MUSCULOSKELETAL SURGERY最新文献

This study aims to identify the potential genes, pathways, and tumor immune microenvironment that might be involved in the metastasis process of osteosarcoma (OS). The GEO2R tool was deployed to screen two datasets obtained from the Gene Expression Omnibus (GEO) database (GSE87624 and GSE85537). Integrated bioinformatic analyses were then performed to investigate Gene Ontology, potential pathways, protein-protein network interaction, core hub genes, genetic alterations, and immune cell infiltration. The hub gene expression levels were validated utilizing another dataset (GSE14329) and patient prognosis was validated using the GDC-TARGET OS dataset. Our analysis identified 263 differentially expressed genes (DEGs), predominantly associated with the PI3K-AKT signaling pathway. Analysis using Cytoscape based on DEGs revealed five validated core hub genes including COL6A1, MMP2, POSTN, TAGLN, and THY1. Additionally, TAGLN and THY1 have a significant association (P = 0.008) (P = 0.03) with unfavorable outcomes in osteosarcoma patients. This study unveiled that TAGLN and THY1 were associated with metastasis and poor prognosis in OS.

Blount disease is a genetic disorder affecting the proximal tibial bone, resulting in a complex deformity of the knee. In the absence of timely treatment, the likelihood of developing degenerative arthritis increases. A total knee arthroplasty (TKA) is the conventional treatment for adult patients with Blount disease or Blount-like deformity with advanced degenerative changes. The aim of this systematic review is to evaluate the results of TKA in this particular cohort of patients. The present systematic review comprised a total of 5 articles. The 5 evaluated studies included data from 9 patients who undergone 12 TKAs. The patients were assessed throughout an average follow-up duration of 4 years. In all, there were three revisions of the prosthetic components. All studies achieved successful clinical scores at the last follow-up. A thorough exploration of PubMed, Embase, and Web of Science was conducted to identify research that documented the results of TKA in patients diagnosed with Blount disease or Blount-like deformity. TKA in patients with Blount disease or Blount-like deformities is intricate and demanding. Constrained implants can effectively mitigate the possible problem of persistent instability. Notwithstanding the unfavorable circumstances, TKA in this cohort of patients appears to yield satisfactory outcomes during the short- to medium-term period of observation. Other study is necessary to establish the enduring outcomes of TKA in this particular cohort of patients.

Total knee arthroplasty (TKA) is the gold standard for advanced knee osteoarthritis and is increasingly performed on younger, active individuals. While low-impact sports are recommended after TKA, running remains controversial due to concerns about implant loosening. Cemented implants have durability issues at the bone-cement interface, while cementless designs seem to promote better osseointegration. Despite limited research, running after TKA is gaining acceptance. The purpose of this paper is to present a systematic review of the literature and present a novel and specific protocol to guide motivated patients in safely resuming running. We conducted a systematic review of PubMed studies regarding running after TKA and the PRISMA flow diagram shows the inclusion and exclusion criteria adopted. In addition, we present a novel protocol (FAST) specifically designed for TKA patients aiming to return to running which combines surgical techniques, perioperative analgesia, and physical therapy. It has been approved by the Ethics Board, the prospective trial is registered (NCT06383936), and we are currently enrolling participants. After screening according to inclusion and exclusion criteria, six studies were included in the analysis. The FAST protocol combines cementless CR-design implants, minimally invasive surgery, and personalized functional alignment. Local infiltration analgesia reduces pain and enables rehabilitation within 24 h. Rehabilitation progresses with range-of-motion exercises, muscle strengthening, and gradual return to running at 6-8 months. Monitoring activity carefully prevents inflammation, optimizing recovery. Running after TKA, once discouraged, now shows low complication rates. Preoperative fitness and patient-specific factors are key predictors of success. The FAST protocol integrates cementless implants, personalized alignment, and structured rehabilitation. Proper patient selection and communication are essential. Further research is required to validate long-term outcomes.

Purpose: A systematic review of the literature was performed in order to synthesize the available data on the outcome of conversion total hip arthroplasty after failed hemiarthroplasty keeping in mind the higher complication rates of conversion as compared to a primary total hip arthroplasty.

