International Orthopaedics最新文献

Purpose: Periprosthetic joint infection (PJI) after shoulder arthroplasty remains a devastating complication, and the optimal surgical approach is still debated. This study aimed to compare the outcomes of single-stage versus two-stage revision and to identify clinical or demographic factors associated with treatment failure.

Methods: A retrospective observational study was conducted at a single tertiary hospital including 29 patients treated for shoulder PJI between 2010 and 2023. Patients underwent either one-stage (n = 15) or two-stage (n = 14) revision according to clinical and microbiological criteria, and the final choice of surgical strategy (one-stage vs. two-stage revision) was made at the discretion of the attending surgeon. The primary outcome was treatment success, defined as infection eradication without further surgery or suppressive antibiotics. Secondary outcomes were pain and functional results measured with the Constant-Murley Score (CMS), the Simple Shoulder Test (SST), and the Visual Analog Scale (VAS). A standard statistical analysis was performed comparing baseline data of both groups and finding factors related to the primary outcome.

Results: Baseline characteristics of both groups were comparable. Overall infection control was achieved in 83% of patients, nonetheless, the one-stage group showed a higher success rate compared with the two-stage group (93% vs. 71%), although this difference did not reach statistical significance (p = 0.169; OR:0.19(0.003,2.29)). Functional outcomes assessed by CMS and VAS did not differ significantly between groups, whereas SST scores were significantly better following one-stage revision (p = 0.006). Increased BMI and a higher number of previous surgeries tended to be associated with treatment failure.

Conclusion: Single-stage revision achieved comparable infection control and better functional outcomes than two-stage revision, supporting its role as a reliable surgical option for shoulder PJI in appropriately selected patients, although it could be influenced by bias selection.

Purpose: This study evaluated the accuracy of intraoperative leg length and femoral anteversion measurements obtained during total hip arthroplasty (THA) using the Mako robotic system with enhanced mode.

Methods: A total of 55 hips in four men and 51 women who underwent primary THA with the Mako system via an anterolateral approach were retrospectively evaluated. Intraoperative measurements of leg length and femoral anteversion displayed by the Mako enhanced mode were compared with postoperative CT-based measurements. Absolute errors and their distributions were calculated to assess the accuracy of intraoperative assessments.

Results: The mean absolute error was 2.3 ± 1.8 mm for postoperative leg length discrepancy and 2.9 ± 2.2° for stem anteversion. Of the 55 hips, 46 (83.6%) showed leg length errors within 3 mm and 51 (92.7%) within 5 mm. For stem anteversion, 48 hips (87.3%) were within 3° and all 55 hips (100%) were within 5°. Mako enhanced mode could not be completed in 10.7% of cases because of femoral array loosening or screw penetration into the medullary canal.

Conclusion: Mako enhanced mode demonstrated clinically acceptable accuracy for intraoperative measurement of leg length and femoral anteversion, contributing to precise femoral stem implantation in robotic-assisted THA.

Purpose: This study aims to describe and analyse pediatric cervical spine (C-spine) trauma over 32 years at a level 1 trauma centre.

Methods: A retrospective observational study was conducted, including patients younger than 16 years hospitalised after C-spine trauma from 1991 to 2022. Data on demographics, injury mechanisms, affected levels, associated injuries, neurological deficits (Frankel scale), treatments, and outcomes were analysed. Patients were divided into two age groups: < eight years (Group A) and nine to 16 years (Group B). Injuries were categorised as SCIWORA or skeletal, and by level-upper (C0 to C2) or lower (C3 to C7). Statistical analysis was performed using SPSS v29.0 (p < 0.05).

Results: A total of 102 patients were identified (67% male; 65% > 8 years). Younger children had more upper C-spine injuries (55.6%), lower injuries were more common in Group B (53%) (p = 0.006). mechanisms included motor vehicle accidents, pedestrian accidents, falls, and sports injuries. Associated injuries were present in 59% of cases, mainly head trauma. SCIWORA occurred in 14.7% of patients, with MRI-confirmed cord contusions in 60% of these. Most patients (74.7%) underwent conservative treatment. Neurological deficits were present in 38% of patients, and 51.2% showed improvement. The mortality rate was 16.5%, significantly higher among those with neurological impairment (p = 0.004).

Conclusion: Pediatric C-spine trauma is uncommon. MRI is essential for detecting spinal cord injury in SCIWORA. The high prevalence and impact of associated injuries on mortality highlight the need for thorough primary evaluation. Multicenter studies are necessary to improve management strategies and outcomes.

