International Orthopaedics最新文献

Purpose: Scaphocapitate fusion (SCF) is an important surgical option for carpal pathologies, which are difficult to manage as Kienböck's disease. With the advantages of arthroscopy combined with percutaneous fixation techniques, arthroscopic scaphocapitate fusion can have the best outcome for the patient from a functional perspective. This study aims to evaluate the clinical, radiological, and functional results of arthroscopic SCF.

Methods: The study included thirty patients with stage IIIB and IIIC Kienböck's disease. The articular surfaces were prepared using arthroscopic burr then fixed by Herbert screw. The mean follows up period was about 29 months.

Results: SCF was achieved in approximately seven weeks. There was a statistically significant difference in pre- and post-operative grip strength and Mayo wrist score.

Conclusion: According to our study findings, arthroscopic SCF may be performed with significant improvements and satisfactory clinical and functional results in patients with stage IIIB and IIIC Kienböck's disease.

Purpose: The primary aim of this retrospective study is to compare the short and medium-term outcomes for shoulder hydrodilatation for treatment of shoulder AC between diabetic and non-diabetic patients, to evaluate if there were better outcomes amongst non-diabetic patients.

Methods: Patients with clinical or radiological diagnosis of AC and who underwent fluoroscopic guided shoulder hydrodilatation in our local institution from January 2021 to June 2022 were included in this study. Clinical outcomes were measured with visual analog scale (VAS) for pain and passive range of motion consisting of forward flexion (FF) and external rotation (ER) at pre-hydrodilatation, one month and six months post hydrodilatation.

Results: A total of 163 shoulders were included, corresponding to 156 patients consisting of 47 diabetics, 109 non-diabetics and seven bilateral shoulders (3 diabetics and 4 non-diabetics). At the time of presentation, there was no significant difference in VAS, FF or ER between diabetics and non-diabetics. From pre-hydrodilatation to 1-month post-hydrodilatation and one month to six months post-hydrodilatation, there was significant improvement in VAS, FF and ER for both groups. Comparing diabetics vs. non-diabetics, the non-diabetic group had significantly better FF (p < 0.01) at one month post hydrodilatation. At 6 months post-hydrodilatation, non-diabetic group also had significantly better outcomes including VAS score (p = 0.02), FF (p < 0.01) and ER (p = 0.02).

Conclusion: Hydrodilatation is an effective treatment option in the short and medium term in both diabetics and non-diabetics with adhesive capsulitis, with good relief of pain and improvement in shoulder range of motion. Diabetic patients have significantly less improvement in range of motion and pain compared to non-diabetics at six months post hydrodilatation.

Purpose: The Japanese Investigation Committee (JIC) classification for osteonecrosis of the femoral head (ONFH) is based on the necrotic area relative to the weight-bearing surface on anteroposterior (AP) radiographs or central coronal MRI. Discrepancies exist between these methods, potentially related to the AP necrosis area. This study evaluated these discrepancies and the extent of AP necrotic lesions.

Methods: We retrospectively reviewed 139 patients (188 hips) with nontraumatic ONFH, JIC type C1 or C2 on radiography, and collapse < 3 mm. Cases with and without discrepancies between radiography and MRI were designated as discrepancy and consistent groups, respectively. We assessed the proportion of patients in the discrepancy group and survival rates in both groups, with femoral head collapse > 3 mm as the endpoint. The cutoff value for AP necrotic regions on lateral radiographs identifying discrepancies was calculated using ROC curve analysis.

Results: The discrepancy group comprised 28 hips (14.9%) vs. 160 hips in the consistent group. Five-year survival rates were 73.3% vs. 31.9% (P < 0.01), and AP necrotic region extent was 61.2 vs. 73.8 mm (P < 0.001) in discrepancy vs. consistent groups. The cutoff value for necrotic region extent revealing discrepancies was 66.9% (AUC 0.833, sensitivity 83.8%, specificity 82.4%).

Conclusion: Patients with AP necrotic regions < 66.9% were more likely to show discrepancies between radiography and MRI in type classification. This study can help improve accuracy in assessing ONFH severity and prognosis.

Purpose: Cannabis refers to medications derived from the Cannabis plant. Cannabis has long been used to treat a wide range of conditions. The widespread legalization of cannabis has increased its use. This meta-analysis evaluates the effects of preoperative cannabis usage on TKA and THA outcomes and complications.

Methods: This review follows CRD Guidance for Undertaking Reviews in Healthcare and PRISMA 2020 guidelines. On October 12, 2023, we extensively searched MEDLINE (PubMed), Scopus, Cochrane Central Register of Controlled Trials, and Web of Science. There were no time, place, or language restrictions. We also examined the references and citations in the included publications to find relevant research.

