Journal of Experimental Orthopaedics最新文献

Reproducibility of a new device for robotic-assisted TKA surgery

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2025-02-18 DOI: 10.1002/jeo2.70153

Domenico Alesi, Vito Gaetano Rinaldi, Tosca Cerasoli, Davide Valente, Giulio Maria Marcheggiani Muccioli, Stefano Zaffagnini

Purpose

Enhancing implant placement to achieve optimal gap balance is crucial in total knee arthroplasty (TKA). Given the limited precision of traditional instrumentation, tools like computer-assisted surgery and robotic-assisted TKA have emerged. This experimental cadaveric study aimed to evaluate the accuracy and reproducibility of the collaborative image-free Robin robotic system to support its future clinical application.

Methods

Fifteen cadaveric specimens were treated by eight experienced TKA surgeons. All surgeons, experts in computer-assisted TKA but new to the Robin system, received standardized training. The Robin system uses a robotic arm to position and hold a universal cutting jig, while surgeons perform osteotomies. The indicator for registration repeatability was the alignment of the cutting block position with the previous pin placement. Bony resection, angles and axes were evaluated by comparing the preoperative planning values to the ones obtained with the Robin system with a validated navigation system.

Results

There were no statistically significant differences between the planned and measured values for most resection angles, except for femoral and tibial orientation on sagittal plane (0.6 ± 0.8° and 0.6 ± 1.0°, respectively). Similarly, no statistically significant differences were recorded for resection thickness values, except for the distal medial femoral cut (0.8 ± 0.7 mm). Moreover, these results showed consistency among the different first-time users.

Conclusions

The study found that the Robin robotic system closely matched the preoperative plan for TKA, demonstrating high accuracy and consistency among first-time users. This allows surgeons to easily achieve their planned targets without having to adapt their surgical technique, potentially improving both efficiency and outcomes even when handling complex cases.

Level of Evidence

Not applicable.

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引用次数: 0

The central fibre areas in the tibial footprint of the posterior cruciate ligament show the highest contribution to restriction of a posterior drawer force—A biomechanical robotic investigation

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2025-02-17 DOI: 10.1002/jeo2.70174

Adrian Deichsel, Thorben Briese, Wenke Liu, Michael J. Raschke, Alina Albert, Christian Peez, Elmar Herbst, Christoph Kittl

Purpose

The purpose of this study was to determine the role of different fibre areas of the tibial footprint of the posterior cruciate ligament (PCL) in restraining posterior tibial translation.

Methods

A sequential cutting study on cadaveric knee specimens (n = 8) was performed, utilizing a six-degrees-of-freedom robotic test setup. The tibial attachment of the PCL was divided into nine areas, which were sequentially cut in a randomized sequence. After determining the native knee kinematics with 89 N anterior, and posterior tibial translation force at 0°, 30°, 60° and 90° knee flexion, a displacement-controlled protocol was performed replaying the native motion. Utilizing the principle of superposition, the reduction of the restraining force represents the contribution (in-situ forces) of each cut fibre area.

Results

The PCL was found to contribute 25.3 ± 11.1% in 0° of flexion, 49.7 ± 19.2% in 30° of flexion, 58.9 ± 19.3% in 60° of flexion and 50.6 ± 15.1% in 90° of flexion, to the restriction of a posterior drawer force. Depending on the flexion angle, every cut area of the tibial PCL footprint was shown to be a significant restrictor of posterior tibial translation (p ≤ 0.05). When investigating the fibre areas from anterior to posterior, the central fibre areas showed the highest contribution (35.0%–44.3%). When investigating the fibre areas from medial to lateral, the lateral fibre areas showed the highest contribution (41.4%–43.6%) from 0 to 30° knee flexion, while the medial fibre areas showed the highest contribution (41.5%) in 90° knee flexion.

Conclusion

The central row areas in the tibial footprint of the PCL were identified to be the main contributors inside the tibial footprint, while, depending on the flexion angle, the medial or lateral column fibre areas showed a higher contribution. These findings might inform the clinician to place a PCL graft centrally into the tibial footprint during reconstruction.

Level of Evidence

Not applicable.

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引用次数: 0

The short version of the ALR-RSI scale is a valid and reproducible scale to evaluate psychological readiness to return to sport after ankle lateral reconstruction

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2025-02-17 DOI: 10.1002/jeo2.70160

Alizée Mahieu, Mohamad K. Moussa, Eugénie Valentin, Ronny Lopes, Alexandre Hardy

Purpose

To develop and validate a short and mini version of the ALR-RSI (Ankle Ligament Reconstruction-Return to Sport after Injury) scale.

