Journal of Joint Surgery and Research最新文献_第5页

Prevention of surgical site infection: need to focus on the enemy within 预防手术部位感染：需要把重点放在敌人里面

Journal of Joint Surgery and Research

Pub Date : 2025-03-01 DOI: 10.1016/j.jjoisr.2025.02.003

Arian Ocean Abedi , Armita Armina Abedi , Javad Parvizi

Purpose

This review aimed to summarize effective measures to prevent surgical site infections (SSIs) and periprosthetic joint infections (PJIs) following total joint arthroplasty (TJA), focusing specifically on the role of the patient's microbiome in the pathogenesis of SSI and highlighting the importance of targeted decolonization strategies.

Methods

The impact of the microbiome of the skin, nose, and oral cavity on SSIs is examined. The review includes a detailed analysis of recent literature regarding microbiome-focused interventions and the role of synbiotics in enhancing the gastrointestinal epithelial barrier and reducing pathogen translocation. It also addresses how the host's resistome contributes to antibiotic resistance, which complicates infection prophylaxis.

Results

The findings suggest that strategic targeting of the microbiome through specific preoperative, intraoperative, and postoperative protocols can significantly improve surgical outcomes. The evidence supports the efficacy of microbiome-centered approaches in infection prevention, with a substantial focus on the roles of the skin, nasal, and oral microbiomes. However, the potential role of the gut microbiome remains less explored in arthroplasty.

Conclusions

Understanding the endogenous sources of SSIs through the microbiome offers a promising direction for reducing infection rates in TJA. While current evidence encourages a shift in pre-operative preparations and post-operative care to incorporate microbiome-centered strategies, further research is necessary to fully explore the potential of the gut microbiome in enhancing prophylaxis against SSIs and PJIs.

目的本综述旨在总结预防全关节置换术（TJA）术后手术部位感染（SSI）和假体周围关节感染（PJIs）的有效措施，特别关注患者微生物组在SSI发病机制中的作用，并强调有针对性的去菌落策略的重要性。方法观察皮肤、鼻腔和口腔微生物组对ssi的影响。这篇综述详细分析了最近关于微生物组干预的文献，以及合生剂在增强胃肠道上皮屏障和减少病原体易位方面的作用。它还解决了宿主的抵抗组如何促进抗生素耐药性，这使感染预防复杂化。结果研究结果表明，通过特定的术前、术中和术后方案，有策略地靶向微生物组可以显著改善手术效果。证据支持以微生物组为中心的方法在预防感染方面的有效性，重点关注皮肤、鼻腔和口腔微生物组的作用。然而，肠道微生物群在关节置换术中的潜在作用尚未得到充分探讨。结论通过微生物组了解ssi的内源性来源，为降低TJA感染率提供了一个有希望的方向。虽然目前的证据鼓励术前准备和术后护理转变为采用以微生物组为中心的策略，但需要进一步的研究来充分探索肠道微生物组在加强预防ssi和PJIs方面的潜力。

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引用次数: 0

Appreciation to reviewers in 2024 感谢 2024 年的审查员

Journal of Joint Surgery and Research

Pub Date : 2025-03-01 DOI: 10.1016/j.jjoisr.2025.01.002

引用次数: 0

Therapeutic strategies for periprosthetic femoral fractures based on three classification systems 基于三种分类系统的股骨假体周围骨折治疗策略

Journal of Joint Surgery and Research

Pub Date : 2025-02-21 DOI: 10.1016/j.jjoisr.2025.02.002

Tomonori Baba , Taiji Watari , Yasuhiro Homma , Kazuo Kaneko , Muneaki Ishijima

Purpose

The standardization of treatment strategies for periprosthetic femoral fractures is a critical objective for orthopedic surgeons. This review outlines detailed therapeutic approaches based on three classification systems: the Baba, AO/OTA, and Vancouver classifications.

Methods

This review examined implant stability assessment, internal fixation techniques, and revision strategies for hip function restoration in periprosthetic femoral fractures.

Results

The Baba classification objectively determines implant stability, guiding treatment selection. The AO/OTA classification assists in identifying the most appropriate internal fixation technique. The Vancouver classification informs the choice of reconstruction methods for revision surgery.

Conclusions

Management of periprosthetic femoral fractures necessitates specialized expertise in joint reconstruction while adhering to the fundamental principles of osteosynthesis to promote bony union.

