Pub Date : 2025-11-24DOI: 10.1097/corr.0000000000003744
Olivia M Jochl,Zachary A Trotzky,Giulia Beltrame,Brian T Muffly,Ernest L Sink
BACKGROUNDAlthough periacetabular osteotomy (PAO) is a commonly used procedure with generally good intermediate and long-term outcomes, complications such as stress fractures of the ischium or pubis have been reported. A limited number of studies have investigated stress fracture after PAO, but the results lack consensus and do not thoroughly explore lifestyle factors or patient-reported outcome measures (PROMs).QUESTIONS/PURPOSESAmong patients treated with PAO: (1) What percentage of patients and hips developed a stress fracture after PAO? (2) What preoperative and intraoperative factors were associated with stress fractures? (3) Did PROMs or the minimum clinically important difference (MCID) and the patient acceptable symptom state (PASS) achievement differ between patients with stress fractures and patients without at most recent follow-up?METHODSSix hundred seventy-five hips (546 patients) were treated with PAO with or without hip arthroscopy for symptomatic acetabular dysplasia between February 2016 and October 2024 by one surgeon in a mature hip preservation practice. Patients were excluded if the index procedure for those who had bilateral PAOs occurred before the study period. Patients who underwent concomitant femoral osteotomy, surgical hip dislocation, or relative neck lengthening were also excluded, yielding 90% (608 of 675) of hips from 487 patients as potentially eligible for analysis. Ninety-four percent (574 of 608) of PAOs were performed in women, and 65% (396 of 608) were performed without concomitant hip arthroscopy. The mean ± SD age was 26 ± 8 years, and the mean BMI was 23.2 ± 3.9 kg/m2. All hips had 6-week, 3-month, and 6-month postoperative radiographs available for review. Two patients with stress fractures and one without converted to THA, leaving 81% (393 of 484) of patients with available minimum 1-year PROMs after their most recent PAO surgery. Stress fracture diagnoses were tallied by hip and by patient to establish the percentages. Exploratory analyses included age, BMI, preoperative vitamin D levels, magnitude of lateral center-edge angle (LCEA) correction, magnitude of anterior center-edge angle correction, Tönnis grade, sex, marijuana use, nicotine use, screw type, prior ipsilateral surgery, PAO with or without concomitant hip arthroscopy, initial PAO versus subsequent contralateral PAO, and diagnoses of Ehlers-Danlos syndrome (EDS) or hypermobility. Factors with p < 0.1 were considered in the multivariate analysis. To determine the association between stress fractures and postoperative outcomes, univariate regression was performed with the presence of stress fractures as the independent variable. Multivariate regressions were performed to determine whether stress fractures were associated with modified Harris hip score (mHHS) and International Hip Outcome Tool-12 (iHOT-12) improvement after controlling for factors identified in the previous analysis. Similarly, regression models were used to determine whether st
背景：虽然髋臼周围截骨术（PAO）是一种常用的手术，通常具有良好的中期和长期疗效，但也有报道称其并发症，如坐骨或耻骨应力性骨折。有限数量的研究调查了PAO后的应力性骨折，但结果缺乏共识，并且没有彻底探索生活方式因素或患者报告的结果测量（PROMs）。问题/目的在接受PAO治疗的患者中：(1)PAO后发生应力性骨折的患者和髋关节的百分比是多少？(2)哪些术前和术中因素与应力性骨折相关？(3)应力性骨折患者与非应力性骨折患者的PROMs或最小临床重要差异（MCID）和患者可接受症状状态（PASS）成就是否存在差异？方法在2016年2月至2024年10月期间，一名外科医生在成熟的髋关节保存实践中对675例髋关节（546例患者）进行PAO治疗，伴有或不伴有髋关节镜检查。如果双侧PAOs患者的指标手术在研究期间之前发生，则排除患者。同时行股骨截骨术、手术髋关节脱位或相对颈部延长术的患者也被排除在外，487例患者中有90%（675例中有608例）的髋关节可能符合分析条件。94%（574 / 608）的PAOs是在女性中进行的，65%（396 / 608）的PAOs没有同时进行髋关节镜检查。平均±SD年龄为26±8岁，平均BMI为23.2±3.9 kg/m2。所有髋部术后6周、3个月和6个月的x线片可供回顾。2例患者发生应力性骨折，1例未转为THA，在最近一次PAO手术后，有81%（484例中的393例）的患者可获得至少1年的prom。应力性骨折诊断按髋部和患者进行统计，以确定百分比。探索性分析包括年龄、BMI、术前维生素D水平、外侧中心棱角（LCEA）矫正幅度、前中心棱角矫正幅度、Tönnis分级、性别、大麻使用、尼古丁使用、螺钉类型、既往同侧手术、PAO伴或不伴髋关节镜检查、初始PAO与后续对侧PAO、ehers - danlos综合征（EDS）或活动过度的诊断。多因素分析考虑p < 0.1的因素。为了确定应力性骨折与术后预后之间的关系，以应力性骨折为自变量进行单变量回归。