Methods

The ALR-RSI scale contains 12 items and was administered to 109 patients following arthroscopic anatomical lateral ankle reconstruction. The short (6-item) and mini (3-item) versions were developed using a systematic selection process to eliminate items based on their category, mean, standard deviation and pertinence. A second group of 75 patients participated in an analysis to validate the predictive value of these scores. These patients filled out all three ALR-RSI versions 6 months after arthroscopic anatomical reconstruction of the lateral ankle to determine the predictive value for the return to sport (RTS) at 12 months. The predictive value was evaluated with receiver operating characteristic curves (area under the curve [AUC]).

Results

The long version of the ALR-RSI had a high internal consistency (Cronbach's α = 0.97), suggesting redundancy of certain items. A short version of 6 items was developed (Cronbach's α = 0.94). A mini version of 3 items was also developed which retained one key item from each category. Factorial analysis confirmed that only one factor explained 76% of the total variance in the mini version (Cronbach's α = 0.89). The scores of the three versions were higher in patients who returned to sport at the same pre-injury level of play or better (p < 0.0001). Both versions were found to have a good predictive value for the RTS at 12 months, with comparable AUC values (full version AUC 0.70 [95% confidence interval; CI, 0.57–0.83]; short version AUC 0.72 [95% CI, 0.59–0.84]); mini version, AUC 0.73 [95% CI, 0.61–0.85].

Conclusion

The shorter versions (6 and 3 items) of the ALR-RSI may be used to predict the RTS at the pre-injury level without affecting the psychometric characteristics of the long score.

Level of Evidence

Level II prospective cohort study.

{"title":"The short version of the ALR-RSI scale is a valid and reproducible scale to evaluate psychological readiness to return to sport after ankle lateral reconstruction","authors":"Alizée Mahieu, Mohamad K. Moussa, Eugénie Valentin, Ronny Lopes, Alexandre Hardy","doi":"10.1002/jeo2.70160","DOIUrl":"https://doi.org/10.1002/jeo2.70160","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To develop and validate a short and mini version of the ALR-RSI (Ankle Ligament Reconstruction-Return to Sport after Injury) scale.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The ALR-RSI scale contains 12 items and was administered to 109 patients following arthroscopic anatomical lateral ankle reconstruction. The short (6-item) and mini (3-item) versions were developed using a systematic selection process to eliminate items based on their category, mean, standard deviation and pertinence. A second group of 75 patients participated in an analysis to validate the predictive value of these scores. These patients filled out all three ALR-RSI versions 6 months after arthroscopic anatomical reconstruction of the lateral ankle to determine the predictive value for the return to sport (RTS) at 12 months. The predictive value was evaluated with receiver operating characteristic curves (area under the curve [AUC]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The long version of the ALR-RSI had a high internal consistency (Cronbach's <i>α</i> = 0.97), suggesting redundancy of certain items. A short version of 6 items was developed (Cronbach's <i>α</i> = 0.94). A mini version of 3 items was also developed which retained one key item from each category. Factorial analysis confirmed that only one factor explained 76% of the total variance in the mini version (Cronbach's <i>α</i> = 0.89). The scores of the three versions were higher in patients who returned to sport at the same pre-injury level of play or better (<i>p</i> < 0.0001). Both versions were found to have a good predictive value for the RTS at 12 months, with comparable AUC values (full version AUC 0.70 [95% confidence interval; CI, 0.57–0.83]; short version AUC 0.72 [95% CI, 0.59–0.84]); mini version, AUC 0.73 [95% CI, 0.61–0.85].</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The shorter versions (6 and 3 items) of the ALR-RSI may be used to predict the RTS at the pre-injury level without affecting the psychometric characteristics of the long score.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level II prospective cohort study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70160","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143431406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Which treatment strategy for irreparable rotator cuff tears is most cost-effective? A Markov model-based cost-utility analysis comparing superior capsular reconstruction, lower trapezius tendon transfer, subacromial balloon spacer implantation and reverse shoulder arthroplasty

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2025-02-13 DOI: 10.1002/jeo2.70180

Jacob F. Oeding, Kyle N. Kunze, Ayoosh Pareek, Kristian Samuelsson

Purpose

Treatment options for irreparable rotator cuff tears (IRCTs) remain controversial and include superior capsular reconstruction (SCR), lower trapezius tendon transfer (LTTT), subacromial balloon spacer (SABS), and reverse shoulder arthroplasty (RSA). Despite reports of positive treatment responses with all approaches, the relative clinical benefit in the context of associated cost has not been well delineated. The purpose of this study was to determine the most cost-effective treatment strategy among SCR, LTTT, SABS, and RSA for patients with massive IRCTs.

