Journal of orthopaedics最新文献_第2页

Comparison of single-stage versus two-stage revision for the treatment of chronic periprosthetic hip joint infections 一期与二期翻修治疗慢性假体周围髋关节感染的比较

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2026-05-01 Epub Date: 2026-02-04 DOI: 10.1016/j.jor.2026.02.021

Austin M. DeBoer , Nickolas L. Van Roekel , Travis D. Parkulo , Gaonhia Y. Moua , Sandy Vang , Scott B. Marston

Background

While two-stage revision is considered the gold standard, single-stage revision continues to gain popularity for the treatment of chronic periprosthetic joint infections. In this single-provider, single-protocol study, the outcomes between the two approaches were compared.

Methods

This was a retrospective study that included 63 consecutive adult patients who underwent single-stage or two-stage total hip revision arthroplasty for chronic periprosthetic joint infection between 2009 and 2020. Only the two-stage approach was performed between 2009 and 2014, while only single stage was performed between 2015 and 2020. Infections were classified using the Delphi-based consensus criteria. Three major outcomes were compared between the revision approaches: the rates of postoperative complications, reinfections, and reoperations.

Results

There were 43 (68.3%) single-stage and 20 (31.8%) two-stage revisions. The mean age was 59.5 ± 13 years with 35 (55.6%) women. The mean body mass index was 35.8 ± 9.1 kg/m². At the mean follow-up rate of 6.9 years (range, 2.1-10.8 years), the rate of no recurrence of infection was 81.4% in the single-stage cohort compared to 80.0% in the two-stage cohort (p = 1.000). Reoperation rate for single-stage revision due to a non-infectious reason was higher than two-stage (20.9% versus 15.0%; p = 0.7367). No statistically significant differences were noted for other postoperative complications.

Conclusion

Single-stage revision is as effective as two-stage revision for the treatment of chronic periprosthetic hip joint infections in patients with limited exclusion criteria.

虽然两阶段翻修被认为是金标准，但单阶段翻修在治疗慢性假体周围关节感染方面继续受到欢迎。在这个单一提供者，单一方案的研究中，比较了两种方法之间的结果。方法：这是一项回顾性研究，纳入了2009年至2020年间连续63例因慢性假体周围关节感染而接受单期或两期全髋关节翻修置换术的成年患者。在2009年至2014年期间只进行了两阶段的方法，而在2015年至2020年期间只进行了单阶段的方法。使用基于delphi的共识标准对感染进行分类。比较两种翻修方式的三个主要结果：术后并发症、再感染和再手术的发生率。结果单期修正43例（68.3%），二期修正20例（31.8%）。平均年龄59.5±13岁，女性35例（55.6%）。平均体重指数为35.8±9.1 kg/m2。在平均随访时间为6.9年（范围2.1-10.8年）时，单期队列感染无复发率为81.4%，而两期队列感染无复发率为80.0% （p = 1.000）。非感染原因单期翻修的再手术率高于两期翻修（20.9%比15.0%;p = 0.7367）。其他术后并发症无统计学差异。结论对于排除标准有限的慢性假体周围髋关节感染患者，一期翻修术与二期翻修术治疗效果相同。

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引用次数: 0

Patients undergoing total knee arthroplasty after tibial plateau fracture show functional improvement similar to primary arthroplasty patients: Propensity-matched cohort analysis 胫骨平台骨折后接受全膝关节置换术的患者表现出与初次关节置换术患者相似的功能改善：倾向匹配队列分析

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2026-05-01 Epub Date: 2026-02-09 DOI: 10.1016/j.jor.2026.02.038

Jacob S. Borgida , Perry L. Lim , Robert K. Wagner , Karim Sorour , Hany S. Bedair , Christopher M. Melnic , Thuan V. Ly , John G. Esposito

Purpose

Patients with a previous tibial plateau fracture (post-TPF) may be susceptible to worse outcomes after total knee arthroplasty (TKA) than patients undergoing primary TKA (pTKA). However, there is limited comparative evidence on patient-reported outcomes (PROMs) of these cohorts. This study aimed to compare PROMs and rate of achieving Minimal Clinically Important Difference for Improvement (MCID-I) and Worsening (MCID-W) between post-TPF TKA and pTKA patients.

Methods

Thirty-three post-TPF TKA patients were identified from an institutional database between 2016 and 2023 and 1:3 propensity score matched to 97 pTKA patients treated in the same period. Outcomes included Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health Mental and Physical, PROMIS Physical Function short form 10a (PF SF 10a), and Knee injury and Osteoarthritis Outcome Score-Physical Function Short-form (KOOS-PS) scores.