在控制先前分析中确定的因素后，进行多变量回归以确定应力性骨折是否与改良Harris髋关节评分（mHHS）和国际髋关节预后工具-12 （iHOT-12）改善相关。同样，回归模型用于确定应力裂缝是否与MCID和PASS的实现相关。结果应力性骨折发生率为8%（487例中37例），髋部发生率为7%（608例中40例）。在接受双侧PAOs的患者中，11%（121例中的13例）在第二次手术后发生应力性骨折。121例患者中有3例（2%）发生双侧应力性骨折。在控制了潜在的混杂变量，如年龄、BMI、LCEA矫正、药物使用、EDS或过度活动后，我们发现有几个因素与发生应力性骨折有关。年龄越大，应力性骨折的几率越高（OR 1.05[95%可信区间（CI） 1.01 ~ 1.09]）；P = 0.03)。BMI越高，应力性骨折的几率越大（BMI每增加kg/m2， OR为1.09 [95% CI 1.002 ~ 1.19]; p = 0.046）。LCEA矫正幅度越大，应力性骨折的发生率越高（每一矫正程度的OR为1.05 [95% CI 1.01至1.10];p = 0.02）。与不吸食大麻的人相比，目前吸食大麻的人发生应力性骨折的几率更高（OR为3.06 [95% CI 1.2至8.0];p = 0.02），目前吸食尼古丁的人发生应力性骨折的几率也更高（OR为6.41 [95% CI 1.2至34]；p = 0.03）。诊断为EDS或活动过度的患者发生应力性骨折的几率也较高（or 2.88 [95% CI 1.3 ~ 6.0]; p = 0.01）。虽然比例更高，但在双侧手术的患者中，第一次PAO和第二次PAO后应力性骨折的发生率没有差异（OR 2 [95% CI 1 ~ 4]; p = 0.07）。在控制了与应力性骨折、术前PROM评分和最近一次PAO后的时间相关的因素后，发现应力性骨折与术前和术后mHHS和iHOT-12评分的改善程度较低有关，同时也与iHOT-12达到PASS和mHHS达到MCID的几率降低有关。有应力性骨折的患者在mHHS方面的改善比无应力性骨折的患者平均少6个点（95% CI -11）。 6 ~ -0.84；P = 0.02)。应力性骨折患者iHOT-12评分的改善比无应力性骨折患者平均少12分（95% CI -20.6 ~ -2.45; p = 0.01）。应力性骨折患者达到iHOT-12 PASS的几率较低（OR 0.36 [95% CI 0.15至0.86];p = 0.02），达到mHHS MCID的几率较低（OR 0.33 [95% CI 0.13至0.83];p = 0.02）。应力性骨折与mHHS的PASS （OR 0.52 [95% CI 0.18至1.53],p = 0.24）或iHOT-12的MCID （OR 0.86 [95% CI 0.33至2.24],p = 0.76）无关。结论：年龄增加、BMI升高、LCEA矫正程度加大、大麻使用、尼古丁使用、EDS或活动过度与有症状的髋臼发育不良PAO术后应力性骨折发生风险增加相关。在至少1年的随访中，应力骨折与mHHS和iHOT-12的改善较小相关，并且达到iHOT-12的PASS和mHHS的MCID的几率较低。这些因素不是手术的障碍，而是可以指导外科医生与患者讨论，提供个性化的咨询和康复，包括关于潜在药物停用的指导，延长非负重期的使用，以及对早期功能获得的现实期望。随着更多的应力性骨折样本，可能通过多中心登记，未来的研究应旨在建立具有临床意义的相关因素阈值，并评估应力性骨折与PROMs之间的长期关系，包括骨折愈合和骨折位置的影响。证据等级：III级，治疗性研究。
{"title":"What Factors and Patient-reported Outcome Measures Are Associated With Stress Fracture After Periacetabular Osteotomy?","authors":"Olivia M Jochl,Zachary A Trotzky,Giulia Beltrame,Brian T Muffly,Ernest L Sink","doi":"10.1097/corr.0000000000003744","DOIUrl":"https://doi.org/10.1097/corr.0000000000003744","url":null,"abstract":"BACKGROUNDAlthough periacetabular osteotomy (PAO) is a commonly used procedure with generally good intermediate and long-term outcomes, complications such as stress fractures of the ischium or pubis have been reported. A limited number of studies have investigated stress fracture after PAO, but the results lack consensus and do not thoroughly explore lifestyle factors or patient-reported outcome measures (PROMs).QUESTIONS/PURPOSESAmong patients treated with PAO: (1) What percentage of patients and hips developed a stress fracture after PAO? (2) What preoperative and intraoperative factors were associated with stress fractures? (3) Did PROMs or the minimum clinically important difference (MCID) and the patient acceptable symptom state (PASS) achievement differ between patients with stress fractures and patients without at most recent follow-up?METHODSSix hundred seventy-five hips (546 patients) were treated with PAO with or without hip arthroscopy for symptomatic acetabular dysplasia between February 2016 and October 2024 by one surgeon in a mature hip preservation practice. Patients were excluded if the index procedure for those who had bilateral PAOs occurred before the study period. Patients who underwent concomitant femoral osteotomy, surgical hip dislocation, or relative neck lengthening were also excluded, yielding 90% (608 of 675) of hips from 487 patients as potentially eligible for analysis. Ninety-four percent (574 of 608) of PAOs were performed in women, and 65% (396 of 608) were performed without concomitant hip arthroscopy. The mean ± SD age was 26 ± 8 years, and the mean BMI was 23.2 ± 3.9 kg/m2. All hips had 6-week, 3-month, and 6-month postoperative radiographs available for review. Two patients with stress fractures and one without converted to THA, leaving 81% (393 of 484) of patients with available minimum 1-year PROMs after their most recent PAO surgery. Stress fracture diagnoses were tallied by hip and by patient to establish the percentages. Exploratory analyses included age, BMI, preoperative vitamin D