International Orthopaedics最新文献

Purpose: Despite numerous studies demonstrating promising short-term outcomes of Total Knee Arthroplasty (TKA) with Customized Individually Made (CIM) implants, there is a significant lack of data on their mid-term effectiveness. Given the increasing number of TKAs performed annually, the rising demand for CIM implants, and the associated burden of revision surgeries, understanding the mid-term performance of CIM implants is crucial. Therefore, this study aims to report on the mid-term (minimum 5 years) outcomes of TKA using a CIM implant.

Methods: This retrospective cohort study included a consecutive series of 116 patients who received the ConforMIS^® iTotal CR implant between 2015 and 2018. Inclusion criteria were end-stage knee osteoarthritis with coronal deformities below 10° and absence of ligamentous instability. Exclusion criteria included simultaneous bilateral TKA. Patients were followed up at a minimum of five years post-surgery. They completed a questionnaire reporting on satisfaction, pain levels using the Visual Analogue Scale (VAS), current weight, the Oxford Knee Score (OKS), and the Forgotten Joint Score for the knee (FJS-knee). Statistical analysis included descriptive statistics for demographic and clinical variables, and outcomes were reported as means with ranges.

Results: The mean follow-up duration was 5.9 ± 0.8 years (range 5-7.4 years). 90% of patients stated they would undergo the same operation again, and 93% were either satisfied or very satisfied. The mean VAS for pain at rest was 2 ± 1.5 (range 0-6) and during exercise was 3 ± 2 (range 0-8). 58 patients (53%) managed to lose weight. The mean OKS was 41 ± 9 points (range 15-48), and the mean FJS-knee was 67 ± 23 points (range 4-100). No severe complications occurred.

Conclusion: CIM TKA using the ConforMIS^® iTotal CR implant can achieve excellent results with 93% of patients being satisfied or very satisfied at mid-term follow-up of five years. Prospective, randomized, and patient-blinded trials comparing off-the-shelf (OTS) TKAs with CIM implants are necessary to evaluate whether these implants are superior or not.

Purpose: To evaluate the influence of patellar morphology on functional outcomes and patellofemoral joint alignment after unicompartmental knee arthroplasty (UKA).

Methods: This study retrospectively analyzed the clinical and imaging data of 207 patients with osteoarthritis of the unicompartment of the knee who underwent UKA between September 2020 and April 2023. Patients were divided into three groups according to the Wiberg classification: group W1 (I, n = 47), group W2 (II, n = 117), and group W3 (III, n = 43). Knee function was assessed using the Hospital for Specialty Surgery (HSS) knee score and Feller patellar score, and the incidence of anterior knee pain after surgery was recorded and compared. Imaging parameters such as patellar tilt angle (PTA), lateral patellofemoral angle (LPA) and Insall-Salvati ratio (ISR) were measured to assess patellofemoral joint alignment.

Results: The HSS scores of the three groups were not statistically different; the postoperative Feller scores of the group W3 differed significantly from those of the other two groups. The incidence of early postoperative anterior knee pain was higher in the group W3 than in the other two groups. The difference between preoperative PTA, postoperative PTA and preoperative LPA in the group W3 and the other two groups was statistically significant.

Conclusion: Patients with Wiberg III patellae exhibited worse patellar scores, as well as more anterior knee pain and patellar tilt postoperatively. This finding highlights the need for individualized treatment to the Wiberg III patella during UKA to enhance surgical outcomes.

Purpose: Non-surgical treatment without weight-bearing restriction, even in the early post-injury phase, may have a favourable effect on the activities of daily living (ADLs) in elderly patients with peri-prosthetic femoral fractures (PFFs). This study aimed to assess the effectiveness of surgical and non-surgical treatments for PFFs in terms of ADL maintenance and clinical safety.

Methods: This retrospective cohort study included 44 patients with PFFs proximal to the stem fixation site without stem loosening. Rehabilitation with weight bearing was initiated after internal fixation of the fracture site in the surgical group (n = 12) and immediately after the injury in the non-surgical group (n = 32). Clinical and radiological outcomes, including time until the first weight-bearing exercise, time until independent walking, ADL deterioration, and bone union rate, were compared between groups. Independent risk factors for ADL deterioration were also evaluated.

