Pub Date : 2025-02-01Epub Date: 2024-12-11DOI: 10.1111/os.14316
Jiangtao Wang, Chunbao Li, Jiating Zhang, Mingyang An, Gang Zhao, Samuel D Stark, Yujie Liu
Objective: Rotator cuff retear after arthroscopy repair is a difficult complication that is often due to poor tendon-bone healing. Decellularized amniotic membrane (DAM) has a variety of bioactive substances which have great potential to enhance tendon-bone healing. However, DAM has three layers, of which the middle basement layer is dense and thick. Whether DAM will hinder tendon-bone healing of rotator cuff after surgical repair is unclear. Our study aims to investigate the effect of DAM on tendon-bone healing of the rotator cuff after surgical repair.
Methods: Thirty-three Sprague-Dawley (SD) rats were selected to establish unilateral supraspinatus (ST) tear models and were randomly treated with only suturing repair (OSR group, n = 11), and suturing repair with DAM placed between the ST and bone (DAM group, n = 11). In the normal control group (NCT group, n = 11), the supraspinatus was only exposed but not detached or repaired. After 4 weeks the rats were sacrificed. The assessment of specimens was conducted by micro-CT analysis, histopathological evaluation, and biomechanical testing.
Results: The DAM group had a significantly higher ultimate load to failure, new bone volume, and histological evaluation at 4 weeks after surgery than the OSR group. When comparing the DAM group to the NCT group, the DAM group performed slightly worse in biomechanical testing, micro-CT analysis, and histological evaluation.
Conclusion: When placed between tendon and bone at the rotator cuff footprint, DAM, despite its dense and thick basement layer, does not impede tendon-bone healing after surgical repair for rotator cuff injury, but rather promotes increased healing quality and biomechanical properties. However, the healing quality and biomechanical properties are still lower than that of the normal rotator cuff, and further improvement should be made to the application strategy of a DAM.
{"title":"Effect of Decellularized Amniotic Membrane on the Tendon-Bone Integration in Rotator Cuff Repair: A Comparative Rat Model Study.","authors":"Jiangtao Wang, Chunbao Li, Jiating Zhang, Mingyang An, Gang Zhao, Samuel D Stark, Yujie Liu","doi":"10.1111/os.14316","DOIUrl":"10.1111/os.14316","url":null,"abstract":"<p><strong>Objective: </strong>Rotator cuff retear after arthroscopy repair is a difficult complication that is often due to poor tendon-bone healing. Decellularized amniotic membrane (DAM) has a variety of bioactive substances which have great potential to enhance tendon-bone healing. However, DAM has three layers, of which the middle basement layer is dense and thick. Whether DAM will hinder tendon-bone healing of rotator cuff after surgical repair is unclear. Our study aims to investigate the effect of DAM on tendon-bone healing of the rotator cuff after surgical repair.</p><p><strong>Methods: </strong>Thirty-three Sprague-Dawley (SD) rats were selected to establish unilateral supraspinatus (ST) tear models and were randomly treated with only suturing repair (OSR group, n = 11), and suturing repair with DAM placed between the ST and bone (DAM group, n = 11). In the normal control group (NCT group, n = 11), the supraspinatus was only exposed but not detached or repaired. After 4 weeks the rats were sacrificed. The assessment of specimens was conducted by micro-CT analysis, histopathological evaluation, and biomechanical testing.</p><p><strong>Results: </strong>The DAM group had a significantly higher ultimate load to failure, new bone volume, and histological evaluation at 4 weeks after surgery than the OSR group. When comparing the DAM group to the NCT group, the DAM group performed slightly worse in biomechanical testing, micro-CT analysis, and histological evaluation.</p><p><strong>Conclusion: </strong>When placed between tendon and bone at the rotator cuff footprint, DAM, despite its dense and thick basement layer, does not impede tendon-bone healing after surgical repair for rotator cuff injury, but rather promotes increased healing quality and biomechanical properties. However, the healing quality and biomechanical properties are still lower than that of the normal rotator cuff, and further improvement should be made to the application strategy of a DAM.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"575-582"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-12-26DOI: 10.1111/os.14339
Mohanad Samaheen, Maen Mohammad, Mikhail Salzmann, Nikolai Ramadanov
Objective: Femoral neck fractures in the elderly are a global health issue, with the choice between cemented and uncemented hemiarthroplasty remaining a topic of debate. This systematic review and meta-analysis aims to compare the effects of the two surgical options on health-related quality of life (HRQoL), mortality, and functional outcomes.
Methods: We searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) comparing cemented with uncemented hemiarthroplasty in patients aged 50 years and older with femoral neck fractures. The primary outcome of interest was HRQoL as measured by the European Quality of Life 5-Dimension Questionnaire (EQ-5D) score. Secondary outcomes included mortality, surgical, general, and local complications.
Results: We included 20 RCTs with a total of 3680 patients with femoral neck fractures, of whom 1871 (50.5%) underwent cemented and 1809 (49.5%) uncemented hemiarthroplasty. The follow-up ranged from 1 to 6 years. The early (after 3-4 months) EQ-5D utility score (MD 0.07; 95% CI 0.03-0.12; p = 0.003; I 2 = 22%) and the 12-month EQ-5D utility score (MD 0.08; 95% CI 0.00-0.16; p = 0.04; I 2 = 67%) suggested an improved HRQoL in the cemented hemiarthroplasty group. The outcomes of 1-year mortality, requirement for additional surgeries, surgery duration, risk of pulmonary embolism, pressure sores or ulcers, intraoperative fractures, and periprosthetic or postoperative fractures demonstrated significant differences between the two groups.
Conclusions: The use of cemented hemiarthroplasty in patients with femoral neck fractures presented better results when compared to uncemented hemiarthroplasty in terms of HRQoL during the first year after surgery and greater mortality reduction at 1 year follow-up and reduced the need for further surgery. Therefore, the use of cemented hemiarthroplasty may be preferred for the treatment of femoral neck fractures in elderly patients.
