International Orthopaedics最新文献

Purpose: Good initial fixation of glenoid component for reverse total shoulder arthroplasty (RTSA) relies on component placement and screw purchase in the scapula bone. This is especially difficult in an Asian population with small glenoid geometry. Optimal glenoid component roll angle and screw angulation to achieve the longest screws for best fixation has not been defined in the current literature.

Methods: Computer 3D modelling of 133 scapulas with RTSA performed were analyzed to determine patient specific optimal glenoid roll angle (GRA) for the longest bi-cortical screws attainable. The cranial-caudal angle (CCA), anterior-posterior angle (APA) and lengths for the superior and inferior screws were measured. Validation testing using calculated average (CA) angles and rounded average (RA) angles to the nearest 5 degree were recomputed for each case to determine the bi-cortical screw lengths achievable. The CA and RA screw lengths were compared against patient specific modelling using paired-sample t-tests.

Results: Average GRA was - 1.6°, almost perpendicular to the long axis of the glenoid and achieves an average bi-cortical screw length of 51.3 mm and 45.5 mm for the superior and inferior screws respectively. The CCA and APA were 9.1° cranial and 6.5° posterior for the superior screw and screw angulation of 11.2° caudal and 0.7° anterior for the inferior screw. Validation testing shows statistically shorter screw lengths in the CA and RA models compared to patient specific modelling (p < 0.01).

Conclusion: Validation testing with average angles for GRA, CCA and APA demonstrates strong patient heterogeneity and anatomical variation. Despite this, screw lengths attainable in the RA group were > 38 mm with good safety profile. Surgeons may consider the additional use of navigation-assisted, or 3D printed patient specific instrumentation to optimize baseplate and screw configuration for RTSA.

Purpose: While bone grafting and augmented components can help restore reverse shoulder arthroplasty (RSA) baseplate version close to neutral, the indication for version correction in RSA is unclear. The purpose of this study was to compare the clinical outcomes of RSA baseplates in high degrees of retroversion and anteversion to components in more neutral version.

Methods: Patients who underwent RSA with minimum two year follow-up were identified from an institutional registry. An RSA system with a glenosphere that is two-thirds of a sphere was utilized. Post-operative radiographs were used to determine baseplate version, and patients were grouped into four categories: ≥ 10 degrees (moderate to severe anteversion; n = 14), 10 to -10 degrees (neutral; n = 69), -10 to -20 (moderate retroversion; n = 25), and ≤ -20 degrees (severe retroversion; n = 7). The outcomes of interest were ability to perform functions requiring internal rotation, external rotation and cross-body adduction, as well as complications and revisions.

Results: There were no differences in final Simple Shoulder Test (SST), final American Shoulder and Elbow Surgeons score (ASES) or change in SST from pre- to post-operative across the four version groups. There was no linear correlation between baseplate version and final SST. There were no statistically significant differences in difficulty performing tasks related to internal rotation, external rotation, and cross-body adduction among the four baseplate version groups; however, patients with moderate to severe anteversion had a greater frequency of difficulty putting on a coat (86%) compared to patients with neutral version (42%), moderate retroversion (45%) and severe retroversion (0%) (p = 0.021). There were no differences in rates of complications and revisions across the four groups.

Conclusion: This study did not find evidence that high values of baseplate retroversion or anteversion were associated with inferior patient reported outcomes or functional rotation after reverse total shoulder arthroplasty.

Level of evidence: Level 3, retrospective comparative study.

Purpose: To compare the efficacy of an internal brace and the arthroscopic Broström-Gould procedure for chronic lateral ankle instability (CLAI).

Methods: The clinical data of 71 patients who were diagnosed with chronic lateral ankle instability between May 2020 and May 2022 were retrospectively analyzed. The American Orthopedic Foot and Ankle Society (AOFAS) scale, Foot and Ankle Ability Measure (FAAM), and Visual Analogue Scale (VAS) were used to assess clinical outcomes.

Results: A total of 59 patients were followed up for a mean of 21 months (range, 16-24 months). Thirty-seven patients underwent the modified Broström-Gould (IB) procedure, and twenty-two patients underwent the arthroscopic Broström-Gould (ABG) procedure. The mean postoperative VAS score (P = 0.790), AOFAS score (P = 0.252), FAAM daily activity score (P = 0.983), and FAAM for sports activity score (P = 0.379) were not significantly different between the ABG and IB groups at the final follow-up. However, the FAAM sports score was better in the internal brace group than in the arthroscopy group at the 1-year postoperative follow-up (P = 0.025).

Conclusion: Patients treated with an internal brace recovered faster than those who underwent the arthroscopic ABG procedure. However, no other significant differences were observed between the two methods.

