Journal of Experimental Orthopaedics最新文献

Purpose

Hip arthroscopy has gained popularity among orthopaedic procedures over the last decade. The present study aims to evaluate the trends of hip arthroscopy procedures in Italy analysing data recorded by the Italian Ministry of Health, reporting demographics, length of hospitalisation (LOS), diagnosis and the economic impact of the procedure.

Methods

The National Hospital Discharge records reported by the Italian Ministry of Health were used, analysing the data regarding hip arthroscopy procedures performed in Italy between 2001 and 2016. A total of 4022 hip arthroscopies were performed in Italy in the adult population.

Results

The present study shows more males being exposed to the procedure, while the mean age of females was always higher than that of males during the 16-year study period. The mean LOS was 2.6 ± 3.2 days, and every procedure had a mean Italian hospital reimbursement from 1361€ to 1512€. Hip arthroscopy procedures have increased substantially between the years 2001 and 2016, as well as the costs related to the surgery.

Conclusions

The findings of this study constitute valuable clinical and scientific evidence for the healthcare system, which is useful not only for the formulation and improvement of national healthcare policies but also to improve awareness and accessibility of hip arthroscopy.

Level of Evidence

Level II.

Purpose

Shoulder dislocations in professional football are severe injuries with an increasing incidence and considerable layoff times. Unlike other football injuries, the mechanisms leading to shoulder dislocations are not well understood, which limits the development of targeted preventive measures. Thus, the aims of this study were: (1) to analyse injury mechanisms of shoulder dislocations in professional football, (2) to evaluate situational and (3) to assess kinematic patterns by performing a systematic video analysis.

Methods

The study included all shoulder dislocations occurring in official matches within Germany's top two professional male football (soccer) leagues (1. and 2. Bundesliga) from the 2012/2013 to the 2022/2023 seasons. A systematic video analysis was performed using the official Bundesliga video database. Two independent reviewers assessed injury-related, situational and kinematic parameters.

Results

A total of 37 shoulder dislocations in 36 players (mean age 25 years) were analysed. Two primary injury mechanisms were identified: Type 1 mechanisms, caused by direct contact to the upper extremity (n = 14), and Type 2 mechanisms, caused by catching a fall (n = 22). Only one case did not fit these categories. Median layoff times were 94 days for Type 1 and 56 days for Type 2, but this difference was not statistically significant. Statistically significant differences between the two types were found in player action (p < 0.001) and type of contact (p = 0.005), while factors like player's speed, movement direction, football-specific actions, ball possession and pitch location showed no statistically significant differences. On-field treatment methods varied, but there were no statistically significant differences in repositioning attempts or reduction techniques (n.s.). Trunk position, shoulder joint version, shoulder elevation, and rotation, as well as elbow and wrist joint positions at the moment of dislocation, were similar between the two types (n.s.).

Conclusion

Shoulder dislocations in professional football typically occur through direct contact or catching a fall, indicating a potential role for specific preventive measures.

Level of Evidence

Level III.

Purpose

The efficacy of medial pivot total knee arthroplasty (MP TKA) in treating valgus knees that may cause medial instability is unknown. The purpose of this study was to investigate the in vivo kinematics of MP TKA for the valgus knees and compare them to those for the varus knees.

Methods

The kinematics of 19 valgus knees and 19 varus knees operated in the MP TKA were investigated under fluoroscopy during squatting using a two- to three-dimensional registration technique. Accordingly, the valgus and varus knees were evaluated and compared in terms of knee flexion angle, anteroposterior translation for the medial and lateral low contact points, axial rotation and valgus–varus angle of the femoral component relative to the tibial component, as well as kinematic pathways.

Results

The knee flexion angle was found to be identical in both knees. There was no anterior translation on the medial side of the valgus knees, and no difference was detected between the two knees. On the lateral side, posterior translation was observed in both knees, with no difference between the two. Femoral external rotation was observed in both knees, and no difference was detected between the two. There was no valgus–varus change in the valgus knees, nor was there a difference between the two knees. The valgus knees demonstrated MP motion, whereas the varus knees demonstrated MP motion and bicondylar rollback.

Conclusion

The medial side of the valgus knees treated with MP TKA showed comparable stable kinematics to the varus knees. The MP TKA is an effective procedure for valgus knees to stabilize the medial compartment.

Level of Evidence

Level Ⅲ.