Results

Post-TPF TKA patients had significantly lower preoperative scores on PROMIS Global Health Mental (47.8 vs. 51.4, P = .042) and PF SF 10a (35.5 vs. 37.5, P = .037) compared to pTKA patients. The absolute increase across all PROMs between the cohorts was similar, however, post-TPF TKA patients had a higher rate of achieving MCID-I for PROMIS Global Health Mental and PF SF 10a. Post-TPF TKA patients had a higher rate of 90-day complications (15 vs. 4%, P = .031).

Conclusion

Post-TPF TKA patients reached higher MCID-I rates in two PROMs, but had significantly higher complication rates compared to pTKA. Despite the risks, post-TPF TKA patients can achieve similar or better improvements, urging further research into long-term outcomes for effective patient counseling and shared decision-making.

目的：术前胫骨平台骨折（tpf后）的患者在全膝关节置换术（TKA）后的预后可能比原发性TKA （pTKA）患者更差。然而，这些队列的患者报告结果（PROMs）的比较证据有限。本研究旨在比较tpf后TKA和pTKA患者的PROMs和达到最小临床重要差异改善（mcid - 1）和恶化（MCID-W）的比率。方法从2016年至2023年的机构数据库中筛选33例tpf后TKA患者，并与同期治疗的97例pTKA患者进行1:3倾向评分匹配。结果包括患者报告的结果测量信息系统（PROMIS）全球健康心理和身体、PROMIS身体功能短表10a （PF SF 10a）和膝关节损伤和骨关节炎结局评分-身体功能短表（KOOS-PS）评分。结果tpf后TKA患者术前PROMIS Global Health Mental评分（47.8比51.4,P = 0.042）和PF SF 10a评分（35.5比37.5,P = 0.037）显著低于pTKA患者。然而，tpf后TKA患者在PROMIS全球健康心理和PF SF 10a中达到mdid - 1的比率更高。tpf后TKA患者90天并发症发生率较高（15% vs. 4%, P = 0.031）。结论tpf后TKA患者在两种PROMs中mids - 1发生率较高，但并发症发生率明显高于pTKA。尽管存在风险，但tpf后TKA患者可以获得类似或更好的改善，这敦促进一步研究有效的患者咨询和共同决策的长期结果。

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引用次数: 0

High accuracy of knee alignment following well-balanced image-based robot-assisted total knee arthroplasty; radiographic validation of implant position and knee alignment 基于图像的机器人辅助全膝关节置换术后膝关节对齐的高精度假体位置和膝关节对齐的影像学验证

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2026-05-01 Epub Date: 2026-02-04 DOI: 10.1016/j.jor.2026.01.018

Dries Verbeke , Hans Van den Wyngaert , Alex Demurie , Ignace Ghijselings , Stefaan Van Onsem

Image based robotic assisted knee replacement surgery enables surgeons to achieve patient-specific alignment through intraoperative ligament balancing and implant positioning. The purpose of this study was to validate the accuracy of the implant position and lower limb alignment using full-leg weight-bearing postoperative radiographs.

This retrospective study included 69 patients receiving total knee arthroplasty (TKA) with the use of a MAKO robot and patella-in-place balancer between 01/2023 and 04/2024. All patients received a Triathlon® CS prosthesis with functional alignment philosophy. Coronal parameters (mechanical hip-knee-ankle-angle (mHKA), lateral distal femoral angle (LDFA), and medial proximal tibial angle (MPTA)) and sagittal alignment parameters (femoral flexion and tibial slope) were collected from the intraoperative plan and compared with pre- and postoperative weight-bearing full leg radiographs (FLR).

Preoperative mean mHKA of 2.4° ± 6.2° varus corrected to 2.2° ± 2.7° varus intraoperatively and 1.4° ± 3.2° varus postoperatively; with no significant differences intra-to postoperatively. LDFA increased significantly from 87.8° ± 3.2° to 90.1° ± 2.2° intraoperatively, but did not differ significantly on postoperative radiographs. Original MPTA angle was preserved intraoperatively at 87.7° ± 1.7°, but increased by 0.9° postoperatively (p = 0.005). Femoral flexion decreased after surgery from 5.8° ± 3.9° to 3.9° ± 2.8° (p < 0.001). Tibial slope decreased intraoperatively from 8.6° to 6.7° (p < 0.001), with no further postoperative change.

