Journal of Orthopaedic Surgery最新文献

AimsThis study aims to evaluate the long-term durability of a unicompartmental knee arthroplasty (UKA) implant using a fixed-bearing all-polyethylene tibial tray with a Cobalt-Chromium (Co-Cr) femoral condyle, stratified by patient age. It also aims to compare implant survivorship between inlay and onlay tibial implantation techniques.MethodsData from the New Zealand Joint Registry (NZJR) was used to evaluate survival of Smith & Nephew Genesis II^® UKA performed between February 2000 and December 2011 in which two different tibial implant techniques (inlay and onlay) were used. The primary endpoint was revision surgery.ResultsAt a minimum follow-up of 10 years, 57 revisions were performed at an average of 6.6 years from index surgery. The revision rate per 100 component years was 1.29 (CI: 0.97 - 1.66), with a significant difference between the over-75 years cohort compared with the under-65 cohort, in favour of the older cohort (p < 0.05). There was a significant difference in survival between inlay and onlay techniques, in favour of the inlay technique (p < 0.05).ConclusionFixed-bearing all-polyethylene tibial UKA show acceptable outcomes at an average 12-year follow-up, especially in elderly patients and use of inlay tibial tray implantation technique.

PurposeFew studies have assessed the link between tibial tubercle (TT) morphology and anterior cruciate ligament (ACL) injury, and most focus only on the TT-trochlear groove (TT-TG) distance. This study aimed to examine the relationship between ACL injury, TT morphology, and posterior tibial slope (PTS) by comprehensively evaluating TT-related radiological parameters.MethodsRadiological images of 100 patients who underwent isolated ACL reconstruction for non-contact injury between 2016 and 2022 and 100 demographically matched controls with no relevant abnormalities on knee MRI were retrospectively analyzed. Thirteen radiological parameters were measured and compared, including PTS; TT torsion (TTT); TT-rotational angle (TT-RA); plateau axis-tuberosity axis (PA-TA); TT-TG; TT-PCL distance and ratio; TT lateralization (TTL) distance and ratio; TT height (TTH); and TT angle (TTA). Associations between these parameters and ACL injury, as well as interparameter correlations, were evaluated using t-tests, logistic regression, ROC analysis, and Pearson correlation.ResultsMean TTT, TT-RA and PA-TA values were significantly lower in the ACL injury group (5.68° vs 8.34°, p < .001; 7.96° vs 12.09°, p < .001; 8.41° vs 11.58°, p < .001). Conversely, TT-TG, PTS and TTH were higher (10.69 mm vs 8.17 mm, p < .001; 12.84° vs 10.61°, p < .001; 11.69 mm vs 10.02 mm, p < .001). Logistic regression showed TTT (OR = -0.849), TT-RA (OR = -0.822), TT-TG (OR = 1.298), PTS (OR = 1.177), and TTH (OR = 1.327) independently associated with ACL injury.ConclusionIn isolated ACL injury patients, TT torsion was lower and TT prominence higher. TT morphology assessment may help personalize ACL reconstruction, identify high-risk individuals, and support future clinical and biomechanical research on ACL injury susceptibility.

Background: Metatarsalgia is a frequent cause of forefoot pain, often linked to isolated gastrocnemius tightness, which increases forefoot pressure during gait. Gastrocnemius recession has been proposed as a surgical treatment to correct this biomechanical dysfunction. This systematic review aims to evaluate the clinical outcomes, complication rates, and quality of evidence regarding gastrocnemius recession performed exclusively for the treatment of isolated metatarsalgia. Materials and Methods: A systematic search of PubMed, MEDLINE, and the Cochrane Library was conducted in February 2025 following PRISMA guidelines. Studies were included if they reported outcomes of gastrocnemius release performed solely for isolated metatarsalgia. Data on surgical techniques, clinical outcomes, complications, and follow-up durations were extracted and analyzed. Results: Three studies met the inclusion criteria, encompassing a total of 86 operated feet with a mean follow-up of 37.5 months. Surgical techniques varied across studies, including proximal medial gastrocnemius release and musculotendinous junction recession. All studies reported significant improvements in Visual Analogue Scale (VAS) scores, along with high rates of patient satisfaction. Nevertheless, approximately 30% of patients required adjunctive forefoot procedures. The complication rate was low and predominantly involved minor nerve symptoms and transient bruising. Conclusion: Gastrocnemius recession appears to be an effective and safe surgical option for the management of isolated metatarsalgia, providing substantial pain relief and high patient satisfaction. However, the multifactorial nature of metatarsalgia often necessitates additional forefoot procedures. Standardization of surgical techniques, postoperative protocols, and outcome measures is essential to enhance clinical decision-making and future research quality.

