Journal of Orthopaedic Surgery最新文献

Purpose: The talar bone plays a crucial role in ankle biomechanics and stability. Understanding the shape variability of the talar bone within specific populations is essential for various clinical applications. In this study, we aimed to investigate the mean shape and principal variability of the human talar bone in the Chinese population using statistical shape modeling (SSM).

Methods: CT scans of 214 tali were included to create SSM models. Principal component analysis was used to describe shape variation among the male, female, and overall groups.

Results: The largest amount of variation among three groups ranges from 17.2%-18.8% of each variation. The first seven principal components (modes) captured 62.4%-67.5% of the cumulative variance. No dominant shape of the talus was found. Male tali generally have a larger size than the female tali, with the exception of the articular surface of the anterior subtalar joint.

Conclusions: SSM is an effective method of finding mean shape and principal variability. Considerable variabilities were noticed among these three groups and all principal modes of variation. No dominant talar model was found to represent the majority of tali, regardless the gender. Such information is crucial to improve the current understanding of talar pathologies and their treatment strategies.

This systematic review evaluates the effects of heat treatments in de novo, residual and recurrent giant cell tumors of bone (GCTB). Studies were eligible for inclusion if one of the following treatments was administered: radiofrequency ablation (RFA), microwave ablation, argon cauterization, electrocauterization and hot liquid treatment. The primary outcome was recurrence. Secondary outcomes were complications, pain, function, and quality of life. Recurrence rates for microwave ablation as an adjuvant to intralesional curettage were 0%, 4% and 10% (3 retrospective single-group studies); for argon cauterization 4%, 8% and 26% (3 cohort studies); electrocauterization 0% to 33% (8 cohort studies); and hot liquid 9.5% and 24% (2 cohort studies). Follow-up was generally ≥24 months. Data on pain, function and quality of life were scarce. Complications included infection and secondary osteoarthritis. Current evidence does not demonstrate or exclude an effect of heat treatments on recurrence in GCTB. Further research should objectify if (subgroups of) patients benefit from these treatments.

Background: In order to simulate weight-bearing Computed Tomography (CT) examination, this study designed a simple stress position device. By analyzing the relevant data of stress position footprints and weight-bearing position footprints, the feasibility of the stress position device to simulate standing weight-bearing was verified.

Methods: This study randomly selected 25 volunteers for standing weight-bearing and stress position footprints collection, and measured the relevant indicators of stress position footprints and standing weight-bearing position footprints. Two foot and ankle surgeons conducted two measurements respectively on the footprints. Intra-observer and inter-observer reliability were calculated using intra-class correlation coefficients (ICC). Pearson correlation coefficient, ICC, scatter plot analysis, and paired t-test were used to analyze the stress and weight-bearing position data.

Results: The intra-observer and inter-observer measurement values were reliable. There was a certain degree of correlation between the stress position footprints and weight-bearing position footprints in terms of Pearson correlation coefficient, ICC, and scatter plot analysis. Paired t-tests showed significant differences in Clarke angle (t 2.636, p .012), C-S index (t 10.568, p .000), arch indx (t 2.176, p .035), and arch lower angle (t 6.246, p .000).

Conclusion: The stress position device can generate a certain degree of stress, and after further optimization and improvement of the stress position device, it is feasible to apply it to weight-bearing CT examination in clinical settings.

Background: To compare the mid-term follow-up clinical efficacy among three treatment approaches for lumbar degenerative diseases (LDD): standalone oblique lumbar interbody fusion (SF), oblique lumbar interbody fusion combined with lateral screw fixation (LF), and oblique lumbar interbody fusion combined with posterior screw fixation (PF).

Method: This retrospective study included a total of 71 cases of single level LDD that underwent OLIF in Hospital of Chengdu University of Traditional Chinese Medicine were retrospectively collected between March 2016 and September 2017. Patients were divided into three groups: 24 cases in the SF group, 24 cases in the LF group and 23 cases in the PF group. Various parameters, such as operation time, hospitalization time, and complications, were recorded. The fusion condition was assessed at last follow up. Clinical outcomes were evaluated using the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) from pre-operation to 5 years post-surgery.

Results: Significantly lower mean operation time and hospitalization time were observed in the SF and LF groups compared to the PF group (p < .05). However, no significant difference in fusion rate was found among the three groups. Regarding clinical outcomes, there was no statistically significant difference in VAS scores between the three groups during all follow-up periods. At the 6th month and 1st year after surgery, the SF and LF groups had significantly lower Oswestry Disability Index (ODI) scores compared to the PF group (p < .05). There was no significant difference in perioperative complication rates among the three groups (p > .05). In the LF group, one case of instrument displacement and urethra injury were reported, while in the SF, LF, and PF groups, 10, 9, and 3 cases of cage subsidence were reported, respectively.

