Orthopaedic Surgery最新文献

Objective: Although the Musculoskeletal Tumor Society (MSTS) score, Toronto Extremity Salvage Score (TESS), and Knee Society Score (KSS) are widely used for postoperative functional evaluation in patients undergoing rotating hinge knee (RHK) megaprosthesis reconstruction, their accuracy in reflecting objective gait performance remains uncertain. The study aimed to analyze the correlations between these scoring systems and gait parameters.

Methods: This retrospective study included 21 patients who underwent RHK between April 2023 and April 2025. At one-year follow-up, functional outcomes were assessed using MSTS, TESS, and KSS. Gait parameters were collected using the Intelligent Device for Energy Expenditure and Activity (IDEEA v3.1, MiniSun LLC). All functional assessments were completed on the same day as the gait analysis. Linear regression analyzed correlations between each scoring system and gait parameters. Friedman and Wilcoxon signed-rank tests compared median coefficients of determination across scoring systems. Stepwise multiple linear regression was used to examine the relationships between the scoring system subitems and gait parameters.

Results: Significant correlations were observed between all three scoring systems and multiple gait parameters after RHK (p < 0.05). The TESS had a significantly greater median R² than did the MSTS score and KSS (p < 0.05), especially for walking velocity (R² = 0.76), step length (R² = 0.75), initial contact phase (R² = 0.65), and stride length (R² = 0.58). Multiple linear regression analysis revealed that the MSTS "walking" and KSS "function" subitems independently or jointly predicted key gait parameters, including walking velocity, step length, and cadence (R² > 0.48).

Conclusions: All three scoring systems showed correlations with multiple key gait parameters in patients who underwent RHK. However, TESS demonstrated stronger and more consistent correlations and therefore appeared to be a more representative score of gait recovery.

Purpose: Ligament tension balance is essential for successful and long-term implant survival of total knee arthroplasty (TKA). Conventional manual tensioning methods are subjective and vary with the surgeon experience. This study evaluated the inter- and intra-rater reliability of pre-resection ligament tension assessments using an imageless robotic-assisted TKA system.

Methods: In this prospective study, 24 patients (30 knees) with end-stage knee osteoarthritis underwent CORI-assisted TKA from September 2024 to February 2025. Three specialist and three trainee surgeons each performed three repeated varus and valgus stress assessments across flexion and extension. Each medial and lateral gap measurement was recorded. Intraclass correlation coefficients (ICCs) were calculated with a two-way mixed-effects and two-way random-effects model.

Results: Both specialists and trainees demonstrated excellent intra- and inter- rater reliability (ICC > 0.90) for medial and lateral gaps in extension and medial gap in flexion. Flexion lateral reliability was good-to-excellent for trainees (ICC = 0.873, 95% CI: 0.784-0.933) and moderate-to-excellent for specialists (ICC = 0.838, 95% CI: 0.729-0.913).

Conclusions: Pre-resection ligament tension assessment with an imageless robotic system yields high inter- and intra-rater reliability, reducing variability linked to surgeon experience. Digital tensioners may standardize soft tissue balancing in TKA, potentially improving surgical outcomes and reproducibility.

Evidence level: Level III, prospective quasi-experimental study.

Objective: Total hip arthroplasty (THA) improves function in patients with dysplastic hip osteoarthritis (DHOA). However, its effect on reducing fall risk remains unclear. This study aimed to evaluate fall risk following THA in patients with DHOA.

Methods: This retrospective cohort study included 85 patients who had DHOA and underwent THA between September 2019 and September 2022 and were evaluated as having a preoperative fall risk (Fall Risk Index 5 items [FRI-5] ≥ 6). They were categorized into two groups according to the FRI-5 score 1 year postoperatively. Evaluation parameters included FRI-5 score, age, sex, body mass index (BMI), Harris hip score (HHS), perceived leg length discrepancy (P-LLD), and radiographic parameters. Logistic regression was used to assess risk factors for postoperative falls.

