Journal of Orthopaedic Surgery最新文献

Background: Over the last few decades, shoulder surgery has undergone rapid advancements, with ongoing exploration and the development of innovative technological approaches. In the coming years, technologies such as robot-assisted surgeries, virtual reality, artificial intelligence, patient-specific instrumentation, and different innovative perioperative and preoperative planning tools will continue to fuel a revolution in the medical field, thereby pushing it toward new frontiers and unprecedented advancements. In relation to this, shoulder surgery will experience significant breakthroughs. Main body: Recent advancements and technological innovations in the field were comprehensively analyzed. We aimed to provide a detailed overview of the current landscape, emphasizing the roles of technologies. Computer-assisted surgery utilizing robotic- or image-guided technologies is widely adopted in various orthopedic specialties. The most advanced components of computer-assisted surgery are navigation and robotic systems, with functions and applications that are continuously expanding. Surgical navigation requires a visual system that presents real-time positional data on surgical instruments or implants in relation to the target bone, displayed on a computer monitor. There are three primary categories of surgical planning that utilize navigation systems. The initial category involves volumetric images, such as ultrasound echogram, computed tomography, and magnetic resonance images. The second type is based on intraoperative fluoroscopic images, and the third type incorporates kinetic information about joints or morphometric data about the target bones acquired intraoperatively. Conclusion: The rapid integration of artificial intelligence and deep learning into the medical domain has a significant and transformative influence. Numerous studies utilizing deep learning-based diagnostics in orthopedics have remarkable achievements and performance.

Background: Information about orthopedics diseases on the Internet has not been extensively assessed. Our purpose was to evaluate the quality of online information of osteosarcoma on current video-sharing platforms in mainland China.

Method: TikTok and Bilibili were independently queried from June to July 2023 by four independent researchers using the Microsoft Edge web browser. Information about the videos and creators was recorded, and descriptive analyses were conducted.

Results: After data extraction, a total of 95 videos were included, in which 43 videos were uploaded by certified doctors (45.3%), with 35 videos (36.8%) uploaded by certified orthopedic surgeons. Of the content of these videos, 78.9% were introduction (n = 75), 64.2% were on professional knowledge (n = 61), 28.4% were on treatment (n = 27), while 5.3% were on surgical techniques (n = 5). The mean DISCERN total score was 43.8 ± 13.4, and the mean JAMA score was 3.8 ± 0.3.

Conclusions: Videos about osteosarcoma on current video-sharing platforms were extensive, but were not comprehensive and professional. Although current online videos have the potential to improve public awareness on osteosarcoma, due to their quality and content, were not assessed to be good sources for medical education.

Background: It is well known that estrogen is closely related to bone and joint tissue. Findings indicate that estradiol, injected during pregnancy, passes through the placental barrier and reaches the fetuses in utero where it exerts its action. Since trochlea appears well established in the prenatal period, however, whether trochlear dysplasia is related to estradiol exposure has not been confirmed, and the pathological process of estradiol exposure-induced trochlear dysplasia remains unclear. This study aimed to establish an estradiol exposure animal model in fetuses and to analyze the morphology of the femoral trochlear in neonatal rats.

Methods: 30 pregnant Wistar rats provided by the local Animal Center were assigned randomly into three groups, a high dose estradiol injection group, a low dose estradiol injection group and a blank control group. Gross, cross-sectional observation, histological staining measurement and microcomputed tomography of the rat offspring were conducted to evaluate the morphological changes of the femoral trochlea.

Results: The incidence of trochlear dysplasia increased with the concentration of estradiol injection. Gross and cross-sectional observation showed a shallower trochlea groove in two groups with estradiol injection. Histological staining measurement indicated that the trochlear sulcus angle and trochlear sulcus depth were significantly different between the two groups with estradiol injection and the blank control group at 0,5 and 10 days after birth. Subchondral bone loss was observed in the two estradiol injection groups by micro-CT, and the bone loss was found to deteriorate over time.

Conclusion: In this study, estradiol exposure in fetuses had an adverse effect on intrauterine development and could induce trochlear dysplasia and bone loss in rat offspring. In addition, this study also showed that the higher concentration of estradiol injection in pregnant rats, the more incidence of trochlear dysplasia in rat offspring.

Background: Unicompartmental knee arthroplasty (UKA) is an effective treatment method for knee osteoarthritis. With the development and implementation of enhanced recovery after surgery, UKA is now increasingly performed in outpatient surgical centers. However, there is ongoing debate regarding the safety and effectiveness of performing UKA in outpatient settings.

Methods: The search was performed to retrieve randomized controlled trials and cohort studies on outpatient UKA from PubMed, Cochrane Library, EMbase, CNKI, and WanFangData databases. The search was conducted from the inception of the databases until August 31, 2023. After independent screening, data extraction, and risk of bias evaluation by two researchers, meta-analysis was performed using RevMan 5.4 software.

Results: A total of eight studies involving 18,411 patients were included. The results showed that the postoperative transfusion rate in the outpatient group was lower than that in the inpatient group [OR = 0.36, 95%CI (0.24, 0.54), p < 0.00001], and the difference was statistically significant. However, there was no significant difference between the two groups in terms of readmission rate, reoperation rate, surgical site infection, and periprosthetic fracture. The differences were not statistically significant.

