International Orthopaedics最新文献

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.

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.

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.

Purpose: Recurrent hip dislocation after total hip arthroplasty is among the most distressing complications for patients, often reshaping their everyday lives. Beyond the immediate physical consequences, repeated instability generates fear of movement, social withdrawal, and emotional strain. Yet, the extent of this burden has rarely been quantified using patient-centered methods.

Methods: We evaluated 170 patients who had experienced at least three dislocations and were scheduled for revision surgery. To capture the impact on health-related quality of life (HRQoL), patients completed a Time Trade-Off (TTO) assessment, estimating how many years of life they would exchange for a dislocation-free state. A parallel measure, the Survival Implant TTO, explored whether patients would sacrifice implant longevity in favor of greater stability. Their preferences were compared with surgeons' attitudes toward balancing implant durability and stability.

Results: Patients consistently described instability as a devastating experience, with many reporting restrictions in daily activities and a loss of independence. On average, patients were prepared to exchange nearly one quarter of their remaining life expectancy for stability and were also willing to shorten projected implant survival if this reduced the likelihood of further dislocations. In contrast, surgeons-particularly when treating younger patients-often emphasized implant durability over stability.

Conclusions: Recurrent hip dislocation has a far-reaching impact on quality of life, comparable to or exceeding that of chronic systemic diseases. Importantly, patient priorities differ from those of surgeons: stability is consistently valued over implant longevity. Incorporating these perspectives into revision planning is essential for truly patient-centered care.

Purpose: Sleep disturbance is common in patients with rotator cuff tear arthropathy (RCTA). While reverse shoulder arthroplasty (RSA) is effective for improving pain and function, its effect on sleep quality (SQ) has not been well defined. This study aimed to evaluate the impact of RSA on SQ, recovery trajectory, and clinical outcomes.

Methods: This retrospective study included patients with RCTA who underwent RSA between 2014 and 2021 with a minimum follow-up of 24 months. SQ and clinical outcomes were assessed using the Visual Analog Scale (VAS), Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES) score, Pittsburgh Sleep Quality Index (PSQI), and Jenkins Sleep Scale (JSS). Preoperative and postoperative values were compared to evaluate changes over time.

Results: Forty-six patients (mean age, 68 years) with a mean follow-up of 5.7 years were included. Sleep disturbance was reported by 45.7% of patients preoperatively, decreasing to 26.1% at three months and 21.7% at the last follow-up (p < 0.001). Median PSQI scores improved from 6 preoperatively to 5 at three months and remained stable thereafter. The mean ASES score increased from 40.2 preoperatively to 62.2 postoperatively (p < 0.001), and the average VAS score decreased from 6.0 to 2.0 by six months (p < 0.001).

Conclusion: RSA leads to improvements in sleep and function in RCTA patients, though gains plateau with time. Future studies using objective sleep measures may further refine rehabilitation outcomes.

Purpose: Hemiarthroplasty with concentric glenoid reaming (ream-and-run [RnR] arthroplasty) may be considered in patients with glenohumeral arthritis who want to avoid activity restrictions of prosthetic glenoid components. However, there are concerns of glenoid wear and medialization following RnR. While the factors responsible for glenoid medialization are unclear, the presence of bacteria may lead to weakening and osteolysis of the glenoid bone. This study sought to correlate the presence and amount of Cutibacterium cultured from RnR arthroplasties that were revised with the amount of radiographic glenoid medialization.

Materials and methods: Patients who underwent open revision surgery after primary RnR with a minimum of six months between primary and open revision surgery were included. Semi-quantitative Cutibacterium load from cultures at the time of revision was calculated. Glenoid medialization was measured from radiographs taken post-primary RnR and before revision surgery. Glenoid medialization amount and rate were assessed against Cutibacterium presence and load.

Results: Radiographs of 39 shoulders with average follow-up of 2.6 ± 2.4 years were analyzed. Twenty-five (64.1%) were culture-positive (≥ 2 positive deep cultures with Cutibacterium). Patients in the culture-positive and negative cohorts had similar glenoid wear rates of 1.4 and 1.3 mm per year, respectively (p = 0.892). There was no significant association between the amount of glenoid medialization and the presence or load of Cutibacterium.

Conclusions: We found no association between glenoid medialization after RnR arthroplasty and the presence or load of Cutibacterium at subsequent revision surgery. Longer follow-up studies are needed to better assess Cutibacterium's role in glenoid medialization after RnR arthroplasty.

Level of evidence: Level IV; Case Series.

Purpose: Preoperative anxiety (Pop-Anx) is highly prevalent among patients undergoing orthopaedic surgery. Pop-Anx can stem from fears related to the procedure, anaesthesia, or the recovery process. It has been linked to poorer postoperative outcomes, including greater pain, reduced function, and a lower quality of life. Despite its clinical significance, Pop-Anx is inconsistently assessed due to a lack of standardized tools and clear guidelines. The objective was to identify instruments used for measuring Pop-Anx in patients undergoing orthopaedic surgeries.

