International Orthopaedics最新文献

Purpose: This study aim was to analyze the joint temperature of patients affected by bilateral knee osteoarthritis (OA) using infrared thermography to investigate whether thermographic imaging patterns are influenced by the severity of symptoms and joint degeneration.

Methods: Sixty-sixpatients ranging from 43 to 78 years old (63.3 ± 8.8 years) with bilateral knee OA and one symptomatic knee were enrolled. Thermograms of the two knees were captured using a thermographic camera FLIR T1020 and analyzed with the ResearchIR software to calculate the temperature of the overall knee and the four regions of interest (ROIs): patella, suprapatellar, medial, and lateral areas.

Results: The temperature of knees affected by OA was influenced by joint degeneration level and symptoms: patients with higher OA grade in the symptomatic knees presented higher total knee temperatures compared to the asymptomatic ones (p = 0.002), as well as in the patellar (p = 0.005), lateral (p = 0.002), and medial (p = 0.001) areas. On the other hand, patients with the same OA level in the two knees presented a higher temperature in the symptomatic knee only in the medial area (p = 0.037). Symptomatic knees demonstrated a different pattern compared to asymptomatic knees, with the medial area presenting the highest temperature changes (p = 0.020). Patients reporting prevalent pain in the lateral knee area presented higher differences in total knee temperature (0.7 ± 0.7 °C) than patients with pain in the medial area (0.1 ± 0.5 °C) (p = 0.023).

Conclusion: The temperature of knees affected by OA is influenced by the degree of joint degeneration and by the presence of symptoms, with higher temperatures found in symptomatic joints, especially with prevalent lateral knee pain, and in more severe OA. Symptomatic knees demonstrated a different pattern compared to asymptomatic knees, with the medial area presenting the highest temperature changes.

Purpose: This study aimed to evaluate the efficacy of a combined treatment approach integrating extensive debridement, immediate internal fixation, and the Masquelet technique for the management of infected nonunion of long bones in the lower limbs caused by multidrug-resistant (MDR) and extensively drug-resistant (XDR) bacteria.

Methods: This retrospective case series was conducted at the Imam Khomeini Hospital Complex, Tehran, Iran, a tertiary-level academic referral centre. The study documented consecutive cases of patients presenting with infected nonunion of the tibia or femur, with a positive culture for MDR or XDR bacteria, treated between January 2019 and December 2022. Inclusion criteria were adults with a confirmed diagnosis of infected nonunion due to MDR or XDR bacteria, with exclusion criteria including patients with unrelated infections or allergies to the components of the treatment regimen. The primary outcomes measured were infection resolution and bone healing.

Results: The study cohort comprised 16 patients, predominantly male (87.5%) with an average age of 38.5 years. Methicillin-resistant Staphylococcus aureus (MRSA) was identified as the causative agent in 31.25% of the infections. Patients were followed for a period ranging from 12 to 26 months. The treatment protocol was uniformly applied across all cases. Successful bone union was observed in the majority of patients within 140 to 240 days following grafting. However, there were two instances where amputation was necessitated due to the failure to eradicate the infection. Complications arose in three cases during the follow-up period: two required re-debridement due to a recurrence of the infection, and one was subjected to bone transport owing to persistent nonunion. Notably, all cases that either failed or encountered complications were smokers.

Conclusions: In this integrated approach, high rates of infection resolution and bone healing were achieved, suggesting this method as a viable option for these complex cases.

Purpose: We determined long-term (1) clinical results of revision total hip arthroplasty (THA) in the presence of Paprosky type IIIB and IV femoral defects using validated scoring instrument; (2) osseointegration and bone remodeling; (3) the fate of cortical strut onlay allograft; (4) rates of revision and osteolysis; and (5) survivorship of the cementless stem.

Methods: We reviewed the results of 240 revision THAs in 220 patients (mean age, 59 years, range, 36-67 years) performed with an extensively porous-coated femoral stem (Solution stem; DePuy, Warsaw, Indiana) combined with a cortical strut onlay allografts for Paprosky Type IIIB and IV femoral diaphyseal bone defects from February 1994 to June 2003. Demographic data, Harris hip score, WOMAC score, UCLA activity score, and radiographic data were recorded. We determined the fate of strut cortical strut allograft and component survival rates at a mean of 26.5 years using revision and aseptic loosening as end points. Minimum follow-up was 21 years (range, 21-30 years).

