International Orthopaedics最新文献

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).

Introduction: In recent years, the interest in hip shelf arthroplasty (HSA) has been increasing and the number of studies documenting long-term results with minimal complications has been growing. The aim of this study is to present long-term results of HSA and analyze the factors that influence them.

Material and methods: The group of 24 patients (38 hips) with a mean age of 30 years (range, 16 to 52 years), with acetabular dysplasia, was treated by HSA (Bosworth technique). The mean follow-up time for all hips was 26 years (range, 22 to 35 years). The endpoint of the follow-up was total hip arthroplasty.

Results: In all 38 hips, the positive effect of HSA lasted for at least 20 years. In 28 hips followed up on average for 24.5 years (range, 22 to 35 years), the positive effect still persisted at the latest follow-up. Three patients (3 hips), followed up for 26, 26 and 31 years, respectively, deteriorated in the last three years, but they rated their condition as good at the latest follow-up and did not require THA. Seven hips had to be converted to THA. The mean age of these patients at the time of HSA was 29 years (range, 16 to 41 years). The average interval between HSA and THA was 25 years (range, 22 to 31 years). In 3 converted hips, the subluxation was identified as a risk factor. No serious complication (infection, neurovascular injury) was recorded. Kaplan-Meier survival curve at 20-year follow-up was 100% in the study cohort and 70.1% in the worst-case scenario and at 30-year follow-up it was 79.6% in the study cohort and 70.1% in the worst-case scenario.

Conclusion: Properly indicated and technically accurately performed HSA can provide very good long-term results. The best results can be expected in dysplastic spherical centered hips with minimal or no osteoarthritic changes (OAC).

Purpose: The purpose of this study was to compare subjective and objective outcomes of conservative and operative treatment of complete distal biceps tendon ruptures in young and physically active patients.

Methods: Eleven patients were treated conservatively. Subjective and objective results were compared with those of a matched group of 11 surgically treated patients. At final follow-up, duration of work incapacity, complications, patient satisfaction, range of motion, flexion strength, supination torque, MEPS and DASH score were assessed.

Results: All conservatively treated patients were satisfied and able to fully return to work and sports activities. Two patients in the surgical group experienced complications requiring revision surgery. The mean duration of work incapacity was four days in the conservative group compared with 120 days in the surgical group. No differences were observed between groups with respect to range of motion, DASH score or MEPS. Compared with the contralateral side, mean loss of flexion strength was 12% in the conservative group and 10% in the surgical group. The mean side-to-side loss of supination torque was 13% in conservatively treated patients and 4% in surgically treated patients.

Conclusion: Conservative treatment of acute distal biceps tendon ruptures allows a rapid return to occupational and recreational activities and results in good clinical outcomes and high patient satisfaction, even among young and physically active patients. Losses in flexion and supination strength are modest and not functionally relevant in daily life. Conservative treatment is also cost effective and should therefore be explained and made available to all patients who have sustained a complete rupture of the distal biceps tendon.

Purpose: Patellofemoral osteoarthritis (PFOA) substantially impairs quality of life, and isolated patellofemoral arthroplasty (PFA) is a surgical option for therapy-refractory symptoms. This study evaluated the clinical and functional outcomes and survivorship of an onlay PFA implant, hypothesizing favourable results in the mid- to long-term follow-up.

Methods: Between 2009 and 2023, 128 knees (123 patients) with PFOA underwent onlay PFA (Journey™ PFJ, Smith & Nephew) and were retrospectively analyzed. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Short Form-12 (SF-12) and the numerical analog scale (NAS) for pain and function were assessed preoperatively and at the final follow-up. Postoperative complications and revisions were recorded.