Functional alignment philosophy in combination with a patella in place balancing device in reliably reproduced the targeted limb alignment and implant positioning, with postoperative measurements closely matching intra-operative values across all alignment subgroups. There was no soft-tissue laxity asymmetry detected that had meaningful effect on alignment outcomes, supporting this technique as a precise and consistent surgical strategy.

基于图像的机器人辅助膝关节置换手术使外科医生能够通过术中韧带平衡和植入物定位实现患者特异性对齐。本研究的目的是通过术后全腿负重x线片验证植入物位置和下肢对齐的准确性。本回顾性研究纳入了2023年1月至2024年4月期间使用MAKO机器人和髌骨原位平衡器接受全膝关节置换术（TKA）的69例患者。所有患者均接受了具有功能对齐理念的Triathlon®CS假体。从术中计划中收集冠状面参数（机械髋关节-膝关节-踝关节角（mHKA）、外侧股骨远端角（LDFA）和内侧胫骨近端角（MPTA））和矢状面对齐参数（股骨屈曲和胫骨斜度），并与术前和术后负重全腿x线片（FLR）进行比较。术前平均mHKA由2.4°±6.2°内翻矫正为术中2.2°±2.7°内翻，术后1.4°±3.2°内翻；术中、术后无明显差异。术中LDFA从87.8°±3.2°显著增加至90.1°±2.2°，但术后x线片上无显著差异。术中MPTA原始角度保持在87.7°±1.7°，术后增加0.9°（p = 0.005）。术后股骨屈曲度从5.8°±3.9°降至3.9°±2.8°（p < 0.001）。术中胫骨斜率从8.6°降至6.7°（p < 0.001），术后无进一步变化。功能对准理念结合髌骨原位平衡装置可靠地再现了目标肢体对准和植入物定位，术后测量值与所有对准亚组的术中值密切匹配。没有检测到软组织松弛不对称对对齐结果有意义的影响，支持该技术作为精确和一致的手术策略。

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引用次数: 0

Preoperative fructosamine is comparable to HbA1c as a short-term glycemic marker for predicting postoperative complications in orthopaedic surgery: A systematic review and meta-analysis 术前果糖胺与HbA1c作为预测骨科手术术后并发症的短期血糖指标相当：一项系统综述和荟萃分析

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2026-05-01 Epub Date: 2026-02-03 DOI: 10.1016/j.jor.2026.02.019

Anil Regmi , Abdus Sami , Surakshya Baral , Vijay Kumar Jain , Karthikeyan. P. Iyengar

Objective

This study systematically evaluates the predictive value of preoperative glycaemic biomarkers, including fructosamine, compared with HbA1c and glycated albumin.

Methods

The databases of PubMed, Embase, and Scopus were searched from inception to September 2025 for studies that assessed preoperative fructosamine levels and postoperative complications in orthopaedic patients. Cohort studies reporting infections, wound complications, readmissions, or reoperations were included. Data extraction and quality assessment were performed independently. A random-effects meta-analysis was used to pool risk estimates, with heterogeneity quantified using the I² statistic.

Results

Seven cohort studies (N = 5217) met the inclusion criteria. Elevated preoperative fructosamine (≈292–293 μmol/L for arthroplasty; ≈238 μmol/L for foot/ankle surgery) was consistently associated with a higher risk of postoperative infection and complications (pooled RR 7.20; 95% CI 1.49–34.91). HbA1c demonstrated a smaller, less consistent effect (pooled RR 2.36; 95% CI 1.04–5.34). Direct comparisons between high fructosamine and high HbA1c cohorts revealed no statistically significant difference, although fructosamine more accurately reflected short-term glycemic status.

Conclusions

Preoperative fructosamine is a robust short-term glycaemic biomarker that frequently outperforms HbA1c in predicting postoperative infectious complications in arthroplasty and other orthopaedic surgery. Standardised cut-offs, multicenter validation, and interventional trials are needed to define its role in perioperative risk stratification.

