MUSCULOSKELETAL SURGERY最新文献

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.

Preoperative stiffness in the knee joint significantly compromises outcomes after total knee arthroplasty (TKA). Robotic-assisted TKA (raTKA) using the imageless CORI system may offer precision in alignment and gap balancing, especially in difficult cases with limited range of motion (ROM). We present a case series of 25 knees in 22 patients with preoperative ROM < 50°, all treated using the imageless CORI robotic system (Smith & Nephew). All patients had advanced osteoarthritis or inflammatory arthritis and underwent primary TKA through a standard medial parapatellar approach with posterior cruciate-sacrificing implants. Postoperative follow-ups were conducted at 15 days, 3 months, 6 months, 1 year, and 2 years, with evaluation of ROM, Knee Society Score (KSS), and Visual Analog Score (VAS). Mean preoperative ROM was 38.7° ± 5.4 (range: 28°-45°). At final follow-up, all patients showed significant improvement in ROM, with a mean of 110.2° ± 6.2. KSS improved from a mean of 32 to 84, and VAS decreased from a mean of 8.2 to 1.6. Varus deformity was corrected in all patients. No cases of postoperative neurovascular complications, patellar tendon injuries, or manipulations under anesthesia were noted. The CORI robotic system offers a promising strategy for managing preoperatively stiff knees. It allows precise bone cuts and real-time soft tissue balancing with minimal releases, reducing complications, and improving functional outcomes. Further controlled studies are needed to establish its long-term advantages.

Study design: A retrospective case series of 4 patients with spinal ochronosis.

Objective: To evaluate the clinical, radiological, and surgical outcomes in patients with spinal ochronosis undergoing surgical intervention. Ochronosis, resulting from alkaptonuria, leads to homogentisic acid deposition in connective tissues, affecting the spine early. Due to its rarity, limited literature addresses the clinical, radiological, and surgical aspects of spinal ochronosis.

Methods: We reviewed four cases of spinal ochronosis where patients underwent surgery for symptoms such as pain, paresthesia, and myelopathy. Radiological findings, intraoperative observations, and postoperative outcomes were analysed. The iOS 'Measure' app was used to quantify angles intraoperatively.

Results: Patients, aged 45-56, presented with leg pain, paresthesia, and gait disturbances. Radiographs revealed disc degeneration, spinal stenosis, and sagittal imbalance. Surgical interventions included decompression, fusion, and en bloc resection of calcified ligamentum flavum. Dural tears occurred in 2 cases but were successfully repaired. All patients experienced significant symptom relief, though residual sagittal imbalance persisted in some.

Conclusions: Spinal ochronosis presents significant surgical challenges due to tissue fragility, adhesions. Surgical intervention can provide symptom relief, however, complete correction of deformities may not always be feasible. Further research is required to optimize treatment strategies for this rare condition.

Background: Displaced acetabulum fracture is one of the most difficult traumatic injuries to be managed. It has a bearing on the patients' life in the long-term. The ability to return to pre-injury quality of life (QoL) is of major importance after acetabular fracture fixation, which in turn depends on quality of fracture reduction. The purpose of this study is to ascertain the effect of the quality of reduction on patients' QoL.

Hypothesis: The patients with non-anatomic reduction of acetabular fracture will have a poorer QoL and higher complication rate as compared to anatomic reduction group.

Method: A retrospective review of all the patients with acetabular fracture who were managed surgically was conducted. The patients were divided into two groups-anatomic reduction (n = 79) and non-anatomic reduction (n = 47) after reviewing the post-operative Computed Tomography (CT) scans. QoL parameters using various patient-reported outcomes measures (PROMs) like, VAS score for hip pain, Modified Harris Hip Score, Short-form 12 questionnaire, UCLA activity score and Patient satisfaction score were compared between the two groups at a minimum follow-up of 2 years. Complications like conversion to Total hip arthroplasties (THA) due to development of arthritis or AVN of femoral head, were also evaluated.

