Orthopedics最新文献

Background: This study compared the predictive performance of the Hounsfield unit (HU) value and vertebral bone quality (VBQ) score based on cage subsidence after anterior cervical discectomy and Zero-P fusion.

Materials and methods: We conducted a retrospective analysis of 104 patients who underwent Zero-P fusion surgery for cervical spondylosis in our hospital. Before surgery, the VBQ of each patient's C2-C7 vertebral body was measured by cervical magnetic resonance imaging, while the HU value was measured by cervical computed tomography. The maximum loss distance of vertebral height was measured immediately after surgery and at final follow-up. Patients were divided into a subsidence group (≥3 mm) and a non-subsidence group (<3 mm). Single-factor analysis was used to preliminarily determine the risk factors for Zero-P cage (ZPC) subsidence. For variables with statistical differences, logistic regression was further used for multivariate analysis to determine independent risk factors. Receiver operating characteristic (ROC) and area under the curve (AUC) were used to evaluate the ability of VBQ score and HU value to predict ZPC subsidence.

Results: Interbody ZPC subsidence was observed in 20 of 104 patients. Significant differences in HU value and VBQ score were found between the two groups. HU value (odds ratio [OR]=0.987, 95% CI 0.978-0.997, P=0.006) and VBQ score (OR=4.462, 95% CI 1.721-11.373, P=0.002) were independent risk factors for ZPC subsidence. On the ROC curve, the AUC of VBQ score was 0.776 (95% CI 0.669-0.883), and the optimal threshold of VBQ score was 3.860 (sensitivity: 60.0%, specificity: 86.9%). The AUC of HU was 0.757 (95% CI 0.645-0.869), and the optimal threshold of HU value was 298.44 (sensitivity: 60.7%, specificity: 90.0%). The AUC of HU value and VBQ score showed no statistical difference, whereas the AUC of the joint index of HU value and VBQ score was 0.833, which was higher than that of the single indicator, and the difference was statistically significant (P<0.05).

Conclusion: Higher VBQ score and lower HU value are independent predictors of ZPC subsidence in patients following Zero-P fusion. The joint index of HU value and VBQ score is more predictive of Zero-P fusion than a single indicator.

Background and objective: The aim of this study was to compare outcomes of endoscopic hip abductor repair with Healicoil^® Regenesorb (RG) vs Q-FIX^® anchors at 2-year follow-up.

Materials and methods: The 2-year follow-up modified Harris Hip Score of 51 consecutive hips (49 patients) repaired with Healicoil RG anchors were compared to that of 38 consecutive hips (35 patients) repaired with Q-FIX anchors.

Results: There was no statistically significant difference between the two groups in terms of age, sex, partial vs full thickness tears, one vs two tendon involvement, single vs double row repair, or concomitant correction of femoroacetabular impingement (FAI). For Healicoil, the mean improvement was 38.6 points, with 98% achieving minimal clinically important difference (MCID) of 6.8 points vs Q-FIX with mean improvement of 29.5 points and 92.1% achieving MCID of 7.5 points. The mean improvement was statistically superior for Healicoil. Within each of the two groups, there was no statistically significant difference in outcomes for partial vs full thickness tears, one vs two tendon involvement, single vs double row repairs, or concomitant correction of FAI. There were no complications in either group. One patient in the Healicoil group subsequently underwent total hip arthroplasty at 11 months following repair.

Conclusion: The Healicoil RG resulted in statistically significant greater improvement over the Q-FIX for endoscopic tendon repair. These two products demonstrate differing features, offering versatility in decision making for a variety of tear types, and both provide successful outcomes in terms of average improvement in modified Harris Hip Scores and percentage of patients achieving MCID with low likelihood of complications or need for further surgery.

Background: Testosterone replacement therapy (TRT) has increased in popularity over the past decade. However, TRT has been associated with medical risks, such as venous thromboembolism. The aim of this study was to characterize perioperative and postoperative complications in total hip arthroplasty (THA) patients taking TRT in the perioperative period.

Materials and methods: A retrospective review of patients from a large academic medical center was performed to identify primary THA patients who underwent TRT within 3 months prior to surgery. Cohorts were propensity score matched with controls using nearest-neighbor method with age, American Society of Anesthesiologists score, and body mass index as covariates. Outcomes studied included 90-day readmissions, emergency department (ED) encounters, infections, myocardial infarctions (MI), deep venous thrombosis (DVT), and pulmonary embolism (PE). Twenty-four-month revision rates were also collected.

Results: One hundred forty-six patients on TRT were evaluated with 294 consecutive control patients not on TRT. There was a significantly greater proportion of 90-day periprosthetic joint infection in the TRT cohort compared to the No TRT cohort (3.4%, n = 5, vs 0.3%, n = 1; P = .017). There was no significant difference in all other postoperative complications between TRT and No TRT cohorts. Ninety-day postoperative ED encounters, readmission rates, DVT, MI, and PE were similar and low between cohorts (P > .05). Twenty-four-month revision rates were also similar between study groups (P > .05).