Results: We found 208 references in PubMed/Medline, Scopus, Web of Science, and other databases. After reviewing all publications, we identified 18 references that match the requirements for further assessment. The odds ratios (ORs) for reoperation and readmission are 1.35 (95% CI: 0.69, 2.66, and p-value = 0.38), and 0.89 (95% CI: 0.41, 1.92, and p-value = 0.76). Inpatient morphine milligram equivalent (MME) and length of stay (LOS) have a mean difference (MD) of -1.71 (95% CI: -13.46, 10.05, and p-value = 0.78), and - 0.13 (95% CI: -0.33, 0.08, and p-value = 0.23). The MD of the VAS pain score 24-72 h after surgery is 0.40 (95% CI: -0.07, 0.87, and p-value = 0.10). The odds ratio for PTE and DVT is 1.54 (95% CI: 0.1, 23.24, and p-value = 0.75), and 1.38 (95% CI: 1.08, 1.77, and p-value = 0.01), respectively.

Conclusion: Cannabis users experienced significantly higher rates of DVT following THA and TKA. Our subgroup analysis found that cannabis users who underwent TKA had considerably higher rates of reoperation (p-value = 0.10) and readmission (p-value ≤ 0.01), while those who underwent THA had significantly lower rates of PTE. These findings highlight the need to include cannabis use as a risk factor in surgical planning and patient care protocols, and further studies are warranted.

Prospero registration: This study design and protocol were performed in accordance with the PRISMA Statement. The protocol was registered previously on PROSPERO CRD42024551078.

Purpose: Hip resurfacing arthroplasty (HRA) is recommended for younger patients seeking higher levels of activity. However, femoroacetabular cup impingement (FACI) between the femoral neck and acetabular prosthesis remains a concern. This study aimed to determine the incidence, risk factors, and prognostic consequences of FACI after HRA.

Methods: This study included 242 HRAs performed at a single institution. Three types of implants with different cup articular arc angle (CAAA) values were used. FACI was defined as indentation or spur formation at the femoral neck corresponding to the ridge of the acetabular cup. Multivariate regression analyses were conducted to identify risk factors for FACI. Clinical outcomes were compared between groups with and without impingement. The mean follow-up duration was 12 years (range, 2‒19).

Results: FACI was identified in 87 out of 242 HRAs (36%). Multivariate regression analysis showed that FACI was associated with the use of implants with a greater CAAA (P < 0.001). At the latest evaluation, the mean Harris Hip Score (94 vs. 93; P = 0.405) and the incidence of groin pain (16.1% vs. 14.8%; P = 0.795) were similar between the groups with and without FACI. Implant survivorship free of any revision was 94.5% in the FACI group and 89.8% in the non-FACI group at 12 years (log-rank, P = 0.165).

Conclusion: This study identified that the incidence of FACI after HRA was 36%. Implants with greater CAAA were associated with a higher risk of impingement. However, radiographic FACI was not associated with adverse clinical outcomes of HRA after a mean follow-up of 12 years.

Purpose: Accurate identification of radiographic landmarks is fundamental to characterizing glenohumeral relationships before and sequentially after shoulder arthroplasty, but manual annotation of these radiographs is laborious. We report on the use of artificial intelligence, specifically computer vision and deep learning models (DLMs), in determining the accuracy of DLM-identified and surgeon identified (SI) landmarks before and after anatomic shoulder arthroplasty.

Materials & methods: 240 true anteroposterior radiographs were annotated using 11 standard osseous landmarks to train a deep learning model. Radiographs were modified to allow for a training model consisting of 2,260 images. The accuracy of DLM landmarks was compared to manually annotated radiographs using 60 radiographs not used in the training model. In addition, we also performed 14 different measurements of component positioning and compared these to measurements made based on DLM landmarks.

Results: The mean deviation between DLM vs. SI cortical landmarks was 1.9 ± 1.9 mm. Scapular landmarks had slightly lower deviations compared to humeral landmarks (1.5 ± 1.8 mm vs. 2.1 ± 2.0 mm, p < 0.001). The DLM was also found to be accurate with respect to 14 measures of scapular, humeral, and glenohumeral measurements with a mean deviation of 2.9 ± 2.7 mm.

Conclusions: An accelerated deep learning model using a base of only 240 annotated images was able to achieve low levels of deviation in identifying common humeral and scapular landmarks on preoperative and postoperative radiographs. The reliability and efficiency of this deep learning model represents a powerful tool to analyze preoperative and postoperative radiographs while avoiding human observer bias.