Results: Modified Harris Hip score (mHHS) for the affected hip [61.5 ± 7.5 (59.9-63 .2) vs 57.1 ± 7.8 (54.8-59.3)], SF-12 (both PCS [50.5 ± 9.9 (48.4-52.7) vs 44.3 ± 8 (42-46.5)] and MCS [53.3 ± 7.8 (51.6-55.1) vs 48.3 ± 9.7 (45.6-51.1)]), UCLA activity score [4.6 ± 1.1 (4.4-4.8) vs 4.1 ± 0.9 (3.8-4.3)], and patient satisfaction scores [47.2 ± 4.5 (46.2-48.2) vs 45.1 ± 5.8 (43.4-46.8)] were significantly (p < 0.05) better in those with anatomic reduction. However, post-operative VAS was comparable in both groups. The conversion rate to THA was not found to be different between the two groups. Multivariate analysis found reduction quality to be an independent factor affecting patients' QoL.

Conclusion: Quality of fracture reduction is one of the most important factors for determining the clinical outcome of the patient. An anatomic reduction not only provides better functionality to the hip; it also results in a better quality of life for the patient.

Level of evidence: III, Retrospective cohort study.

In this article, data of nerve and bone recovery were reported in a series of patients treated with open reduction and internal fixation (ORIF) with plate in humeral shaft fractures (HSF) associated with radial nerve palsy (RNP). The authors highlight the role of early surgical intervention for optimal nerve repair and patient's recovery, and to avoid subsequent and more complex surgery to patients. This is a retrospective study of 24 of 31 patients with HSF with RNP (10,1%) out of 308 patients with HSF, treated surgically between 2012 and 2023 in a level I Trauma Center. The mean age was 57 years. The mean follow-up time was 42 months (range 12-60). Twenty-seven were closed fractures and 4 were open. All patients were treated within 24 hours with ORIF with plate and exploration and decompression of radial nerve. The medical records of all patients and their X-ray were reviewed to evaluate fracture's type, location, energy of trauma, status of RN injury and, beyond the time of recovery from RNP, the time of bone healing and functionally recovery. We reviewed 24 patients, and 7 were lost to follow-up. All patients (100%) had good nerve palsy recovery in a mean time of 6.2 months. The mean X-ray bone consolidation occurred after 4 months. The mean time of Rom recovery was 4.46 months. None of our patients needed further surgery for the failure of the radial nerve recovery. In conclusion, our study, even of mall size, demonstrated that early surgical exploration of radial nerve during ORIF with plate of RHSF facilitates nerve repair and enhancing patient recovery. Furthermore, the low incidence of radial nerve palsy should not preclude surgical exploration, conversely, as many patients may have undiagnosed nerve injuries that can be addressed through timely intervention.Level of Evidence: Level IV, retrospective study.

Introduction: The purpose of this systematic review of the literature was to evaluate long-term clinical and radiological outcomes, postoperative complications, and implant survivorship of robotic-assisted total knee arthroplasty (RA-TKA) compared to conventional manual total knee arthroplasty (Co-TKA).

Methods: A systematic review of the literature was performed with a primary search on Medline through PubMed. The PRISMA 2009 flowchart and checklist were used to edit the review. Exclusively human studies comparing RA-TKA with Co-TKA, with at least 12-month follow-up, were included. Outcomes assessed included clinical and radiographic results, postoperative complications, and implant survivorship.

Results: Twenty-three articles met the inclusion criteria, mostly rated as level II or III evidence. RA-TKA was associated with improved component alignment, better knee balance, reduced blood loss, and soft tissue preservation. These findings were linked to lower postoperative pain and reduced opioid consumption. Regarding long-term outcomes, RA-TKA showed similar rates in post-operative complications compared to Co-TKA, though results varied across studies. Data on implant survivorship were limited, with most studies reporting comparable medium- and long-term survival rates between RA-TKA and Co-TKA.

Conclusion: Current evidence suggests RA-TKA offers superior short-term outcomes over conventional techniques, but long-term benefits, especially regarding complications and survivorship, are still uncertain. Additional long-term studies are essential to clarify the potential of RA-TKA in improving durability and patient outcomes in knee arthroplasty surgery.