目的:老年人股骨颈骨折是一个全球性的健康问题,选择骨水泥和非骨水泥半关节置换术仍然是一个有争议的话题。本系统综述和荟萃分析旨在比较两种手术选择对健康相关生活质量(HRQoL)、死亡率和功能结局的影响。方法:我们检索PubMed、Embase和Cochrane数据库,比较50岁及以上股骨颈骨折患者骨水泥与非骨水泥半关节置换术的随机对照试验(rct)。主要观察指标为HRQoL,由欧洲生活质量5维问卷(EQ-5D)评分衡量。次要结局包括死亡率、手术、一般和局部并发症。结果:我们纳入了20项随机对照试验,共纳入3680例股骨颈骨折患者,其中1871例(50.5%)行骨水泥半关节置换术,1809例(49.5%)行非骨水泥半关节置换术。随访时间为1 - 6年。早期(3-4个月后)EQ-5D效用评分(MD 0.07;95% ci 0.03-0.12;p = 0.003;I2 = 22%)和12个月EQ-5D效用评分(MD 0.08;95% ci 0.00-0.16;p = 0.04;I2 = 67%)表明骨水泥半关节置换术组HRQoL有所改善。两组1年死亡率、额外手术需求、手术持续时间、肺栓塞、压疮或溃疡、术中骨折、假体周围或术后骨折的风险均有显著差异。结论:股骨颈骨折患者采用骨水泥半关节置换术后第一年的HRQoL优于非骨水泥半关节置换术,随访1年死亡率降低幅度更大,减少了进一步手术的需要。因此,骨水泥半关节置换术可能是治疗老年股骨颈骨折的首选方法。
{"title":"The Health-Related Quality of Life for Cemented Versus Uncemented Hemiarthroplasty in Elderly Patients With Femoral Neck Fractures: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Mohanad Samaheen, Maen Mohammad, Mikhail Salzmann, Nikolai Ramadanov","doi":"10.1111/os.14339","DOIUrl":"10.1111/os.14339","url":null,"abstract":"<p><strong>Objective: </strong>Femoral neck fractures in the elderly are a global health issue, with the choice between cemented and uncemented hemiarthroplasty remaining a topic of debate. This systematic review and meta-analysis aims to compare the effects of the two surgical options on health-related quality of life (HRQoL), mortality, and functional outcomes.</p><p><strong>Methods: </strong>We searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) comparing cemented with uncemented hemiarthroplasty in patients aged 50 years and older with femoral neck fractures. The primary outcome of interest was HRQoL as measured by the European Quality of Life 5-Dimension Questionnaire (EQ-5D) score. Secondary outcomes included mortality, surgical, general, and local complications.</p><p><strong>Results: </strong>We included 20 RCTs with a total of 3680 patients with femoral neck fractures, of whom 1871 (50.5%) underwent cemented and 1809 (49.5%) uncemented hemiarthroplasty. The follow-up ranged from 1 to 6 years. The early (after 3-4 months) EQ-5D utility score (MD 0.07; 95% CI 0.03-0.12; p = 0.003; I <sup>2</sup> = 22%) and the 12-month EQ-5D utility score (MD 0.08; 95% CI 0.00-0.16; p = 0.04; I <sup>2</sup> = 67%) suggested an improved HRQoL in the cemented hemiarthroplasty group. The outcomes of 1-year mortality, requirement for additional surgeries, surgery duration, risk of pulmonary embolism, pressure sores or ulcers, intraoperative fractures, and periprosthetic or postoperative fractures demonstrated significant differences between the two groups.</p><p><strong>Conclusions: </strong>The use of cemented hemiarthroplasty in patients with femoral neck fractures presented better results when compared to uncemented hemiarthroplasty in terms of HRQoL during the first year after surgery and greater mortality reduction at 1 year follow-up and reduced the need for further surgery. Therefore, the use of cemented hemiarthroplasty may be preferred for the treatment of femoral neck fractures in elderly patients.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"361-372"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142896534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-12-12DOI: 10.1111/os.14318
Kai Zheng, Xiu-Chun Yu, Jinfang Cai, Ming Xu, Haocheng Cui, Qian Chen, Jing-Yu Zhang
Objective: Ilizarov technology is highly effective in addressing complex orthopedic challenges. This study aims to describe our experience with distraction osteogenesis in managing bone tumors in the lower extremity, focusing on composite bone defects and associated complications.
Methods: A retrospective clinical study was conducted to analyze patients with primary bone tumors who underwent distraction osteogenesis using the Ilizarov method from 2010 to 2020. Some young children received epiphyseal distraction and bone transport as part of their sarcoma surgical treatment. Additionally, external fixation, bone transport, or limb lengthening were employed to address complex postoperative complications associated with bone tumors. The clinical outcomes assessed included the patient's general information, the location of bone defects, the length of bone repair, the status of bone healing, and limb function.
Results: Eleven patients were followed up for an average of 66 months (range, 24-132 months). The average length of repaired bone defects was 13 cm (range, 2.5-32 cm). The cohort comprised three females and eight males, with ages at presentation ranging from 6 to 42 years (mean, 18 years). The sites of involvement included the distal femur (n = 4), femoral diaphysis (n = 3), proximal tibia (n = 2), and the distal tibia (n = 2). Nine patients were diagnosed with osteosarcoma, while one presented with Ewing's sarcoma and another with a giant cell tumor of bone. Three young children were successfully treated with epiphyseal stretching; however, one patient experienced treatment failure. Additionally, seven patients underwent external fixation to address complex postoperative complications, including infection, bone defects, and limb shortening. At the last follow-up, with the exception of one failure, the average Musculoskeletal Tumor Society (MSTS) limb function scores for the remaining 10 patients were 25 (range, 21-30). Three months post-fixator removal, the Asociación Latinoamericana de Oncología (ASAMI) bone score was rated as excellent in 63.6% (7/11) of patients, whereas the ASAMI function score was excellent in 36.4% (4/11) and good in 54.5% (6/11) of cases.