Results: The FRI-5 score significantly decreased from 7.79 (6.0-13.0) preoperatively to 4.56 (0-13.0) postoperatively (p < 0.001). The number of falls during the year decreased from 36 (42.4%) to 18 (21.2%) after surgery (p = 0.005). The high-risk and low-risk groups comprised 33 and 52 individuals, respectively. The high-risk group was significantly older than the low-risk group (p = 0.006). Postoperative P-LLD was significantly large in the high-risk group compared to that in the low-risk group (p = 0.005). Preoperative and postoperative sagittal vertical axes (SVA) were significantly larger and preoperative lumbar lordosis (LL) was significantly lower in the high-risk group than in the low-risk group (p = 0.039, p = 0.034, and p = 0.021, respectively). Logistic regression analysis identified age (OR: 1.2, 95% CI: 1.05-1.36, p = 0.006), preoperative low LL (OR: 0.944, 95% CI: 0.892-0.999, p = 0.046), and postoperative P-LLD (OR: 5.81, 95% CI: 1.23-27.5, p = 0.026) as significant factors associated with fall risk.

Conclusion: THA for patients who have DHOA at high risk of falls reduces the likelihood for falls. Therefore, surgeons should plan surgeries considering the risk factors post-THA.

Objectives: Hip Osteoarthritis (OA) affects a significant component of the adult population, placing itself among the most important causes of disability and need for total hip replacement. Femoroacetabular impingement (FAI) is an anatomic alteration of the proximal femur and/or acetabulum leading to chondro-labral damage and playing a prominent role in OA pathogenesis. Thus, treating FAI is fundamental to relieve hip pain and further joint tissue deterioration. Labral reconstruction is considered the treatment of choice, in particular using tendon allografts or autografts which, however, have some limitations. Here, we investigated the possibility to create a synthetic graft for labral reconstruction to best restore the load bearing and ready to be used in the surgical room.

Methods: The graft was designed analyzing the anatomical structures from intact tissue samples. After a preliminary screening of different polymers, silicone was selected for its flexibility and elasticity to better adhere to the implantation site. We used an FDA-approved biocompatible silicone (VK100), and a mold casting was selected as a fabrication method. Cytocompatibility of VK100 was tested in vitro with an immortalized chondrocytes human cell line (C-28/I2). A cadaver lab was used to test the implantation procedure and to investigate the effects of the device transplantation on hip range of motion, translation, and resultant joint stability. To test the long-term strength of the reconstruction under cyclic loading, synthetic hemipelves were prepared for biomechanical testing and subjected to 10,000 cycles where deflections of up to 5 mm were imposed.

Results: In vitro tests showed that up to 14 days of culture C-28/I2 cells were alive and adherent to VK100 surface with the formation of cell protrusions. As for cell cytotoxicity, a slight increase in LDH levels was observed at 14 days, probably due to the high confluence of adherent cells. We also demonstrated with the ex vivo procedure on cadaver that the device was suitable for arthroscopic implantation without damage or structural compromise during fixation to the acetabular bone. The range of motion and joint stability were preserved after implantation. Furthermore, the graft reconstruction successfully passed strenuous biomechanical cyclic loading. The force peak decreased by less than 10% during the test, indicating no detectable reduction of stiffness nor displacement/failure of the graft. No sign of damage was observed after test completion.

Conclusions: Overall, these results suggest that we have developed a functional synthetic graft that might be quickly transferred to clinical practice.

Purpose: Although percutaneous endoscopic lumbar decompression (PELD) has achieved substantial technical advancements over recent decades, it still presents considerable technical challenges in elderly patients with high iliac crest morphology who have concomitant lumbar foraminal stenosis and nerve root canal stenosis. To evaluate the preliminary clinical efficacy of percutaneous endoscopic lumbar decompression (PELD) assisted by an L-shaped impactor system in elderly patients with high iliac crest anatomy complicated by lumbar foraminal stenosis.