IntroductionFirst metatarsophalangeal (MTP) joint arthrodesis is the gold-standard treatment for end-stage arthritis and hallux deformities. Successful fusion is improved by achieving adequate compression across the joint. Traditional plating systems provide single-point compression, whereas the Arthrex MTP valgus plate is designed for double compression, potentially improving stability and union rates. This study aimed to confirm double compression and compare two anchoring methods: K-wire and olive tip guide wire (BB-tack).MethodsTwelve cadaveric feet were randomised to plate fixation using either K-wire or BB-tack anchoring. Compression was measured with Tekscan sensors during three stages: after seating the first compression screw, after seating the second screw, and after reseating the second screw without the stabilising K-wire. Peak force and contact pressure were analysed using ANOVA and t-tests (α = 0.05).ResultsBoth techniques achieved measurable compression after the first screw, which increased significantly with the second screw (mean pressure: 0.55-0.62 MPa; peak force: 18.3-22.2 N). Removing the stabilising K-wire before reseating reduced peak force but maintained comparable pressure. No significant differences were found between anchoring methods (p > 0.05).ConclusionThe Arthrex MTP valgus plate achieves double compression, enhancing construct rigidity compared to single-compression systems. Further clinical studies are warranted to validate these biomechanical advantages.

BackgroundSuperior labrum anterior and posterior (SLAP) lesions are a common cause of shoulder pain and instability. Accurate diagnosis remains challenging in clinical practice. This study aims to develop and evaluate radiomics models and combined models integrating radiomics and clinical features for SLAP lesion detection.MethodsThis retrospective study included 149 patients who underwent shoulder arthroscopic surgery with preoperative shoulder magnetic resonance imaging (MRI) between 2019 and 2024. Regions of interest (ROIs) were manually delineated on MRI oblique coronal proton density-weighted fat-suppressed (PD FS) images, and radiomics features were subsequently extracted from these defined regions. Feature selection employed independent t-tests, Mann-Whitney U tests, Pearson correlation analysis, and least absolute shrinkage and selection operator (LASSO) regression. Common machine learning models including Support Vector Machine (SVM), Random Forest (RF), and Light Gradient Boosting Machine (LightGBM) were employed to construct diagnostic models based on radiomics features. A combined model integrating radiomics and clinical features was developed and visualized using nomograms.ResultsIn the test cohort, the LightGBM-based radiomics model achieved optimal performance with the Area Under the Curve (AUC) of 0.867, sensitivity of 0.952, and specificity of 0.625. The combined model demonstrated enhanced diagnostic capability with AUC of 0.899, sensitivity of 0.762, and specificity of 0.917. Manual diagnosis of SLAP injury using MRI achieved an accuracy of 50.3%, with a sensitivity of 27.7%, specificity of 78.8%, and AUC of 0.619.ConclusionMachine learning models based on MRI radiomics features demonstrated superior diagnostic accuracy compared to traditional radiologist assessment for SLAP lesions. The combined model incorporating both radiomics and clinical features provides effective risk prediction for SLAP lesions.