Results: The time until first weight-bearing exercise was shorter and the ADL deterioration rate was smaller in the non-surgical group than in the surgical group (8.8 ± 9.2 vs. 21 ± 13 days, P = 0.004; 6.2% vs. 12.5%, P = 0.04, respectively). Bone union rates were similar between groups (91% vs. 83%, P = 0.42), and aseptic loosening of the stem was not observed. Time until first weight-bearing exercise was identified as an independent risk factor for ADL deterioration (odds ratio, 1.13; 95% confidence interval, 1.01-1.26; P = 0.03).

Conclusion: Non-surgical treatment of PFFs proximal to the stem fixation site without stem loosening, which does not restrict early weight-bearing exercise after injury, is an effective and safe treatment procedure that maintains ADL performance in elderly patients.

Purpose: This study aims to measure the peri-incisional numbness developing after Total Knee Arthroplasty (TKA) performed using the midline skin incision. It studies the natural course of the numbness and determines its correlation with the skin incision length (SIL).

Materials & methods: 66 knees undergoing primary TKA with a standard midline incision were evaluated. The SIL and the area of numbness (AON) were measured in complete knee extension and 90° of flexion. The area was marked by the patient using a sketch pen and then determined by an independent observer using monofilament testing. The "ImageJ" software was used to calculate the area.

Results: All patients developed numbness around the knee after TKA. There was a statistically significant correlation between the SIL and AON in both flexion and extension at two weeks (p < 0.001) and three months (p < 0.001). However, there was a weak and insignificant correlation at six months (p = 0.217).

Conclusion: When TKA is performed using the midline skin incision, the SIL positively correlates with the AON postoperatively during the initial short-term follow-up. At six monthly follow-ups, there is no significant correlation between the two.

Purpose: Total knee arthroplasty (TKA) is highly effective for end-stage knee osteoarthritis, providing long-term benefits and anticipated increased prevalence. The study compares Medial Pivot TKA's (MP-TKA) historical success for varus deformities with recent findings suggesting comparable outcomes for valgus deformities. Despite prevalent use of Posterior Stabilized TKA (PS-TKA) for valgus deformities, this research explores the unexplored comparative efficacy of MP-TKA vs. PS-TKA in knee osteoarthritis patients with valgus deformity.

Methods: This single-centre cohort study focused on 57 knees in 53 patients undergoing TKA for knee osteoarthritis with valgus deformity. Conducted between January 2013 and April 2021, the study compared MP-TKA and PS-TKA. Surgeries adhered to a medial parapatellar approach and modified gap technique, with perioperative interventions for pain, bleeding, and swelling. Outcome measurements included knee joint range of motion, radiographic evaluation, patients-reported outcomes, operative time, blood laboratory tests, estimated blood loss, and postoperative adverse events, and analyzed between the two groups.

Results: Postoperative hip-knee-ankle angles showed no significant difference between MP-TKA and PS-TKA. The pie crust technique was similarly used in both groups, and deformity correction showed no significant difference. Range of motion and clinical outcomes, measured by WOMAC and JOA scores, were comparable postoperatively. MP-TKA had a shorter surgical duration (p = 0.01), and PS-TKA exhibited higher estimated blood loss (p = 0.01) without significant complications in either group.

Conclusions: This pioneering study compares the outcomes of MP TKA and PS TKA in patients with valgus-deformed osteoarthritic knees. Compared to PS TKA, MP TKA shows a prolonged operative duration and increased blood loss, likely due to the requirement for patellar replacement. However, postoperative range of motion and clinical outcomes are similar. Both groups exhibit favorable midterm clinical results, supporting the viability of MP TKA for valgus deformed knees. The study, consistent in surgical approach, highlights MP TKA's effectiveness for valgus deformities.

