International Orthopaedics最新文献

Purpose: The cumulative probability of a first-time dislocation (CPD) after total hip arthroplasties (THAs) with a 22-mm head was reported in 2004 to rise steadily to 7% at 25 years. Later reports employing larger heads indicated that dislocations were concentrated in shorter periods after THA. Therefore, dislocations may occur differently over time depending on head sizes, which has not been clearly demonstrated. The purpose was to examine this hypothesis.

Methods: With first-time dislocation as the endpoint, the Cox proportional-hazards regression model and the Kaplan-Meier analyses were applied to 6,339 THAs performed for nontraumatic osteonecrosis of the femoral head, considering all possible influencing variables. Follow-up was 6.5 years on average (range, 0 to 27).

Results: First-time dislocations occurred in 289 THAs (4.6%) at a mean of 2.9 years (range, 0 to 19) following THA, with head sizes of 22, 26, 28, 32, and ≧ 36 mm in 33, 76, 86, 58, and 36 THAs, respectively (dislocation rate: 13.5, 8.2, 5.7, 2.5, and 2.7%, respectively; p < 0.001 in χ2 test). CPD increased linearly after THA in the 22-mm group, while larger-head groups showed a steep early rise followed by a decline.

Conclusion: First-time dislocations occurred differently over time with different head sizes.

Purpose: The aim of this study was to report the 10-year clinical and radiological outcomes, survivorship, and patient-reported results of the Persona posterior-stabilized (PS) total knee arthroplasty (TKA) performed in a single centre.

Methods: This retrospective cohort study was based on a prospectively institutional database. A total of 293 primary Persona PS TKAs performed between 2012 and 2015 were identified. After applying inclusion and exclusion criteria, 185 knees (168 patients) were available for analysis at a minimum follow-up of ten years. Clinical evaluation included the Knee injury and Osteoarthritis Outcome Score (KOOS) and the 2011 Knee Society Score (KSS). Radiological assessment consisted of the hip-knee-ankle (HKA) angle. Implant survivorship was analyzed using Kaplan-Meier methods.

Results: At 10 years, Kaplan-Meier survivorship for revision for any reason was 94.1% (95% CI 90.3-97.9%). Four revisions were performed (2 infections, 2 aseptic loosening). Mean KOOS scores improved significantly from preoperative to ten year follow-up (Pain 48→86; Symptoms 45→84; ADL 50→89; Sport 25→72; QoL 30→82; all p < 0.001). The KSS 2011 domains also significantly improved. The mean postoperative HKA angle was 179° ± 2°, with 7.8% of knees outside ± 3° from neutral. No radiographic evidence of radiolucent lines, osteolysis, or loosening was observed.

Conclusion: At ten years, the Persona PS knee system demonstrated excellent survivorship and durable functional results comparable to other contemporary TKA designs. Further comparative studies are required to determine whether its morphometric concept provides additional clinical benefit.

Level of evidence: IV Retrospective cohort study.

Purpose: Platelet-rich plasma (PRP) is a promising treatment for enhancing the outcomes of bone marrow stimulation for osteochondral lesions of the talus (OLT) and has demonstrated efficacy in alleviating symptoms due to its biological properties. However, the role of leukocyte concentration in PRP remains unclear, particularly regarding cartilage regeneration. This study aimed to compare the clinical outcomes and time to return to activity between leukocyte-poor PRP (LP-PRP) and leukocyte-rich PRP (LR-PRP) in OLT surgery.

Methods: Data from 29 patients with ≥ two year follow-up were retrospectively reviewed: 18 who received LP-PRP and 11 who received LR-PRP with OLT surgery. The study assessed the timeline of return to activity and Self-Managed Foot Evaluation Questionnaire (SAFE-Q) scores preoperatively and at three months, six months, and two years postoperatively.

Results: The LP-PRP group resumed jogging and sports significantly earlier than the LR-PRP group (P = 0.03, P < 0.01). No patients in either group experienced complications. Both groups showed improved SAFE-Q scores at six months, but at two years, the LP-PRP group maintained significantly higher scores compared to their preoperative levels, whereas the LR-PRP group showed declines in some domains.

Conclusion: LP-PRP enabled an earlier return to sports compared with LR-PRP. Additionally, LP-PRP maintained good clinical scores two years after surgery. In contrast, the LR-PRP group showed some decline from their early postoperative peak, although absolute scores remained above preoperative levels. These findings suggest that LP-PRP may be an effective adjuvant treatment for OLT surgery.

Level of evidence: III.

Purpose: Degeneration at the common extensor origin leads to lateral elbow pain and reduced quality of life. We conducted a double-blind, randomized, placebo-controlled trial involving 71 patients treated with leukocyte-poor PRP (LP-PRP), leukocyte-rich PRP (LR-PRP), or saline.

Methods: PRP content was analyzed using flow cytometry, confocal microscopy, and holotomography. Clinical outcomes (Visual Analogue Scale, Oxford Elbow Score) were assessed at baseline and at three, six, 12, 24, and 55 weeks.

Results: LR-PRP contained 3.8 × more leukocytes and 2.7 × fewer platelets than LP-PRP. Imaging revealed distinct platelet morphology and activation patterns between PRP types. The LP-PRP group showed significantly greater pain reduction at six weeks and improved elbow function from three to six weeks onward.

