Journal of Orthopaedic Surgery and Research最新文献

Background: This study aims to comprehensively examine the distal femoral valgus cut angle (VCA) utilized during total knee arthroplasty (TKA) in the Turkish population and identify the radiological and demographic factors influencing this critical surgical parameter.

Methods: A retrospective analysis was performed on 193 lower extremity orthoradiographs from 120 patients diagnosed with end-stage knee osteoarthritis between January 2020 and December 2023. Key radiological variables assessed included VCA, mechanical femorotibial angle (MTFA), neck-shaft angle (NSA), medial offset (MO), and lateral distal femoral angle (LDFA).

Results: The mean VCA was 6.48 ± 0.83 degrees, with no statistically significant differences observed between genders (p = 0.755). A moderate negative correlation was identified between VCA and NSA (r = - 0.423, p < 0.001), while weak to moderate positive correlations were observed between VCA and both MO (r = 0.337, p < 0.001) and LDFA (r = 0.307, p = 0.002). No significant associations were found between VCA and the other evaluated parameters.

Conclusions: The results highlight the necessity of personalized assessment of VCA during TKA to optimize radiological outcomes, as opposed to a standardized approach. In the Turkish population, VCA is primarily influenced by NSA, MO, and LDFA, with coronal plane deformities showing no significant effect. This study emphasizes the importance of considering patient-specific anatomical variations during preoperative planning.

Purpose: Open arthrotomy is the standard treatment for septic arthritis of the hip (SAH) in pediatric patients. The anterior and medial approaches are commonly employed; however, these techniques result in substantial tissue trauma and unfavourable scarring. The bikini incision technique has also been documented in several studies. This study evaluated the efficacy of open drainage via a mini-bikini anterior approach for pediatric SAH patients.

Methods: This was a single-centre retrospective analysis. From January 2020 to March 2024, pediatric patients diagnosed with SAH were enrolled and underwent open drainage via an anterior approach with a mini-bikini incision. Postoperatively, all patients received initial intravenous antibiotic therapy, followed by a transition to oral antibiotics. Patients were followed for a minimum of 12 months, during which time clinical outcomes were assessed, including hip joint function, sensory evaluation, radiological sequelae, and both subjective and objective assessments of scar appearance.

Results: A total of 25 pediatric patients with SAH were included in this study, including 14 females, with a mean age of 32 months. The left hip joint was involved in 15 patients, with a mean surgical time of 31 min, average intraoperative blood loss of 13 ml, and an average hospital stay of 12 days. The overall pathogen detection rate was 64%, with methicillin-sensitive Staphylococcus aureus (MSSA) being the most prevalent pathogen in this cohort. No complications occurred during or after surgery, and the surgical incisions of all patients healed in the first stage. The average follow-up time was 23 months, and at the last follow-up, according to Bennett's classification, 21 patients (84%) achieved excellent clinical outcomes, the remaining 4 children (16%) had good clinical results, and the range of motion of the affected hip joint returned to normal. All patients achieved infection clearance with excellent/good clinical outcomes (Bennett's classification). The mean incision length was 2.3 cm, the mean Vancouver scar scale score was 4.5, and 100% parental satisfaction was reported.

Conclusion: Our findings suggest that anterior mini-bikini approach is a potential safe and effective treatment for septic arthritis of the hip in children, offering minimal tissue trauma and improved cosmetic outcomes. These results support future investigation in larger, prospective cohorts to establish broader clinical applicability.

Background: Intramedullary nailing (IMN) is considered the gold standard surgical technique for the management of femoral shaft fractures. Nonunion is characterized by the absence of complete healing within nine months post-injury or the lack of any radiographic evidence of callus formation within three months. In this study, we aimed to evaluate the effects of postoperative fracture interval and translation and other factors on bone union in femoral shaft fractures treated with IMN.

