Journal of Orthopaedic Science最新文献

Background: This study aimed to evaluate the predisposing factors for Su type 2 femur periprosthetic fractures. Moreover, we compared the mid- and short-term outcomes of patients who had undergone single-plate and double-plate fixation for Su type 2 fractures.

Methods: A retrospective review was conducted on 3817 patients who had undergone knee replacement surgery at our hospital between January 2009 and December 2022. Of these, 39 patients (Group 1: fracture group) developed periprosthetic femoral Su type 2 fractures. A control group of 40 patients (Group 2: non-fracture group) without fractures was selected using propensity score matching for comparison. To minimize potential confounding, propensity score matching (PSM) was conducted using age, sex, body mass index, and comorbidities. Preoperative Kellgren-Lawrence grading, postoperative hip-knee-ankle (HKA) angles, weight-bearing line (WBL) ratios, femoral component angulation in anteroposterior and lateral views, and femoral notch status were evaluated. Body mass index, vitamin D levels, calcium levels, bone mineral density, and comorbid conditions were recorded and compared.

Results: No statistically significant differences in femoral notching, HKA angle, and femoral component angulation in the coronal plane were observed between the fracture (Group 1) and nonfracture (Group 2, control group) groups (p > 0.05). However, statistically significant differences in WBL ratio and femoral component angulation in the sagittal plane were observed between the two groups (p < 0.05). Vitamin D and calcium levels also significantly differed between the two groups (p < 0.05). Five patients who underwent single-plate fixation experienced refractures after a mean of 19 ± 8.1 (12-33) months, whereas no refractures occurred in patients with double-plate fixation.

Conclusion: Perioperative and postoperative calcium and vitamin D supplementation and close follow-up of high-risk patients (those with low femoral component sagittal plane angulation and WBL ratio) may help prevent fractures. Double-plate fixation is more advantageous than single-plate fixation for Su type 2 periprosthetic stable fractures.

Level of evidence: Level III, retrospective comparative study.

Background: The number of adult spinal deformity (ASD) surgery has increased in recent years; however, it remains associated with significant hospitalization cost. The purpose of this study is to evaluate the total hospitalization cost associated with ASD surgery in Japan and to identify cost-related factors.

Methods: This multicenter prospective observational study included patients aged 50-79 years who underwent corrective fusion of more than 5 vertebral segments between March 2021 and March 2024. Demographic, surgical, and radiographic data were collected. Total hospitalization cost, including surgical procedure, surgical supplies, implants, anesthesia, transfusion, rehabilitation, and bundled hospitalization cost were obtained from medical billing data. Univariate and multivariate analyses were performed to determine factors independently associated with total cost.

Results: A total of 194 patients (25 males, 169 females; mean age 69.4 ± 6.7 years) were included. The average total hospitalization cost was $47,923.8 ± 8631.1, with implant cost accounting for the largest proportion. Multivariate linear regression analysis identified staged surgery as the most significant independent predictor of increased total cost, followed by the number of fused vertebrae, surgical time, and the use of lateral lumbar interbody fusion (LLIF). Staged surgery was associated with longer surgical time, more fused vertebrae, and more frequent use of LLIF, resulting in approximately 10,000 USD higher total cost than single surgery.

Conclusions: This multicenter prospective study revealed that the total hospitalization cost for ASD surgery exceeded USD 47,000 per patient. Staged surgery was identified as the most significant independent factor associated with increased costs, primarily due to higher surgical procedure and implant-related cost.

Background: Rotational instability of the proximal fragment in intertrochanteric femoral fractures increases the risk of fixation failure. However, most prior research has focused on the analysis of bony structures. To confirm the characteristics of rotational instability in intertrochanteric femoral fractures, this study evaluated the fracture morphology and soft tissue attachment relationship at the fracture site using computed tomography.

Methods: The anteroposterior fracture line of the proximal fragment and the attachment of capsular ligaments were compared between patients with confirmed rotational instability during cephalomedullary nailing for 372 intertrochanteric fractures and 1 to 1 matching controls. Rotational instability was defined based on whether the proximal fragment rotation occurred during lag screw insertion. The anterior fracture line was classified as medial, lateral, or crossing, according to its positional relationship with the femoral intertrochanteric line. Concerning the posterior fracture line of the proximal fragment, the study evaluated whether the posterior fracture line was located at the medial base of the intertrochanteric crest. In addition, separation of the greater and lesser trochanters was evaluated.

Results: Rotational instability was confirmed in 40 patients (10.8 %). The patients included 4 men and 36 women with a mean age of 84.7 years (range: 63-97 years). In the group with rotational instability, the anterior fracture line was more commonly located medial or lateral to the femoral intertrochanteric line in 11 and 13 cases, respectively, whereas the group without rotational instability showed a fracture line crossing the femoral intertrochanteric line in 35 cases (P < 0.001). No significant differences were observed in the posterior fracture characteristics between the two groups.