Methods

A Markov Chain Monte Carlo probabilistic model was developed to evaluate the outcomes and costs of 1000 simulated patients undergoing either SCR, LTTT, SABS, or RSA for massive IRCTs. Upfront costs, health utility values, and reoperation rates including revisions and conversion to RSA were derived from the published literature. Outcome measures included costs, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER).

Results

Mean total costs of SCR, RSA, LTTT, and SABS were $30,540 ± 5,770, $26,896 ± 5,622, $25,819 ± 4,325, and $16,412 ± 2,583, respectively. On average, total QALYs from SCR, RSA, LTTT, and SABS were 6.17 ± 0.53, 3.78 ± 0.38, 5.33 ± 0.49, and 5.59 ± 0.48. Overall, SCR was determined the preferred, most cost-effective strategy in 60% of patients included in the microsimulation model, with SABS the optimal strategy in 31% of cases and LTTT the optimal strategy in 9% of cases.

Conclusion

SCR was found to be the most cost-effective treatment option for IRCTs based on the current microsimulation and probabilistic sensitivity analyses, although LTTT and SABS were also found to be cost-effective in select patients. Given that this statistical model does not consider the unique experiences of individual patients, shared decision-making remains an important component in determining the optimal treatment strategy for IRCTs.

Level of Evidence

Level III, economic decision model.

{"title":"Which treatment strategy for irreparable rotator cuff tears is most cost-effective? A Markov model-based cost-utility analysis comparing superior capsular reconstruction, lower trapezius tendon transfer, subacromial balloon spacer implantation and reverse shoulder arthroplasty","authors":"Jacob F. Oeding, Kyle N. Kunze, Ayoosh Pareek, Kristian Samuelsson","doi":"10.1002/jeo2.70180","DOIUrl":"https://doi.org/10.1002/jeo2.70180","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Treatment options for irreparable rotator cuff tears (IRCTs) remain controversial and include superior capsular reconstruction (SCR), lower trapezius tendon transfer (LTTT), subacromial balloon spacer (SABS), and reverse shoulder arthroplasty (RSA). Despite reports of positive treatment responses with all approaches, the relative clinical benefit in the context of associated cost has not been well delineated. The purpose of this study was to determine the most cost-effective treatment strategy among SCR, LTTT, SABS, and RSA for patients with massive IRCTs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A Markov Chain Monte Carlo probabilistic model was developed to evaluate the outcomes and costs of 1000 simulated patients undergoing either SCR, LTTT, SABS, or RSA for massive IRCTs. Upfront costs, health utility values, and reoperation rates including revisions and conversion to RSA were derived from the published literature. Outcome measures included costs, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Mean total costs of SCR, RSA, LTTT, and SABS were $30,540 ± 5,770, $26,896 ± 5,622, $25,819 ± 4,325, and $16,412 ± 2,583, respectively. On average, total QALYs from SCR, RSA, LTTT, and SABS were 6.17 ± 0.53, 3.78 ± 0.38, 5.33 ± 0.49, and 5.59 ± 0.48. Overall, SCR was determined the preferred, most cost-effective strategy in 60% of patients included in the microsimulation model, with SABS the optimal strategy in 31% of cases and LTTT the optimal strategy in 9% of cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>SCR was found to be the most cost-effective treatment option for IRCTs based on the current microsimulation and probabilistic sensitivity analyses, although LTTT and SABS were also found to be cost-effective in select patients. Given that this statistical model does not consider the unique experiences of individual patients, shared decision-making remains an important component in determining the optimal treatment strategy for IRCTs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III, economic decision model.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70180","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143396767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

No significant impact of platelet-rich plasma on recovery after Achilles tendon surgery: A double-blind randomized controlled trial 富血小板血浆对跟腱手术后的恢复无明显影响：双盲随机对照试验

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2025-02-13 DOI: 10.1002/jeo2.70168

Youichi Yasui, Wataru Miyamoto, Jun Sasahara, Tsukada Keisuke, Maya Kubo, Gen Sasaki, Asako Yamamoto, Hirotaka Kawano

Purpose

Double-blind, randomized, placebo-controlled trials evaluating the efficacy and safety of Platelet-rich plasma (PRP) in the treatment of Achilles tendon rupture (ATR) have been scant. This study examines the therapeutic impact of PRP injection 3 weeks after surgery in middle-aged males.

