Journal of Orthopaedic Surgery最新文献

Objective: To explore the diagnostic value of MR T2 mapping in monitoring and evaluating the rabbit vertebral model with Echinococcus multilocularis infection.

Materials and methods: 24 New Zealand white rabbits were randomly divided into the experimental group (n = 16), saline control group (n = 4), and blank control group (n = 4). The experimental group underwent surgery to drill holes on the surface of the spinous process of the 12th thoracic vertebra, fill it with a gelatin sponge, and adsorb multilocular hydatid suspension. The saline control group received an operation with saline, and the blank control group did not receive any intervention. The model rabbits were dynamically evaluated by routine MRI and MR T2 mapping once a month after surgery, 6 times. Two rabbits with positive imaging results were randomly selected every 2 months for histopathological examination to evaluate the severity and pathological features of the rabbit model with Echinococcus multilocular infection.

Results: There was no significant difference in the T2 mapping values between the diseased vertebrae and the undiseased vertebrae in the experimental group at the 1st month after surgery (t = 1.7, p = .119), and the differences were statistically significant at the 2nd to 6th month after surgery (p < .05). In the 1st and 2nd months after an operation, there was no significant difference in T2 values between the vertebrae of the saline control group, the blank control group, and the experimental group. In the third, fourth, fifth, and sixth months after surgery, the vertebrae of the experimental group were compared with that of the saline control group and the blank control group, and the difference was statistically significant (p < .05). There was no significant difference in T2 mapping values every month after surgery between the saline control group and the blank control group (p > .05).

Conclusion: The MR T2 mapping technique can quantitatively evaluate the changes of vertebral alveolar echinococcosis, and it shows sensitivity to pathological changes in vertebrae prior to detectable damage using conventional MRI; this offers potential for early detection of vertebral alveolar echinococcosis.

Background: Large language models (LLMs) have many clinical applications. However, the comparative performance of different LLMs on orthopedic board style questions remains largely unknown.

Methods: Three LLMs, OpenAI's GPT-4 and GPT-3.5, and Google Bard, were tested on 189 official 2022 Orthopedic In-Training Examination (OITE) questions. Comparative analyses were conducted to assess their performance against orthopedic resident scores and on higher-order, image-associated, and subject category-specific questions.

Results: GPT-4 surpassed the passing threshold for the 2022 OITE, performing at the level of PGY-3 to PGY-5 (p = .149, p = .502, and p = .818, respectively) and outperforming GPT-3.5 and Bard (p < .001 and p = .001, respectively). While GPT-3.5 and Bard did not meet the passing threshold for the exam, GPT-3.5 performed at the level of PGY-1 to PGY-2 (p = .368 and p = .019, respectively) and Bard performed at the level of PGY-1 to PGY-3 (p = .440, .498, and 0.036, respectively). GPT-4 outperformed both Bard and GPT-3.5 on image-associated (p = .003 and p < .001, respectively) and higher-order questions (p < .001). Among the 11 subject categories, all models performed similarly regardless of the subject matter. When individual LLM performance on higher-order questions was assessed, no significant differences were found compared to performance on first order questions (GPT-4 p = .139, GPT-3.5 p = .124, Bard p = .319). Finally, when individual model performance was assessed on image-associated questions, only GPT-3.5 performed significantly worse compared to performance on non-image-associated questions (p = .045).

Conclusion: The AI-based LLM GPT-4, exhibits a robust ability to correctly answer a diverse range of OITE questions, exceeding the minimum score for the 2022 OITE, and outperforming predecessor GPT-3.5 and Google Bard.

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.

Purpose: This study aims to investigate if the addition of PedsQL 4.0 generic core scales (PedsQL) with other validated instruments in day-to-day clinical context is feasible. Methods: Patients with idiopathic scoliosis who were undergoing brace treatment and aged 8-18 were asked to fill in the PedsQL 4.0 generic core scales, SRS-22r and EQ5D questionnaires at the spine specialist outpatient clinic and were followed up at 6 months by phone consultation. Questionnaire scores at baseline and follow-up were compared. Correlation of score changes of different questionnaires were tested. Results: A total of 232 patients (58 males, 174 females) were included. PedsQL school functioning scores and total scores at follow-up were lower than at baseline (p < 0.001), with greatest reductions in school functioning domain (range: -2.8 ± 7.0 to -5.1 ± 3.6). For those aged 13-18 years, changes of PedsQL school functioning correlated with changes of SRS total score (r = 0.20; p = 0.042). For patients with baseline major Cobb angle >30°, changes in PedsQL physical functioning correlated with SRS domain score changes in function (r = 0.25; p = 0.017), pain (r = 0.24; p = 0.021) and SRS total score (r = 0.26; p = 0.016). Both changes in PedsQL school functioning (r = 0.23; p = 0.032) and total score (r = 0.22; p = 0.043) correlated with SRS total score changes. Conclusion: PedsQL was sensitive to changes of HRQoL together with SRS-22r and EQ-5D-Y-5L questionnaires. Changes in PedsQL scores were related to changes in SRS-22r scores in patients of 13-18 years with more severe curves (>30°). PedsQL is recommended to be used in conjunction with validated instruments like SRS-22r with its ability to assess changes of patient's school functioning and overall HRQoL. The short-term nature of our study highlighted the need for future research with a larger cohort and longer duration to investigate long-term HRQoL outcomes assessed by individual questionnaires.

Introduction: The rising number of cancer patients with metastatic bone disease (MBD) reflects advancements in treatment. The concept of oligometastatic disease, associated with improved prognosis, has emerged. This study evaluated prognostic factors, including oligometastases, in patients undergoing urgent orthopaedic surgery for MBD to inform preoperative decision-making and reduce morbidity and mortality from immobilization.

Materials and methods: We retrospectively analysed records of patients who underwent surgery for MBD between 2005 and 2022. Data included medical history, tumour type, metastatic status, surgical method, lesion location, imaging, and survival outcomes. Multivariate survival analyses were conducted.

Results: The number of metastases and presence of visceral metastases significantly influenced survival. Patients with single metastases had a median survival of 65 months, oligometastases 25 months, and polymetastases 11 months. Visceral metastases were associated with a median survival of 9 months versus 27 months without. Tumour type also impacted prognosis, with thyroid cancer patients having the highest median survival and lung cancer patients the lowest. Pathological fractures reduced survival significantly (11 months vs 36 months without fractures).

Conclusion: Oligometastatic disease is a strong prognostic factor for MBD patients undergoing orthopaedic surgery, with better outcomes compared to polymetastatic disease. Other key factors include tumour type, visceral metastases, and pathological fractures. Improved staging, risk assessment, and early interdisciplinary collaboration could mitigate pathological fractures and improve outcomes.

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.