Indian Journal of Orthopaedics最新文献

Background: Preoperative planning in total hip arthroplasty (THA) is crucial for ensuring the availability of appropriate implants and providing surgeons with accurate size expectations. Without accurate templating, surgeons risk making incorrect decisions about implant size, potentially leading to intra-operative fractures, instability, dislocation and early prosthesis failures. While commercial digital templating tools are available, their costs can be prohibitive, especially in resource-limited settings. Open-source alternatives like Detroit Bone Setter offer a potential solution, but their reliability requires rigorous validation.

Methods: We retrospectively analysed 85 patients who underwent primary THA between 2021 and 2024. Preoperative digital templating was performed using Detroit Bone Setter by two blinded senior orthopaedic surgeons who independently predicted femoral stem and acetabular cup sizes. Templated sizes were compared to intraoperatively implanted components using paired Student's t-tests and Bland-Altman plots. Inter-observer reliability was assessed using intraclass correlation coefficients (ICC).

Results: Significant differences were found between templated and actual implant sizes, with a mean bias of + 0.71 mm (p = 0.0003) for femoral stems and + 3.20 mm (p < 0.0001) for acetabular cups. The templated size fell within ± 2 sizes of the actual size in 85% of cases for femoral stems and 65% of cases for acetabular cups. Inter-observer reliability was high (ICC = 0.89 for femoral stems and 0.83 for acetabular cups).

Conclusion: These findings underscore the potential of Detroit Bone Setter to serve as a viable low-cost planning tool, especially in resource-constrained surgical environments. Detroit Bone Setter demonstrates reasonable accuracy for femoral stem templating. However, it tends to overestimate acetabular cup sizes. Surgeons should be aware of this tendency and use intraoperative verification techniques to complement templating results.

Introduction: Patellar dislocation in children and adolescents, particularly habitual and congenital types, is a challenging condition that can cause significant functional impairment and long-term morbidity if untreated. Medial patellofemoral ligament (MPFL) is a critical structure in stabilizing the patella, and its reconstruction has been widely attempted in clinical practice using various tissue autografts. The same has been extensively published for adults; however, not many studies have been published in pediatric patients with habitual patellofemoral instability using the iliotibial band as a graft without implants. This study proposes a novel technique for MPFL reconstruction using a TFL graft without implants, coupled with modified vastus medialis oblique (VMO) advancement, aimed at restoring normal knee function and preventing habitual patellar dislocation in children.

Materials and methods: This study included pediatric patients aged 6-16 years with habitual or congenital patellar dislocation. Clinical diagnoses were based on history, physical examination, and imaging studies. Exclusion criteria involved patients with neurovascular conditions, severe skeletal deformities, traumatic dislocations, or prior knee surgeries. The surgical procedure comprised four key interventions: lateral release, fractional lengthening of the TFL, MPFL reconstruction using the TFL graft without implants, and modified VMO advancement. The outcomes were measured using the Kujala Patello-femoral Score, assessing pain, knee stability, and return to function, with follow-up assessments ranging from 3 months to 2 years.

Results: Seventeen patients (20 knees) were included in the study, with an average age of 8.75 years. The mean post-operative Kujala score was 93.25, indicating significant improvement in knee function. Postoperative pain was minimal (mean score 9), normal patellar tracking, and patients showed excellent recovery in dynamic movements, such as running and jumping. A complication of wound dehiscence with knee flexion contracture occurred in one patient, which was treated with wound debridement and secondary suturing. Importantly, there were no instances of recurrence of patellar dislocation.

Conclusion: The modified MPFL reconstruction technique using a TFL graft without implants, combined with modified VMO advancement, proved to be an effective surgical solution for treating habitual and congenital patellar dislocation in pediatric patients. This technique offers excellent functional outcomes, with minimal complications and no recurrence of dislocation, while avoiding the need for implants, thus reducing the potential growth disturbances and associated morbidity.

Background and aims: This study performed a comprehensive bibliometric analysis comparing Indian and international highly-cited papers (HCPs) in the Indian Journal of Orthopaedics (IJO).