目的规范股骨假体周围骨折的治疗策略是骨科医生的重要目标。本文概述了基于三种分类系统的详细治疗方法：Baba、AO/OTA和Vancouver分类。方法本综述综述了假体稳定性评估、内固定技术和股骨假体周围骨折髋功能恢复的翻修策略。结果Baba分类客观地决定种植体的稳定性，指导治疗方案的选择。AO/OTA分类有助于确定最合适的内固定技术。温哥华分类提示翻修手术重建方法的选择。结论股骨假体周围骨折的治疗需要专业的关节重建技术，同时坚持植骨术的基本原则，促进骨愈合。

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引用次数: 0

Comparison of cup placement accuracy using the navigation in total hip arthroplasty between three models using inverse probability of treatment weighting 在全髋关节置换术中，比较三种使用逆治疗概率加权法的导航模型的髋臼杯置放准确性

Journal of Joint Surgery and Research

Pub Date : 2025-02-20 DOI: 10.1016/j.jjoisr.2025.01.003

Shotaro Tachibana, Shinya Hayashi, Yuichi Kuroda, Tomoyuki Kamenaga, Masanori Tsubosaka, Kensuke Wada, Yoshihito Suda, Yuma Onoi, Kemmei Ikuta, Kensuke Anjiki, Naoki Nakano, Tomoyuki Matsumoto, Ryosuke Kuroda

Purpose

This study compared the accuracy of acetabular cup placement between three portable navigation systems during total hip arthroplasty (THA). Furthermore, factors affecting accuracy were investigated.

Methods

A total of 101 patients who underwent THA using accelerometer-based navigation, 3D mini-optical navigation, or augmented reality (AR)-based navigation were analyzed. Post-operative cup placement angles were measured using three-dimensional templates. Propensity scores were calculated based on age, sex, body mass index (BMI), and target placement angle. After adjusting for confounding factors using inverse probability of treatment weighting matching, absolute differences in post-operative and intra-operative inclination and anteversion angles were analyzed using one-way analysis of variance (p < 0.05). The backgrounds of outliers (an absolute difference in inclination or anteversion >5°) and non-outliers were compared using t-test and Fisher's exact test. Additionally, logistic regression analysis was performed to calculate the odds ratios of background outliers.

Results

The absolute differences in post-operative and intra-operative inclination angles were 2.8°, 3.0°, and 2.9° for accelerometer-based navigation, 3D mini-optical navigation, and AR-based navigation, respectively, with no significant differences. The mean differences in anteversion angles among the groups were 2.2° for accelerometer-based navigation, 2.7° for 3D mini-optical navigation, and 2.2° for AR-based navigation, with no significant differences. BMI was significantly higher in the outlier group (p = 0.03), and logistic regression analysis results showed an odds ratio of 1.2 (p = 0.02).

Conclusions

This study demonstrated no significant differences in cup placement accuracy among the three navigation systems after adjusting for confounding factors. High BMI may have affected accuracy.

目的比较三种便携式导航系统在全髋关节置换术中髋臼杯放置的准确性。进一步探讨了影响精度的因素。方法对101例采用加速度计导航、3D微型光学导航和增强现实（AR）导航的THA患者进行分析。术后杯子放置角度采用三维模板测量。根据年龄、性别、身体质量指数（BMI）和目标放置角度计算倾向得分。采用治疗权重匹配逆概率对混杂因素进行校正后，采用单因素方差分析分析术中、术后倾斜角和前倾角的绝对差异(p <；0.05)。使用t检验和Fisher精确检验比较异常值（倾斜或前倾的绝对差值>；5°）和非异常值的背景。此外，进行逻辑回归分析以计算背景异常值的优势比。结果加速度计导航、3D微型光学导航和ar导航术中、术后倾斜角度绝对差值分别为2.8°、3.0°和2.9°，差异无统计学意义。加速度计导航组前倾角平均差异为2.2°，3D微型光学导航组前倾角平均差异为2.7°，ar导航组前倾角平均差异为2.2°，差异不显著。异常组BMI显著增高（p = 0.03）， logistic回归分析结果显示比值比为1.2 （p = 0.02）。结论在校正混杂因素后，三种导航系统的杯子放置精度无显著差异。高BMI可能会影响准确性。

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引用次数: 0

Examination of intra-operative blood loss on the first side to perform simultaneous bilateral total hip arthroplasty without allogeneic blood transfusion 检查第一侧同时进行双侧全髋关节置换术的术中失血情况，无需输注异体血