Conclusion: This study found that TRT was associated with greater periprosthetic joint infection in THA. Further studies will need to be performed to identify optimal discontinuation of treatment prior to joint replacement.

Background: The purpose of this study was to compare rates of manipulation under anesthesia (MUA) and revision total knee arthroplasty (TKA) in patients undergoing TKA with and without perioperative use of an angiotensin-receptor blocker (ARB).

Materials and methods: Embase and PubMed/MEDLINE were searched, and peer-reviewed studies with a minimum follow-up period of 90 days comparing rates of MUA and revision surgery in patients undergoing TKA with and without perioperative use of an ARB were included. Studies that were not available in English and/or used animal models or cadavers, as well as case reports, non-full text articles, review articles, letters to the editor, and studies reporting data that was non-comparative or lacked outcome measures were excluded. Included studies were evaluated for quality using the Methodological Index for Non-Randomized Studies criteria. Patient demographics, comorbidities, and outcomes were extracted from the included studies.

Results: Six studies consisting of 997,086 control patients and 129,874 patients who received perioperative ARB were included. All included studies were at level III evidence. Patients taking an ARB had higher rates of diabetes (42% vs 28%), hypertension (87% vs 58%), obesity (34% vs 23%), and hyper-cholesterolemia (63% vs 35%) compared to the control groups. The rate of MUA across control patients ranged from 2.8% to 7.6%, compared to 2.5% to 6% in patients taking an ARB. The rate of revision TKA across control patients ranged from 1.4% to 7.6%, whereas the rate for patients taking an ARB ranged from 1.14% to 1.3%.

Conclusion: Perioperative ARB use may decrease rates of MUA and revisions after TKA. This study can guide risk stratification and counseling for patients undergoing TKA. Higher-level studies need to be conducted to determine whether ARBs should be prescribed for the sole purpose of preventing arthrofibrosis.

Background: Tenosynovial giant cell tumor (TGCT) is a rare, mostly benign neoplasm originating in the synovium of joints, tendon sheaths, and bursae that can locally recur after excision and cause osseous erosions. Studies have suggested increased local recurrence with diffuse TGCT, but few have assessed associations of local recurrence or erosions in TGCT of the knee. Our aim was to determine associations of erosions and local recurrence with patient and tumor characteristics in knee TGCT.

Materials and methods: A retrospective chart review was performed on 53 patients with intraarticular, biopsy-proven TGCT of the knee diagnosed at our institution from December 2002 to December 2020. Bivariate analysis assessed the significance of associations between patient and tumor characteristics, surgical management, erosions, and local recurrence.

Results: Of 53 patients with intra-articular, biopsy-proven TGCT of the knee, 24 (45%) patients had diffuse, intra-articular TGCT, and 7 (13%) patients had radiographic evidence of osseous erosions. In the diffuse, intra-articular subgroup, 12 (50%) patients had local recurrence, but 5 of 5 patients with erosions had local recurrence. Of the 19 patients with diffuse, intra-articular TGCT without erosion, 7 (37%) had local recurrence (P = .037). Of the 24 patients with diffuse, intra-articular TGCT, both those who had and did not have local recurrence had similar surgical treatment (75% arthroscopic, 25% open). The average recurrent-free survival was 936 days.

Conclusion: Patients with diffuse, intra-articular TGCT of the knee with osseous erosions had a greater incidence of local recurrence than those without. Using erosions as a positive prognostic indicator for local recurrence may assist physicians in risk stratification of patients with diffuse, intra-articular TGCT.

Background: This study assessed the long-term clinical outcomes of women (≥50 years of age) who undergo operative management of lateral tibial plateau fractures, with particular focus on risk of conversion to total knee arthroplasty (TKA).

Materials and methods: A retrospective review was conducted on female patients aged 50 and older who sustained lateral tibial plateau fractures treated with open reduction and internal fixation (ORIF) at a level 1 trauma center between January 2003 and July 2023. The primary outcome measure was conversion to TKA. Secondary outcome measures included lateral joint subsidence, arthrosis progression, surgical complications, and reoperations for any reason.

Results: Forty-one women underwent ORIF of lateral tibial plateau fractures during the study period with an average age of 63.5 ± 9.0 years. The mechanism of injury for most patients was a ground-level fall (n = 24, 58.5%). At final follow-up, lateral joint subsidence was present in 22 women (53.7%), and patients progressed an average of 1.0 Kellgren-Lawrence grade in terms of arthrosis. A total of 7 women (17.1%) underwent conversion to TKA at a mean of 4.0 years after ORIF.

