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 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.

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.