Journal of Joint Surgery and Research

Pub Date : 2025-02-20 DOI: 10.1016/j.jjoisr.2025.02.001

Hiroshige Hamada, Kazuhiro Oinuma, Hidetaka Higashi, Yoko Miura, Taishi Ninomiya, Keishin Ueno, Takamitsu Sato, Hideaki Shiratsuchi

Purpose

Simultaneous bilateral total hip arthroplasty (THA) offers benefits such as early rehabilitation and reduced medical costs but carries a risk of peri-operative bleeding necessitating post-operative blood transfusion. This study aimed to investigate factors associated with post-operative anemia in simultaneous bilateral THA using the direct anterior approach (DAA) and to identify criteria for limiting the surgery to one side.

Methods

Patients who underwent simultaneous bilateral THA without allogeneic blood transfusion during surgery at Funabashi Orthopaedic Hospital (Chiba, Japan) between January 2022 and December 2022 were included. Multiple regression analysis was performed to identify factors associated with post-operative anemia. Receiver operating characteristic (ROC) analysis was performed using the results in multiple regression analysis to calculate cutoff values.

Results

In total, 161 patients (28 men and 133 women) were included, with a mean age of 61 years. Pre-operative hemoglobin levels and intra-operative blood loss on the first side were identified as factors associated with post-operative anemia. ROC analysis showed that the cutoff value of intra-operative blood loss on the first side was 9.2% of the patient blood volume (PBV) when the pre-operative hemoglobin level was <12 g/dL and 16.9% of the PBV when it was ≥12 g/dL.

Conclusion

This study identified factors associated with post-operative anemia in simultaneous bilateral THA using DAA as well as the criteria for limiting surgery to the first side to prevent post-operative blood transfusion.

同时双侧全髋关节置换术（THA）具有早期康复和降低医疗费用等优点，但存在围手术期出血的风险，需要术后输血。本研究旨在探讨采用直接前路（DAA）同时行双侧THA术后贫血的相关因素，并确定将手术限制在一侧的标准。方法纳入2022年1月至2022年12月期间在日本千叶船桥骨科医院（Funabashi Orthopaedic Hospital, Chiba, Japan）手术期间同时行双侧THA且无异体输血的患者。采用多元回归分析确定与术后贫血相关的因素。采用多元回归分析结果进行受试者工作特征（ROC）分析，计算截止值。结果共纳入161例患者，其中男28例，女133例，平均年龄61岁。术前血红蛋白水平和术中一侧出血量被确定为术后贫血的相关因素。ROC分析显示，术前血红蛋白水平为12 g/dL时，术中第一侧失血量的截断值为患者血容量（PBV）的9.2%，≥12 g/dL时为患者血容量（PBV）的16.9%。结论本研究使用DAA识别了双侧同期THA术后贫血的相关因素，并确定了将手术限制在一侧以防止术后输血的标准。

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引用次数: 0

Radiological evaluation of coronal femoral and tibial morphology and coronal limb alignment in windswept deformity of the knee 膝关节风扫畸形的冠状股胫形态和冠状肢体对线的放射学评价

Journal of Joint Surgery and Research

Pub Date : 2025-01-22 DOI: 10.1016/j.jjoisr.2025.01.001

Tomoki Koyama , Takehiko Sugita , Akira Sasaki , Kento Harada , Hidetatsu Tanaka , Takashi Aki , Naohisa Miyatake , Seiya Miyamoto , Ikuo Maeda , Masayuki Kamimura , Toshimi Aizawa

Purpose

Windswept deformity (WSD) of the knee, involving valgus deformity in one knee and varus deformity in the other, is uncommon and not well understood. This study aimed to clarify the radiological characteristics of WSD patients with osteoarthritis.

Methods

WSD knees with Kellgren–Lawrence stage 3 or 4 osteoarthritis in 36 patients were radiologically evaluated. Mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), arithmetic hip–knee–ankle (aHKA) angle, and joint line obliquity were measured. Comparisons in radiological measurements were made with 47 patients with bilateral valgus and 135 patients with bilateral varus knee osteoarthritis (control groups).

