International Orthopaedics最新文献

Background: Scapular neck fractures, typically caused by high-energy trauma, often require surgical fixation. Conventional reconstruction plates (RPs) are limited by poor anatomical conformity and extended operative times. We developed a novel scapular neck anatomical locking compression plate (SNALCP) and assessed its biomechanical stability and clinical performance.

Methods: Finite element analysis (FEA) was used to compare the biomechanical behaviour of SNALCP and RP in Miller type IIA/B fractures, simulating forward flexion (FF), abduction (AB), internal rotation (IR), and external rotation (ER). Clinically, 40 patients treated between January 2021 and August 2023 were enrolled: RP group (n = 22) and SNALCP group (n = 18). Operative time, blood loss, Visual Analog Scale (VAS) pain scores, healing time, complications, and Constant-Murley scores were evaluated.

Results: SNALCP demonstrated lower stress and displacement than RP across all loading conditions. For type IIA fractures, AB and FF stresses were 10.133 < 19.223 and 36.698 < 65.761 MPa; for type IIB, AB 63.089 < 97.578, FF 74.346 < 137.110, IR 379.290 < 540.640, and ER 1982.300 < 2253.100 MPa. Clinically, SNALCP yielded shorter surgical times (97.7 ± 19.3 min), less blood loss (152.6 ± 58.5 mL), faster healing (7.6 ± 1.4 weeks), and superior VAS and Constant-Murley scores (all p < 0.05). Only three cases of transient shoulder stiffness were observed.

Conclusion: SNALCP provides superior biomechanical stability and improved functional outcomes compared with RP. Larger, multicenter studies are warranted to validate these findings.

Purpose: Smoking is a potentially modifiable risk factor for adverse outcomes after total hip arthroplasty (THA), but evidence on early postoperative complications in Asian populations remains limited. This study examined the association between smoking and early postoperative complications after elective THA using a nationwide inpatient database in Japan.

Methods: This retrospective cohort study analysed data from the Japanese Diagnosis Procedure Combination (DPC) database between December 2011 and March 2023. Patients undergoing elective primary THA for osteoarthritis, osteonecrosis of the femoral head, or rheumatoid arthritis were included. Smoking status was identified using administrative codes. One-to-one propensity score matching was used to balance baseline characteristics between smokers and non-smokers. Primary outcomes were early postoperative surgical complications, medical complications, and in-hospital mortality. Dose-dependent effects were assessed using the Brinkman Index, with heavy smoking defined as ≥ 600.

Results: After propensity score matching, 52,551 patients were included in each group. Smoking was associated with a higher risk of postoperative infection (odds ratio [OR] 1.31; 95% confidence interval [CI] 1.15-1.49; p < 0.001) and a lower likelihood of blood transfusion (OR 0.83; 95% CI 0.80-0.85; p < 0.001). No significant associations were observed with dislocation, periprosthetic fracture, wound dehiscence, reoperation, major medical complications, or in-hospital mortality. Heavy smoking (Brinkman Index ≥ 600) was not associated with postoperative complications.

Conclusions: Smoking was associated with an increased risk of early postoperative infection following elective THA, but not with other major complications or in-hospital mortality. Smoking cessation should be considered an important component of perioperative optimisation.

Background: While the original Paul Grammont Inlay design had a 155° neck-shaft angle (NSA), developments in humeral stem designs have led to the emergence of the Onlay design with a more vertical angle. The purpose of the study is to compare three year clinical and radiological outcomes of two humeral stem designs, namely Inlay versus Onlay designs, with a 145° NSA and identical glenoid component.

Methods: In this multicentric retrospective study, 227 patients (141 Inlay versus 86 Onlay) that underwent primary reverse shoulder arthroplasty (RSA) between March 2019 and April 2020, were reviewed at a minimum follow-up of three years. Clinical evaluation included pain on visual analogue scale (VAS), active range of motion, subjective shoulder value (SSV), and Constant score. Radiological assessment included in situ stem inclination, cortical contact bone remodelling, and scapular notching.

Results: The two groups were comparable in terms of age, sex, diagnosis, and follow-up (mean follow-up, 3.3 ± 0.5 years). No significant differences were found for pain on VAS, SSV or Constant score. The Onlay group had significantly greater external rotation with 90° of abduction (ISA-Inlay, 52.2 ± 24.2; versus ISA-Onlay, 59.2 ± 25; p = 0.037), more valgus alignment (ISA-Inlay, -0.573; versus ISA-Onlay, -5.55; p < 0.001), and a higher rate of cortical contact (ISA-Inlay, 9%; versus ISA-Onlay, 39%; p < 0.001). No significant differences were found in terms of bone remodelling around the stem and scapular notching.