Methods

This double-blind, randomized, placebo-controlled trial included consecutive ATR patients who satisfied the inclusion criteria and was conducted from 5 September 2018 to 24 June 2021. Three weeks after surgery using the side-locking loop technique, PRP or saline was injected at the suture site under ultrasound guidance. Evaluations were conducted at predetermined intervals (6, 10, 12, 16 and 24 weeks and 1 and 2 years) after surgery. The primary outcome was the period needed to perform a bilateral heel raise, and the important secondary outcomes were the periods needed to perform a single heel raise and 20 unilateral heel raises, respectively.

Results

There were seven participants in the PRP group and seven in the saline group. Demographically, both groups exhibited comparable characteristics. No complications were reported. At 6 weeks after surgery, all participants achieved bilateral heel raise. The PRP and saline groups averaged 12.3 ± 2.7 and 15.7 ± 5.9 weeks to achieve a single heel raise and 14.3 ± 2.7 and 17.7 ± 4.5 weeks to achieve 20 unilateral heel raises, respectively, with no significant differences between both groups. Moreover, no substantial disparities in clinical scores, period of jogging initiation and magnetic resonance imaging tendon assessments were noted.

Conclusions

PRP did not offer a distinct advantage over saline in terms of recovery from ATR in middle-aged males. This finding underscores the need to reassess the post-operative significance of PRP and highlights the importance of further research to determine its potential advantages and risks.

Level of Evidence

Level I.

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引用次数: 0

Open reduction and internal fixation offers lower hip-related complications compared to stem revision in Vancouver B2 fractures around cemented polished tapered femoral stems

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2025-02-13 DOI: 10.1002/jeo2.70179

Olof Sköldenberg, Sebastian Mukka, Michael Axenhus, Carl-Johan Hedbeck, Martin Magnéli

Purpose

Periprosthetic femoral fractures (PFFs) after total hip arthroplasty (THA) are increasing, particularly Vancouver B2 fractures around cemented polished tapered femoral stems. Open reduction and internal fixation (ORIF) are more frequently used in comparison to the traditional stem revision to deal with these complex fractures. This observational study aims to compare the outcomes of ORIF versus stem revision in the treatment of Vancouver B2.

Methods

A retrospective cohort study was conducted at Danderyd Hospital, Stockholm, from 2008 to 2022, including 157 patients (mean age 83.4 ± 7.0 years, 59% females) with a surgically treated Vancouver B2 fractures with an intact bone-cement interface. The study assessed the immediate and long-term outcomes of ORIF versus stem revision, examining post-operative complications, reoperation rates, and implant survivorship.

Results

Among the 157 patients, 37 were treated with ORIF and 120 with stem revision. The ORIF group, which consisted of older patients and had a higher prevalence of cognitive dysfunction, experienced no hip-related adverse events. In contrast, the revision group had a 17.8% incidence of adverse events. Mortality within 90 days was significantly higher in the ORIF group (24%) compared to the revision group (4%) (p = 0.0007). One-year mortality was also higher in the ORIF group (32%) than in the revision group (15%) (p = 0.03).

Conclusions

ORIF presents as a viable option for managing Vancouver B2 fractures in the proximity of a polished tapered stem when anatomical reduction is possible. The less invasive surgery provides potential advantages in patient outcomes and resource utilization. Further research is warranted to aid in the development of treatment guidelines.

Level of Evidence

III

{"title":"Open reduction and internal fixation offers lower hip-related complications compared to stem revision in Vancouver B2 fractures around cemented polished tapered femoral stems","authors":"Olof Sköldenberg, Sebastian Mukka, Michael Axenhus, Carl-Johan Hedbeck, Martin Magnéli","doi":"10.1002/jeo2.70179","DOIUrl":"https://doi.org/10.1002/jeo2.70179","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Periprosthetic femoral fractures (PFFs) after total hip arthroplasty (THA) are increasing, particularly Vancouver B2 fractures around cemented polished tapered femoral stems. Open reduction and internal fixation (ORIF) are more frequently used in comparison to the traditional stem revision to deal with these complex fractures. This observational study aims to compare the outcomes of ORIF versus stem revision in the treatment of Vancouver B2.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study was conducted at Danderyd Hospital, Stockholm, from 2008 to 2022, including 157 patients (mean age 83.4 ± 7.0 years, 59% females) with a surgically treated Vancouver B2 fractures with an intact bone-cement interface. The study assessed the immediate and long-term outcomes of ORIF versus stem revision, examining post-operative complications, reoperation rates, and implant survivorship.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 157 patients, 37 were treated with ORIF and 120 with stem revision. The ORIF group, which consisted of older patients and had a higher prevalence of cognitive dysfunction, experienced no hip-related adverse events. In contrast, the revision group had a 17.8% incidence of adverse events. Mortality within 90 days was significantly higher in the ORIF group (24%) compared to the revision group (4%) (<i>p</i> = 0.0007). One-year mortality was also higher in the ORIF group (32%) than in the revision group (15%) (<i>p</i> = 0.03).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>ORIF presents as a viable option for managing Vancouver B2 fractures in the proximity of a polished tapered stem when anatomical reduction is possible. The less invasive surgery provides potential advantages in patient outcomes and resource utilization. Further research is warranted to aid in the development of treatment guidelines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>III</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70179","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143404657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Epidemiology of hallux valgus surgery in Italy: A nationwide study from 2001 to 2016 意大利外翻手术的流行病学：2001年至2016年的全国性研究