ObjectiveTo investigate the clinical efficacy and incidence of complications in the treatment of adult congenital high scapula (Sprengel deformity) using the modified combined Woodward and Green surgical approach.MethodsFrom January 2020 to January 2024, 9 adult patients with congenital Sprengel deformity were treated with the modified Woodward and Green combined procedure. There were two males and seven females, aged 18-35 years (mean: 23.5 ± 4.2 years), with 6 cases on the left and 3 on the right. The surgical procedure involved the modified combined Woodward and Green technique. Postoperatively, routine infection prevention, 4-weeks brace fixation, and rehabilitation guidance were performed. Shoulder appearance was evaluated using the Cavendish grading system; bilateral scapular height difference was measured; and shoulder function was assessed using the UCLA Shoulder Function Rating System, including pain, daily activity ability, range of motion, and muscle strength. Paired t-tests were used to analyze pre- and postoperative data with SPSS 22.0 software.ResultsAll 9 patients were followed up for 12-36 months (mean: 24.11 ± 6.63 months). Postoperatively, shoulder appearance significantly improved, with marked reduction in scapular position, good correction of elevation and shrugging deformities, and near-normal shoulder contour. Cavendish grading improved significantly (p < 0.05). The scapular height difference decreased from 4.50 ± 0.67 cm preoperatively to 0.89 ± 0.77 cm at the last follow-up, and the UCLA shoulder function score increased from 23.44 ± 1.57 to 30.33 ± 0.67, with statistically significant differences (p < 0.001 for both).ConclusionThe modified combined Woodward and Green procedure is a safe and effective treatment for adult congenital Sprengel deformity, significantly improving shoulder appearance and joint function. However, due to the small sample size and short follow-up period, future studies with larger samples and longer follow-ups are needed to accurately evaluate the long-term efficacy.

ObjectiveTo investigate the effects of denosumab on pain relief, bone mineral density (BMD), and refracture risk during long-term follow-up in patients with osteoporotic vertebral compression fractures (OVCF) after percutaneous vertebroplasty, and to identify factors associated with refracture.MethodsThis retrospective study included 396 OVCF patients who underwent percutaneous vertebroplasty and received denosumab between January 2021 and June 2023. Patients were classified into a completed-treatment group (n = 184) and a discontinued-treatment group (n = 212). After 1:1 propensity score matching, 101 patients were included in each group. Changes in visual analog scale (VAS) scores and lumbar spine and femoral neck T-score were compared over 24 months. Refracture risk was assessed using Kaplan-Meier analysis and multivariable Cox regression in the matched cohort.ResultsAfter matching, baseline characteristics were well balanced between groups. Over 24 months of follow-up, the completed-treatment group showed significantly lower VAS scores and greater improvements in lumbar spine and femoral neck T-score compared with the discontinued-treatment group. The incidence of refracture was significantly lower in the completed-treatment group. In the PSM cohort, multivariable Cox regression analysis demonstrated that completed denosumab treatment was independently associated with a lower risk of refracture (HR = 0.314, 95% CI 0.125-0.792, P = 0.014).ConclusionIn patients with OVCF treated with percutaneous vertebroplasty, persistent denosumab therapy for at least 24 months is associated with sustained pain relief, improved BMD, and a lower risk of refracture, underscoring the importance of long-term treatment adherence.

Total knee arthroplasty (TKA) is a frequently performed surgery for restoring function in patients with severe knee osteoarthritis. TKA is associated with significant healthcare costs, partly due to complications leading to readmissions. This study aimed to identify biomarkers predictive of readmission after TKA. Data of adult patients who underwent primary TKA between 2014 and 2022 extracted from the Chang Gung Medical Research Database were retrospectively reviewed. Associations between the monocyte-to-albumin ratio (MAR), red cell distribution with (RDW)-to-albumin ratio (RAR), hemoglobin-to-albumin ratio (HAR), leukocyte-to-albumin ratio (LAR), and platelet-to-albumin ratio (PAR) with 14-day readmission were determined using univariate and multivariable regression analyses. A score termed the 'MAR-LAR-PAR' score was developed using the combination of these 3 markers, and its prognostic value was assessed. Data from 1,137 patients were included. Elevated MAR (adjusted odds ratio [aOR] = 1.77, 95% confidence interval [CI]: 1.08-2.89, p = 0.022), LAR (aOR = 1.59, 95% CI: 1.02-2.45, p = 0.039), and PAR (aOR = 1.88, 95% CI: 1.12-3.15, p = 0.016) were significantly associated with increased risk of 14-day readmission. The highest MAR-LAR-PAR score (score = 3) was significantly associated with 14-day readmission compared to score = 0 (aOR = 4.24, 95% CI: 1.91-9.44, p < 0.001). This study highlights the potential of MAR, LAR, PAR, and the score based on their combination, as significant predictors of short-term readmission following TKA. Incorporating these biomarkers into preoperative assessment may help determine the risk of readmission, and provide additional care for these patients.

