International Orthopaedics最新文献

Background: Enhanced Recovery After Surgery (ERAS®) is a coordinated, evidence-based program delivered through a multidisciplinary team, which objective is to improve outcomes and patient satisfaction, while minimizing complications. The objective of this two-cohort study is to evaluate the clinical impact of an ERAS program on elective primary hip (THA) and knee (TKA) arthroplasties with regards to hospital length of stay, during the first 12 months after implementation.

Methods: We compared a retrospective pre-ERAS with a prospective ERAS cohort. Key aspects of this program included preoperative education, minimal fasting, standardised, anaesthetic and surgical techniques, multimodal analgesia, and early mobilization. The primary outcome was hospital length of stay. Other outcomes included rest, dynamic pain scores, and rates of complications.

Results: From December 1st, 2021 to November 30th, 2022, data from 267 patients (138 THA, 129 TKA) were compared with data from 258 patients (128 THA, 130 TKA) collected between December 1st, 2022, and November 30th, 2023, who underwent the ERAS® program (total: 525 patients). The mean hospital length of stay for THA patients before ERAS® was 5.5 ± 2.9 days versus 4.5 ± 2.0 days after ERAS® implementation (p = 0.002). For TKA patients, it was 6.6 ± 3.1 days before vs 5.6 ± 1.9 days after ERAS® implementation (p = 0.001). Rest, dynamic pain scores, and rates of complications were similar between groups except for pneumonia in patients undergoing TKA.

Conclusion: The implementation of an ERAS® program for hip and knee arthroplasty led to a reduced hospital length of stay, below the Swiss national average, without impacting pain outcomes and rates of complications.

Background: While curved intertrochanteric varus osteotomy is an effective treatment for osteonecrosis of the femoral head, whether this procedure is applicable to bilateral cases remains unclear. The aim of this study was to compare the clinical outcomes of bilateral curved intertrochanteric varus osteotomy and unilateral curved intertrochanteric varus osteotomy for osteonecrosis of the femoral head.

Methods: This comparative study included 60 patients with osteonecrosis of the femoral head; 15 (30 hips) underwent bilateral curved intertrochanteric varus osteotomy (bilateral group) and 45 (45 hips) underwent unilateral curved intertrochanteric varus osteotomy (unilateral group). Patients in the bilateral group were followed up for a mean of 8.0 years, whereas those in the unilateral group were followed-up for a mean of 8.2 years. The Harris Hip Score, complication rates, radiographic parameters, and survival rates were assessed. Conversion to total hip arthroplasty and radiographic failure were the endpoints.

Results: The postoperative Harris Hip Score was significantly lower in the bilateral group than in the unilateral group. Complication rates and radiographic parameters were not significantly different between the groups. Ten-year survival rates, with conversion to total hip arthroplasty and radiographic failure as endpoints, did not differ significantly between the groups. In bilateral curved intertrochanteric varus osteotomy, the survival rate, with radiographic failure as the endpoint, tended to be poorer on the contralateral side than on the initial side.

Conclusion: The clinical outcomes of bilateral curved intertrochanteric varus osteotomy were not necessarily favorable. When planning for bilateral curved intertrochanteric varus osteotomy, surgeons should ensure that the contralateral hip could undergo surgical intervention timeously.

Purpose: This study aimed to explore the biomechanical interrelationships in Progressive Collapsing Foot Deformity (PCFD), also known as flatfoot, with concurrent hallux valgus (HV), first metatarsal pronation and sesamoid bone displacement. The primary purposes were to quantify correlations between arch collapse, first metatarsal rotation, HVA (hallux valgus angle), and sesamoid displacement using weight-bearing computed tomography (WBCT), which provides superior three-dimensional insights compared to traditional radiographs. The central research question was: How is M1 rotation related to alterations in arch angles in PCFD and to sesamoid malposition, and is it independent?

Methods: A retrospective analysis was conducted on WBCT scans from 22 patients (aged 18-65) with symptomatic PCFD, collected between 2023 and 2025. Inclusion required arch angle > 131°; exclusions included prior surgery or systemic conditions. Scans used a cone-beam system (96 kV, 7.5 mAs, 0.4 mm slices) in bipedal stance. Two observers measured: forefoot arch angle (FAA) for PCFD severity, alpha angle for metatarsal rotation, HVA via axial axes, and sesamoid displacement graded as 0-3 on axial views. Inter-observer reliability was assessed with intraclass correlation coefficients (ICC > 0.8). Spearman's correlations evaluated relationships, with p < 0.05 significant, using SPSS.