Methods: Comprehensive search of literature was performed for the systematic review through online databases-PubMed, EMBASE, Scopus, and the Cochrane database. The abstracts were identified first by the above-mentioned search methods and were assessed for eligibility based on strict criteria. 15 studies regarding conversion hemiarthroplasty were finally included for the study.

Results: The 15 studies evaluating 3432 hips revealed that the main indication for conversion to arthroplasty was pain in the groin or thigh symptomatically and acetabular erosion with well-fixed femoral stem (455 cases; 13.25%) radiologically. Majority of the cases were revised in a single stage (292 cases) as compared to 25 cases revised in 2-stage surgery mostly owing to infection. The mean pre-conversion Harris Hip Score (HHS) improved from 45.74 to 84.03 in the post-conversion time. Majority of the conversions constituted cemented fixation for the femoral component and uncemented fixation for the acetabular component. Mean survivorship was found to be 97.21% at 5-6 years. The conversions were most commonly complicated by prosthetic joint infection most commonly which was managed by long-term antibiotics and/or debridement with or without exchange of implants.

Conclusion: The conversion group had consistently higher odds of prosthetic joint dislocation, prosthetic joint infection, periprosthetic fracture, aseptic loosening and revision both at 1- and 2-year follow-ups. It was also noteworthy that the odds of developing these complications increased significantly from 1-year follow-up to the 2 years follow-up.

Artificial intelligence (AI) is transforming orthopedic research by optimizing academic workflows, improving evidence synthesis, and expanding access to advanced data analysis tools. Generative AI models such as ChatGPT and GPT-4, alongside specialized platforms such as Consensus and SciSpace, empower researchers to refine search queries, enhance literature reviews, synthesize documents, and conduct advanced statistical analyses. These technologies enable the interpretation of large datasets, saving time and boosting efficiency. For orthopedic residents, AI is particularly impactful, revolutionizing their education and fostering greater independence in research. This review explores the key applications of AI as a research assistant in orthopedics, as well as its ethical considerations and challenges.

To systematically review the variability of reporting of clinically significant outcomes (CSOs) including minimal clinically important difference (MCID), substantial clinical benefit (SCB) and patient acceptable symptom state (PASS), and threshold calculation methods following surgical treatments for cartilage defects of the knee. A systematic review was performed using the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A literature search was performed on August 12th, 2024, using the PubMed, Embase, and Scopus online databases for human clinical studies with publication dates ranging from 2010 to 2024 reporting on MCID, SCB, or PASS following surgical treatments for cartilage defects of the knee. Study demographics, patient-reported outcome measures (PROMs), CSO thresholds, and methods of CSO calculation were collected. A total of 19 studies (n = 3659 patients) with an average follow-up of 36.5 months were included. A total of 14 (93.3%) studies reported MCID, six (31.8%) studies reported SCB, and five (26.3%) studies reported PASS. Of the included studies, 16 (80%) referenced another study for calculating their CSO whereas three (20%) studies calculated their own CSO. A total of 16 different PROMs were reported among the included studies. Eight studies utilized the anchor-based method for CSO calculation, ten studies used both the anchor and the distribution-based methods for calculation, while only one study used the distribution-based method alone. There is considerable variation in the reporting and calculation methods of MCID, SCB, and PASS for different PROMs following surgical treatments for cartilage defects of the knee.Level of Evidence: IV, Systematic Review of Level I-IV studies.

Purpose: Short-stem implants offer several advantages, including the preservation of bone stock and a physiological load transfer in the subtrochanteric area. The aim of this study was to compare the radiological and functional outcomes of short stem and traditional stem during midterm follow-up.

Materials and methods: We conducted a retrospective analysis of a consecutive series of 50 patients with Fitmore and CLS stems. Clinical assessment was performed by Harris hip score; additionally, thigh pain was assessed at six months, one year, and the latest follow-up. The following radiological parameters were evaluated: stem alignment, presence of radiolucent lines and osteolysis around the stem, stem subsidence, cortical hypertrophy, femoral stress-shielding, pedestal formation at the tip of the stem, calcar resorption, heterotopic ossification, and implant loosening.