Conclusion: The Ilizarov method demonstrates some clinical value in the resection and reconstruction of bone tumors, as well as in the management of postoperative complications associated with such tumors.
{"title":"Management of Bone Defects and Complications After Bone Tumor Resection Using Ilizarov Method.","authors":"Kai Zheng, Xiu-Chun Yu, Jinfang Cai, Ming Xu, Haocheng Cui, Qian Chen, Jing-Yu Zhang","doi":"10.1111/os.14318","DOIUrl":"10.1111/os.14318","url":null,"abstract":"<p><strong>Objective: </strong>Ilizarov technology is highly effective in addressing complex orthopedic challenges. This study aims to describe our experience with distraction osteogenesis in managing bone tumors in the lower extremity, focusing on composite bone defects and associated complications.</p><p><strong>Methods: </strong>A retrospective clinical study was conducted to analyze patients with primary bone tumors who underwent distraction osteogenesis using the Ilizarov method from 2010 to 2020. Some young children received epiphyseal distraction and bone transport as part of their sarcoma surgical treatment. Additionally, external fixation, bone transport, or limb lengthening were employed to address complex postoperative complications associated with bone tumors. The clinical outcomes assessed included the patient's general information, the location of bone defects, the length of bone repair, the status of bone healing, and limb function.</p><p><strong>Results: </strong>Eleven patients were followed up for an average of 66 months (range, 24-132 months). The average length of repaired bone defects was 13 cm (range, 2.5-32 cm). The cohort comprised three females and eight males, with ages at presentation ranging from 6 to 42 years (mean, 18 years). The sites of involvement included the distal femur (n = 4), femoral diaphysis (n = 3), proximal tibia (n = 2), and the distal tibia (n = 2). Nine patients were diagnosed with osteosarcoma, while one presented with Ewing's sarcoma and another with a giant cell tumor of bone. Three young children were successfully treated with epiphyseal stretching; however, one patient experienced treatment failure. Additionally, seven patients underwent external fixation to address complex postoperative complications, including infection, bone defects, and limb shortening. At the last follow-up, with the exception of one failure, the average Musculoskeletal Tumor Society (MSTS) limb function scores for the remaining 10 patients were 25 (range, 21-30). Three months post-fixator removal, the Asociación Latinoamericana de Oncología (ASAMI) bone score was rated as excellent in 63.6% (7/11) of patients, whereas the ASAMI function score was excellent in 36.4% (4/11) and good in 54.5% (6/11) of cases.</p><p><strong>Conclusion: </strong>The Ilizarov method demonstrates some clinical value in the resection and reconstruction of bone tumors, as well as in the management of postoperative complications associated with such tumors.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"492-499"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2025-01-15DOI: 10.1111/os.14295
Yichao Ma, Jiangpeng Wu, Yanlong Dong, Hongmei Tang, Xiaojun Ma
Objective: The pedicle screw insertion technique has evolved significantly, and despite the challenges of precise placement, advancements like AR-based surgical navigation systems now offer enhanced accuracy and safety in spinal surgery by integrating real-time, high-resolution imaging with virtual models to aid surgeons. This study aims to evaluate the differences in accuracy between novel AR-guided pedicle screw insertion and conventional surgery techniques.
Methods: A randomized controlled trial was conducted from March 2019 to December 2023 to compare the efficacy of AR-guided pedicle screw fixation with conventional freehand surgery using CT guidance. The study included 150 patients, aged 18-75, with 75 patients in each group. The total number of pedicle screws planned for the clinical trial placement was 351 and 348 in the experimental and control groups. The safety and efficacy of the procedures were evaluated by assessing screw placement accuracy and complication rates.
Results: In the full analysis set (FAS) analysis, the difference in the excellent and good rates of screw placement (experimental group - control group) and 95% confidence interval was 6.3% [3.0%-9.8%], with a p value of 0.0003 for the superiority test. In the FAS sensitivity analysis, the success rate was 98.0% (344 out of 351) in the experimental group and 91.7% (319 out of 348) in the control group, with a difference and 95% confidence interval of 6.3% [2.9% and 9.8%, respectively]. In the per-protocol set (PPS) analysis, the difference in the excellent and good rates of screw placement between the experimental and control groups, and the 95% confidence interval was 6.4% [3.3%-9.5%], with a p value of 0.0001 for the superiority test. In the actual treatment set (ATS) analysis, the excellent and good rates of screw placement were 99.1% in the experimental group and 91.7% in the control group. The difference in the excellent and good rates of screw placement (experimental group - control group) and 95% confidence interval was 7.3% [4.1%-10.6%], with a p value of < 0.0001 for the superiority test.
Conclusions: The AR surgical navigation system can improve the accuracy of pedicle screw implantation and provide precise guidance for surgeons during pedicle screw insertion.
