Journal of Orthopaedic Surgery最新文献

Objective: Revision surgeries for periprosthetic joint infections (PJIs) in arthroplasty can follow either one- or two-stage treatment protocols. Previous studies have reported similar reinfection rates and reductions in complication rates for both treatment options. However, the literature on the selection of one protocol is still controversial. Thus, our aim was to compare the outcomes, including reinfections, complications, reoperations, and mortality, associated with one- and two-stage revision surgeries for PJI via a systematic review and meta-analysis of comparative studies.

Methods: Comparative studies were identified through searches in PubMed, EMBASE, the Web of Science, and the Cochrane Library as of November 2023. RevMan version 5.3 was used for the analyses. The included studies directly compared one-stage revisions with two-stage revisions for PJI. The primary outcomes included reinfection, complications, reoperation, and mortality.

Results: Sixteen cohort studies (fifteen retrospective and one prospective) were included in the systematic review. All studies comprising 2039 patients were included in the meta-analysis. Fourteen studies reported reinfection patient risk postrevision; when pooled via random effects models, 10.02% of patients in the one-stage group and 14.75% of patients in the two-stage group were reinfected, indicating low heterogeneity (risk ratio = 0.69; 95% CI = 0.50 - 0.94, I² = 0%). A pooled analysis of ten studies reported complications between the two groups. Compared with the two-stage group, the one-stage group was associated with significantly fewer complications (risk ratio = 0.76; 95% CI = 0.63 - 0.91, I² = 27%). The meta-analysis revealed no significant difference in reoperation events between the 1st-stage and 2nd-stage groups in nine studies (risk ratio = 0.77; 95% CI = 0.59 - 1.01, I² = 20%) or in mortality in ten studies (risk ratio = 0.93; 95% CI = 0.49 - 1.78, I² = 0%).

Conclusions: Among the available observational studies, the meta-analysis revealed a lower incidence of reinfection and complications in the one-stage group than in the two-stage group, but there were no significant differences in reoperation events or mortalities.

Background: The purpose of this study was to assess whether China-made robot-assisted medial UKA can improve prosthesis placement accuracy and yield superior short-term outcomes compared with conventional UKA.

Methods: 50 patients who underwent initial medial UKA were included in this single-center, prospective, parallel, randomized, controlled trial. Preoperatively, patients were randomly categorized the robot-assisted UKA group and conventional UKA group. The operation time, intraoperative blood loss, postoperative pain scores (VAS scores at 24 h, 72 h, and 3 months post-surgery), KSS scores (clinical and functional scores), and knee range of motion (ROM) were compared between the two groups. The coronal deviation values of the femoral component, tibial component, and knee joint line height change were also compared between the two groups.

Results: The deviations in tibial component coronal plane alignment, femoral component coronal plane alignment, and joint line height change were significantly smaller in the robot-assisted group compared to those in the conventional group (p < 0.05). The operation time of the robot-assisted group was longer than that of the conventional group (p < 0.05). At 24 h and 72 h postoperatively, patients in the robot-assisted group reported lower VAS scores compared to those in the conventional group (p < 0.05). No significant differences were observed between the two groups regarding intraoperative bloodloss, the VAS scores at 3 months postoperatively, the KSS scores (clinical scores and functional scores) at 3 months postoperatively, and the Knee range of motion at 3 months postoperatively.

Conclusions: The China-made UKA robot can enhance the precision of prosthesis placement, yielding favorable short-term therapeutic outcomes.

Objective: This study aimed to compare infection, aseptic loosening, revision, operation time, function scores, and the radiographic radiolucent line (RLL) between cementless and cemented fixation in total knee arthroplasty (TKA).

Methods: Articles reporting the outcomes of cemented and cementless TKA were searched in Medline, EMBASE, Web of Science, and the Cochrane Library. The search was conducted from articles published from January 1996 to May 2024. Odds Ratios (OR) and confidence intervals (CI) were used to measure the results. Cochrane Collaboration's Review Manager software was used to perform the meta-analysis.

Results: Sixteen randomized controlled trials containing 2358 participants were included in this meta-analysis. Pooled data found that, in TKA, there were no significant differences between cemented fixation and cementless fixation for a prosthesis in infection, aseptic loosening and revision. The subgroup analysis and sensitivity analysis results of the knee society score (KSS) showed a significant difference favoring cementless fixation in a follow-up of less than 5 years (MD = -2.30, 95%CI -3.85 -0.74, p = .001) while favoring cemented fixation in a follow-up over 5 years (MD = 2.79, 95%CI 0.95 4.63, p = .003). The operation time of cementless was less than that of cemented (MD = 12.03, 95%CI 8.30 15.77, p < .00001). No significant difference was detected in knee society function score, Western Ontario and McMaster Universities osteoarthritis index, and RLL. There was no heterogeneity across studies (p > .1), and most studies have a low risk of bias.

Conclusions: Within a follow-up period of less than 5 years, cementless TKA had better KSS, while over 5 years, KSS was better in cemented TKA, and cementless TKA required less operation time.

