MUSCULOSKELETAL SURGERY最新文献

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.

Purpose: To evaluate the radiographic and functional outcomes of scaphoid fractures and nonunions treated with volar locked plate fixation, with or without autologous bone grafting, and to explore whether graft use was associated with improved consolidation or function.

Methods: This retrospective cohort study included 19 adult patients who underwent surgical treatment with volar anatomical plates for scaphoid fractures or nonunions. Radiographic union was assessed at 3, 6, and 12 months. Functional outcomes were measured using the QuickDASH score preoperatively and at 12 months postoperatively. Graft use was determined intraoperatively based on defect characteristics. Statistical analyses included non-parametric tests and multivariable models.

Results: The mean patient age was 24.5 ± 5.4 years, and 94.7% were male. Scaphoid nonunion was present in 11 patients (57.9%), and autologous bone grafting was performed in 15 (78.9%). Radiographic consolidation was achieved in 94.7% of cases at 12 months. QuickDASH scores improved significantly (mean change: 20.6 points; p < 0.001). There were no significant differences in union or functional outcomes between grafted and non-grafted patients (p = 1.000 and p = 0.115, respectively). Interestingly, patients with nonunions demonstrated significantly better postoperative function than those with acute fractures (p = 0.034), although this did not exceed the minimal clinically important difference. Multivariable analysis failed to identify predictors of union or function, explaining only 37% of the variance.

Conclusion: Volar locked plate fixation provides high union rates and significant functional improvement in scaphoid fractures and nonunions. Bone grafting did not confer additional benefit, supporting selective rather than routine use. Further studies are warranted to clarify prognostic factors and optimize treatment strategies.

Background: Patellofemoral joint instability is the most common knee pathology observed in childhood and adolescence. One significant contributing factor to this condition is trochlear dysplasia (TD) of the femoral trochlea, which can lead to chronic pain, recurrent instability, and premature wear of the patellofemoral joint. Amongst the identified risk factors, breech presentation (BP) at birth has been highlighted as a potential contributor to the development of trochlear dysplasia. This study explores the association between breech presentation and the femoral trochlea's increased sulcus angle (SA), further emphasising its role in patellofemoral joint pathology.

Methods: A prospective cohort study was conducted with 85 newborns (170 knees), including healthy infants born in breech presentation (BP) between weeks 31 and 42 and those born in cephalic presentation (CP) between weeks 35 and 41. Sulcus angle (SA) values were measured using ultrasound, and a physical examination was performed for each group.

Results: We observed significant differences in the SA measurements between the two groups (p < 0.05): 149.92º (95% CI 148.81-151.04; SD = 5.56), compared to the CP group, which had a mean SA of 142.52º (95% CI 141.83-143.21; SD = 2.94). The BP group also had shorter gestation periods (267 days, SD = 11 vs 274 days, SD = 8) and lower birth weights (3091.71 g, SD = 500.94 vs. 3380.74 g, SD = 424.72, p < 0.05). Additionally, the rate of caesarean-section deliveries was higher in the BP group (44.8%) compared to the CP group (17.14%) (p < 0.05).

Conclusion: Newborns with breech presentation exhibit significantly higher SA values, suggesting a flatter trochlear groove and a potential predisposition to patellofemoral joint instability.

Background: Greater trochanteric pain syndrome (GTPS) is a common cause of lateral hip pain, primarily affecting middle-aged women. It involves tendinopathy or tears of the gluteus medius and minimus tendons, often misdiagnosed as trochanteric bursitis. Accurate diagnosis and management require thorough clinical assessment and diagnostic imaging.

Methods: This review examines the pathogenesis, clinical examination, and diagnostic tools like ultrasound (US) and magnetic resonance imaging (MRI) for GTPS. A narrative literature was conducted from May 2002 to February 2024 using PubMed. A total of 85 articles were reviewed, with 56 included, focusing on conservative and interventional treatments such as physical therapy, extracorporeal shock wave therapy (ESWT), corticosteroid injections, and platelet-rich plasma (PRP).

Results: Non-surgical interventions showed variable efficacy. ESWT provided significant long-term pain relief, while corticosteroid injections offered short-term benefits that diminished over time. PRP injections demonstrated sustained improvement. US-guided procedures were found superior in precisely targeting anatomical structures.

Conclusions: GTPS remains a challenging, often chronic condition. Non-surgical approaches can effectively manage early stages, but persistent cases may require advanced interventional strategies. Further research is needed to standardize treatment protocols, particularly for severe tendinopathy cases.

Introduction: Anterior femoral notching during TKA is thought to weaken the distal femur, potentially increasing periprosthetic fracture risk, but its clinical impact remains debated. This study examines whether notching independently predicts such fractures and assesses related clinical outcomes using the Tayside classification system for cortical violations.

Methods: A retrospective cohort study was conducted on 715 patients who underwent primary TKA. Patients were divided into Group 1 without notching (control group) and Group 2 with any presence of notching according to Tayside classification system, which assesses cortical violations based on the extent of involvement. Fracture incidence and additional multivariate analysis were used to control for confounding factors, including bone quality (presence of osteoporosis) and demographics.

Results: PPFs were significantly more frequent in the notching group (2.67%) than in the control group (0.24%) (p < 0.01). Despite 6.68% of patients having osteoporosis, no correlation with PPFs was found. All fractures occurred in female patients due to falls. A cortical defect > 2.5 mm was a potential predictor of femoral weakness, with larger defects in the notching group (2.20 ± 0.54 mm) vs. control (0.02 ± 0.16 mm), p < 0.01. PPF incidence was 1.33% for Grade 1 and 2 defects and 0.33% for Grade 3 defects.

Conclusion: Preventive strategies, including meticulous surgical technique and tailored postoperative rehabilitation, are essential to minimize PPF risk. Anterior femoral notching compromises femoral integrity, with defects > 2.5 mm significantly increasing fracture risk. Careful surgical planning, especially in patients with poor bone quality or advanced age, is crucial to optimize outcomes and reduce complications.

Introduction: Sarcopenia is a pathologic condition frequent in aged population, leading to functional and cognitive impairment. Given the ageing of the population worldwide, the topic has generated interest in the last decades and is expected to be more relevant in the near future. This paper aims to present the mechanism of sarcopenia, the current state of knowledge regarding diagnosis and treatment and the role of sarcopenia in orthopaedic and traumatological settings. Sarcopenia is an age-related condition which overlaps with other features of frailty syndrome by similar biochemical pathways. It is characterized by a loss of muscle mass and function, mainly due to reduced anabolism. The importance of prompt diagnosis is highlighted; however, there is a lack of standardized cut-offs, thus affecting also non-pharmacological and pharmacological therapeutic options, which are not well defined. The increased risk of falls, disability, cognitive impairment and association with osteoporosis exacerbates fracture risk. Post-surgery inactivity contributes to sarcopenia, which also leads to prolonged hospital stays, increased complications and worse clinical outcomes.

Conclusion: Ageing of population will increase chronic-related conditions. Sarcopenia is a growing and still largely unexplored clinical challenge. Research should focus on diagnostic thresholds and therapeutic protocols to promote interdisciplinary assessment and targeted interventions. In the orthopaedic field, attention ranges from the prevention of fragility fractures to proper perioperative management.