{"title":"Augmented Reality Navigation System Enhances the Accuracy of Spinal Surgery Pedicle Screw Placement: A Randomized, Multicenter, Parallel-Controlled Clinical Trial.","authors":"Yichao Ma, Jiangpeng Wu, Yanlong Dong, Hongmei Tang, Xiaojun Ma","doi":"10.1111/os.14295","DOIUrl":"10.1111/os.14295","url":null,"abstract":"<p><strong>Objective: </strong>The pedicle screw insertion technique has evolved significantly, and despite the challenges of precise placement, advancements like AR-based surgical navigation systems now offer enhanced accuracy and safety in spinal surgery by integrating real-time, high-resolution imaging with virtual models to aid surgeons. This study aims to evaluate the differences in accuracy between novel AR-guided pedicle screw insertion and conventional surgery techniques.</p><p><strong>Methods: </strong>A randomized controlled trial was conducted from March 2019 to December 2023 to compare the efficacy of AR-guided pedicle screw fixation with conventional freehand surgery using CT guidance. The study included 150 patients, aged 18-75, with 75 patients in each group. The total number of pedicle screws planned for the clinical trial placement was 351 and 348 in the experimental and control groups. The safety and efficacy of the procedures were evaluated by assessing screw placement accuracy and complication rates.</p><p><strong>Results: </strong>In the full analysis set (FAS) analysis, the difference in the excellent and good rates of screw placement (experimental group - control group) and 95% confidence interval was 6.3% [3.0%-9.8%], with a p value of 0.0003 for the superiority test. In the FAS sensitivity analysis, the success rate was 98.0% (344 out of 351) in the experimental group and 91.7% (319 out of 348) in the control group, with a difference and 95% confidence interval of 6.3% [2.9% and 9.8%, respectively]. In the per-protocol set (PPS) analysis, the difference in the excellent and good rates of screw placement between the experimental and control groups, and the 95% confidence interval was 6.4% [3.3%-9.5%], with a p value of 0.0001 for the superiority test. In the actual treatment set (ATS) analysis, the excellent and good rates of screw placement were 99.1% in the experimental group and 91.7% in the control group. The difference in the excellent and good rates of screw placement (experimental group - control group) and 95% confidence interval was 7.3% [4.1%-10.6%], with a p value of < 0.0001 for the superiority test.</p><p><strong>Conclusions: </strong>The AR surgical navigation system can improve the accuracy of pedicle screw implantation and provide precise guidance for surgeons during pedicle screw insertion.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"631-643"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2025-01-05DOI: 10.1111/os.14346
Qian Liu, Jianhua Ren, Wenhui Zhang, Tangzhao Liang, Zhe Wang, Siwei Xie, Yuhang Li, Jianfeng Hou, Kun Wang, Ronghan He
Objective: Gap balancing is a vital process during mobile-bearing unicompartmental knee arthroplasty (MB-UKA). However, this process commonly depends on the surgeon's experience and lacks specific unified standards. This study aimed to propose and evaluate a novel "measured resection" method for gap balance in MB-UKA.
Methods: This prospective study included 49 consecutive patients (52 knees) who underwent MB-UKA from February 1, 2023, to September 1, 2023. Gap balance was achieved by the traditional "two-finger" method (Group 1, 26 knees) or the measured resection method (Group 2, 26 knees). The novel "measured resection" method was performed by measuring the thickness of the resected posterior femoral condyle and resected medial posterior tibial plateau to assess proper meniscal bearing thickness. Data were collected at baseline and the 6-month follow-up. Prosthetic angles, range of motion (ROM), visual analog scale (VAS) score, Oxford knee score (OKS), and Global Perceived Scale (GPE) were used to evaluate clinical outcomes. Independent samples t-test and Mann-Whitney U test were used to compare the differences.
Results: There were significant improvements in all measured outcomes at the 6-month follow-up from baseline in both groups (p < 0.01). Patients using measured resection method showed better ROM (130° vs. 120°, p = 0.007), VAS score (1 vs. 2, p = 0.013), and OKS scores (39.9 vs. 38.1, p = 0.013) at 6-month follow-up than the traditional "two-finger" method group. The prosthetic angles, ROM improvement, and GPE showed no significant difference between the groups (p > 0.05).
Conclusions: The measured resection method is a reliable method for assisting surgeons in choosing the ideal meniscal bearing thickness in MB-UKA to achieve proper gap balance and gain better clinical outcomes.
{"title":"Measured Resection as Gap Balance Method in Mobile-Bearing Medial Unicompartmental Knee Arthroplasty: A Randomized Controlled Trial.","authors":"Qian Liu, Jianhua Ren, Wenhui Zhang, Tangzhao Liang, Zhe Wang, Siwei Xie, Yuhang Li, Jianfeng Hou, Kun Wang, Ronghan He","doi":"10.1111/os.14346","DOIUrl":"10.1111/os.14346","url":null,"abstract":"<p><strong>Objective: </strong>Gap balancing is a vital process during mobile-bearing unicompartmental knee arthroplasty (MB-UKA). However, this process commonly depends on the surgeon's experience and lacks specific unified standards. This study aimed to propose and evaluate a novel \"measured resection\" method for gap balance in MB-UKA.</p><p><strong>Methods: </strong>This prospective study included 49 consecutive patients (52 knees) who underwent MB-UKA from February 1, 2023, to September 1, 2023. Gap balance was achieved by the traditional \"two-finger\" method (Group 1, 26 knees) or the measured resection method (Group 2, 26 knees). The novel \"measured resection\" method was performed by measuring the thickness of the resected posterior femoral condyle and resected medial posterior tibial plateau to assess proper meniscal bearing thickness. Data were collected at baseline and the 6-month follow-up. Prosthetic angles, range of motion (ROM), visual analog scale (VAS) score, Oxford knee score (OKS), and Global Perceived Scale (GPE) were used to evaluate clinical outcomes. Independent samples t-test and Mann-Whitney U test were used to compare the differences.</p><p><strong>Results: </strong>There were significant improvements in all measured outcomes at the 6-month follow-up from baseline in both groups (p < 0.01). Patients using measured resection method showed better ROM (130° vs. 120°, p = 0.007), VAS score (1 vs. 2, p = 0.013), and OKS scores (39.9 vs. 38.1, p = 0.013) at 6-month follow-up than the traditional \"two-finger\" method group. The prosthetic angles, ROM improvement, and GPE showed no significant difference between the groups (p > 0.05).</p><p><strong>Conclusions: </strong>The measured resection method is a reliable method for assisting surgeons in choosing the ideal meniscal bearing thickness in MB-UKA to achieve proper gap balance and gain better clinical outcomes.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov (NCT03815448).</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"603-613"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