Conclusion: Compared to the traditional inpatient route, the blood transfusion rate for single-condyle replacement in the outpatient operation center is lower, and there is no significant difference in readmission rate, reoperation rate, surgical site infection, and periprosthesis fracture. The outpatient approach to UKA is safe, feasible, and highly satisfactory for patients. However, the results have certain limitations, and a rigorous preoperative complication risk assessment can minimize the risk of UKA in outpatient surgery centers.

Trial registration: PROSPERO number CRD42023405373.

Objective: Periprosthetic fracture (PPF) is an uncommon but devastating complication after total knee arthroplasty (TKA). Anterior femoral notching (AFN) is one of a perioperative risk factor for PPF. The main purpose of this study was to compare between the rates of anterior femoral notching (AFN) and supracondylar periprosthetic femoral fracture (sPPF) of manual TKA and robotic arm-assisted TKA (RATKA). Meanwhile, blood loss, transfusion rates, inflammatory responses, complications, early clinical and radiological outcomes were also assessed.

Methods: This retrospective study included 330 patients (133 RATKA and 197 manual TKA). Differences in risks of inflammatory, blood loss, complications (periprosthetic fracture and periprosthetic joint infection), pre-operative and post-operative distal lateral femoral angle (LDFA), distal femoral width (DFW), prosthesis-distal femoral width (PDFW) ratio, AFN, femoral component flexion angle (FCFA), peri-operative and post-operative functional outcomes between the RATKA and manual TKA groups were compared.

Results: The operation time and postoperative CRP level in the RATKA group was significantly longer and higher than that in the manual TKA group (p < .001). However, there was no significant difference in postoperative WBC level (p = .217), hemoglobin loss (p = .362), postoperative drainage (p = .836), and periprosthetic fracture (p = 1.000). There was no significant difference in LDFA (p > .05), DFW(p = .834), PDFW ratio (p = .089) and FCFA (p = .315) between the two groups, but the rate of AFN in the RATKA group was significantly lower than that in the manual TKA group (p < .05). There was no significant difference in ROM between the two groups on POD3, POD 90 and 1 year (p < .05), but the FJS-12 score in the RATKA group was higher than that in the manual TKA group on 1 year (p = .001).

Conclusion: Robotic-assisted total knee arthroplasty can decrease the incidence of anterior femoral notching compared to posterior referenced instrumented total knee arthroplasty.

Introduction: Soft tissue defects are a devastating complication of prosthetic joint infections (PJI) after total knee arthroplasty (TKA). Rotational flaps are commonly utilized to address these defects with variable reports of success. This study aimed to identify predictors of poor outcomes in rotational muscle flap placement after prosthetic knee infections. The authors hypothesized that outcomes may vary based on infecting pathogen and treatment characteristics.

Methods: 44 cases of rotational muscle flaps for prosthetic knee infection were retrospectively evaluated at a tertiary referral hospital from 2007 to 2020. Muscle flap types included 39 medial and four lateral gastrocnemius, and one anterior tibialis. Minimum follow-up was 1 year (median: 3.4 years). Primary outcome was flap-related complications. Secondary outcomes included recurrent infection requiring additional surgery, final joint outcomes, and mortality.

Results: One-year complication-free flap survivorship was 83.9%, recurrent infection-free survivorship was 65.7%, and amputation-free survivorship was 79%. Multivariable cox regression revealed that rheumatoid arthritis diagnosis (HR: 3.4; p = .028) and methicillin-resistant Staphylococcus aureus-positive culture (HR: 4.0; p = .040) had increased risk, while Coagulase-negative Staphylococcus infections had reduced risk for recurrent or persistent infection (HR: 0.2; p = .023). Final joint outcome was retained TKA implant in 18 (40.9%), amputation in 15 (34.1%) patients, and definitive treatment with articulating spacer in 10 (22.7%). 5-years survivorship from death was 71.4%.

Conclusion: Rotational muscle flaps for soft tissue coverage of the knee are often performed in limb salvage situations with poor survivorship from flap complications, reinfections, and amputation. When considering surgical options for limb salvage, patients should be counseled on these risks.

Background: The prevalence of both type 2 diabetes mellitus (T2DM) and osteoporosis has been increasing among older individuals, with these two health conditions often coexisting. Our aim in this study was to evaluate the association between T2DM status and bone mineral density (BMD) of the femoral neck among older adults in the United States.

Methods: This was a retrospective analysis of the data from 5695 adults, 60-80 years of age. The data were obtained from the National Health and Nutrition Examination Survey, for the following years: 2005-2006, 2007-2008, 2009-2010, 2013-2014, and 2017-2018. Weighted multivariable regression analyses, with subgroup analyses as appropriate, were performed to identify an association between T2DM/prediabetes status and femoral BMD and mediating factors.

Results: There was a significant positive association between T2DM/prediabetes status and femoral neck BMD among older women, but not men, after adjusting for body mass index (BMI). On subgroup analysis, stratified by BMI, the significant positive association was retained for T2DM women with a BMI of 25-29.9 kg/m² (β, 0.030; 95% CI, 0.007-0.052) or ≥30 kg/m² (β, 0.029; 95% CI, 0.007-0.05), and for prediabetes women with a BMI of 25-29.9 kg/m² (β, 0.016; 95% CI, 0.001-0.030).

Conclusions: The association between a positive T2DM/prediabetes status and femoral neck BMD differed by sex among older individuals, with the association being further modulated by BMI. For women with a BMI of 25-29.9 kg/m² or ≥30 kg/m², T2DM was associated with a significantly higher femoral neck BMD, compared to the non-diabetes group.

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.