Orthopedic Reviews最新文献

Background: Bipolar hemiarthroplasty (BHA) is commonly used for displaced femoral neck fractures but less frequently for unstable intertrochanteric fractures. This study aimed to compare outcomes of BHA in these two fracture types among elderly patients.

Methods: We retrospectively reviewed 319 femoral neck and 40 intertrochanteric fracture patients treated with BHA. After 1:4 propensity score matching, 38 intertrochanteric patients were compared with 152 femoral neck patients. Primary outcomes included operative time, blood loss, transfusion needs, hospital stay, and complications.

Results: The intertrochanteric group had significantly longer median operation time (195 vs. 170 minutes, p = 0.008), greater blood loss (300 vs. 200 mL, p < 0.001), and higher transfusion requirements postoperatively (2.4 vs. 0.7 units, p < 0.001). Hospital stay was longer (11.5 vs. 9 days, p < 0.001). Medical complications, particularly cardiovascular events (13.2% vs. 1.3%), were more common in the intertrochanteric group (p= 0.007). Surgical complication rates were similar between groups (p = 0.78).

Conclusions: BHA for unstable intertrochanteric fractures is associated with greater surgical burden and a higher risk of medical complications compared with its use for displaced femoral neck fractures. However, the similar rates of surgical complications observed suggest that bipolar hemiarthroplasty may be considered in carefully selected high-risk elderly patients when stable internal fixation is not feasible.

Background: Hip fracture in elderly patients represents a major clinical challenge, with recovery influenced not only by surgical factors but also by frailty, nutritional vulnerability, inflammation and postoperative pain trajectories. While acute postoperative pain is well studied, determinants of pain persistence and chronification remain unclear.

Objective: To investigate associations between nutritional screening tools, selected inflammatory and metabolic biomarkers, and postoperative pain outcomes in elderly patients undergoing hip fracture surgery. Secondary objectives included examining relationships with frailty and postoperative functional independence.

Methods: Eighty patients aged ≥80 years undergoing surgical repair of femoral neck or intertrochanteric fractures were prospectively enrolled. Preoperative assessments included frailty evaluation, Mini Nutritional Assessment-Short Form (MNA-SF), modified Nutrition Risk in the Critically Ill (mNUTRIC) score, APACHE and SOFA scores, and laboratory biomarkers (albumin, CRP, RDW, LDH, ferritin and calcium). Pain intensity was assessed using the Visual Analog Scale preoperatively, acutely postoperatively, at 30 days and at six months. Functional independence was evaluated after discharge. Associations were analyzed using Spearman's rank correlation.

Results: Acute postoperative pain was weakly associated with preoperative pain. Pain at 30 days and six months showed stronger associations with frailty, hypoalbuminemia, inflammatory markers and higher APACHE/SOFA scores. Lower MNA-SF and higher mNUTRIC scores were moderately associated with 30-day pain and strongly associated with chronic pain. Better nutritional status correlated with greater postoperative functional independence.

Conclusion: Chronic postsurgical pain in elderly hip fracture patients reflects frailty, nutritional depletion and metabolic stress rather than surgical injury alone. Integrating nutritional screening into perioperative care may improve recovery.

Periprosthetic joint infection (PJI) remains one of the most devastating complications of total joint arthroplasty (TJA), with profound clinical, economic and psychosocial consequences. While modern operating theatres are designed to reduce microbial load, there remains ongoing debate about the role of laminar airflow (LAF), turbulent ventilation, high-efficiency particulate air (HEPA) systems, ultraviolet adjuncts and surgical helmet systems (SHS) in mitigating infection risk. This narrative review synthesizes current evidence on airborne contamination, environmental controls and adjunctive measures in orthopaedic theatres. It highlights key advances in monitoring (e.g., particle counts vs. microbiological sampling), the impact of human behaviour on contamination and integrates findings with patient risk factors, operative efficiency and seasonality. It further examines economic and regulatory perspectives, providing a holistic framework for future directions in infection prevention.

Background: Revision total hip arthroplasty (THA) in the presence of severe acetabular bone loss remains technically demanding. Oversized, highly porous acetabular components ("Mega Cups") have been introduced to maximize host bone contact, enhance biological fixation, and restore the anatomical hip center.

Methods: A retrospective study was conducted between 2014 and 2022, including 34 hips reconstructed with highly porous Mega Cups for Paprosky type II and selected type III defects. Clinical outcomes (Harris Hip Score [HHS], WOMAC, pain VAS), radiographic stability, complications, and implant survivorship were analyzed at mid-term follow-up.