目的本研究系统评价术前血糖生物标志物（包括果糖胺）与HbA1c、糖化白蛋白的预测价值。方法检索PubMed、Embase和Scopus数据库，检索自成立以来至2025年9月骨科患者术前果糖胺水平和术后并发症的相关研究。包括报告感染、伤口并发症、再入院或再手术的队列研究。数据提取和质量评估独立进行。随机效应荟萃分析用于汇总风险估计，异质性使用I2统计量进行量化。结果7项队列研究（N = 5217）符合纳入标准。术前果糖胺升高（关节置换术≈292-293 μmol/L；足/踝关节手术≈238 μmol/L）与术后感染和并发症的高风险一致相关（合并RR 7.20; 95% CI 1.49-34.91）。HbA1c表现出较小的、不一致的影响（合并RR 2.36; 95% CI 1.04-5.34）。高果糖胺组和高HbA1c组的直接比较显示，尽管果糖胺更准确地反映短期血糖状态，但没有统计学上的显著差异。结论：在关节置换术和其他骨科手术中，术后果糖胺是一种强有力的短期血糖生物标志物，在预测术后感染并发症方面往往优于HbA1c。需要标准化的临界值、多中心验证和介入性试验来确定其在围手术期风险分层中的作用。

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引用次数: 0

Patient- and disease-specific factors associated with atrophy of the intrinsic muscles of the ulnar nerve in cubital tunnel syndrome 与肘管综合征尺神经固有肌萎缩相关的患者和疾病特异性因素

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2026-05-01 Epub Date: 2026-02-03 DOI: 10.1016/j.jor.2026.02.013

Kenichi Asano , Katsuyuki Iwatsuki , Hiroki Yokoyama , Marie Mabuchi , Michiro Yamamoto

Introduction

Patients presenting with severe neuropathy are less likely to recover after surgery for cubital tunnel syndrome. The purpose of this study was to investigate patient- and disease-specific factors associated with atrophy at presentation of the intrinsic muscles innervated by the ulnar nerve.

Methods

A retrospective data of patients with cubital tunnel syndrome were included in the study. Paralysis of the intrinsic muscles was evaluated as muscle atrophy of the first dorsal interossei, adductor pollicis, or abductor digiti minimi. The muscle atrophy group comprised 64 patients with atrophy of the intrinsic muscles. The non-atrophy group comprised 57 patients without intrinsic muscle atrophy at presentation. Univariate and multivariate regression analyses were conducted to assess patient factors including age, sex, body mass index, disease duration, comorbidities (diabetes mellitus and cervical spondylosis), and other elbow disorders (osteoarthritis of the elbow, presence of a ganglion, and cubitus varus or valgus deformity). A radiographic evaluation of elbow osteoarthritis was conducted using the Broberg and Morrey classification; osteophytes of the ulna were also assessed.

Results

Through univariate analysis, patients in the muscle atrophy group were identified as being significantly older, with significantly longer disease duration and more osteophytes of the ulna, than those in the non-atrophy group. Cervical spondylosis and osteoarthritis of the elbow were more frequently observed in the muscle atrophy group than in the non-atrophy group. Multivariate analysis identified patient's age as an independent risk factor related to atrophy of the intrinsic muscles, while other factors were not significant association.

Conclusion

There was no association between the intrinsic muscle atrophy in cubital tunnel syndrome and elbow osteoarthritis. Older patients with cubital tunnel syndrome were more likely to present with atrophy of the intrinsic muscles of the ulnar nerve. Knowledge of the factors associated with severe neuropathy may allow for earlier diagnosis and therapeutic intervention.

摘要以严重神经病变为表现的肘管综合征患者术后恢复的可能性较小。本研究的目的是调查与尺神经支配的固有肌萎缩有关的患者和疾病特异性因素。方法回顾性分析肘管综合征患者的临床资料。固有肌麻痹被评价为第一背骨间肌萎缩、拇内收肌或指外展肌萎缩。肌萎缩组包括64例固有肌萎缩患者。非萎缩组包括57例在就诊时没有固有肌肉萎缩的患者。进行单因素和多因素回归分析，以评估患者因素，包括年龄、性别、体重指数、病程、合并症（糖尿病和颈椎病）和其他肘部疾病（肘关节骨关节炎、神经节的存在、肘内翻或外翻畸形）。采用Broberg和Morrey分级对肘关节骨关节炎进行影像学评价；尺骨骨赘也进行了评估。结果通过单因素分析，肌萎缩组患者明显比非肌萎缩组年龄大、病程长、尺骨骨赘多。与非萎缩组相比，肌肉萎缩组颈椎病和肘关节骨性关节炎的发生率更高。多因素分析发现，患者年龄是内在肌萎缩的独立危险因素，其他因素无显著相关性。结论肘管综合征固有肌萎缩与肘关节骨性关节炎无相关性。老年肘管综合征患者更容易出现尺神经固有肌萎缩。了解与严重神经病变相关的因素可能有助于早期诊断和治疗干预。

