However, the indication for non-operative treatment should be carefully considered owing to potential enlargement of the torn area.

Conclusions

Inadequate treatment of concomitant meniscus tears can result in residual instability and poor outcomes despite successful ACL reconstruction. High-quality evidence on the long-term outcomes of meniscus tears complicating ACL injuries is scarce and hence future studies are required.

目的前十字韧带（ACL）损伤时的半月板撕裂如果治疗不当，会影响术后效果和稳定性。为减少术后骨关节炎并改善疗效，必须选择准确的诊断和治疗方案。本综述旨在回顾有关半月板损伤的生物力学和诊断以及半月板撕裂治疗方案的最新证据，前交叉韧带损伤通常会并发半月板撕裂。由于一些半月板撕裂在磁共振成像（MRI）上难以识别，因此关节镜对半月板病理诊断起着至关重要的作用。半月板切除术的适应症应受到限制，因为术后不稳定性会随之加重，并导致骨关节炎改变。虽然半月板修复术是治疗斗柄撕裂、斜坡病变、外侧半月板后根撕裂和外侧半月板斜径向撕裂的标准方法，但非手术治疗对稳定的半月板撕裂也有一定的疗效。结论：尽管前交叉韧带重建成功，但同时发生的半月板撕裂治疗不当会导致残余不稳定性和不良后果。有关前交叉韧带损伤并发半月板撕裂的长期疗效的高质量证据尚不多见，因此需要今后进行研究。

{"title":"Meniscus tears in the setting of anterior cruciate ligament injury","authors":"Koji Nukuto , Efstathios Konstantinou , Anja Maximiliane Wackerle , Jaren C. Lagreca , Camila Grandberg , Yunseo Linda Park , Brooke Collins , Volker Musahl","doi":"10.1016/j.jjoisr.2024.10.003","DOIUrl":"10.1016/j.jjoisr.2024.10.003","url":null,"abstract":"<div><h3>Purpose</h3><div>Meniscus tears in the setting of anterior cruciate ligament (ACL) injury can affect post-operative outcomes and stability when not treated correctly. To reduce post-operative osteoarthritis and to improve outcomes, accurate diagnosis and treatment options must be selected. The purpose of this review was to review recent evidence regarding biomechanics and diagnosis of meniscus injury as well as treatment options for meniscus tears, which are often complicated by ACL injuries.</div></div><div><h3>Methods</h3><div>Studies and topics on concomitant meniscus tears in the presence of ACL injury were searched.</div></div><div><h3>Results</h3><div>Various risk factors have been identified for meniscus tears associated with ACL injuries. As some meniscus tears are difficult to identify on magnetic resonance imaging (MRI), arthroscopic diagnosis of meniscal pathology plays a crucial role. Indications for meniscectomy should be limited due to subsequent exacerbation of post-operative instability and contribution to osteoarthritic changes. Although meniscal repair is the standard treatment for bucket handle tears, ramp lesions, lateral meniscus posterior root tears, and lateral meniscus oblique radial tears, non-operative treatment may be also effective to a certain extent for stable meniscal tears. However, the indication for non-operative treatment should be carefully considered owing to potential enlargement of the torn area.</div></div><div><h3>Conclusions</h3><div>Inadequate treatment of concomitant meniscus tears can result in residual instability and poor outcomes despite successful ACL reconstruction. High-quality evidence on the long-term outcomes of meniscus tears complicating ACL injuries is scarce and hence future studies are required.</div></div>","PeriodicalId":100795,"journal":{"name":"Journal of Joint Surgery and Research","volume":"2 4","pages":"Pages 180-188"},"PeriodicalIF":0.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142661122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Changes in the cortical bone reaction around the stem after uncemented total hip replacement using short tapered wedge stem 使用短锥形楔形柄进行非骨水泥全髋关节置换术后柄周围皮质骨反应的变化

Journal of Joint Surgery and Research

Pub Date : 2024-11-06 DOI: 10.1016/j.jjoisr.2024.10.001

Hao Dinh Anh Hoang , Hironobu Hoshino , Mitsuru Hanada , Yukihiro Matsuyama

Purpose

This study examined the relationship between stem alignment and the cortical bone area around the distal end of the femoral component using three-dimensional computed tomography (3D-CT) images after uncemented total hip arthroplasty (THA).