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2025-02-13 DOI: 10.1002/jeo2.70142

Umile Giuseppe Longo, Rocco Papalia, Alessandro Mazzola, Sergio De Salvatore, Andrea Marinozzi, Stefano Campi, Ilaria Piergentili, Margaux D'Hooghe, Stefano Zaffagnini, Kristian Samuelsson, Vincenzo Denaro

Purpose

This study intended to estimate the annual number of hallux valgus surgical procedures in Italy and the patients' epidemiological features. A secondary goal was to compare the demographic differences in access to hallux valgus surgery amongst three Italian macroregions.

Methods

The analysis was conducted by using the National Hospital Discharge Records database provided by the Italian Ministry of Health.

Results

721,514 surgical procedures for Acquired Hallux valgus were performed. The cumulative incidence was 88.2 procedures for every 100,000 Italian residents. The highest number of procedures was found in the 60–64 age class. 91.2% of patients were females. The mean length of hospitalisation was 2.1 ± 2.2 days. Patients aged 95–99 had more days of hospitalisation on average. 51.9% of procedures were performed in the North, 25.7% in the Centre and 22.4% in the South. 98.5% of patients from the North received surgical treatment in the same macroregion of domicile: 90% in the Centre and 78.5% in the South. The main primary procedure was: bunionectomy with soft tissue correction and osteotomy of the first metatarsal (79.9%, 77.51 International Classification of Diseases, Ninth Revision, Clinical Modification code).

Conclusions

The socio-economic burden of hallux valgus surgery in Italy is relevant. The incidence of hallux valgus surgery has progressively increased between 2001 and 2012 and decreased from 2012 to 2016. A geographically unequal distribution of procedures between the three Italian macroregions was pointed out. Migratory flows of patients from the South to the North for undergoing the procedure were observed.

Level of Evidence

Level III.

{"title":"Epidemiology of hallux valgus surgery in Italy: A nationwide study from 2001 to 2016","authors":"Umile Giuseppe Longo, Rocco Papalia, Alessandro Mazzola, Sergio De Salvatore, Andrea Marinozzi, Stefano Campi, Ilaria Piergentili, Margaux D'Hooghe, Stefano Zaffagnini, Kristian Samuelsson, Vincenzo Denaro","doi":"10.1002/jeo2.70142","DOIUrl":"https://doi.org/10.1002/jeo2.70142","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study intended to estimate the annual number of hallux valgus surgical procedures in Italy and the patients' epidemiological features. A secondary goal was to compare the demographic differences in access to hallux valgus surgery amongst three Italian macroregions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The analysis was conducted by using the National Hospital Discharge Records database provided by the Italian Ministry of Health.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>721,514 surgical procedures for Acquired Hallux valgus were performed. The cumulative incidence was 88.2 procedures for every 100,000 Italian residents. The highest number of procedures was found in the 60–64 age class. 91.2% of patients were females. The mean length of hospitalisation was 2.1 ± 2.2 days. Patients aged 95–99 had more days of hospitalisation on average. 51.9% of procedures were performed in the North, 25.7% in the Centre and 22.4% in the South. 98.5% of patients from the North received surgical treatment in the same macroregion of domicile: 90% in the Centre and 78.5% in the South. The main primary procedure was: bunionectomy with soft tissue correction and osteotomy of the first metatarsal (79.9%, 77.51 International Classification of Diseases, Ninth Revision, Clinical Modification code).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The socio-economic burden of hallux valgus surgery in Italy is relevant. The incidence of hallux valgus surgery has progressively increased between 2001 and 2012 and decreased from 2012 to 2016. A geographically unequal distribution of procedures between the three Italian macroregions was pointed out. Migratory flows of patients from the South to the North for undergoing the procedure were observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70142","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143396768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Revolutionising orthopaedic imaging: From 2D radiography and computed tomography to 3D volumetric radiography