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引用次数: 0

Safety of posterolateral approach with a polished cemented stem and a modular dual mobility implant in patients over 75 years old 75岁以上患者后外侧入路采用抛光骨水泥柄和模块化双活动种植体的安全性

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2026-05-01 Epub Date: 2026-02-10 DOI: 10.1016/j.jor.2026.02.042

Cesare Meschini , Mattia Chirico , Matteo Innocenti , Giovanni Valentini , Paolo Salari , Andrea Baldini

Background

With increasing life expectancy, total hip arthroplasty (THA) is increasingly performed in patients over 75 years, a population at higher risk of perioperative complications. This study assessed the safety and short-to mid-term outcomes of a standardized THA strategy in elderly patients using a posterolateral approach, a polished cemented stem, and—when indicated—a modular dual mobility (DM) cup.

Methods

This retrospective multicenter study included patients >75 years who underwent primary THA with a cemented polished femoral stem and posterolateral approach (2017–2023). Group A received a modular DM cup, while Group B received a fixed-liner acetabular component. Clinical outcomes (Oxford Hip Score, VAS satisfaction) and complications were recorded. Survivorship was evaluated using Kaplan–Meier analysis in best- and worst-case scenarios.

Results

642 THAs were analyzed (Group A: 460; Group B: 182). Groups were comparable in age and sex distribution. Dislocation rate was significantly lower with DM (0.7% vs 2.75%; p = 0.045). No differences were observed in infection, aseptic loosening, periprosthetic fracture, reoperation, readmission, or mortality. Postoperative OHS was similar, while patient satisfaction (VAS) was higher in Group A (93.0 ± 7.0 vs 81.9 ± 14.2; p < 0.001). Kaplan–Meier analysis demonstrated excellent survivorship in both cohorts, without significant differences. No intraprosthetic dislocations or DM-related mechanical failures occurred.

Conclusion

THA using a posterolateral approach and a polished cemented stem is safe in patients over 75 years. Modular DM cups reduced dislocations and improved patient satisfaction without increasing complications. Their selective use may be advantageous in elderly, high-risk patients. Further prospective long-term studies are warranted.

Level of evidence

Level III, retrospective cohort study.

随着预期寿命的增加，全髋关节置换术（THA）越来越多地用于75岁以上的患者，这一人群围手术期并发症的风险更高。本研究评估了标准化THA策略在老年患者中的安全性和中短期结果，该策略采用后外侧入路、抛光骨水泥柄和（如有需要）模块化双活动杯。方法本回顾性多中心研究纳入了75岁的经骨水泥抛光股骨干和后外侧入路行原发性THA的患者（2017-2023）。A组采用模组化DM杯，B组采用固定式髋臼假体。记录临床结果（牛津髋关节评分、VAS满意度）和并发症。在最佳和最坏情况下，使用Kaplan-Meier分析评估生存率。结果共分析THAs 642例（A组460例，B组182例）。各组在年龄和性别分布上具有可比性。脱位率明显低于DM （0.7% vs 2.75%; p = 0.045）。在感染、无菌性松动、假体周围骨折、再手术、再入院或死亡率方面没有观察到差异。A组患者术后满意度（VAS）高于对照组（93.0±7.0 vs 81.9±14.2;p < 0.001）。Kaplan-Meier分析显示两组患者的生存率都很好，没有显著差异。无假体内脱位或dm相关机械故障发生。结论对于75岁以上的患者，采用后外侧入路和抛光骨水泥干是安全的。模块化DM杯减少了脱位，提高了患者满意度，同时没有增加并发症。它们的选择性使用可能对老年、高危患者有利。进一步的前瞻性长期研究是必要的。证据水平：III级，回顾性队列研究。

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引用次数: 0

Restricted kinematic alignment in total knee arthroplasty achieves equivalent or superior functional outcomes to mechanical alignment without compromising implant survivorship: A systematic review 全膝关节置换术中受限的运动学对齐达到了与机械对齐相当或更好的功能结果，而不影响植入物的存活：一项系统综述

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2026-05-01 Epub Date: 2026-02-04 DOI: 10.1016/j.jor.2026.02.025

Amaan A. Merchant , Maryam Imran , Mihika Joshi , Padmanabhan Subramanian , Farhad Iranpour

Purpose

This systematic review assesses the viability of restricted kinematic alignment compared to mechanical alignment by assessing clinical outcomes, radiological findings, and patient-reported outcome measures. Median follow-up was 20.3 months. Both RCTs and observational studies are included in this review.

