Orthopedic Reviews最新文献

Background: Prosthetic joint infection (PJI) is a devastating complication following hip and knee arthroplasty, with significant morbidity and mortality. While 24 hours of intravenous antibiotics is standard for inpatient arthroplasty, there is no consensus on postoperative antibiotic prophylaxis for outpatient procedures. This study evaluated 90-day PJI rates in patients undergoing same-day discharge primary hip and knee arthroplasty with 24 hours of perioperative oral antibiotics.

Methods: A retrospective review was conducted on 1,843 patients who underwent primary total knee arthroplasty (TKA; 1,052, 57.1%), total hip arthroplasty (THA; 638, 34.7%), unicompartmental knee replacements (medial: 89, 4.8%; lateral: 5, 0.3%), isolated patellofemoral replacements (14, 0.8%), or conversion of previous hip surgeries (4, 0.2%) from 2021 to 2023 at two ambulatory surgery centers. All patients received 24 hours of perioperative oral antibiotics. Patient data were collected via chart review and the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI). The primary outcome was PJI within 90 days of surgery.

Results: The median age was 66 years, and the median BMI was 31 kg/m². PJI occurred in 5 patients (0.3%; 3 THA, 2 TKA). There were no significant differences in PJI rates based on gender, BMI, race, smoking status, diabetes, ASA class, procedure type, or surgical approach (P < 0.05).

Conclusion: Twenty-four hours of perioperative oral antibiotics following outpatient TKA, THA, unicompartmental, and patellofemoral procedures is associated with low PJI rates. Larger, randomized prospective studies are needed to refine antibiotic protocols for outpatient arthroplasty.

Background: Chronic low back pain due to degenerative disc disease (DDD) and lumbar spondylosis is a leading cause of disability. Many patients exhaust conservative and interventional treatments yet remain poor surgical candidates. Spinal cord stimulation may be an effective therapy for many of these patients.

Case presentation: A 65-year-old female with lumbar DDD and lumbar spondylosis presented with chronic low back pain refractory to conservative therapy. She previously failed acetaminophen, NSAIDs, gabapentinoids, muscle relaxants, and opioids, as well as multiple interventional procedures including epidural steroid injections, medial branch blocks, radiofrequency ablation, and sacroiliac joint injections. The patient underwent an SCS trial using the Biotronik Prospera system with multiphase stimulation, achieving approximately 60% pain relief and marked functional improvement. She subsequently received a permanent SCS implant, reporting >90% sustained pain reduction. She was able to discontinue opioid therapy entirely. At >9-month follow-up, she continued to experience durable benefit, had lost more than 35 pounds, increased physical activity, and returned to independent function.

Conclusion: This case highlights the effectiveness of SCS as a treatment option for chronic nonsurgical back pain, demonstrating not only substantial pain reduction but also improved function, weight loss, medication reduction, and overall quality of life. Multiphase stimulation with the Biotronik Prospera system may provide an effective alternative for patients who do not respond to comprehensive conservative care.

Proximal humerus fractures are very common injuries. In young people the treatment options include non-operative management, internal fixation, and in selected cases, shoulder arthroplasty. One of the most challenging complications after internal fixation is the fracture non-union that can lead to the dreaded implant breakage. In such a situation, the treatment depends on the patient's age, bone quality, bone loss, infection status, and functional demands, and consists of revision open reduction and internal fixation employing autologous bone grafting or conversion to shoulder arthroplasty. We report the case of a 38-year-old women who presented with painful shoulder stiffness, non-union and implant breakage three years following the internal fixation of an extra-articular humerus proximal fracture. The patient was successfully undergoing removal of the internal fixation and implantation of a cementless long-stem reverse shoulder arthroplasty. At four-year follow-up, the patient showed excellent functional recovery and stable implants on plain radiographs. This case underscores the significant therapeutic challenges in the case of non-union and implant breakage after failure of an internal fixation for a displaced extra-articular humerus fracture in young people and highlights the role of reverse shoulder arthroplasty conversion as an effective salvage solution, providing pain relief, functional recovery and radiographic stability. Proper pre-operative planning, implant selection, and a meticulous intra-operative technique remain key factors for achieving favourable results in similar complex conditions.

The authors present the case of a 69 yearold female who complained of leg pain. She was ultimately diagnosed with a psoas abscess. The case evolution including history of present illness, laboratory and imaging studies are reviewed.

