International Orthopaedics最新文献

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.

Purpose: Pelvic-ring injuries in women often result in urinary dysfunction owing to the proximity of pelvic organs to the urinary tract, significantly affecting quality of life. However, detailed research on urinary sequelae remains limited. This study aimed to assess the incidence of urinary dysfunction in women after pelvic-ring injuries and to identify risk factors influencing urinary function.

Methods: We conducted a retrospective cohort study of women who underwent osteosynthesis for pelvic-ring injuries between January 2022 and June 2023 with ≥ 12 months of follow-up. Urinary dysfunction was evaluated using the Questionnaire for Urinary Incontinence Diagnosis and Female Urinary Symptom Score at one, three, six and 12 months postoperatively.

Results: Fifty-eight patients (mean age, 43.2 years) were included, with motor-vehicle collisions being the most common cause for pelvic-ring injuries (74.1%). Most injuries (84.5%) were classified as Type B. Nearly half of the patients reported urinary symptoms one month post-surgery, which significantly improved over 12 months (P < 0.05). In the multivariate analysis, greater injury severity was independently associated with urinary dysfunction at six months (adjusted odds ratio: 1.05, 95% confidence interval 1.00-1.12, p = 0.049), while no other clinical or procedural factors, including age, arterial embolisation, or surgical approach, stayed significant. Functional recovery correlated with reduced symptoms over time.

Conclusion: Urinary dysfunction is a frequent but under-recognised complication after pelvic-ring injuries. Although most patients experience gradual improvement over time, greater injury severity is independently associated with early urinary symptoms. Continuous monitoring and timely rehabilitation may help optimise long-term functional recovery.

Purpose: Rotational instability is a key factor in fixation failure of extracapsular hip fractures. The U-Blade (RC) lag screw was designed to improve rotational stability. This study aimed to compare mechanical complication rates between Gamma3 and Gamma3 RC nails in elderly patients with rotationally unstable extracapsular fractures.

Methods: We conducted a prospective, single-center randomized controlled trial including 316 patients aged ≥ 65 years with rotationally unstable extracapsular fractures. Patients were randomized to treatment with a Gamma3 nail (n = 169) or a Gamma3 RC nail (n = 147). Mechanical complications were classified as major (rotation and migration of the implant, cut-out, non-union) or minor (back-out, cervicodiaphyseal angle change, excessive sliding).

Results: The overall rate of major complications was 2.9 per 10,000 person-days, being the most frequent the cut out (2.2%), with no significant difference between Gamma3 and Gamma3 RC groups (RR = 1.0; 95% CI: 0.4-2.7). TAD > 25 mm increased the risk of major complications (RT = 3.7; 95% CI: 1.2-11.2), as did superior screw placement (Cleveland zones 1-3: RT = 7.5; 95% CI: 2.7-20.8) and postoperative diastasis (RT = 4.7; 95% CI: 1.4-16.2). Similarly, implant type was not significantly associated with minor complications that were observed in 85 patients (26.9%), most frequently back-out (14.6%).

Conclusion: The U-Blade (RC) lag screw did not reduce mechanical complication rates compared with the standard Gamma3. Radiographic parameters, particularly TAD, reduction quality, screw position, and postoperative diastasis, were the main predictors of fixation failure.

Purpose: This study quantifies the reproducibility of soft tissue laxity and gap measurements under manual stress, and implant positioning planning using the imageless ROSA^® robotic system, by comparing a senior high-volume surgeon with a low-volume resident.

Methods: In this single-centre prospective study, 17 patients undergoing robotic-assisted total knee arthroplasty were evaluated. Intra- and inter-operator variability was assessed by recording intraoperative measurements and planning outcomes using a standardized protocol for functional alignment (FA).

Results: Both intra and inter-operator analyses demonstrated good to excellent reproducibility (ICC > 0.75-0.9) for soft tissue and gap assessments. Minor variability was observed in planning parameters (ICC < 0.60), specifically stylus height, femoral flexion, and distal femoral resection, likely reflecting subjective adjustments by the high-volume surgeon.

