Indian Journal of Orthopaedics最新文献

Background: Osteoarthritis (OA) is a chronic degenerative joint disease affecting millions of people mainly aged over 65. OA leads to progressive damage across joint components, including bone degeneration with osteophyte formation, cartilage erosion, synovitis, and meniscal deterioration. Early OA treatments focus on symptom management, but advanced knee OA often requires alternative approaches. Regenerative medicine, such as tissue engineering, offers promising solutions. Mesenchymal stem cell (MSC) intra-articular injections have gained popularity for OA management. Autologous sources, such as bone marrow aspirate concentrate (BMAC) and adipose-derived stem cells (ADSCs), are widely used.

Objective: This study compared the therapeutic efficacy of single BMAC and ADSC injections in knee OA patients, focusing on MSC quantity and quality in harvested tissues. To support this, hematological studies analyzed and quantified CD34+ cells in adipose and bone marrow samples.

Methods: 60 patients diagnosed with symptomatic degenerative knee OA were enrolled. Patients under 50 received BMAC injections, while those over 50 received ADSC injections. Follow-ups were conducted at baseline(t0), 1 month (t1), 3 months (t2), and 6 months (t3) using the Visual Analog Scale (VAS), WOMAC score, Kellgren-Lawrence classification, and range of motion (ROM). Bone marrow and adipose samples were harvested and processed to quantify viable MSCs. Mononuclear cells were isolated using density gradient centrifugation, and CD34+ cells were subsequently enriched through magnetic separation using column-based processing. Cultured MSCs were counted weekly to evaluate proliferation.

Results: Both groups showed significant clinical improvements in VAS, WOMAC, and ROM scores (p < 0.01). No statistically significant correlation was observed between MSC quantity and treatment efficacy (p ≥ 0.01). MSC cultures succeeded in 32 aspirates: 30 from bone marrow and 2 from adipose tissue, with cell counts ≥ 0.35 × 10⁵ cells/mL.

Conclusions: At 6 months, both BMAC and ADSC treatments resulted in significant clinical improvements (p < 0.01), with no significant differences between groups (p ≥ 0.01). Our findings indicated that bone marrow samples generally yielded higher MSC counts and showed slightly faster recovery rates among BMAC-treated patients, but with no substantial differences at the 6 month mark. MSC efficacy may depend on factors beyond cell quantity. Further studies with extended follow-ups are required.

Graphical abstract:

Supplementary information: The online version contains supplementary material available at 10.1007/s43465-025-01525-z.

Introduction: Calcaneal osteomyelitis poses a problem as any other chronic osteomyelitis in the body. Correct diagnosis and prompt treatment are essential to avoid limb-threatening amputation surgery. In this retrospective study, we describe the 4 golden principles of treatment of such cases through extended debridement, dead space management, soft tissue coverage and post-operative orthosis.

Materials and methods: We have studied 14 calcaneal osteomyelitis in 13 patients. Six of them were due to neuropathy. All the patients underwent debridement and sequestrectomy. Eight patients had instillation of calcium sulfate antibiotic granules in them. Silo technique was used in 10 patients. Total calcanectomy was performed in one case. Most of the patients were offloaded till their ulcers healed and were given custom orthosis to prevent recurrences.

Results: 13 cases had a successful result (P-value = 0.00092). One diabetic patient required a below-knee amputation. There were three cases of complications of re-ulceration, but it was not associated with calcaneal infection. The ulcers healed in 1.75 months (15 days-4 months). Insoles or ankle foot orthosis with hindfoot offloading were given to eight patients, while one patient required a silicon heel insole.

Conclusion: Thorough debridement, dead space management and prevent of recurrences by offloading orthosis is necessary for limb salvage in calcaneal osteomyelitis.

Brodie's abscess is a form of subacute osteomyelitis that typically arises in the metaphyseal regions of long bones and is characterised by an insidious onset in the absence of raised inflammatory markers. Standard treatment involves evacuation and curettage of the abscess cavity, often in conjunction with a course of antibiotics. Traditionally, this is done through an open surgical approach under fluoroscopic guidance; however, in the paediatric population, this holds the potential for damage to the growth plate and injury to adjacent neurovascular structures. Needle arthroscopy (NA) is emerging as a minimally invasive alternative to conventional arthroscopy, facilitating access to joints using small "Nano-instruments". We report on the novel application of this technology to assist in treating a transphyseal Brodie's abscess in the left distal tibia of a 16-month-old male. To our knowledge, this is the first reported instance of NA being used to instrument Brodie's abscess.

Background: The combination of vancomycin and ceftazidime antibiotics in bone cement remains a viable option for treatment of periprosthetic joint infections (PJI). This study evaluates the impact of these antibiotics on the biomechanical characteristics of the bone cement.

Methods: Bone cement specimens containing varying dosages of vancomycin and ceftazidime were prepared. Their properties were assessed to examine the effect of increasing antibiotic concentrations on the biomechanical properties of the cement. All groups underwent axial compression and three-point bending tests using the Instron^® 3365 Material Testing System (Norwood, MA).

