Orthopaedic Surgery最新文献

Objective: The treatment of lumbar disc herniation (LDH) with bilateral radiculopathy using transforaminal endoscopic lumbar discectomy (TELD) remains challenging, especially at the L5/S1 level with narrow foramen or high iliac crest. Full-endoscopic visualized foraminoplasty and discectomy (FEVFD) is a newly developed technique for LDH and lumbar stenosis. However, there is limited evidence on the efficacy of FEVFD technique in the treatment of LDH with bilateral radiculopathy. This study was to assess the clinical outcomes and safety of using FEVFD in the treatment of LDH with bilateral radiculopathy.

Methods: This retrospective study enrolled 63 patients with LDH presenting with bilateral radiculopathy between January 2018 and January 2022. Patients enrolled before January 2020 were treated using a conventional transforaminal endoscopic surgical system (TESSYS) technique (TESSYS, n = 33) and treated using a FEVFD technique after that (FEVFD, n = 30). The total operation time and the number of intraoperative fluoroscopies were recorded. The Oswestry Disability Index (ODI) and visual analog scale (VAS) were evaluated preoperatively and postoperatively (at 1-month, 3-month, 6-month, and final follow-ups). Global outcomes at final follow-up were assessed using modified MacNab criteria.

Results: Compared with TESSYS, patients in FEVFD group had a shorter operation time (92.9 vs. 78.0 min). The intraoperative fluoroscopies in FEVFD group were significantly lower than those in TESSYS group (18.7 vs. 4.9). After the operation, the VAS and ODI scores at all follow-ups in the two groups were significantly lower than those before operation. For the L5/S1 level, the values of VAS and ODI scores in FEVFD group were significantly lower than those of in TESSYS group at 3-month, 6-month, and final follow-up. For the L4/5 level, however, no significant difference was found in VAS and ODI scores between these two groups at the follow-ups. According to the modified MacNab criteria, the excellent-to-good rate in TESSYS and FEVFD groups was 84.8% and 90.0%, respectively.

Conclusion: For LDH with bilateral radiculopathy, using the FEVFD technique could not only reduce the operation time and radiation, but also improve the clinical outcomes at the L5/S1 level.

Objective: Periacetabular tumors, especially in young to middle-aged patients with invasive benign tumors or low-grade malignant tumors involving type II or II + III, present significant challenges due to their rarity and the complexity of the anatomical and biomechanical structures involved. The primary difficulty lies in balancing the need to avoid unfavorable oncological outcomes while maintaining postoperative hip joint function during surgical resection. This study aimed to evaluate the effectiveness and reliability of a surgical method involving partial weight-bearing acetabular preservation combined with the use of an uncontaminated femoral head autograft to reconstruct the segmental bone defect after intra-articular resection of the tumorous joint, providing a solution that ensures both oncological safety and functional preservation of the hip joint in these patients.

Methods: We conducted a retrospective study with a follow-up period of at least 36 months. From January 2010 to October 2020, we reviewed 20 cases of patients under 60 year of age with periacetabular invasive benign tumors or primary low-grade malignant tumors. All patients underwent reconstruction of the tumorous joint using autologous femoral head grafts. Data collected included patient age, gender, tumor type, preoperative and postoperative visual analog scale (VAS) scores, Musculoskeletal Tumor Society (MSTS) scores, Harris Hip Scores (HHS), patient survival rates, postoperative tumor recurrence, and surgical complications. To analyze the data, we utilized various statistical methods, including descriptive statistics to summarize patient demographics and clinical characteristics, and paired sample t-tests to compare preoperative and postoperative scores.

