International Orthopaedics最新文献

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.

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: 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.