Journal of Orthopaedic Science最新文献

Objective: To evaluate medical and surgical outcomes postoperatively for patients using GLP-1RA at the time of undergoing THA surgery, with a focus on early 30 day medical complications and 1 year surgical complications.

Methods: This was a retrospective cohort study. Current Procedural Terminology (CPT) and International Classification of Diseases (ICD)-10 codes were utilized to identify patients. Patients were placed into two groups based on whether they were on a GLP-1RA or not. Sex, age, body mass index (BMI), smoking status, and Elixhauser comorbidity index (ECI) and diabetes status were control variables. Outcomes studied were surgical site infection (SSI), medical complications, all-cause readmissions, implant complications, revision THA, and in-hospital mortality or discharge to hospice.

Results: 13,206 patients met inclusion criteria. 335 (2.5 %) patients were on a GLP-1RA. In both cohorts, GLP-1RA users were younger, had higher BMIs, and more comorbidities than those not on GLP-1RA (p < 0.05). At 30 days postoperatively patients taking GLP-1RA experienced higher rates of pulmonary embolism (PE) (p = 0.004), acute kidney injury (AKI) (p = 0.006), hypoglycemia (p < 0.001), and overall complications (p < 0.001) compared with patients not receiving GLP-1RA. However, when bivariate logistic regression analyses, controlling for age, sex, BMI, smoking status, ECI, and diabetes status was undertaken, GLP-1RA use was not associated with elevated risks of adverse outcomes at 30 days for medical complications (Odds Ratio (OR): 1.611; 95 % Confidence Interval (CI) 0.881-2.947, p = 0.1215). Bivariate logistic regression also revealed no difference in complications for 90 days readmission or SSI, and 1 year postoperative surgical outcomes or readmissions.

Conclusions: The results suggest that GLP-1RA use was not associated with any statistical difference in overall medical complications at 30 days, 90 day readmissions or SSI, or 1 year postoperative surgical outcomes when patients undergo THA while taking a GLP-1RA medication when controlling for confounding variables. GLP-1RA medications do not appear to be associated with increased risk of complications for patients undergoing THA, however, future studies can further evaluate if complications exist.

Background: In pectoralis minor muscle (PMiM) transfer, the PMiM tendon is typically harvested with a bone chip using a chisel from the medial surface of the coracoid process, as it is primarily composed of muscle tissue. However, variations in the insertion patterns and attachment sites of the PMiM tendon on the coracoid process have been reported, which may affect surgical techniques. This study aimed to investigate the anatomical variations in the attachment site of the PMiM tendon to the coracoid process using cadaveric shoulders.

Methods: The attachment site of the PMiM tendon to the coracoid process was examined in 22 cadaver shoulders. The coracoid length and width were also measured as indicators of body size.

Results: In 11 of the 22 shoulders, the PMiM tendon was attached to the medial surface of the coracoid process. In the remaining 11 shoulders, the tendon was attached to either the superior or medial-to-superior surface, with the tendon extending toward the glenohumeral joint. The mean coracoid length and width were 42.1 ± 4.2 mm and 17.1 ± 2.1 mm, respectively, and both measurements were significantly greater in shoulders with medial surface attachments (P < 0.05).

Conclusions: The PMiM tendon was attached to the medial surface of the coracoid process in 50 % of the examined shoulders. Shoulders with medial surface attachments exhibited significantly greater coracoid lengths compared with those with superior or medial-to-superior attachments. These anatomical insights may assist in reducing the risk of damaging the muscle-bone junction during PMiM tendon harvesting for surgical transfer.

Context: The prevalence of central neuropathic pain (cNeuP) is increasing, particularly in older patients with spinal cord injury (SCI) without radiographic abnormalities resulting from minor external forces. Preclinical research has shown the effectiveness of gabapentinoid treatment for cNeuP after SCI in the spinal cord without stenosis. However, no studies have reported the efficacy of this treatment in models of spinal cord compressive lesions.

Objective: To determine the effects of mirogabalin for cNeuP after SCI in a rat model of chronic spinal cord compressive lesions.

Methods: A model of chronic spinal compressive lesion was created in rats by inserting an expandable water-absorbing polyurethane sheet under the sublaminar space. After 8 weeks, SCI without radiographic abnormalities causing hypersensitivity was induced using an Infinite Horizon Impactor device. The rats with cNeuP were divided into 3 groups: a saline group, a high-dose mirogabalin besylate (MGB) group, and an MGB low-dose group. Pain-related behavior and histology were evaluated for up to post operative 28 days.

Results: Compared with rats in the saline-treated group, those in the MGB-treated groups presented an increased pain threshold. Significant improvement was observed in MGB-treated rats for up to 21 days. Histology and mRNA expression revealed reduced expression of Iba-1 and α2δ-1 in MGB-treated rats.

Conclusion: Administration of MGB decreased Iba-1 and α2δ-1 immunoreactivity in the dorsal horns of a rat model of cervical SCI at 4 weeks after injury. The inhibitory effect of MGB on the α2δ-1 subunit after SCI may contribute to the analgesic effect on cNeuP.

Background: In Japan, secondary screening for developmental hip dysplasia has expanded. However, the capacity of screening programs has outpaced the availability of ultrasonography and the number of clinicians who perform and interpret examinations outside tertiary centers. Plain radiography is widely accessible; however, interpreting images in infants can be challenging. This study developed and validated a deep learning-based system to support radiographic diagnosis and test a prespecified two-step triage strategy for clinical use.