Purpose: Proximal humerus fractures account for 4-5% of all fractures in adults and affect females more than males. With the advent of special locking plates, the treatment trend has shifted more towards a surgical approach. These methods have produced good results but very high complications rates have been reported in the literature. This study was undertaken to analyse the radiological parameters which reflect towards a favourable long term functional outcome in order to advance the surgical fixation skills for managing fractures of the proximal part of the humerus.

Materials and methods: 83 study participants with proximal humerus fracture fixed using proximal humerus locking plates were retrospectively analysed. The radiological parameters studied were neck shaft angle, head shaft angle, head diameter, head height, greater tuberosity to articular surface distance and reduction of the medial hinge with or without placement of calcar screw. The functional parameters assessed were the Constant Murley Score and range of movements of the shoulder joint. The patients were not followed further for the purpose of the study.

Results: The mean Constant Murley Score for the participants was 80.75 ± 8.09 (range 60-90). The participants with good to excellent CM Score had a significantly higher neck shaft angle (107.47 ± 9.74 v/s 124.16 ± 10.68) and (-0.28 ± 0.85 v/s 2.37 ± 2.28), head shaft angle (23.09 ± 4.82 v/s 31.76 ± 7.76), head diameter (40.08 ± 8.63 v/s 45.15 ± 4.73), head height (18.77 ± 1.96 v/s 20.69 ± 2.76) and greater tuberosity to articular surface distance (-0.28±0.85 v/s 2.37±2.28) as compared to the patients with satisfactory and worse CM Score. The patients with a higher neck shaft angle and a maintained subacromial space had a better range of shoulder abduction. A higher rate of valgus collapse was seen with an inadequate medial hinge reduction.

Conclusion: The radiological parameters which can predict towards a good functional outcome are a higher neck shaft angle and head shaft angle, a larger head diameter and head height, a superior position of the greater tuberosity in relation to the articular surface and a good medial hinge reduction.

Purpose: Management of chronic moderate and severe slipped capital femoral epiphysis (SCFE) remains controversial. We propose that the modified trochanteric triplane osteotomy(MTTO) with a 130⁰ angled blade plate, without removal of bone wedge, is effective for addressing moderate and severe chronic SCFE.

Methods: A retrospective review was performed on patients who underwent MTTO for moderate to severe chronic SCFE, with at least two years follow-up. Radiological outcomes assessed were osteotomy union, alpha angle, neck shaft angle, mechanical axis deviation and limb length discrepancy(LLD). Functional outcomes were assessed using modified Harris hip score, lower extremity functional scale (LEFS) and SF-36 questionnaire.

Results: A total of 11 patients (13 hips) underwent MTTO for chronic SCFE, with a mean age of 12.9 ± 2.1 years. The pre-operative median modified Harris Hip Score was 73. 12 had severe slip and one had moderate slip. All the osteotomies went on to unite by two months. At an average of 37 months follow up, the mean neck shaft angle was 129⁰, mean alpha angle was 69.7⁰, and mean LLD was 1.05 cm. There was significant improvement in the post-operative modified Harris hip score (p < 0.001), the median post-operative modified Harris hip score was 96, and the median LEFS was 78. One case had bone scan evidence of AVN, but did well with bisphosphonate therapy and one case had a superficial infection.

Conclusion: MTTO is a safe and effective option for addressing deformities in chronic moderate and severe SCFE. However, a residual proximal femoral Cam deformity persists after this procedure which may need to be treated with a simultaneous or a staged osteochondroplasty.

Purpose: To report the radiological and clinical outcomes of non-vascularized coracoid process autografts used for glenoid reconstruction during revision shoulder arthroplasty.

Material and method: This is a retrospective, monocentric study from January 2016 to October 2022 targeting patients treated with a coracoid bone graft for glenoid reconstruction during revision of shoulder arthroplasty. The primary outcome measures were coracoid graft union rate and graft-implant osseointegration. Secondary outcome measures included clinical and CT-scan identified radiological complications and functional outcomes as measured by the Visual Analog Scale (VAS), Range of Motion (ROM), Subjective Shoulder Value (SSV), Constant score (absolute and ponderate), and ASES score.