levels, magnitude of lateral center-edge angle (LCEA) correction, magnitude of anterior center-edge angle correction, Tönnis grade, sex, marijuana use, nicotine use, screw type, prior ipsilateral surgery, PAO with or without concomitant hip arthroscopy, initial PAO versus subsequent contralateral PAO, and diagnoses of Ehlers-Danlos syndrome (EDS) or hypermobility. Factors with p < 0.1 were considered in the multivariate analysis. To determine the association between stress fractures and postoperative outcomes, univariate regression was performed with the presence of stress fractures as the independent variable. Multivariate regressions were performed to determine whether stress fractures were associated with modified Harris hip score (mHHS) and International Hip Outcome Tool-12 (iHOT-12) improvement after controlling for factors identified in the previous analysis. Similarly, regression models were used to determine whether st","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"20 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145599760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-24DOI: 10.1097/CORR.0000000000003776
Ju-Ho Song, Jong-Min Kim, Bum-Sik Lee, Seong-Il Bin, Jaejung Ryu
<p><strong>Background: </strong>The influence of the posterior tibial slope on the knee has been extensively studied, particularly in the context of surgical outcomes in sports medicine, such as cruciate ligament reconstruction. From a biomechanical perspective, the posterior tibial slope affects not only knee kinematics but also contact pressure, potentially contributing to the development and progression of degenerative change in the joint over time. However, whether or not there is an association on the chondral wear pattern of the medial tibial plateau remains unclear.</p><p><strong>Questions/purposes: </strong>(1) Is posterior tibial slope associated with the chondral wear pattern of the medial tibial plateau? (2) Does an increase in posterior tibial slope correlate with chondral wear in the posterior part of the medial tibial plateau?</p><p><strong>Methods: </strong>The chondral wear pattern of the medial tibial plateau was evaluated in 2555 knees (1912 patients) that underwent primary TKA for medial osteoarthritis (OA) by a single surgeon between July 2005 and December 2022. A total of 290 knees were excluded because of (1) inflammatory arthritis, (2) extensive chondral wear across the medial tibial plateau that prevented pattern classification, or (3) prior surgeries that influenced the wear pattern. To avoid including bilateral knees from the same patient, only one knee per patient was analyzed, with the knee selected at random. Accordingly, the final study cohort consisted of 1703 patients (1703 knees). Intraoperative assessment of medial tibial plateau chondral wear patterns was recorded in a preformatted electronic database. The surgeon identified the region with the most severe wear from among three predefined areas-anterior, central, and posterior-using a categorical input. Based on this selection, chondral wear patterns were classified as anteromedial OA, centromedial OA, or posteromedial OA. To answer our primary study question, we measured the posterior tibial slope on preoperative true lateral radiographs and compared it across different chondral wear patterns. To answer our second study question, we analyzed the association between posterior tibial slope and chondral wear patterns using multinomial logistic regression, adjusting for variables such as patient demographics, mechanical hip-knee-ankle (mHKA) angle, and the presence of ACL deficiency and medial meniscus radial tear. Among the 1703 knees, 33% (562 of 1703) were classified as having anteromedial OA, 28% (477 of 1703) as centromedial OA, and 39% (664 of 1703) as posteromedial OA. The mean ± SD posterior tibial slope was 10° ± 4°, and the mean mHKA angle was 10° ± 5°.</p><p><strong>Results: </strong>There was a difference in posterior tibial slope between all three groups, with the slope progressively increasing as the chondral wear pattern shifted from anterior to posterior: mean ± SD 8° ± 3° in anteromedial OA, 10° ± 3° in centromedial OA, and 12° ± 3° in posteromedia