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2025-02-13 DOI: 10.1002/jeo2.70161

Ben Efrima, Amit Benady, Jari Dahmen, Gino M. M. J. Kerkhoffs, Jon Karlsson, Federico Giuseppe Usuelli

<p>Since its inception in 1972 [<span>12</span>], spiral computed tomography (CT) has become an invaluable diagnostic tool, offering precise three-dimensional (3D) image acquisition [<span>3</span>]. However, spiral CT has several potential limitations; it is relatively expensive and space-consuming, making it accessible only to large clinics or hospitals. Additionally, it requires high radiation exposure, posing potential risks to both patients and medical personnel. Lastly, image acquisition is performed in a non-weight-bearing position.</p><p>Cone beam computed tomography (CBCT) emerged in the late 1990s as an alternative. CBCT machines utilise X-rays in the form of a large cone that covers the designated surface to be examined. Unlike the traditional CT, CBCT machines employ rotating flat panel. This design allows the machine to irradiate a large volume area rather than a thin slice, requiring only a single rotation to gather all the necessary information for reconstructing the region of interest (ROI) and creating 3D reconstructions quickly, with low radiographic exposure. Moreover, the scanner is relatively small and affordable compared with spiral CT, making it suitable for in-office use. Finally, a major disadvantage of CBCT was its high susceptibility to metal artifacts. Currently, computer algorithms are implemented in the devices, as such, it is not any more of a problem than it is for conventional CT [<span>12</span>].</p><p>The concept of acquiring images in a vertical position, rather than solely horizontally, originated in dentistry with the clinical introduction of CBCT [<span>12</span>]. Over the last decade, vertical CBCT has been introduced to orthopaedic surgery in the form of weight-bearing CT (WBCT) [<span>5-8, 13</span>]. This technology enables image acquisition in the weight-bearing position, providing a 3D view of the upper and lower limb under the load of the body's weight. The use of WBCT has significantly improved the visualisation of foot and ankle morphology under load-bearing conditions, enhancing diagnostic capabilities and providing more precise postoperative follow-up. Consequently, in certain countries, surgeons are using WBCT as an in-office device, enabling orthopaedic surgeons to provide accurate 3D imaging already during patient visits without the need for referral to large medical centres. This development has made 3D image acquisition more accessible in the ordinary day-to-day practice.</p><p>While WBCT provides a reliable representation of the 3D morphology of the foot, standard imaging software still requires surgeons to rely on 2D slices in the coronal, axial, and sagittal planes within the 3D scan. Traditionally, creating accurate 3D models has required a manual segmentation process, where surgeons had to outline the 3D boundaries of each individual bone. The imaging analysis software would then analyse the manual segmentation to create a 3D model of the scanned area [<span>4-7</span>]. This segmentat

{"title":"Revolutionising orthopaedic imaging: From 2D radiography and computed tomography to 3D volumetric radiography","authors":"Ben Efrima, Amit Benady, Jari Dahmen, Gino M. M. J. Kerkhoffs, Jon Karlsson, Federico Giuseppe Usuelli","doi":"10.1002/jeo2.70161","DOIUrl":"https://doi.org/10.1002/jeo2.70161","url":null,"abstract":"<p>Since its inception in 1972 [<span>12</span>], spiral computed tomography (CT) has become an invaluable diagnostic tool, offering precise three-dimensional (3D) image acquisition [<span>3</span>]. However, spiral CT has several potential limitations; it is relatively expensive and space-consuming, making it accessible only to large clinics or hospitals. Additionally, it requires high radiation exposure, posing potential risks to both patients and medical personnel. Lastly, image acquisition is performed in a non-weight-bearing position.</p><p>Cone beam computed tomography (CBCT) emerged in the late 1990s as an alternative. CBCT machines utilise X-rays in the form of a large cone that covers the designated surface to be examined. Unlike the traditional CT, CBCT machines employ rotating flat panel. This design allows the machine to irradiate a large volume area rather than a thin slice, requiring only a single rotation to gather all the necessary information for reconstructing the region of interest (ROI) and creating 3D reconstructions quickly, with low radiographic exposure. Moreover, the scanner is relatively small and affordable compared with spiral CT, making it suitable for in-office use. Finally, a major disadvantage of CBCT was its high susceptibility to metal artifacts. Currently, computer algorithms are implemented in the devices, as such, it is not any more of a problem than it is for conventional CT [<span>12</span>].</p><p>The concept of acquiring images in a vertical position, rather than solely horizontally, originated in dentistry with the clinical introduction of CBCT [<span>12</span>]. Over the last decade, vertical CBCT has been introduced to orthopaedic surgery in the form of weight-bearing CT (WBCT) [<span>5-8, 13</span>]. This technology enables image acquisition in the weight-bearing position, providing a 3D view of the upper and lower limb under the load of the body's weight. The use of WBCT has significantly improved the visualisation of foot and ankle morphology under load-bearing conditions, enhancing diagnostic capabilities and providing more precise postoperative follow-up. Consequently, in certain countries, surgeons are using WBCT as an in-office device, enabling orthopaedic surgeons to provide accurate 3D imaging already during patient visits without the need for referral to large medical centres. This development has made 3D image acquisition more accessible in the ordinary day-to-day practice.</p><p>While WBCT provides a reliable representation of the 3D morphology of the foot, standard imaging software still requires surgeons to rely on 2D slices in the coronal, axial, and sagittal planes within the 3D scan. Traditionally, creating accurate 3D models has required a manual segmentation process, where surgeons had to outline the 3D boundaries of each individual bone. The imaging analysis software would then analyse the manual segmentation to create a 3D model of the scanned area [<span>4-7</span>]. This segmentat","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70161","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143404658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Geriatric Nutritional Risk Index is a risk factor for long-term decreases in patient-reported outcome measures following total knee arthroplasty

