Orthopaedics and Trauma最新文献

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Answers to the CME questions on Children's Orthopaedics 关于儿童骨科的CME问题解答

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-02-01 DOI: 10.1016/j.mporth.2024.12.009

引用次数: 0

The infected total knee replacement: the worst and unfortunately most frequent complication 感染全膝关节置换术：最严重和最常见的并发症

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-02-01 DOI: 10.1016/j.mporth.2024.12.006

Lee M Jeys, Romir Patel, Thomas Jenkins, Semay Baydar, Joseph Pagkalos

Periprosthetic joint infection (PJI) is the most common reason for early revision following total knee replacement surgery. It is associated with poor patient outcomes, prolonged inpatient stay, costly surgical interventions and extended treatment in the community. Despite advances in surgical technique, implants and operating room technology, PJI is an unresolved problem in arthroplasty. As the volume of knee replacement procedures continues to increase, PJI continues to be a significant burden for the health service. Treatment of PJI has historically been with two-stage exchange, but with single-stage revision surgery increasing in popularity for selected cases. In this review we aim to follow the patient journey from presentation to diagnosis and treatment, and discuss contemporary management strategies when treating this devastating complication.

假体周围关节感染（PJI）是全膝关节置换术后早期翻修的最常见原因。它与患者预后差、住院时间延长、昂贵的手术干预和在社区的长期治疗有关。尽管手术技术、植入物和手术室技术都有所进步，但PJI仍是关节置换术中尚未解决的问题。随着膝关节置换术的数量不断增加，PJI仍然是卫生服务的一个重大负担。PJI的治疗历来采用两期置换，但在特定病例中，单期翻修手术越来越受欢迎。在这篇综述中，我们的目标是跟随患者从表现到诊断和治疗的过程，并讨论治疗这种毁灭性并发症的当代管理策略。

引用次数: 0

Unicondylar knee replacements: the Oxford perspective 单髁膝关节置换术：牛津视角

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-02-01 DOI: 10.1016/j.mporth.2024.12.003

Richard Myatt, William Jackson

Anteromedial osteoarthritis is a common phenomenon in degenerative conditions of the knee. This limited wear pattern is contingent on a functioning anterior cruciate ligament and medial collateral ligament, and can be managed differently to tricompartmental or inflammatory arthritis. The UK National Institute for Health and Care Excellence (NICE) stipulate that patients with this pattern of disease should be offered the choice of either unicondylar (UKA) or total knee replacements, but many knee surgeons are either unfamiliar with UKA or do not readily include it in their practice. The Oxford UKA is an established and trusted prosthesis with excellent outcomes, yet cumulative marginal gains that improve outcomes further can be achieved by following the approach of high-volume centres. In this article we discuss the Oxford perspective on this subject, touching on the design philosophy, indications, perioperative pearls, day-case protocols, outcomes and tips for starting practice. The most common number of UKAs performed by knee surgeons a year is one; this article aims to provide readers with the understanding, confidence and tips to optimize UKA use within their practice and maximize patient outcomes.

前内侧骨关节炎是膝关节退行性疾病的常见现象。这种有限的磨损模式取决于前交叉韧带和内侧副韧带的功能，可以不同于三室关节炎或炎症性关节炎。英国国家健康与护理卓越研究所（NICE）规定，患有这种疾病的患者应该选择单髁（UKA）或全膝关节置换术，但许多膝关节外科医生要么不熟悉UKA，要么不愿意将其纳入实践。牛津UKA是一种成熟且值得信赖的假体，具有良好的效果，但通过遵循大容量中心的方法，可以进一步提高效果的累积边际收益。在这篇文章中，我们讨论了牛津大学对这一主题的看法，涉及设计理念、适应症、围手术期珍珠、日常病例协议、结果和开始实践的提示。膝关节外科医生每年进行的UKAs最常见的次数是一次；本文旨在为读者提供理解，信心和技巧，以优化UKA在他们的实践中使用，并最大限度地提高患者的结果。

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引用次数: 0

Patellofemoral joint replacement: the Bristol perspective 髌股关节置换术：布里斯托视角

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-02-01 DOI: 10.1016/j.mporth.2024.12.004

Tomos A Edwards, James RA Smith, Louis Hainsworth, Jonathan D Eldridge

With improvements to implant design, a better understanding of patellofemoral biomechanics, and a sound understanding of the correct surgical indications, patellofemoral joint replacement (PFR) has become an attractive surgical option for patients with isolated patellofemoral osteoarthritis (PFOA). However, PFR is a specialist procedure, with a number of essential pre- and intraoperative considerations that surgeons preforming the procedure must be cognisant of. The aim of this paper is to discuss a number of salient points that our institutions have found to be of great importance following over 30 years of experience in assessing and managing patients with PFOA and subsequent PFR.