{"title":"Posterior Tibial Slope Is Associated With the Chondral Wear Pattern of the Medial Tibial Plateau.","authors":"Ju-Ho Song, Jong-Min Kim, Bum-Sik Lee, Seong-Il Bin, Jaejung Ryu","doi":"10.1097/CORR.0000000000003776","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003776","url":null,"abstract":"<p><strong>Background: </strong>The influence of the posterior tibial slope on the knee has been extensively studied, particularly in the context of surgical outcomes in sports medicine, such as cruciate ligament reconstruction. From a biomechanical perspective, the posterior tibial slope affects not only knee kinematics but also contact pressure, potentially contributing to the development and progression of degenerative change in the joint over time. However, whether or not there is an association on the chondral wear pattern of the medial tibial plateau remains unclear.</p><p><strong>Questions/purposes: </strong>(1) Is posterior tibial slope associated with the chondral wear pattern of the medial tibial plateau? (2) Does an increase in posterior tibial slope correlate with chondral wear in the posterior part of the medial tibial plateau?</p><p><strong>Methods: </strong>The chondral wear pattern of the medial tibial plateau was evaluated in 2555 knees (1912 patients) that underwent primary TKA for medial osteoarthritis (OA) by a single surgeon between July 2005 and December 2022. A total of 290 knees were excluded because of (1) inflammatory arthritis, (2) extensive chondral wear across the medial tibial plateau that prevented pattern classification, or (3) prior surgeries that influenced the wear pattern. To avoid including bilateral knees from the same patient, only one knee per patient was analyzed, with the knee selected at random. Accordingly, the final study cohort consisted of 1703 patients (1703 knees). Intraoperative assessment of medial tibial plateau chondral wear patterns was recorded in a preformatted electronic database. The surgeon identified the region with the most severe wear from among three predefined areas-anterior, central, and posterior-using a categorical input. Based on this selection, chondral wear patterns were classified as anteromedial OA, centromedial OA, or posteromedial OA. To answer our primary study question, we measured the posterior tibial slope on preoperative true lateral radiographs and compared it across different chondral wear patterns. To answer our second study question, we analyzed the association between posterior tibial slope and chondral wear patterns using multinomial logistic regression, adjusting for variables such as patient demographics, mechanical hip-knee-ankle (mHKA) angle, and the presence of ACL deficiency and medial meniscus radial tear. Among the 1703 knees, 33% (562 of 1703) were classified as having anteromedial OA, 28% (477 of 1703) as centromedial OA, and 39% (664 of 1703) as posteromedial OA. The mean ± SD posterior tibial slope was 10° ± 4°, and the mean mHKA angle was 10° ± 5°.</p><p><strong>Results: </strong>There was a difference in posterior tibial slope between all three groups, with the slope progressively increasing as the chondral wear pattern shifted from anterior to posterior: mean ± SD 8° ± 3° in anteromedial OA, 10° ± 3° in centromedial OA, and 12° ± 3° in posteromedia","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145892276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUNDPosterior vertebral column resection (PVCR) is associated with improved spinal alignment and function in patients with severe thoracolumbar Pott deformity. However, the loads it places on spinal implants can result in those implants breaking or loosening, which can result in