Conclusion: At a follow up of three years, both humeral stem designs resulted in comparable clinical and radiological outcomes, while the Onlay design seemed to improve external rotation without increasing the risk of bony complications. The choice of stem design should be motivated by patient specific functional needs and surgeon experience. However, the conclusions of the present study are limited to mid-term follow-up.

Purpose: Reverse Shoulder Arthroplasty (RSA) is widely used to treat shoulder joint pathologies. However, this procedure may result in reduced range of motion (ROM), scapular notching, and prosthetic instability. These complications vary among patients, highlighting the need for individualized preoperative planning. This study introduces a novel parametric methodology to determine optimal glenoid component positioning by evaluating ROM, instability ratio, and the percentage of bone resected.

Method: The proposed approach was applied to four patient models treated with two prosthetic designs. The methodology consists of four steps within a patient-specific parametric tool: 3D anatomical reconstruction, virtual surgical planning, biomechanical and geometric evaluation, and identification of optimal configurations. Fifteen glenoid component orientations were generated by varying tilt angles. The best configurations were identified based on ROM and instability assessments, while bone resection volume was calculated as an additional parameter.

Results: Maximum values of abduction-adduction, internal rotation, and external rotation were 87.23°, 90°, and 70.59°, respectively, although not achieved in a single configuration. Instability ratios ranged from 0.23 to 0.62. Bone resection varied between 0.4% and 5.5%, depending on the configuration.

Conclusions: This methodology provides a patient-specific framework to support preoperative planning in RSA. By combining ROM analysis, instability assessment, and bone preservation, the approach enables the identification of glenoid component orientations that improve mobility while minimizing instability risk and surgical invasiveness.

Introduction: Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in adults. Despite its clinical importance, nationwide data on long-term hospitalization and surgical management trends in Germany remain scarce.

Methods: A retrospective analysis was conducted using the German Federal Statistical Office's hospital discharge database covering all inpatient cases with the primary diagnosis of DCM (ICD-10-GM code M50.0) from 2005 to 2024. Annual case numbers, age and sex distributions, and surgical procedures were analyzed descriptively. Hospitalization rates per 100,000 inhabitants were calculated using mid-year population data.

Results: Between 2005 and 2024, approximately 70,000 hospital discharges with a primary diagnosis of DCM were recorded in Germany. Annual hospitalizations increased from 2,477 cases in 2005 to a peak of 4,076 cases in 2015, followed by a decline to 3,037 cases in 2024. Corresponding hospitalization rates rose from 3.0 to 4.96 per 100,000 inhabitants before decreasing to 3.7 per 100,000 in 2024. Segmented Poisson regression demonstrated a significant increase until 2015 followed by a significant decline thereafter. Age-specific analyses demonstrated a stable predominance of middle-aged and older adults, with consistently highest hospitalization volumes in patients aged 50-70 years. After age standardization to the 2015 reference population, the temporal pattern remained largely unchanged, indicating that observed trends were not solely attributable to population ageing. Mean length of hospital stay decreased steadily over time. Anterior surgical approaches accounted for the majority of procedures throughout the study period, while the proportion of surgically treated cases per hospitalization increased over time.

Conclusions: This nationwide, discharge-based analysis demonstrates substantial temporal changes in hospitalizations and surgical treatment patterns for DCM in Germany over the past two decades. Hospitalization volumes increased until approximately 2015 and declined thereafter, a pattern that persisted after age standardization. DCM predominantly affected patients aged 50-70 years throughout the study period, without a pronounced shift toward progressively older age groups. The increasing ratio of surgical procedures to hospitalizations suggests more selective inpatient admissions focusing on operative management. These findings provide a descriptive reference for long-term hospitalization and surgical trends in DCM.

Purpose: Postoperative stiffness is a common and incapacitating complication after total knee arthroplasty (TKA), significantly impacting functional outcomes. Open arthrolysis remains a less-studied surgical option. The objective of this study was to assess the use and outcomes of open arthrolysis in post-TKA stiffness management. We hypothesised that open arthrolysis is the least frequently used technique.

Methods: This was a retrospective multicentre study conducted as part of the 2024 SOFCOT symposium on post-TKA stiffness management, including 13 centres in France. Patients who underwent open arthrolysis for post-TKA stiffness between 2015 and 2019 were included. Demographic, radiographic, and clinical data were collected, and functional outcomes were evaluated using KOOS, Oxford, and JFS-12 scores preoperatively and postoperatively. Range of motion (ROM) was assessed and compared across different treatment modalities.