Results: The control group had an axial compression strength of 105.60 ± 14.77 MPa and a three-point bending strength of 63.75 ± 8.98 MPa. The highest axial compression and three-point bending strengths were observed with the combination of 2 g vancomycin and 2 g ceftazidime, which had an axial compression strength of 78.24 ± 11.04 MPa and a three-point bending strength of 43.78 ± 22.57 MPa. The lowest strengths were observed with the 4 g vancomycin and 4 g ceftazidime formulation, which had an axial compression strength of 23.98 ± 5.93 MPa and a three-point bending strength of 9.76 ± 2.35 MPa. The mechanical strength of the bone cement decreased as the antibiotic concentration increased.

Conclusion: The strength of bone cement diminishes with an increase in antibiotic dose. Based on our findings, the optimal dosage to prevent bone cement fracture is a combination of 2 g vancomycin and 2 g ceftazidime.

Background: Acute and chronic anemia is common in hip fracture patients, and blood transfusions may be necessary during pre-operative optimization. However, transfusions increase the risk of complications. This study evaluates the impact of red blood cell (RBC) transfusion timing on outcomes including mortality, major complications, and readmission rates for hip fracture patients who present with chronic anemia of at least 6 months.

Methods: A retrospective chart review of chronically anemic hip fracture patients was conducted to assess demographics, lab values, transfusion timing, and outcomes. Charlson comorbidity index (CCI) and Score for Trauma Triage in the Geriatric and Middle Aged (STTGMA) were calculated for each patient. Patients were stratified into three transfusion cohorts: pre-operative transfusion, post-operative transfusion, and no-transfusion. Variables were compared using Chi-square and ANOVA as appropriate. Binary logistic regression analysis was performed to account for confounding variables.

Results: Patients who received a pre-operative RBC transfusion had a significantly higher risk of 1-year mortality (25.5%) compared to the no RBC transfusion cohort (8.4%) (odds ratio = 7.670) (p = 0.012). There was a significant difference between the no-transfusion cohort, pre-operative transfusion cohort, and post-operative transfusion cohort for 1-year mortality (8.4%, 25.5%, 17.6%, respectively; p = 0.006), overall mortality (9.2%, 32.7%, 23.0%, respectively; p < 0.001), major complications (10.6%, 32.7%, 21.6%, respectively; p < 0.001). Post-operative transfusion or no-transfusion was not linked to readmission rates, complications, or mortality.

Conclusion: Pre-operative RBC transfusion is an independent risk factor for 1-year mortality in chronically anemic hip fracture patients, suggesting careful consideration of transfusion timing.

Introduction: The coracoid process is a key anatomical component of the scapula, playing a vital role in shoulder biomechanics and various procedures. The success of these interventions depends on accurate anatomical knowledge, which may vary across populations. However, there is limited anthropometric data available for the Indian population. Thereby, this study aims at a detailed anthropometric assessment of the coracoid process in the Indian population using 3D computed tomography (CT), intending to improve surgical planning and outcomes.

Materials and methods: A cross-sectional observational study was conducted from April to September 2021. CT scans of 105 adults aged 20-60 years with normal shoulders were analyzed bilaterally. Morphological measurements of the coracoid process were obtained and data was analyzed statistically. Individuals with previous fractures, pathologies, and dislocations around the shoulder joint were excluded.

Results: The mean coracoid length, tip height, tip width, midpoint height, midpoint width, coracoid height, and tip-to-midpoint distance on the right side were 39.86 ± 1.20 mm, 10.10 ± 0.71 mm, 12.36 ± 0.58 mm, 11.31 ± 0.99 mm, 13.34 ± 0.56 mm, 17.72 ± 1.26 mm, and 19.93 ± 0.60 mm, respectively. Corresponding values on the left side were 39.69 ± 1.18 mm, 10.05 ± 0.73 mm, 12.31 ± 0.57 mm, 11.27 ± 0.98 mm, 13.29 ± 0.55 mm, 17.67 ± 1.24 mm, and 19.84 ± 0.59 mm. These dimensions were comparable on both sides, with slightly higher values on the right and significantly greater in males compared to females (p < 0.05), while no significant associations were observed with age indicating that gender, not age, influences coracoid morphology in this population.

Conclusion: This study presents detailed 3D anthropometric data of the coracoid process and offers valuable reference points for orthopaedic surgeons during surgical planning to improve procedural outcomes.

Background: Ipsilateral fractures and dislocations involving the hip, distal femur, and patella are rare and pose significant management challenges.

Case presentation: We present a unique case of a 50-year-old male who sustained a posterior hip dislocation with femoral head fracture, medial femoral condyle fracture, and rotational patellar dislocation incarcerated between the femoral condyles following a high-energy roadside accident. The patient presented with limb deformity and a knee wound within 30 min post-injury. Initial closed reduction attempts failed, and surgical intervention under spinal anaesthesia achieved hip reduction via the Allis manoeuvre, open fixation of the distal femur fracture, and patellar relocation.