目的:髓内钉是治疗老年肱骨近端骨折的首选方法,但二次复位很常见,尤其是在老年和骨质疏松患者中。出现这种情况的原因是髓内钉固定的抗旋转能力不足,以及骨-植入物界面的应力过高。我们的目标是通过结构设计提高固定结构的抗旋转稳定性,同时降低骨和内固定的应力:我们开发了一种新型骨内膜解剖支撑钉(EASN),它将骨内膜环形结构整合到角度稳定的肱骨近端钉的近端部分。骨内环形结构包括骨内解剖支撑(EAS),其平面可直接固定肱骨头碎片,其形状与肱骨近端髓腔的内侧相吻合。我们进行了有限元分析,以评估四种结构的生物力学稳定性:EAS 带有胫骨螺钉 (CS)、EAS 不带 CS、非 EAS 带有 CS 和非 EAS 不带 CS。该分析确定了在内侧柱破坏的两部分 PHF 中,EAS 对肱骨近端机械稳定性的贡献。试样承受了模拟部分负重(如从椅子上站起来或使用拐杖)和完全负重(如从床上站起来)的载荷。我们评估了结构的刚度、骨折部位的位移、冯-米塞斯应力和应力分布:结果:在压缩或旋转负荷下,EAS结构(无论有无CS)的刚度明显高于非EAS结构。采用 EAS 固定结构时,骨折部位的位移明显小于非 EAS 固定结构。然而,无CS的EAS固定结构与有CS的非EAS固定结构在骨折部位的硬度和位移量相当。EAS 结构减轻了钉子的负荷,降低了植入失败的风险。使用EAS结构固定后,冯米斯应力和应力分布都明显降低:本研究提出了一种新颖的 EAS 概念,以增强肱骨头的抗旋转能力,并在治疗老年 PHF 时分散骨与植入物界面的应力。根据我们有限的分析,这一策略前景广阔。
{"title":"Enhanced Biomechanical Stability in Proximal Humeral Fractures: Finite Element Analysis of a Novel Endosteal Anatomical Support Nail for Improved Fixation in Elderly Patients.","authors":"Jiawen Chen, Zhonghe Wang, Changda Li, Peiyu He, Zhongxuan Chen, Lijun Sun, Xiaoyan Cao, Na Tian, Xiang Dong, Peifu Tang, Hua Chen","doi":"10.1111/os.14297","DOIUrl":"10.1111/os.14297","url":null,"abstract":"<p><strong>Objectives: </strong>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.</p><p><strong>Materials and methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"551-562"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142731522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-12-05DOI: 10.1111/os.14308
Lei Li, Chao Wang, Hao Zhang, Zhiming Liu, Zheng Lian, Han Li, Hao Tao, Xuexiao Ma
Objectives: Lumbar disc herniation (LDH) is a common degenerative spinal disease in clinical practice. This study aims to investigate the impact of Modic changes (MCs) on postoperative recovery and disease recurrence following percutaneous endoscopic lumbar disc discectomy (PELD), providing important insights for improving the management of chronic low back pain. This study investigates the 1-year progression rate of MCs after PELD and their impact on surgical outcomes and recurrence.
Methods: This retrospective cohort study analyzed data from 419 patients with single-segment lumbar disc herniation who underwent PELD between January 2019 and December 2022. Lumbar MRI assessed preoperative and postoperative MCs. Pain levels and surgical outcomes were evaluated using the visual analog scale, Oswestry Disability Index, and Macnab criteria. Univariate analysis explored the relationship between postoperative MCs and pain, while subgroups investigated the associations between postoperative efficacy, recurrence, and MCs type and area.
Results: One-year follow-up revealed that the probability of MCs postsurgery was 24.8%. Patients with postoperative MCs had significantly lower pain scores compared with the control group (p < 0.05). Univariate analysis indicated that the type and area of postoperative MCs were risk factors for poor outcomes in PELD patients (p < 0.05). During the 1-year follow-up, recurrence rates in the no-MCs and MCs groups were 3.8% and 9.6%, respectively (p < 0.05). Univariate analysis concluded that the area of postoperative MCs was a risk factor for PELD recurrence.
Conclusion: The postoperative MCs, as a risk factor, may have a detrimental effect on the surgical efficacy and short-term recurrence of LDH following PELD based on a large sample. Furthermore, the harmful effect is affected by the area and type of the postoperative MCs.
{"title":"New-Occurrence of Postoperative Modic Changes and Its Influence on the Surgical Prognosis After Percutaneous Endoscopic Lumbar Disc Discectomy.","authors":"Lei Li, Chao Wang, Hao Zhang, Zhiming Liu, Zheng Lian, Han Li, Hao Tao, Xuexiao Ma","doi":"10.1111/os.14308","DOIUrl":"10.1111/os.14308","url":null,"abstract":"<p><strong>Objectives: </strong>Lumbar disc herniation (LDH) is a common degenerative spinal disease in clinical practice. This study aims to investigate the impact of Modic changes (MCs) on postoperative recovery and disease recurrence following percutaneous endoscopic lumbar disc discectomy (PELD), providing important insights for improving the management of chronic low back pain. This study investigates the 1-year progression rate of MCs after PELD and their impact on surgical outcomes and recurrence.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed data from 419 patients with single-segment lumbar disc herniation who underwent PELD between January 2019 and December 2022. Lumbar MRI assessed preoperative and postoperative MCs. Pain levels and surgical outcomes were evaluated using the visual analog scale, Oswestry Disability Index, and Macnab criteria. Univariate analysis explored the relationship between postoperative MCs and pain, while subgroups investigated the associations between postoperative efficacy, recurrence, and MCs type and area.</p><p><strong>Results: </strong>One-year follow-up revealed that the probability of MCs postsurgery was 24.8%. Patients with postoperative MCs had significantly lower pain scores compared with the control group (p < 0.05). Univariate analysis indicated that the type and area of postoperative MCs were risk factors for poor outcomes in PELD patients (p < 0.05). During the 1-year follow-up, recurrence rates in the no-MCs and MCs groups were 3.8% and 9.6%, respectively (p < 0.05). Univariate analysis concluded that the area of postoperative MCs was a risk factor for PELD recurrence.</p><p><strong>Conclusion: </strong>The postoperative MCs, as a risk factor, may have a detrimental effect on the surgical efficacy and short-term recurrence of LDH following PELD based on a large sample. Furthermore, the harmful effect is affected by the area and type of the postoperative MCs.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"482-491"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: The biomechanical mechanism of brace intervention on bone, muscle, and disc should be comprehensively considered for AIS patients. We aimed to developmentally construct a musculoskeletal finite element model of adolescent idiopathic scoliosis to simulate the coupling of corrective forces and analyze the mechanical properties of bone, muscle, and disc. Investigateing, more effective clinical interventions to break the vicious cycle of patients during growth.