Materials and methods: A total of 87 patients with femoral shaft fractures who underwent IMN surgery in our clinic between January 2017 and January 2024 were included in this retrospective study. The patients were followed postoperatively through routine clinical and radiological assessments.

Results: Open reduction was associated with a 3.7-fold higher risk of nonunion compared to closed reduction. No significant correlation was observed between healing time and either the fracture gap in the anteroposterior and lateral planes or the nail-to-canal diameter ratio. In the regression analysis, with healing time as the dependent variable, both open reduction and anteroposterior translation emerged as independent predictors of delayed union (p < 0.001).

Conclusions: Our study results showed that the rate of open reduction was higher in patients with nonunion and those with open fractures and those undergoing open reduction had longer healing times. We also observed a positive correlation between translation values in the anteroposterior and lateral planes and healing time, with increased translation leading to longer healing durations. These findings indicate that open reduction and increased fracture translation, particularly in the anteroposterior plane, are significant factors influencing delayed union and nonunion in femoral shaft fractures treated with IMN.

Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by synovial inflammation and joint destruction. C-X-C motif chemokine ligand 13 (CXCL13) is a chemokine involved in B-cell recruitment and lymphoid neogenesis, but its regulatory mechanisms in RA remain unclear.

Methods: Fibroblast-like synoviocytes (FLS) were isolated from synovial tissues of RA patients and traumatic knee disease volunteers. Differentially expressed genes between healthy and RA synovial tissues were analyzed using GEO datasets (GSE55235, GSE12021, and GSE89408). Quantitative real-time PCR was used to measure mRNA levels of CXCL13, signal transducer and activator of transcription 1 (STAT1), interleukin (IL-6), interleukin-1β (IL-1β), and interleukin-18 (IL-18), while Western blotting was used to detect CXCL13, STAT1, interleukin-8 (IL-8), and cyclooxygenase-2 (COX-2) protein expression. Enzyme-linked immunosorbent assays were used to quantify IL-6, IL-1β, and IL-18 levels. Cell viability, proliferation, and apoptosis were assessed via cell counting kit-8, 5-Ethynyl-2'-deoxyuridine, flow cytometry, and TUNEL assays. Chromatin immunoprecipitation (ChIP) and dual-luciferase reporter assays were used to verify the STAT1-CXCL13 interaction.

Results: CXCL13 and STAT1 were significantly upregulated in RA-FLS. Silencing CXCL13 suppressed pro-inflammatory cytokines (IL-6, IL-1β, IL-18) and proteins (IL-8, COX-2), inhibited cell viability and proliferation, and induced apoptosis. STAT1 knockdown reduced CXCL13 expression with inhibiting phosphorylated STAT1 expression. STAT1 acted as a transcriptional activator of CXCL13 in RA-FLS. Overexpressing CXCL13 reversed the anti-inflammatory, anti-proliferative, and pro-apoptotic effects of STAT1 knockdown in RA-FLS.

Conclusion: STAT1 transcriptionally activated CXCL13 to enhance inflammation, promote proliferation, and suppress apoptosis in RA-FLS. These findings highlight the STAT1/CXCL13 axis as a potential therapeutic target for modulating synovial hyperplasia and inflammation in RA.

Background: The Attune knee system was released in 2011 aiming to improving patient satisfaction rates following total knee arthroplasty. There have been few large non-design centre studies published to date. The aim of this study is to assess failure rates and patient-reported outcome measures(PROM) of the Attune knee implant in a non-design centre.

Methods: We retrospectively analysed a prospectively collected database of consecutive series of the first 500 primary, cemented, posterior stabilised, fixed bearing, Attune total knee arthroplasty cases performed by a single non-design surgeon, at one hospital. PROMs were measured as Oxford Knee Scores(OKS) and Patient's Knee Implant Performance(PKIP) questionnaires pre-operatively, 3-months post-operatively and at an average of 5.44 years (minimum 2 years) post-operatively. We recorded failure rates and examined the learning curve by comparing outcomes per 100 cases over time. The majority of cases (n = 445) were performed with the 1st generation Legacy™ tray. No patients were lost to follow-up.