Outcome: Postoperative recovery was uneventful, with satisfactory joint function at five months. However, at 20 months, the patient developed avascular necrosis with osteoarthritic changes for which total hip replacement was advised.

Conclusion: This case highlights the importance of prompt diagnosis and coordinated surgical management of complex lower-limb trauma.

Background: 3D printing is a latest technique used in planning fracture management which helps to plan accurate surgery leading to better results than traditional management of fractures.

Materials and methods: In this randomised-controlled trial, 30 patients between 18 and 65 years of age having proximal tibia fractures AO type 41B and 41C were included. They were divided into two groups, 15 cases each of 3D model group and traditional surgery group. The 3D model group were assessed pre-operatively with 3D printed model and pre-operative planning was done using the model, whilst the traditional surgery group of patients were assessed pre-operatively with radiological assessment like X-rays and 3D Reconstruction CT scan. Both groups were then subjected to standard surgical management. Operative time, blood loss, and number of intra-operative fluoroscopy were recorded. Through the follow-up, the recovery of patients was observed.

Results: The functional outcomes of surgically treated tibial plateau fractures were assessed using HSS scores which was better in the 3D-Group than the traditional group. Operative time, blood loss, and number of intra-operative fluoroscopy were less in 3D model group than traditional group. The P value was highly significant in HSS scores, operative time, blood loss, and number of intra-operative fluoroscopy between 3D model group and traditional surgery group.

Conclusion: This study showed that use of 3D printing pre-operatively gives better result than traditional surgery.

Background: The use of cementless stems in patients with stovepipe-type femoral morphology (Dorr type C) remains controversial. Limited data are available on the clinical and radiological outcomes of cementless total hip arthroplasty using the Polarstem, particularly with proximal femoral bone morphology. This study compared clinical and radiological outcomes following Polarstem total hip arthroplasty (THA) based on medullary canal morphology, with a secondary aim of evaluating short-term findings.

Methods: This retrospective study included 101 consecutive patients who underwent Polarstem THA. Inclusion criteria required a minimum 2-year postoperative follow-up. We excluded patients with incomplete clinical data, pathological fractures, or severe comorbidities. Resulting in 95 patients (112 hips) for final analysis. Radiographic findings and Japanese Orthopaedic Association (JOA) hip scores were compared among the three Dorr-type classifications.

Results: Postoperative JOA scores showed significant improvement compared to preoperative values (p < 0.001). No significant differences were observed among Dorr types preoperative and postoperative JOA scores, subsidence incidence, or cortical hypertrophy (p = 0.199, 0.061, 0.623, and 0.384, respectively). No cases exhibited radiolucent lines. Pedestal formation occurred in 64 hips, with significantly higher occurrence in Dorr type C (p < 0.009). Stress shielding was observed in 47 hips, with significantly higher grade 2 incidence in Dorr type A and lower incidence type B (p < 0.001).

Conclusions: The Polarstem demonstrated favorable short-term clinical outcomes regardless of proximal femoral morphology. However, grade 2 stress shielding occurred more frequently in Dorr type A femurs, suggesting that medullary canal morphology should be considered when selecting this stem design.

Introduction: Hip fractures in the elderly are a significant cause of morbidity and mortality, with 1-month and 1-year mortality rates reaching up to 10% and 20%, respectively. While non-modifiable risk factors such as age and comorbidities are well-documented, modifiable factors such as surgical delay and rehabilitation remain underexplored in the Indian context. This study aimed to evaluate postoperative mortality and survival outcomes in elderly patients undergoing bipolar hemiarthroplasty and identify key predictors of mortality.

Methods: A retrospective cohort study was conducted on patients aged ≥ 70 years who underwent bipolar hemiarthroplasty for proximal femoral fractures at a tertiary institute from January 2021 to July 2024. Data were collected from hospital records and follow-up was conducted telephonically. Patients with incomplete records or who were unavailable for follow-up were excluded. Survival was assessed using Kaplan-Meier analysis, and predictors were evaluated using log-rank tests and Cox proportional hazards modeling.

Results: Sixty-two patients (30 males, 32 females) were included; 46 were aged ≥ 75 years. Cemented implants were used in 30 and uncemented in 32 patients. Comorbidities were present in 19 patients. Seventeen patients (27.4%) died during follow-up: 8 within 1 month, 7 within 6 months, and 2 within 2 years postoperatively. The mean time to mobilization was 3.27 days. Increasing age was a significant predictor of mortality (HR 1.08; 95% CI 1.01-1.17; p = 0.035), as were comorbidities (p = 0.014). Gender, implant type, anesthesia, and hospital stay duration were not significantly associated with mortality.

Conclusions: Advanced age and the presence of comorbidities significantly increase the risk of mortality following bipolar hemiarthroplasty in elderly patients. Early postoperative deaths highlight the need for timely surgery and robust perioperative care. Improving systemic optimisation may offer the best chance at enhancing survival in this high-risk population.