Background: Bipolar hip endoprosthesis replacement is a commonly employed procedure in orthopaedic oncology that requires the resection and reconstruction of the proximal femur. With improving survival rates, issues of implant durability and acetabular wear have become increasingly important. The decision to replace the acetabulum in bipolar hip endoprosthesis replacement procedures remains a topic of debate. Aim: This study aimed to assess the prevalence of secondary osteoarthritis following bipolar hip replacement, the need for revision to total joint replacement post-procedure, the functional status of patients in relation to radiological findings of joint degeneration, and the survivorship of bipolar hip replacements. Methods: Patients with orthopaedic oncology cases who underwent bipolar hip endoprosthesis replacement between 2006 and October 2021, with a minimum follow-up of six months, were included. Both clinical and radiological evaluations were carried out. The clinical evaluation utilised the Musculoskeletal Tumor Society (MSTS), Toronto Extremity Salvage Score (TESS), and modified Harris Hip Score (mHHS) systems. The radiological assessment focused on identifying acetabular erosion. Results: Forty eligible patients were identified. Radiological assessments revealed 21 patients (52.5%) with grade 0, 17 patients (42.5%) with grade 1, and 2 patients (5.0%) with grade 2 acetabular erosion. No patients exhibited grade 3 acetabular erosion. One patient (2.5%) required revision surgery from proximal femoral bipolar replacement to total hip replacement due to recurrent postoperative hip dislocation. There was no statistically significant difference in MSTS and mHHS scores but a significant difference in TESS scores. The ten-year implant survival rate was 77.8%, while the overall patient survivorship at ten years was 72.1%. Conclusion: Bipolar hip replacement is a durable limb-preserving reconstruction that can outlast patients' lifespans and is well-tolerated by oncology patients. The incidence of acetabular erosion and revision surgery is low. Despite radiological evidence of hip degeneration, functional status in patients is not significantly impacted.

Background: The purpose of this study was to determine whether high BMI affect short-term clinical and radiologic outcomes of robotic-assisted total knee arthroplasty (TKA) by comparing the clinical outcomes, radiologic outcomes and complications between high BMI and normal patients.

Methods: We retrospectively compared the short-term clinical and radiological outcomes of 424 knees (408 patients). The patients were divided into four groups: BMI < 24.9 kg/m² (normal); BMI between 25.0 and 29.9 kg/m² (overweight); BMI between 30.0 and 34.9 kg/m² (obese class I) and BMI between 35.0 and 39.9 kg/m² (obese class II). Clinical and radiologic outcomes were evaluated.

Results: There was no significant difference in radiologic outcomes between those groups (p > .05). Furthermore, there was no significant difference in operation time, drainage volume, fall in hemoglobin, post-operative CRP and complications, including periprosthetic fracture and periprosthetic joint infection (PJI), between those groups.

Conclusion: High BMI does not affect short-term clinical and radiologic outcomes in robot-assisted TKA.

Purpose: We investigated the potential efficacy of abaloparatide (Abalo) and zoledronate (ZA) combination therapy for accelerating femoral union in a rat osteotomy model. Methods: Nine-week-old male Sprague-Dawley rats were randomly divided into four groups (n = 14 per group): control, abaloparatide (Abalo, 30 μg/kg via subcutaneous injection [s.c.] 5 times per week for 6 weeks), zoledronate (ZA; 0.1 mg/kg via s.c., single dose), and Abalo + ZA. Rats were then subjected to unilateral osteotomy of the femoral shaft, followed by osteosynthesis with intramedullary nailing to establish bone healing models. At 2 and 4 weeks after osteotomy, both femurs were removed from seven rats per group for soft X-ray imaging to evaluate bone union and microcomputed tomography (micro-CT) for bone morphometric evaluation. Blood samples were collected from all rats every 2 week starting 6 weeks pre- to 4 weeks postosteotomy. Toluidine blue staining was used for histopathological evaluation of the undecalcified specimens. Results: Soft X-ray imaging revealed accelerated callus formation, callus maturation, and fracture line closure in Abalo and Abalo + ZA groups compared to ZA and control groups. Micro-CT demonstrated greater cortical bone and trabecular bone to total volume ratios in contralateral (left) femurs of the Abalo + ZA group compared to the Abalo group. Both trabecular and cortical bone mineral densities were also greater in contralateral femurs of the Abalo + ZA group compared to Abalo and ZA groups. Conclusion: These findings suggest substantial additive or synergistic efficacy of abaloparatide plus zoledronate combination therapy for accelerating bone healing following osteotomy and for maintaining normal bone health.

Purpose: A drug known as carbazochrome sodium sulfonate (CSS) can reduce blood loss. But, it is not known how it can prevent the development of hemostatic and inflammatory conditions in patients who undergo bilateral simultaneous total hip arthroplasty (SBTHA). This study will analyze the safety and effectiveness of combining this drug with SBTHA.

Methods: The study was conducted on 100 patients who underwent SBTHA with simultaneous total hip replacement. They were split into two groups: group B received TXA with CSS, group A received TXA with no CSS. The main observation of the study was the total blood loss, which is the most common indication of blood loss. Other secondary indicators of the study included hidden blood loss, postoperative blood transfusion rate, level of inflammatory reactants, hip function, pain score, venous thromboembolism (VTE) and the incidence of adverse events.

Results: Group B had significantly lower TBL and HBL compared to Group A. Group B showed significant improvement in inflammatory biomarker levels, blood transfusion rate when compared to Group A (p < .05). No thromboembolic complications occurred in either group. There were no significant differences between the two groups in terms of postoperative swelling rate, intraoperative blood loss, visual analog scale pain score, platelet count, discharge motion and average length of stay.

Conclusions: As a hemostatic agent, CSS combined with TXA can reduce postoperative blood loss in patients undergoing SBTHA, and is more effective than TXA alone in terms of blood loss and inflammation, and does not increase the incidence of thromboembolic complications.