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2025-02-12 DOI: 10.1002/jeo2.70170

Yasuhiko Kokubu, Shinya Kawahara, Satoshi Hamai, Yukio Akasaki, Taishi Sato, Toshiki Konishi, Takahiro Inoue, Yasuharu Nakashima

Purpose

Total knee arthroplasty (TKA) is an effective treatment for alleviating pain and improving function in patients with end-stage knee osteoarthritis. However, factors influencing long-term patient-reported outcome measures (PROMs) remain underexplored. This study aimed to evaluate the relationship between preoperative nutritional status, specifically the Geriatric Nutritional Risk Index (GNRI), and the long-term decline in PROMs following TKA.

Methods

We conducted a retrospective cohort study including patients who underwent TKA between 2000 and 2009. PROMs were assessed using the Knee Society Score (KSS) at two time points: an initial evaluation in 2012 (median postoperative 4 years) and a follow-up in 2023 (median 13 years). Preoperative GNRI, body mass index (BMI), and other demographic and clinical data were collected from medical records. Statistical analysis included paired t-tests and multivariate logistic regression to identify independent risk factors for long-term decline in KSS scores.

Results

A total of 75 patients completed follow-up assessments. Over the 11-year follow-up period, there was a significant decrease in the KSS functional activity scores (p < 0.001), with 47 patients experiencing a decline exceeding the minimal clinically important difference. A multivariate analysis revealed low preoperative GNRI (p = 0.0043) as a significant risk factor for long-term decline in PROMs.

Conclusion

Preoperative malnutrition, as indicated by a low GNRI, is a significant risk factor for long-term decline in functional outcomes following TKA. These findings highlight the importance of preoperative nutritional interventions and rehabilitation for improving the long-term outcomes of patients undergoing TKA.

Level of Evidence

Level III, retrospective cohort study.

{"title":"Geriatric Nutritional Risk Index is a risk factor for long-term decreases in patient-reported outcome measures following total knee arthroplasty","authors":"Yasuhiko Kokubu, Shinya Kawahara, Satoshi Hamai, Yukio Akasaki, Taishi Sato, Toshiki Konishi, Takahiro Inoue, Yasuharu Nakashima","doi":"10.1002/jeo2.70170","DOIUrl":"https://doi.org/10.1002/jeo2.70170","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Total knee arthroplasty (TKA) is an effective treatment for alleviating pain and improving function in patients with end-stage knee osteoarthritis. However, factors influencing long-term patient-reported outcome measures (PROMs) remain underexplored. This study aimed to evaluate the relationship between preoperative nutritional status, specifically the Geriatric Nutritional Risk Index (GNRI), and the long-term decline in PROMs following TKA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study including patients who underwent TKA between 2000 and 2009. PROMs were assessed using the Knee Society Score (KSS) at two time points: an initial evaluation in 2012 (median postoperative 4 years) and a follow-up in 2023 (median 13 years). Preoperative GNRI, body mass index (BMI), and other demographic and clinical data were collected from medical records. Statistical analysis included paired <i>t</i>-tests and multivariate logistic regression to identify independent risk factors for long-term decline in KSS scores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 75 patients completed follow-up assessments. Over the 11-year follow-up period, there was a significant decrease in the KSS functional activity scores (<i>p</i> < 0.001), with 47 patients experiencing a decline exceeding the minimal clinically important difference. A multivariate analysis revealed low preoperative GNRI (<i>p</i> = 0.0043) as a significant risk factor for long-term decline in PROMs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Preoperative malnutrition, as indicated by a low GNRI, is a significant risk factor for long-term decline in functional outcomes following TKA. These findings highlight the importance of preoperative nutritional interventions and rehabilitation for improving the long-term outcomes of patients undergoing TKA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III, retrospective cohort study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70170","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Recurrent posterior shoulder instability—Long-term results after arthroscopic posterior bone block with capsular reconstruction