Methods

A total of 59 patients who underwent primary THA using an uncemented short tapered wedge stem from 2019 to 2021 were followed for at least 24 months. Patients were divided into groups based on stem position. Changes in stem position and cross-sectional area of femoral cortical bone at the distal end of the stem were examined using 3D-CT at 12 months and 24 months post-operatively and were compared with pre-operative values.

Results

The 12-month post-operative cortical bone area around the stem showed significant differences compared with the pre-operative area in the anterior, posterior, and lateral zone 1. Differences at these same points were noted when comparing the 24-month post-operative area with the pre-operative area. No significant difference was found in the change in the cortical bone area over time among the neutral, flexed, and extended stem groups. In the varus stem group, a significant increase in cortical bone area over time was observed in lateral zone 2. In the valgus stem group, a significant increase in the cortical bone area over time was observed in medial zone 1.

Conclusions

Stem alignment may affect periprosthetic cortical bone changes after THA using an uncemented short tapered wedge stem. Cortical bone reaction was revealed laterally to the stem tip in the varus-aligned stem, and medially to the stem tip in the valgus-aligned stem.

目的本研究使用三维计算机断层扫描（3D-CT）图像，研究了非骨水泥全髋关节置换术（THA）后股骨组件远端周围的骨干对位与皮质骨面积之间的关系。根据骨干位置将患者分为几组。术后12个月和24个月时，使用3D-CT检查了股骨柄位置和股骨柄远端皮质骨横截面积的变化，并与术前值进行了比较。将术后 24 个月的皮质骨面积与术前面积进行比较时，也发现这些部位存在差异。中性、屈曲和伸展骨干组的皮质骨面积随时间的变化无明显差异。在骨干外翻组，观察到外侧第2区的皮质骨面积随着时间的推移显著增加。结论使用非骨水泥短锥形楔形骨干进行THA后，骨干排列可能会影响假体周围皮质骨的变化。在屈曲对齐的骨干中，骨干顶端外侧显示皮质骨反应，而在内翻对齐的骨干中，骨干顶端内侧显示皮质骨反应。

{"title":"Changes in the cortical bone reaction around the stem after uncemented total hip replacement using short tapered wedge stem","authors":"Hao Dinh Anh Hoang , Hironobu Hoshino , Mitsuru Hanada , Yukihiro Matsuyama","doi":"10.1016/j.jjoisr.2024.10.001","DOIUrl":"10.1016/j.jjoisr.2024.10.001","url":null,"abstract":"<div><h3>Purpose</h3><div>This study examined the relationship between stem alignment and the cortical bone area around the distal end of the femoral component using three-dimensional computed tomography (3D-CT) images after uncemented total hip arthroplasty (THA).</div></div><div><h3>Methods</h3><div>A total of 59 patients who underwent primary THA using an uncemented short tapered wedge stem from 2019 to 2021 were followed for at least 24 months. Patients were divided into groups based on stem position. Changes in stem position and cross-sectional area of femoral cortical bone at the distal end of the stem were examined using 3D-CT at 12 months and 24 months post-operatively and were compared with pre-operative values.</div></div><div><h3>Results</h3><div>The 12-month post-operative cortical bone area around the stem showed significant differences compared with the pre-operative area in the anterior, posterior, and lateral zone 1. Differences at these same points were noted when comparing the 24-month post-operative area with the pre-operative area. No significant difference was found in the change in the cortical bone area over time among the neutral, flexed, and extended stem groups. In the varus stem group, a significant increase in cortical bone area over time was observed in lateral zone 2. In the valgus stem group, a significant increase in the cortical bone area over time was observed in medial zone 1.</div></div><div><h3>Conclusions</h3><div>Stem alignment may affect periprosthetic cortical bone changes after THA using an uncemented short tapered wedge stem. Cortical bone reaction was revealed laterally to the stem tip in the varus-aligned stem, and medially to the stem tip in the valgus-aligned stem.</div></div>","PeriodicalId":100795,"journal":{"name":"Journal of Joint Surgery and Research","volume":"2 4","pages":"Pages 173-179"},"PeriodicalIF":0.0,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Pain characteristics in patients with hip osteoarthritis 髋关节骨关节炎患者的疼痛特征

