Journal of Orthopaedic Surgery最新文献

PurposePosterior medial meniscus root tears often cause persistent extrusion and altered joint mechanics despite repair. This study compared standard transtibial pull-out repair with repair plus a second-tunnel centralization, hypothesizing better patient-reported outcomes without major MRI extrusion changes.MethodsThis retrospective two-center cohort (2019-2024) included adults with MRI-confirmed root tears treated with anatomic repair alone or with an additional centralization tunnel. Propensity matching yielded 96 patients (54 vs 42). The primary endpoint was 24-months change in IKDC score. Secondary outcomes included KOOS subscales, Lysholm, visual analogue scale pain, and Tegner activity. Structural outcomes-medial meniscus extrusion and Meniscal Extrusion Index-were assessed on coronal MRI at 12 ± 4 months. Analyses used ANCOVA adjusted for baseline values, supported by inverse-probability weighting and mixed-effects checks.ResultsBaseline characteristics were balanced. Extrusion changes were small and similar; residual pathologic extrusion rates were comparable (65% vs 62%). Centralization showed greater IKDC improvement (+5.7 points; p = 0.008) and higher KOOS-Quality of Life. Knees with ≥3 varus demonstrated additional benefit (interaction p = 0.048). Complications were infrequent.ConclusionsSecond-tunnel centralization significantly increased the probability of achieving clinically meaningful functional improvement, despite unchanged static MRI extrusion. This suggests dynamic load-sharing benefits not captured by static imaging. Therefore, centralization is recommended as a selective adjunct, particularly in varus alignment, rather than a routine necessity.

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.

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.

BackgroundPrevious studies reported that medial shoulder balance (MSB) with neck tilt correlated radiologically with T1 tilt, first rib angle (FRA), and cervical axis (CA), whereas lateral shoulder balance (LSB) correlated radiologically with clavicle angle (Cla-A), coracoid height difference (CHD), clavicle-rib intersection distance (CRID), and radiographic shoulder height (RSH). Nevertheless, there is a scarcity of literature correlating both the clinical and radiological shoulder balance parameters in adolescent idiopathic scoliosis (AIS) patients. This study investigates the correlations between preoperative radiological and clinical shoulder balance (MSB and LSB) in Lenke type 1 and 2 AIS patients.MethodsWe reviewed 50 Lenke type 1 and 2 AIS patients between 2021 and 2022. Preoperative clinical shoulder parameters included front/neck base angle, front/back clavicle angle, front/back trapezium angle ratio, front/back axilla angle, trapezial area, shoulder area index 1 (SAI 1), SAI 2, and inner/outer shoulder height (SHi/SHo). Radiological shoulder parameters included T1 tilt, FRA, CA, Cla-A, CHD, CRID, and RSH.ResultsStrong correlations (r ≥ 0.6) were observed between T1 tilt, FRA, and CA (MSB with neck tilt), and between Cla-A, CHD, CRID, and RSH (LSB) (r > 0.9). T1 tilt and FRA correlated strongly (r ≥ 0.6) with front and back neck base angles, Ln [L/R trapezial area], SAI 1, SAI 2, and SHi, with the highest coefficients for front/back neck base angles (r ≥ 0.8). CA correlated strongly with front and back neck base angles, SAI 2, and SHi. Cla-A, CHD, CRID, and RSH correlated strongly with back clavicle angle.ConclusionMSB (T1 tilt and FRA) demonstrated very strong correlation with front and back neck base angles, and strong correlation with Ln [L/R trapezial area], SAI 1, SAI 2, and SHi. Neck tilt (CA) correlated strongly with front and back neck base angles, SAI 2, and SHi. Meanwhile, LSB (Cla-A, CHD, CRID, and RSH) correlated strongly with back clavicle angle.

BackgroundThe optimal positioning range for the femoral component in unicompartmental knee arthroplasty (UKA) performed in osteoporotic bone remains undefined. Most existing biomechanical studies have been established using normal bone quality models, whereas limited evidence addresses abnormal bone conditions. Complications involving the operative-side compartment are closely associated with the high revision rates after UKA.MethodsCT and MRI scans of the right knee of a volunteer without pathological changes were used to construct a three-dimensional finite element model. A normal bone quality UKA model (NB group) was created, and an osteoporotic model (OP group) was generated by reducing the elastic modulus of bone tissue proportionally. Femoral component alignment was set at 0°, as well as 3°, 6°, and 9° of varus and valgus. Stress changes within operative-side structures were quantified and compared between the two models.Results(1) In both models, peak stress on the femoral component increased progressively with greater varus alignment, with the OP group consistently demonstrating higher stress values than the NB group. Compared to their respective 0° neutral position, the peak von Mises stress on the femoral component surface increased by 71.8% and 70.8% at 9° of varus in the NB and OP groups, respectively. (2) Peak stresses on the PE insert and on the cortical bone beneath the tibial component increased with both varus and valgus malalignment; the increase was more pronounced under varus. The OP group exhibited higher peak stresses and greater incremental changes than the NB group. Compared to their respective 0° neutral position, the peak von Mises stress on the cortical bone surface beneath the tibial component increased by 50.0% in the NB group and 40.8% in the OP group at 9° varus, and by 14.2% and 27.0%, respectively, at 9° valgus.ConclusionEven small coronal-plane deviations (±3°) in femoral component positioning during medial UKA may substantially elevate stresses within the operative-side compartment. Strict control of coronal alignment is essential to avoid varus or valgus and prevent abnormal stress concentrations around the implant. Additionally, the impact of osteoporosis on postoperative biomechanical stability warrants careful consideration to optimize implant design and surgical technique, thereby reducing the risks of aseptic loosening, periprosthetic fracture, and improving long-term outcomes.