Results

Among WSD patients, 75% had valgus deformity in the right knee, while 25% had it in the left knee. The mLDFA in valgus WSD knees was significantly lower than that in varus WSD knees (85.1 ± 2.2° vs. 87.3 ± 2.3°; p < 0.001), whereas the MPTA in varus WSD knees was significantly lower than that in valgus WSD knees (83.9 ± 0.5° vs. 87.8 ± 0.5°; p < 0.001). The calculated aHKA angle indicated that valgus and varus WSD knees corresponded to constitutional valgus and varus alignments, respectively. Compared with the control groups, the mLDFA in valgus WSD knees was significantly higher than that in bilateral valgus knees (85.1 ± 0.4° vs. 83.5 ± 0.3°; p = 0.003), whereas the mLDFA in varus WSD knees was significantly lower than that in bilateral varus knees (87.4 ± 0.4° vs. 88.5 ± 0.2°; p = 0.008).

Conclusion

WSD is more frequently associated with right knee valgus deformity in the Japanese population. Significant side-specific differences in coronal femoral and tibial morphology and constitutional limb alignment were observed in WSD.

目的：膝关节风掠畸形（WSD）是一种少见的膝关节外翻畸形和另一膝关节内翻畸形。本研究旨在阐明WSD合并骨关节炎患者的影像学特征。方法对36例伴有Kellgren-Lawrence期3、4期骨关节炎的swsd膝关节进行影像学检查。测量机械股骨外侧远端角（mLDFA）、胫骨内侧近端角（MPTA）、算术髋关节-膝关节-踝关节角（aHKA）和关节线倾角。对47例双侧膝外翻患者和135例双侧膝内翻骨性关节炎患者（对照组）进行放射学测量比较。结果WSD患者右膝外翻畸形占75%，左膝外翻畸形占25%。外翻组的mLDFA明显低于内翻组（85.1±2.2°vs 87.3±2.3°）；p & lt;而内翻WSD膝关节的MPTA明显低于外翻WSD膝关节(83.9±0.5°vs 87.8±0.5°；p & lt;0.001)。计算的aHKA角表明WSD膝外翻和内翻分别符合体质外翻和内翻对准。与对照组相比，双侧外翻膝的mLDFA明显高于双侧外翻膝（85.1±0.4°vs 83.5±0.3°）；p = 0.003)，而双侧膝内翻的mLDFA明显低于双侧膝内翻(87.4±0.4°vs 88.5±0.2°；p = 0.008)。结论日本人群右膝外翻畸形多与wsd相关。在WSD中观察到显著的侧边特异性差异在冠状股和胫骨形态和肢体结构对齐。

{"title":"Radiological evaluation of coronal femoral and tibial morphology and coronal limb alignment in windswept deformity of the knee","authors":"Tomoki Koyama , Takehiko Sugita , Akira Sasaki , Kento Harada , Hidetatsu Tanaka , Takashi Aki , Naohisa Miyatake , Seiya Miyamoto , Ikuo Maeda , Masayuki Kamimura , Toshimi Aizawa","doi":"10.1016/j.jjoisr.2025.01.001","DOIUrl":"10.1016/j.jjoisr.2025.01.001","url":null,"abstract":"<div><h3>Purpose</h3><div>Windswept deformity (WSD) of the knee, involving valgus deformity in one knee and varus deformity in the other, is uncommon and not well understood. This study aimed to clarify the radiological characteristics of WSD patients with osteoarthritis.</div></div><div><h3>Methods</h3><div>WSD knees with Kellgren–Lawrence stage 3 or 4 osteoarthritis in 36 patients were radiologically evaluated. Mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), arithmetic hip–knee–ankle (aHKA) angle, and joint line obliquity were measured. Comparisons in radiological measurements were made with 47 patients with bilateral valgus and 135 patients with bilateral varus knee osteoarthritis (control groups).</div></div><div><h3>Results</h3><div>Among WSD patients, 75% had valgus deformity in the right knee, while 25% had it in the left knee. The mLDFA in valgus WSD knees was significantly lower than that in varus WSD knees (85.1 ± 2.2° <em>vs.</em> 87.3 ± 2.3°; <em>p</em> < 0.001), whereas the MPTA in varus WSD knees was significantly lower than that in valgus WSD knees (83.9 ± 0.5° <em>vs.</em> 87.8 ± 0.5°; <em>p</em> < 0.001). The calculated aHKA angle indicated that valgus and varus WSD knees corresponded to constitutional valgus and varus alignments, respectively. Compared with the control groups, the mLDFA in valgus WSD knees was significantly higher than that in bilateral valgus knees (85.1 ± 0.4° <em>vs.</em> 83.5 ± 0.3°; <em>p</em> = 0.003), whereas the mLDFA in varus WSD knees was significantly lower than that in bilateral varus knees (87.4 ± 0.4° <em>vs.</em> 88.5 ± 0.2°; <em>p</em> = 0.008).</div></div><div><h3>Conclusion</h3><div>WSD is more frequently associated with right knee valgus deformity in the Japanese population. Significant side-specific differences in coronal femoral and tibial morphology and constitutional limb alignment were observed in WSD.</div></div>","PeriodicalId":100795,"journal":{"name":"Journal of Joint Surgery and Research","volume":"3 1","pages":"Pages 48-52"},"PeriodicalIF":0.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143099729","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

