International Orthopaedics最新文献

Purpose: To compare lesion debridement with bone grafting (LDBG) versus core decompression (CD) in preventing femoral head collapse in early glucocorticoid-associated osteonecrosis (GA-ONFH).

Methods: This single-center, superiority randomized controlled trial (Level I) enrolled 86 patients (18-60 years) with ARCO stage II GA-ONFH, randomized to CD or LDBG.

Primary outcome: proportion maintaining ARCO stage II at 24 months.

Secondary outcomes: interval-specific progression to collapse (0-6, 6-12, 12-24 months) and Harris Hip Scores (HHS) among non-collapsed hips. Safety outcomes included perioperative blood loss, hospital stay, and surgery-related adverse events.

Results: Of 86 patients, 81 completed follow-up. At 24 months, ARCO stage II was maintained in 70% (28/40) of LDBG vs. 41% (17/41) of CD patients (P = 0.010; RR = 1.69; NNT = 4). CD had better HHS at six months (P < 0.001), but no difference at 12/24 months among non-collapsed hips. CD involved less blood loss (P < 0.001) and shorter hospital stays (P = 0.002); serious adverse events were similar (P = 0.72). Prespecified subgroup analyses showed consistent LDBG benefit, especially in females, patients with BMI < 23.9, high glucocorticoid dose, and non-manual occupations.

Conclusion: LDBG significantly reduces collapse risk versus CD in early GA-ONFH, with comparable mid-term function and safety, supporting its use as a preferred joint-preserving strategy, particularly for females, patients with lower BMI (< 23.9), high glucocorticoid exposure, and non-manual occupations.

Purpose: Regarding patellar resurfacing in total knee arthroplasty (TKA), no consensus has been reached, but most studies have not addressed specific pathological circumstances. Evidence on the roles of patellar resurfacing and synovectomy in managing postoperative effusion in patients with severe chondrocalcinosis is limited.

Material and methods: This single-centre observational cohort study included 160 patients who underwent the same TKA for osteoarthritis with severe chondrocalcinosis (grade 4) between January 2000 and December 2010. A matched design created four comparable groups of 40 patients each: (1) TKA without patellar resurfacing or synovectomy, (2) TKA with patellar resurfacing alone, (3) TKA with synovectomy alone, and (4) TKA with both patellar resurfacing and synovectomy. Severe chondrocalcinosis (advanced calcium pyrophosphate deposition disease) was confirmed through radiographic findings, synovial fluid analysis using polarized light microscopy, and histology. Significant postoperative effusion was diagnosed with ultrasound, quantified by sterile joint aspiration, and classified as stage I (10-20 cm³), stage II (21-30 cm³), or stage III (> 30 cm³).

Results: Postoperative joint effusion varied significantly between the strategies. In the patellar resurfacing group, 25% (10/40) of patients developed only stage I effusion without synovectomy. Conversely, 45% (18/40) of patients in the synovectomy-only group developed stage II effusion, while 62.5% (25/40) of patients without either procedure developed stage III effusion (p < 0.0001). TKA with both patella resurfacing and synovectomy resulted in either stage I (7/40) or stage II effusion (6/40). Multivariate regression confirmed patellar resurfacing as an independent protective factor against postoperative effusion (p < 0.01). Average aspirated effusion volumes further supported these findings: 39 ± 6 cm³ for TKA without additional procedures, 18 ± 8 cm³ with synovectomy, 6 ± 4 cm³ with patellar resurfacing, and 7 ± 4 cm³ with both patellar resurfacing and synovectomy. The results showed that as total knee effusion volume increased, inflammatory markers (C-reactive protein level) increased, and range of motion decreased.

Conclusion: In severe chondrocalcinosis, patellar resurfacing may be appropriate to prevent joint effusion after TKA.

Purpose: Intraoperative calcar fracture (IOCF) can compromise initial stability, leading to stem subsidence and instability. We aimed to compare 2-year complications and revision rates between patients who sustained IOCF and matched controls without IOCF using short stem total hip arthroplasty (THA).

Method: Patients who underwent short stem THA from November 2010 to October 2023 were included. They were categorized into those who sustained IOCF and were treated intraoperatively with double-loops cerclage wiring, and those without IOCF. Propensity score matching was performed to balance baseline characteristics between the two groups. The following outcomes were evaluated at two years: femoral stem subsidence, periprosthetic femoral fracture (PFF), periprosthetic joint infection (PJI), dislocation, aseptic femoral loosening, and revision.

Results: Initially, 844 cases were identified. After matching, 80 and 640 cases were included in IOCF and non-IOCF groups respectively. There was one case (1.25%) of stem subsidence in the IOCF group and 11 cases (1.72%) in the non-IOCF group, with no significant difference (p = 0.76). PFF occurred in one case (1.25%) of the IOCF group and four cases (0.63%) of the non-IOCF group; the difference was not significant (p = 0.53). In the non-IOCF group, there were five cases (0.78%) of PJI, 11 cases (1.72%) of dislocation, one case (0.16%) of aseptic femoral loosening and 13 cases (2%) of revisions. There was no revision in the IOCF group.