Methods

A search was carried out according to PRISMA guidelines over PubMed, Embase, Cochrane and Web of Science databases. The following search string, (‘restricted kinematic alignment’ AND ‘mechanical alignment’) AND (‘total knee arthroplasty’ OR ‘total knee replacement’) was used. Titles, abstracts and keywords were screened against predetermined inclusion and exclusion criteria. Data was extracted by two independent reviewers and conflict was resolved by consensus.

Results

A total of 110 papers between 1975 and January 2025 were screened with 11 texts included in the final analysis.

Restricted kinematic alignment achieved superior FJS (p = 0.044) and KSS (p = 0.028) at 12 and 24 months respectively compared to mechanical alignment. Radiographic analyses confirmed coronal limb alignment and femoral/tibial component positioning remained within defined safe zones, with no significant increase in outliers. Importantly, complication and revision rates did not differ significantly between groups, indicating no compromise in short-term safety which is defined as follow-up less than five years.

Conclusion

This analysis suggests restricted kinematic alignment provides functional advantages whilst adhering to strict ‘intraoperative safe zones’ with no increase in short-term complications. However, surgical technique remains variable with some studies using robotic assisted surgery and others utilising calipered kinematic adjustments or navigation-assisted resections. Long-term implant durability also remains a crucial unanswered question.

Level of evidence

Level III

目的：本系统综述通过评估临床结果、影像学表现和患者报告的结果测量，评估受限运动学对齐与机械对齐的可行性。中位随访时间为20.3个月。本综述包括随机对照试验和观察性研究。方法根据PRISMA指南在PubMed、Embase、Cochrane和Web of Science数据库中进行检索。使用以下搜索字符串，（‘受限运动学对齐’和‘机械对齐’）和（‘全膝关节置换术’或‘全膝关节置换术’）。根据预先确定的纳入和排除标准筛选标题、摘要和关键词。数据由两名独立审稿人提取，冲突通过共识解决。结果从1975年至2025年1月共筛选论文110篇，其中11篇纳入最终分析。与机械对齐相比，受限运动学对齐在12个月和24个月时分别获得了更好的FJS （p = 0.044）和KSS （p = 0.028）。x线分析证实，冠状肢体对准和股骨/胫骨部件定位仍在确定的安全区域内，异常值没有显著增加。重要的是，并发症和翻修率在两组之间没有显著差异，表明短期安全性（定义为随访少于5年）没有妥协。结论：在严格遵守“术中安全区域”的同时，受限的运动学对齐提供了功能优势，不会增加短期并发症。然而，手术技术仍然是可变的，一些研究使用机器人辅助手术，另一些研究使用卡尺运动调节或导航辅助切除。种植体的长期耐久性也是一个关键的未解之谜。证据等级：III级

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引用次数: 0

Failure of the femoral stem: A case series of intra-prosthetic fractures and proposed classification system 股骨干骨折：假体内骨折病例系列及分类系统建议

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2026-05-01 Epub Date: 2026-02-07 DOI: 10.1016/j.jor.2026.02.035

R. Woods, A. Price, T. Donovan, S.R. Kearns, C.G. Murphy, G.A. Sheridan

Background

Femoral implant failure is an uncommon but significant complication in orthopaedic surgery associated with significant patient morbidity. This study presents a case series of femoral implant fractures treated at a single institution between 2007 and 2024, alongside a review of the relevant literature, to identify possible risk factors.

Methods

A retrospective analysis of patients with femoral implant fractures was, over a 17-year period, conducted at a single academic institution. Data collected included patient demographics, implant type, time to failure, treatment approach and postoperative outcomes. A literature review was performed to contextualise findings within existing research. We also propose a pragmatic and reproducible classification system based on anatomical location of the fractures within the stem.

Results

A total of fourteen cases were identified across the defined study period with implant fractures occurring at a mean of 129 months postoperatively. The mean age of patients in this study was 71.76. Seven of the fourteen cases involved polished taper slip (PTS) stems, while twelve of the fourteen intra-prosthetic fractures occurred around cemented stems. The most frequent fracture sites were the middle third of the stem. Each of the cases were treated with revision arthroplasty. Postoperative complications and functional outcomes varied based on fracture type and patient factors. Four types of fracture are described based on the fracture location – Type A-D.

