International Orthopaedics最新文献

Purpose: To establish a national consensus on the minimum expected competencies that orthopaedic surgery residents in Chile should achieve by the end of training, providing a foundation for competency-based curriculum development in comparable training contexts.

Methods: A multicentre modified Delphi study was conducted involving academic leaders from orthopaedic residency programmes across Chile. An initial round of open-ended questions among programme directors generated draft competency statements, which were refined through two subsequent rounds using a 5-point Likert scale. Consensus was predefined as ≥ 80% agreement (ratings of 4 or 5) with an interquartile range ≤ 1. Competencies were organised into six ACGME core competencies and one CanMEDS role.

Results: Twenty-eight experts completed the final rounds. Consensus was achieved on 32 competency statements spanning patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, system-based practice, and scholar-research. Agreement was observed for non-procedural competencies and foundational surgical skills. In contrast, consensus was not reached regarding autonomy, even under supervision, for advanced surgical procedures, particularly arthroplasty and selected soft-tissue procedures. Qualitative feedback attributed disagreement to patient-safety considerations, procedural complexity, and differing views on the boundary between residency and fellowship-level competence.

Conclusions: This national Delphi study establishes the first consensus-based definition of minimum expected competencies for orthopaedic surgery residency training in Chile. The resulting framework provides a shared reference aligned with international competency-based principles while remaining responsive to local training contexts, and is intended to inform educational development and accreditation discussions in similar training settings rather than mandate a uniform training model.

Background: Currently, the primary treatment for ulnar neuropathy at the elbow is open in-situ decompression surgery. The effectiveness of ultrasound localization therapy, especially small-incision surgery using ultrasound combined with SWE, remains unclear.

Objectives: To evaluate the effect of small-incision ulnar nerve release in treating ulnar neuropathy at the elbow by ultrasound combined with shear wave elastography (SWE).

Methods: A retrospective analysis of 98 patients treated in our hospital for ulnar neuropathy at the elbow was conducted from June 2023 to March 2025. According to the treatment style, these patients were divided into a traditional open in-situ decompression surgery group (n = 51) and an ultrasound combined with SWE small-incision surgery group (n = 47). The maximum proximal Cross-sectional Area (CSA), Sensory Conduction Velocity (SCV), Motor Conduction Velocity (MCV), modified Bishop score, Quick-DASH score, and Visual Analogue Scale(VAS) score were compared between the two groups. Additionally, the amount of intraoperative blood loss, operation duration, hospital stay, patients' satisfaction with postoperative incision aesthetics, the postoperative complications of different operation methods, and the degree of damage to the medial cutaneous nerve of the forearm were studied.

Results: All patients underwent surgical treatment, with preoperative ultrasonography confirming no ulnar nerve subluxation. No statistically significant differences in age, preoperative SCV, MCV, CSA, Quick-DASH score, or VAS score were found between the two groups. The postoperative and the last follow-up SCV, MCV, and CSA were similar in the two groups. In addition, the improved Bishop score, Quick-DASH score, VAS score, postoperative hematoma rate, elbow stiffness rate, and postoperative protection of the medial cutaneous nerve of the forearm in the ultrasound combined with SWE surgery group were better than those in the traditional open surgery group. What's more, compared with the traditional open surgery group, the ultrasound combined with SWE surgery reduced the amount of intraoperative blood loss, shortened the operation duration and hospital stay, and the patients were more satisfied with the scar of the incision.

Conclusions: For patients with ulnar neuropathy at the elbow who are amenable to in situ decompression, this study highlights the potential of preoperative ultrasound combined with SWE to guide a targeted, minimally invasive surgical approach.

Purpose: Smoking is a potentially modifiable risk factor for adverse outcomes after total hip arthroplasty (THA), but evidence on early postoperative complications in Asian populations remains limited. This study examined the association between smoking and early postoperative complications after elective THA using a nationwide inpatient database in Japan.

Methods: This retrospective cohort study analysed data from the Japanese Diagnosis Procedure Combination (DPC) database between December 2011 and March 2023. Patients undergoing elective primary THA for osteoarthritis, osteonecrosis of the femoral head, or rheumatoid arthritis were included. Smoking status was identified using administrative codes. One-to-one propensity score matching was used to balance baseline characteristics between smokers and non-smokers. Primary outcomes were early postoperative surgical complications, medical complications, and in-hospital mortality. Dose-dependent effects were assessed using the Brinkman Index, with heavy smoking defined as ≥ 600.