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2025-02-12 DOI: 10.1002/jeo2.70166

Roman F. Karkosch, Juergen Slapar, Tomas Smith, Mathias Wellmann, Marc-Frederic Pastor, Hauke Horstmann

Purpose

This study reports the long-term post-operative clinical outcomes after arthroscopic posterior bone block augmentation with posterior capsular repair.

Methods

Eighteen shoulders (13 patients) with unidirectional posterior shoulder instability were treated with an arthroscopic posterior bone block augmentation and posterior capsular repair in 2011 and 2013 in a single specialized orthopaedic clinic. These patients were invited to participate in a clinical and radiological follow-up examination to receive long-term results regarding clinical outcomes, instability, and development of osteoarthritis (OA).

Results

From the initial study group, 13 patients (18 shoulders) could be obtained for a follow-up examination. The mean follow-up period was 111 months. At the final follow-up, two patients (two shoulders) reported recurrent subluxations with a positive apprehension sign. No redislocation was reported. Screw fixation was still in place in seven patients (38.9%). Overall, good clinical outcomes were achieved among Constant–Murley score (77.6 ± 16; p = 0.55), Rowe score (67.5 ± 22.1; p = 0.34), Walch–Duplay score (58.3 ± 28.2) and Western Ontario Shoulder Index (40.4 ± 23.3%; p = 0.96), showing insignificant changes compared with the 2-year results. Three shoulders developed severe OA (Samilson and Prieto III). No patient required arthroplasty.

Conclusion

Arthroscopic posterior bone block augmentation with posterior capsular repair represents a salvage procedure that can achieve long-term shoulder stability with overall moderate clinical results. Patients have to be informed about the probable need for implant removal and the high risk of OA development, especially in the presence of pre-existing cartilage damage, beforehand.

Level of Evidence

Level IV.

{"title":"Recurrent posterior shoulder instability—Long-term results after arthroscopic posterior bone block with capsular reconstruction","authors":"Roman F. Karkosch, Juergen Slapar, Tomas Smith, Mathias Wellmann, Marc-Frederic Pastor, Hauke Horstmann","doi":"10.1002/jeo2.70166","DOIUrl":"https://doi.org/10.1002/jeo2.70166","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study reports the long-term post-operative clinical outcomes after arthroscopic posterior bone block augmentation with posterior capsular repair.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Eighteen shoulders (13 patients) with unidirectional posterior shoulder instability were treated with an arthroscopic posterior bone block augmentation and posterior capsular repair in 2011 and 2013 in a single specialized orthopaedic clinic. These patients were invited to participate in a clinical and radiological follow-up examination to receive long-term results regarding clinical outcomes, instability, and development of osteoarthritis (OA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From the initial study group, 13 patients (18 shoulders) could be obtained for a follow-up examination. The mean follow-up period was 111 months. At the final follow-up, two patients (two shoulders) reported recurrent subluxations with a positive apprehension sign. No redislocation was reported. Screw fixation was still in place in seven patients (38.9%). Overall, good clinical outcomes were achieved among Constant–Murley score (77.6 ± 16; <i>p</i> = 0.55), Rowe score (67.5 ± 22.1; <i>p</i> = 0.34), Walch–Duplay score (58.3 ± 28.2) and Western Ontario Shoulder Index (40.4 ± 23.3%; <i>p</i> = 0.96), showing insignificant changes compared with the 2-year results. Three shoulders developed severe OA (Samilson and Prieto III). No patient required arthroplasty.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Arthroscopic posterior bone block augmentation with posterior capsular repair represents a salvage procedure that can achieve long-term shoulder stability with overall moderate clinical results. Patients have to be informed about the probable need for implant removal and the high risk of OA development, especially in the presence of pre-existing cartilage damage, beforehand.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70166","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0