International Orthopaedics最新文献

Purpose: The modified Broström operation is the gold standard surgical approach for chronic lateral ankle instability. The aim of surgical treatment for chronic lateral ankle instability is to shorten and repair the lax lateral ligaments, once the healing process is complete, the sutures will no longer be necessary. While non-absorbable sutures are commonly used, they may cause complications, such as inflammation and foreign body reactions. The purpose of this study was to evaluate the clinical outcomes of the modified Broström operation using absorbable sutures, which we expected to yield favorable results.

Methods: From 2019 to 2023, 157 cases of mechanical chronic lateral ankle instability treated with the modified Broström operation using absorbable sutures were analyzed retrospectively Functional outcomes were assessed using preoperative and postoperative AOFAS Ankle-Hindfoot scores and Karlsson-Peterson scores.

Results: The mean AOFAS score improved from 66.84 (range: 36-98) preoperatively to 88.20 (range: 55-100) postoperatively, and the mean Karlsson score improved from 53.67 (range: 25-95) to 82.29 (range: 35-100). Recurrence of instability or sprains occurred in 6.3% of cases, with only two patients (1.2%) requiring reoperation. Complications other than recurrence were rare, limited to a single case of superficial peroneal nerve injury and one deep infection. Multivariate analysis revealed that younger age was associated with a higher risk of recurrence.

Conclusion: The modified Broström operation using absorbable sutures demonstrated favorable functional improvement with low recurrence and complication rates, suggesting that it may represent a safe and effective surgical option.

Background: The COVID-19 pandemic produced a substantial reduction in arthroplasties, which could have affected patient quality of life. This study investigated quality of life in Australians undergoing elective arthroplasty before and during the COVID-19 pandemic.

Methods: Using data from the Australian Orthopaedic Association National Joint Replacement Registry, quality of life was assessed in patients before and six months after primary total hip arthroplasty (THA), total knee arthroplasty (TKA) and reverse total shoulder arthroplasty (RTSA) using the EQ-5D-5L instrument. Patients with an EQ-5D Utility score less than zero were considered to have a quality of life worse than dead. Secondary outcomes included Oxford Scores, joint-specific pain, patient perceived change, responder status and patient satisfaction. Quality of life was compared before (1 July 2018-10 March 2020) and during the pandemic (11 March 2020-10 March 2023) using linear or logistic regression models.

Results: The analysis included preoperative data for more than 24,000 THA patients, 20,000 TKA patients and 1,100 RTSA patients. Compared to the pre-pandemic period, preoperative and postoperative quality of life significantly reduced during the pandemic for THA and TKA, but not by a meaningful amount (adjusted mean difference ≤ 0.03 points, p < 0.001). The likelihood of having quality of life worse than dead increased during the pandemic but was only significant for preoperative THA (ORs 1.24 to 1.40, p < 0.02). For secondary outcomes, joint-specific scores deteriorated, and joint pain increased to a small degree during the pandemic for THA and TKA (p < 0.05), but not for RTSA. The proportion of THA and TKA patients satisfied with their surgery outcome increased modestly during the pandemic by approximately five percentage points, compared to pre-pandemic.

Conclusion: The COVID-19 pandemic was not associated with a clinically meaningful deterioration in pre- or post-operative quality of life, on average, for patients undergoing THA, TKA or RTSA in Australia.

Purpose: To compare platelet-rich plasma (PRP) with hyaluronic acid (HA), corticosteroid (CS), or saline placebo (NS) for symptomatic knee osteoarthritis (OA) and to assess whether total blood-draw volume, a proxy for platelet dose, is associated with treatment effect.

Methods: Following PRISMA, randomized controlled trials comparing intra-articular PRP with HA, CS, or NS were identified. Random-effects meta-analyses estimated mean differences (MDs) in pain (VAS) and function (WOMAC) at six and twelve months. Risk of bias was assessed with RoB 2.0 and certainty of evidence with GRADE. Subgroup analyses stratified PRP vs HA trials by total blood draw volume (< 40 mL vs ≥ 40 mL).

Results: Sixty-two trials (n = 4,969) were included. PRP improved VAS and WOMAC versus HA, CS, and NS at six months and remained superior versus HA and CS at twelve months (insufficient studies for twelve-month PRP vs NS). In PRP vs HA trials, blood draw volume ≥ 40 mL was associated with larger improvements in six-month WOMAC (P = 0.004) and twelve-month VAS (P = 0.029). Heterogeneity was substantial (I² > 90% for most analyses), and evidence certainty ranged from moderate to very low.

Conclusion: PRP provides superior patient-reported pain and function outcomes compared with HA, CS, and NS through six months, with benefits maintained to twelve months versus HA and CS in longer-term trials. Blood-draw volume may be a useful alternate when platelet dose is unreported.