Methods: A finite element model, including muscle, bone, and disc, was established using computed tomography data of a patient with RigoA3 adolescent idiopathic scoliosis. The three-point force coupling, antigravity, and bending effects of the Chêneau brace were simulated, and the correction force of the secondary lumbar bend was gradually reduced while observing the mechanical characteristics of bone, muscle, and disc. The correction force in line with symmetrical spine growth was comprehensively evaluated.
Results: The correction rate of the main thoracic (MT) curve, the intervertebral space height on the concave side of the vertebrae at the apex, and the stress ratio of the intervertebral discs were optimal when the maximum corrective pressure threshold was reached. However, the proximal thoracic (PT) curve was aggravated and the axial forces on the concave side were unbalanced. At this time, the biomechanical performance of the model is also not optimal. The correction rate of the Cobb Angle of the MT curve decreased with the decrease of the correction pressure in the lumbar region. When reduced to 25% of the maximum threshold, the convex side of disc stress, intervertebral space, and muscle axial force is more in line with the biomechanical mechanism of correction and can avoid sacrificing the PT curve.
Conclusions: Downward adjustment of the corrective force to the secondary lumbar curve, using the Chêneau brace, results in better primary thoracic curvature mechanics in the musculoskeletal finite element model, suggesting that breaking the vicious cycle of scoliosis progression to guide benign spinal growth is beneficial.
{"title":"Reducing the Brace Correction Stress on the Secondary Lumbar Curve Results in Excellent Muscle, Bone, and Disc Mechanical Performance: A Musculoskeletal Finite Element Simulation of AIS Patient With Rigo A3.","authors":"Xiaohui Zhang, Di Wang, Danyu Lv, Jinmiao Lv, Huiyi Tang, Jinlin Qian, Bagen Liao","doi":"10.1111/os.14296","DOIUrl":"10.1111/os.14296","url":null,"abstract":"<p><strong>Objectives: </strong>The biomechanical mechanism of brace intervention on bone, muscle, and disc should be comprehensively considered for AIS patients. We aimed to developmentally construct a musculoskeletal finite element model of adolescent idiopathic scoliosis to simulate the coupling of corrective forces and analyze the mechanical properties of bone, muscle, and disc. Investigateing, more effective clinical interventions to break the vicious cycle of patients during growth.</p><p><strong>Methods: </strong>A finite element model, including muscle, bone, and disc, was established using computed tomography data of a patient with RigoA3 adolescent idiopathic scoliosis. The three-point force coupling, antigravity, and bending effects of the Chêneau brace were simulated, and the correction force of the secondary lumbar bend was gradually reduced while observing the mechanical characteristics of bone, muscle, and disc. The correction force in line with symmetrical spine growth was comprehensively evaluated.</p><p><strong>Results: </strong>The correction rate of the main thoracic (MT) curve, the intervertebral space height on the concave side of the vertebrae at the apex, and the stress ratio of the intervertebral discs were optimal when the maximum corrective pressure threshold was reached. However, the proximal thoracic (PT) curve was aggravated and the axial forces on the concave side were unbalanced. At this time, the biomechanical performance of the model is also not optimal. The correction rate of the Cobb Angle of the MT curve decreased with the decrease of the correction pressure in the lumbar region. When reduced to 25% of the maximum threshold, the convex side of disc stress, intervertebral space, and muscle axial force is more in line with the biomechanical mechanism of correction and can avoid sacrificing the PT curve.</p><p><strong>Conclusions: </strong>Downward adjustment of the corrective force to the secondary lumbar curve, using the Chêneau brace, results in better primary thoracic curvature mechanics in the musculoskeletal finite element model, suggesting that breaking the vicious cycle of scoliosis progression to guide benign spinal growth is beneficial.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"525-539"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142625203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2025-01-08DOI: 10.1111/os.14332
Zhaokai Jin, Yi Tang, Hua Huang, Lei Chen, Zhongyi Zhang, Tianyou Ma, Zhengming Wang, Hai Su, Haojing Zhou, Shuaijie Lv, Peijian Tong
Objective: The rehabilitation methods after total knee arthroplasty (TKA) can affect the recovery of complications and joint function, and the selection and comparison of rehabilitation methods after TKA still need further research.
Methods: A comprehensive search of five databases and two clinical trial registration platforms was conducted from inception through March 31, 2024, and conducted to identify eligible randomized controlled trials (RCTs). We extracted the required data according to the Cochrane Handbook for Systematic Reviews of Interventions. Finally, 32 trials involving 2292 patients were included, the mean age of the enrolled patients was ~69.10 years, the sex ratio of males was (31.6%), and the longest follow-up time was 2 years. And we have summarized nine rehabilitation intervention measures: conventional physical therapy (CPT), cryotherapy, thermal therapy (TT), acupuncture, hydrotherapy, neuromuscular training (NT), electrotherapy, continuous passive motion (CPM), continuous active motion (CAM). And use the range of motion (ROM), visual analog scale (VAS), Western Ontario and McMaster Universities osteoarthritis index (WOMAC) as the outcome measure to evaluate the effectiveness of various interventions. A Bayesian network meta-analysis (NMA) was carried out for calculating standardized mean difference (SMD) and the surface under cumulative ranking curve (SUCRA) of improvement of knee joint function after TKA by different rehabilitation methods.