Results: The mean follow-up duration was 8.4 ± 2.1 years in the CLS group and 7.6 ± 2.2 years in the Fitmore group. The mean HHS improved from 43.0 ± 3.3 to 93.2 ± 2.5 for the CLS group and from 43.2 ± 4.4 to 93.6 ± 3.2 for the Fitmore group, without any statistical differences between the two groups. Thigh pain disappeared in all patients in the Fitmore group, while it persisted in 8% of the patients in the CLS group. There was a significant difference in the level of cortical hypertrophy between the two groups, with 28% in the Fitmore group compared to 12% in the CLS group. No statistically significant difference was observed for other radiological parameters.

Conclusions: Both short stems and standard stems demonstrated stable fixation and satisfactory clinical and radiological outcomes.

Purpose: Magnetic resonance imaging (MRI) is often used to evaluate patients with patellar dislocations to facilitate diagnosis and management strategies. Many radiological parameters have been described in the literature. The aim of this study was to assess the significance of tibial-tubercle trochlear groove distance (TT-TG) distance and other MRI measurements in patients with and without patellar instability.

Methods: This case-control study included 41 patients with recurrent patellar instability and 50 patients with stable knees, all of whom underwent MRI scans. A total of 19 radiological parameters were measured in both groups.

Results: All measured MRI parameters had statistically significant differences between both groups (p < 0.05) apart from trochlear cartilage length. TT-TG distance. 20 mm had the strongest association with patellar instability (OR 53.3, p = 0.006, 95%CI [3.1- 927.4]) and the highest specificity (100%) but had the lowest sensitivity (34%) out of all the measured parameters. TT-TG. 13 mm had a higher sensitivity (68%) but lower specificity (72%) and weaker association with patellar instability (OR 5.5, p < 0.001, 95%CI [2.2. 13.7]). TT-TG/trochlear articular cartilage width ratio also had a strong association with patellar instability (OR 14.7, p < 0.001, 95%CI [4.5. 48.5]) with high specificity (92%) but lower sensitivity (56%).

Conclusion: The cut-off values for TT-TG distance at 13 mm and 20 mm both had advantages and disadvantages which supports the concept of using patient-individualised ratios. Patellar instability is associated with many radiological abnormalities demonstrated on MRI scans. Selection of the most appropriate measurement is dependent on the philosophy and preference of the treating clinician.

Introduction: Irreparable rotator cuff tears (IRCTs) are large tears that can't be surgically repaired due to poor tissue quality, degeneration, or severe tendon retraction. These tears often involve multiple tendons and lead to fatty infiltration, humeral head migration, and tendon retraction. Patients with IRCTs typically present with pseudoparalysis, muscle atrophy, or anterosuperior escape. While various surgical options exist, outcomes are often inconsistent. This case series presents a novel technique for managing massive IRCTs, showing excellent, consistent results and offering a promising advancement for treating these challenging cases.

Methodology: Our case series involved 20 patients with massive irreparable rotator cuff tears, presenting clinically with pseudoparalysis and radiographically with signs of fatty infiltration, anterosuperior escape, and tendon retraction. The outcomes of interest included the Western Ontario Rotator Cuff Index (WORI), Oxford Shoulder Score (OSS), and range of motion arc (forward flexion and abduction), measured both preoperatively and postoperatively.

Results: The mean age of our patient cohort was 53.6 years, with a mean follow-up time of 40 months. The mean preoperative WORI score was 155.3, which improved to 54.2 postoperatively, showing an improvement of 101 points from the baseline. The mean preoperative OSS was 34.4, improving to 10.5 postoperatively, with a gain of 23.8 points. The mean preoperative range of motion for forward flexion was 67.0°, which improved to 164° postoperatively, resulting in a mean gain of 97°. The mean preoperative abduction was 57°, which improved to 166° postoperatively, with a mean gain of 109°. All these findings were statistically significant (p < 0.05).

Conclusion: In our surgical technique, all patients demonstrated clinically and statistically significant improvements in both range of motion and patient-reported outcomes. This makes our approach a novel, robust, and reliable technique for managing massive irreparable tears, particularly in young adult patients.

Level of evidence: Case Series, Level IV.