Purpose: To evaluate the Fast Anterior Medium Approach (FAMA) as an alternative to traditional anterior cervico-thoracic approaches, enhancing access to the C7-T1-T2 and T2-T4 junctions while minimizing postoperative morbidity. The cervico-thoracic junction is one of the most challenging regions to access surgically due to its deep location and proximity to critical neurovascular structures. Conventional approaches, including postero-lateral thoracotomy and transmanubrial techniques, are associated with high morbidity. The FAMA technique was designed to provide enhanced exposure while reducing surgical trauma.

Methods: A cadaveric study was performed to understand how FAMA approach could find application in spine surgery in order to obtain wider access to the cervico-thoracic spine with lower post-operative morbidity compared to the surgical procedure with sternotomy. This approach involves controlled dislocation of the sterno-clavicular joint to extend anterior access without requiring sternotomy.

Results: The approach allowed excellent exposure of the thoracic apex, enabling safe spinal stabilization procedures with minimal disruption to surrounding structures. No major neurovascular injuries occurred.

Conclusion: The FAMA approach represents a viable alternative to conventional cervico-thoracic surgical techniques, offering improved visualization and accessibility while preserving anatomical integrity. This technique has the potential to reduce morbidity and improve patient recovery. Larger-scale studies are required to validate these findings.

Background: Favourable long-term clinical and radiological outcomes with low revision and reoperation rates have been reported for unicondylar knee arthroplasty (UKA) in the treatment of end-stage unicompartmental knee osteoarthritis. However, no information on these data is available for the Turkish population. Our aim was to analyze the demographics, indications, outcomes, and revision rates of UKA in Türkiye using a nationwide database.

Methods: The electronic medical records of 8,590 patients undergoing UKA for unicompartmental osteoarthritis between 2016 and 2022 were retrospectively analyzed. Demographic data of the study population including sex, age, body mass index (BMI), and institution were assessed. The primary outcome measures were complication and revision rates.

Results: Of the 8,590 analyzed patients, 85.2% were women with an average age of 59 ± eight years. The primary indication was osteoarthritis in 7,205 (94.1%) cases. Most patients received cemented implants (78% vs. 22%) and the use of fixed insert designs increased from 18 to 74% between 2018 and 2022. The overall complication rate for the study population was 5.5% (475/8,590). The rate of complications did not differ according to fixation type. However, it was statistically significantly higher in patients who received mobile UKA than the fixed design (3.8% vs. 1.8% for mechanical complications and 1.7% vs. 0.6% for other complications, respectively; P < 0.001). The overall revision rate was 4.4% (234/5,377), with rates being similar for cemented and cementless designs (P = 0.832). However, the revision rate of mobile UKA was significantly higher than that of fixed designs (P < 0.001).

Conclusion: The majority of UKAs in Türkiye were cemented implants with an increased usage of fixed bearings over time. Mobile-bearing designs had significantly greater complication and revision rates compared to fixed-bearing implants.

Background: Morton's neuroma is a painful forefoot condition commonly treated with corticosteroid injections. Although ultrasound guidance improves injection accuracy, various single-operator approaches exist with differing reproducibility and technical challenges. This study describes and evaluates a novel " three-handed " ultrasound-guided technique involving coordinated manipulation by both a radiologist and an injecting physician, hypothesized to enhance the therapeutic response while maintaining a low complication rate.

Methods: We retrospectively reviewed the data of 56 evaluable patients (selected from a total of 110 treated patients) with symptomatic Morton's neuroma. The technique involved a radiologist applying dorsal compression to stabilize the neuroma while an orthopaedic surgeon performed a plantar, ultrasound-guided injection of 1 cc betamethasone. The primary outcome was patient-reported pain relief at ≥ one month follow-up, categorized as significant (> 50% relief), partial (30-50%), or minimal (< 30%).

Results: The cohort (n = 56; 75.0% female; mean age 54.3 ± 11.4 years) had a mean follow-up of 9.5 months. Significant improvement (> 50% pain reduction) was reported by 75.0% (42/56) of the patients. The overall clinical response rate (pain reduction > 30%) was 80.4% (of 45/56). The outcomes were not significantly different (p = 0.746) between the one-site (n = 33) and two-site (n = 23) injection groups. No major complications occurred, and 8.9% (5/56) of the patients reported transient pain.

Conclusions: Ultrasound-guided three-handed technique is a safe and feasible method for Morton's neuroma injection. This cooperative approach enhances neuroma stabilization and needle visualization, yielding high rates of preliminary clinical improvement. These retrospective findings are limited by selection bias and lack of control. Prospective randomized trials are warranted to validate its efficacy against standard single-operator techniques.