Methods: The study used a bibliometric design to analyze HCPs published in the IJO between 2007 and 2024, a period selected based on the journal's Scopus coverage. The Scopus database was used for its comprehensive coverage and robust citation analysis capabilities. All documents published in the IJO during this period were retrieved on June 20, 2025. The threshold for an HCP was set at 51 or more citations, as this indicates significant peer recognition and influence within the academic community. For each HCP, the following data was extracted: the title, publication year, and citation count; the country of origin (Indian or foreign); the study type (original article, review, conference paper, editorial, or letter); the subject focus (e.g., trauma, joint disorders, or infection); author and institutional affiliations; and collaboration patterns, defined as single-institution, national collaboration (two or more institutions within India), or international collaboration (institutions from different countries).

Results: The 54 HCPs accumulated 4697 citations, averaging 86.98 per paper. Indian HCPs, averaging 89.61 citations, predominantly comprised original articles and reviews focusing on trauma, joint disorders, and infection. Notably, 74% of Indian HCPs were single-institution studies, with limited international collaboration. In contrast, foreign HCPs, averaging 92.46 citations, exhibited a broader range of topics and more frequent national and international collaborations. Until 2011, Indian publications had a statistically significant lower mean difference in CPP (14.4 ± 2.0) compared to foreign publications (19.4 ± 3.9) with a p-value of 0.042; however, after 2011, this disparity vanished, with both Indian and foreign publications showing an 8.1 mean difference (± 4.2 and ± 4.4 respectively) and a p-value of 0.999.

Conclusions: Indian HCPs focus on localized clinical priorities and have lower collaboration rates than their international counterparts. To enhance the global impact and citation potential of Indian orthopaedic research, expanding national and international collaborations and diversifying research topics is crucial.

Graphical abstract:

Supplementary information: The online version contains supplementary material available at 10.1007/s43465-025-01555-7.

While the disruption of the knee's extensor mechanism is rare, its effects can be severe. Surgical intervention is the primary approach for treating these injuries, and proper execution is needed to prevent lasting functional deficits. The Quadriceps muscle-tendon unit is essential for knee extension, and injuries can hinder independent mobility. Numerous surgical techniques are advocated to re-establish the continuity of the quadriceps tendon. We aim to present a reliable technique for quadriceps tendon repair utilized by both authors of this article in a high-volume practice for the past five years.

Background: Arthroscopic rotator cuff repair is performed with various commonly used suture anchors. The aim of this study was to compare soft and metal suture anchor types after repair.

Methods: This study includes patients who were operated and followed up by a single surgeon in a single center. This study is a retrospective comparative case-control study. The data of 184 patients who underwent arthroscopic rotator cuff repair with the single-row technique using soft anchors and metal anchors between August 2018 and April 2024 were analyzed. Patients were evaluated by Constant-Murley score and clinical range of motion of the shoulder in abduction, external rotation and internal rotation. Preoperative and final follow-up constant scores of all patients were compared. Shoulder joint range of motion was also measured at the last follow-up and compared between the two groups.

Results: The study was performed with 131 patients who met all criteria and 50 metal anchors and 81 soft suture anchors were used. There was a statistically significant difference between the preop and postop constant score values of both participants with metal and soft anchor type (p < 0.001). There was no significant correlation between internal rotation and anchor type (p > 0.05). There was no significant difference between metal and soft anchors in terms of abduction, external rotation, preop constant score and postop constant score (p > 0.05).

Discussion: Both soft anchor and metal anchor types can be used successfully in repair operations of rotator cuff injuries. No significant difference was found between the treatment results of these two anchor types.

Background: Postoperative pain is reported as a major complication of total knee arthroplasty (TKA) and is found in about 20% of the patients. The persistent pain is considered the main reason for dissatisfaction after surgery. We conducted a meta-analysis of randomized controlled trials (RCTs) to assess the efficacy of peri-operative cognitive behavioral therapy (CBT) in postoperative pain relief and restoration of joint function.