Purpose

Assessing scapulothoracic kinematics typically involves visually observing patients during movement, which has limited inter- and intraobserver reliability. Dynamic rasterstereography (DRS) records, measures and visualizes surface structures in real time, using a curvature map to colour-code convex, concave and saddle-shaped structures on the body surface. This study aimed to evaluate the diagnostic efficacy of DRS-assisted observation in identifying dyskinetic scapulothoracic patterns.

Methods

Thirty-seven healthy participants performed shoulder abduction/adduction and flexion/extension cycles without additional weight, recorded using both DRS and a conventional video camera. A metronome ensured consistent timing, and for DRS a grid of parallel light rays projected onto the back surface was captured using indirect optical measurement techniques. The mean surface curvature was converted into a colour scale. The diagnostic performance of conventional and DRS videos in detecting dyskinetic patterns, including static asymmetries, dynamic asymmetries, motion delays and rapid compensatory movements, were compared. Two investigators independently evaluated the videos twice in a blinded and randomized sequence to assess intra- and interrater reproducibility.

Results

Analysis of 118 videos showed good-to-excellent intrarater and interrater reproducibility for both techniques (ICCs 0.727–0.949). Movement delays and dynamic asymmetries were observed more frequently when evaluating DRS videos rather than conventional videos (p = 0.0008 and p = 0.0016). However, no differences were found in static asymmetry and rapid compensatory movement detection.

Conclusions

DRS can create a real-time model of the trunk surface and allows observers to evaluate the scapular movements with good-to-excellent intrarater and interrater reproducibility; compared to clinical observation, some specific scapular motion alterations can be observed more frequently.

Clinical Trial Registration: Part of the DRKS00022334 trial.

Level of Evidence

Level II, prospective cohort study.

Purpose

Ruptures of the posterior cruciate ligament (PCL) are often accompanied by posterolateral corner (PLC) and posteromedial corner (PMC) injuries. This study investigates the incidence and impact of PMC and PLC injuries on posterior tibial translation (PTT). It was hypothesized that PMC injuries are more common and impactful than previously reported.

Methods

In this retrospective study, all patients with a PCL injury between January 2016 and December 2023 and received magnetic resonance imaging (MRI) within 30 days of trauma were included. Patients with atraumatic PCL instability, missing MRI or additional anterior cruciate ligament (ACL) rupture were excluded. Posttraumatic MRI was analyzed for peripheral injuries. Preoperative stress radiographs for PTT were measured, and the side-to-side difference was calculated. The statistical significance level was set at p < 0.05.

Results

Ninety-two patients were included, predominantly male (71.7%) with a mean age of 35.8 ± 15.6 years at injury. The mean time from injury to MRI was 7.3 ± 7.9 days. There were 16 patients (27.4%) with isolated PCL injuries. The prevalence of medial injuries (37.0% superficial medial collateral ligament [sMCL], 66.3% deep medial collateral ligament and 51.1% posterior oblique ligament [POL]) was comparable to lateral injuries (22.8% LCL, 55.4% PLC and 13.0% popliteus tendon). Injuries of the PMC (sMCL ± POL) occurred in 53 patients (57.6%) and of the PLC (POP ± PLC ± LCL) in 59 (64.1%) patients. PTT was significantly increased in the presence of a peripheral-associated injury compared to isolated PCL injury (p < 0.01). With a combined injury of PMC + PLC the PTT was significantly larger than in the case of a unilateral injury (p < 0.05 compared to PLC; p < 0.05 compared to PMC).

Conclusion

PCL injuries are commonly associated with PMC and/or PLC injuries. A PTT of >10 mm is equally caused by PLC and PMC-associated injuries. Knowledge about the severity and localization of peripheral-associated injuries is therefore essential for therapeutic decision-making.

Level of Evidence

Level III retrospective cohort study.

Purpose

Total knee arthroplasty (TKA) is the standard treatment of end-stage osteoarthritis. TKA is often used and, therefore, poses a healthcare and societal burden, which is likely to increase further. Headroom analyses evaluate a technology under development by making assumptions about its effectiveness. This article applies a headroom approach to forecast the potential value of innovations that improve TKA-related care in the Netherlands in terms of cost-effectiveness and surgeries avoided.

Methods

A state-transition model estimating lifetime direct health effects, healthcare- and societal costs and percentage of avoide d surgeries was developed. The model compared care as usual to five hypothetical interventions to calculate the headroom associated with (1) preventing the need for TKAs, (2) preventing the need for all TKA revisions, (3) postponing TKAs without quality-of-life loss, (4) preventing periprosthetic joint infections (PJIs) and (5) improving patient satisfaction.