instability, pain, and unplanned reoperations. Identifying the controllable factors associated with implants breaking or loosening may be beneficial in the development of more effective surgical strategies.QUESTIONS/PURPOSESWhat (1) radiographic and (2) clinical factors were associated with implant failure (defined as the mechanical failure of implanted spinal instrumentation) among patients who underwent PVCR surgery for severe thoracolumbar Pott deformity?METHODSBetween January 2013 and June 2020, we treated 168 patients who underwent PVCR for severe thoracolumbar Pott deformity. Twenty-four percent (41) of patients, however, were lost because of incomplete data, incompliance, emigration, nonsurgical-related death, less than 2-year minimum follow-up, or they had not been seen in the last 5 years, leaving 76% (127) for analysis here. There were 56% (71) males and 44% (56) females, with a mean ± SD age at surgery of 39 ± 11 years. Mean follow-up time was 45 ± 12 months. Two trained spine surgeons independently measured spinopelvic parameters, demonstrating excellent agreement (intraclass correlation coefficient = 0.99; p < 0.001). Based on the occurrence of implant failure, which we defined as a mechanical compromise of spinal instrumentation (such as screws, rods, plates, titanium mesh, or cages) resulting in loss of structural integrity, spinal instability, or neurologic deficits, participants were categorized into an implant failure group (n = 19) and a no implant failure group (n = 108). Comparative analyses were conducted on surgical-related data (such as apex location, number of resected vertebra, instrumented levels, anterior support, and use of multiple rods) and spinopelvic parameters (such as local kyphosis, residual segmental kyphotic angle [RSKA]-which we defined as the angle formed by the projection lines extending from the upper and lower endplates of the healed focal vertebra-sagittal vertical axis, and pelvic tilt). Notably, before the two-sample t-test, normality distribution and homogeneity of variance test (Levene test) were performed. Cox regression analysis was employed to determine the independent factors associated with postoperative implant failure. DeepSeek-V3 was utilized to enhance the spelling and grammatical accuracy of the writing.RESULTSAfter controlling for potentially confounding variables such as age, sex, bone mineral density (BMD), BMI, and the number of instrumented levels, we found that a higher RSKA was associated with increased risk of implant failure (HR 1.15 per 1° increment [95% confidence interval (CI) 1.08 to 1.22]; p < 0.001). We also found that BMI ≥ 24 kg/m2 was associated with an increased risk of implant failure afte
{"title":"What Factors Were Associated With Implant Failure After Posterior Vertebral Column Resection for Severe Thoracolumbar Pott Deformity?","authors":"Junlong Zhong,Jingtao Gao,Jiachao Xiong,Lu Chen,Mardan Mamat,Yingsong Wang,Zhaohui Ge,Shengbiao Ma,Zhenhai Zhou,Yoon Ha,Kai Cao","doi":"10.1097/corr.0000000000003772","DOIUrl":"https://doi.org/10.1097/corr.0000000000003772","url":null,"abstract":"BACKGROUNDPosterior vertebral column resection (PVCR) is associated with improved spinal alignment and function in patients with severe thoracolumbar Pott deformity. However, the loads it places on spinal implants can result in those implants breaking or loosening, which can result in instability, pain, and unplanned reoperations. Identifying the controllable factors associated with implants breaking or loosening may be beneficial in the development of more effective surgical strategies.QUESTIONS/PURPOSESWhat (1) radiographic and (2) clinical factors were associated with implant failure (defined as the mechanical failure of implanted spinal instrumentation) among patients who underwent PVCR surgery for severe thoracolumbar Pott deformity?METHODSBetween January 2013 and June 2020, we treated 168 patients who underwent PVCR for severe thoracolumbar