Conclusion

Femoral implant fractures remain a challenging issue in orthopaedic surgery. Identifying risk factors and optimising implant selection and surgical technique are crucial for complication prevention. This case series highlights key patterns and management strategies, contributing to the growing body of evidence on implant longevity and failure mechanisms. Further research is needed to improve early detection and intervention strategies for at-risk patients. A simple, pragmatic, location-based classification system could improve communication and standardisation of revision strategies.

背景：股骨假体失败是骨科手术中一种罕见但重要的并发症，与患者的发病率相关。本研究介绍了2007年至2024年间在一家机构治疗的股骨植入物骨折病例系列，并对相关文献进行了回顾，以确定可能的危险因素。方法回顾性分析某学术机构17年来股骨植入物骨折患者。收集的数据包括患者人口统计学、种植体类型、失败时间、治疗方法和术后结果。对现有研究中的发现进行了文献综述。我们还提出了一个实用的和可重复的分类系统，基于骨折在茎内的解剖位置。结果在研究期间共发现14例假体骨折，平均术后129个月发生假体骨折。本研究患者的平均年龄为71.76岁。14例中有7例涉及抛光锥形滑移（PTS）柄，而14例假体内骨折中有12例发生在骨水泥柄周围。最常见的骨折部位是椎弓根中部的三分之一。所有病例均行关节翻修成形术。术后并发症和功能结果因骨折类型和患者因素而异。根据裂缝位置分为四种类型——A-D型。结论股骨假体骨折仍然是骨科手术中一个具有挑战性的问题。确定危险因素，优化种植体选择和手术技术是预防并发症的关键。本病例系列强调了关键模式和管理策略，为种植体寿命和失败机制提供了越来越多的证据。需要进一步的研究来改进对高危患者的早期发现和干预策略。一个简单的、实用的、基于位置的分类系统可以改善复习策略的交流和标准化。

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引用次数: 0

Femoroacetabular impingement–related deformities correlate with advanced osteoarthritis in asymptomatic caucasians over 60: A CT-based cross-sectional study 60岁以上无症状白种人股骨髋臼撞击相关畸形与晚期骨关节炎相关：一项基于ct的横断面研究

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2026-05-01 Epub Date: 2026-02-10 DOI: 10.1016/j.jor.2026.02.041

Sophia Freya Ulrike Blum , Felix Schön , Katja Brauer , Petri Bellova , Jens-Peter Kühn , Ralf-Thorsten Hoffmann , Klaus-Peter Günther , Jens Goronzy

Objective

Osteoarthritis (OA) is a common finding in the elderly population. Femoroacetabular Impingement (FAI)-related deformities can cause OA. Their prevalence and clinical relevance in the asymptomatic elderly population are unclear. This study aims to determine the prevalence of cam and pincer deformities in asymptomatic, non-orthopedic Caucasian patients over 60 years in computed tomography (CT) and correlate the presence of those deformities with radiological signs of OA.

Design

CTs of oncological patients over 60 years without any previous history of hip pathology or pain, containing a complete scan of both hips, were included. All hips were analysed for signs of OA according to the Kellgren-Lawrence (KL) classification. The acetabular anteversion, acetabular sector angles (ASA), and alpha angles were measured in clockwise positions of the hip. All angles were modeled conditionally on KL, sex, age, and obesity using random-effects median regression.

Results

One hundred ninety-five non-orthopedic patients (130 male, 65 female; mean age 70.4 years; 290 hips) were included. Signs of severe OA (KL 3/4) were found in 19.2 %. Patients over 80 years had significantly higher alpha angles at 9-11 o'clock, higher ASA at 9-12 o'clock, and a higher acetabular anteversion at the level of the acetabular roof. Individuals with advanced OA showed higher alpha angles, higher ASA, and a lower acetabular anteversion than those without/with moderate OA.

Conclusions

This study provides an estimate of the distribution of FAI-related deformities within a population of individuals over 60 years with asymptomatic hips. The prevalence of these deformities is correlated with advanced OA.

