Orthopaedic Surgery最新文献

Objective: To evaluate the clinical efficacy, safety profile, and clinical outcomes of AUSS versus PELD in single-level LSS treatment.

Methods: This retrospective comparative study included 68 consecutive LSS patients treated between January 2023 and January 2024: 35 underwent AUSS and 33 underwent PELD. Primary outcomes included total operative time, extracanal working time, intracanal decompression duration, incision length, fluoroscopy exposure time, intraoperative blood loss, preoperative/postoperative day 3 hemoglobin levels, hospitalization duration, total treatment costs, and postoperative complications. Clinical assessments utilized the visual analog scale (VAS) for axial back/leg pain evaluation, Oswestry Disability Index (ODI) for functional assessment, and modified MacNab criteria for clinical success. Minimum follow-up was 12 months.

Results: All 68 patients completed 12-month follow-up with no demographic disparities between groups. AUSS exhibited superior operative efficiency with significantly shorter total operating time (45.6 ± 3.14 vs. 54.6 ± 5.54 min, p < 0.01) and intracanal decompression time (21.25 ± 2.38 vs. 35.4 ± 3.36 min, p < 0.01), although with marginally prolonged extracanal operating time (27.35 ± 3.28 vs. 18.6 ± 3.54 min, p < 0.01). Fluoroscopy duration was significantly reduced in AUSS (7.45 ± 2.39 vs. 38.38 ± 7.62 s, p < 0.01). AUSS required larger incisions (19.74 ± 2.13 vs. 7.83 ± 1.08 mm, p < 0.01) and resulted in higher estimated blood loss (17.18 ± 6.43 vs. 9.53 ± 1.38 mL, p < 0.05), and higher total costs (21937.44 ± 579.36 vs. 17459.44 ± 589.26 ¥, p < 0.05), though without clinically significant changes in hemoglobin levels (130.24 ± 7.02 vs. 130.31 ± 6.25, p > 0.05) and postoperative hospital stay (6.48 ± 2.72 vs. 6.84 ± 1.93 days, p > 0.05). AUSS had lower postoperative VAS-leg pain scores at early postoperative periods (3 days and 1 month) (p < 0.01) and higher patient satisfaction rates (94.29% vs. 84.85% excellent/good outcomes, p < 0.05). One PELD case required secondary surgical interventions within 12 months for persistent radiculopathy, whereas no AUSS patients required reoperations. Overall complication rates were comparable between groups.

Conclusion: Both techniques showed similar safety. AUSS offers superior operative efficiency, reduced radiation exposure, and better early clinical outcomes compared to PELD for LSS treatment. Despite slightly larger incisions and increased blood loss, AUSS demonstrates enhanced decompression completeness with lower revision rates, suggesting AUSS as a valuable alternative to PELD, particularly for cases requiring comprehensive neural decompression.

Background: Total knee arthroplasty (TKA) offers significant relief for advanced knee osteoarthritis. With an aging population, TKA procedures are increasing, leading to a higher demand for revision surgeries. Rotating-hinge knee (RHK) prostheses have emerged as a solution for complex revisions, but the long-term durability of RHK prostheses and their effectiveness in infection-related revisions remain controversial. Therefore, this study aimed to evaluate the mid- to long-term clinical and survivorship outcomes of a single-design rotating hinge knee (SDRHK) system in revision TKA, comparing patients revised for infection with those revised for noninfectious causes.

Methods: This retrospective study analyzed 110 patients who underwent revision total knee arthroplasty (rTKA) with a SDRHK system from 2004 to 2023, with an average follow-up of 11.3 years. Patients were divided into an infection group (n = 51) and a noninfection group (n = 59) for comparative analysis. Preoperative diagnostic arthrocentesis was performed to evaluate synovial cell count, leukocyte differential, and microorganisms. Functional outcomes were assessed using Hospital for Special Surgery (HSS) knee score, range of motion (ROM), and Knee Society Score (KSS). Study outcomes included prosthesis survival, mechanical failure, and complications. Data were analyzed using Kaplan-Meier survival analysis, t test, and χ ² test, with statistical significance set at p ≤ 0.05.

Result: The infection group experienced symptom onset significantly earlier than the noninfection group (18.8 vs. 50 months, p = 0.003), had a shorter initial prosthesis lifespan (32.7 vs. 66.8 months, p = 0.001), and underwent more surgeries before revision (2.6 vs. 1.6, p = 0.004). Microbiological analysis indicated that coagulase-negative staphylococci and Staphylococcus aureus were the most commonly isolated pathogens. The 5- and 10-year prosthesis survival rates in the infection group were 78.4% and 71%, respectively, while those in the noninfection group were 83.1% and 74.6%. At the latest follow-up, survival rates for the two groups were 68.6% and 71.2%, showing similar outcomes. Functional scores in both groups improved postoperatively, with no significant differences in HSS, ROM, or KSS scores between the groups.