Results: At a mean follow-up of 5.3 years, Mega Cups demonstrated 95.5% survivorship. Radiographic stability was achieved in 90.9% of hips, with graft incorporation observed in 88.9%. Functional recovery was substantial: HHS improved by +34.4 points, WOMAC decreased by -37.8, and pain VAS declined by -4.8 (all p < 0.001 vs. baseline). Subgroup analysis confirmed excellent outcomes in Paprosky II defects and in patients aged 40-65 years. Complication rates were low, with dislocation (2.9%), mechanical failure (2.9%), superficial infection (8.6%), and thromboembolism (2.9%) within published benchmarks.

Conclusion: Highly porous oversized acetabular cups provide reliable fixation, durable mid term survivorship, and superior functional improvement in revision THA for Paprosky II and selected III defects. Their ability to maximize host bone contact and reduce reliance on grafts makes them a dependable option in complex acetabular reconstructions. Longer multicenter studies are warranted to validate durability beyond 10 years and to benchmark outcomes against alternative strategies.

Background: Acute compartment syndrome of the leg is a well-documented orthopedic emergency; however, cases missed following open reduction and internal fixation (ORIF) of tibial plateau fractures are rarely reported. Delayed diagnosis can lead to severe sequelae such as foot deformity and functional impairment, posing significant challenges for rehabilitation.

Case presentation: We report the case of a 41-year-old female presenting with chronic sequelae of missed compartment syndrome 6 months after ORIF for a Schatzker II tibial plateau fracture. Clinical presentation included progressive equinus deformity, ankle stiffness, loss of active dorsiflexion, sensory disturbance in the anterolateral leg and dorsum of the foot, and an inability to maintain a plantigrade foot during ambulation. The patient underwent a comprehensive late reconstruction strategy, comprising percutaneous Achilles tendon lengthening, common peroneal nerve release, deep flexor tendon release, and the Bridle procedure to restore active dorsiflexion.

Results: At the 6-year follow-up, the patient achieved a plantigrade foot, improved gait mechanics without equinus deformity, restoration of active dorsiflexion, and sensory recovery. The AOFAS Ankle-Hindfoot Scale score was 73/100, indicating good functional recovery.

Conclusion: Missed compartment syndrome after ORIF of tibial plateau fractures can cause severe functional impairment if not recognized early. In chronic cases, a personalized reconstruction strategy combining tendon lengthening, nerve release, and tendon transfer can provide sustained functional improvement, even when intervention is delayed.

Femoral neck fractures (FNFs) remain one of the most devastating injuries in adult patients, associated with a high morbidity, mortality and economic burden worldwide. The global incidence of hip fractures exceeds 1.6 million annually and is projected to rise to between 4.5 and 6.5 million by 2050. FNFs account for approximately 50% of all hip fractures and are strongly associated with aging, osteoporosis and frailty. Mortality rates remain high, approaching 10% within the first month and up to 36% within one year of injury. While displaced FNFs are widely managed with arthroplasty, the role of internal fixation (IF) in minimally displaced fractures is controversial, particularly in the context of emerging evidence highlighting high significant reoperation rates after fixation. Current treatment pathways must balance functional recovery, risk of complications such as dislocation, periprosthetic fracture and infection with long-term implant survivorship. Evolving strategies include utilising dual mobility (DM) total hip arthroplasty (THA) to mitigate instability and registry-based comparisons that refine patient selection criteria for hemiarthroplasty (HA) versus THA. Classification systems such as Garden, Pauwels, and AO/OTA remain central to guiding treatment, though their reliability is limited, and simplified displaced/undisplaced categorization improves interobserver agreement. This review synthesises contemporary evidence across epidemiology, surgical timing, classification, fixation versus arthroplasty, innovations in implant design, complications, outcomes, and policy implications, integrating registry analyses, randomised trials, and systematic reviews.

