Orthopedics最新文献

Background: Tetrahydrocannabinol (THC)-based and cannabidiol (CBD)-based products are increasing in popularity for the management of pain. Cannabis-based products may serve as a valuable alternative to traditional analgesics such as opioids for pain management among orthopedic patients. The purpose of this study was to investigate the perspective of orthopedic sports medicine patients regarding the use of THC- and CBD-based products for the management of musculoskeletal pain.

Materials and methods: A short, 11-question survey was distributed to orthopedic sports medicine patients in clinic and via email. Survey participation was voluntary. Retrospective chart review was conducted for participating patients to collect additional data such as visit diagnosis.

Results: A total of 182 patients completed the survey. Most were familiar or somewhat familiar with THC (61%) and CBD (63.2%) products and their use for musculoskeletal pain. Of the patients, 53.3% were aware of friends and family currently using CBD products to help manage musculoskeletal pain. Of the patients, 81.3% were amenable to receiving THC-based products and 90.1% were amenable to receiving CBD-based products for the management of their musculoskeletal pain. The patients were statistically more amenable to receiving CBD-based products than THC-based products (P=.017). Among the patients, 85.3% believed cannabis-based products would help in the fight against the opioid epidemic.

Conclusion: Orthopedic patients are aware of THC- and CBD-based products, and the majority are willing to receive these products to help manage their musculoskeletal pain and orthopedic-related issues. Orthopedic surgeons should be aware of the increasing popularity of CBD-based products and educate themselves and their patients regarding the appropriate use of them. [Orthopedics. 2025;48(2):98-103.].

Bipolar hemiarthroplasty (BHA) for osteoporotic femoral neck fractures has a risk of proximal femoral fracture during trials, especially with larger trial bipolar shells. This study introduces a novel technique for BHA via the direct anterior approach, aiming to reduce trial use and lower the risk of iatrogenic femoral fractures. The "no trial reduction technique" involves positioning only the trial neck segment against the acetabulum's me-dial wall, without the bipolar shell and trial head. Fluoros-copy measures limb length differences to determine optimal femoral head and bipolar shell thickness, resulting in comparable limb lengths without early complications. [Orthopedics. 2025;48(2):74-78.].

There is debate over the treatment of displaced femoral neck fractures with either hemiarthroplasty or total hip arthroplasty. This study aimed to evaluate the fragility index (FI) of randomized controlled trials (RCTs) comparing these methods. We queried for these RCTs containing dichotomous outcomes, finding 11 RCTs with 63 dichotomous outcomes. The median FI for all outcomes was 6, signifying that 6 event reversals would change the statistical significance of an outcome. The median FI was 2 for significant outcomes and 6 for nonsignificant outcomes, indicating that outcomes favoring one surgical method are more statistically fragile than those demonstrating equivalency. [Orthopedics. 2025;48(2):69-73.].

Background: As the prevalence of osteoporotic fractures increases, impacting the health of the aging population significantly, understanding the genetic link between chronic diseases such as primary biliary cholangitis (PBC) and osteoporosis (OP) is crucial. Despite existing research, the direct genetic relationship between these conditions remains unclear.

Materials and methods: This study used a two-sample Mendelian randomization approach, drawing on the largest available genome-wide association studies. Instrumental variables were selected based on single nucleotide polymorphisms to explore the genetic correlations affecting the association between PBC and OP. This method helps overcome the limitations of traditional observational studies by reducing confounding factors and preventing reverse causation.

Results: The results, primarily derived from the inverse variance weighted method along with MR-Egger and weighted median supplementary methods, demonstrated a significant causal link between the genetic markers associated with PBC and an increased risk of OP. Sensitivity analyses reinforced these findings, affirming the robustness of the genetic associations.

Conclusion: These findings highlight the genetic underpinnings that potentially link PBC to an increased risk of OP, suggesting that genetic factors play a significant role in the progression of chronic diseases. This knowledge could lead to better prevention and treatment strategies for OP, emphasizing the need for integrated treatment approaches that account for genetic predispositions of patients with chronic conditions. Future research should focus on validating these genetic links further and exploring them as potential therapeutic targets. [Orthopedics. 2025;48(2):111-115.].

Background: The goal of this study is to report our findings on the application of the enhanced recovery after surgery (ERAS) protocol for patients undergoing unicompartmental knee arthroplasty (UKA) and to evaluate the benefits and drawbacks of this approach.