Pott deformity. Twenty-four percent (41) of patients, however, were lost because of incomplete data, incompliance, emigration, nonsurgical-related death, less than 2-year minimum follow-up, or they had not been seen in the last 5 years, leaving 76% (127) for analysis here. There were 56% (71) males and 44% (56) females, with a mean ± SD age at surgery of 39 ± 11 years. Mean follow-up time was 45 ± 12 months. Two trained spine surgeons independently measured spinopelvic parameters, demonstrating excellent agreement (intraclass correlation coefficient = 0.99; p < 0.001). Based on the occurrence of implant failure, which we defined as a mechanical compromise of spinal instrumentation (such as screws, rods, plates, titanium mesh, or cages) resulting in loss of structural integrity, spinal instability, or neurologic deficits, participants were categorized into an implant failure group (n = 19) and a no implant failure group (n = 108). Comparative analyses were conducted on surgical-related data (such as apex location, number of resected vertebra, instrumented levels, anterior support, and use of multiple rods) and spinopelvic parameters (such as local kyphosis, residual segmental kyphotic angle [RSKA]-which we defined as the angle formed by the projection lines extending from the upper and lower endplates of the healed focal vertebra-sagittal vertical axis, and pelvic tilt). Notably, before the two-sample t-test, normality distribution and homogeneity of variance test (Levene test) were performed. Cox regression analysis was employed to determine the independent factors associated with postoperative implant failure. DeepSeek-V3 was utilized to enhance the spelling and grammatical accuracy of the writing.RESULTSAfter controlling for potentially confounding variables such as age, sex, bone mineral density (BMD), BMI, and the number of instrumented levels, we found that a higher RSKA was associated with increased risk of implant failure (HR 1.15 per 1° increment [95% confidence interval (CI) 1.08 to 1.22]; p < 0.001). We also found that BMI ≥ 24 kg/m2 was associated with an increased risk of implant failure afte","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"52 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-21DOI: 10.1097/CORR.0000000000003775
Monty Khela, David Gendelberg
{"title":"Classifications in Brief: The AO Spine Upper Cervical Injury Classification System.","authors":"Monty Khela, David Gendelberg","doi":"10.1097/CORR.0000000000003775","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003775","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145780597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-21DOI: 10.1097/corr.0000000000003770
Zhen Chen,Jianqun Zhang,Xiaoyin Liu,Rong Ma,Simin Liang,Kai Cao,Yingsong Wang,Zhaohui Ge
BACKGROUNDAlthough posterior intervertebral release (PIVR) has been reported for rigid scoliosis, its clinical efficacy and specific contribution to the management of severe and rigid adult idiopathic scoliosis remain unclear.QUESTIONS/PURPOSES(1) Is the addition of convex PIVR to Scoliosis Research Society (SRS) Grade 2 osteotomy associated with improved radiographic correction of severe rigid adult idiopathic scoliosis, specifically in terms of the main coronal curve correction rate, apical vertebral rotation, and rib hump reduction? (2) Is the combined PIVR and SRS Grade 2 osteotomy procedure associated with superior patient-reported outcomes in the domains of self-image and mental health compared with SRS Grade 2 osteotomy alone? (3) Is the PIVR procedure associated with a higher risk of complications, particularly neurologic deficits?METHODSBetween 2018 and 2021, a total of 210 patients with severe rigid spinal deformity were assessed. After excluding 15 patients preoperatively, 195 with adult idiopathic scoliosis (major coronal curve > 80°, flexibility < 25%) underwent surgery. Based on a standardized intraoperative algorithm, 195 patients