Methods: RCTs (published in English) that compared the outcomes of patients who underwent TKA with or without peri-operative CBT were systematically searched in PubMed, Embase, Cochrane Library, and Web of Science. Main endpoints, namely Oxford Knee Score (OKS), knee joint range of motion (ROM) and EuroQol five dimensions questionnaire (EQ-5D), were pooled and assessed by RevMan.

Results: Six RCTs mainly focused on TKA were included in the meta-analysis. Compared with the conventional care group, the CBT group had lower OKS at three months (SMD = - 0.47, 95% CI - 1.50, 0.55) and 12 months (SMD = - 0.78, 95% CI - 1.76, 0.21) and improved knee ROM at 12 months (SMD = 4.19, 95% CI - 3.77, 12.15), but not at 7 days (SMD = 0.07, 95% CI - 0.24, 0.38) or 3 months (SMD = 0.24, 95% CI - 0.07, 0.55) after TKA. In addition, the CBT group showed better EQ-5D performance at three months (SMD = - 0.67, 95% CI - 4.97, 1.64) and 12 months (SMD = - 1.38, 95% CI - 3.37, 0.61) after TKA.

Conclusion: Peri-operative CBT is partially effective for improving pain, functional recovery, psychological conditions and ROM after TKA.

Supplementary information: The online version contains supplementary material available at 10.1007/s43465-025-01553-9.

Objective: In this pilot study, we analyzed whether there is an association between hip radiographic parameters and the severity of osteonecrosis secondary to sickle cell disease, according to the Ficat and Arlet, and Ohzono classifications.

Methods: This descriptive cross-sectional study included 20 patients aged 18 to 45 years treated at Professor Edgard Santos University Hospital (HUPES). All patients underwent an anteroposterior pelvic radiograph at HUPES. Clinical and radiographic data were collected, including the classification of osteonecrosis according to Ficat and Arlet, and Ohzono, as well as the following radiographic parameters: position of the hip center, femoral head extrusion index, Wilberg angle, Tönnis acetabular roof angle, and cervicodiaphyseal angle.

Results: Seven hips were excluded because they had already undergone surgical treatment. Of the 33 hips evaluated, most were in advanced stages of osteonecrosis. The cervicodiaphyseal angle showed a significant difference between advanced stages (III and IV) and early stages (IIA and IIB) in the Ficat & Arlet classification, while other parameters did not present statistically significant differences.

Conclusion: The study identified significant variations in the cervicodiaphyseal angle between different stages of osteonecrosis. Despite being limited by the small sample size and excluding post-surgical cases, the study provides an initial basis for the radiographic characterization of osteonecrosis associated with Sickle Cell Disease. It indicates the need for future research with larger samples.

Background: Orthopedic research in Nepal has grown over the past two decades, but a comprehensive analysis of its trends and patterns remains lacking. This study aims to map the volume, nature, and scope of orthopedic publications from Nepal using bibliometric methods.

Methods: A bibliometric analysis was conducted using the Scopus database. Publications were retrieved using the query: ((TITLE-ABS-KEY(ORTHOPAEDIC OR ORTHOPEDIC) AND AFFILCOUNTRY(NEPAL)) AND PUBYEAR > 1999 AND PUBYEAR < 2025), searched on January 12, 2025. Data on publication year, publication types, institutional affiliations, authorship, collaborating countries, and source journals were analyzed descriptively, focusing on the top results.

Results: A total of 218 orthopedic-related publications were identified. The peak publication output occurred in 2023 with 26 articles. Original research articles accounted for 85.3% of the total, followed by review articles (7.3%). The most frequent international collaborators were from the United States, India, and the United Kingdom. Tribhuvan University and Kathmandu University were the leading institutions.

Conclusion: Orthopedic research in Nepal has become increasingly visible. High reliance on international collaborations has enhanced global reach but may overshadow contributions from Nepal-based surgeons. In addition, the exclusion of non-Scopus-indexed national journals likely underrepresents the country's actual research volume.