Spinal cord stimulation (SCS) is an established treatment for chronic neuropathic pain, particularly in patients who have failed conservative therapy or prior spine surgery. This case highlights significant pain reduction and functional recovery in a patient with severe lumbar radiculopathy and weakness following prior lumbar surgery. A 39-year-old female with multilevel disc bulges causing spinal stenosis, and chronic lumbar radiculopathy presented with severe low back and left leg pain. She had undergone lumbar decompression surgery in 2023 but continued to experience debilitating neuropathic pain despite medication management and multiple epidural steroid injections. Spine surgery reevaluation determined that no further surgery was indicated. At initial pain clinic evaluation, the patient was wheelchair bound and exhibited significant left lower extremity weakness. She underwent a spinal cord stimulator (SCS) trial using the Biotronik system with Multiphase Stimulation resulting in >65% pain relief and the ability to ambulate with a cane. Based on the successful trial, a permanent SCS implant was performed. Post-implantation, she maintained >70% pain improvement, progressed to independent ambulation for short distances, and reported substantial improvements in function and quality of life. This case demonstrates that SCS can offer meaningful pain reduction and functional restoration, even in patients with severe baseline disability and failed prior surgery utilizing Prospera Spinal Cord Stimulation System with Multiphase Stimulation.

Background: Nerve root fibrosis (NRF) is a common postoperative complication following spinal decompression procedures and is associated with persistent pain and functional impairment. Although poloxamer and hyaluronic acid (HA) have been investigated as anti-adhesive agents, the global research landscape in this field has not been systematically evaluated.

Methods: A bibliometric analysis was conducted using the Web of Science Core Collection to evaluate publications on poloxamer and HA for NRF prevention from 2000 to 2024. Citation analysis, co-authorship networks, and keyword co-occurrence including citation trends, co-authorship networks, and keyword co-occurrence mapping analysis were performed.

Results: The final investigation comprised 42 relevant studies. The annually publishing trend indicated a considerable growth in research interest, with the largest number of publications in 2016(7 articles). Between 2020 and 2024, approximately 35% (15/42) of the total studies were published, indicating a growing focus on this field. The top contributing countries were Turkey (16 articles, 37.1%), China (13 articles, 30.2%), and Taiwan (7 articles, 16.3%). Citation analysis found that the most referenced journal was the Journal of Neurosurgery: Spine numbering 87 citations, followed by European Spine Journal (58 citations) and Neurosurgery Journal (55 citations). Co-citation analysis highlighted Mei-Hsiu C (70 citations) and Yu S (67 citations) as key researchers in this domain. Keyword mapping indicated that major research themes included "epidural fibrosis" (32 occurrences), "laminectomy" (24 occurrences), and "adhesion" (10 occurrences).

Conclusion: Research on poloxamer and HA for NRF prevention has increased steadily, with emerging emphasis on inflammation modulation and biomaterial optimization. These findings provide a comprehensive overview of current trends and future research directions.

Background: Level I trauma centers employ various orthopaedic call strategies based on resources and surgeon subspeciality availability.

Objective: We hypothesize when surgeons fellowship trained in trauma are solely on call that patient outcomes will be improved compared to a combined plan.

Methods: Retrospective cohort study from two 24-month time periods at an academic level one trauma center. The first cohort consisted of only trauma surgeons taking call. The second cohort consisted of a combination of trauma and other subspecialities taking call. The primary outcome analyzed was time from admission to operating room for hip, femoral shaft, distal femur, tibia shaft, pelvic ring and acetabulum fractures. Secondary outcomes analyzed included length of stay, 90 day incidence of reoperation, mortality, VTE and readmission.

Results: Eight hundred and fifty seven patients in the trauma cohort and 992 patients in the combined cohort met the inclusion criteria. The time from admission to index surgical procedure was significantly shorter in the trauma cohort (1.7 vs 2.4). Length of stay (8.95 vs 11 days) and 90 day mortality (1.8% vs 3.8%) was improved in the trauma cohort. There was no difference in 90 day rate of VTE, readmission or reoperation. Length of stay and time to OR in pelvic ring injuries and acetabulum fractures were doubled compared to the hybrid group.

Conclusions: Our findings suggest that when trauma fellowship trained surgeons are the only ones taking call patients have a shorter time from admission to index surgical procedure, length of stay and lower mortality rate.