Lateral extra-articular procedures in anterior cruciate ligament reconstruction: Narrative review on current evidence 前交叉韧带重建的外侧关节外手术：对当前证据的叙述性回顾

Journal of Joint Surgery and Research

Pub Date : 2024-12-31 DOI: 10.1016/j.jjoisr.2024.12.001

Takeo Tokura , Alan M.J. Getgood

Purpose

Techniques for anterior cruciate ligament reconstruction (ACLR) have evolved over time, but residual anterolateral rotatory instability (ALRI) often persists, which can result in poor patient-reported outcomes and an increased rate of graft failure. The re-emergence of lateral extra-articular procedures (LEAPs), either lateral extra-articular tenodesis (LET) or the newer anterolateral ligament reconstruction, in combination with ACLR has changed practice significantly. Here we describe a literature review of ACLR and LEAPs, focusing on LET.

Methods

Studies describing anatomy, history, biomechanical and clinical studies, and current practice regarding ACLR and LET were searched in PubMed. Our current practice and future directions are also discussed.

Results

There is accumulating evidence supporting the effectiveness of LEAP in controlling ALRI and reducing the risk of anterior cruciate ligament (ACL) graft failure. A number of cadaveric studies have shown that LEAP would help control ALRI in combination with ACLR. There are also several randomized controlled studies showing that addition of LET significantly reduces the risk of ACL graft failure. However, only a paucity of data about its long-term outcomes are currently available.

Conclusions

LEAP has had a great impact on our daily practice. However, indications, optimal ACL graft type, and long-term outcomes still need to be thoroughly investigated.

目的：前交叉韧带重建（ACLR）技术随着时间的推移而发展，但残留的前外侧旋转不稳定（ALRI）经常持续存在，这可能导致患者报告的结果较差和移植物失败率增加。外侧关节外手术（LEAPs）的再次出现，无论是外侧关节外肌腱固定术（LET）还是较新的前外侧韧带重建，结合ACLR已经显著改变了实践。在这里，我们描述了ACLR和飞跃的文献综述，重点是LET。方法在PubMed中检索描述ACLR和LET的解剖学、历史、生物力学和临床研究以及当前实践的研究。并讨论了我们目前的实践和未来的发展方向。结果越来越多的证据支持LEAP在控制ALRI和降低前交叉韧带（ACL）移植失败风险方面的有效性。许多尸体研究表明，LEAP与ACLR联合使用有助于控制ALRI。也有一些随机对照研究表明，添加LET可显著降低前交叉韧带移植失败的风险。然而，目前关于其长期结果的数据很少。结论sleap对我们的日常实践产生了很大的影响。然而，适应症、最佳前交叉韧带移植类型和长期结果仍需深入研究。

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引用次数: 0

Predictive symptoms associated with the development of radiographic knee osteoarthritis: a 10-year longitudinal study from the Iwaki cohort 膝骨关节炎影像学发展相关的预测性症状：来自Iwaki队列的10年纵向研究

Journal of Joint Surgery and Research

Pub Date : 2024-12-29 DOI: 10.1016/j.jjoisr.2024.12.002

Eitaro Sato , Eiji Sasaki , Daisuke Chiba , Takahiro Tsushima , Yuka Kimura , Yukiko Sakamoto , Yoshiko Takahashi , Mizuri Ishida , Eiichi Tsuda , Yasuyuki Ishibashi

Purpose

This 10-year longitudinal cohort study aimed to investigate the annual rate of development of radiographic knee osteoarthritis (drKOA) and its predictive symptoms in the general Japanese population.