Results: The study included 20 patients, and a total median follow-up was 83 months. Their pathologic diagnoses comprised 13 giant cell tumors (GCTs), 5 chondrosarcomas, one chondroblastoma, and 1 leiomyosarcoma. Postoperatively, the median differences in vertical and horizontal center of rotation (COR) were 3.8 and 4.0 mm. Median limb length discrepancy (LLD) postoperatively was 5.7 mm (range, 2.3-17.8 mm). Two patients (10%) experienced delayed wound healing, resolved with antibiotics and early surgical debridement. One patient experienced dislocation 3 months postoperatively, which was promptly addressed under general anesthesia without further dislocation.

Conclusion: Through multiplanar osteotomy with limited margins, femoral head autograft, and uncemented total hip replacement for pelvic segmental bone defects in selected patients in type II or II + III appears to be an encouraging limb-sparing surgery worthy of consideration for carefully selected patients.

Objective: The risk factors for the degeneration of the patellofemoral joint (PFJ) have not been adequately and thoroughly studied. This study aimed to analyze the population distribution characteristics of patients with patellofemoral osteoarthritis (PFOA) and assess the correlation between PFOA and radiological parameters, including patella morphology, PFJ congruity, and patellar alignment. Moreover, the risk factors across various demographic groups were further analyzed.

Methods: A retrospective analysis was conducted to examine the population distribution characteristics of PFOA patients from September 2020 to September 2023. Radiological parameters of the PFJ were measured from the anteroposterior and lateral views of knee joint as well as axial view of patella using X-ray imaging and the PACS imaging system at the First Affiliated Hospital of Kunming Medical University. These parameters included patella morphology (patella type, width, thickness, and Wiberg index), PFJ congruity (patella height, Wiberg angle, sulcus angle, and lateral patella angle), and patellofemoral alignment (patella tilt angle, displacement, and lateral patellofemoral angle). PFOA severity was classified according to the Iwano PFJ radiological classification, and its correlation with the aforementioned parameters was examined. Additionally, risk factors for PFOA across different populations were further evaluated.

Results: The study included 1080 patients according to the inclusion and exclusion criteria. Age, female gender, overweight or obesity, and manual workers were significantly associated with PFOA. Moreover, type III patella (OR = 3.03, p < 0.05), greater patella width (OR = 1.12, p = 0.01), sulcus angle (OR = 1.04, p < 0.01), patella tilt angle (OR = 1.13, p < 0.01), and patella displacement (OR = 1.22, p < 0.01) as well as smaller patella thickness (OR = 0.87, p < 0.01), Insall-Salvati index (OR = 0.24, p = 0.04), and lateral patellofemoral angle (OR = 0.93, p = 0.02) were identified as risk factors for PFOA. Furthermore, greater patella thickness (OR = 1.17, p < 0.05) and smaller patella displacement (OR = 0.79, p < 0.01) correlated with higher Kujala patellofemoral scores. Discrepancies in risk factors across different populations were also observed.

Conclusions: Older age, female gender, obesity, manual workers, and specific aberrations in patellofemoral parameters are predictive factors for PFOA. Additionally, greater patella thickness and smaller patella displacement were associated with increased severity of clinical symptoms. Thus, more attention should be paid to the discrepancies that exist in different populations.

Objective: The gait analysis of patients after surgery for tumors around the knee joint relies on the use of a three-dimensional motion capture system. However, obtaining long-term, free-standing, real-world gait data with three-dimensional gait analysis is challenging. In this study, we utilized a portable gait analyzer to collect gait data from patients who underwent rotating hinge knee megaprosthesis (RHK) and total knee arthroplasty (TKA), this study aims to compare via gait analysis patients who underwent megaprosthesis with patients with TKA.

Methods: A retrospective study was conducted on eight patients with knee bone tumors (RHK group) and ten patients with knee osteoarthritis who underwent standard TKA (TKA group) from January 2018 to January 2022. Gait analysis, was conducted using the Intelligent Device for Energy Expenditure and Activity (IDEEA), and the results were compared with those of a healthy control group. The lower limb alignment of the RHK and TKA groups was evaluated, and the KSS scores of the two groups were collected and compared. Energy consumption during a 20-m walk was measured and compared among the RHK, TKA, and healthy control groups using one-way ANOVA. Paired t-tests were used to compare the operated and nonoperated limbs within groups.