Background: It remains unclear whether altered bone density may be a stability issue in stemless reverse shoulder arthroplasty (RSA).

Methods: This was a retrospective multicentric study. Patients with stemless RSA with two-year postoperative shoulder X-ray and clinical data were included. Measurement of proximal humeral cortical bone thickness (CBT avg) on postoperative radiography was used to assess bone density.

Results: 68 patients (mean age, 67.0 years) were included. CBT avg < 6 mm (osteoporosis) at two years was reported in 22.2% (2/9) of patients with humeral loosening and 35.6% (21/59) without humeral loosening (p = 0.7073). After adjustment for age and body mass index (BMI), CBT avg < 6 mm was not significantly associated with humeral loosening at two years (OR 0.37; 95% CI 0.04-2.21). Factors associated with humeral loosening vs. no humeral loosening at two years were BMI (24.2 vs. 27.9 kg/m²; p = 0.0131), cervico-diaphyseal angle < 140° at two years (66.7% vs. 16.9%; p = 0.0039) and lateralization of polyethylene (100% vs. 59.3%; p = 0.0217).

Conclusions: These results suggest that radiological evaluation of bone density does not predict early migration of stemless RSA implants. Some clinical factors such as BMI or implant configuration were associated to early implant migration, but never led to implant removal.

Background: Dynamic anterior shoulder stabilization (DAS) combined with Bankart repair (BR) has gained attention for treating anterior shoulder instability (ASI) with subcritical anterior glenoid bone loss (GBL). This study aims to evaluate the clinical and biomechanical outcomes of DAS combined with BR for ASI.

Methods: A comprehensive search of PubMed, Embase, and Scopus through August 2024 identified biomechanical and clinical studies assessing DAS in ASI. Reviews, surgical techniques, case reports, and abstracts were excluded. A meta-analysis was performed using a random-effects model, with using weighted mean differences (WMD) for continuous variables to compare pre-to-post treatment effects. MINORS and QuADS tools were used to assess the quality of the included studies.

Results: Five biomechanical studies (60 cadaveric shoulders, GBL 10%-20%) demonstrated that DAS significantly improved anterior glenohumeral stability and load-to-dislocation compared to isolated BR, particularly in models with < 20% GBL and on-track Hill-Sachs lesions (HSL). Three clinical studies (100 shoulders, mean age ranged from 23.4 to 21, GBL 8.2%-10.5%) revealed significant improvements in Rowe scores (mean difference [WMD] = 58.7; p < 0.001) and forward elevation (WMD = 4.8; p = 0.02), with no significant changes in external or internal rotation. Return-to-sport rates were high (90% at any level, 71% at the same level), with 8% experiencing recurrent instability and 2% requiring reoperation.

Conclusion: Available evidence suggests that DAS combined with BR offered significant biomechanical improvements, substantial patient-reported outcome improvements, better forward elevation, high return-to-sport rates, and a low complication profile for ASI with subcritical GBL. However, caution is advised in cases with off-track HSL and GBL of approximately 20%, where DAS offers less stability when compared to Remplissage and Latarjet and increased reoperations rates.

Purpose: Supracondylar humerus fractures are the most common elbow injuries in children, with non-operative management frequently preferred in Gartland type I and selected type II cases. While biomechanical factors affecting outcomes have been well documented, the influence of socioeconomic status (SES) on functional and radiological results remains insufficiently explored.

Methods: This retrospective cohort study analyzed 237 children (aged 3-13 years) treated non-operatively for supracondylar humerus fractures between February 2019 and February 2024. Socioeconomic status was determined using the Hollingshead Index and categorized as low, middle, or high. Functional outcomes were assessed using Flynn's criteria, while radiological evaluation included Baumann and carrying angle measurements. Subgroup analyses were performed according to fracture type.

Results: There were no significant differences in age, gender, or fracture type between SES groups (p > 0.05). However, Flynn functional scores were significantly lower in the low-SES group compared with middle- and high-SES groups (p = 0.014). Radiological parameters, including Baumann and lateral humerocapitellar angles, did not differ significantly among groups (p = 0.41 and p = 0.37, respectively). Complications were rare (2.3%) and similar between groups.

Conclusion: Socioeconomic disadvantage was associated with poorer functional recovery after non-operative management of paediatric supracondylar humerus fractures, despite comparable fracture characteristics and radiological results. Early follow-up and caregiver support may help mitigate these disparities.

Level of evidence: Level III (retrospective cohort study).

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.