Conclusion: High reproducibility in soft tissue measurements and surgical planning across surgeons with different experience levels is shown by the ROSA^® robotic system, while flexibility for individualized surgical strategies is retained.

This letter provides a critical commentary on the recent article by Hachadorian et al. entitled "Assessing glenoid orientation on the axillary view: a novel technique using the posterolateral acromion-to-coracoid line." The authors introduced the posterolateral acromion-to-coracoid (PLAC) line as a reproducible reference for assessing glenoid version on axillary radiographs, demonstrating excellent reliability and strong correlation with 3D CT measurements. We highlight the clinical significance of this technique as a cost-effective and radiation-sparing alternative for postoperative evaluation of glenoid orientation. Furthermore, we suggest extending validation to postoperative cases, quantifying projection-related errors, and exploring AI-assisted automation for landmark detection. This work represents a valuable step toward standardized radiographic assessment following shoulder arthroplasty.

Purpose: Aseptic loosening of the acetabular cup component is the primary cause for complex revision surgery following total hip arthroplasty. However, the extent to which the different zones of the prosthetic contribute to successful osseointegration and how reliable this integration can be assessed using conventional radiographs remain unclear. The aim of the study was to evaluate the osseointegration of cementless threaded acetabular cups through a combination of radiological analysis and histological validation.

Methods: Eight hemipelves of body donors with cementless threaded acetabular cups were included in this study. Conventional radiographs were used to assess the specimens for existing radiolucent lines, periprosthetic osteolysis, or fractures. For histological analysis, thin sections of the acetabular cup were examined for the presence of a periprosthetic membrane, particle debris or inflammatory cells. The areas of visible contact were identified and the bone-to-implant contact (BIC) was calculated.

Results: Radiographic analysis revealed no signs of insufficient osseointegration, osteolytic lesions, or periprosthetic loosening, in any of the specimens. Histological examination showed an average osseointegration rate of 41.84%. Bone-to-implant contact analysis showed no significant differences between different sectors or zones, or between conical and bi-conical acetabular cups.

Conclusion: This study highlights successful osseointegration of cementless threaded acetabular cups, with a mean survival of 18.2 years. Radiological imaging aligned closely to histological finding, confirming implant stability and long-term clinical effectiveness.

Purpose: To compare functional and radiological outcomes between two stage ORIF and single stage external fixation for complex pilon fractures.

Methods: Prospective, single-center randomized controlled trial at a Level I trauma facility (April 2021-April 2023). Sixty skeletally mature patients with AO/OTA 43-C pilon fractures unsuitable for primary ORIF were randomized to two-stage ORIF (control group) or single-stage limited internal fixation with external fixation (LIFEF) (treatment group). Minimum follow-up was 24 months. The primary outcome was the AOFAS score at final follow-up. Secondary outcomes included time to union, time to return to work, ankle range of motion (ROM), fracture-related infection (FRI), bone-healing complications (nonunion, malunion, delayed union), post-traumatic osteoarthritis (PTOA), and need for secondary procedures.

Results: All 60 patients completed follow-up. Compared with LIFEF, two-stage ORIF achieved higher AOFAS scores (85 ± 9 vs. 77 ± 10; P = 0.006), earlier return to work (7 ± 1.5 vs. 10 ± 3 months; P < 0.001), and shorter time to union (17 ± 3.6 vs. 19 ± 3.5 weeks; P = 0.02). Groups did not differ in quality of reduction (P = 0.14), ankle ROM (P = 0.10 and 0.058 for dorsiflexion and plantarflexion), FRI (P = 0.69), PTOA (P = 0.64), or bone-healing complications (nonunion, delayed union, malunion; P = 0.24, 0.39, 0.39).

Conclusion: Two-stage ORIF provided superior functional outcomes and faster recovery (earlier union and return to work) compared with LIFEF, with similar reduction quality and complication rates. These findings support two-stage ORIF as the preferred strategy for AO/OTA 43-C pilon fractures with soft-tissue compromise.

Registry: ClinicalTrials.gov , NCT05141227, Registration date: 29 July 2021.