Results: All patients exhibited slower walking speeds and cadence than the healthy control participants (p < 0.01), While no significant differences were found between the RHK and TKA groups. The single support time (521.15 ± 94.56 ms) of the RHK-operated limb was significantly shorter than that of the nonoperated limb (576.53 ± 77.40 ms, p = 0.004). The pulling acceleration of the RHK group (0.71 ± 0.27 G) was lower than that of the TKA group (1.04 ± 0.31 G, p = 0.029). The push-off angle in the RHK group (24.91° ± 10.91°) was significantly greater than that in the TKA group (10.64° ± 5.41°, p = 0.007). The RHK group showed significant differences between the operated and nonoperated limbs in terms of swing power, ground impact, footfall, and push-off. The RHK (0.03 ± 0.01 kcal/min/kg) and TKA (0.029 ± 0.01 kcal/min/kg) groups had significantly greater energy expenditures than did the healthy control group (0.02 ± 0.00 kcal/min/kg, p < 0.05). The comparison of HKA angles and KSS scores between the TKA and RHK groups showed statistically significant differences.

Conclusion: A portable gait analyzer appears to be suitable for evaluating the effects of RHK. RHK patients demonstrate more pronounced gait abnormalities than TKA patients, reflected in greater energy expenditure, implying reduced walking efficiency. This suggests the need for increased energy expenditure in RHK patients to compensate for abnormal knee joint conditions during walking and maintain body balance.

Objective: The long-term effectiveness of total hip arthroplasty (THA) largely depends on the accuracy of acetabular prosthesis placement. To improve the accuracy of acetabular prosthesis placement, we utilized a new surgical navigation system: visual treatment solution (VTS). The purpose of this study was to verify the efficacy and safety of this system in assisting THA.

Methods: This was a prospective, multicenter, randomized controlled trial. One hundred and twenty-four patients undergoing primary THAs were included. The experimental group underwent VTS-assisted THA, and the control group underwent traditional surgical techniques. The main efficacy evaluation indicators were the proportion of anteversion and inclination angles in the Lewinnek safe zone, and secondary evaluation indicators included operation time, Western Ontario and McMaster University Osteoarthritis index (WOMAC) score, Harris score, short-form-36 (SF-36) score, and hip dislocation rate. Statistical analysis was performed mainly by t-test and chi-square test.

Results: The proportion of both anteversion and inclination angles in the safe zone was 93.1% in the experimental group and 50.9% in the control group; the difference was significant (p < 0.01). The average operation time was 112.5 min in the experimental group and 92.6 min in the control group; the difference was significant (p < 0.01). There were no significant differences in WOMAC score, Harris score, or SF-36 score between the experimental and control groups at 3 months after the operation (p > 0.05). The dislocation rate was 0% in the experimental group and 1.6% in the control group; the difference was not significant (p > 0.05).

Conclusion: VTS-assisted THA can significantly improve the accuracy of acetabular prosthesis placement. However, there were no differences in short-term clinical outcomes or dislocation rates between the two groups.

Background: There is little research done on ground reaction forces (GRF) in terms of 3D impulses after total hip replacement (THR). This study aimed to investigate the GRFs and 3D impulses in four sub-phases of stance during gait in the patients undergoing THR.

Methods: A total of 10 pain-free THR patients and 10 healthy people were recruited. This is an observational and retrospective study. The gait data was collected between 2008 and 2014 and analyzed between 2020 and 2024. All the participants were included in the three-dimensional gait analysis. Gait parameters, phase durations, GRFs and impulses' key values during gait were calculated in four sub-phases of stance. Statistical comparisons were performed with generalized linear models including age, gender, body mass index and walking speed as interactive factors.