Results: The clinical results improved significantly for the Harris hip score, WOMAC, and UCLA activity scores (p < 0.001). At the final follow-up, mean Harris hip, WOMAC, and UCLA activity scores were 83 ± 15 (34-100), 20 ± 15 (11-52) and 6.7 ± 1.3 (5-8) points, respectively. Of the 240 femoral stems, 218 (91%) had bone ingrowth, and 22 (9%) were unstable. Allografts were well incorporated in the host femur in all hips. The resorption of allografts was graded as mild in 192 hips (80%) and moderate in 48 hips (20%). A Kaplan-Meier survivorship analysis at a mean of 26.5 years follow-up showed that the survival rate of the femoral component was 91% (95% CI, 0.88-0.96) with re-revision for any reason as the endpoint for failure. The survival rate at a mean of 26.5 years for worst case scenario was 76% (95% CI, 0.71-0.88).

Conclusion: We found good results at a mean of 26.5 years after the revision surgery in terms of longevity and functional outcome using an extensively porous-coated stem combined with cortical strut allografts in the Paprosky Type IIIB and IV femoral diaphyseal defects. We agree that the initial quality of an uncomplicated revision of THA using supportive cortical strut allografts maintains relatively well beyond minimum 21 years of follow-up. Future studies might compare this approach with allograft-prosthesis composites, proximal femoral replacement, or modular fluted tapered stems.

Purpose: Tissue biopsy is the gold standard for differentiating osteoporotic vertebral compression fractures from malignant lesions. However, the necessity of routine biopsies during percutaneous vertebroplasty and kyphoplasty is debated due to the low malignancy detection rates. This study aims to identify key predictors of positive biopsy outcomes in patients undergoing these procedures, with the goal of refining biopsy selection criteria to enhance diagnostic yield and improve clinical decision-making.

Methods: We conducted a retrospective cohort study involving 295 patients who underwent percutaneous vertebroplasty and kyphoplasty with biopsy between June and December 2023. Clinical data, including age, gender, fracture aetiology, imaging findings, and biopsy results, were collected. Binary logistic regression analysis was employed to identify significant predictors of positive biopsy outcomes.

Results: The biopsy results revealed an overall malignancy rate of 1.01% (3/295). Among the 17 cases with abnormal (positive) biopsy findings, 17.6% were malignant, while the remainder were benign. Significant predictors included age (OR = 0.936), gender (OR = 0.307 for males), fracture aetiology (OR = 5.300 for fractures with no apparent cause), and imaging abnormalities (OR = 8.388).

Conclusion: This study underscores the low malignancy detection rate in routine biopsies for vertebral compression fractures, advocating for a more selective approach by reserving biopsies for patients with specific high-risk factors. A targeted biopsy strategy, informed by enhanced pre-operative screening, could improve diagnostic accuracy and treatment outcomes, optimizing clinical management.

Purpose: The proximal humeral reconstruction is challenging. This study aims to investigate the survival, function and complications of clavicla pro humero (CPH) for pediatric proximal humeral reconstruction.

Methods: A retrospective cohort study was conducted on eight patients (4 males, and 4 females) who underwent clavicla pro humero reconstruction between January 2009 and December 2020 in our institution. The average age was 10.4 ± 2.7 years (range, 6 to 14 years). The functional outcomes were assessed by the Musculoskeletal Tumor Society Score (MSTS-93), the Toronto Extremity Salvage Score (TESS), the American Shoulder and Elbow Surgeons (ASES) score and the range of motion (ROM) of the shoulder. The complications and overall survivorship of clavicla pro humero were recorded in the follow-up.

Results: The mean follow-up of all patients was 54.6 ± 23.9 months (range, 24 to 84 months) and 73.3 ± 8.5 months (range, 72 to 84 months) in all survivors. All patients had a bone union at an average of 3.8 months after the initial procedure. Only one patient had no complications in the follow-up. The most common complications were clavicle fracture (87.5%, 7/8), followed by pseudarthrosis (62.5%, 5/8), proximal clavicle osteolysis (37.5%, 3/8) and skin flap necrosis (12.5%, 1/8). The average MSTS-93 score was 79% (range, 73-86%), the average TESS was 82% (range, 76-86%) and the average ASES was 70% (68-73%), respectively.