Results: After propensity score matching, 52,551 patients were included in each group. Smoking was associated with a higher risk of postoperative infection (odds ratio [OR] 1.31; 95% confidence interval [CI] 1.15-1.49; p < 0.001) and a lower likelihood of blood transfusion (OR 0.83; 95% CI 0.80-0.85; p < 0.001). No significant associations were observed with dislocation, periprosthetic fracture, wound dehiscence, reoperation, major medical complications, or in-hospital mortality. Heavy smoking (Brinkman Index ≥ 600) was not associated with postoperative complications.

Conclusions: Smoking was associated with an increased risk of early postoperative infection following elective THA, but not with other major complications or in-hospital mortality. Smoking cessation should be considered an important component of perioperative optimisation.

Purpose: Postoperative stiffness is a common and incapacitating complication after total knee arthroplasty (TKA), significantly impacting functional outcomes. Open arthrolysis remains a less-studied surgical option. The objective of this study was to assess the use and outcomes of open arthrolysis in post-TKA stiffness management. We hypothesised that open arthrolysis is the least frequently used technique.

Methods: This was a retrospective multicentre study conducted as part of the 2024 SOFCOT symposium on post-TKA stiffness management, including 13 centres in France. Patients who underwent open arthrolysis for post-TKA stiffness between 2015 and 2019 were included. Demographic, radiographic, and clinical data were collected, and functional outcomes were evaluated using KOOS, Oxford, and JFS-12 scores preoperatively and postoperatively. Range of motion (ROM) was assessed and compared across different treatment modalities.

Results: Among 490 patients treated for post-TKA stiffness, 12 (2.4%) underwent open arthrolysis. The mean follow-up duration was seven years. Open arthrolysis patients were treated later than those undergoing manipulation under anaesthesia (28.1 vs. 7.2 months, p = 0.001) and later than arthroscopic arthrolysis patients without statistical difference (9.9 months, p = 0.216). Mean ROM improved by 27° postoperatively but remained lower than in other treatment groups (74° vs. 98°, p = 0.011). More than 90% of open arthrolysis patients reported dissatisfaction, compared to 26% for other techniques (p < 0.001).

Conclusion: Open arthrolysis is rarely performed for post-TKA stiffness with higher patient dissatisfaction rates than other treatment modalities. These findings suggest that open arthrolysis may have a limited role in post-TKA stiffness management.

Introduction: This study aims to determine whether distal femoral morphology (DFM) constitutes a risk factor for periprosthetic femoral fractures (PPFs) in a cohort of patients who underwent posterior-stabilized total knee arthroplasty (PS-TKA).

Materials and methods: Retrospective study of patients who had undergone primary PS-TKA, with a follow-up of minimum two years. Citak's ratio was calculated, and patients were classified according to DFM. Univariate and multivariate statistical analysis was performed to identify PPFs risk factors. ROC analysis was performed to evaluate the ability of DFM to distinguish patients at risk for PPFs.

Results: A total of 2452 patients 1644 female, 808 male were included in the analysis. The mean age of the participants was 70.2 years (SD = 6.4). PPFs were detected in 33 patients (1.35%). According to the Citak classification, patients were categorized as Group A (4/33, 12.1%), Group B (8/33, 24.2%), and Group C (21/33, 63.7%). DFM was significantly related to the PPFs rate (p = 0.001). The ROC curve analysis yielded an Area Under the Curve (AUC) of 0.669 (CI 95% 0.580-0.758) for the DFM.

Conclusions: Preoperative evaluation of distal femoral morphology and management of osteoporosis may reduce the risk of fractures after PS-TKA.

Purpose: This study aimed to compare the acetabular component positioning accuracy and clinical outcomes between the direct anterior approach (DAA) and the posterolateral approach (PLA) for total hip arthroplasty (THA) in patients with a history of pelvic osteotomy.

Methods: This retrospective study included 37 hips from 35 patients who underwent THA following pelvic osteotomy between 2005 and 2023. The primary outcomes were acetabular component positioning accuracy within the target zones and Japanese Orthopaedic Association (JOA) scores. The component angles were measured using postoperative computed tomography.

Results: The mean follow-up was 4.3 ± 3.0 years in the DAA group (short- to mid-term outcomes) and 11.2 ± 3.6 years in the PLA group (mid- to long-term outcomes). Significant improvement in JOA scores was observed in both groups, with no significant difference in final JOA scores. Mean inclination angles were similar with comparable variance. Although mean anteversion angles did not significantly differ, DAA demonstrated significantly lower variability. Optimal cup positioning within the target zones was significantly higher in the DAA group than in the PLA group. No dislocations occurred in the DAA group, whereas one did in the PLA group.

Conclusion: Both approaches demonstrated comparable clinical outcomes. Although the DAA showed higher rates of optimal cup placement and improved anteversion angle consistency, the overall clinical results were similar. The DAA and PLA are valid options for THA after pelvic osteotomy.

