Orthopaedic Surgery最新文献

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.

Introduction: Elbow instability often arises from collateral ligament (LUCL) complex failure, causing varus and posterolateral rotatory subluxations. Conventional docking repair requires technical expertise balancing slack and tension. Existing suture anchors lack adjustable tensioning and rely on bone tunnel length for mechanical performance. A novel tensegrity-based suture anchor system was developed to enhance implant-bone fixation and optimize suture tensioning for early stability.

Methodology: Static three-point bending tests were conducted using Sawbones (n = 20) and paired cadaveric elbows (n = 14) with either conventional suture docking (CON) or elbow tensegrity screw (TEN). Force-displacement relationships were plotted. Stiffness, maximum force, and displacement at peak force were measured and compared using nonparametric Mann-Whitney U tests in GraphPad Prism 10.5.0.

Results: In foam elbows, TEN demonstrated significantly higher stiffness (3.46 ± 1.44 N/mm) than CON (1.44 ± 1.17 N/mm, p < 0.01). Maximum forces were 132.60 ± 28.82 N for TEN versus 75.02 ± 20.28 N for CON (p < 0.01), while displacement at peak force was slightly lower in TEN (35.54 ± 5.80 mm) versus CON (39.03 ± 9.05 mm, p = 0.22). In cadaveric elbows, TEN also had greater stiffness (12.79 ± 9.73 N/mm) versus CON (3.53 ± 2.43 N/mm, p < 0.05). Maximum forces were significantly greater for TEN (199.93 ± 35.89 N) compared to CON (140.11 ± 37.23 N, p < 0.05), while displacements at peak force were lower in TEN (22.31 ± 10.06 mm) than CON (38.68 ± 8.64 mm, p < 0.05). All CON samples failed from irreversible yielding and suture stretching, whereas most TEN samples failed due to suture rupture, suggesting superior bone-implant and suture-implant interface resistance.

Conclusion: TEN devices significantly improved mechanical strength and pretensioning over conventional docking, enhancing early stability and reducing yield failure risk.

Objectives: Obesity significantly influences the future of total knee arthroplasty (TKA). However, body mass index (BMI), the prevailing proxy for obesity, has limited predictive value for TKA outcomes, necessitating a more accurate obesity indicator. This study aimed to assess the utility of the fat-to-muscle ratio (FMR) in predicting postoperative outcomes related to obesity in patients undergoing TKA and compared its predictive value with that of BMI.

Methods: After excluding patients with secondary osteoarthritis, severe joint deformity, or neuromotor deficits, prospective data from 146 unilateral primary TKA patients were analyzed, including demographics, BMI, and systemic and leg-specific FMR. Primary outcomes included complications and 12-month patient-reported function (assessed using the University of California, Los Angeles [UCLA] activity scale and the Hospital for Special Surgery [HSS] score) and secondary outcomes including hospitalization length and surgery information were analyzed. Multivariable regression models were used to identify significant obesity-related predictors of outcomes, with linear regression employed for continuous outcomes (UCLA activity score, HSS score) and logistic regression for binary outcomes (complications).

Results: The mean BMI was 28.6 ± 4.4 kg/m², systemic FMR 0.70 ± 0.23, and leg-specific FMR 0.62 ± 0.19. Both systemic FMR (OR 1.094, p = 0.036) and BMI (OR 1.050, p = 0.015) predicted systemic complications, with FMR explaining more variance (partial R ² = 0.134 vs. 0.088). Likewise, systemic FMR (RR, 0.950, p = 0.045; partial R ² = 0.227) and leg-specific FMR (RR, 0.922, p = 0.033; partial R ² = 0.344) showed stronger associations with HSS functional score, than BMI (RR, 0.974, p = 0.037; partial R ² = 0.118). Only leg-specific FMR predicted wound complications (OR 1.063, p = 0.024; partial R ² = 0.262), and HSS pain scores (RR = 0.923, p = 0.025; partial R ² = 0.077). Neither FMR nor BMI was correlated with surgical duration, hospitalization, activity, or ULCA activity scores (p > 0.05).

Conclusions: In this single-center study, FMR demonstrated statistically stronger associations than BMI with both perioperative complications and 12-month functional outcomes following TKA. FMR assessment may provide incremental value for preoperative risk stratification and functional outcome prediction in elective TKA.

Objective: Dorsal articular collapse in distal radius fractures presents unique fixation challenges. While volar locking plating (VLP) dominates current practice, dorsal vertical double plating (DVDP) offers direct biomechanical support but carries perceived tendon risks. This study compares DVDP versus VLP for dorsally collapsed comminuted fractures.

Methods: A retrospective cohort of 106 patients (2022-2024) with AO type C2/C3 fractures received either VLP (n = 50) or DVDP (n = 56). General information encompassed gender, age, injured side, injury mechanism, AO classification, time from injury to surgery, operative time and complication profiles. Primary outcomes included 12-month radiographic parameters (volar tilt, ulnar inclination, and radial height), wrist range of motion (ROM), functional scores (DASH, Gartland-Werley), and complications. Continuous variables were compared using the Mann-Whitney U test. Categorical variables were analyzed with Pearson's χ ² test.