Conclusions: The clavicla pro humero procedure provides rapid bone union but has a high complication rate. Therefore, we do not recommend this technique as a routine surgical procedure for paediatric proximal humeral reconstruction when other methods are available.

Level of evidence: level IV therapeutic study.

Purpose: To investigate the impact on career, leadership positions, and involvement in educational roles among participants in the International Visiting Physician (IVP) program at a leading Level I Trauma centre.

Methods: An electronic survey was conducted among Denver Health Department of Orthopedics IVP program alumni from 2010 to 2024. Data collected included demographics, baseline experience, career level, and leadership positions at the time of application and their current status. Factors influencing the decision to apply, research, surgical observership, educational, and host city experiences during the fellowship were assessed using a 10-point Likert scale. The impact of the fellowship on career advancement, leadership roles, and educational involvement post-fellowship was also evaluated using a 7 and 10-point Likert scale.

Results: Since 2010, 61 surgeons participated in the program, with 45 (73.8%) responding to the survey. Respondents originated from 26 countries across all continents (5 from Europe, 23 from Asia, 5 from Africa, 9 from South America, 2 from North America, and 1 from Oceania). Six alumni were female (13.3%), and the mean age was 37.02 years. On a 10-point Likert scale, the fellowship's impact on the current working position scored 7.53, effects on future positions scored 8.14, inclination to serve in teaching/research roles scored 7.67, and future leadership roles scored 8.00.

Conclusion: International Visiting Physician (IVP) programs significantly benefit participants' careers, enhancing their professional positions, leadership roles, and inclination to be involved in teaching and research.

Purpose: This paper examines how Vladimir Ćepulić at the orthopaedic department of the Red Cross Hospital in Zagreb described, understood and treated hysterical motility disorders between 1915 and 1917.

Methods: We analysed Ćepulić's article from 1919 on 107 cases of motility disorders among World War I veterans. Our analysis involved a formal examination of historical records, articles, and contemporary literature on conversion disorders, as well as a contextual analysis of Ćepulić's work.

Results: Ćepulić's report is a rare record of patients with conversion disorder treated within an orthopaedic department during the First World War. It provides detailed descriptions and documentation including photographs. By subscribing to the hysterical aetiology of this disorder, Croatian orthopaedists employed a diverse range of treatments, such as hypnosis, suggestion, electricity, anaesthesia and surgery.

Conclusion: We have demonstrated that a significant number of patients with motility disorders of psychogenic origin were treated at the orthopaedic department of the Red Cross Hospital in Zagreb. The detailed descriptions left by our predecessors can be used to trace the epidemiology and evolution of these disorders over time, including complex conditions like conversion disorder.

Purpose: Fractures around the hip are known to be an indicator for fragility and are associated with high mortality and various complications. A special type of fractures around the hip are periprosthetic femur fractures (PPF) after Total Hip Arthroplasty (THA). The aim of this study was to investigate the mortality rate associated with PPF after THA and to identify risk factors that may increase it.

Methods: Consecutive patients (N = 158) who were treated for a PPF after THA in our university hospital between 2010 and 2020 were identified and mortality was assessed using the residential registry. Univariate (Kaplan-Meier-Estimator) and multivariate (Cox-Regression) statistical analysis was performed to identify risk factors influencing mortality.

Results: One-year-mortality rate was 23.4% and 2-year mortality was 29.2%. Mortality was significantly influenced by age, gender, treatment, type of comorbidity and time of surgery (p < 0.05). Surgical treatment during regular working hours (8 to 18 h) reduced mortality by 53.2% compared to surgery on call (OR: 0.468, 95% CI 0.223, 0.986; p = 0.046). For every year of age, mortality risk increased by 12.9% (OR: 1,129, 95% CI 1.078, 1.182; p < 0.001). The type of fracture according to the Vancouver classification had no influence on mortality (p = 0.179). Plate fixation and conservative treatment were associated with a higher mortality compared to revision arthroplasty (plate: OR 2.8, 95% CI 1.318, 5.998; p = 0.007; conservative: OR 2.5, 95% CI 1.421, 4.507; p = 0.002).