Orthopedic surgical procedures are consistently associated with significant postoperative pain due to extensive tissue manipulation, osseous injury, and inflammatory responses. Effective perioperative analgesia is therefore fundamental to successful orthopedic outcomes, influencing early mobilization, complication rates, length of hospital stay, and patient satisfaction. Although opioid-sparing and enhanced recovery after surgery (ERAS) pathways have gained popularity, opioids remain central to analgesic management in orthopedic operating rooms. This narrative review examines the opioids most commonly used in orthopedic perioperative care, including fentanyl, morphine, remifentanil, hydromorphone, oxycodone, sufentanil, and methadone. Emphasis is placed on pharmacologic properties, clinical indications, dosing considerations, adverse effects, and comparative evidence in orthopedic populations. In addition, the evolving role of opioids within multimodal analgesia frameworks is discussed, with attention to balancing effective pain control against opioid-related risks.

Background: Gabapentinoids are commonly incorporated into multimodal analgesia protocols for total knee arthroplasty (TKA) to reduce opioid use, yet new evidence suggests important safety concerns. Past studies often label gabapentinoid exposure as a binary variable, without taking into account factors such as chronic continuation, perioperative initiation, and no use, which may carry distinct postoperative risks.

Methods: Adults undergoing primary TKA in a large federated EHR network were classified into three perioperative gabapentinoid exposure groups: continuation, new-start, or never use. Postoperative outcomes were evaluated at 30 and 90 days, with risks summarized as risk ratios and hazard ratios with 95% confidence intervals.

Results: After matching, 126,941 patients were included in the continuation vs never comparison, 6,227 in continuation vs new start, and 6,221 in new start vs never. Compared with never users, continuation was associated with higher 30- and 90-day risks of acute respiratory failure, acute renal failure, sepsis, venous thromboembolism, emergency department utilization, and postoperative infection. New-start use showed a consistently adverse profile, with increased risks of acute renal failure, postoperative infection, venous thromboembolism, and emergency department utilization at both time points vs never use. Continuation and new-start users had largely similar complication rates, with no clear benefits of continuation.

Conclusions: Perioperative gabapentinoid exposure following TKA is associated with higher short-term postoperative complication rates than no exposure, greatest with new initiation and intermediate with continuation. These findings argue against routine perioperative gabapentinoid use in TKA enhanced recovery pathways and support a patient-specific approach pending further randomized evaluation.

Benzodiazepines are frequently administered in orthopedic anesthesia for anxiolysis, sedation, amnesia, and seizure prophylaxis. Their role continues to evolve with the growing use of regional anesthesia, outpatient joint procedures, and enhanced recovery after surgery (ERAS) pathways. This narrative review examines the pharmacology, mechanisms of action, clinical indications, contraindications, and key clinical studies of benzodiazepines commonly used in the operating room in the United States, with a specific focus on their application in orthopedic surgical practice.

Background: Osteoarthritis (OA) is a degenerative joint disorder that causes pain, stiffness, and functional impairment. Conventional treatments relieve symptoms but do not restore cartilage, limiting long-term efficacy. Cell-based therapies, including mesenchymal stem cells (MSCs) and MSC-derived secretome, have emerged as promising strategies for cartilage regeneration.

Object: This study aimed to assess the therapeutic effects of UC-MSCs and UC-MSC-derived secretome in OA patients through both clinical outcomes and synovial fluid (SF) analyses.

Methods: Eligible participants were divided into two groups; group who underwent arthroscopy and group who did not. All the participants received an intra-articular injection consisting of an initial 2 mL dose of UC-MSC secretome, followed by 10 million UC-MSCs, and two additional 2 mL doses of secretome administered biweekly. Synovial fluid samples were collected at baseline and 12 weeks post-treatment, centrifuged to obtain the supernatant, and analyzed for inflammatory cytokines and matrix-degrading markers using multiplex and ELISA assays. Clinical evaluations were conducted at 6- and 12-months post-treatment.

Result: The results showed that UC-MSC therapy significantly improved functional outcomes in patients with knee osteoarthritis, as indicated by WOMAC scores up to six months. In vitro studies showed similar results, where co-culture of osteoarthritic synovial fluid-derived MSCs with UC-MSCs or UC-MSC secretome enhanced proliferation and differentiation while rapidly reducing pro-inflammatory cytokines (IL-1β, IFN-γ, IL-6, IL-12p70, IL-17A, IL-18) and MMPs (MMP1, MMP7, MMP13).

Conclusion: Our findings support a two-stage therapeutic strategy in which UC-MSC secretome first alleviates inflammation, followed by UC-MSCs to promote cartilage regeneration. Post-injection rehabilitation or repeated MSC dosing may further enhance treatment efficacy, highlighting the potential of MSC-based therapies for knee OA management.