Materials and methods: Sixty patients with medial unicompartmental knee osteoarthritis (UKOA) who underwent UKA were the subject of a retrospective investigation. The patients were categorized into 2 groups based on the use of ERAS protocols. Among the metrics that were measured and statistically analyzed were Kellgren-Lawrence grade, femorotibial angle (FTA), Tegner activity score, Lysholm knee score, University of California at Los Angeles (UCLA) activity score, Berg Balance Scale (BBS), numeric pain rating scale (NPRS) score, forgotten joint score, range of motion (ROM), hospital length of stay (LOS), procedure duration, intraoperative bleeding volume, time to ambulation, time to resume normal walking, duration of urinary catheter retention, time to resume a regular diet, and postoperative satisfaction.

Results: The patients allocated to the ERAS cohort showed distinct characteristics compared with the control cohort, including faster resumption of regular dietary intake, ambulation, and gait patterns. The ERAS group showed a decreased FTA and improved BBS scores. On final evaluation, the ERAS group had lower UCLA scores, indicative of superior overall outcomes.

Conclusion: The initial application of ERAS showed promising results in enhancing patient rehabilitation outcomes, reducing the impact of hospitalization, and improving efficient allocation of health care resources. Nevertheless, additional research is necessary to assess the feasibility and effectiveness of widespread implementation for patients undergoing UKA. [Orthopedics. 2025;48(2):87-97.].

Background: Slipped capital femoral epiphysis (SCFE) is a problem affecting the pediatric population, with high rates of re-slip and contralateral pinnings. The purpose of this study was to identify both rates of recurrence and contralateral slips after in situ pinning of stable and unstable SCFE.

Materials and methods: Pediatric patients who underwent in situ and revision pinning of SCFE from January 2000 to December 2022 were reviewed for subsequent procedures, including contralateral pinning and revision procedures. All hips were pinned in situ using a technique consisting of a single, cannulated, 6.5-mm partially threaded screw. Association with age and sex were prioritized and compared with previous literature. Data analysis was performed using t tests and chi-square tests. Statistical significance was set at P>.05.

Results: Eighty-eight patients were selected for review, with a total of 124 native hips pinned and 7 revision hips (5.6% revised for progression of deformity). Twelve contralateral hips underwent sequential pinning for contralateral slip (24.0% of all unilateral procedures performed). Seventy-four percent of patients were male. The mean age at initial slip for patients who did not undergo a subsequent procedure was 13.0±1.5 years, compared with 10.8±1.6 years for contralateral slips and 11.5±1.5 years for revision hips (P<.001).

Conclusion: The rates of revision and contralateral slip were comparable to and slightly lower than those reported in the current literature. The complication rate for this procedure is low. This study demonstrates a safe and an efficient technique for management of SCFE. [Orthopedics. 2025;48(2):e100-e104.].

Background: Establishing stable femoral component fixation in revision total hip arthroplasty (rTHA) remains challenging. Early monobloc tapered, fluted, titanium (TFT) designs were complicated by high rates of subsidence, while modular designs were complicated by taper corrosion and junctional fractures. Newer generation monobloc stems have been designed to minimize subsidence. Therefore, the aim of this study was to present the clinical and radio-graphic results of the most recent modular and monobloc TFT designs.

Materials and methods: Patients undergoing rTHA in which TFT femoral stems were used, whether modular or monobloc, were included in this retrospective review. Included stems had the same design characteristics and were from the same manufacturer. The only difference was neck modularity. Radiographic analysis for stem subsidence was performed. Clinical outcomes including Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, and re-revisions were collected. We examined survivorship for the endpoints of subsidence or re-revision for any reason.

Results: Ninety-four (66 monobloc, 28 modular) hips met inclusion criteria, with a median follow-up of 25.9 months. Mean stem subsidence was 1.9±0.2 mm in the modular group and 2.1±0.3 mm in the monobloc group (P=.56), with 90 of 94 (95%) stems subsiding less than 5 mm. Twelve hips (13%) required re-revision with no difference in survival between the groups. HHS and WOMAC scores significantly improved from preoperative to last recorded follow-up in both groups (P≤.01).

Conclusion: Advances in implant design including spline geometry and more aggressive tapers in monobloc TFT femoral components offer encouraging clinical outcomes with an overall low risk of clinically significant subsidence. [Orthopedics. 2025;48(2):79-86.].

