MUSCULOSKELETAL SURGERY最新文献

Purpose: Effective rehabilitation following ankle fracture surgery is essential for optimal recovery and patient satisfaction. However, traditional rehabilitation strategies often lack personalisation, leading to suboptimal outcomes. This study aimed to co-design a rehabilitation package, collaborating directly with patients, to understand their individual needs, using the Behaviour Change Wheel (BCW) framework.

Methods: Integrated within the larger weight-bearing in ankle fractures (WAX) trial, this study employed the BCW to understand behaviour, intervention options and content implementation. Nominal Group Technique was used to facilitate a workshop with 10 ankle fracture patients, and subsequent surveys were used to gather and prioritise rehabilitation needs and strategies. Participants were aged between 28 and 69, and nine (90%) were female, with representation from seven different NHS hospital trusts. Two experienced patient representatives facilitated the workshop.

Results: Rehabilitation strategies were developed focussing on interventions that included education, training, environmental restructuring, persuasion and enablement, delivered through an app or website. Survey results indicated high patient enthusiasm for structured, accessible rehabilitation support, including instructional videos, live chats with physiotherapists and peer support forums. Patients desired advice on returning to hobbies and life roles, and particularly returning to driving, bathing and work.

Conclusion: The BCW framework facilitated the development of a patient-centred rehabilitation package, highlighting the importance of tailored, accessible interventions. Patients expressed strong support for the proposed strategies, suggesting potential for improved rehabilitation outcomes through personalised, digitally delivered support. These components will be used to co-design future rehabilitation interventions.

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.

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.

Introduction: Traditional management of forearm fractures involves open reduction and internal fixation (ORIF) using plates and screws after wound healing. However, recent years have seen the emergence of minimally invasive techniques like titanium elastic nailing (TENS) as potential alternatives. This retrospective study evaluates the role of TENS in managing open forearm fractures in adults.

Methodology: A retrospective analysis was conducted over 5 years, including 18 adult patients with open forearm fractures without neurovascular or tendon injury, classified as Gustilo Anderson III A and IIIB. Surgical management involved TENS insertion following debridement with patients undergoing general anaesthesia or brachial block. Patients were positioned supine, and reduction was performed under fluoroscopy. TENS nails were inserted into the radius and ulna, with appropriate sizing and positioning. Plastic surgical interventions were performed as necessary.

Results: There were satisfactory outcomes in 14 patients, with four patients achieving excellent outcomes at 12-month follow-up. The radiological union was observed in 12 patients, while six required revision surgeries. Deep tissue infection occurred in two patients, managed with debridement and vacuum-assisted closure. No forearm shortening was observed, with average supination and pronation of 70° and 80°, respectively. No evidence of infection was noted at the last follow-up.

Conclusion: The study underscores the feasibility of TENS as an alternative to external fixation or ORIF in managing open forearm fractures. TENS provides a viable option, particularly in combined orthopaedic and plastic surgery management, offering satisfactory outcomes and allowing for subsequent plating if needed. Ultimately, treatment decisions should be individualised, weighing various factors to optimise patient care and outcomes.

Introduction: Medial patellofemoral ligament (MPFL) reconstruction has become a popular treatment option for recurrent patellofemoral instability. At the fifth-year follow-up, patients reported a high satisfaction rate and experienced few episodes of instability. The literature is scarce regarding the long-term outcomes after MPFL reconstruction. Therefore, a retrospective study was conducted, covering the period between 2008 and 2013.

Material and methods: Demographic and clinical data, including age, gender, number of dislocations, and revision surgery, were collected. Radiologic measurements included patellar height, tilt, maltracking, and trochlear dysplasia. Radiologic assessment was made with computed tomography (CT) preoperatively and magnetic resonance imaging (MRI) postoperatively, contributing to the further identification of chondral lesions. Functional evaluation was based on the Kujala and Lysholm scores.

Results: In this study, 32 patients (62.5% female and 37.5% male, mean age 18 ± 5 years) underwent MPFL reconstruction. There was an increase in the tibial tubercle-trochlear groove (TT-TG) distance in the postoperative (16.2 [IQR 13.8-18.3] vs. 20 [IQR 18-21] mm). Patellar tilt improved both in 0º extension (24 [IQR 15-29.5]° vs. 15 [IQR 6.5-26.8]°; p > 0.05) and with quadriceps contraction (32 [IQR 26-41]° vs. 22.5 [IQR 9.25-37.5]°; p > 0.05). Among patients with lateral release (40%), postoperative tilt reduction was significant (p < 0.005). Two patients experienced re-dislocation, with one requiring revision surgery. More than half showed grade III/IV chondral lesions, mainly on the lateral patellar facet, with an association between a higher patellar tilt and chondral damage (p < 0.05). Median Kujala and Lysholm scores were 89 (IQR 81.25-96.75) and 86 (IQR 76.75-94.75), respectively.

Conclusion: This study suggests that MPFL reconstruction yields good long-term clinical outcomes, though it is insufficient to fully correct a TT-TG offset. Increased preoperative patellar tilt was significantly linked to patellofemoral chondropathy; adjunct lateral release might be a preventive procedure since it helps by reducing lateral facet contact pressures.

Level of evidence: III.

Purpose: Acetabular bone loss poses a significant challenge in total hip arthroplasty (THA), especially during revision procedures. Impaction bone grafting (IBG) using allografts with uncemented cups is established as a biological reconstruction technique which aims to restore bone stock and achieve a stable fixation. However, there are inconsistent reports regarding its outcomes. This systematic review and meta-analysis aimed to evaluate the clinical and functional outcomes of IBG with uncemented cups in acetabular bone loss.