Purpose: To identify thresholds of acetabular chondral burden (number of Ilizaliturri zones involved) associated with failure to achieve minimal clinically important difference (MCID) following hip arthroscopy for femoroacetabular impingement, and to determine whether cartilage extent provides prognostic information independent of lesion severity (Outerbridge grade).

Methods: We analyzed 168 consecutive patients who underwent hip arthroscopy with two year follow-up. Acetabular cartilage was assessed intraoperatively for extent (Ilizaliturri 6-zone classification) and severity (Outerbridge grading). Patients were categorized by chondral burden: 0 zones (N = 70), 1-2 zones (N = 62), or ≥ 3 zones (N = 36). Primary outcome was MCID achievement (≥ 9-point improvement) in Hip Outcome Score-Activities of Daily Living. Multivariable regression adjusted for age, sex, BMI, baseline function, and Outerbridge grade (Table 3).

Results: MCID achievement differed significantly by chondral burden: 70% (0 zones), 79% (1-2 zones), and 50% (≥ 3 zones) (p = 0.011), representing a 29 percentage-point difference between groups. In multivariable analysis adjusting for Outerbridge grade and other confounders, the ≥ 3 zone group showed a trend toward reduced odds of achieving MCID (OR = 0.43, 95% CI: 0.18-1.02, p = 0.056). Extent and severity showed low correlation (ρ = 0.20), suggesting they represent distinct aspects of cartilage pathology.

Conclusion: Acetabular chondral involvement of ≥ 3 Ilizaliturri zones was associated with a lower probability of achieving clinically meaningful improvement after hip arthroscopy. Cartilage extent may provide prognostic information beyond lesion severity and should be considered during preoperative counseling and surgical decision-making.

Aims: This study evaluated the accuracy of resection of bone tumours and the fit between host bone and massive bone allograft (MBA) in children with malignant bone tumours of lower limb who underwent surgery using in-house 3-dimensional (3D)-printed patient-specific instruments (PSIs) for tumour resection and graft-specific instruments (GSIs) for shaping the MBA.

Methods: This retrospective study included seven children (3 males, 4 females; median age 13) with malignant bone tumours of the lower limb who underwent intercalary resection and reconstruction with MBA between September 2023 and March 2025 using in-house designed 3D-printed PSIs and GSIs. Tumours were located in the femur (5 children) and tibia (2 children). We analysed the accuracy of bone resection, complications of reconstruction, and function of patients.

Results: All resections achieved R0 margins. The median planned resection length was 16.5 cm versus 16.8 cm actually resected (median difference 0.2 cm). Bone union was achieved in 13 of 14 (92.9%) osteotomy sites. Bone union was faster at metaphyseal junctions (median 5.9 months) than diaphyseal junctions (median 8.4 months) (p = 0.01). One of the osteotomy sites (7.1%) had a delayed union requiring secondary bone grafting. The median Musculoskeletal Tumour Society score was 30 at the last follow-up.

Conclusion: 3D-printed PSIs and GSIs appear to enhance the accuracy of bone tumour resection and host bone-MBA fit, thereby reducing the risks of inadequate margins and non-union, respectively.

Purpose: To systematically review the efficacy, safety, and outcomes of limb lengthening procedures in patients with achondroplasia, including effects on quality of life.

Methods: Following PRISMA guidelines, a systematic review and meta-analysis was performed. Eligible studies included patients with achondroplasia who underwent limb lengthening of the upper and/or lower extremities. Data were extracted on length gain, external fixator index, fixation duration, complications, and quality of life. Pooled means and 95% confidence intervals (CIs) were calculated using single-arm meta-analysis.

Results: Fourteen studies including 1149 patients were analyzed. The mean femoral gain was 8.85 cm (95% CI: 7.42-10.28), tibial gain 7.36 cm (95% CI: 6.21-8.52), and humeral gain 8.38 cm (95% CI: 7.01-9.74). The mean fixator index was 37.1 days/cm (95% CI: 32.37-41.82), with a mean fixation duration of 7.71 months (95% CI: 5.98-9.63). The overall complication rate was 56.1% (95% CI: 26.9-85.2). Importantly, the pooled quality of life score measured by the Paediatric Quality of Life Inventory was 75.69 (95% CI: 65.14-86.23), indicating moderate improvement despite high treatment burden.

Conclusion: Limb lengthening in achondroplasia achieves significant stature and proportional gains but requires prolonged treatment and carries a high complication risk. Nevertheless, improvements in functional ability and quality of life are evident, particularly when multi-limb lengthening is performed. Future studies should standardize outcome reporting, assess long-term QoL trajectories, and evaluate newer technologies such as intramedullary nails combined with multidisciplinary support.