Results: Analysis revealed a strong positive correlation between increased arch angle and increased first metatarsal rotation (r = 0.72, p < 0.01), strong positive correlation between greater arch angle and HVA (r = 0.67, p < 0.01), and moderate positive correlation between greater M1 rotation and sesamoid bone displacement (r = 0.5, p < 0,01). No correlation was found between HVA and metatarsal rotation (r = 0.1, p > 0,01).

Conclusion: PCFD is strongly associated with hallux valgus deformity and first metatarsal rotation, which is closely linked to sesamoid displacement. Metatarsal rotation appears to be an independent and likely early component of HV deformity, related to foot pronation and sesamoid malposition, and should be specifically evaluated and addressed in both diagnosis and treatment. No significant association exists between hallux valgus angle and metatarsal rotation. Additionally, hallux valgus deformity is associated with increased arch angle, which should be considered in the management of both conditions.

Purpose: To evaluate the incidence, magnitude, and risk factors for secondary angular deformity after tibial lengthening with a circular external fixator in skeletally immature patients. We hypothesized that younger age and low bone healing index would predispose to late valgus drift.

Methods: A retrospective review was conducted on 98 children who underwent tibial lengthening using a circular external fixator, with a minimum follow-up of one year. Radiographic assessment included full-length standing AP radiographs and lateral tibial views obtained preoperatively, at fixator removal, six months post-removal, and at final follow-up. Measured parameters included the mechanical Medial Proximal Tibial Angle, Center of Rotation of Angulation, and Posterior Proximal Tibial Angle. Risk factors for secondary deformity were analyzed using independent T test, Chi-Square test, Pearson test and multivariate logistic regression.

Results: A valgus deformity greater than 3° developed in 36 patients (37%), primarily within the first six months after frame removal. Younger age at surgery (p = 0.017) and a bone healing index ≤ 40 days/cm (OR 2.3; p = 0.049) were significantly associated with valgus drift. A progressive valgus shift in CORA correlated with a shorter consolidation index (p = 0.021). Sagittal alignment showed a small but significant early decrease.

Conclusion: Secondary valgus deformity is a common and under-recognized complication following tibial lengthening with a circular external fixator in skeletally immature patients. Younger age at surgery and low bone healing index are the principal risk factors for this late angular drift. Furthermore, they question the efficacy of intentional frontal overcorrection to reliably prevent secondary deformity and suggest that additional corrective strategies may be required.

Purpose: This study assessed early complications and postoperative blood transfusion rates after simultaneous bilateral prosthetic hip or knee replacement.

Materials and methods: Between 2020 and 2024, 285 patients underwent single-session bilateral total hip arthroplasty (THA), total knee arthroplasty (TKA), or unicompartmental knee arthroplasty (UKA) at a single referral centre. The cohort consisted of 102 patients in the TKA group, 83 in the THA group, and 100 in the UKA group. Patients were 57.2% male, with a mean age of 65.2 years ± 10.9 and a mean BMI of 27.9 ± 4.5. Based on the American Society of Anesthesiologists (ASA) classification, preoperative risk assessment showed a mean score of 1.8 ± 0.5. Early complications occurring within the first two postoperative months and anaemia requiring blood transfusion were recorded.

Results: The early complication rate was 2.5% (7/285), with no complications in the UKA group, 5% (4/83) in the THA group, and 2% (2/100) in the TKA group. No deaths, deep venous thrombosis, pulmonary embolisms, or surgical site infections were reported. Complications included three periprosthetic fractures, one hip dislocation, one early unipolar revision for acetabular migration, and one extensor mechanism rupture. The transfusion rate was 4.6% (13/285), with no transfusions required in the UKA group, which was lower compared to THA (6%; 5/83) and TKA (8%; 8/100) (p = 0.02).

Conclusion: Single-stage bilateral hip and knee replacement prove to be a safe procedure with a low complication rate. UKA showed no early complications or transfusion needs, confirming its reliability as a safe option for single-stage bilateral procedures.

Objective: In the context of the widespread implementation of enhanced recovery after surgery (ERAS) in orthopaedics, postoperative supportive interventions for patients with lower limb fractures remain limited. This study aimed to introduce a vibration-stimulation device designed in accordance with ERAS principles and to evaluate its clinical effectiveness.