Methods: A retrospective cohort analysis was conducted on 40 elderly patients with high iliac crest anatomy and radiologically confirmed foraminal stenosis who underwent L-shaped impactor-assisted PELD between January 2022 and August 2023. Patients were divided into early (first 20 cases) and late (latter 20 cases) groups by surgical order. Outcome measures included preoperative/postoperative visual analog scale (VAS) scores for low back/leg pain, Oswestry Disability Index (ODI), MacNab criteria (1 day, 3-month, and 12-month follow-ups), and foraminal anteroposterior diameter, operation time, blood loss, and complications.

Results: VAS scores significantly improved from 6.83 ± 1.03 preoperatively to 3.00 ± 0.72 at 12 months. ODI scores decreased progressively from 55.9 ± 4.9 to 11.7 ± 1.9 at final follow-up. Excellent/good outcomes by MacNab criteria were achieved in 92.5% of patients at 12 months. Complications included transient dysesthesia (one case) and aggravated postoperative low back pain (one case). Compared with the early group, the late group had shorter operation time (58.90 ± 6.91 vs. 66.05 ± 7.26 min), less blood loss (30.85 ± 5.84 vs. 36.10 ± 6.75 mL), and lower postoperative VAS (3.80 ± 1.17 vs. 4.65 ± 1.23 < 0.05).

Conclusion: The L-shaped impactor-assisted PELD technique demonstrates favorable clinical efficacy in treating foraminal stenosis in elderly patients with high iliac crest anatomy. A favorable learning curve exists: more experience shortens operative time, reduces blood loss, and improves postoperative pain control without compromising safety. This minimally invasive approach may serve as a feasible surgical option for anatomically complex cases, warranting further prospective validation.

Objective: There is a paucity of large-scale epidemiological evidence on cartilage injuries among the Chinese population. This cross-sectional study was designed to delineate the prevalence, distribution, and determinants of knee cartilage injuries in patients undergoing primary knee arthroscopy.

Methods: We retrospectively reviewed patients who underwent primary knee arthroscopy from 2017 to 2023. Intraoperative findings were used to document the location, severity, and size of cartilage defects. Mixed-effects logistic regression models were employed to identify independent factors, accounting for bilateral procedures. Analysis of covariance was conducted to assess differences in preoperative Patient-Reported Outcome Measures (PROMs).

Results: Among 25,293 arthroscopies, the overall prevalence of cartilage injury was 66.2%, and severe lesions (Outerbridge Grade III-IV) were present in 26.6%. Patellar cartilage exhibited the highest overall prevalence (39.4%), whereas the trochlea showed the highest prevalence of severe lesions (12.0%). Patella-related disorders revealed the highest prevalence of concomitant cartilage injuries of 86.08% (severe injuries of 51.42%). Positive associations were found between overall cartilage injuries with professional athletic status (adjusted OR = 2.18, 95% CI: 1.47, 3.22, p < 0.001), higher BMI (adjusted OR = 1.05, 95% CI: 1.04, 1.06, p < 0.001), longer injury duration (adjusted OR = 1.00, 95% CI: 1.00, 1.00, p < 0.001), patella-related disorders (adjusted OR = 3.73 vs. meniscal tear, 95% CI: 3.18, 4.37, p < 0.001), and prior musculoskeletal injury (adjusted OR = 1.31, 95% CI: 1.17, 1.47, p < 0.001). Negative associations were observed for pre-injury regular sports participation (adjusted OR = 0.74, 95% CI: 0.65, 0.85, p < 0.001), ACL rupture (adjusted OR = 0.47 vs. meniscal tear, 95% CI: 0.43, 0.52, p < 0.001). A significant sex-age interaction was noted. In males, older age was associated with higher prevalence of cartilage injuries, while females exhibited an even more significant increase after 50 years. For patients with isolated cartilage injuries, patient-reported outcomes and limitations on daily activity were significantly worse than those with other intra-articular disorders (all with p < 0.001).

Conclusions: Knee cartilage injury was highly prevalent in patients undergoing primary arthroscopy. Patellar and trochlear cartilage were the most frequently and most severely affected, respectively. Patella-related disorders carried the greatest risk of concomitant cartilage damage. Several potentially modifiable factors, including regular sports participation, were associated with injury occurrence, underscoring opportunities for prevention and early intervention.