Conclusion: Women 50 years and older demonstrated a 17.1% rate of conversion to TKA following operative management of laterally impacted tibial plateau fractures, more than two times higher than rates seen in the general population affected by these fractures. Appropriate counseling should be offered preoperatively for these patients.

Background: Distal femur fractures historically required prolonged weight-bearing restrictions following fixation. Allowing immediate weight-bearing is gaining traction due to the benefits of early mobilization. This study compares postoperative complications of immediate weight-bearing as tolerated (WBAT) versus restricted weight-bearing (RWB) in distal femur fractures fixed with a lateral locking plate.

Materials and methods: A retrospective analysis was conducted on all patients who underwent lateral locking plate fixation for distal femur fractures between October 2011 and April 2022 at four hospitals. Data collected included fracture characteristics, weight-bearing status, 30-day complications, and 1-year mortality. Radiographic outcomes including implant failure, malunion, nonunion, and time to union were assessed.

Results: One hundred twenty-four patients met inclusion criteria. Immediate weight-bearing was permitted in 76 (61.3%). The WBAT group was older (83.2 vs 68.9 years, P < .001), had a lower body mass index (BMI) (28.1 vs 30.8, P = .037), and had fewer 30-day complications (7.9% vs 25.0%, P = .008). There was no difference in 30-day (6.3% vs 2.6%, P = .374) or 1-year mortality (14.6% vs 17.1%, .468). There was no difference in implant failure, malunion, nonunion, and time to union between groups. Logistic regression demonstrated lower 30-day complications with WBAT (OR 0.207, P = .041), lower BMI (OR 1.095, P = .040) and lower Charlson Comorbidity Index. (OR 1.547, P = .023).

Conclusion: Immediate weight-bearing after lateral locking plate fixation for distal femur fractures is associated with fewer early postoperative complications compared to RWB. WBAT did not increase the rate of fixation failure, malunion, or nonunion.

Background: The aim of this study was to evaluate the prevalence and perceived efficacy of cannabidiol (CBD) products in patients presenting to an orthopedic hand and upper extremity clinic.

Materials and methods: New patients seen for an initial surgical consultation between July and December 2022 were surveyed regarding CBD use, pain, and function. Pain was measured with the Numeric Pain Rating Scale (NPRS, 0-10) and function with the Single Assessment Numeric Evaluation (SANE, 0-100). Demographic and clinical factors were collected via chart review.

Results: A total of 918 patients completed the survey (53% female; mean age 63 years, range 18-97). Joints involved included elbows (106), wrists (335), and hands/fingers (667). Common diagnoses included arthritis (199), tendinopathy (273), and nerve-related conditions (160). Overall, 15% (135/918) reported prior CBD use, and 39% (53/135) perceived pain relief. CBD users were more likely to be female (65% vs 51%; P=0.003), to present with wrist pathology (44% vs 35%; P=0.038), and to have arthritis (36% vs 19%; P<0.001). Compared to non-users, CBD users reported higher pain scores (mean NPRS 6.2 vs 5.1; P<0.001) and lower contralateral function (mean SANE 77.3 vs 87.4; P<0.001).

Conclusions: In this cohort, CBD use was uncommon, and only a minority of users reported subjective benefit. CBD users tended to report higher pain and worse function, particularly in the setting of wrist arthritis. CBD products did not appear to provide measurable objective improvement in pain or function. Further studies are needed to clarify optimal dosing, administration, and potential role in upper extremity care.

Background: Electronic medical record portals enable real-time communication between patients and surgeons after total knee arthroplasty (TKA). This study evaluated the impact of message timing and frequency on postoperative outcomes and patient-reported outcome measures (PROMs).

Materials and methods: We retrospectively reviewed 9,353 primary TKAs performed at a single academic institution. Of these, 1,219 patients sent messages within 2 weeks of surgery (early), 507 sent messages between 2 and 8 weeks (late), and 7,627 did not message.

Results: Patients who messaged within 2 weeks following surgery had shorter hospital length of stay (LOS) (41.2 vs 47.45 vs 53.40 hours, P < .001) and were more likely to be discharged home (99.5% vs 97.6% vs 96.8%, P < .001) compared to both late messengers and non-messengers. Patients who messaged late were more likely to experience a 90-day readmission surgery (3.2% vs 5.3% vs 3.3%, P = .05). Most messages were sent within 2 weeks (1.76 vs 1.48; P < .001). There was no difference in PROMs regardless of message timing, and there was no association between the number of messages sent and perioperative outcomes or PROMs.

Conclusion: Older age and longer LOS were associated with less patient-initiated contact after TKA. Older patients may be less familiar with digital platforms and less likely to send messages. Early messaging may reflect heightened recognition of postoperative issues, enabling counseling or intervention and reducing readmissions. These findings underscore the importance of preoperative education and equitable access, though long-term effects of messaging warrant further study.