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.

BackgroundThe routine use of postoperative drainage after total knee arthroplasty (TKA) remains controversial, particularly in the era of modern blood-saving strategies. While drains have traditionally been used to reduce hematoma formation, their effect on early postoperative pain has not been clearly established. This study aimed to evaluate whether postoperative drainage influences early pain outcomes following primary TKA.MethodsAn assessor-blinded randomized comparative study was conducted including 60 patients undergoing primary hybrid TKA with posterior cruciate ligament preservation. Patients were randomly allocated to a drainage or no-drainage group, with stratification by sex. All patients followed identical anesthetic, surgical, and multimodal analgesic protocols, including routine administration of tranexamic acid. Pain was assessed using the visual analogue scale (VAS) preoperatively and at 48 h postoperatively. The number of postoperative morphine rescue doses was recorded as an objective pain-related outcome. Secondary outcomes included haemoglobin level at discharge and length of hospital stay.ResultsNo significant differences were observed between the drainage and no-drainage groups regarding postoperative VAS pain scores, morphine rescue requirements, haemoglobin levels at discharge, or length of hospital stay (all p > 0.05). In both groups, postoperative pain was significantly lower than preoperative pain (p < 0.05). Higher body mass index was associated with greater preoperative pain but did not influence postoperative pain outcomes.ConclusionWithin contemporary perioperative protocols including tranexamic acid, routine use of postoperative drainage after primary TKA does not improve early postoperative pain control or reduce opioid requirements. These findings support omitting routine drainage without compromising early pain outcomes.

ObjectiveTo evaluate and compare pain management, complication patterns, and functional outcomes between cannulated screw and Kirschner wire fixation for treating pediatric medial epicondylar fractures.MethodA retrospective cohort study was conducted at a tertiary hospital from 2013 to 2023, involving 31 pediatric patients with displaced medial epicondylar fractures (Watson-Jones Types III and IV). Patients were divided into two groups: 16 received cannulated screw fixation, while 15 underwent Kirschner wire fixation. Clinical outcomes, including operation time, fracture healing, pain levels, and complications, were assessed.ResultsBoth groups demonstrated similar long-term functional outcomes, with no significant difference in Mayo Elbow Performance Scores (p > 0.05). The cannulated screw group experienced significantly lower pain on the third postoperative day compared to the Kirschner wire group (p < 0.001). The Kirschner wire group had a higher rate of pin-track infections (13.3%) and delayed union (6.7%), whereas the cannulated screw group had fewer complications, with one case of superficial wound infection. Hardware removal occurred significantly earlier in the Kirschner wire group (p < 0.001).ConclusionBoth fixation methods offer effective treatment for pediatric medial epicondylar fractures, with cannulated screws providing better pain control and fewer complications but requiring longer retention. Kirschner wires allow for earlier removal but carry a higher risk of infection and delayed healing. Treatment decisions should be individualized, considering factors such as pain sensitivity, family preferences, and medical resources.

ObjectiveThe feasibility of placing longer, larger diameter double-threaded screws into the pedicle for good fixation in osteoporotic patients with lumbar spondylolisthesis was investigated via robot-assisted optimal access planning.MethodA total of 80 patients with degenerative lumbar spondylolisthesis needed posterior incision decompression and bone grafting combined with pedicle screw fixation due to spondylolisthesis. The patients were equally and randomly assigned to a robot-assisted group and a bone cement-strengthened group. The operative time, intraoperative blood loss, and intraoperative radiation dose were recorded. X-ray and CT scans were routinely reviewed after the surgery. The ratio of screw diameter to pedicle width (SD/PW) was calculated. The pedicle position was graded. The Bub score assessed proximal facet joint invasion. Visual analogue pain scale (VAS) was recorded before surgery and 3 days after surgery. The Oswestry Disability Index (ODI) and health Survey Summary Form (SF-36 to assess patients' quality of life) were performed before surgery and 6 months after surgery. The rate of screw loosening, removal, complications and revision were evaluated by X-ray and CT 12 months after operation.ResultsVAS score on day 3 after surgery was significantly better in the robot-assisted group than in the bone cement-strengthened group. (p = 0.027). The operative time and intraoperative radiation dose of the robot-assisted group were lower than those of the bone cement-strengthened group (p < 0.001). The ratios of screw length, screw diameter, and SD/PW in both groups were significantly better in the robot-assisted group than in the bone cement-strengthened group (p < 0.001). The incidence of screw small joint invasion was 10.2% in the robot-assisted group and 19.1% in the bone cement-strengthened group, with a statistically significant difference between the two (p = 0.020). The Oswestry Disability Index (ODI) and Health Survey Summary Form (SF-36) at 6 months after surgery were significantly improved in both groups.ConclusionPatients with osteoporotic lumbar spondylolisthesis who use robot assistance to implant longer, thicker-diameter double-threaded screws achieved a similar fixation effect as those of bone cement-reinforced screws. Meanwhile, the operation time was shorter, the radiation damage was less, and the difficulty of later revision surgery was reduced. Thus, the proposed surgical protocol can be applied as a new option for patients with osteoporotic lumbar spondylolisthesis.