Result: After treatment, the ROM results showed that cryotherapy, electrotherapy, and NT had better therapeutic effects. Among them, cryotherapy (WMD = 10.3, 95% CI 1.63-18.2) had a significant therapeutic effect. In terms of VAS, NT and TT showed good therapeutic effects. Among them, NT had a more significant therapeutic effect, while CAM had less effect. After treatment, in terms of WOMAC, TT, hydrotherapy, cryotherapy, and NT had better therapeutic effects. TT had the best therapeutic effect, while Hydrotherapy and Cryotherapy also had certain advantages.
Conclusion: NT, TT, cryotherapy, hydrotherapy, and electrotherapy rehabilitation therapies have good therapeutic effects for TKA patients compared with other interventions. Among them, NT may be the best postoperative rehabilitation therapy.
目的:全膝关节置换术(TKA)术后康复方式影响并发症及关节功能的恢复,TKA术后康复方式的选择与比较仍需进一步研究。方法:综合检索5个数据库和2个临床试验注册平台,从建立之日起至2024年3月31日止,筛选符合条件的随机对照试验(rct)。我们根据Cochrane干预措施系统评价手册提取所需数据。最终纳入32项试验2292例患者,入组患者平均年龄~69.10岁,男性性别比为(31.6%),最长随访时间为2年。并总结了9种康复干预措施:常规物理治疗(CPT)、冷冻疗法(crt)、热疗法(TT)、针灸、水疗、神经肌肉训练(NT)、电疗、持续被动运动(CPM)、持续主动运动(CAM)。并以活动度(ROM)、视觉模拟量表(VAS)、Western Ontario And McMaster Universities osteoarthritis index (WOMAC)作为结局指标,评价各种干预措施的有效性。采用贝叶斯网络meta分析(NMA)计算不同康复方法对全膝关节置换术后膝关节功能改善的标准化平均差(SMD)和累积排序曲线下曲面(SUCRA)。结果:治疗后ROM结果显示冷冻疗法、电疗、NT治疗效果较好。其中冷冻治疗效果显著(WMD = 10.3, 95% CI 1.63-18.2)。在VAS方面,NT和TT表现出良好的治疗效果。其中,NT治疗效果更显著,CAM效果较差。治疗后,在WOMAC方面,TT、水疗法、冷冻疗法和NT治疗效果较好。TT治疗效果最好,水疗和冷冻治疗也有一定优势。结论:与其他干预措施相比,NT、TT、冷冻、水疗法、电疗康复疗法对TKA患者的治疗效果较好。其中,NT可能是最佳的术后康复治疗方法。
{"title":"Comparison of Therapeutic Effects of Different Rehabilitation Methods on Patients Undergoing Total Knee Arthroplasty: A Network Meta-Analysis of Randomized Controlled Trials.","authors":"Zhaokai Jin, Yi Tang, Hua Huang, Lei Chen, Zhongyi Zhang, Tianyou Ma, Zhengming Wang, Hai Su, Haojing Zhou, Shuaijie Lv, Peijian Tong","doi":"10.1111/os.14332","DOIUrl":"10.1111/os.14332","url":null,"abstract":"<p><strong>Objective: </strong>The rehabilitation methods after total knee arthroplasty (TKA) can affect the recovery of complications and joint function, and the selection and comparison of rehabilitation methods after TKA still need further research.</p><p><strong>Methods: </strong>A comprehensive search of five databases and two clinical trial registration platforms was conducted from inception through March 31, 2024, and conducted to identify eligible randomized controlled trials (RCTs). We extracted the required data according to the Cochrane Handbook for Systematic Reviews of Interventions. Finally, 32 trials involving 2292 patients were included, the mean age of the enrolled patients was ~69.10 years, the sex ratio of males was (31.6%), and the longest follow-up time was 2 years. And we have summarized nine rehabilitation intervention measures: conventional physical therapy (CPT), cryotherapy, thermal therapy (TT), acupuncture, hydrotherapy, neuromuscular training (NT), electrotherapy, continuous passive motion (CPM), continuous active motion (CAM). And use the range of motion (ROM), visual analog scale (VAS), Western Ontario and McMaster Universities osteoarthritis index (WOMAC) as the outcome measure to evaluate the effectiveness of various interventions. A Bayesian network meta-analysis (NMA) was carried out for calculating standardized mean difference (SMD) and the surface under cumulative ranking curve (SUCRA) of improvement of knee joint function after TKA by different rehabilitation methods.</p><p><strong>Result: </strong>After treatment, the ROM results showed that cryotherapy, electrotherapy, and NT had better therapeutic effects. Among them, cryotherapy (WMD = 10.3, 95% CI 1.63-18.2) had a significant therapeutic effect. In terms of VAS, NT and TT showed good therapeutic effects. Among them, NT had a more significant therapeutic effect, while CAM had less effect. After treatment, in terms of WOMAC, TT, hydrotherapy, cryotherapy, and NT had better therapeutic effects. TT had the best therapeutic effect, while Hydrotherapy and Cryotherapy also had certain advantages.</p><p><strong>Conclusion: </strong>NT, TT, cryotherapy, hydrotherapy, and electrotherapy rehabilitation therapies have good therapeutic effects for TKA patients compared with other interventions. Among them, NT may be the best postoperative rehabilitation therapy.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"348-360"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Youwei Ai, Qian Chen, Li Li, Juehan Wang, Ce Zhu, Hong Ding, Yongdi Wang, Zhuojie Xiao, Yuting Zhan, Yueming Song, Ganjun Feng, Limin Liu
Objective: Pedicle screw loosening is one of the common complications in elderly patients undergoing transforaminal lumbar interbody fusion (TLIF) for lumbar spine disease. Malnutrition, prevalent among elderly patients, has been shown to be associated with increased complications. The Geriatric Nutritional Risk Index (GNRI) serves as a simple indicator of nutritional status. However, the relationship between malnutrition, particularly GNRI, and pedicle screw loosening has not been adequately investigated. This study aims to investigate the relationship between GNRI and pedicle screw loosening following TLIF to guide the perioperative nutritional management of patients and prevent postoperative complications.