Journal of Joint Surgery and Research

Pub Date : 2024-10-04 DOI: 10.1016/j.jjoisr.2024.09.003

Toru Nishiwaki, Hisatoshi Ishikura, Tatsuya Yamamoto

Purpose

Exacerbations of osteoarthritis (OA) pain significantly impair activities of daily living and walking, thereby reducing quality of life. Despite various treatments, persistent pain remains a challenge, particularly in patients with hip OA, where pain perception mechanisms extend beyond nociceptive pain. This study examined the pain characteristics in patients with hip OA, with an emphasis on neuropathic pain and central sensitization (CS).

Methods

A total of 421 patients scheduled for unilateral total hip arthroplasty were analyzed using the painDETECT score and Central Sensitization Inventory to classify the pain types as nociceptive (Noc), CS, neuropathic (Neu), or neuropathic with CS (NeuCS).

Results

The results indicated that 72.9% of patients experienced Noc pain, while 5.0% experienced combined NeuCS pain. The Neu and NeuCS groups exhibited significantly lower modified Harris Hip Score and EuroQol-5 Dimensions Questionnaire (EQ-5D) scores than the Noc group, indicating worse clinical outcomes and quality of life. Neu pain was more intense at rest, and when combined with CS it significantly diminished the quality of life.

Conclusion

These findings highlight the need for mechanism-based pain treatment strategies, such as Neu pain and CS components, which independently and cumulatively affect clinical scores and quality of life. This study highlights the importance of early recognition and targeted treatment of these pain mechanisms in patients with hip OA. Future research should focus on evaluating therapeutic interventions for Neu pain and CS to optimize patient outcomes.

目的骨关节炎（OA）疼痛加剧会严重影响日常生活和行走活动，从而降低生活质量。尽管采取了各种治疗方法，但持续性疼痛仍是一项挑战，尤其是髋关节 OA 患者，其疼痛感知机制已超出了痛觉疼痛的范畴。本研究探讨了髋关节 OA 患者的疼痛特征，重点是神经病理性疼痛和中枢敏感化（CS）。结果显示，72.9% 的患者有 Noc 疼痛，5.0% 的患者合并有 NeuCS 疼痛。Neu 组和 NeuCS 组的改良 Harris 髋关节评分和 EuroQol-5 Dimensions 问卷 (EQ-5D) 得分明显低于 Noc 组，表明临床疗效和生活质量更差。结论：这些研究结果强调了基于机制的疼痛治疗策略的必要性，如 Neu 疼痛和 CS 成分，它们会独立并累积影响临床评分和生活质量。本研究强调了早期识别和有针对性地治疗髋关节 OA 患者这些疼痛机制的重要性。未来的研究应重点评估神经痛和CS的治疗干预措施，以优化患者的预后。

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引用次数: 0

Comparison of physical function recovery in patients with rheumatoid arthritis and those with osteoarthritis after total knee arthroplasty 类风湿性关节炎患者与骨关节炎患者在全膝关节置换术后身体功能恢复情况的比较

Journal of Joint Surgery and Research

Pub Date : 2024-09-19 DOI: 10.1016/j.jjoisr.2024.08.001

Eriko Mashimoto , Manabu Nankaku , Gakuto Kitamura , Kohei Nishitani , Shinichiro Nakamura , Shinichi Kuriyama , Ryosuke Ikeguchi , Shuichi Matsuda

Purpose

Patients with rheumatoid arthritis (RA) who have undergone primary total knee arthroplasty (TKA) have a different recovery process of walking ability compared with patients with osteoarthritis (OA). However, how this relates to pain and other physical functions is unknown. This study aimed to evaluate and compare physical function after TKA in patients with RA and knee OA.

Methods

This study enrolled 146 patients (24 with RA and 122 with OA) who underwent primary TKA. Data on the following were collected pre- and post-TKA (3 weeks and 1 year): 10 Meter Walk Test (10MWT), Timed Up and Go (TUG) test, knee pain, physical activity, isometric knee extensor and flexor strength, passive knee extension and flexion angle, and one-leg standing time. Two-way repeated measures analysis of variance (ANOVA) with Bonferroni post hoc comparisons was performed to examine the influence of the different diseases on post-operative changes in physical function over time.