Conclusion: This study highlights the important value of RHK prostheses in the treatment of prosthetic joint infection (PJI) after TKA. Despite challenges such as earlier symptom onset, shorter prosthesis lifespan, and higher complication rates in the infection group, their functional outcomes and prosthesis survival rates were comparable to those of the noninfection group, further validating the effectiveness of RHK prostheses. These findings provide useful references for clinical management of PJI and underscore the importance of continued innovation in revision techniques.

Introduction: There are many instruments and facilities designed to facilitate the procedure of minimally invasive spine surgery. However, those current instrumentation systems may increase the complexity to accomplish the procedure. Our department developed a specific two small incision surgery for MI-TLIF, and the benefits of this technique could control only one unilateral surgical incision for two-screw insertion, which the length of each wound was as small as 3.0-4.0 cm. In this retrospective study, we compared the intraoperative and postoperative results of novel two incisions technique and traditional four surgical incisions for patients with 1-level MI-TLIF treatment.

Methods: We retrospective recruited 80 consecutive patients who had degenerative spinal stenosis or spondylolisthesis and received primary 1-level MI-TLIF in single hospital from September 10, 2020, to October 19, 2023. The Wiltse approach for interbody fusion and a single-plane fluoroscopy-guided method to insert the pedicle screws were used. Patients were divided into two groups depending on different surgical techniques. Patient demographics, intraoperative and postoperative data were assessed. The Mann-Whitney U test or Fisher exact test were used to evaluate the data and a p value < 0.05 was considered significant in this study.

Results: A total of 71 patients met the inclusion criteria in this study. The baseline data were similar between novel technique (n = 41, two incisions) and traditional MI-TLIF group (n = 30, four incisions). Among all intraoperative, postoperative and complication categories, the instrumentation time was the only item that showed significant difference, which is shorter in novel technique group (p = 0.034). The difference became more apparent in the obese group (BMI ≥ 27 kg/m ² , p = 0.01).

Conclusion: Although the novel technique could reduce the number of surgical incisions compared to traditional MI-TLIF, the intraoperative and postoperative results were similar to the traditional MI-TLIF. Hence the reduction in wound number and the total length of surgical wound does not have obvious benefits in 1-level MI-TLIF patients. However, the less surgical exposure may offer less surgical wounds complications for specific groups, which were immune-compromised, such as diabetics, chronic renal disease, or cancer patients, and the clinical follow-up of specific groups will be planned to perform in the future.

Background: Despite technical and material improvements in rotator cuff repair, clinical and radiological failure remains common. Following suture fixation, tension and footprint compression decrease from time zero. A novel suture has been designed to shorten when submerged in liquid to maintain tension and increase repair construct security. The aim of this study was to assess the safety and clinical outcomes (IDEAL 2a assessment) in patients receiving rotator cuff repair with the self-tensioning suture with a minimum of 12 months follow up. Clinical registries allow early identification of outlier or poorly performing prosthesis with prevention of avoidable complications.

Methods: A cohort analysis was performed utilizing patients from the PRULO (Patient Reported Outcomes in Upper Limb Surgery) registry. All patients with the suture of interest who underwent a rotator cuff repair with 12 months follow up were included. Results included patient reported outcome scores: Quick Disability of the Arm, Shoulder and Hand (QuickDASH), and the Western Ontario Rotator Cuff Index (WORC) and complications. Patient reported outcome measures (PROMs) were analyzed using multiple imputation and a linear model to assess changes over 12 months follow up.

Results: A cohort of 255 patients was included for analysis. At 12 months follow up, median scores for QuickDASH decreased by 36 and WORC increased by 41, both of which surpass the minimum clinically important difference. Our observed rates of complications included: Infection 2.4%, stiffness/capsulitis 13%, and retear 12%. Complication rates and functional improvements were similar to other studies. These results suggest the suture is safe and adequately effective for ongoing clinical use and further study.

Conclusion: The novel suture demonstrated comparable safety and efficacy profiles, with outcomes similar to those published in the literature. This study suggests this novel suture is safe and does not seem to produce unique complications. Further research is warranted to specifically investigate clinical efficacy in the longer term.

Trial registration: ACTRN12619000770167.

Purpose: To compare the mobility and health-related quality of life (HRQoL) for femoral neck fractures (FNFs) in the elderly treated with either hemiarthroplasty (HA) or total hip arthroplasty (THA).