Methods: A systematic search was conducted across five databases up to September 2024, following PRISMA guidelines. Data on anxiety assessment tools, timing, administration, and related outcomes were extracted. Meta-analyses were conducted on studies with a low risk of bias using random-effects models.

Results: Screening of the literature revealed that 42 studies assessed Pop-Anx, involving a total of 115,380 patients. Ten different tools were used to measure Pop-Anx, with the Hospital Anxiety and Depression Scale (HADS) being the most frequent. Significant variability was observed in assessment timing and methodology. A meta-analysis showed that Pop-Anx was positively correlated with postoperative anxiety (z = 0.60) and pain (z = 0.22) and negatively correlated with joint function (z = -0.25). Females reported higher Pop-Anx (g = 0.38). The timing of outcome assessment did not significantly moderate these relationships.

Conclusion: Although Pop-Anx is associated with worse postoperative outcomes, it is assessed using heterogeneous and sometimes inadequate tools. Standardized, context-specific assessment methods are needed. Despite its clinical relevance, Pop-Anx remains underassessed in some common orthopaedic procedures.

This study evaluated the outcomes of double mobility trapeziometacarpal prostheses for treating osteoarthritis (OA) of the trapeziometacarpal (TMC) joint. A prospective observational analysis was conducted on 150 implants with a maximum follow-up of four years, including a clinical and radiographic assessment and an evaluation of complications. The results indicate a prosthesis survival rate of 97.9% after the first two years post-surgery, calculated using the Kaplan-Meier method. Significant improvements were observed in pain reduction (mean VAS at 3 months post-surgery 2,9 and 1.5 after 6 months), hand grip strength (25.93 kg at 6 months post-surgery), and range of motion (Kapandji score from 8.8 to 9.2, comparing the preoperative mean with the mean after the first postoperative month). The complication rate was low, with only two cases of cup migration and one case of trapezium resorption. Patient satisfaction was high due to the rapid functional recovery and reduced invasiveness compared to traditional techniques. Double-mobility prostheses offer a highly effective treatment for stage II and III TMC OA according to the Eaton-Littler classification, with minimal need for revision surgeries.

Introduction: Two-stage revision of total hip arthroplasty (THA) remains the gold standard for periprosthetic joint infection (PJI). Trabecular Metal (TM) offers a valuable option for acetabular reconstruction, but evidence in septic revision THA (rTHA) is scarce. This study evaluated outcomes of TM implants in two-stage rTHA for infection, hypothesizing results comparable to existing literature, especially in cases with major bone loss.

Materials and method: We retrospectively analyzed 32 two-stage rTHA (32 patients) performed between January 2010 and July 2021, with a minimum two years follow-up. All patients received TM acetabular implants. Bone loss was classified according to Paprosky: 3 IIA, 8 IIB, 3 IIC, 12 IIIA, and 6 IIIB, with pelvic discontinuity in 13 cases.

Results: At mean follow-up of 30.2 ± 10.9 months (range, 24 to 69), infection eradication was achieved in 87,5%. Staphylococcus species accounted for 84,4% of cases. Seven complications occurred, including six reoperations: five revisions (two for recurrent infection, 3 for mechanical failure). The overall failure rate was 21,9%. At 24 months, the healing rate, including all causes of failure, was 78,1% and revision-free rate 84,4%.

Conclusion: TM implants in two-stage rTHA for septic failure achieved satisfactory mid-term results, even in advanced acetabular bone loss (44% Paprosky II, 56% Paprosky III). To our knowledge, this is the first study exclusively evaluating TM in this context, supporting its role in complex acetabular reconstruction during septic revisions.

Level of evidence: IV.

Purpose: To compare, in two groups of patients, the prognosis of unplanned resections of soft tissue sarcomas treated in a specialised centre, in terms of survival, local recurrence and complications.

Methods: A retrospective investigation was performed between 2006-2016. A total of 191 patients were included. 147 (77%) were included in the control group (planned reactions) and 44 (23%) corresponded to the study group (unplanned resection). The control group, patients underwent primary limb salvage surgery by the orthopaedic oncology team and the study group those who were initially treated at another center and required a second oncologic surgery to achieve free margins. Overall survival, local recurrence, postoperative complications and prognostic factors were analyzed.

Results: Overall survival at five years was 67% (95% CI: 62-76%). Compared to both groups, there was no significant difference (p = 0.22). The risk of LR at five years was 19.1% (95% CI: 18.89-19.30) for the control group and 35.64% (95% CI: 34.56-36.11) for the control group. for the study group (p = 0.047). Postoperative complications were significantly higher in the study group, 45% versus 21% (p < 0.01). We found a greater number of small tumours in the unplanned resection group.

Conclusions: Unplanned resection of extremity soft tissue sarcomas does not affect the overall survival of patients, but has a higher risk of local recurrence, a higher risk of developing postoperative complications and a lower chance of limb preservation. This study underscores the importance of thorough preoperative evaluation, particularly for small (< 5 cm) soft tissue tumours of the limb, and supports referral to specialised centres for optimal management.