International Orthopaedics最新文献

Introduction: Osteonecrosis of the femoral head (ONFH) is a progressive condition that often requires surgical intervention. Although treatment strategies have traditionally emphasized joint-preserving procedures in younger patients, advances in implant technology and perioperative management may have altered contemporary surgical decision-making. However, large-scale evidence describing temporal changes in surgical treatment patterns for ONFH is limited.

Materials and methods: Using the Japanese Diagnosis Procedure Combination (DPC) database, we conducted a nationwide retrospective cohort study of patients who underwent surgical treatment for ONFH between December 2012 and March 2023. Surgical procedures were categorized as total hip arthroplasty (THA), bipolar hemiarthroplasty (BHA), proximal femoral osteotomy, pelvic osteotomy, or hip arthroscopy. Temporal trends in procedure selection were evaluated overall and by age group. Postoperative complications, including infection, deep vein thrombosis (DVT), pulmonary embolism, periprosthetic fracture, and in-hospital mortality, were compared between THA and BHA using univariate and multivariable logistic regression analyses.

Results: A total of 36,109 patients were included. THA was the most frequently performed procedure throughout the study period, with its proportion increasing from 72.6% in 2012 to 90.6% in 2022, while the use of BHA and joint-preserving osteotomy steadily declined. Among patients aged ≤ 20 years, proximal femoral osteotomy predominated until 2020; thereafter, arthroplasty procedures accounted for more than half of all surgeries in this age group. Similar shifts toward THA were observed in patients aged 21-40 years. In adjusted analyses, BHA was associated with a higher risk of postoperative infection and DVT, whereas THA was associated with a higher risk of periprosthetic fracture and in-hospital mortality. No significant differences were observed in dislocation or pulmonary embolism rates.

Conclusions: Nationwide data demonstrate a substantial shift in surgical management of ONFH in Japan, with increasing use of THA and declining reliance on joint-preserving procedures, even among younger patients. While arthroplasty has become the dominant treatment modality, careful consideration of long-term outcomes, complication profiles, and patient age remains essential. Integration of large-scale administrative data with detailed clinical and imaging information may further refine optimal treatment strategies for ONFH.

Purpose: To investigate the effect of surgical timing and surgical technique on reoperation rates and early clinical outcomes in acute native knee septic arthritis.

Methods: This retrospective cohort study included adult patients who underwent surgical treatment for acute native knee septic arthritis between 2018 and 2025. Patients were treated with either arthroscopic or open debridement according to the treating surgeon's assessment. Time from symptom onset to surgery was recorded in hours, and an a priori defined 48-h threshold was used to classify early versus delayed lavage. All cases received standardized joint irrigation with nine L of normal saline. The primary outcome was the need for reoperation due to persistent or recurrent infection. Secondary outcomes included knee range of motion at discharge and length of hospital stay. Culture-positive cases were analyzed separately. Multivariable logistic regression analysis was performed to identify independent predictors of reoperation.

Results: A total of 129 patients were included (mean age 58.3 ± 12.3 years; 62.8% male). Baseline demographic and comorbidity characteristics were similar between surgical technique groups; however, early lavage was more frequent in the arthroscopy group (p < 0.001). In early lavage cases, reoperation rates did not differ between arthroscopy and arthrotomy (p = 0.432). In delayed lavage cases, arthroscopy was associated with a significantly higher reoperation rate compared to arthrotomy (p < 0.001). Arthroscopy resulted in greater postoperative range of motion across all subgroups (p < 0.001). Length of hospital stay was shorter with arthroscopy in early lavage but longer in delayed lavage. Early lavage was independently associated with a reduced risk of reoperation (OR 0.02; 95% CI 0.00-0.10; p < 0.001).

Conclusion: In acute native knee septic arthritis, our findings suggest that surgical timing may influence the relative outcomes of arthroscopic and open treatment. Early arthroscopic lavage may provide functional advantages without increasing the risk of reoperation, whereas delayed arthroscopy may be associated with higher reoperation rates. Prospective studies are warranted to confirm these observations.

Purpose: Robotic assistance has recently been introduced for reverse shoulder arthroplasty (RSA) with the goal of improving the accuracy and consistency of implant positioning, but the additional workflow steps required for its use may prolong operative time. Whether operative time returns to a conventional benchmark after an initial learning period remains uncertain. This study sought to characterize the operative time learning curve for robotic-assisted RSA using the Mako robotic system (Stryker, Kalamazoo, MI).

Methods: We conducted a retrospective observational study of 30 consecutive elective robotic-assisted primary RSA cases performed by a single shoulder fellowship-trained surgeon using the Mako robotic system at an academic ambulatory surgery centre between October 2025 and February 2026. The operative time benchmark was defined a priori as all consecutive conventional primary RSA cases performed at the same surgery centre from its opening in July 2025 through October 2025 (n = 16). Operative time was defined as incision start to incision closure. Learning curve behaviour among robotic cases was assessed using linear regression of operative time on sequential robotic case number. Robotic cases were also grouped into three prespecified 10-case blocks (1-10, 11-20, 21-30).

Results: Mean operative time for conventional RSA was 74.9 min (95% CI, 67.3-82.5; range, 55-105). Across robotic-assisted cases, mean operative time was 88.6 min (95% CI, 79.8-97.4; range, 55-170). Operative time decreased with increasing robotic experience (- 1.85 min per case; p = 0.00010; R² = 0.42), and the fitted regression reached the conventional benchmark mean at approximately robotic case 23. Mean operative time declined across prespecified adoption phases from 105.5 min (cases 1-10; 95% CI, 89.3-121.7), to 92.6 min (cases 11-20; 95% CI, 79.4-105.8), and to 67.8 min (cases 21-30; 95% CI, 62.6-73.0; p = 0.0034). The final 10 robotic cases had a shorter mean operative time than the conventional benchmark (67.8 vs 74.9 min) but this difference was not statistically significant (p = 0.37).

Conclusion: In a single-surgeon ambulatory surgery centre series, robotic-assisted RSA showed a clear learning curve and achieved operative time neutrality relative to conventional RSA after approximately two dozen cases. These findings support the feasibility of integrating robotic workflows into RSA without a persistent operative time penalty after early adoption, and provide practical expectations for surgeons and institutions planning implementation.

Background: In an era of healthcare cost containment, this study introduces a novel closed reduction technique using the Ilizarov circular external fixator for comminuted tibial fractures (AO/OTA 42C2-3), minimizing operative interventions and costs compared to internal fixation.

Methods: We conducted a retrospective analysis of 20 consecutive patients with high-energy tibial fractures managed with a single Ilizarov frame. Postoperative deformities (angulation, translation, rotation) were corrected painlessly in outpatient settings without anaesthesia.

Results: Eighteen patients (90%) achieved union with one frame application; median time to union (injury to frame removal) was 150 days. Two patients had delayed union resolving conservatively. All injuries resulted from road traffic collisions (42C2/42C3). No amputations or compartment syndromes occurred. Pin-tract infections in two patients (10%) required wire exchange. No malunions necessitated reoperation, though two patients (10%) suffered refractures requiring repeat Ilizarov treatment. Per modified ASAMI scores, most achieved excellent/good functional outcomes.

Conclusion: This technique delivers reliable union with outpatient, anaesthesia-free deformity correction, avoiding internal fixation's risks (deep infection, compartment syndrome, malrotation) while optimizing cost-effectiveness. Multicenter validation is warranted.