Level of evidence: Level IV, retrospective case series.

Purpose: The aim of this study was to observe the effects of changing humeral tray thickness on the resultant of intraoperative glenohumeral joint loads using a load-sensing system (LSS).

Methods: An rTSA was performed on fresh frozen full-body cadaver shoulders by using an internal proprietary LSS on the humeral side. The glenohumeral loads (Newtons) and the direction of the resultant force applied on the implant were recorded during four standard positions (External rotation, Extension, Abduction, Flexion) and three "complex" positions of Activity Daily Life ("behind back", "overhead reach" and "across chest"). For each position, the thickness was increased from 0 to 6 mm in a continuous fashion using the adjustment feature of the humeral system. Each manoeuvre was repeated three times.

Results: All shoulder positions showed a high repeatability of the glenohumeral load magnitude measured with an intra-class correlation coefficient of over 0.9. For each position, we observed a strong but no linear correlation between humeral tray thickness and joint loads. It was a cubical correlation (r_s = 0,91) with a short ascending phase, then a plateau phase, and finally a phase with an exponential growth of the loads on the humeral implant. In addition, an increase in trail-poly thickness led to a recentering of force application at the interface of the two glenohumeral implants.

Conclusion: This study provides further insight into the effects of humeral implant thickness on rTSA glenohumeral joint loads during different positions of the arm. Data obtained using this type of device could guide surgeons in finding the proper implant balance during rTSA.

Purpose: Hip arthroscopy is effective in treating bordline developmental dysplasia of the hip (BDDH), but there are only a few clinical reports in China, and its postoperative failure rate is still a problem that cannot be ignored. The aim of this study was to analyze the clinical effect of hip arthroscopy in BDDH treatment in China and to explore the risk factors influencing the efficacy of hip arthroscopy in BDDH treatment.

Methods: All of 22 cases of BDDH treated with arthroscopy in our hospital from November March 2017 to February 2022 were analyzed retrospectively, including ten males and 12 females, with an average age of 34.7 ± 9.5 years (19-53 years). All patients underwent arthroscopic treatment with acetabular plasty, labral repair, femoral osteoplasty, and capsular plication. Visual Analogue Scale (VAS), modified Harris Hip Scores (mHHS), Hip Outcome Score-activities of Daily Living (HOS-ADL) and International Hip Outcome Tool-12 (iHOT-12) were measured before operation and at the follow-up, and statistical analysis was performed. The Minimum clinically significant difference (MCID) and Patient Acceptable Symptom State (PASS) were also obtained.

Results: 22 patients were followed up, and the follow-up time was ≥ one year, with an average of 21.4 ± 8.2 months. The VAS score decreased from 5.27 ± 1.58 points before surgery to 1.96 ± 0.92 points at the follow-up, and the difference was statistically significant (t = 9.05,P < 0.001). The mHHS score increased from 64.84 ± 13.58 points before surgery to 90.4 ± 10.11 points at the follow-up, and the difference was statistically significant (t=-7.07, P < 0.001). The HOS-ADL score increased from 68.92 ± 11.76 points before surgery to 88.91 ± 9.51 points at the follow-up, and the difference was statistically significant (t=-8.15,P < 0.001). The iHOT-12 score increased from 49.32 ± 12.01 points before surgery to 79.61 ± 15.89 points at the follow-up, and the difference was statistically significant (t=-7.66,P < 0.001). The MCID (mHHS) and MCID (HOS-ADL) were 81.8% and 77.3% respectively, and the PASS (mHHS) and PASS (HOS-ADL) were 86.4% and 72.7% respectively at the follow-up.

Conclusion: Hip arthroscopy can achieve good short-term outcomes in the treatment of BDDH.

Level of evidence: IV Therapeutic Study.

Purpose: A retrospectively analyze of instability after RSA in terms of aetiology, treatment and final functional outcome.

Methods: A bicentric retrospective study of 31 patients (mean age 67.6 years; 42-83) treated for RSA instability using RSA Arrow System (FH Orthopedics, Mulhouse, France), mean follow-up 41months (range 12-158). Aetiologies for dislocation were evaluated using a previously described classification system for RSA instability. Actions performed during the Revision Surgeries were analyzed and grouped into five categories. Clinical outcome measures included range of motion, SSV, VAS, Constant-Murley scores, satisfaction level and recurrence of instability.