ObjectiveThis study examined the associations of visceral adiposity index (VAI), body roundness index (BRI), and lipid accumulation product (LAP) with the risk, severity, and prognosis of knee osteoarthritis (KOA). The aim was to evaluate the clinical utility of these novel adiposity indices for early screening and prognostic assessment of KOA.MethodsA total of 124 patients with clinically and radiographically confirmed KOA and 120 healthy individuals who underwent routine physical examinations during the same period were enrolled as the KOA and control groups, respectively. Baseline data were collected retrospectively from electronic medical records. KOA patients were further classified into mild, moderate, and severe subgroups based on K-L grading and were followed for 12 months.ResultsCompared with controls, the KOA group had significantly higher BMI, TG, TC, LDL-C, VAI, BRI, and LAP, and lower HDL-C (p < 0.05). VAI, BRI, and LAP increased progressively with KOA severity (p < 0.05), showing positive correlations (r = 0.608, 0.489, 0.551, p < 0.001), and were confirmed as independent risk factors (p < 0.05). ROC analysis yielded AUCs of 0.775 (95% CI: 0.718-0.833; cutoff: 2.91) for VAI, 0.752 (95% CI: 0.692-0.813; cutoff: 5.21) for BRI, and 0.779 (95% CI: 0.722-0.836; cutoff: 48.58) for LAP, with a combined AUC of 0.880 (95% CI: 0.839-0.922). Survival time differed significantly across groups stratified by these cutoffs (VAI: χ² = 4.238; BRI: χ² = 3.956; LAP: χ² = 6.043; all p < 0.05).ConclusionThis study concludes that VAI, BRI, and LAP are closely linked to KOA. Firstly, their levels are significantly raised in patients and show a positive correlation with disease severity, marking them as useful clinical indicators. Secondly, the combined detection of these indices provides superior predictive value for KOA and is associated with an unfavorable prognosis, suggesting their utility in comprehensive risk assessment.

PurposePatients withspinal degenerative diseases are often older and have multiple comorbidities. This study aims to evaluate the impact of epidural patient-controlled analgesia (PCA) on postoperative pain relief in patients undergoing lumbar spine surgeries for spinal degenerative diseases.MethodsThis retrospective case-control study included patients who underwent lumbar spine surgeries for degenerative spinal stenosis, spondylolisthesis, herniated intervertebral discs, or osteoporotic spinal fractures with spinal stenosis. The PCA group consisted of patients who received 72-h epidural PCA for postoperative pain control, while the control group received standard postoperative pain management. All patients were allowed to request intramuscular rescue analgesics for additional pain control. The primary endpoint was defined as the mean visual analogue scale (VAS) score during the effective PCA period (postoperative day [POD] 1-3). Secondary endpoints included individual daily VAS scores, rebound pain, rescue analgesic injections, morphine consumption, drainage duration, drainage volume, length of hospital stay, and complications.ResultsA total of 209 patients (mean age 73.8 years) were included, with 88 patients in the PCA group and 121 in the control group. Mean VAS score across POD 1-3 was significantly lower in the PCA group (Cohen's d = -1.89, 95% CI = -2.22 to -1.56, p < 0.001). During hospitalization, the PCA group required significantly fewer rescue analgesic injections (Cohen's d = -2.47, 95% CI = -2.84 to -2.11) and less total morphine consumption (Cohen's d = -0.39, 95% CI = -0.67 to -0.11) compared to the control group. Although the PCA group experienced greater drainage volume and longer duration of drainage placement, the incidence of infection and the length of hospital stay were comparable between the two groups.ConclusionIn this real-world cohort of elderly patients with multiple comorbidities undergoing lumbar spinal surgery, epidural PCA provided effective pain relief without an observed increase in infection rates in this study population.