Methods: A comprehensive literature search of five databases: PubMed, Embase, CINAHL, Cochrane, and Web of Science was completed. Studies reporting functional outcomes and/or complications of IBG in uncemented THA were included. 20 studies, all observational, involving 1166 THAs in 1122 patients met prespecified inclusion criteria. A meta-analysis was conducted for these outcomes, and heterogeneity was assessed.

Results: Meta-analysis revealed significant improvement in mean Harris Hip Score (HHS) of 41.51 (95% CI: 35.71-47.30). Pooled complication rates were low: aseptic loosening (7%; 95% CI: 4%-13%), infection (4%; 95% CI: 3%-5%), need for revision (9%; 95% CI: 6%-14%), and mortality (4%; 95% CI: 2%-11%). There was considerable heterogeneity in the results, reflecting methodological variation across studies.

Conclusions: IBG with uncemented cups suggests meaningful functional improvement and generally acceptable complication rates in managing acetabular bone loss, particularly in revision THA. However, the current evidence base is limited by risk of bias, high heterogeneity, observational study designs, and lack of defect stratification. Future studies should focus on randomised controlled trials to better optimise surgical decision-making.

Backround: Modular neck implants in total hip arthroplasty (THA) allow control of length, offset, and version. However, these implants showed problems such as implant fracture and adverse reactions due to metal debris. This study aims to analyze our modular titanium-titanium neck THA stems, focus on mechanical complications related to its breakage, conduct a metallurgical analysis on these broken implants, and report revision surgery outcomes.

Methods: We performed a retrospective review to identify patients who had undergone THA with a specific modular (H2M-C2F Implants) implant at our institute (Fondazione Policlinico Universitario Campus Bio-Medico, Rome). Patient demographics, implant characteristics, clinical follow-up, and revision outcomes were obtained. A metallurgical examination was conducted on the broken implants.

Results: Out of thirty-eight patients eligible patients, seventeen had a titanium alloy neck, whereas the remaining twenty-one had CrCo necks. Thirteen of seventeen patients with titanium necks reported spontaneous ruptures of the neck due to fretting corrosion phenomena. Revision surgery was offered to all patients, including the ones who did not experience spontaneous rupture (four patients). Neither intraoperative nor long-term complications were reported, except for one patient who showed gluteal insufficiency. No clinical differences were reported between the patients who underwent revision surgery and those who were revised preventively.

Conclusion: Using modular implants should be limited to strict indications. Patients' characteristics are vital in selecting the ideal candidate for a modular THA. Modular implants should answer all the questions regarding durability and fracture risk to become a valid alternative to fixed-neck stems.

Background: Hip resurfacing is often reserved for younger, active patients due to concerns over implant durability and fracture risk in older patients. However, there is a lack of long-term data evaluating outcomes in patients over 65 years old at time of surgery. This study addresses this gap by directly comparing implant survivorship, failure and complication rates, and clinical outcomes in a younger control cohort from the same large single-surgeon series (> 6000 cases).

Methods: We queried a large, prospective institutional clinical database comprising over 7000 hip resurfacing cases performed by a single, high-volume surgeon; findings may not be generalizable to lower-volume or less-experienced centers. From this cohort, we identified 395 cases in patients ≥ 65 years (mean age 68.8) and 5,106 cases in patients < 65 years of age at time of surgery. All included patients had a minimum of 2-year follow-up, and 88.4% of the study cohort had up-to-date follow-up.

Results: There was no difference in the 98.6% 10- and 98.2% 16-year Kaplan-Meier implant survivorship of our over-65 study group when compared to a younger under-65 control group. These results exceed the NICE (National Institute for Clinical Excellence) criteria and registry benchmarks for total hip replacement from three major registries. The early femoral failure rate (femoral failure occurring < 1 year postoperative) was only 0.3%, which compares favorably with total hip arthroplasty perioperative fracture data. The long-term femoral fracture rate over the duration of this study was 1.3% for this older cohort, lower than what was reported for total hip arthroplasty.

Conclusions: This is the first known long-term study to demonstrate that hip resurfacing patients over 65 can achieve implant survivorship rates equivalent to younger resurfacing patients and superior to national total hip arthroplasty registry benchmarks. These findings challenge age-based restrictions and support expanded candidacy for hip resurfacing in select older adults when managed by experienced surgeons.

Burundi remains one of the most socioeconomically challenged countries globally, facing profound limitations in healthcare infrastructure, workforce, and access. In this context, the Italian Medical Foundation for Central Africa (FIMAC) has conducted humanitarian orthopaedic missions for over two decades in Bubanza, addressing critical musculoskeletal conditions in both paediatric and adult populations. This essay provides a comprehensive overview of the operational, clinical, and ethical dimensions of these missions. Commonly treated pathologies include chronic osteomyelitis, neglected fractures, open injuries, and congenital or acquired limb deformities-conditions frequently encountered in advanced stages due to delayed access to care. Resource-sensitive protocols guide interventions and rely heavily on collaboration with local healthcare workers, who receive targeted training in trauma management, postoperative care, and basic surgical techniques. The aim is not just to deliver urgent care but to foster sustainable improvements through capacity building and knowledge exchange. Major challenges include a lack of surgical infrastructure, limited availability of diagnostics and sterile equipment, as well as sociocultural barriers to care, such as language and traditional beliefs. Despite these constraints, the missions yield significant functional and psychosocial outcomes, particularly among paediatric patients. Ethical considerations, including informed consent, scope of practice, and cultural humility, are central to responsible practice in this setting. The personal and professional impact on participating surgeons is profound, often reshaping clinical priorities and reinforcing the humanistic foundations of the medical profession. The paper concludes by advocating for the establishment of permanent surgical facilities, structured deployments, and scalable innovations to enhance the continuity of care and address surgical inequities in low-resource settings.