Results

The RA group had a significantly more severe pre-operative pain score than the OA group (p < 0.05). A two-way repeated measures ANOVA showed a significant group × time interaction in the TUG test and 10MWT time. The RA group had a slower pre-operative time in these tests than the OA group (p < 0.01). However, the TUG test and 10MWT time at 3 weeks and 1 year post-TKA were not significantly different between the two groups.

Conclusion

In patients with RA, walking ability significantly improved at 3 weeks following TKA, and showed recovery from 3 weeks up to 1 year similar to patients with OA.

目的与骨关节炎（OA）患者相比，接受过初级全膝关节置换术（TKA）的类风湿性关节炎（RA）患者的行走能力恢复过程有所不同。然而，这与疼痛和其他身体功能的关系尚不清楚。本研究旨在评估和比较 RA 和膝关节 OA 患者接受 TKA 后的身体功能。收集了TKA术前和术后（3周和1年）的以下数据：10 米步行测试 (10MWT)、定时上下楼测试 (TUG)、膝关节疼痛、体力活动、等长膝关节伸屈力量、被动膝关节伸屈角度和单腿站立时间。采用双向重复测量方差分析（ANOVA）和Bonferroni事后比较来研究不同疾病对术后身体功能随时间变化的影响。双向重复测量方差分析显示，在TUG测试和10MWT时间上，组别与时间之间存在显著的交互作用。在这些测试中，RA 组的术前时间慢于 OA 组（p < 0.01）。结论在TKA术后3周，RA患者的行走能力明显改善，从3周到1年的恢复情况与OA患者相似。

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引用次数: 0

What are the most difficult steps in total hip arthroplasty for early-career surgeons and how can future technology help most? A survey of the American Association of Hip and Knee Surgeons Young Arthroplasty Group 对于初入职场的外科医生来说，全髋关节置换术中最困难的步骤是什么？美国髋关节和膝关节外科医生协会青年关节成形术小组的一项调查

Journal of Joint Surgery and Research

Pub Date : 2024-09-17 DOI: 10.1016/j.jjoisr.2024.09.002

Ken Tashiro , Yasuhiro Homma , Jesse Wolfstadt , Christopher M. Melnic , Muneaki Ishijima , Atul F. Kamath

Purpose

While technology in total hip arthroplasty (THA) is generally developed by experienced surgeons, particular difficulties in surgical steps and technical demands experienced by early-career surgeons remain important. This study investigated the challenges early-career surgeons currently face in THA in order to obtain insights into how they perceive future innovative technologies might reduce the difficulties and complications associated with THA.

Methods

Members of the American Association of Hip and Knee Surgeons Young Arthroplasty Group were surveyed. The perceived degree of difficulty with key THA surgical steps and the utility of adjunctive technology were recorded (scale 1–10, from no difficulty/not important to very difficult/very important).

Results

The membership response rate was 16.1%. The most common THA approach was the direct anterior approach (DAA) (67.4%). Four of the top five most difficult surgical steps were associated with cup preparation/placement. Fluoroscopy was the most used technology (56.7%), followed by no technology use (21.2%) and robot arm assistance (12.1%). With respect to the importance of technology, accurate cup placement ranked first. Dislocation and stem subsidence were the top two complications for which technological advances were thought to be most beneficial. Subgroup analysis based on surgical approach suggested that DAA users had significantly more difficulty with direction of stem rasping than non-DAA users (p < 0.0001).

Conclusion

This is the first survey to reveal data about perceived difficulties in THA surgical steps from the perspective of early-career arthroplasty surgeons and the role of technology in mitigating these complications. Future technological developments may take these needs of early-career surgeons into account.