Results: The study cohort comprised 106 patients with dorsally collapsed distal radius fractures (VLP = 50, DVDP = 56). Baseline characteristics, including age (VLP median 59 years [IQR: 55-61.25] vs. DVDP 57 [53-61]), gender distribution (36% vs. 35.7% male), injury mechanism (72% vs. 71.4% falls), and AO classification (C3: 76% vs. 76.8%), showed no significant differences (all p > 0.05). At 12-month follow-up, all fractures achieved union with comparable radiographic outcomes: volar tilt (10° [8°-12°] vs. 10° [9°-12°]), ulnar inclination (22° [20°-23°] vs. 23° [22°-23°]), and radial height (11 mm [9-12] vs. 11 mm [10-12]) (all p > 0.05). Functional assessments revealed equivalent ranges of motion: dorsiflexion (69.5° [62°-76°] vs. 70° [68°-75°]), palmar flexion (68° [60°-70°] vs. 69.5° [66°-70°]), and rotation (pronation-supination: 80° [67.75°-65°]/71.5° [61.5°-81.25°] vs. 75.5° [70°-82°]/75° [68°-80°]). Patient-reported outcomes were similar: Gartland-Werley scores (5 [3-8] vs. 5 [3-7.75]) and DASH scores (12.5 [10-15.42] vs. 12.5 [12.5-15]) (all p > 0.05). Complication rates were comparable (VLP: 10% transient median neuropathy vs. DVDP: 12.5% tendon adhesions, p = 0.69), with all cases resolving conservatively within 3 months. Crucially, the DVDP group demonstrated zero tendon ruptures using tendon-sparing techniques.

Conclusion: DVDP demonstrates non-inferior functional and radiographic outcomes to VLP for dorsally collapsed fractures. With meticulous technique-including intercompartmental approaches and low-profile implants-DVDP eliminates historical tendon risks and serves as a viable surgical alternative.

Objective: Early readmission following total hip arthroplasty (THA) is not uncommon and impacts patient outcomes and healthcare costs. However, easily accessible biomarkers for early identification of high-risk patients remain limited. This study aims to evaluate the association between various blood component-derived ratios and 14-day readmission after THA.

Methods: Data from the Chang Gung Medical Research Database (CGRD) from 2014 to 2022 were retrospectively analyzed. Patients ≥ 20 years old who underwent primary THA by a single surgeon were included. The primary outcome was 14-day readmission. Five hematologic markers were evaluated: monocyte-to-albumin ratio (MAR), red cell distribution width (RDW)-to-albumin ratio (RAR), hemoglobin-to-albumin ratio (HAR), leukocyte-to-albumin ratio (LAR), and RDW-to-platelet ratio (RPR). Ratios were calculated from blood collected within 1 month before to 1 week after surgery. Receiver operating characteristic (ROC) Curve analysis was used to determine their optimal thresholds, and multivariable logistic regression assessed associations between these markers and readmission risk.

Results: A total of 307 patients were included in the analysis. Among the ratios evaluated, only high RPR (≥ 0.10; aOR = 5.92, 95% CI: 2.19-16.00, p = 0.001) was significantly associated with increased risk of 14-day readmission after adjustment in the multivariable analysis.

Conclusion: RPR is independently associated with 14-day readmission following THA in this exploratory study. As an easily obtainable marker, it may aid postoperative risk stratification, and the findings provide a foundation for future multicenter prospective investigations incorporating more granular perioperative factors and additional biomarkers before clinical application.

Objective: Osteoarthritis (OA) is a progressive joint disease characterized by cartilage degradation driven by matrix-degrading enzymes. Reproducible ex vivo models are essential for studying early degenerative processes and evaluating potential therapeutics. However, there remains a lack of accessible, cost-effective models that accurately replicate the biochemical environment and early-stage damage of OA. This study aimed to develop and validate a bovine cartilage explant model that replicates key features of early OA through enzymatic induction of tissue damage.

Methods: Bovine stifle cartilage explants were exposed to combinations of matrix metalloproteinases, aggrecanases, and cartilage biomarkers. Tissue damage was evaluated histologically, and semiquantitative scoring was used to assess structural changes. Statistical analyses were conducted to determine differences between treatment groups.

Results: Enzyme-treated samples exhibited significantly greater cartilage degradation compared to controls. The addition of cartilage oligomeric matrix protein (COMP) increased tissue damage, suggesting an active role in matrix destabilization. In contrast, the inclusion of TIMP-3, a known protease inhibitor, did not reduce degradation, raising questions about its protective efficacy in this context.

Conclusion: This chemically induced bovine model successfully simulates early cartilage degeneration consistent with OA pathology. Supported by recent literature on the roles of MMPs, ADAMTS-5, and COMP in joint disease, the model offers a valuable platform for future studies on OA mechanisms and therapeutic screening.