Results: Among 490 patients treated for post-TKA stiffness, 12 (2.4%) underwent open arthrolysis. The mean follow-up duration was seven years. Open arthrolysis patients were treated later than those undergoing manipulation under anaesthesia (28.1 vs. 7.2 months, p = 0.001) and later than arthroscopic arthrolysis patients without statistical difference (9.9 months, p = 0.216). Mean ROM improved by 27° postoperatively but remained lower than in other treatment groups (74° vs. 98°, p = 0.011). More than 90% of open arthrolysis patients reported dissatisfaction, compared to 26% for other techniques (p < 0.001).

Conclusion: Open arthrolysis is rarely performed for post-TKA stiffness with higher patient dissatisfaction rates than other treatment modalities. These findings suggest that open arthrolysis may have a limited role in post-TKA stiffness management.

Background: Enhanced Recovery After Surgery (ERAS®) is a coordinated, evidence-based program delivered through a multidisciplinary team, which objective is to improve outcomes and patient satisfaction, while minimizing complications. The objective of this two-cohort study is to evaluate the clinical impact of an ERAS program on elective primary hip (THA) and knee (TKA) arthroplasties with regards to hospital length of stay, during the first 12 months after implementation.

Methods: We compared a retrospective pre-ERAS with a prospective ERAS cohort. Key aspects of this program included preoperative education, minimal fasting, standardised, anaesthetic and surgical techniques, multimodal analgesia, and early mobilization. The primary outcome was hospital length of stay. Other outcomes included rest, dynamic pain scores, and rates of complications.

Results: From December 1st, 2021 to November 30th, 2022, data from 267 patients (138 THA, 129 TKA) were compared with data from 258 patients (128 THA, 130 TKA) collected between December 1st, 2022, and November 30th, 2023, who underwent the ERAS® program (total: 525 patients). The mean hospital length of stay for THA patients before ERAS® was 5.5 ± 2.9 days versus 4.5 ± 2.0 days after ERAS® implementation (p = 0.002). For TKA patients, it was 6.6 ± 3.1 days before vs 5.6 ± 1.9 days after ERAS® implementation (p = 0.001). Rest, dynamic pain scores, and rates of complications were similar between groups except for pneumonia in patients undergoing TKA.

Conclusion: The implementation of an ERAS® program for hip and knee arthroplasty led to a reduced hospital length of stay, below the Swiss national average, without impacting pain outcomes and rates of complications.

Purpose: Periprosthetic joint infection (PJI) is a potentially devastating complication following total elbow arthroplasty. In this retrospective study, we aimed to review our cohort of patients to assess the treatment success rates of elbow PJI using different treatment methods and to report on the additional treatment approach for failed cases.

Methods: The study included 26 patients who underwent revision surgery for elbow PJI between 2007 and 2023. Patients were enrolled if they possessed a minimum follow-up of two years. Success of different treatment strategies, including debridement, antibiotics, and implant retention (DAIR) with or without modular component exchange, and two-stage revision was evaluated, as well as the fate of patients who experienced initial treatment failure.

Results: At a mean follow-up of 140.5 ± 74.5 months, only 11 patients (42.3%) were successfully treated after a single revision. The overall infection-free survival rates were 65.4% at one year, 50.0% at two years, and 45.8% at five years. DAIR without component exchange had the lowest success (23.1%), while DAIR with modular component exchange and two-stage revision showed the highest (60.0% and 62.5%, respectively). Failed cases (57.7%) required a mean of 2.1 additional procedures to achieve infection control.

Conclusion: Treatment of elbow PJI remains especially challenging due to an overall high treatment failure. While two-stage exchange appears to be the most effective treatment modality, DAIR with modular component exchange shows promising outcomes in well-fixed prostheses. DAIR without modular components exchange yields poor infection control rates and should be omitted.

Purpose: Degeneration at the common extensor origin leads to lateral elbow pain and reduced quality of life. We conducted a double-blind, randomized, placebo-controlled trial involving 71 patients treated with leukocyte-poor PRP (LP-PRP), leukocyte-rich PRP (LR-PRP), or saline.

Methods: PRP content was analyzed using flow cytometry, confocal microscopy, and holotomography. Clinical outcomes (Visual Analogue Scale, Oxford Elbow Score) were assessed at baseline and at three, six, 12, 24, and 55 weeks.

Results: LR-PRP contained 3.8 × more leukocytes and 2.7 × fewer platelets than LP-PRP. Imaging revealed distinct platelet morphology and activation patterns between PRP types. The LP-PRP group showed significantly greater pain reduction at six weeks and improved elbow function from three to six weeks onward.

Conclusion: LP-PRP produced superior and longer-lasting clinical outcomes compared to LR-PRP and saline.

Clinicaltrials: GOV: NCT06854666 (retrospectively registered on 2025-01-13).