Methods: This study constitutes a post hoc analysis of a prospective cohort study. In this secondary analysis, we enrolled patients aged ≥ 65 years who underwent arthroplasty for FNFs at a tertiary hospital in Beijing, China, between 2018 and 2019. Patients were stratified into the HA group and THA group based on the surgical type. All patients were followed up via telephone at 30, 120, and 365 days postoperatively. The Fracture Mobility Score (FMS) was utilized to assess patients' mobility, while the EuroQol 5-Dimension (EQ-5D) instrument was adopted to evaluate their HRQoL. Intergroup comparisons, multivariate logistic regression models, and linear regression models were used to compare outcomes between the two groups and analyze the impact of surgical type on these outcomes.

Results: Among 416 eligible patients, 333 completed all three follow-up evaluations, including 250 patients in the HA group and 83 in the THA group. Multivariate logistic regression models adjusted for potential confounders indicated that patients in the THA group were significantly more likely to achieve unrestricted mobility at 120 and 365 days postoperatively compared with the HA group (OR [95% CI] = 2.407 [1.210-4.788], p.adj = 0.012; OR [95% CI] = 2.410 [1.120-5.183], p.adj = 0.024), with no significant difference observed at the 30-day follow-up. In addition, multivariate linear regression models adjusted for 12 covariates demonstrated that the THA group achieved significantly higher EQ-5D scores at 30 and 120 days postoperatively (p.adj = 0.003 and p.adj = 0.003, respectively). However, this advantage was not sustained at the 365-day follow-up (p.adj = 0.100).

Conclusion: THA may yield a higher probability of independent mobility recovery and better postoperative HRQoL than HA in elderly patients with FNFs.

Objective: Adolescent idiopathic scoliosis (AIS) necessitates multimodal management strategies integrating orthotic intervention and physiotherapeutic scoliosis-specific exercises (PSSE). This study aimed to compare the clinical efficacy of brace therapy combined with tele-rehabilitation-guided PSSE versus brace treatment with self-guided home-based PSSE in mitigating spinal deformity progression.

Methods: A cohort of 67 treatment-naïve AIS patients from a tertiary scoliosis center (July 2021-July 2023) was stratified into two intervention groups: (1) tele-rehabilitation (real-time digitally supervised PSSE) and (2) autonomous practice (self-guided home PSSE). Longitudinal evaluations at baseline, 6, 12, and 24-month intervals included radiographic Cobb angle quantification, scoliometric angle of trunk rotation (ATR) assessment, and Scoliosis Research Society-22 (SRS-22) patient-reported outcomes. Treatment success was categorized as improvement (Cobb reduction ≥ 5°), stability (change < 5°), or progression (increase ≥ 5°). Data were analyzed using paired and independent t-tests, Mann-Whitney U test, and Pearson's χ² test.

Results: At 24-month follow-up, the tele-rehabilitation group exhibited significantly higher Cobb angle improvement rates (70.6% vs. 57.6%, p < 0.05) and lower progression rates (2.9% vs. 6.1%) compared to the autonomous practice group. Axial rotation correction demonstrated superior outcomes in the supervised cohort (final ATR: 6.9° ± 1.9° vs. baseline, p < 0.01). All SRS-22 domains showed clinically meaningful improvements (p < 0.05).

Conclusion: Tele-rehabilitation-guided PSSE combined with bracing demonstrates enhanced efficacy over self-guided protocols in achieving three-dimensional deformity correction, stabilizing curve progression, and optimizing patient-centered outcomes. Structured digital supervision emerges as a critical adjunct to orthotic management, advocating for technology-integrated conservative strategies in adolescent spinal deformity care.

Objective: Postoperative loss of cervical lordosis remains a common and clinically relevant complication following laminoplasty, negatively affecting neck pain, neurological recovery, and long-term sagittal balance. However, reliable and easily applicable preoperative predictors for identifying patients at high risk of cervical lordosis deterioration remain limited. This study aims to investigate whether preoperative C2 slope (C2S) independently predicts cervical lordosis deterioration following laminoplasty.

Methods: This retrospective cohort study included 179 patients who underwent cervical laminoplasty for cervical spondylotic myelopathy at our institution between April 2014 and December 2020, with a minimum follow-up of 24 months. Radiological parameters including C2-7 Cobb angle, cervical sagittal vertical axis (cSVA), C7 slope, and C2S are measured preoperatively and at final follow-up. Patients are divided into lordosis deterioration group (> 5°) and control group (≤ 5°). B Between-group comparisons are performed using independent-samples t tests and χ² tests. Binary logistic regression analysis is conducted to identify independent predictors of postoperative cervical lordosis loss. Receiver operating characteristic (ROC) curve analysis is used to evaluate predictive performance and determine the optimal cutoff value.