目的虽然全髋关节置换术（THA）的技术通常是由经验丰富的外科医生开发的，但职业生涯初期的外科医生在手术步骤和技术要求方面遇到的特殊困难仍然很重要。本研究调查了职业生涯初期的外科医生目前在全髋关节置换术中面临的挑战，以便深入了解他们认为未来的创新技术会如何降低全髋关节置换术的难度和并发症。结果会员回复率为 16.1%。最常见的 THA 方法是直接前路 (DAA)（67.4%）。最困难的五个手术步骤中有四个与髋臼杯准备/置入有关。透视是使用最多的技术（56.7%），其次是不使用技术（21.2%）和机械臂辅助（12.1%）。就技术的重要性而言，精确的杯置放位居首位。脱位和柄下沉是技术进步被认为最有益的前两种并发症。基于手术方法的亚组分析表明，DAA使用者在茎杆拉锯方向上遇到的困难明显多于非DAA使用者（p < 0.0001）。未来的技术发展可能会考虑到早期职业外科医生的这些需求。

{"title":"What are the most difficult steps in total hip arthroplasty for early-career surgeons and how can future technology help most? A survey of the American Association of Hip and Knee Surgeons Young Arthroplasty Group","authors":"Ken Tashiro , Yasuhiro Homma , Jesse Wolfstadt , Christopher M. Melnic , Muneaki Ishijima , Atul F. Kamath","doi":"10.1016/j.jjoisr.2024.09.002","DOIUrl":"10.1016/j.jjoisr.2024.09.002","url":null,"abstract":"<div><h3>Purpose</h3><p>While technology in total hip arthroplasty (THA) is generally developed by experienced surgeons, particular difficulties in surgical steps and technical demands experienced by early-career surgeons remain important. This study investigated the challenges early-career surgeons currently face in THA in order to obtain insights into how they perceive future innovative technologies might reduce the difficulties and complications associated with THA.</p></div><div><h3>Methods</h3><p>Members of the American Association of Hip and Knee Surgeons Young Arthroplasty Group were surveyed. The perceived degree of difficulty with key THA surgical steps and the utility of adjunctive technology were recorded (scale 1–10, from no difficulty/not important to very difficult/very important).</p></div><div><h3>Results</h3><p>The membership response rate was 16.1%. The most common THA approach was the direct anterior approach (DAA) (67.4%). Four of the top five most difficult surgical steps were associated with cup preparation/placement. Fluoroscopy was the most used technology (56.7%), followed by no technology use (21.2%) and robot arm assistance (12.1%). With respect to the importance of technology, accurate cup placement ranked first. Dislocation and stem subsidence were the top two complications for which technological advances were thought to be most beneficial. Subgroup analysis based on surgical approach suggested that DAA users had significantly more difficulty with direction of stem rasping than non-DAA users (<em>p</em> < 0.0001).</p></div><div><h3>Conclusion</h3><p>This is the first survey to reveal data about perceived difficulties in THA surgical steps from the perspective of early-career arthroplasty surgeons and the role of technology in mitigating these complications. Future technological developments may take these needs of early-career surgeons into account.</p></div>","PeriodicalId":100795,"journal":{"name":"Journal of Joint Surgery and Research","volume":"2 4","pages":"Pages 157-162"},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949705124000239/pdfft?md5=ec3389e929d99dfbe76509b80d584033&pid=1-s2.0-S2949705124000239-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142241530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Plain radiograph evaluation of concurrent filling of tibial peg holes with bone in cementless total knee arthroplasty 无骨水泥全膝关节置换术中胫骨钉孔同时填充骨质的平片评估

Journal of Joint Surgery and Research

Pub Date : 2024-09-14 DOI: 10.1016/j.jjoisr.2024.09.001

Kazue Hayakawa, Hideki Date, Sho Nojiri, Yosuke Kaneko, Kohei Shibata, Nobuyuki Fujita

Purpose

This study aimed to evaluate the effectiveness of a novel technique for securing the tibial component in cementless total knee arthroplasty (TKA) by utilizing resected cancellous bone to fill the peg holes. It was hypothesized that this method would reduce the incidence of radiolucent lines (RLLs) on plain radiographs. To test this hypothesis, a retrospective comparison of plain radiographs from patients who underwent the bone-filling technique (bone filling group) versus those who did not receive this treatment (conventional group) was conducted.

Methods

Participants were 151 patients (213 joints) who underwent TKA with the NexGen trabecular metal (TM) modular tibia (Zimmer Biomet) from 2011 to 2016 [bone filling group, 54 patients (69 joints); conventional group, 100 patients (144 joints); 3 patients had 1 joint in each group]. Clinical evaluations, plain radiographs, and operative time were compared between groups.

