Journal of Bone and Joint Surgery, American Volume最新文献

Background: No previous studies have investigated the application of an ultrasonic bone scalpel (UBS) in the treatment of osteoid osteoma (OO). We aimed to evaluate the safety and effectiveness of UBS use, either as a standalone treatment or in combination with radiofrequency ablation (RFA), for managing OO.

Methods: In this single-center study, a retrospective analysis was performed that included patients who were radiographically or histologically diagnosed with OO at Shanghai General Hospital from September 2022 to November 2023. The treatment modalities were RFA, UBS, or RFA and UBS combined. Demographic data, clinical presentation, and radiographic characteristics were collected and analyzed. Treatment failure was defined as symptom recurrence, reoperation, or the occurrence of complications.

Results: A total of 77 patients (mean age, 16.12 ± 10.91 years; 70% male; 100% Han Chinese) were included. Most lesions (60%) were located in the femur, and the mean nidus diameter in the cohort was 11.58 ± 6.57 mm. Imaging classification revealed cortical (36%), subperiosteal (7%), cancellous (32%), and intra-articular (25%) types. Treatment included RFA (30%), UBS (34%), and RFA+UBS (36%). Visual analogue scale (VAS) pain scores decreased significantly from 4.55 ± 1.12 preoperatively to 0.99 ± 0.60 on postoperative day 3 and to 0.25 ± 0.52 at 1 month (p < 0.001). No major complications occurred. The treatment success rate was 97% during the 18 to 34 months of follow-up (mean, 27.32 ± 5.05 months).

Conclusions: The UBS, whether used alone or in combination with RFA, effectively improved short-term pain relief and functional recovery in patients with OO, with no major complications. Similar to RFA, UBS use appears to be a safe and reliable treatment option for OO. Because each treatment approach has its own advantages, it is recommended to select the surgical method on the basis of the lesion characteristics. This recommended treatment algorithm supports clinical decision-making and broadens minimally invasive treatment options for OO.

Level of evidence: Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.

Background: The trapezius is recognized as a dynamic stabilizer of the acromioclavicular (AC) joint. This function has drawn attention in the treatment of AC joint dislocation. We aimed to clarify the anatomy of the aponeurosis of the trapezius insertion about the AC joint. We hypothesized that the trapezius aponeurosis would exhibit distinctive characteristics in 3 regions: the acromial, AC-joint, and clavicular insertions.

Methods: We analyzed 21 cadaveric shoulder girdle specimens from 13 donors of Japanese ethnicity (4 male and 9 female; mean age [and standard deviation], 86 ± 7.9 years [range, 72 to 97 years]). Fifteen specimens were analyzed macroscopically and 5 histologically. One specimen was excluded because of osteoarthritis. Macroscopic examination included aponeurosis length measurement and fiber orientation analysis.

Results: The trapezius aponeurosis inserted on the medial edge of the acromion, the posterior end of the AC joint, and the posterior edge of the lateral clavicle. The mean aponeurosis length was longest at the acromial insertion (mean, 28.9 ± 5.4 mm), followed by the AC-joint insertion (20.3 ± 7.7 mm), and shortest at the clavicular insertion (7.2 ± 3.2 mm) (p < 0.001). The trapezius aponeurosis was found to extend to the surface of the acromion and AC joint, connecting these structures to the deltoid origin. The coherency value, which reflects the regularity of fiber orientation, was higher on the osseous surface of the acromial insertion (median [interquartile range], 0.36 [0.26 to 0.55]) and the AC-joint insertion (0.37 [0.23 to 0.44]) than at the clavicular insertion (0.22 [0.18 to 0.30]). Histological observation showed that the aponeurosis was inserted via fibrocartilage only at the acromial insertion, just posterior to the AC joint. The aponeurosis at the AC-joint insertion was thicker than that at the clavicular insertion.

Conclusions: The trapezius aponeurosis at the acromial and AC-joint insertions formed a contiguous complex with the origin of the deltoid tendon and with the superior AC-joint capsule.

Clinical relevance: The trapezius aponeurosis at the acromial insertion, just posterior to the AC joint, may be critical for the dynamic stability of the joint.

Background: The associations between spine-specific muscle sarcopenia and clinical outcomes after cervical and lumbar spinal surgery have been investigated. However, no study has investigated the associations between cervical multifidus sarcopenia (CMS) and outcomes after laminoplasty for cervical ossification of the posterior longitudinal ligament (OPLL). The aim of the present study was to investigate whether CMS affects cervical sagittal alignment (CSA) and patient-reported outcomes (PROs) in patients with cervical OPLL who underwent laminoplasty.

Methods: A retrospective review of prospectively collected data on patients with cervical OPLL who underwent laminoplasty was conducted from 2015 to 2020. CMS was evaluated on T2-weighted magnetic resonance imaging sequences at the C5-C6 level and graded according to the Goutallier classification. CSA parameters, including the C2-C7 lordosis angle, C2-C7 sagittal vertical axis (SVA), C2 slope, and T1 slope, were measured. PROs, including visual analog scale (VAS) neck and arm pain, Japanese Orthopaedic Association (JOA), and Neck Disability Index (NDI) scores, were recorded. Patients were grouped according to the Goutallier classification of CMS, and their preoperative demographic and OPLL characteristics, preoperative and latest follow-up PROs, and preoperative, immediate postoperative, and latest follow-up CSA parameters were analyzed.