Conclusion: Short stem THA complicated by IOCF, when promptly recognized and treated intraoperatively, did not increase complications or revision rates at two years.

Purpose: Waste management in hospitals is important for environmental sustainability, as disposal of operations waste causes substantial greenhouse gas emissions. This study aimed to identify factors influencing waste generation in orthopaedics and traumatology.

Methods: In this prospective study, the weight of waste and drapes from 272 orthopaedic and trauma operations was measured. Waste production was analyzed regarding to anatomical region, operation type, and duration.

Results: Analysing all operations, the amount of waste differed significantly between anatomical regions (p < 0.001). When separating drapes, no significant differences between anatomical regions were found in waste, but in drapes (p < 0.001). The amount of waste differed significantly between operation types and correlated significantly with the operation duration (p < 0.001).

Conclusion: Operating room waste is influenced by anatomical regions and the drapes required for it. Operation duration significantly increases the amount of waste. These findings can support the development of targeted strategies to reduce waste in operating rooms.

Purpose: Hip involvement in hereditary multiple exostoses (HME) may lead to coxa valga, femoral impingement and progressive hip subluxation. This study aimed to evaluate the outcomes of a single-stage technique combining proximal femoral varus osteotomy with femoral neck osteochondroma trimming performed through the osteotomy site.

Methods: A retrospective series of fifteen patients (23 hips) with HME was reviewed. Clinical outcomes were assessed using the Postel-Merle d'Aubigné score. Radiographic evaluation included femoral and acetabular parameters assessed pre-operatively, immediately post-operatively and at latest follow-up.

Results: Mean age at surgery was 10.1 years, with a mean follow-up of nine years. Surgery achieved immediate correction of the neck-shaft angle and improved femoral head containment. At latest follow-up, significant improvement was observed in both femoral and acetabular parameters, suggesting secondary acetabular remodelling. Clinical scores improved significantly, with resolution of pain. Four nonunions required revision surgery, highlighting the technical demands of fixation in compromised bone. Loss of correction tended to occur more frequently in younger patients, with age below nine years associated with a higher risk of secondary valgus recurrence. No cases of femoral head avascular necrosis were observed.

Conclusion: This combined femoral approach allows effective correction of proximal femoral deformity while facilitating osteochondroma resection, providing durable containment and favourable mid-term outcomes.

Background: While the original Paul Grammont Inlay design had a 155° neck-shaft angle (NSA), developments in humeral stem designs have led to the emergence of the Onlay design with a more vertical angle. The purpose of the study is to compare three year clinical and radiological outcomes of two humeral stem designs, namely Inlay versus Onlay designs, with a 145° NSA and identical glenoid component.

Methods: In this multicentric retrospective study, 227 patients (141 Inlay versus 86 Onlay) that underwent primary reverse shoulder arthroplasty (RSA) between March 2019 and April 2020, were reviewed at a minimum follow-up of three years. Clinical evaluation included pain on visual analogue scale (VAS), active range of motion, subjective shoulder value (SSV), and Constant score. Radiological assessment included in situ stem inclination, cortical contact bone remodelling, and scapular notching.

Results: The two groups were comparable in terms of age, sex, diagnosis, and follow-up (mean follow-up, 3.3 ± 0.5 years). No significant differences were found for pain on VAS, SSV or Constant score. The Onlay group had significantly greater external rotation with 90° of abduction (ISA-Inlay, 52.2 ± 24.2; versus ISA-Onlay, 59.2 ± 25; p = 0.037), more valgus alignment (ISA-Inlay, -0.573; versus ISA-Onlay, -5.55; p < 0.001), and a higher rate of cortical contact (ISA-Inlay, 9%; versus ISA-Onlay, 39%; p < 0.001). No significant differences were found in terms of bone remodelling around the stem and scapular notching.

Conclusion: At a follow up of three years, both humeral stem designs resulted in comparable clinical and radiological outcomes, while the Onlay design seemed to improve external rotation without increasing the risk of bony complications. The choice of stem design should be motivated by patient specific functional needs and surgeon experience. However, the conclusions of the present study are limited to mid-term follow-up.

Purpose: To investigate whether ultrasound-guided preoperative portal localization in a modified double-medial-portal endoscopic technique reduces postoperative complications while maintaining comparable clinical outcomes in patients with recalcitrant plantar fasciitis.