Background: Wearable activity-measurement devices are increasingly popular among the public, but there is little information regarding their use among patients undergoing sports medicine procedures. The purpose of this study was to compare accelerometer-measured data with traditional patient-reported measures and to determine the trajectory of physical activity from before surgery to 1 year after anterior cruciate ligament reconstruction.

Materials and methods: Adult patients undergoing primary anterior cruciate ligament reconstruction were enrolled in this prospective cohort pilot study. The Tegner activity scale, Marx activity scale, International Physical Activity Questionnaire Short Form (IPAQ-SF), Knee injury and Osteoarthritis Outcome Score (KOOS), and EuroQoL-5D were administered preoperatively and 3, 6, and 12 months postoperatively. At these intervals, each patient was asked to wear an accelerometer for 7 consecutive days. Time spent in moderate-to-vigorous physical activity (MVPA min/wk), metabolic equivalents of physical activity, and average daily steps were calculated from the accelerometer output and correlated with patient-reported measures.

Results: Twenty-eight patients were included in this study. Of the 28 patients, 20 remained, and at the 12-month analysis, 18 patients were analyzed. There were significant improvements in Tegner activity scale score, KOOS symptoms, sports/recreation, and quality of life subscales, and IPAQSF MVPA min/wk at final follow-up. All accelerometer-based outcomes had improvements at 3, 6, and 12 months.

Conclusion: The accelerometer may be a useful tool for understanding patients' activity levels at different time points during their recovery and for providing tangible targets for patients to achieve at least an average recovery. [Orthopedics. 2025;48(2):e62-e68.].

Background: This study was conducted to determine the difference in clinical outcomes and satisfaction between men and women after total knee arthroplasty (TKA) and whether the relationship between postoperative outcomes and satisfaction differs between the 2 groups after TKA.

Materials and methods: This retrospective study included 324 patients who underwent TKA. The participants were divided by sex as follows: male (n=130) and female (n=194). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Knee Society Score (KSS), and satisfaction score and their correlation coefficients at 1 and 2 years after TKA were compared between the groups.

Results: The satisfaction scores of the male and female patients were 27.1 and 22.7, respectively (P<.001), 1 year after TKA and 29.7 and 29.2, respectively (P=.575), 2 years after TKA. No significant differences in the WOMAC score or KSS were observed between the 2 groups. The correlation coefficients between the satisfaction score and WOMAC score or KSS (function scores) were higher for women than for men 1 and 2 years after TKA (1-year WOMAC score: men, -0.682; women, -0.724; 1-year KSS function score: men, 0.500; women, 0.795) (2-year WOMAC score: men, -0.536; women, -0.778; 2-year KSS function score: men, 0.444; women, 0.702).

Conclusion: The early postoperative satisfaction of female patients was lower than that of male patients but eventually improved to the satisfaction level of male patients, and the association between outcomes and satisfaction within 2 years after TKA was higher for female patients than for male patients. [Orthopedics. 2025;48(2):121-127.].

Background: Maintaining appropriate soft tissue tension is essential in total hip arthroplasty (THA). Surgeons generally achieve this by altering the neck length. However, experimenting with different neck lengths is time-consuming, as it requires repeated hip dislocations. To address this, we have used a new extensible trial neck device that allows for easy adjustment of neck length during surgery. This device can help surgeons avoid the need for repeated hip dislocations to determine the correct neck size. The objective of this research was to investigate whether this device could help shorten operative times and decrease surgical invasion for patients.

Materials and methods: Patients undergoing THA were randomly separated into two groups. The first group used the extensible trial neck during trial reduction after the stem and cup were placed (group M), while the second group used a conventional trial neck (group C). Operative time, blood loss, number of additional dislocations needed during the operation, and C-reactive protein (CRP) and creatine phosphokinase (CPK) levels after the operation were compared.

Results: Operative time was significantly shorter and the number of additional dislocations required to choose the final neck size was significantly lower in group M compared with group C. No significant difference in blood loss was observed. CRP and CPK levels days 3 and 7 after surgery decreased in group M compared with group C.

Conclusion: The extensible trial neck was useful for THA by greatly reducing operative time and stress on the patient. [Orthopedics. 2025;48(2):e88-e93.].