Conclusion: Surgical treatment during regular working hours is associated with lower mortality compared to surgery outside these hours. In this retrospective cohort, time to surgery showed no significant impact on all-cause mortality, and revision arthroplasty was associated with lower mortality than conservative treatment or plate fixation.

Level of evidence: IV (Retrospective cohort study).

Purpose: To compare the clinical outcomes and complications of mini-open (MOT) and percutaneous techniques (PT) in the surgical repair of acute Achilles tendon rupture (AATR).

Methods: We systematically searched PubMed, Scopus, Web of Science, Clinical Trials, and the Cochrane Library for studies comparing MOT with PT for AATR. We assessed functional outcomes, complication rates, and operation time. Statistical analyses were performed using RevMan Web. Odds ratios (ORs) and mean difference (MD) with 95% confidence intervals (CIs) were pooled with a fixed-effects model for dichotomous and continuous endpoints, respectively. Heterogeneity was evaluated with I² statistics.

Results: Eight studies, comprising 484 patients, were included, of whom 226 (46%) underwent MOT. MOT was associated with a significantly lower re-rupture rate (1.48% vs. 6.11%; OR 0.28; 95% CI 0.09-0.86; p = 0.03; I² = 6%) and sural nerve injury rate (0.57% vs. 5.64%; OR 0.24; 95% CI 0.07-0.81; p = 0.02; I² = 0%). No significant differences were observed in venous thrombosis (OR 0.81; 95% CI 0.17-3.94; p = 0.33; I² = 0%), wound infection (OR 0.56; 95% CI 0.12-2.62; p = 0.46; I² = 0%), or operation time (MD 1.83 min; 95% CI -1.13-4.79; p = 0.23; I² = 88%). Functional outcomes showed higher American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scores in the MOT group (MD 1.52 points; 95% CI 0.62-2.42; p = 0.001; I² = 3%), while (Achilles Tendon Total Rupture Score) ATRS, time to return to activities, and ankle plantar and dorsiflexion were comparable.

Conclusions: MOT for AATR repair seems to reduce re-ruptures and sural nerve injuries while improving AOFAS scores, with no significant differences in other complications compared to PT. These findings suggest that the MOT may offer a safer and equally effective alternative to PT for AATR.

Purpose: Surgical treatments for symptomatic borderline dysplastic hips (Lateral Center-Edge Angle: LCEA 18-25°) remain challenging, instability being the primary issue. Currently, treatment options include arthroscopic procedures or peri-acetabular osteotomy (PAO). Although the popularity of the acetabular shelf bone block has declined in favor of PAO, it may still be relevant as a hip joint stabilizer and coverage area, rather than for increasing coverage area by cartilage. We analyzed clinical and radiographic outcomes of 23 borderline hips after undergoing shelf procedure with a minimum follow-up of two years.

Methods: This is a retrospective descriptive study. Clinical evaluations (modified Harris Hip Score: mHHS, Non-Arthritic Hip Score: NAHS, International Hip Outcome Tool: iHOT12) and radiographic assessments were performed before and after surgery. We collected data on revision surgery rates, associated surgical procedures (labrum, impingement), complications, arthrosis progression, and conversion to total hip replacement (THR).

Results: The mean LCEA was 21°, and the mean follow-up period was five years (2 to 14 years). Clinical scores showed significant improvement at the last follow-up, mHHS increasing from 47 to 72 (p < 0.001), NAHS from 42 to 68 (p < 0.001), iHOT12 from 28 to 52 (p < 0.001), and pain levels decreasing from 7 to 3. Revision surgery rate was 13%, and complication rate was 8%. No osteoarthritis beyond Tönnis grade 2, and no cases required conversion to THR.

Conclusion: Arthroscopic procedures and PAO have shown promising results in the treatment of borderline hips. The hip shelf procedure appears to be a simple and effective treatment for stabilizing borderline hips, with favorable outcomes for 80% of patients and a low rate of arthritic progression. Shelf procedure could be a valuable addition to the therapeutic options for painful borderline dysplasia of the hip.