Results: Fifteen patients (9 males, 6 females; mean age 66.9 years, range 38-85) were included. At a mean follow-up of 20.9 months (range 12-56 months), 93.3% achieved complete graft integration. One case of partial lysis without baseplate loosening was noted. Regarding range of motion, the mean forward elevation was 130° (range 90°-170°), external rotation at the side 25° (range 10°-40°), external rotation in 90° of abduction 45° (range 10°-80°), and internal rotation 52° (range 10-80°). The mean VAS for pain was 1.1 (range 0-8), mean SSV 67.3% (range 40-90%), mean ASES score 85.5 (range 65-98.3), mean Absolute Constant score 58.6 (range 21-83), and mean Ponderate Constant score 77.5% (range 28.8-110.7%). No neurological injuries were reported.

Conclusion: Utilizing a non-vascularized coracoid graft during shoulder arthroplasty revision is a safe, reproducible, and time-efficient technique that demonstrated satisfactory osseointegration, implant stability, good functional results, and a low complication rate.

Purpose: Hip and knee arthroplasties are daily procedures in orthopaedic departments. Recently, same-day discharge (SDD) became increasingly popular, but doubts remain about its safety and generalization. Our hypothesis is that outpatient arthroplasty, in a high volume centre and with an institutional protocol, is an effective and reliable practice.

Methods: We realized a monocentric retrospective study of patients undergoing outpatient partial (UKA) or total (TKA) knee or hip arthroplasty (THA) in a high volume academic centre using a well-defined institutional pathway. Epidemiological data and complications occurring in the month following surgery were studied.

Results: 498 patients undergoing 501 arthroplasties (219 hips and 282 knees) were examined. The percentage of men and women was 60.28% and 39.72% respectively, mean age was 64.56 ± 9.59 years, mean BMI was 26.87 ± 4.2 and the most represented ASA score was 2. The success rate for same-day discharge was 97.21%. The most frequent causes of failure were urinary retention (28.6%), orthostatic hypotension (28.6%) and insufficiently controlled pain (14.3%). The readmission rate in the month following the operation was 0.8% and the rate of emergency department visits was 1.6%. Finally, the rate of early consultation visits was 7.98%. The comparison between success and failure subgroups in the outpatient setting of our cohort did not highlight statistically significant differences for studied parameters.

Conclusion: Outpatient arthroplasty, performed in a center used to managing such operations and with a well-established institutional pre- and post-operative protocol, is a safe practice.

Purpose: Acetabular defect reconstruction can be a complex and challenging surgical procedure, with stable long-term fixation of the implants remaining the ultimate goal. The purpose of this study was (1) to evaluate the radiological and clinical outcome of complex acetabular reconstruction surgery with the use of modular tantalum TM augments in combination with cemented revision cups; (2) to investigate blood tantalum concentrations in these patients; and (3) to report complications and mechanisms of failure related to this procedure at mid-term follow-up (mean 4.5 years).

Methods: We retrospectively reviewed 29 patients (29 hips) with severe acetabular bone loss (Paprosky type III A) reconstructed using a modular tantalum TM augment in combination with a cemented cup. We evaluated the implant survival and the radiological and clinical outcomes after a mean follow-up of 4.5 years (SD 2.2; range 8.4 - 2.1 years) using patient reported outcome scores (PROMs). Blood samples were analysed regarding tantalum concentration and compared with a control group.

Results: The cumulative survival rate at 4.5 years with the endpoint "revision of the acetabular component for any reason" was 96.2% (95% Confidence Interval 75.7-99.5). The PROMs improved significantly up to the latest follow-up, and radiographic data showed only one patient with signs of initial implant migration with a broken screw and a change of the position of the augment and the cup. Mean blood tantalum concentrations were significantly higher in the study group (0.16 µg/L) compared to the control group (0.002 µg/L) (P < 0.001).

Conclusions: This study has demonstrated good mid-term (mean 4.5 years) clinical and radiological outcomes of modular tantalum TM augments in combination with a cemented cup for the reconstruction of major acetabular defects. Mean blood tantalum concentrations were increased in patients with stable tantalum implants compared to healthy controls.