Results: It is found that (1) cadence, walking speed, stride length and step width in THR group were significantly decreased in compared with control group; (2) the THR decreased loading response duration in operative side and pre-swing duration in non-operative side compared with the control group, but the THR's two sides have similar duration proportions in sub-stance phases; (3) the THR group had lower GRFs than the control group in vertical direction but higher in the medial-lateral direction; (4) in operative side, the THR's impulses in loading response phase were lower than the control group in anterior-posterior direction, and (5) in non-operative side, the THR's impulse in pre-swing phase in anterior-posterior direction was higher than the control side.

Conclusion: The THR group showed slower walking speeds than the control group. The reasons could be from the decreased impulse in loading response phase, the decreased 2nd peak of GRF and the decreased pre-swing impulse in vertical direction in operative side. Clinicians are suggested to consider the information provided when designing relevant rehabilitation exercises on the related muscles and functions.

Objective: Despite being well-studied and widely utilized, the efficacy of cryotherapy after total knee arthroplasty (TKA) in enhancing early rehabilitation lacks consensus. The aim of this systematic review and meta-analysis was to investigate (1) whether cryotherapy is able to promote the rehabilitation of patients undergoing TKA and (2) whether continuous cold flow device has superior results than cold pack in cryotherapy.

Methods: A comprehensive trial searching was performed in the PubMed, Embase, Cochrane Library, and Google Scholar electronic databases in May, 2024. Randomized controlled trials (RCTs) comparing cryotherapy with no cryotherapy or comparing continuous cold flow device with cold pack after TKA were included. The primary outcome was visual analogue scale (VAS) of pain, and secondary outcomes included opioid consumption, blood loss (hemoglobin decrease and drainage), range of motion (ROM), swelling, length of stay (LOS), and adverse event.

Results: A total of 31 RCTs were included in this meta-analysis with 18 trials comparing cryotherapy with no cryotherapy and 13 trials comparing continuous cold flow device with cold pack. Pooled results showed cryotherapy group had significantly lower VAS scores than no cryotherapy group on postoperative day (POD) 1 (MD, -0.59 [95% CI, -1.14 to -0.04]; p = 0.04), POD 2 (MD, -0.84 [95% CI, -1.65 to -0.03]; p = 0.04), and POD 3 (MD, -0.86 [95% CI, -1.65 to -0.07]; p = 0.03). Cryotherapy group also showed reduced opioid consumption, reduced hemoglobin loss, decreased drainage, and improved ROM after TKA. Continuous cold flow device group had comparable VAS, opioid consumption, blood loss, ROM, knee swelling, and LOS with cold pack group.

Conclusion: Cryotherapy can effectively alleviate postoperative pain, reduce blood loss, improve ROM, and thus promote the postoperative rehabilitation for TKA patients, but the continuous cold flow device did not show better efficacy than cold packs. These findings support the routine use of cryotherapy for the rapid rehabilitation of TKA patients, and the traditional cold pack is still recommended.

Objectives: To describe a simplified classification scheme for endplate injury morphology based on 3D CT and to examine possible associations between endplate injury morphology and vertebral space and other variables such as type of fracture and disc degeneration in a group of patients with thoracolumbar fractures.

Methods: This study was a retrospective cohort study. We collected patients with thoracolumbar fractures admitted from January 2015 to August 2020 and divided them into three groups based on the morphology of endplate injury (45 cases of mild endplate injury, 54 cases of moderate endplate injury, and 42 cases of severe endplate injury, SEI). Data of vertebral body and intervertebral space height and angle, the Pfirrmann grade, endplate healing morphology were collected during preoperative, postoperative, and long-term follow-up of patients in each group. One-way analysis of variance (ANOVA), chi-squared test, and repeated measurement ANOVA were used to compare and analyze the influence of endplate injury morphology on patient prognosis.

Results: Most moderate injuries to the endplate (fissure-type injury) and severe injuries (irregular depression-type injury, Schmorl's node-type injury) resulted in significant disc degeneration in the long-term transition. This study also showed significant differences in the height of the anterior margin of the injured spine and the intervertebral space height index during this process.