Level of evidence: IV.

Purpose: Lateral epicondylitis (LE) is often attributed to degenerative changes and microscopic ruptures in the extensor carpi radialis brevis (ECRB). Surgical procedures, such as arthroscopic or open ECRB release, are commonly used to address this condition. However, there is limited research on changes in wrist muscle strength and their clinical impact after ECRB release. This study aims to investigate the changes in wrist extension strength following ECRB release in patients with lateral epicondylitis.

Methods: A retrospective study was conducted involving thirty-six right-handed patients who underwent open ECRB release at a single institution. Wrist extension strength was measured using a Biodex system during both the initial and two-year follow-up clinical visits. Additionally, clinical outcomes were assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) score, pain visual analog scale (pain VAS), grip strength, and wrist extension strength. Correlations among these factors were analyzed to explore potential associations.

Results: Significant improvements were observed in all clinical outcomes, including grip strength and wrist extension strength, following ECRB release. However, at the two-year follow-up, a statistically significant decrease in wrist extension strength was noted compared to the unaffected arm. Despite this decrease, there were no adverse effects on the clinical outcomes (DASH, pain VAS) or grip strength.

Conclusion: Our study demonstrated a decrease in wrist extension power following ECRB release, which did not significantly impact clinical outcomes. Therefore, we recommend that clinicians inform patients about the potential reduction in wrist extension strength and incorporate wrist extension strengthening exercises into postoperative rehabilitation protocols to facilitate recovery to normal levels.

Level of evidence: III.

Psychiatric disorders significantly impact orthopaedic practice, often manifesting in ways that can complicate diagnosis and treatment. This narrative review explores psychiatric conditions that mimic musculoskeletal disorders, including Conversion Disorder, Factitious Disorder, Somatic Symptom Disorder, and Malingering. These disorders present a range of challenges, from interfering with accurate diagnosis to contributing to suboptimal clinical outcomes and increased healthcare costs. Is fundamental the role of orthopaedic surgeons in recognizing these conditions, which can present as genuine musculoskeletal symptoms but have underlying psychiatric origins. It emphasizes the need for heightened awareness and proper training to avoid misdiagnosis and ensure timely, appropriate treatment. By examining current literature, the review provides a comprehensive overview of each disorder, detailing their clinical presentations, diagnostic criteria, and treatment strategies. The aim is to enhance orthopedic practitioners' ability to identify and manage these complex cases effectively, improving patient care and reducing the risk of unnecessary interventions.

Purpose: While surgical intervention of scoliosis in cerebral palsy (CP) patients has shown notable improvements in quality of life, the high risk of post-operative complications in CP patients necessitates careful preoperative optimization. A preoperative multidisciplinary (Multi-D) pathway at our tertiary pediatric hospital in effect since 2014 led to a significant reduction in mortality at one year. However, such a strategy delays surgery, potentially increasing the risk of curve progression. This study aims to elucidate the impact of the Multi-D screening process on curve progression in neuromuscular scoliosis among complex CP patients.

Methods: A retrospective review of all CP patients with scoliosis at a tertiary care center from 2012 to 2020 was conducted. This assessment focused on the progression of the major Cobb angle from the time of the indications conference to surgery of patients who went through Multi-D screening. Patient demographics and perioperative variables were obtained from the electronic medical record (EPIC, Systems Verona, WI).

Results: After exclusion criteria were met, there were 85 patients who went through Multi-D, 78 of whom had surgery, and seven who did not. Surgery was delayed an average of 202 days for Multi-D optimization. We found a trend in increasing Cobb angle over time, but this correlation did not reach statistical significance (p = 0.079). 45 Multi-D surgery participants had a decrease or no change in Cobb angle and had surgery an average of 5.6 months after indications. 33 Multi-D surgery participants had an increase in Cobb angle and had surgery an average of 8.5 months after indications. Cobb angle progressed an average of 13.4° in the increased group, and - 0.4° in the decrease or no change group. There were no associations with change in Cobb angle and GMFCS, starting major curve angle, number of referrals, or intrathecal baclofen pump use according to this analysis.

Conclusions: Multi-D optimization resulted in an average delay in surgery of 6.7 months. Patients that did not have a change in Cobb angle had surgery within 5.6 months vs. patients that had an increase in Cobb angle had surgery on average 8.5 months after indicated for surgery, with an average increase of Cobb angle of 13.4°.

Level of evidence: Level III, retrospective comparative study.