with severe rigid adult idiopathic scoliosis were allocated to treatment: all patients initially underwent SRS Grade 2 osteotomies; PIVR was added only if the senior surgeon deemed that persistent rigidity compromised adequate correction after posterior release. This algorithm allocated 48% (93 of 195) of patients to the PIVR-augmented group and 52% (102) to the SRS Grade 2 osteotomy alone group. After accounting for loss to follow-up (n = 19), the final analysis included 176 patients with complete 2-year data (PIVR, n = 84; SRS Grade 2 osteotomy, n = 92). The median (IQR) follow-up duration was 27 months (27 to 28) for the PIVR group and 28 months (27 to 28) for the SRS Grade 2 osteotomy alone group. The two groups were comparable at baseline, with no differences in demographic characteristics (age, sex), patient-reported outcomes (SRS-22r questionnaire and SF-36 scores), or radiographic parameters (including the magnitude of the major coronal curve, thoracic kyphosis, apical vertebral rotation, apical vertebral translation, and rib hump) (all p > 0.05). Radiographic parameters and health-related quality of life scores were compared between the groups to evaluate radiographic correction and clinical effectiveness. The minimum clinically important difference (MCID) thresholds were defined according to published values as follows: SRS-22r domains (function = 0.90, pain= 0.85, self-image= 1.05, mental health = 0.70) and SF-36 summary scores (physical component summary = 7.83, mental component summary [MCS] = 5.14).RESULTSThe addition of convex PIVR to SRS Grade 2 osteotomy was associated with a larger mean ± SD correction of the major coronal curve (70% ± 2% versus 56% ± 2% at 1 month and 67% ± 2% versus 53% ± 2% at final follow-up; p < 0.001), resulting in a smaller residual curve (26° ± 2° versus 38° ± 2°
{"title":"Can Posterior Intervertebral Release Enhance the Correction Efficiency of Severe and Rigid Adult Idiopathic Scoliosis? A Multicenter Study With a Minimum 2-year Follow-up.","authors":"Zhen Chen,Jianqun Zhang,Xiaoyin Liu,Rong Ma,Simin Liang,Kai Cao,Yingsong Wang,Zhaohui Ge","doi":"10.1097/corr.0000000000003770","DOIUrl":"https://doi.org/10.1097/corr.0000000000003770","url":null,"abstract":"BACKGROUNDAlthough posterior intervertebral release (PIVR) has been reported for rigid scoliosis, its clinical efficacy and specific contribution to the management of severe and rigid adult idiopathic scoliosis remain unclear.QUESTIONS/PURPOSES(1) Is the addition of convex PIVR to Scoliosis Research Society (SRS) Grade 2 osteotomy associated with improved radiographic correction of severe rigid adult idiopathic scoliosis, specifically in terms of the main coronal curve correction rate, apical vertebral rotation, and rib hump reduction? (2) Is the combined PIVR and SRS Grade 2 osteotomy procedure associated with superior patient-reported outcomes in the domains of self-image and mental health compared with SRS Grade 2 osteotomy alone? (3) Is the PIVR procedure associated with a higher risk of complications, particularly neurologic deficits?METHODSBetween 2018 and 2021, a total of 210 patients with severe rigid spinal deformity were assessed. After excluding 15 patients preoperatively, 195 with adult idiopathic scoliosis (major coronal curve > 80°, flexibility < 25%) underwent surgery. Based on a standardized intraoperative algorithm, 195 patients with severe rigid adult idiopathic scoliosis were allocated to treatment: all patients initially underwent SRS Grade 2 osteotomies; PIVR was added only if the senior surgeon deemed that persistent rigidity compromised adequate correction after posterior release. This algorithm allocated 48% (93 of 195) of patients to the PIVR-augmented group and 52% (102) to the SRS Grade 2 osteotomy alone group. After accounting for loss to follow-up (n = 19), the final analysis included 176 patients with complete 2-year data (PIVR, n = 84; SRS Grade 2 osteotomy, n = 