Results: Of the 500 knees, mean age was 72 years. Mean follow up was 5.44 years (SD 1.62, range 2-8.9 years). The mean OKS increased post-operatively from 18.26/48 to 45.61/48. The mean PKIP increased post-operatively from 19.01/100 to 88.37/100. Both PROMs were maintained at medium-term follow up (2 years). In total there were 11 (2.2%) revisions of which three (0.6%) were revised for tibial tray loosening, two (0.4% were revised for infection, one (0.2%) for unexplained pain and five (1%) patients underwent a polyethylene liner upsizing due to instability.

Conclusions: This prospective study shows favourable early post-operative results of the Attune knee with just three patients (0.6%) being revised for tibial tray loosening. The strengths of this study include the large consecutive cohort in a non-design centre with no loss to follow-up. Further long-term follow-up is required however, this is the largest non-design centre study to our knowledge to date.

Objective: This study aims to evaluate the effectiveness of skin staplers for wound closure following extended L-shaped incisions in the treatment of calcaneal fractures.

Methods: A randomized controlled trial was performed on 82 calcaneal fracture cases (Sanders types III-IV) that underwent extended L-shaped incisions at the Second Hospital of Shanxi Medical University from June 2022 to March 2025. Out of these, 60 cases met the inclusion and exclusion criteria. A non-blinded, open, randomized controlled trial was conducted, assigning patients to either the stapler group (n = 28) or the Allgower-Donati group (n = 32). The key parameters assessed included wound closure time, the area of postoperative inflammatory reaction, changes in skin temperature at the incision corners, and wound healing grades. These parameters were then compared between the two groups.

Results: At the 2-week postoperative follow-up, when sutures were removed, no significant differences were found in terms of inflammatory reaction area, skin temperature changes, or wound healing grades between the two groups. However, the stapler group demonstrated a notably shorter wound closure time (10.89 ± 2.87 min) compared to the Allgower-Donati group (20.44 ± 2.01 min).

Conclusion: The use of skin staplers for wound closure resulted in healing outcomes that showed no statistically significant differences from those achieved with the Allgower-Donati suturing technique in extended L-shaped incisions for calcaneal fractures. Importantly, the skin stapler method significantly reduces wound closure time (P < 0.05), which can lead to shorter overall surgical durations and a decreased risk of wound infections.

Background: Rotational alignment of the femoral component is pivotal in total knee arthroplasty (TKA). However, fixed rules such as posterior condylar axis (PCA) + 3° external rotation may neglect patient-specific anatomy and cartilage loss in knee osteoarthritis (KOA). MRI can visualize cartilage and may refine rotational planning. This study aimed to determine, on MRI, how posterior condylar cartilage defects affect femoral rotational alignment (cartilage-aware surgical epicondylar axis (SEA)-PCA), to assess variation by coronal alignment and KOA severity, and to evaluate the utility of tangential anterior line (TAL) -SEA as a complementary descriptor.

Methods: In this cross-sectional study, 548 knees (≥ 60 years) underwent standardized MRI measurements of SEA-PCA and TAL-SEA. Coronal alignment was classified as neutral/varus/valgus; KOA severity as none/early/advanced (Kellgren-Lawrence classification). We calculated a PCA + 3° femoral rotation and computed resultant malrotation relative to SEA.

Results: Both angles declined with increasing KOA severity (SEA-PCA: 3.0° vs. 2.6° vs. 2.2°; TAL-SEA: 4.7° vs. 4.4° vs. 2.9°; all p < 0.001). Among KOA knees, valgus alignment exhibited larger rotational angles than neutral/varus (e.g., advanced KOA SEA-PCA 4.4° valgus vs. 2.0°/1.8°; TAL-SEA 5.7° valgus vs. 2.8°/2.7°; all p < 0.001). The PCA + 3° rule produced frequent malrotation: internal in most valgus KOA knees and external in most varus KOA knees; notably, this pattern reversed in non-KOA knees. Alignment-angle correlations were positive but modest.