Methods: A retrospective review was conducted on clinical data from patients who underwent single-level TLIF between 2014 and 2022. Data collection encompassed patient demographics, preoperative laboratory parameters, surgery-related data, perioperative radiographic data, and patient-reported outcomes were comprehensively documented. All patients were followed up for a minimum of 12 months. The relationship between GNRI and pedicle screw loosening was evaluated by univariate and multivariate Cox regression analysis, restricted cubic spline (RCS) analysis, receiver operating characteristic (ROC) analysis, and Kaplan-Meier survival analysis.
Results: A total of 426 patients were included in the study. The rate of pedicle screw loosening rate was 16.4% at a minimum follow-up of 12 months. Patients with pedicle screw loosening exhibited significantly lower GNRI (89.0 ± 8.0 vs. 99.2 ± 9.3, p < 0.001) and volumetric bone mineral density measured by quantitative computed tomography (QCT-vBMD) (84.2 [interquartile range (IQR) 79.6-92.2] vs. 104.0 [IQR 88.2-126.0] mg/cm3, p < 0.001) compared with those in the non-loosening group. Multivariate Cox regression analysis identified sex (hazard ratio [HR] 1.433, 95% confidence interval [CI] 0.714-2.876, p = 0.027), age (HR 1.062, 95% CI 1.014-1.113, p = 0.012), GNRI (HR 0.841, 95% CI 0.711-0.994, p = 0.043), and QCT-vBMD (HR 0.982, 95% CI 0.967-0.997, p = 0.019) as independent risk factors for screw loosening. RCS analysis showed that GNRI was negatively correlated with screw loosening (p < 0.0001). The area under the curve (AUC) for the GNRI in predicting pedicle screw loosening was 0.794, with a cut-off value of 95.590 (sensitivity, 85.7%; specificity 65.2%). Kaplan-Meier survival analysis identified that the lower-level GNRI group exhibited a higher cumulative incidence of screw loosening (log-rank test, p < 0.0001).
Conclusion: The GNRI was an independent risk factor for postoperative screw loosening in elderly patients undergoing TLIF for lumbar spine disease. Preoperative GNRI may potentially serve as a valuable tool in predicting postoperative screw loosening in elderly patients undergoing TLIF.
{"title":"Predictive Value of Preoperative Nutritional Risk Index for Screw Loosening After Lumbar Interbody Fusion in Elderly Patients With Lumbar Spine Diseases.","authors":"Youwei Ai, Qian Chen, Li Li, Juehan Wang, Ce Zhu, Hong Ding, Yongdi Wang, Zhuojie Xiao, Yuting Zhan, Yueming Song, Ganjun Feng, Limin Liu","doi":"10.1111/os.14369","DOIUrl":"https://doi.org/10.1111/os.14369","url":null,"abstract":"<p><strong>Objective: </strong>Pedicle screw loosening is one of the common complications in elderly patients undergoing transforaminal lumbar interbody fusion (TLIF) for lumbar spine disease. Malnutrition, prevalent among elderly patients, has been shown to be associated with increased complications. The Geriatric Nutritional Risk Index (GNRI) serves as a simple indicator of nutritional status. However, the relationship between malnutrition, particularly GNRI, and pedicle screw loosening has not been adequately investigated. This study aims to investigate the relationship between GNRI and pedicle screw loosening following TLIF to guide the perioperative nutritional management of patients and prevent postoperative complications.</p><p><strong>Methods: </strong>A retrospective review was conducted on clinical data from patients who underwent single-level TLIF between 2014 and 2022. Data collection encompassed patient demographics, preoperative laboratory parameters, surgery-related data, perioperative radiographic data, and patient-reported outcomes were comprehensively documented. All patients were followed up for a minimum of 12 months. The relationship between GNRI and pedicle screw loosening was evaluated by univariate and multivariate Cox regression analysis, restricted cubic spline (RCS) analysis, receiver operating characteristic (ROC) analysis, and Kaplan-Meier survival analysis.</p><p><strong>Results: </strong>A total of 426 patients were included in the study. The rate of pedicle screw loosening rate was 16.4% at a minimum follow-up of 12 months. Patients with pedicle screw loosening exhibited significantly lower GNRI (89.0 ± 8.0 vs. 99.2 ± 9.3, p < 0.001) and volumetric bone mineral density measured by quantitative computed tomography (QCT-vBMD) (84.2 [interquartile range (IQR) 79.6-92.2] vs. 104.0 [IQR 88.2-126.0] mg/cm<sup>3</sup>, p < 0.001) compared with those in the non-loosening group. Multivariate Cox regression analysis identified sex (hazard ratio [HR] 1.433, 95% confidence interval [CI] 0.714-2.876, p = 0.027), age (HR 1.062, 95% CI 1.014-1.113, p = 0.012), GNRI (HR 0.841, 95% CI 0.711-0.994, p = 0.043), and QCT-vBMD (HR 0.982, 95% CI 0.967-0.997, p = 0.019) as independent risk factors for screw loosening. RCS analysis showed that GNRI was negatively correlated with screw loosening (p < 0.0001). The area under the curve (AUC) for the GNRI in predicting pedicle screw loosening was 0.794, with a cut-off value of 95.590 (sensitivity, 85.7%; specificity 65.2%). Kaplan-Meier survival analysis identified that the lower-level GNRI group exhibited a higher cumulative incidence of screw loosening (log-rank test, p < 0.0001).</p><p><strong>Conclusion: </strong>The GNRI was an independent risk factor for postoperative screw loosening in elderly patients undergoing TLIF for lumbar spine disease. Preoperative GNRI may potentially serve as a valuable tool in predicting postoperative screw loosening in elderly patients undergoing TLIF.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}