92). The median (IQR) follow-up duration was 27 months (27 to 28) for the PIVR group and 28 months (27 to 28) for the SRS Grade 2 osteotomy alone group. The two groups were comparable at baseline, with no differences in demographic characteristics (age, sex), patient-reported outcomes (SRS-22r questionnaire and SF-36 scores), or radiographic parameters (including the magnitude of the major coronal curve, thoracic kyphosis, apical vertebral rotation, apical vertebral translation, and rib hump) (all p > 0.05). Radiographic parameters and health-related quality of life scores were compared between the groups to evaluate radiographic correction and clinical effectiveness. The minimum clinically important difference (MCID) thresholds were defined according to published values as follows: SRS-22r domains (function = 0.90, pain= 0.85, self-image= 1.05, mental health = 0.70) and SF-36 summary scores (physical component summary = 7.83, mental component summary [MCS] = 5.14).RESULTSThe addition of convex PIVR to SRS Grade 2 osteotomy was associated with a larger mean ± SD correction of the major coronal curve (70% ± 2% versus 56% ± 2% at 1 month and 67% ± 2% versus 53% ± 2% at final follow-up; p < 0.001), resulting in a smaller residual curve (26° ± 2° versus 38° ± 2°","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"5 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145645105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-19DOI: 10.1097/CORR.0000000000003769
Anthony Michael Griffin
{"title":"CORR Insights®: Is Ipsilateral Femoral Head Autograft Reconstruction Durable in Patients Undergoing Enneking II/II+III Tumor Resections at a Minimum 5-year Follow-up?","authors":"Anthony Michael Griffin","doi":"10.1097/CORR.0000000000003769","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003769","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145602530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-19DOI: 10.1097/corr.0000000000003768
Timothy A Radosevich,Nicholas M Hernandez
{"title":"Classifications in Brief: Tile Classification of Pelvic Ring Fractures.","authors":"Timothy A Radosevich,Nicholas M Hernandez","doi":"10.1097/corr.0000000000003768","DOIUrl":"https://doi.org/10.1097/corr.0000000000003768","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"205 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145599761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-19DOI: 10.1097/CORR.0000000000003762
Linjie Dai, Kuangyang Yang
{"title":"Letter to the Editor: To What Degree Do Patients' and Clinicians' Ratings of Appropriateness of TKA Align, and Were Expected Outcomes Associated With Those Ratings?","authors":"Linjie Dai, Kuangyang Yang","doi":"10.1097/CORR.0000000000003762","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003762","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145602604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-17DOI: 10.1097/CORR.0000000000003766
Imad Kashir, Kim Madden
{"title":"Cochrane in CORR®: Surgical Approaches for Inserting Hemiarthroplasty of the Hip in People With Hip Fractures.","authors":"Imad Kashir, Kim Madden","doi":"10.1097/CORR.0000000000003766","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003766","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145892212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-13DOI: 10.1097/CORR.0000000000003763
Yilun Huang, Jacob Oh, Youheng Ou Yang
{"title":"Letter to the Editor: Is Biportal Endoscopic Laminectomy Equivalent to Microscopic Laminectomy in Patients With Lumbar Spinal Stenosis? A Multicenter, Assessor-blind, Randomized Clinical Trial.","authors":"Yilun Huang, Jacob Oh, Youheng Ou Yang","doi":"10.1097/CORR.0000000000003763","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003763","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145647570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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