Objective: MRI-derived vertebral bone quality (VBQ) score predicts osteoporotic vertebral compression fracture (OVCF) in a fat-dependent way. This retrospective study aimed to evaluate the predictive potential of inter-vertebral signal concordance index (ISCI), derived by MRI in a fat-independent way, as a novel factor for assessing the risk of OVCF.

Methods: Patients who suffered OVCF (OVCF group) and lumbar degenerative diseases (non-OVCF group) between January 2022 and July 2024 were included. The ISCI was calculated from the MRI signal intensity of the L1-L4 vertebrae, measured from the lumbar T1-weighted, T2-weighted, and short tau inversion recovery (STIR)-weighted sequences. The demographic data, including sex, age, body mass index (BMI), and medical history, were recorded. The ISCIs of the OVCF and non-OVCF groups were additionally compared. Inter-group comparisons were performed using the rank-sum, chi-square, or median test, as appropriate. Risk factors were identified by logistic regression, and correlations were assessed using Spearman's correlation coefficient.

Results: A total of 448 patients were included in this study. The T1-ISCIs, T2-ISCIs, and STIR-ISCIs of the OVCF group were higher than those of the non-OVCF cohort (13.18 vs. 9.90, 14.69 vs. 10.68, and 19.31 vs. 15.67, respectively, all p < 0.001). Comparative analysis of the ISCIs across the subgroups categorized by sex and age revealed that the T1-ISCIs, T2-ISCIs, and STIR-ISCIs were higher in the OVCF group. Additionally, there were no significant differences in the ISCIs across fresh, old, and fresh + old fracture type subgroups. The results of multivariate logistic regression analysis revealed that the STIR-ISCI (odds ratio (OR) = 1.025, p = 0.013) could serve an independent predictive factor for assessing the risk of OVCF.

Conclusions: The study evaluated a novel index for predicting the risk of OVCF. The T1-ISCI and STIR-ISCI could serve as potential predictive factors for evaluating the risk of OVCF in clinical practice.

Objective: Excessive lateral pressure syndrome (ELPS), a major cause of anterior knee pain, stems from axial lateral patellar tilt. Current diagnostic methods exhibit limited accuracy, poor reproducibility, and difficulty in cases with morphological abnormalities. This study introduces the Lateral Alignment Angle (LAA) as a novel measurement technique.

Methods: In this retrospective study (June 2021-March 2025), 150 patients were enrolled and matched 1:1 with controls (total n = 300). Two senior surgeons independently measured LAA, Lateral Patellofemoral Angle (LPFA), Patellar Tilt Angle (PTA), and Patellofemoral Index (PFI) at separate time points. Receiver operating characteristic (ROC) curves were constructed to evaluate diagnostic performance, with area under the curve (AUC) computed and optimal cut-off determined by maximum Youden index. Intraclass correlation coefficients (ICC) assessed interobserver reproducibility.

Results: LAA demonstrated superior diagnostic accuracy with an AUC of 0.913, sensitivity of 89.3%, specificity of 88.0%, and overall accuracy of 88.7%, all significantly outperforming LPFA and PTA. LAA achieved higher positive (88.2%) and negative predictive values (89.2%), with a positive likelihood ratio of 7.44 and negative likelihood ratio of 0.12. The ICC for LAA was 0.782, indicating good interobserver reliability. The optimal diagnostic cut-off value was determined to be 5.35°.

Conclusions: The LAA is a stable, accurate measurement that minimizes morphological influence on patellofemoral joint assessment. An LAA greater than 5.35° reliably indicates lateral patellar tilt, providing enhanced diagnostic utility and improved clinical management of ELPS.

Objective: Hip fracture is a severe injury in the elderly population and can trigger a strong physiologic stress reaction with potential impact on clinical outcomes. However, few data are available on the temporal evolution of hematologic parameters after this injury. This study aimed to evaluate the temporal trends of key hematological and inflammatory-immune markers in elderly patients with hip fractures.