Results: The most frequent aetiology for RSA instability was loss of compression (18), followed by impingement (8) and loss containment (5). Total RSA revision (bipolar procedure) involving both distalization and lateralization occurred in 13 instances. Isolated distalization through the humerus was performed in ten patients and Isolated lateralization through the glenoid in three patients. Three cases of components exchange due to mechanical failure were noted. Bone graft was used in nine instances. Three patients (10%) suffered recurrent instability following Revision Surgery and required an additional stabilizing procedure. At final follow-up all 31 RSA were reported as stable with a mean VAS of 1.1, SSV 54.5%, constant score 48.3, constant ponderate 74.9%.

Conclusion: The management of unstable RSA represent a challenge that can be successfully overcome with a revision surgery with compromised functional results. Loss of compression was the most common cause for primary and recurrent RSA instability that were treated principally with bipolar revisions involving component lateralization and distalization.

Purpose: Flexible flatfoot (FF) can interrupt children's activity through uneven pressure distribution to the medial column of the foot and may require surgery. Medialising calcaneal osteotomy (MCO) helps restore the foot‒tripod complex. The objective was to compare pedobarography and ankle‒foot kinematics in children with symptomatic FF after MCO to those in controls.

Methods: Gait analysis was performed on 21 children with FF (37 feet, age 13.7 ± 4.9 years) 4.5 ± 3.4 years after MCO and on 21 controls (42 feet, age 12.1 ± 1.1 years). Ankle‒foot kinematics and pedobarography parameters (maximum pressure, impulse, contact area, and percentage of contact time in the stance phase) of ten anatomic foot regions from an average of five gait trials were compared. The functional outcome was determined by the AOFAS-AHFS score in the FF group.

Results: The average AOFAS-AHFS score was 96. The FF group had a larger contact area and expressed more force on the medial column of the foot. The maximum pressure, impulse, contact area, and percentage of contact time in the stance phase in the midfoot region for the FF and control groups were 0.66 ± 0.5 vs. 0.24 ± 0.4 N/cm² (p = 0.005), 0.12 ± 0.1 vs. 0.03 ± 0.1 Ns/cm² (p = 0.02), 47.1 ± 13.4 vs. 30.1 ± 7.1 cm² (p < 0.001), and 53.7 ± 17.4 vs. 68.2 ± 15.7% (p = 0.007), respectively. The kinematics of the FF exhibited a greater range of abduction and eversion during the mid- and terminal-stance phases of the gait cycle.

Conclusions: The MCO procedure did not normalise the pressure on the midfoot in FF to the level of that in the controls, and the deformity persisted in the forefoot.

Purpose: Upper cervical fracture combined with non-contiguous lower cervical fracture are not uncommon but complicated. In order to outline a management principle for the upper cervical fracture combined with non-contiguous lower cervical fracture and assess its clinical characteristics, we retrospectively analyzed 59 cases of patients who underwent surgical treatment for upper cervical fracture combined with non-contiguous lower cervical fracture.

Methods: 59 patients of upper cervical fracture combined with non-contiguous lower cervical fracture were treated by surgery in our hospital. According to the AO Spine classification for cervical fractures, there were 21 cases of type B atlas fractures, nine cases of type C atlas fractures; 15 cases of type B axis fractures, 14 cases of type C axis fractures; 19 cases of type B lower cervical fractures, 40 cases of type C lower cervical fractures. The operation time, intraoperative blood loss, complications, VAS scores, JOA scores, ASIA grades, and radiological evaluation of cervical lordosis and stability were collected and recorded.

Results: Our results showed the segments of upper cervical fracture combined with non-contiguous lower cervical fracture are mainly concentrated in the atlas-axis and C6, C7 levels. There were 43 cases (72.88%) of associated injuries, mainly involving head trauma and thoracic injuries. Four patients underwent anterior approach surgery only, 43 patients underwent posterior approach surgery only, and 12 patients underwent combined anterior and posterior approach surgery in one stage. All patients had regular follow up with an average duration of 67.83 ± 11.25 months (range, 39 to 103 months). The VAS scores and JOA scores at 12 months postoperatively and at final follow-up showed significant improvement compared to preoperative scores (P < 0.05). At the final follow-up, ASIA grades had improved by 0 to 2 levels. The cervical lordosis at the final follow-up (24.71°±7.39°) showed no statistically significant difference compared to preoperative measurements (26.89°±13.32°). Surgical complications occurred in 17 patients. No cases of vertebral artery injury, screw loosening, or other internal fixation failures were found at final follow-up.

Conclusions: Upper cervical fracture combined with non-contiguous lower cervical fracture can result in varying extents of cervical spinal cord injury and combined trauma in other parts. Surgical treatment of these injuries can achieve favourable clinical and radiological outcomes in the medium to long term follow-up. More research is still needed to optimize clinical decision-making regarding surgical approach.