Methods: Overall, 1188 anteroposterior pelvic radiographs of infants aged 2-12 months were retrospectively analyzed. Three non-overlapping test subsets (50 images each) represented routine screening, images without a visible femoral-head ossification center, and images from external hospitals; the remainder were used for training and internal validation. The system generates measurements and the International Hip Dysplasia Institute grades for each radiograph. All test images were independently graded by two pediatric orthopedic surgeons, and the consensus served as a categorical reference. The agreement was summarized using the intraclass correlation coefficient for measurements and quadratic-weighted kappa for grades. The triage strategy was as follows: (1) no further imaging or referral when both hips were grade 1, and (2) high-priority alert when either hip was grade ≥2 and/or the acetabular angle was at least 25°.

Results: Agreement for the principal measurement between the system and each reader was 0.83-0.84 by intraclass correlation, comparable to inter-reader agreement (0.81), with small biases and acceptable limits of agreement. For grades, quadratic-weighted kappa was 0.63-0.75 across subsets, with disagreements mainly between adjacent categories. With a 25-degree cutoff, the triage strategy achieved sensitivities of 0.75-0.93 and specificities of 0.62-0.95 across subsets.

Conclusions: The system supported radiographic screening decisions across diverse images typical of this age range, achieving comparable agreement with clinicians. Therefore, a prospective multicenter evaluation with thresholds adjusted for age and location is required.

Background: Short cementless stems are increasingly used in total hip arthroplasty owing to potential advantages such as bone preservation, optimised load transfer, and reduced surgical invasiveness. However, their fixation reliability in osteoporotic bone remains a concern, and evidence regarding outcomes in elderly patients is limited. This study compared mid-to long-term outcomes of a flat-tapered short cementless stem in patients aged ≥75 years and ≤60 years, hypothesising that results in the elderly would be comparable with those in younger patients.

Methods: We retrospectively reviewed 350 primary total hip arthroplasties performed between 2010 and 2021 using a titanium, porous, plasma-sprayed, flat-tapered cementless stem (Taperloc Microplasty™), restricted to Dorr type A or B femora. Patients aged ≥75 years comprised the elderly group, and those ≤60 years formed the younger group. Clinical outcomes were evaluated with the modified Harris Hip Score. Radiographic assessments included stem alignment, fixation stability, subsidence, radiolucent lines, cortical hypertrophy, and stress shielding. Kaplan-Meier survival analysis was performed with revision for any reason as the end-point.

Results: The analysis included 45 hips in the elderly and 132 hips in the younger group, with mean follow-up of 6.2 and 7.7 years, respectively. The modified Harris Hip Score improved significantly in both groups. All stems achieved bone ingrowth fixation. Posterior angulation was more frequent in the elderly, whereas distal cortical hypertrophy was more common in the younger group. Ten-year survival was 100 % in the elderly and 98.1 % in the younger group, with no significant difference.

Conclusions: Short, flat-tapered cementless stems provided durable outcomes in elderly patients with Dorr type A or B femora. These findings suggest that short cementless stems may be a reasonable option for carefully selected elderly patients undergoing total hip arthroplasty.

Background: The impact of the COVID-19 pandemic on habitual exercise, physical function, and general condition in patients after total hip arthroplasty (THA) remains unclear. This study aimed to evaluate habitual exercise, self-reported changes, and associated factors, and to examine the vulnerability of postoperative THA patients to external environmental restriction that may limit habitual exercise, as exemplified by the COVID-19 pandemic.

Methods: A postal survey was distributed to 2714 THA patients; 1413 responded (264 males, 1149 females; mean age 72 ± 10 years; BMI 23 ± 3.5 kg/m²; follow-up 5.6 ± 2.9 years). The questionnaire assessed habitual exercise, physical function (falls, walking speed, stair climbing), and general condition (strength, fatigue, motivation, sleep, weight, appetite). Patient-reported outcomes (Oxford Hip Score, UCLA-AS, EQ-5D) were also collected. Multivariable analyses were performed to identify factors associated with habitual exercise and with self-reported changes in physical function and general condition.

Results: Habitual exercise declined from 50 % before the pandemic to 41 % during the pandemic, with a continuation rate of 83 %. Most habitual exercise consisted of low-impact sports, with walking being the most common. Older age, female sex, higher BMI, and lower UCLA-AS were independent negative factors associated with the continuation of habitual exercise. About 30 % reported functional decline and 50 % reported deterioration in general condition. Discontinuation of exercise was significantly associated with both self-reported changes, whereas COVID-19 infection itself was not.

Conclusions: Habitual exercise in THA patients decreased by nearly 20 % during the pandemic. Discontinuation was significantly associated with declines in function and general condition, suggesting the importance of developing targeted strategies for elderly and high-BMI patients.

Background: Distal radius fractures are common injuries in children, accounting for 20-30 % of all childhood fractures. Although fracture location is thought to reflect skeletal maturity in children, the precise relationship between skeletal maturity and fracture location remains unclear. This retrospective observational study of 83 pediatric patients with distal radius fractures aimed to investigate the relationships between chronological age, skeletal maturity, fracture location, and fracture type.

Methods: Patients were divided into two groups: those with physeal fractures (38 patients) and those with metaphyseal fractures (45 patients). Fracture types were classified as complete, greenstick, or torus. Skeletal maturity was assessed using a 9-point scale derived from the Tanner-Whitehouse method based on distal radius radiographs.

Results: Both chronological age and skeletal maturity were significantly higher in the physeal fracture group than in the metaphyseal fracture group. In addition, chronological age showed a slightly stronger association with fracture location than skeletal maturity. No significant association was found between age and fracture type.

Conclusions: These results suggest that age-specific activity levels and injury mechanisms, in addition to skeletal maturity, may influence fracture location. Furthermore, greenstick and buckle fractures can occur even in older children with advanced skeletal maturity, highlighting the need for careful radiographic evaluation. These findings contribute to understanding the pathophysiology of pediatric fractures and may aid in fracture prevention and accurate diagnosis of radius fractures.