Results

Preventing the need for all TKAs amounted to €43,076 of headroom. Preventing the need for TKA revisions amounted to €2276 (5.8% of surgeries avoided), postponing TKAs by 5 years amounted to €7634 (32.4% of surgeries avoided), preventing PJIs amounted to €1187 (1.4% of surgeries avoided) and improving patient satisfaction amounted to €16,622 (0% of surgeries avoided). The headroom of each hypothetical intervention was highest in younger populations (<50 years of age).

Conclusion

There is a headroom for improving TKA-related care. Innovations to avoid or postpone TKA (i.e., joint-preserving treatments) as well as those that improve patient satisfaction can be effective in maximizing the value for money and avoiding surgeries. Due to the decreasing average patient age, innovations to reduce revision rates and PJIs will become more valuable as these are most effective in younger patients. It is currently unclear how cost-effectiveness considerations should be traded off against the prevention of surgery to reduce the increasing burden on the healthcare system.

Level of Evidence

Level III economic evaluation/decision-analytic model.

Purpose

To determine the scope and accuracy of medical information provided by ChatGPT-4 in response to clinical queries concerning total shoulder arthroplasty (TSA), and to compare these results to those of the Google search engine.

Methods

A patient-replicated query for ‘total shoulder replacement’ was performed using both Google Web Search (the most frequently used search engine worldwide) and ChatGPT-4. The top 10 frequently asked questions (FAQs), answers, and associated sources were extracted. This search was performed again independently to identify the top 10 FAQs necessitating numerical responses such that the concordance of answers could be compared between Google and ChatGPT-4. The clinical relevance and accuracy of the provided information were graded by two blinded orthopaedic shoulder surgeons.

Results

Concerning FAQs with numeric responses, 8 out of 10 (80%) had identical answers or substantial overlap between ChatGPT-4 and Google. Accuracy of information was not significantly different (p = 0.32). Google sources included 40% medical practices, 30% academic, 20% single-surgeon practice, and 10% social media, while ChatGPT-4 used 100% academic sources, representing a statistically significant difference (p = 0.001). Only 3 out of 10 (30%) FAQs with open-ended answers were identical between ChatGPT-4 and Google. The clinical relevance of FAQs was not significantly different (p = 0.18). Google sources for open-ended questions included academic (60%), social media (20%), medical practice (10%) and single-surgeon practice (10%), while 100% of sources for ChatGPT-4 were academic, representing a statistically significant difference (p = 0.0025).

Conclusion

ChatGPT-4 provided trustworthy academic sources for medical information retrieval concerning TSA, while sources used by Google were heterogeneous. Accuracy and clinical relevance of information were not significantly different between ChatGPT-4 and Google.

Level of Evidence

Level IV cross-sectional.

Purpose

The purpose of this study was to determine the effects of medial opening low tibial osteotomy (LTO) on lower limb alignment, including the knee joint, 1 year after low tibial osteotomy.

Methods

This study included 20 legs of 20 patients (mean age, 66.8 ± 5.4 years) who underwent LTO for medial ankle osteoarthritis and evaluated the changes in the hip–knee–ankle angle (HKA), percentage hip-to-ankle line (%HA), percentage hip-to-calcaneal line (%HC), medial proximal tibial angle (MPTA), knee joint line convergence angle (K-JLCA), tibio-calcaneal angle (TCA), tibial anterior surface angle (TAS), tibio-plafond inclination (TPI), talar inclination (TI), ankle joint line convergence angle (A-JLCA), mechanical ankle joint axis point (MAJAP) on radiographs and the Japanese Society for Surgery of the Foot (JSSF) ankle/hindfoot scale before and 1 year after low tibial osteotomy.

Results

The mean preoperative/postoperative measured values showed the following: HKA (degrees) of 1.0 ± 3.7/−0.8 ± 3.7; %HC of 38.8 ± 10.0/53.8 ± 16.1; MPTA (degrees) of 85.6 ± 2.4/87.6 ± 2.1; and A-JLCA (degrees) of 4.2 ± 2.9/1.1 ± 2.3 respectively. Including other measurements, a significant increase in the %HA, %HC, MPTA, TCA, TAS, MAJAP and JSSF ankle/hindfoot scale was observed postoperatively, whereas a significant decrease in the HKA, TPA, TI and A-JLCA was observed postoperatively (p < 0.05). With the numbers available, no significant differences were observed between the preoperative and postoperative values of K-JLCA (n.s.).

Conclusion

After LTO, the entire lower limb alignment became valgus, and the loading points of the knee and ankle joints shifted laterally. These changes must be considered when performing LTO, especially in patients with lateral knee OA.

Level of Evidence

Ⅳ