Conclusion: LP-PRP produced superior and longer-lasting clinical outcomes compared to LR-PRP and saline.

Clinicaltrials: GOV: NCT06854666 (retrospectively registered on 2025-01-13).

Background: Modular dual mobility (MDM) cups are widely used in primary total hip arthroplasty (THA) to reduce dislocation, but their impact on range of motion (ROM) to impingement versus single-mobility (SM) cups remains uncertain.

Methods: In this paired robotic-simulation study, 108 primary robotic-assisted THAs were virtually planned twice with CT-based software, once with an SM cup and once with an MDM cup. Cup and stem orientation were optimised to restore intra-articular length and global offset within 5 mm of the contralateral hip and to avoid impingement. ROM to first impingement was measured in extension/external rotation (ER), flexion/internal rotation (IR) with physiological pelvic tilt, and flexion/IR with 20° adduction. The mode of first impingement (intra-articular, extra-articular, or mixed) was recorded.

Results: Compared with SM, MDM cups increased ROM to impingement in extension and ER but slightly reduced ROM in flexion and IR at several test positions. Maximal extension to impingement and ER in extension were higher with MDM, whereas flexion with pelvic anteversion and IR at 100° flexion were lower. ROM to impingement was not uniformly greater with MDM, and first contact often shifted from intra-articular implant-on-implant impingement toward extra-articular impingement.

Conclusion: In robotic THA, MDM cups provide selective gains in ROM to impingement and shift the impingement towards extra-articular structures rather than providing a global increase in safe ROM. Clinically, MDM may suit patients needing extension/ER reserve or with anterior instability risk, and planning should consider osteophytes and bony constraints. Further prospective clinical validation is warranted.

Purpose: Knee coronal angular deformities are a frequently encountered challenge in paediatric orthopaedic practice. When surgical treatment is indicated, guided growth techniques have many advantages in managing these conditions. The purpose of this study is to evaluate the outcome of a modification of the original Percutaneous Epiphysiodesis using Transphyseal Screw (PETS) technique described by Métaizeau as a minimally invasive surgical approach in the treatment of knee angular deformities.

Methods: In this prospective study, a total of 14 patients (comprising 25 limbs) with a coronal plane deformity of the knee underwent percutaneous transphyseal screw hemiepiphysiodesis. Operative time is assessed. The patients were subsequently monitored for an average duration of 28 months. The radiological assessment was conducted using the metrics of MAD (mechanical axis deviation), mLDFA (mechanical lateral distal femoral angle), and MPTA (medial proximal tibial angle). Clinical assessment included the intermalleolar distance (IMD) and intercondylar distance (ICD). The functional outcome evaluation was conducted using a modified version of the original Böstman score, taking into account the different age groups of the targeted cases.

Results: In the genu valgum group, the mean preoperative values were: intermalleolar distance (IMD) 16.9 cm, mechanical axis deviation (MAD) 2.6 cm, and mechanical lateral distal femoral angle (mLDFA) 84°. In the genu varum group, the mean preoperative values were: intercondylar distance (ICD) 8.4 cm, mechanical axis deviation (MAD) -3.0 cm, and medial proximal tibial angle (MPTA) 77.8°. The mean operative time was 15 min. All radiological and clinical outcome measures showed significant improvement (P ≤ 0.05). At 24 months, 96% of cases achieved an excellent Böstman knee score. One patient reached skeletal maturity before full correction could be achieved. No other complications were observed.

Conclusion: This modification of the Métaizeau technique retains the advantages of PETS and offers a simplified approach that may reduce operative time and fluoroscopy use. Our results suggest that it is a safe and effective option for correcting coronal angular knee deformities in children. Further comparative studies are needed to confirm these potential benefits.

Introduction: Accurate cup sizing is crucial in total hip arthroplasty (THA). Conventional templating and intra-operative head sizing show inconsistent accuracy, whereas CT-based planning in robotic-assisted THA may offer superior precision. We aimed to compare implanted cup size with both CT-based planning and intra-operative native head sizing, hypothesising that CT planning would provides greater accuracy and consistency.

Methods: This single-centre study included 619 consecutive robot-assisted primary THAs templated with pre-operative CT scans. Implanted cup size was compared with the pre-operative CT-planned size in all hips, and with the intra-operative measurement of the native femoral head in 299 hips.

Results: CT-based planning closely predicted the implanted cup (exact 94.3%; ±1 size 98.7%; mean difference 0.05 ± 0.67 mm; r = 0.984, p < 0.001). Implant-native head comparisons showed larger mismatches (3.14 ± 2.31 mm; exact 9.4%; ±1 size 40.5%; r = 0.817, p < 0.001). Plan-implant agreement was modestly better in females (p = 0.039) and in smaller head categories (< 50 and 50-54 mm) versus > 54 mm (p = 0.007). For implant versus head, mismatch magnitude varied by head size, smaller heads tended toward greater relative oversizing, without a sex effect (p = 0.76).

Conclusion: In robotic THA, CT-based 3-D planning provides near-perfect cup-size prediction and substantially outperforms using the native head as a sizing reference. Residual variation reflects patient-specific factors, chiefly native head size and, to a lesser extent, sex, which should be considered alongside the CT plan. Using native head diameter as a complementary check may further refine pre-operative algorithms and guide intra-operative choices, optimizing component selection for long-term stability and function.

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.