Results: The lordosis loss group (n = 55) shows significantly higher preoperative C2S (14.57° ± 3.47° vs. 9.52° ± 7.30°, p < 0.001), lower preoperative Cobb angle (13.01° ± 4.91° vs. 16.1° ± 6.50°, p < 0.001), and greater cSVA (2.58 ± 1.45 cm vs. 2.13 ± 1.42 cm, p = 0.027) compared to controls. The lordosis loss group demonstrates worse postoperative neck pain VAS scores (3.31 ± 1.63 vs. 2.40 ± 1.56, p < 0.001) and slightly lower JOA scores (15.45 ± 1.14 vs. 15.78 ± 1.12, p = 0.037). Multivariate analysis reveals preoperative C2S as the only independent predictor (OR = 1.176, p < 0.001), with 11.49 as cutoff value for C2S.

Conclusion: Elevated preoperative C2S independently predicts postoperative cervical lordosis deterioration. C2S measurement provides a simple, effective tool for identifying high-risk patients and optimizing surgical planning.

Purpose: Posterior endoscopic surgery has become a mainstream minimally invasive approach for the treatment of cervical spondylotic radiculopathy (CSR). Arthroscopic-assisted uni-portal spine surgery (AUSS), an emerging technique, has demonstrated favorable clinical outcomes in lumbar spine surgery; however, its feasibility and effectiveness in cervical spine surgery have not yet been reported. Accordingly, this technical note aimed to describe the surgical technique of AUSS combined with Kirschner wire anchoring for the treatment of CSR and to evaluate its preliminary clinical outcomes.

Methods: Fifteen consecutive CSR patients (9 males, 6 females) underwent AUSS combined with Kirschner wire anchoring between February and October 2024. Clinical outcomes were evaluated using the Visual Analogue Scale (VAS) for neck and arm pain, the Neck Disability Index (NDI), and the modified MacNab criteria. Pre- and postoperative pain and functional scores were compared using a paired t-test, with effect sizes (Cohen's d) and 95% confidence intervals (CIs) for mean differences calculated. Radiological parameters included osteotomy area and facet joint resection rate.

Results: All procedures were successfully completed with a mean operative time of 97.7 ± 18.2 min and a mean incision length of 1.7 ± 0.2 cm. Postoperatively, VAS score for arm improved from 6.5 ± 0.9 to 2.8 ± 0.7 (p < 0.05), VAS score for neck from 4.3 ± 1.9 to 2.7 ± 1.0 (p < 0.05), and NDI from 54.3 ± 6.7 to 9.7 ± 2.4 (p < 0.05). The mean osteotomy area measured 98.6 ± 12.1 mm², with a facet joint removal rate of 27.6% ± 8.6%. At the 6-month follow-up, 86.7% (13/15) of patients achieved excellent/good outcomes. No serious surgery-related complications were observed.

Conclusion: The AUSS with Kirschner wire anchoring achieved significant pain relief and functional improvement in CSR, demonstrating feasibility and safety in the short term. However, larger cohorts and long-term studies are required to validate its efficacy.

Objective: Although advances in disease-modifying therapies have improved rheumatoid arthritis (RA) management, many patients still require total hip or knee arthroplasty. Long-term data on baseline characteristics and treatment patterns of RA patients undergoing arthroplasty in China are scarce. This study aimed to investigate time trends in baseline demographic, clinical, laboratory, and treatment parameters of RA patients undergoing THA and TKA between 2002 and 2022.

Methods: A retrospective study of consecutive THAs and TKAs for RA patients between 2002 and 2022 was conducted at a single center. The preoperative patient demographics, clinical and laboratory parameters were collected. All joints were divided into 2002-2011 and 2012-2022 groups, THA and TKA groups, juvenile-onset rheumatoid arthritis (JORA) (0-16 years), adult-onset rheumatoid arthritis (AORA) (16-60 years), and late-onset rheumatoid arthritis (LORA) (≥ 60 years) groups, respectively. The intergroup comparisons were performed.

Results: A total of 1363 primary TKAs in 897 patients with RA and 561 hips in 511 patients with RA were included. The number of arthroplasties performed annually from 2002 to 2022 demonstrated a significantly increasing trend. The use of glucocorticoids (GCs) before surgery demonstrated a significant decreasing trend while conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) and biological DMARDs (bDMARDs) + targeted synthetic DMARDs (tsDMARDs) demonstrated an increasing trend. Comparison by time period (2002-2011 vs. 2012-2022) showed that the percentage of preoperative use of csDMARDs and bDMARDs + tsDMARDs was significantly higher and GCs were significantly higher in the 2002-2011 group.

Conclusions: The number of THAs and TKAs performed annually from 2002 to 2022 demonstrated a significantly increasing trend in a tertiary care center for musculoskeletal diseases. In contrast, a significantly increasing trend for the percentage of preoperative use of csDMARDs and bDMARDs + tsDMARDs and a significantly decreasing trend for preoperative use of GCs and inflammatory markers was identified.