Methods: A retrospective cohort study was conducted among elderly patients with hip fractures managed at a tertiary referral center from January 2022 to October 2024. Included patients were required to have both complete serial hematological measurements obtained during the first 5 days post-fracture and relevant clinical data. We used generalized estimating equation models for repeated measurements to describe the temporal trends of key hematological markers, with analyses stratified by fracture type and age group.

Results: A total of sixty patients were included, with a mean age of 80 ± 7.4 years (range: 65-96 years) and 68.3% females (n = 41). Within the first 1-5 days post-fracture, hemoglobin decreased by a mean of 9.66 g/L, hematocrit by 3.10 percentage points, neutrophil percentage by 8.12 percentage points, neutrophil count by a mean of 2.41 × 10⁹/L, and neutrophil-to-lymphocyte ratio (NLR) by 3.07 (all p-values < 0.001). Conversely, lymphocyte and monocyte counts exhibited a biphasic change, peaking on day 4 prior to subsequent decline. Subgroup analyses revealed that monocyte levels demonstrated significant interactions between time and fracture type (p = 0.036), whereas both lymphocytes (p = 0.034) and monocytes (p = 0.012) exhibited significant interactions between age and time.

Conclusions: Hemoglobin, hematocrit, neutrophil percentage, neutrophil count, and NLR progressively decrease during days 1-5 after hip fracture in older patients, whereas lymphocyte and monocyte counts exhibit biphasic patterns and vary significantly according to fracture type and age. These findings may help clinicians in interpreting early post-fracture laboratory dynamics and provide a basis for future outcome-oriented validation.

Objective: Anterior cruciate ligament reconstruction (ACLR) with autologous hamstring tendon is the standard treatment for ACL rupture. However, tibial tunnel enlargement and delayed graft maturation may affect long-term outcomes. Evidence on their mid- to long-term associations with clinical recovery remains limited. The main objectives of this study include: (i) analyze longitudinal changes in tibial tunnel morphology after single-bundle ACLR; (ii) quantitatively evaluate graft maturation at different tunnel regions using the signal intensity ratio (SIR) from MRI; and (iii) examine the correlations between tibial tunnel enlargement, graft healing, and clinical outcomes.

Methods: A retrospective study was conducted on 35 patients who underwent single-bundle ACLR using autologous hamstring grafts and completed a 5-year follow-up. Knee function was evaluated preoperatively and at 2 and 5 years postoperatively using the KT-2000 arthrometer, pivot-shift test (PST) grade, Lysholm Knee Scoring Scale, International Knee Documentation Committee (IKDC) questionnaire, Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner Activity Scale, and the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale. Tibial tunnel diameter was measured via MRI at 1 week, 2 years, and 5 years postoperatively. Graft maturation was evaluated using the signal intensity ratio (SIR). Changes in tunnel diameter and SIR over time were analyzed. Pearson correlation coefficients (r) were used to assess the relationship between bone tunnel enlargement (BTE), graft healing, and knee function. Spearman's rank correlation coefficient was used to assess the association between BTE and PST grade.

Results: Tibial tunnel diameter increased from 1 week to 2 years and partially regressed at 5 years, remaining larger than baseline. SIR increased significantly from 1 week to 2 years and decreased slightly by 5 years. At 2 years, tunnel diameter in the tibial tunnel exit (ttE) region was positively correlated with intra-articular graft SIR (r = 0.455, p < 0.01), but not with clinical outcomes. By 5 years, no significant correlation was observed between tibial tunnel diameter and graft SIR. However, tibial tunnel diameter in the ttE region was positively correlated with KT-2000 side-to-side difference (SSD) (r = 0.411, p < 0.05).

Conclusion: Tibial tunnel enlargement progressed until 2 years post-ACLR, then partially regressed by 5 years. BTE was associated with graft healing at 2 years and with anterior knee stability at 5 years but had no significant adverse impact on long-term clinical outcomes.