Results: A total of 134 patients with cervical OPLL were enrolled, including 36 patients with mild CMS (Goutallier grade >0 to 1.0), 47 patients with moderate CMS (grade 1.5 to 2.0), and 38 patients with severe CMS (grade 2.5 to 4.0). All patients were Han Chinese. The mean age differed significantly among the groups (p = 0.004), whereas the other demographic characteristics were comparable among the groups. CMS severity was significantly associated with the OPLL occupancy ratio. Significant differences were found in the postoperative changes in C2-C7 lordosis angle, C2-C7 SVA, C2 slope, and T1 slope among the groups. Greater CMS severity was associated with worse NDI and VAS neck pain scores at the latest follow-up.

Conclusions: In a uniform cohort of patients who underwent laminoplasty for cervical OPLL, CMS had a negative impact on CSA and PROs. These findings highlight the potential value of preoperative assessment of CMS in this patient population.

Level of evidence: Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

➢ The incidence of vertebral compression fractures is increasing, particularly in elderly populations and postmenopausal women, in whom low bone mineral density is a key underlying factor.➢ Conservative management remains the first-line treatment option due to its high success rate and avoidance of surgical complications. When surgical intervention is necessary, cement augmentation via kyphoplasty and via vertebroplasty remain the most common options.➢ Kyphoplasty may be favored over vertebroplasty, especially in patients with severe preoperative kyphotic deformities, as kyphoplasty has a lower risk of adjacent vertebral fractures and demonstrates a greater reduction of the kyphotic deformity.➢ Consideration of restoring proper local spinal alignment is essential in preventing adjacent vertebral fractures and maintaining long-term spinal stability.

Background: Although total knee arthroplasty (TKA) is known to improve patient-reported outcome measure (PROM) scores in the short term to midterm, the long-term trajectories of both disease-specific and generic PROM scores remain unclear.

Methods: We retrospectively analyzed the prospectively collected registry data of 1,264 patients (mean age, 68.5 years; 93.7% female) who underwent primary TKA for osteoarthritis between 2005 and 2013 and completed PROM assessments at baseline and 10 years postoperatively. Disease-specific PROMs were assessed using the Knee Society Knee Score (KSKS), Knee Society Function Score (KSFS), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Generic PROMs were assessed using the Short Form-36 Health Survey (SF-36). Assessments were performed preoperatively and at 6 months and 1, 2, 5, 10, and 15 years postoperatively. Generalized linear models and linear mixed-effects models were used to evaluate temporal changes and subgroup differences by age and sex.

Results: All PROM scores improved significantly within 6 months after TKA. Thereafter, disease-specific PROMs showed modest changes up to 1 year, with relative stability until 5 years, whereas generic PROMs demonstrated heterogeneous patterns across different domains. Between 5 and 10 years postoperatively, WOMAC pain and stiffness scores did not show significant changes, the KSKS decreased but not significantly so, and WOMAC physical function scores exhibited small but significant deterioration that was not clinically meaningful. SF-36 domains demonstrated varied trajectories: physical and mental component scores declined by more than the minimal clinically important difference after 5 years, whereas the social functioning score showed continuous improvement, although not all changes were significant. Octogenarians demonstrated lower physical functioning scores but higher social functioning scores in the long term compared with younger patients, and female patients demonstrated inferior functional and vitality scores compared with male patients.

Conclusions: Both disease-specific and generic PROM scores after TKA improved significantly and remained superior to baseline scores over a 15-year period, although physical function scores tended to decline in the long term. In this large, predominantly female Korean cohort, the distinct age- and sex-specific trajectories highlight the importance of implementing individualized, time-adapted long-term management strategies to optimize patient outcomes.

Level of evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

Background: Revision total hip arthroplasty (THA) presents several unique challenges, one of which is the removal of osseointegrated uncemented femoral stems. Traditional techniques, such as extended trochanteric osteotomy, are associated with complications and patient morbidity. Recently, the advent of osteotome systems designed to facilitate femoral stem extraction has improved the capacity for complete fixation disruption without the need for osteotomy. This study describes our experience with one such novel system in a large series of revision THAs.

Methods: Patients undergoing femoral component revision during revision THA from December 2017 to July 2024 were identified from our institutional database. We included and analyzed patients undergoing revision for any indication so long as the revised femoral component was cementless and confirmed to be osseointegrated at the time of revision surgery. Extraction was attempted with the femoral-extraction osteotome system of interest in all cases.

Results: Of the 92 included cases, 65% involved single-taper wedge stems; 16%, fit-and-fill style designs; and 9%, fully hydroxyapatite (HA)-coated stems. Using the osteotome system, femoral extraction was successful (no intraoperative fracture or requirement for osteotomy) in 73% of the cases. Osteotomy was required in 10% of the cases but was not required for extraction of any single-taper wedge stem. Of those with fit-and-fill or fully HA-coated stems, 57% required osteotomy or sustained an extraction-related fracture. Extraction-related intraoperative fractures occurred in 13% of the cases.

Conclusions: In this large series of revision THAs, the use of a novel osteotome system designed for femoral component extraction led to successful extraction in 73% of the cases. The relatively low rate of osteotomy (10%) suggests that this technique is useful, but it also highlights limitations and the need for further innovation given the contemporary shift toward the use of collared, fully coated triple-tapered stems.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.