Results: Follow-up data were available for 91 knees (88 patients; mean age 60.7 ± 10.3 years) over 6.1 ± 3.4 years. Significant improvements in the WOMAC total score (57.3% to 22.5%; p < 0.001), SF-12 physical (29.6 to 43.5; p < 0.001) and mental scores (46.8 to 52.7; p < 0.001), and NAS function (4.7 to 7.2; p < 0.001) and pain (7.8 to 3.1; p < 0.001) were observed. Patients who did not achieve the minimal clinically important difference (MCID) had higher preoperative WOMAC scores (61.3% vs. 46.0%; p = 0.018). The SF-12 mental component summary (MCS) scores was correlated with the pre- and postoperative WOMAC scores (r² = 0.21-0.32; p ≤ 0.002). Kaplan-Meier analysis revealed PFA survivorship rates of 89%, 75%, and 67% at five, ten and 15 years, respectively.

Conclusion: Onlay PFA provides significant and sustained improvements in pain, function, and quality of life in patients with PFOA, with satisfactory mid- to long-term implant survivorship. A high preoperative WOMAC score and poor mental health, as indicated by the SF-12 MCS, may be associated with less favourable postoperative outcomes.

Background: Giant cell tumour of the distal radius (GCTDR) is a locally aggressive benign tumour that often results in local recurrence and functional impairment. While curettage preserves joint function, it has high recurrence rates, particularly for grade III lesions. Wide resection reduces recurrence but compromises wrist function. This study evaluates the outcomes of non-vascularized fibular head-shaft autografting combined with distal radioulnar ligament (DRUL) reconstruction for GCTDR management.

Methods: A retrospective study was conducted from 2010 to 2020, involving 50 patients with histologically confirmed GCTDR (Campanacci grade III). Surgical treatment included wide tumour excision, non-vascularized ipsilateral fibular head-shaft autograft reconstruction, and DRUL reconstruction using the palmaris longus tendon.

Results: The recurrence rate was 4%, with no malignant transformation or metastasis. The average time to graft union was 7.2 ± 1.2 months, and functional outcomes were favourable, with an MSTS score of 26.2 ± 3.7 and a DASH score of 9.7 ± 13.1. No DRUJ instability was observed, and graft fractures occurred in 14% of patients, all of which healed.

Conclusion: Non-vascularized fibular head-shaft autografting, combined with DRUL reconstruction, is an effective approach for GCTDR, reducing recurrence, preserving wrist function, and maintaining long-term stability.

Background: Modular dual mobility (MDM) cups are widely used in primary total hip arthroplasty (THA) to reduce dislocation, but their impact on range of motion (ROM) to impingement versus single-mobility (SM) cups remains uncertain.

Methods: In this paired robotic-simulation study, 108 primary robotic-assisted THAs were virtually planned twice with CT-based software, once with an SM cup and once with an MDM cup. Cup and stem orientation were optimised to restore intra-articular length and global offset within 5 mm of the contralateral hip and to avoid impingement. ROM to first impingement was measured in extension/external rotation (ER), flexion/internal rotation (IR) with physiological pelvic tilt, and flexion/IR with 20° adduction. The mode of first impingement (intra-articular, extra-articular, or mixed) was recorded.

Results: Compared with SM, MDM cups increased ROM to impingement in extension and ER but slightly reduced ROM in flexion and IR at several test positions. Maximal extension to impingement and ER in extension were higher with MDM, whereas flexion with pelvic anteversion and IR at 100° flexion were lower. ROM to impingement was not uniformly greater with MDM, and first contact often shifted from intra-articular implant-on-implant impingement toward extra-articular impingement.

Conclusion: In robotic THA, MDM cups provide selective gains in ROM to impingement and shift the impingement towards extra-articular structures rather than providing a global increase in safe ROM. Clinically, MDM may suit patients needing extension/ER reserve or with anterior instability risk, and planning should consider osteophytes and bony constraints. Further prospective clinical validation is warranted.

Introduction: Nonoperative treatment is the preferred initial intervention for plantar fasciitis. However, some patients fail to respond and present with continued pain. This study investigated the effectiveness of concentrated bone marrow aspirate concentrate (BMAC) injections in the treatment of recalcitrant plantar fasciitis.

Methods: Retrospective chart review was performed to identify patients diagnosed with chronic plantar fasciitis that underwent treatment with BMAC injection. Bone marrow aspirate was harvested from the iliac crest, concentrated, and injected into the site of maximal tenderness in the plantar fascia. Visual analogue scale (VAS) pain scores were collected before and after the BMAC injection at six, ten, 24, and 48 weeks. Postoperative complications were recorded.