Conclusion: The study findings suggest that oblique lumbar interbody fusion (OLIF) is a safe and effective treatment for mid-term management of lumbar degenerative diseases (LDD). Compared to the posterior screw fixation (PF) group, both the standalone OLIF (SF) and OLIF combined with lateral screw fixation (LF) groups showed advantages in terms of reduced operation time, shorter hospitalization, and faster symptom alleviation in the short-term. However, OLIF combined with PF demonstrated comparable symptom relief in the mid-term and had the additional benefit of lower cage subsidence rates while improving fusion rates as well.

Background: The improvement of flexion contracture is important in knee arthroplasty since residual flexion contracture postoperatively is associated with decreased quality of life and patient satisfaction. In this study, we investigated the effect of bi-cruciate stabilized (BCS)-type total knee arthroplasty (TKA) as compared to posterior stabilized (PS)-type TKA on osteoarthritic primary knees with flexion contractures.

Methods: 59 TKAs from January 2014 to December 2020, of which 30 were PS-type TKAs (NexGen LPS-flex^Ⓡ; 76.3 years, BMI 27.5) and 29 BCS-type TKAs (Journey II^Ⓡ; 72.5 years, BMI 28.6), were performed for knee osteoarthritis with preoperative flexion contracture of 15° or greater. Full extension was obtained intraoperatively during all TKAs. Clinical outcomes, radiological evaluations, and the amount of additional distal femoral osteotomy during TKA were evaluated in a retrospective study design.

Results: The range of motion improved in the both groups. Postoperative flexion contracture was significantly improved in the BCS group. Knee Society Score improved significantly in both groups, with no difference between the two groups. The amount of additional distal femoral osteotomy was 2.5 ± 1.3 mm for the PS group, and 1.8 ± 1.5 mm for the BCS group, showing a significant difference (p = 0.04).

Discussion: The BCS-type TKA significantly improved preoperative flexion contracture and reduced the amount of additional distal femoral osteotomy compared to PS-type TKA. This is attributed to the anterior cam in the BCS-type TKA, which leads to a smaller amount of protrusion of the posterior femoral condyle from the posterior margin of the tibial component in the BCS-type in knee extension, as compared to the PS-type.

Background: The occurrence of prosthesis-related complications after total shoulder arthroplasty is devastating and costly. The purpose was to determine the incidence and risk of in-hospital prosthesis-related complications after total shoulder arthroplasty utilizing a large-scale sample database.

Methods: A retrospective database analysis was performed based on Nationwide Inpatient Sample from 2010 to 2014. Patients who underwent total shoulder arthroplasty were included. Patient demographics, hospital characteristics, length of stay, economic indicators, in-hospital mortality, comorbidities, and peri-operative complications were evaluated.

Results: A total of 34,198 cases were capture from the Nationwide Inpatient Sample database. There were 343 cases of in-hospital prosthesis-related complications after total shoulder arthroplasty and the overall incidence was 1%, with a more than 2.5-fold decrease from 2010 to 2014. Dislocation was the most common category among prosthesis-related complications (0.1%). The occurrence of in-hospital prosthesis-related complications was associated with significantly more total charges and slightly longer length of stay while less usage of Medicare. Risk factors of prosthesis-related complications were identified including younger age (<64 years), female, the native American, hospital in the South, alcohol abuse, depression, uncomplicated diabetes, diabetes with chronic complications, fluid and electrolyte disorders, metastatic cancer, neurological disorders, and renal failure. Interestingly, advanced age (≥65 years) and proprietary hospital were found as protective factors. Furthermore, prosthesis-related complications were associated with aseptic necrosis, rheumatoid arthritis, rotator cuff tear arthropathy, Parkinson's disease, prior shoulder arthroscopy, and blood transfusion.

Conclusions: It is of benefit to study risk factors of prosthesis-related complications following total shoulder arthroplasty to ensure the appropriate management and optimize consequences although a relatively low incidence was identified.

Background: Total knee arthroplasty is the most effective treatment for advanced-stage knee arthritis, and the majority of knee prostheses are made of metal. Nevertheless, metal prostheses still have several problems. The objective of this study is to introduce new metal-free knee prostheses made of polyether-ether-ketone (PEEK) and to compare their cement bond strength with metal prostheses.

Methods: Twelve sets of knee prostheses were divided into four groups (unloaded PEEK, unloaded Metal, 10 million cycles (MC) PEEK, 10 MC Metal, N = 3 each), and then attached to composite bones using bone cement. Both the 10 MC PEEK and 10 MC Metal groups were subjected to dynamic gait simulations of 10 MC, whereas the other two sets were not. Afterwards, a pull-off strength test was performed on the femoral prostheses and a shear strength test was performed on the tibial prostheses.

Results: No apparent cracks were observed in the bone cement after subjecting the PEEK and Metal groups to 10 million cycles of dynamic simulation. No statistically significant differences were observed (p > .05) in the strength tests for unloaded PEEK vs. unloaded Metal, 10 MC PEEK vs.10 MC Metal in the femoral pull-off test, and for unloaded PEEK vs. unloaded Metal in the tibial shear test. The shear strength of 10 MC PEEK was significantly lower (p < .05) compared to that of 10 MC Metal.