Background: The trapeziometacarpal (TMC) joint is critical for thumb function, and its instability leads to significant disability. While the volar-only Eaton-Littler ligament reconstruction is a classic treatment, its efficacy is debated. Modern techniques like the Zhang method address both volar and dorsal ligaments, but comparative biomechanical data are scarce. This study aimed to biomechanically compare the stability of the traditional Eaton-Littler technique with the Zhang technique and a modified Zhang technique using a palmaris longus (PL) tendon graft.

Methods: A descriptive comparative study was conducted on 21 cadaveric specimens from 14 hands. Three techniques were evaluated: Eaton-Littler (n=7), Zhang (n=7), and modified Zhang (n=7). The Modified Zhang technique utilized PL tendon instead of flexor carpi radialis (FCR). Biomechanical testing measured joint displacement under controlled loads (10N, 20N, 30N) in four anatomical directions (dorsal, volar, radial, ulnar). Statistical analysis employed Wilcoxon signed-rank test with significance at p<0.05.

Results: The Eaton-Littler technique demonstrated significantly greater displacement compared to both Zhang methods in dorsal (5.27mm vs 3.75mm vs 3.95mm at 30N; p<0.03), volar (6.29mm vs 5.27mm vs 5.05mm at 30N; p<0.03), and ulnar (5.73mm vs 3.90mm vs 3.68mm at 30N; p=0.018) directions. No significant differences existed between techniques for radial displacement (p>0.05) or between Zhang and modified Zhang methods (p>0.05). The PL and half-slip FCR grafts showed equivalent cross-sectional diameters (2.11mm vs 2.08mm; p=0.499).

Conclusion: Both Zhang and modified Zhang techniques demonstrate superior biomechanical stability profiles compared to the traditional Eaton-Littler procedure. The PL tendon represents a viable alternative graft option with comparable biomechanical properties, offering potential advantages in preserving FCR function.

Objective: To describe the clinical and paraclinical features and the surgical outcomes of multiple flexor tendon ruptures in a patient with neglected lunate dislocation.

Methods: A case report.

Results: Lunate dislocation is rare and easily missed at initial diagnosis. Delayed/neglected cases can lead to wrist osteoarthritis, median nerve involvement, and flexor tendon injury. We report a patient with multiple flexor tendon ruptures associated with a 4-year neglected lunate dislocation. The patient underwent flexor tendon reconstruction using an autologous palmaris longus graft combined with lunate excision. At 1-year follow-up, finger motion was good and there was no evidence of wrist osteoarthritic change.

Conclusion: Multiple flexor tendon ruptures associated with neglected lunate dislocation are rare. Surgery achieved successful functional recovery, allowing the patient to return to everyday work.

Objective: The incidence of hip osteoarthritis (OA) is increasing with the aging population, leading to interest in intra-articular orthobiologic injections to alleviate symptoms and potentially slow disease progression. This systematic review aims to evaluate the clinical outcomes associated with six orthobiologic therapies for hip OA: hyaluronic acid (HA), platelet-rich plasma (PRP), autologous cells therapy (ACT), microfragmented adipose tissue (MFAT), and bone marrow aspirate (BMA) and its concentration (BMAC).

Methods: We conducted a literature search according to the PRISMA guidelines. Studies were included in our review if they used at least one of the four orthobiologic therapies and reported on the clinical outcome using patient reported outcome measures (PROMs). Since there is a large variability among clinical outcomes, we focused on the three most utilized PROMs (VAS, WOMAC, and HHS) and the latest follow-up time point.

Results: Of the 716 studies reviewed, thirty-six studies (n=36) fit inclusion criteria. There were 21 studies examining HA, 11 on PRP, 3 for MFAT, 2 for ACT, and 3 on BMA/BMAC. Eight studies were randomized controlled trials and 28 were cohort studies. The mean age of the patient population ranged from 45 ± 17.0 to 74 ± 8.0. The baseline grade of osteoarthritis ranged from 1-4 but was most reported as moderate (2-3). Overall, there was an improvement in PROMs at the latest follow-up after receiving orthobiologic interventions.

Discussion: Orthobiologic injections have shown promise for improving PROMs in patients with hip OA. Future studies should evaluate long-term efficacy and include randomized trials to establish efficacy.