Purpose: The measurement of glenoid and reverse total shoulder arthroplasty (rTSA) inclination has both clinical and research relevance. The purpose of this study was to better understand if and how much radiographic projection and scapula position affect the perception of glenoid inclination.

Materials and methods: Twenty computed-tomography (CT) scans of arthritic shoulders were used to create digitally reconstructed radiographs (DRR) through 3° increments of inclination, retraction and protraction on a scapular coordinate system. The reverse total shoulder arthroplasty (rTSA) and total shoulder arthroplasty (TSA) angles were measured on each image.

Results: The mean range (difference between maximum and minimum values) of rTSA and TSA angle measurements based on simulation of scapula inclination was 14° and 17°, respectively. Nineteen of 20 cases showed a trend towards a higher rTSA and TSA angle with greater forward inclination. With simulated scapula retraction, the maximum difference between rTSA and TSA angle measurements was a mean 11° and 14°, respectively. With simulated scapula protraction, the maximum difference observed for rTSA and TSA angle measurements based was a mean 14° and 11°, respectively. Scapula protraction and retraction did not produce consistent or linear trends in rTSA or TSA angle measurement.

Conclusion: The radiographic measurement of rTSA and TSA angles is moderately variable based on scapula protraction, retraction and inclination. Forward inclination may increase the perception of superior tilt.

Purpose: Reverse Shoulder Arthroplasty (RSA) is widely used to treat shoulder joint pathologies. However, this procedure may result in reduced range of motion (ROM), scapular notching, and prosthetic instability. These complications vary among patients, highlighting the need for individualized preoperative planning. This study introduces a novel parametric methodology to determine optimal glenoid component positioning by evaluating ROM, instability ratio, and the percentage of bone resected.

Method: The proposed approach was applied to four patient models treated with two prosthetic designs. The methodology consists of four steps within a patient-specific parametric tool: 3D anatomical reconstruction, virtual surgical planning, biomechanical and geometric evaluation, and identification of optimal configurations. Fifteen glenoid component orientations were generated by varying tilt angles. The best configurations were identified based on ROM and instability assessments, while bone resection volume was calculated as an additional parameter.

Results: Maximum values of abduction-adduction, internal rotation, and external rotation were 87.23°, 90°, and 70.59°, respectively, although not achieved in a single configuration. Instability ratios ranged from 0.23 to 0.62. Bone resection varied between 0.4% and 5.5%, depending on the configuration.

Conclusions: This methodology provides a patient-specific framework to support preoperative planning in RSA. By combining ROM analysis, instability assessment, and bone preservation, the approach enables the identification of glenoid component orientations that improve mobility while minimizing instability risk and surgical invasiveness.

Introduction: Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in adults. Despite its clinical importance, nationwide data on long-term hospitalization and surgical management trends in Germany remain scarce.

Methods: A retrospective analysis was conducted using the German Federal Statistical Office's hospital discharge database covering all inpatient cases with the primary diagnosis of DCM (ICD-10-GM code M50.0) from 2005 to 2024. Annual case numbers, age and sex distributions, and surgical procedures were analyzed descriptively. Hospitalization rates per 100,000 inhabitants were calculated using mid-year population data.

Results: Between 2005 and 2024, approximately 70,000 hospital discharges with a primary diagnosis of DCM were recorded in Germany. Annual hospitalizations increased from 2,477 cases in 2005 to a peak of 4,076 cases in 2015, followed by a decline to 3,037 cases in 2024. Corresponding hospitalization rates rose from 3.0 to 4.96 per 100,000 inhabitants before decreasing to 3.7 per 100,000 in 2024. Segmented Poisson regression demonstrated a significant increase until 2015 followed by a significant decline thereafter. Age-specific analyses demonstrated a stable predominance of middle-aged and older adults, with consistently highest hospitalization volumes in patients aged 50-70 years. After age standardization to the 2015 reference population, the temporal pattern remained largely unchanged, indicating that observed trends were not solely attributable to population ageing. Mean length of hospital stay decreased steadily over time. Anterior surgical approaches accounted for the majority of procedures throughout the study period, while the proportion of surgically treated cases per hospitalization increased over time.

Conclusions: This nationwide, discharge-based analysis demonstrates substantial temporal changes in hospitalizations and surgical treatment patterns for DCM in Germany over the past two decades. Hospitalization volumes increased until approximately 2015 and declined thereafter, a pattern that persisted after age standardization. DCM predominantly affected patients aged 50-70 years throughout the study period, without a pronounced shift toward progressively older age groups. The increasing ratio of surgical procedures to hospitalizations suggests more selective inpatient admissions focusing on operative management. These findings provide a descriptive reference for long-term hospitalization and surgical trends in DCM.