目的骨关节炎（OA）是老年人的常见病。股髋臼撞击（FAI）相关畸形可导致OA。它们在无症状老年人群中的患病率和临床相关性尚不清楚。本研究旨在通过计算机断层扫描（CT）确定60岁以上无症状、非矫形的高加索患者中cam和钳子畸形的患病率，并将这些畸形的存在与骨关节炎的影像学征象联系起来。设计纳入60岁以上无任何髋关节病理或疼痛史的肿瘤患者的ct，包括双髋关节的完整扫描。根据Kellgren-Lawrence （KL）分类分析所有髋部是否有骨关节炎的迹象。在髋关节顺时针位置测量髋臼前倾、髋臼扇形角（ASA）和α角。使用随机效应中位数回归对所有角度进行有条件地建模，包括KL、性别、年龄和肥胖。结果共纳入195例非骨科患者，其中男性130例，女性65例，平均年龄70.4岁，290髋。有严重骨关节炎（KL 3/4）的患者占19.2%。80岁以上的患者在9-11点钟的α角明显升高，在9-12点钟的ASA较高，在髋臼顶水平的髋臼前倾较高。与没有/中度OA的患者相比，晚期OA患者表现出更高的α角、更高的ASA和更低的髋臼前倾。结论：本研究估计了60岁以上无症状髋关节人群中fai相关畸形的分布。这些畸形的流行与晚期OA相关。

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引用次数: 0

Imageless robotic assisted TKA: a systematic review 无图像机器人辅助TKA：系统综述

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2026-05-01 Epub Date: 2026-02-11 DOI: 10.1016/j.jor.2026.02.046

Alessandro El Motassime , Greta Tanzi Germani , Rudy Sangaletti , Luca Andriollo , Virginia Cinelli , Francesco Benazzo , Stefano Marco Paolo Rossi

Background

Imageless robotic-assisted TKA (RATKA) has arisen as a potential technology designed to improve surgical accuracy, advance clinical outcomes, and reduce complications. This systematic review evaluates the clinical efficacy, safety, and radiological accuracy of imageless RATKA.

Methods

Review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and PROSPERO registered (CRD1161673). A thorough search of PubMed, Scopus, and Web of Science databases was conducted through April 2025. Data were independently withdrawn by reviewers, and study quality was assessed using the Modified Coleman Score and RoB 2 and ROBINS-I tools. Descriptive synthesis and weighted mean analysis were performed.

Results

A total of 8 studies involving 612 knees were included. Mean patient age was 67.7 years and mean follow-up was 15.8 months. The overall methodological quality was moderate (mean Modified Coleman Score: 70/100). The preoperative and postoperative functional scores combined demonstrated significant improvement: KSS increased from 34.2 (95% CI, 27.2–41.1) to 88.5 (95% CI, 77.9–91.1), KSS-F increased from 44.5 (95% CI, 38.1–50.9) to 83.1 (95% CI, 74.2–92.1), and KOOS-JR increased from 30.3 (95% CI, 23.4–37.2) to 87.7 (95% CI, 76.8–98.5). Across all studies, the overall complication rate was 2.4%, with the most common adverse event being surgical site infection.

Conclusions

Imageless robotic-assisted TKA is distinguished by significant functional and radiologic gains, minimal rate of complications, and acceptable short-term safety. Homogeneity of combined PROMs and alignment data validates accuracy and reliability of imageless systems.

无图像机器人辅助TKA （RATKA）已成为一种潜在的技术，旨在提高手术准确性，改善临床结果，减少并发症。本系统综述评价无影像RATKA的临床疗效、安全性和放射学准确性。方法根据系统评价和荟萃分析首选报告项目（PRISMA）和PROSPERO注册号（CRD1161673）进行综述。到2025年4月，对PubMed、Scopus和Web of Science数据库进行了彻底的搜索。资料由审稿人独立撤回，研究质量采用改良Coleman评分、rob2和ROBINS-I工具进行评估。描述性综合和加权平均分析。结果共纳入8项研究，涉及612个膝关节。患者平均年龄67.7岁，平均随访时间15.8个月。总体方法学质量一般（平均修正Coleman评分：70/100）。术前和术后功能评分综合显示有显著改善：KSS从34.2 （95% CI, 27.2-41.1）增加到88.5 (95% CI, 77.9-91.1)， KSS- f从44.5 （95% CI, 38.1-50.9）增加到83.1 (95% CI, 74.2-92.1)， KOOS-JR从30.3 （95% CI, 23.4-37.2）增加到87.7 （95% CI, 76.8-98.5）。在所有研究中，总并发症发生率为2.4%，最常见的不良事件是手术部位感染。结论无图像机器人辅助TKA具有显著的功能和放射学获益、最小的并发症发生率和可接受的短期安全性。组合prom和对准数据的同质性验证了无像系统的准确性和可靠性。

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引用次数: 0