Methods

A total of 263 volunteers (154 women) from the Iwaki Health Promotion Project were followed up over 10 years. Standing anteroposterior knee radiographs were obtained and the Kellgren–Lawrence grade was evaluated. drKOA was defined as a change from grade 0 or 1 to ≥2 over 10 years. Knee symptoms were evaluated using the Knee injury and Osteoarthritis Outcome Score at baseline. Logistic regression analyses were performed to identify symptoms related to drKOA, and a predictive formula was created based on the associated symptoms.

Results

The overall incidence of drKOA was 52.9% (annual rate, 4.34%). Regression analysis revealed that predictive symptoms for drKOA were stiffness [p = 0.033; odds ratio (OR) = 1.89], frequent pain (p = 0.024; OR = 1.38), difficulty in ascending stairs, jumping, twisting, and kneeling (p = 0.009–0.046; OR = 1.71–2.78), and poor knee-related quality of life (p < 0.001–0.005; OR = 1.53–2.18). Furthermore, the prediction formula created using these predictive symptoms demonstrated an area under the curve of 0.663, a cutoff value of 97 out of 100 points, an OR of 2.99, p < 0.001, sensitivity of 0.676, and specificity of 0.589.

Conclusions

The annual incidence rate of drKOA was 4.34% in the general Japanese population. The identified symptoms would be useful to predict the drKOA and consider the etiology of the early phase of this disease.

目的：这项为期10年的纵向队列研究旨在调查日本普通人群中放射性膝骨关节炎（drKOA）的年发病率及其预测症状。方法对来自磐城健康促进项目的263名志愿者（154名女性）进行10年以上的随访。获得站立膝关节前后位x线片并评估Kellgren-Lawrence分级。drKOA定义为在10年内从0或1级变为≥2级。在基线时使用膝关节损伤和骨关节炎结局评分评估膝关节症状。进行逻辑回归分析以确定与drKOA相关的症状，并根据相关症状创建预测公式。结果总发病率为52.9%，年发病率为4.34%。回归分析显示，drKOA的预测症状为僵硬[p = 0.033；优势比(或)= 1.89),频繁疼痛(p = 0.024;OR = 1.38)，上楼梯、跳跃、扭转和跪地困难(p = 0.009-0.046；OR = 1.71-2.78)，与膝关节相关的生活质量较差(p <；0.001 - -0.005;or = 1.53-2.18)。此外，使用这些预测症状创建的预测公式显示，曲线下面积为0.663，截止值为97分（满分100分），OR为2.99,p <；0.001，敏感性为0.676，特异性为0.589。结论日本普通人群drKOA年发病率为4.34%。确定的症状将有助于预测drKOA，并考虑该疾病早期的病因。

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引用次数: 0

Achievement of minimal clinically important difference in shoulder function after reverse shoulder arthroplasty: a retrospective cohort study 逆向肩关节置换术后肩关节功能最小临床重要差异的实现：一项回顾性队列研究

Journal of Joint Surgery and Research

Pub Date : 2024-12-16 DOI: 10.1016/j.jjoisr.2024.11.005

Yumi Kubo , Naoyuki Kubo , Kotaro Yamakado

Purpose

Reverse shoulder arthroplasty (RSA) is a surgical procedure to relieve pain and improve shoulder function. This study aimed to investigate the percentage of patients achieving a minimal clinically important difference (MCID) in the American Shoulder and Elbow Surgeons (ASES) score following RSA and to examine factors associated with MCID achievement.

Methods

This study included 74 patients (26 males and 48 females; mean age 76.9 ± 4.7 years) who underwent RSA between January 2019 and July 2022. Patients were grouped based on the change in ASES total score from pre-operative to 1 year post-operative as follows: not achieved group (<16 point change); and improvement criteria achieved group (≥16 point change).

Results

Overall, 81% of patients achieved an ASES score change of ≥16 points. There were no significant differences in demographic characteristics between the two groups. However, the not achieved group had a significantly lower pre-operative pain visual analog scale score and a significantly higher pre-operative ASES total score than the improvement criteria achieved group. Logistic regression analysis identified pre-operative ASES total score as significantly associated with MCID achievement (odds ratio = 0.91, 95% confidence interval 0.87–0.96; p = 0.0007).

Conclusions

The rate of patients achieving a ≥16 point improvement in the ASES total score after RSA was 81%. A high pre-operative ASES total score was identified as a factor limiting MCID achievement, suggesting that patients with a high pre-operative function may experience less significant post-operative improvement.