Methods: This prospective randomized controlled trial consecutively screened 1,241 patients aged 18-75 years with lower limb fractures admitted to a tertiary university-affiliated orthopaedic hospital between January and December 2024, of whom 707 met the inclusion criteria. Patients were randomly assigned in a 1:1 ratio by a random number table to a vibration group or a blank control group. The primary outcomes were the seven day postoperative pain visual analogue scale (VAS) score and the incidence of lower limb deep vein thrombosis (DVT). Secondary outcomes were radiographic fracture-healing time and postoperative functional scores. The primary analysis followed the intention-to-treat (ITT) principle, comparing all randomized patients with available outcome data according to their original allocation, and a per-protocol (PP) sensitivity analysis was additionally performed.

Results: A total of 707 patients completed six to 12 months of follow-up and were included in the ITT analysis (350 in the vibration group and 357 in the control group). In the overall population, the seven day postoperative incidence of lower limb DVT was significantly lower in the vibration group than in the control group [10.9% (38/350) vs 22.6% (81/357); absolute risk difference (ARD) = 11.7%]. The seven day postoperative pain scores were lower in the vibration group (weighted mean approximately 5.1 vs 5.7), radiographic fracture-healing time was shorter (approximately 5.2 vs 5.5 months), and functional scores at final follow-up were higher (approximately 127.8 vs 123.2). PP sensitivity analyses yielded results consistent in direction with the ITT analyses, further supporting the robustness of the study conclusions.

Conclusion: Vibration-stimulation therapy facilitates rapid postoperative recovery in patients with lower limb fractures and has a favourable safety profile, and may represent a promising component of postoperative ERAS strategies in the future.

Background: The quest for optimal treatment of acute distal tibiofibular syndesmotic disruptions is still in full progress. Using suture-button repair devices is one of the dynamic stabilization options, however, they may not be always appropriate for stabilization, for example in length-unstable syndesmotic injuries. The aim of this biomechanical study was to investigate whether a novel screw-suture implant addresses such issues compared to suture-button implants while preserving dynamic capabilities.

Methods: Eight pairs of human cadaveric lower legs were injured by complete syndesmosis and deltoid ligaments cuts, and reconstructed using a screw-suture (FIBULINK, Group 1) or a suture-button (TightRope, Group 2) implant for syndesmotic stabilization, placed 20 mm proximal to the tibia plafond. Following, all specimens were biomechanically tested over 5000 cycles under combined 1400 N axial and ± 15° torsional loading. Anteroposterior, axial/vertical, mediolateral and torsional movements at the distal tibiofibular joint level were evaluated biomechanically via optical motion tracking.

Results: Anteroposterior and axial/vertical movements were significantly smaller and maintained over the cycles in Group 1 compared with Group 2 (p < 0.001). No further significant differences were identified between the groups (p ≥ 0.318).

Conclusion: Although both implant systems demonstrate ability for stabilization of unstable syndesmotic injuries, the screw-suture reconstruction provides better anteroposterior and axial/vertical stability of the distal tibiofibular joint, and maintains it over time under dynamic loading in a cadaveric study design. Therefore, it could be considered as a valid option for treatment of syndesmotic disruptions with length-unstable fibula.

Level of evidence/ study design: Level V, Controlled Laboratory Study.

Purpose: Hip arthroscopy is widely used for treating femoroacetabular impingement (FAI), yet long-term data evaluating PASS, MCID thresholds, functional recovery, and revision rates remain limited. This study aimed to assess minimum five year outcomes following hip arthroscopy for FAI and to identify predictors of postoperative success.

Methods: In this retrospective cohort study, 133 patients with a minimum of five years of follow-up were evaluated. Preoperative and postoperative outcomes included mHHS and VAS scores. Postoperative PROMs included iHOT-12, HOS-ADL, and HOS-Sport. PASS, MCID achievement, return to sport (RTS), return to work (RTW), revision arthroscopy, and conversion to total hip arthroplasty (THA) were recorded. MCID for ΔmHHS was determined using ROC analysis with PASS as the external anchor. Logistic regression identified predictors of PASS.

Results: The mean mHHS improved from 62.0 ± 12.9 preoperatively to 83.6 ± 12.8 at final follow-up (p < 0.001). VAS scores improved from 7.7 ± 1.9 to 3.1 ± 2.3 (p < 0.001). PASS was achieved by 72.2% of patients, and 83.1% met the MCID threshold of a 10-point increase in mHHS. Return-to-sport and return-to-work rates were 96.2% and 96.9%, respectively.

Conclusion: Hip arthroscopy for FAI provides durable clinical improvement at long-term follow-up, with high PASS and MCID achievement rates. RTS and RTW rates were excellent, and revision and THA conversion rates were comparable with contemporary long-term reports. Preoperative pain severity was the only independent predictor of PASS.