International Orthopaedics最新文献

Purpose: To investigate the incidence and risk factors for dressing-induced allergic contact dermatitis (DIACD) following total hip and knee arthroplasty (THA and TKA, respectively) across different dressings and sealants.

Methods: A retrospective review was conducted of patients who underwent primary, elective THA or TKA between 2019 and 2024 with ≥ 90 days of follow-up. Incidences of DIACD were identified by reviewing medical records for "allergy" diagnoses and use of antihistamines or corticosteroids within 30 days postoperatively. Patient characteristics, prior exposure, treatment, dressing type, and allergy history were analyzed.

Results: A total of 61 (0.3%) of the 23,396 investigated patients developed a DIACD on average 12.2 ± 7.3 days postoperatively. Overall, 41% had a preoperative allergy (excluding seasonal), and 55.7% were treated with topical or low-dose oral antihistamines and corticosteroids. The majority (41%) of the DIACD involved mesh-adhesive dressings, and a liquid skin adhesive (2-octyl cyanoacrylate) was also used in 41% of cases, often in combination with the primary dressing. Of the 61 DIACD patients, 24 (39.3%) had previously undergone THA or TKA, and nearly half of these (n = 11, 45.8%) had been exposed to the same dressing without prior occurrence of DIACD. DIACD patients were significantly more likely to have undergone TKA (73.8 vs. 58.3%, p = 0.015) and to have never smoked (75.4 vs. 58.4%, p = 0.014). The effect sizes of these findings were negligible (Cramer's V = 0.016 and 0.019, respectively).

Conclusions: The incidence of DIACD following joint arthroplasty is low (0.3%) but remains a frustrating complication, primarily occurring two weeks postoperatively, with mesh-adhesive dressings most frequently implicated. Patients with prior exposure to dressings, those undergoing TKA, and non-smokers are at higher risk. Identifying at-risk patients can guide dressing selection and application.

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.

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: Periprosthetic joint infection (PJI) is a potentially devastating complication following total elbow arthroplasty. In this retrospective study, we aimed to review our cohort of patients to assess the treatment success rates of elbow PJI using different treatment methods and to report on the additional treatment approach for failed cases.

Methods: The study included 26 patients who underwent revision surgery for elbow PJI between 2007 and 2023. Patients were enrolled if they possessed a minimum follow-up of two years. Success of different treatment strategies, including debridement, antibiotics, and implant retention (DAIR) with or without modular component exchange, and two-stage revision was evaluated, as well as the fate of patients who experienced initial treatment failure.

Results: At a mean follow-up of 140.5 ± 74.5 months, only 11 patients (42.3%) were successfully treated after a single revision. The overall infection-free survival rates were 65.4% at one year, 50.0% at two years, and 45.8% at five years. DAIR without component exchange had the lowest success (23.1%), while DAIR with modular component exchange and two-stage revision showed the highest (60.0% and 62.5%, respectively). Failed cases (57.7%) required a mean of 2.1 additional procedures to achieve infection control.

Conclusion: Treatment of elbow PJI remains especially challenging due to an overall high treatment failure. While two-stage exchange appears to be the most effective treatment modality, DAIR with modular component exchange shows promising outcomes in well-fixed prostheses. DAIR without modular components exchange yields poor infection control rates and should be omitted.

Background: Unicompartmental Knee Arthroplasty (UKA) is effective for knee anteromedial osteoarthritis (AMOA), but aseptic prosthetic loosening causes failures. While periprosthetic bone loss links to loosening in Total Knee Arthroplasty (TKA), this association and post-UKA periprosthetic Bone Mineral Density (BMD) changes are understudied. Systematically exploring dynamic post-UKA BMD changes is vital for optimizing management and reducing loosening risk.​.

Patients and methods: This prospective study included 40 patients (40 knees) with knee AMOA who underwent UKA (January 2020-January 2024). All received cemented Oxford unicompartmental prostheses implanted by the same surgeon (standard technique). Dual-Energy X-ray Absorptiometry (DEXA) measured periprosthetic BMD preoperatively, and at one, three, six and 12 months postoperatively to analyze change patterns.​.

Results: Periprosthetic BMD decreased rapidly at one and three months postoperatively, then increased at six and 12 months (p < 0.05). No significant differences were noted in tibial prosthesis BMD changes (ROI 1, ROI 2) or femoral prosthesis stem posterior BMD values (ROI 4) between six and 12 months (p > 0.05).​.

Conclusion: Early postoperative (≤ 3 months) rapid periprosthetic BMD decline in UKA suggests potential clinical value of early anti-osteoporotic treatment.

Level of evidence: Level 2b - Prospective case-control study.

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.

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.

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: 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.