Conclusions: In intertrochanteric femoral fractures, if the location of the anterior fracture line deviates from the femoral intertrochanteric line, there is a possibility of rotational instability, which seems to be related to the attachment of the anterior capsular ligament around the fracture. In these fractures, attention must be paid to the rotation of the proximal fragment during the insertion of a lag screw or blade during osteosynthesis.

Objectives: Hallux valgus (HV) is common in middle-aged and older adults. However, previous studies that linked HV to factors such as sex, knee osteoarthritis, footwear, and aging were mostly cross-sectional. This longitudinal study aimed to investigate HV risk factors and progression.

Materials and methods: Serial radiographs were assessed in Japanese mountain villagers aged ≥50 years who underwent at least two health checkups within an interval of 4 or more years. Demographic data, medical history, and radiographic measurements were collected.

Results: We included 271 participants (542 feet; mean age: 69.6 years); the mean follow-up period was 6.7 years. The average annual change in the HV angle (HVA) was 0.19°. In 16.1 % of the feet, the HVA increased by ≥ 1°/year. Lateral tibial sesamoid bone positioning was a significant risk factor for HV.

Conclusions: HVA progression was less likely in adults aged ≥50 years without tibial sesamoid bone malposition.

Background: We investigated the influence of abnormal magnetic resonance imaging findings and serum bone metabolism on varus deformity progression in the proximal tibia of women without radiographic abnormalities.

Methods: A hundred and forty-six participants without radiographic knee osteoarthritis were assessed using a 5-year longitudinal analysis of the Iwaki cohort. Participants were classified into a normal or an early radiographic knee osteoarthritis group based on the Knee Injury and Osteoarthritis Outcome Score, clinical examinations, and bilateral radiographs. The medial proximal tibial angle was measured on knee radiographs. Abnormal imaging findings were assessed using the whole-organ magnetic resonance imaging scoring method. Serum bone metabolic markers were also measured.

Results: Thirty-eight of the participants (26 %) were classified into the early radiographic knee osteoarthritis group. Variation in the medial proximal tibial angle was greater in participants with early radiographic knee osteoarthritis and bone marrow lesions than in those without either of them (p < 0.001). Varus deformity in the proximal tibia negatively correlated with tartrate-resistant acid phosphatase-5b (r = -0.192, p = 0.022) and N-telopeptide of type I collagen (r = -0.031, p < 0.001). Linear regression revealed that varus deformity was associated with bone marrow lesions (β = -0.252, p = 0.002), N-telopeptide of type I collagen (β = -0.249, p = 0.002), and early radiographic knee osteoarthritis (β = -0.163, p = 0.037).

Conclusions: Early radiographic knee osteoarthritis with bone marrow lesions and a high bone absorption metabolism are potential risk factors for the progression of varus deformity in the proximal tibia.

Background: Femoral shaft fractures represent common pediatric injuries. AO/OTA 32-A3 fractures pose significant challenges for closed reduction due to shortening displacement and muscular traction, frequently necessitating open reduction. This study describes a novel Kirschner-wire distractor-assisted technique and evaluates its efficacy versus traditional manual reduction in children with AO/OTA 32-A3 femoral shaft fractures.

Methods: A retrospective study was conducted on 33 pediatric patients with AO/OTA 32-A3 femoral shaft fractures treated at our hospital from October 2014 to January 2025. The patients were divided into two groups (Group A and Group B) based on the reduction methods used. Group A (n = 15) underwent closed reduction assisted by a Kirschner-wire distractor, whereas Group B (n = 18) received traditional manual reduction. Both groups underwent fracture stabilization using elastic stable intramedullary nailing. We compared closed reduction success rates between Group A and Group B. Group B was further subdivided into successful closed reduction cases (Subgroup B1) and failed closed reduction cases (Subgroup B2). Surgical parameters including incision length, operative time, number of intraoperative fluoroscopy exposures, intraoperative blood loss, postoperative pain scores, and bone union time were then compared between Group A and B.

Results: The K-wire distractor group (Group A) achieved 100 % closed reduction success (15/15) versus 66.7 % (12/18) in the manual reduction group (Group B) (P = 0.02). Compared to Group B1, Group A required significantly fewer fluoroscopies and less operative time (P = 0.01), no statistically significant differences were observed in the remaining postoperative parameters, include incision length, intraoperative blood loss, postoperative pain scores and bone union time. Compared to Group B's failed reduction subgroup (B2), Group A showed superior outcomes in all parameters (all P < 0.001): shorter incision, operative time, reduced Fluoroscopy, reduced blood loss, lower pain scores, and faster union.