Methods: A retrospective study was performed on 62 patients suffering from stubborn plantar fasciitis with a calcaneal spur from January 2023 to August 2024. 32 patients had a traditional endoscopic partial release of the plantar fascia, whereas 30 patients underwent a modified release guided by ultrasound. Two medial portals were used by both the traditional and altered groups. Every patient was monitored for a minimum of 12 months. The clinical results for both groups were assessed using the Visual Analogue Scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) score, the medial longitudinal arch angle (MLAA), and the Arch Index (AI).

Results: Both groups showed significant improvements in VAS and AOFAS scores at one, six and 12 months postoperatively. No significant between-group differences were observed in pain relief, functional recovery, or foot structural parameters at any follow-up time point. The ultrasound-guided group demonstrated a significantly lower incidence of postoperative complications. Patient-reported satisfaction appeared to be higher in the ultrasound-guided group.

Conclusion: Ultrasound-guided modified double-medial-portal endoscopic surgery provides comparable clinical outcomes with fewer postoperative complications, suggesting a safety advantage rather than superior efficacy in recalcitrant plantar fasciitis.

Background: Scapular neck fractures, typically caused by high-energy trauma, often require surgical fixation. Conventional reconstruction plates (RPs) are limited by poor anatomical conformity and extended operative times. We developed a novel scapular neck anatomical locking compression plate (SNALCP) and assessed its biomechanical stability and clinical performance.

Methods: Finite element analysis (FEA) was used to compare the biomechanical behaviour of SNALCP and RP in Miller type IIA/B fractures, simulating forward flexion (FF), abduction (AB), internal rotation (IR), and external rotation (ER). Clinically, 40 patients treated between January 2021 and August 2023 were enrolled: RP group (n = 22) and SNALCP group (n = 18). Operative time, blood loss, Visual Analog Scale (VAS) pain scores, healing time, complications, and Constant-Murley scores were evaluated.

Results: SNALCP demonstrated lower stress and displacement than RP across all loading conditions. For type IIA fractures, AB and FF stresses were 10.133 < 19.223 and 36.698 < 65.761 MPa; for type IIB, AB 63.089 < 97.578, FF 74.346 < 137.110, IR 379.290 < 540.640, and ER 1982.300 < 2253.100 MPa. Clinically, SNALCP yielded shorter surgical times (97.7 ± 19.3 min), less blood loss (152.6 ± 58.5 mL), faster healing (7.6 ± 1.4 weeks), and superior VAS and Constant-Murley scores (all p < 0.05). Only three cases of transient shoulder stiffness were observed.

Conclusion: SNALCP provides superior biomechanical stability and improved functional outcomes compared with RP. Larger, multicenter studies are warranted to validate these findings.

Background: The long head of the biceps tendon (LHBT) is a common source of anterior shoulder pain, particularly in older adults, and may persist despite conservative treatment. Arthroscopic tenotomy is effective but requires an operating room, anaesthesia, and postoperative restrictions, which may be suboptimal in elderly or comorbid patients. Ultrasound-guided percutaneous LHBT tenotomy has emerged as a minimally invasive alternative, yet long-term clinical outcomes remain insufficiently reported. This study aimed to evaluate two-year pain, functional, and sleep-quality outcomes following ultrasound-guided percutaneous LHBT tenotomy in patients with isolated LHBT tendinopathy.

Methods: This retrospective case series included 51 consecutive patients (mean age 61.8 ± 4.8 years) with MRI-confirmed isolated LHBT tendinopathy who underwent ultrasound-guided percutaneous tenotomy between 2022 and 2024. Pain (VAS), functional scores (ASES and Constant-Murley), and sleep quality (PSQI) were assessed at baseline and at three, six, 12, and 24 months. Repeated-measures ANOVA or Friedman tests were used for longitudinal analysis, with effect sizes reported as partial eta-squared. Complications and patient satisfaction were recorded at the final follow-up.

Results: All outcome measures improved significantly at each postoperative time point compared with baseline (p < 0.001). Mean VAS decreased from 6.84 ± 1.29 to 2.16 ± 0.89 at 24 months (η² = 0.71), with 92.1% achieving the minimal clinically important difference (MCID). Functional outcomes improved markedly (ASES: 35.7 → 85.1; Constant-Murley: 60.4 → 82.5), both with large effect sizes (η² = 0.68 and 0.64). PSQI improved from 9.2 ± 3.1 to 4.8 ± 2.2 (η² = 0.56), reducing clinically significant sleep disturbance from 78.4% to 29.4%. Four patients (7.8%) developed asymptomatic Popeye deformity; no major complications occurred. Patient satisfaction at 24 months was 88.2%.

Conclusions: Ultrasound-guided percutaneous LHBT tenotomy is a safe, minimally invasive, and effective procedure that provides durable improvements in pain, function, and sleep quality over two years, with a low complication rate. It represents a valuable alternative to arthroscopic tenotomy in appropriately selected patients.