Conclusions: The current study suggests that although the region of injury in endplate fissure-type injury is small preoperatively, it may be a major factor in leading to severe disc degeneration, loss of intervertebral height, and Cobb angle in the long term. The results of our study therefore may allow surgeons to predict the prognosis of patients with thoracolumbar fractures and guide their treatment.

Objectives: Intramedullary nailing is preferred for treating elderly proximal humeral fractures, but secondary reductions are common, particularly in elderly and osteoporotic patients. This occurs due to the intramedullary nail fixation's insufficient anti-varus and anti-rotational capacities and high stress at the bone-implant interface. We aim to enhance the anti-varus and anti-rotational stability of the fixation structure while reducing the stresses on the bone and internal fixation through structural design.

Materials and methods: We developed a novel endosteal anatomical support nail (EASN) that integrates an endosteal torus construct into the proximal portion of the angle-stable proximal humerus nail. The endosteal torus construct includes endosteal anatomical support (EAS) with a flat plane that allows direct fixation of the humeral head fragments and is shaped to conform to the medial side of the medullary cavity of the proximal humerus. We conducted finite element analysis to assess the biomechanical stability of four constructs: EAS with a calcar screw (CS), EAS without CS, non-EAS with CS, and non-EAS without CS. This analysis determined the contribution of the EAS to the mechanical stability of the proximal humerus in two-part PHF with medial column disruption. Specimens were subjected to loads simulating partial-weight-bearing (as in rising from a chair or using crutches) and full-weight-bearing (as in rising from bed). We evaluated the stiffness of the construct, displacement at the fracture site, von Mises stress, and stress distribution.

Results: Under compressive or rotational loads, the EAS construct, with or without CS, was significantly stiffer than the non-EAS construct. Displacement at the fracture site was significantly less with the EAS fixation than with the non-EAS fixation. However, the stiffness and displacement at the fracture site of the EAS fixation without CS were comparable to those of the non-EAS construct with CS. The EAS construct reduced the load on the nail and decreased the risk of implant failure. Both von Mises stress and stress distribution were significantly lower following fixation with the EAS constructs.

Conclusions: This study introduces a novel EAS concept to enhance the anti-varus and anti-rotational capabilities of the humeral head and distribute stress at the bone-implant interface in treating elderly PHFs. This strategy shows promise based on our limited analysis.

Purpose: The conjoined tendon-preserving posterior (CPP) approach is a modified posterior approach for total hip arthroplasty (THA) that preserves the short external rotator muscles and most ischiofemoral ligaments. The objective of the present study was to compare the short-term clinical outcomes, complications, and imaging evaluations of CPP and posterior approaches in THA.

Methods: This retrospective study included 83 patients from May 2018 to September 2021: 36 patients with 42 hips who underwent THA with the CPP approach (CPP group) and 47 patients with 60 hips who underwent THA with the standard posterior approach (PA group) with a minimum of 2 years of follow-up. Assessment tools included operative times, blood loss, preoperative and last follow-up Harris Hip Scores (HHS), postoperative complications, and implant placement angles between the groups. Statistical analysis was performed using chi-square tests and T-tests.

Results: The CPP approach had a significantly longer operative time and greater blood loss compared to the PA group. Preoperative and postoperative HHS were not significantly different between groups. Considering complications, the PA group had one case each of dislocation and infection, and the CPP group had two cases of sciatic nerve palsy, but the difference was not significant. Cup anteversion, inclination and stem anteversion were not significantly different between groups.

Conclusion: Functional outcomes, complication rates, and implant placement angles were comparable with the posterior approach, and the CPP approach has the potential to reduce postoperative dislocations. However, careful attention should be paid to sciatic nerve palsy during early initiation of the CPP approach, and this study did not demonstrate that the CPP approach was clearly superior to the posterior approach.