目的大范围肩关节置换术（RSA）是一种减轻疼痛和改善肩关节功能的外科手术。本研究旨在调查RSA后美国肩肘外科医生（ASES）评分达到最小临床重要差异（MCID）的患者百分比，并检查与MCID实现相关的因素。方法纳入74例患者，其中男26例，女48例；平均年龄76.9±4.7岁)，在2019年1月至2022年7月期间接受了RSA。根据术前至术后1年的as总分变化将患者分组如下：未达到组（<；16分变化）；改善标准达到组（≥16点变化）。结果总体而言，81%的患者实现了≥16分的as评分变化。两组患者的人口学特征无显著差异。然而，与达到改善标准的组相比，未达到改善标准的组术前疼痛视觉模拟量表评分明显低于对照组，术前asa总分明显高于对照组。Logistic回归分析发现，术前as总分与MCID成就显著相关(优势比= 0.91,95%可信区间0.87-0.96；p = 0.0007)。结论RSA术后患者asa总分改善≥16分的比例为81%。高术前as总分被认为是限制MCID成就的一个因素，这表明术前功能高的患者术后改善可能不太显著。

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引用次数: 0

Classification of coronal plane alignment of arthritic and healthy knees in Japan 日本患关节炎和健康膝关节冠状面排列的分类

Journal of Joint Surgery and Research

Pub Date : 2024-12-11 DOI: 10.1016/j.jjoisr.2024.11.004

Gai Kobayashi, Masahiro Hasegawa, Yohei Yamabe, Shine Tone, Yohei Naito, Akihiro Sudo

Purpose

There are geographic differences in the prevalence of coronal plane alignment of the knee (CPAK) phenotypes. This study aimed to evaluate the CPAK classification of healthy and arthritic knees in Japan.

Methods

A cohort of arthritic knees (150 knees in 125 patients who underwent primary total knee arthroplasty) and a cohort of healthy knees (150 knees in 150 patients who underwent total hip arthroplasty or bipolar hip arthroplasty with healthy knees) underwent radiological assessment with long-leg radiographs and were categorized into nine phenotypes. The lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), mechanical and arithmetic hip–knee–ankle angles (mHKA and aHKA, respectively), and joint line obliquity were measured.

Results

The mean LDFA was 88.1° and 86.9° in the arthritic and healthy knee cohorts, respectively, and the mean MPTA was 85.2° and 86.6°, respectively. The mean mHKA was −8.0° and −1.2° and the mean aHKA was −2.9° and −0.3° in the arthritic and healthy knee cohorts, respectively. There was no significant difference in the distribution of varus/valgus knee on mHKA between the arthritic and healthy knee cohorts. In the arthritic knee cohort, most were CPAK type I (97 knees, 64.7%). Healthy knees were most commonly classified as type II (71 knees, 47.3%).

Conclusions

The distribution of varus/valgus knee was similar in Japanese arthritic and healthy knees. However, the distribution of the CPAK classification in the arthritic and healthy knees of Japanese individuals was different.

目的膝关节冠状面排列（CPAK）表型的患病率存在地理差异。本研究旨在评估日本健康膝关节与关节炎膝关节的CPAK分类。方法采用长腿x线片对患关节炎的膝关节（125例首次全膝关节置换术患者中的150例膝关节）和健康的膝关节（150例健康的全髋关节置换术或双极髋关节置换术患者中的150例膝关节）进行放射学评估，并将其分为9种表型。测量股骨外侧远端角（LDFA）、胫骨内侧近端角（MPTA）、机械和算术髋关节-膝关节-踝关节角（mHKA和aHKA）以及关节线倾斜度。结果膝关节关节炎组和健康组的平均LDFA分别为88.1°和86.9°，平均MPTA分别为85.2°和86.6°。关节炎组和健康膝关节组的平均mHKA分别为- 8.0°和- 1.2°，平均aHKA分别为- 2.9°和- 0.3°。在mHKA上，关节炎组和健康组的膝关节内翻/外翻分布无显著差异。在关节炎膝关节队列中，大多数为CPAK I型（97个膝关节，64.7%）。健康膝关节最常见的分类为II型（71个，47.3%）。结论日本关节炎患者膝关节内翻/外翻分布与正常膝关节相似。然而，日本个体的CPAK分类在关节炎和健康膝关节中的分布是不同的。

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