Conclusion: Kirschner-wire distractor-assisted closed reduction demonstrates superior efficacy compared to conventional manual reduction for AO/OTA 32-A3 femoral fractures.

Background: Although the significance of preoperative denosumab administration for giant cell tumor of bone (GCTB) is still controversial, sporadic reports have suggested a clinical benefit of administration prior to surgery for spinal GCTB. In this retrospective, multi-institutional study, we assessed the effects of preoperative denosumab administration for spinal GCTB.

Methods: Ten cases of GCTB in the spine with preoperative denosumab administration (the denosumab group) and 19 cases without preoperative denosumab administration (the control group) were included. Oncological outcomes (local recurrence, distant metastasis, and overall survival), duration of the surgery, intraoperative blood loss, functional outcomes as evaluated by the Frankel classification, perioperative complications, adverse events associated with denosumab administration, and margin status in resection cases were surveyed.

Results: The median frequency of preoperative denosumab administration was four times in the denosumab group. Curettage against resection and no preoperative denosumab administration were revealed as independent risks for local recurrence. Preoperative denosumab administration significantly reduced intraoperative blood loss. It also resulted in significantly better postoperative function. Periodontitis as an adverse effect of denosumab administration was found only in two cases in the control group, where it was applied for controlling local recurrence. Cases with local recurrence showed worse function at the final follow-up, suggesting the significant impact of local recurrence on function. The negative margin rate was significantly higher in the denosumab group. No significant difference was noted in the risk for metastasis and lethal events, duration of surgery, and incidence of postoperative complications between the two groups.

Conclusions: Preoperative denosumab administration resulted in better local control, reduced intraoperative blood loss, and better function. The present data suggest that it has a clinical benefit in the treatment of spinal GCTB.

Background: To examine the characteristics of hip dynamics caused by abnormal spinopelvic alignment in patients with spinal fusion and identify appropriate targets for acetabular component placement in such patients undergoing total hip arthroplasty.

Methods: Dynamic imaging of the chair-rising motion and computed tomography images in the supine position were obtained for 40 patients with spinal fusion and normal hips. The sagittal pelvic tilt and hip flexion angle were measured with three-dimensional dynamic analysis using the image-matching method. The hip flexion angle based on the functional pelvic plane in the supine position (supine-FPP) was calculated using pelvic tilt and hip flexion angles. The hip flexion angle based on supine-FPP was compared in participants with and without adverse pelvic mobility in extension (APM; posterior pelvic tilt >13° from supine to standing), flatback deformity (pelvic incidence-lumbar lordosis mismatch ≥10°), and stiff spinopelvic mobility (stiff-SPM; posterior pelvic tilt <10° between standing and sitting).

Results: The flexion angle based on supine-FPP was 5.4°-7.2° lower in patients with APM than in those without APM throughout the chair-rising motion (sitting, deep-sitting, and standing), and there were no significant differences between patients with and without flatback deformity throughout the chair-rising motion and 11.1° and 9.9° higher in patients with stiff-SPM than in those without stiff-SPM in sitting and deep-sitting positions, respectively, but there were no significant differences in standing position.

Conclusions: The importance of adjusting cup placement according to abnormal spinopelvic alignment was demonstrated in the following cases: APM requires a decrease in cup anteversion based on supine-FPP, cup anteversion based on supine-FPP is an appropriate target for flatback deformity, and stiff-SPM requires an increase in cup anteversion.

Introduction: The reconstruction of upper extremity bone defects remains a complex challenge in orthopedic surgery, frequently arising from trauma, infection, or tumor resection. The Masquelet technique, a two-stage reconstructive approach, has demonstrated promising outcomes in addressing such defects. This study aims to assess the efficacy of the Masquelet technique in the management of upper extremity bone loss.

Methods: This retrospective study reviewed 13 cases in 10 patients treated with the Masquelet technique between 2015 and 2024. Patient demographics, defect characteristics, surgical details, healing time, complications, and functional outcomes were analyzed. Bone healing was assessed radiographically, while clinical outcomes were evaluated using VAS and QuickDASH scores.

Results: The mean bone defect length was 4.26 ± 2.46 cm, and the average healing time was 13.6 ± 3.18 weeks. The second-stage surgery was performed at an average of 10.1 ± 4.2 weeks after the first stage. Bone union was achieved in all patients, with three experiencing range of motion limitations. The mean postoperative VAS and QuickDASH scores were 3.54 ± 1.05 and 34.75 ± 11.2, respectively. The average return-to-work time was 5.69 months post-treatment. Only one patient experienced a complication requiring reoperation.

Conclusion: The Masquelet technique is an effective and reliable option for reconstructing upper extremity bone defects, demonstrating satisfactory bone healing, functional recovery, and low complication rates. Further studies with larger patient groups are needed to validate these findings.