Conclusion: Rotational axes vary with KOA severity and coronal alignment on MRI, and these phenotype-dependent differences explain why a uniform PCA + 3° approach produced a high malrotation rate (internal in many valgus KOA knees and excessive external in many varus KOA knees). Therefore, femoral rotational alignment planning should be individualized using anatomy-based references-prioritizing the SEA, cross-checking with TAL-SEA, and applying directional tolerances that avoid internal rotation relative to the SEA-rather than relying on a fixed-angle rule.

Objective: To compare the comparative efficacy and safety of leukocyte-rich platelet-rich plasma (L-PRP), leukocyte-poor platelet-rich plasma (LP-PRP), hyaluronic acid (HA), and placebo for the treatment of knee osteoarthritis (KOA).

Design: Systematic review and network meta-analysis of randomized controlled trials (RCTs).

Data sources: A comprehensive search of PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science was conducted from inception to October 2025, without language restrictions.

Eligibility criteria for selecting studies: We included RCTs that compared at least two of the following interventions in patients with KOA: L-PRP, LP-PRP, HA, or placebo. The primary outcome was functional improvement measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes were pain reduction and the incidence of short-term adverse events.

Results: Twenty-one RCTs, comprising 2,254 patients, were included. The network meta-analysis demonstrated that for functional improvement at 6-12 months, both L-PRP (Mean Difference [MD] vs. placebo: -13.20; 95% Confidence Interval [CI]: -20.80 to -5.60) and LP-PRP (MD: -10.54; 95% CI: -18.37 to -2.71) were significantly superior to placebo. Both were also superior to HA. According to P-score rankings, LP-PRP was the most effective treatment for function (0.96), followed by L-PRP (0.82). However, the direct comparison between LP-PRP and L-PRP showed no statistically significant difference in efficacy. For pain reduction, all active treatments were superior to placebo. While L-PRP was associated with a higher incidence of transient local adverse events, the data were inconsistently reported. Sensitivity analyses confined to studies with a low risk of bias confirmed the robustness of these findings.

Conclusion: Intra-articular PRP provides clinically significant functional improvement and pain relief for patients with KOA, with an efficacy superior to that of HA. Both L-PRP and LP-PRP are effective treatment options with comparable efficacy based on current evidence. Although qualitative trends suggest a potentially better safety profile for LP-PRP, robust data are lacking. Therefore, there is insufficient evidence to recommend one PRP formulation over the other.

Background: The combined injury of multiple knee ligaments, commonly referred as "multiligament knee injury" (MKI), is a rare pathology that most often occurs in high-energy trauma. The associated lesions present a technical challenge for surgical reconstruction in terms of operative strategy. Various anatomical techniques have been described. Despite their proven advantages over non-anatomical techniques, these techniques have several disadvantages, such as the need for multiple grafts and allografts and the creation of multiple tunnels. Our technique aims to overcome these disadvantages.

Materials and methods: We present an original surgical technique for the anatomical reconstruction of the medial collateral ligament and the posterior oblique ligament using a pediculated autograft from the semitendinosus or gracilis. Fourteen patients were analysed.

Results: The minimum follow-up period was 2 years (mean: 44 months, 33-61). Good clinical and objective paraclinical results were achieved, with a mean range of motion of 0-1-119° at the last follow-up. 93% of patients showed no valgus laxity and 100% of patients had an objective IKDC score of A or B.

Conclusion: We propose a new approach to reconstructing the medial and posteromedial structures. This involves anatomical and isometric ligamentoplasty using an autograft. Our results confirm the effectiveness of this technique, demonstrating good clinical and paraclinical outcomes.

Level of evidence: IV.