Conclusions: By comparing the force analysis of previous investigations on knee prostheses with the failure pattern observed in the PEEK knee prosthesis of this study, which replicates that of the metal prosthesis. We believe that the combination of the peek knee prosthesis with bone cement is reliable. We anticipate that metal-free PEEK knee prostheses will find application in Total Knee Arthroplasty (TKA) in the future, thereby benefiting patients.

Objective: Pharmacotherapy is the most common strategies to reduce pain for osteoarthritis (OA) patients. To analyze the trend and pattern of prescription analgesic medication use in American OA patients. Besides, our study also tried to figure out the demographic characteristics of opioid use among OA population which may helpful for managing the use of opioids.

Methods: We included 2214 OA patients from 2007 to 2018. We extracted data from National Health and Nutrition Examination Survey (NHANES) database. We compared analgesics and anti-depression medications use by category between survey participants with OA and without.

Results: For OA patients, NSAIDs, acetaminophen and gabapentinoid were the mostly highly used analgesics (10.2%, 9.0% and 8.9%, respectively). However, we also found that opioids use was very common in OA patients (7.7%) and the duration of opioids use was significantly long. In addition, the opioids use did not decrease from 2007 to 2018, while gabapentinoid increased rapidly from recent decade (From 5.0% to 12.1%). The common analgesic combination used by OA population was opioids with acetaminophen and gabapentinoid with selective serotonin reuptake inhibitors (SSRIs) (2.9% and 2.7%, respectively).

Conclusion: The use of gabapentinoid increased rapidly from recent decade, while opioids use did not decrease. The long-term excessive use of opioids was also a serious problem for OA pain control. More improvements such as focusing more on healthcare education and paying more attention on non-pharmacotherapy and the psychological situation of patients are needed.

Bone defects caused by osteomyelitis can lead to severe disability. Surgeons still face significant challenges in treating bone defects. Nano-hydroxyapatite (n-HA) plays an important role in bone tissue engineering due to its excellent biocompatibility and osteoconductivity. Levofloxacin (Levo) was encapsulated in mesoporous silica nanoparticles (MSNs) via electrostatic attraction to serve as a drug delivery system. MSNs were incorporated with n-HA and polyurethane (PU). The degradation and osteoconductivity properties of these novel composite scaffolds and their effectiveness in treating chronic osteomyelitis in a rabbit model were assessed. Gross pathology, radiographic imaging, micro-computed tomography, Van Gieson staining, and hematoxylin and eosin staining were conducted at 6 and 12 weeks. The group of composite scaffolds combining n-HA/PU with MSNs containing 5 mg Levo (n-HA/PU + Nano +5 mg Levo) composite scaffolds showed superior antibacterial properties compared to the other groups. At 12 weeks, the n-HA/PU + Nano +5 mg Levo composite scaffolds group exhibited significantly greater volume of new trabecular bone formation compared to the other three groups. The surface of the novel composite scaffolds exhibited degradation after 6 weeks implantation. The internal structure of the scaffolds collapsed noticeably after 12 weeks of implantation. The rate of material degradation corresponded to the rate of new bone ingrowth. This novel composite scaffold, which is biodegradable and osteoconductive, has potential as a drug delivery system for treating chronic osteomyelitis accompanied by bone defects.

Background: Clavicle fractures are traditionally treated non-operatively. This study determines the functional outcome of midshaft clavicle fractures treated non-operatively, the factors influencing it, and the incidence of acromioclavicular joint (ACJ) arthrosis.

Methods: Patients with midshaft clavicular fractures treated non-operatively between 16 and 50 years old with no prior AC joint problems were assessed. Demographics, hand dominance, type of occupation, and smoking status were documented. Functional scoring using DASH score, CM score, and radiological evaluation was done with special tests to diagnose AC joint arthrosis. Two or more positive special tests were considered significant for this study.

Results: 101 patients were recruited, 83 male and 18 female patients. The average age of 34.7 ± 13.93 years. The average follow-up was 32.7 months (range: 24-75; SD ± 9.9 months). 48.5% were blue-collar workers, and 60.4% involved the dominant upper limb. 44.6% were cigarette smokers. There was 20 mm and more shortening in 21.8% of subjects. 40.6% had a significant special test, and 36.6% had radiological changes of AC joint osteoarthritis. Positive two or more special tests were significantly associated with radiological evidence of arthrosis (p = .00). The mean DASH score was 28.28 ± 17.4, and the mean CM score was 27.58 ± 14.34. Most have satisfactory to excellent scores. Hand dominance, smoking, and blue-collar work were significantly associated with poorer CM scores, and hand dominance was significant for Dash scores.

Conclusion: There is an equal distribution poor, satisfactory and excellent functional outcomes in patients with midshaft clavicle fractures treated non-operatively. The poor outcomes may be attributed to ACJ arthrosis. Hand dominance, smoking and blue-collar work affected the functional outcome. Shortening of the clavicle had no bearing on the clinical and radiological findings of osteoarthritis and functional scores. The presence of two or more positive special tests is an accurate predictor of AC joint arthritis.