Results: A total of 19 patients (19 feet) with chronic plantar fasciitis were treated with BMAC injection. Average age was 52.6 (SD, ± 7.5) years with an average BMI of 26.4 (SD, ± 4.6) kg/m². The average duration of pain prior to the BMAC injection was 2.5 (SD, ± 1.3) years. Preoperatively, average VAS was 7.5 (SD, ± 2.3), with significant improvement at six weeks (mean, 2.3; SD, ± 1.2), ten weeks (mean, 2.2; SD, ± 1.2), 24 weeks (mean 1.7; SD, ± 1.1), and at 48 weeks (mean, 1.1; SD, ± 0.7) postoperatively (all p < 0.05). No complications were observed at the surgical or donor site.

Conclusion: Patients with recalcitrant plantar fasciitis treated with BMAC injection demonstrated and maintained a statistically significant decrease in VAS pain score upon assessment at each postoperative follow-up up to 48 weeks, with no adverse effects at the donor or injection site. These findings suggest that BMAC injection may be a safe treatment option offering early pain relief.

Purpose: Hip arthroscopy is widely used for treating femoroacetabular impingement (FAI), yet long-term data evaluating PASS, MCID thresholds, functional recovery, and revision rates remain limited. This study aimed to assess minimum five year outcomes following hip arthroscopy for FAI and to identify predictors of postoperative success.

Methods: In this retrospective cohort study, 133 patients with a minimum of five years of follow-up were evaluated. Preoperative and postoperative outcomes included mHHS and VAS scores. Postoperative PROMs included iHOT-12, HOS-ADL, and HOS-Sport. PASS, MCID achievement, return to sport (RTS), return to work (RTW), revision arthroscopy, and conversion to total hip arthroplasty (THA) were recorded. MCID for ΔmHHS was determined using ROC analysis with PASS as the external anchor. Logistic regression identified predictors of PASS.

Results: The mean mHHS improved from 62.0 ± 12.9 preoperatively to 83.6 ± 12.8 at final follow-up (p < 0.001). VAS scores improved from 7.7 ± 1.9 to 3.1 ± 2.3 (p < 0.001). PASS was achieved by 72.2% of patients, and 83.1% met the MCID threshold of a 10-point increase in mHHS. Return-to-sport and return-to-work rates were 96.2% and 96.9%, respectively.

Conclusion: Hip arthroscopy for FAI provides durable clinical improvement at long-term follow-up, with high PASS and MCID achievement rates. RTS and RTW rates were excellent, and revision and THA conversion rates were comparable with contemporary long-term reports. Preoperative pain severity was the only independent predictor of PASS.

Purpose: The cumulative probability of a first-time dislocation (CPD) after total hip arthroplasties (THAs) with a 22-mm head was reported in 2004 to rise steadily to 7% at 25 years. Later reports employing larger heads indicated that dislocations were concentrated in shorter periods after THA. Therefore, dislocations may occur differently over time depending on head sizes, which has not been clearly demonstrated. The purpose was to examine this hypothesis.

Methods: With first-time dislocation as the endpoint, the Cox proportional-hazards regression model and the Kaplan-Meier analyses were applied to 6,339 THAs performed for nontraumatic osteonecrosis of the femoral head, considering all possible influencing variables. Follow-up was 6.5 years on average (range, 0 to 27).

Results: First-time dislocations occurred in 289 THAs (4.6%) at a mean of 2.9 years (range, 0 to 19) following THA, with head sizes of 22, 26, 28, 32, and ≧ 36 mm in 33, 76, 86, 58, and 36 THAs, respectively (dislocation rate: 13.5, 8.2, 5.7, 2.5, and 2.7%, respectively; p < 0.001 in χ2 test). CPD increased linearly after THA in the 22-mm group, while larger-head groups showed a steep early rise followed by a decline.

Conclusion: First-time dislocations occurred differently over time with different head sizes.