Results

The mean follow-up period was 5 years and 5 months. Knee Society Scores and Knee Society Functional Scores did not differ significantly between groups; however, the bone filling group had a significantly lower incidence of RLLs (p < 0.05) and significantly more longitudinal trabecular thickening below the pegs (p < 0.05). Multiple logistic regression analysis with the presence/absence of RLLs as the dependent variable revealed a significant effect of bone filling (odds ratio = 2.820, 95% confidence interval 1.033–7.700; p < 0.05).

Conclusion

Concurrent peg hole bone filling significantly reduces the incidence of RLLs and significantly increases longitudinal trabecular thickening below the pegs during TKA with the NexGen TM modular tibial component.

目的本研究旨在评估利用切除的松质骨填充钉孔来固定无骨水泥全膝关节置换术（TKA）胫骨组件的新技术的有效性。我们假设这种方法可以减少平片上放射性透明线 (RLL) 的发生率。为了验证这一假设，我们对接受骨填充技术的患者（骨填充组）与未接受该治疗的患者（传统组）的平片进行了回顾性比较。方法参与者为 2011 年至 2016 年期间接受 NexGen 小梁金属 (TM) 模块化胫骨（Zimmer Biomet）TKA 的 151 位患者（213 个关节）[骨填充组，54 位患者（69 个关节）；传统组，100 位患者（144 个关节）；每组 3 位患者有 1 个关节]。结果平均随访时间为 5 年零 5 个月。膝关节协会评分和膝关节协会功能评分在组间无明显差异；但骨填充组的 RLL 发生率明显较低（p < 0.05），骨钉下方的纵向骨小梁增厚明显较多（p < 0.05）。结论在使用 NexGen TM 模块化胫骨组件进行 TKA 时，同时进行钉孔骨填充可显著降低 RLL 的发生率，并显著增加钉孔下方的纵向骨小梁增厚。

{"title":"Plain radiograph evaluation of concurrent filling of tibial peg holes with bone in cementless total knee arthroplasty","authors":"Kazue Hayakawa, Hideki Date, Sho Nojiri, Yosuke Kaneko, Kohei Shibata, Nobuyuki Fujita","doi":"10.1016/j.jjoisr.2024.09.001","DOIUrl":"10.1016/j.jjoisr.2024.09.001","url":null,"abstract":"<div><h3>Purpose</h3><p>This study aimed to evaluate the effectiveness of a novel technique for securing the tibial component in cementless total knee arthroplasty (TKA) by utilizing resected cancellous bone to fill the peg holes. It was hypothesized that this method would reduce the incidence of radiolucent lines (RLLs) on plain radiographs. To test this hypothesis, a retrospective comparison of plain radiographs from patients who underwent the bone-filling technique (bone filling group) versus those who did not receive this treatment (conventional group) was conducted.</p></div><div><h3>Methods</h3><p>Participants were 151 patients (213 joints) who underwent TKA with the NexGen trabecular metal (TM) modular tibia (Zimmer Biomet) from 2011 to 2016 [bone filling group, 54 patients (69 joints); conventional group, 100 patients (144 joints); 3 patients had 1 joint in each group]. Clinical evaluations, plain radiographs, and operative time were compared between groups.</p></div><div><h3>Results</h3><p>The mean follow-up period was 5 years and 5 months. Knee Society Scores and Knee Society Functional Scores did not differ significantly between groups; however, the bone filling group had a significantly lower incidence of RLLs (<em>p</em> < 0.05) and significantly more longitudinal trabecular thickening below the pegs (<em>p</em> < 0.05). Multiple logistic regression analysis with the presence/absence of RLLs as the dependent variable revealed a significant effect of bone filling (odds ratio = 2.820, 95% confidence interval 1.033–7.700; <em>p</em> < 0.05).</p></div><div><h3>Conclusion</h3><p>Concurrent peg hole bone filling significantly reduces the incidence of RLLs and significantly increases longitudinal trabecular thickening below the pegs during TKA with the NexGen TM modular tibial component.</p></div>","PeriodicalId":100795,"journal":{"name":"Journal of Joint Surgery and Research","volume":"2 4","pages":"Pages 151-156"},"PeriodicalIF":0.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949705124000240/pdfft?md5=16cac605b90a9f1a297352fca61334b7&pid=1-s2.0-S2949705124000240-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142232759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0