随着植入物设计的改进，对髌股生物力学的更好理解，以及对正确手术指征的充分理解，髌股关节置换术（PFR）已成为孤立性髌股骨关节炎（PFOA）患者的一种有吸引力的手术选择。然而，PFR是一种专科手术，外科医生在进行该手术前和术中必须认识到一些基本的注意事项。本文的目的是讨论我们的机构在评估和管理PFOA和随后的PFR患者超过30年的经验后发现的一些重要问题。

引用次数: 0

Off-the-shelf knee replacements versus robotics versus customized implants: the reality versus the hype 现成的膝关节置换、机器人技术、定制植入物：现实与炒作

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-02-01 DOI: 10.1016/j.mporth.2024.12.005

Ian D McDermott, Gregory M Martin

With traditional ‘off-the-shelf’ implants for knee replacement surgery, 15–20% of patients end up unhappy with their knee. At least part of the reason for this may be the significant differences that can exist between individuals in their distal femoral and proximal tibial geometries. This article explains how patient-specific customized knee implants can address many of the deficiencies that may exist with off-the-shelf designs. Evidence is presented of how customized knee implants can lead to better alignment, better coverage, better knee kinematics, less bone resection, improved efficiency in theatre, fewer complications, better patient-reported outcomes and increased long-term prosthetic survivorship, all without any significant overall additional costs. This article also dispels some of the myths and the hype that surround the current trend towards robotic-assisted knee replacement surgery.

使用传统的“现成的”膝关节置换术植入物，15-20%的患者最终对他们的膝盖不满意。至少部分原因可能是个体股骨远端和胫骨近端几何形状存在显著差异。这篇文章解释了患者定制的膝关节植入物是如何解决现有设计中可能存在的许多缺陷的。有证据表明，定制的膝关节植入物可以带来更好的对齐、更好的覆盖、更好的膝关节运动学、更少的骨切除、更高的手术效率、更少的并发症、更好的患者报告结果和更高的长期假体存活率，所有这些都没有显著的总体额外成本。这篇文章也消除了围绕机器人辅助膝关节置换手术当前趋势的一些神话和炒作。

引用次数: 0

The National Joint Registry 22 years on: what have we learned about knee replacements? 22年过去了：我们对膝关节置换术学到了什么？

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-02-01 DOI: 10.1016/j.mporth.2024.12.008

Paul M Sutton, James S Murray

The National Joint Registry (NJR) of England and Wales was established in 2002 to collect, analyse and report high-quality data about joint replacement surgery. Submission of knee arthroplasty data has been mandated since 2003 in the private sector, and 2010 in the NHS, making the NJR the largest orthopaedic registry in the world. This powerful audit tool collects information on preoperative, intraoperative and postoperative variables, enabling advancement in most of, if not every, facet of the procedure. These data can be used to inform surgeons and other healthcare providers, healthcare commissioners, industry, and patients themselves about outcomes and best practice, ensuring informed decision-making. Drawing from NJR reports, as well as work from external authors using these data, the aim of this review is to highlight what knee surgeons can learn from 22 years of the NJR. We will discuss trends in knee surgery, changes in surgical technique, surgical outcomes and future developments.

英格兰和威尔士国家联合登记处（NJR）成立于2002年，目的是收集、分析和报告有关关节置换手术的高质量数据。自2003年以来，私营部门和2010年NHS都强制要求提交膝关节置换术数据，使NJR成为世界上最大的骨科登记处。这个强大的审计工具收集术前、术中和术后变量的信息，即使不是手术的每个方面，也可以在大多数方面取得进展。这些数据可用于告知外科医生和其他医疗保健提供者、医疗保健专员、行业和患者自己的结果和最佳实践，确保知情决策。根据NJR的报告，以及外部作者使用这些数据的工作，本综述的目的是强调膝关节外科医生可以从NJR 22年的研究中学到什么。我们将讨论膝关节手术的趋势、手术技术的变化、手术结果和未来的发展。

引用次数: 0

Focal resurfacing of the knee 局部膝关节置换术

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-02-01 DOI: 10.1016/j.mporth.2024.12.002

Francesca de Caro

In the past decade, three distinct systems for addressing focal cartilage lesions in the knee through resurfacing have emerged, namely the Hemicap/Unicap, BioPoly and Episealer systems. These technologies provide a new approach for treating patients who might not be suitable candidates for other biological treatment options. Specifically, they target individuals considered too old to benefit from biologic repair methods, but who are also too young for a unicompartmental knee arthroplasty. The three systems have demonstrated promising clinical outcomes, with the literature showing that they can effectively relieve pain and restore knee function, with success rates comparable to other established treatments for cartilage injuries. An additional advantage of these surface replacement systems is their relatively short rehabilitation period, which allows for a quicker return to daily activities. In conclusion, they are an ideal option for ‘gap-age’ patients, representing a valuable alternative for managing knee cartilage defects in this specific patient cohort.

在过去的十年中，出现了三种不同的系统，通过表面修复来解决膝关节局灶性软骨病变，即Hemicap/Unicap， BioPoly和Episealer系统。这些技术为那些可能不适合其他生物治疗方案的患者提供了一种新的治疗方法。具体来说，他们的目标是那些被认为年龄太大而不能从生物修复方法中获益，但又太年轻而不能进行单室膝关节置换术的患者。这三种系统已显示出良好的临床效果，文献显示它们可以有效缓解疼痛并恢复膝关节功能，其成功率与其他已建立的软骨损伤治疗方法相当。这些地面替代系统的另一个优点是修复周期相对较短，可以更快地恢复日常活动。总之，它们是“间隙年龄”患者的理想选择，代表了在这一特定患者群体中治疗膝关节软骨缺损的有价值的替代方案。

引用次数: 0

CME questions on Knee Arthroplasty 关于膝关节置换术的CME问题

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-02-01 DOI: 10.1016/j.mporth.2024.12.010

引用次数: 0

Legg–Calvé–Perthes disease: pertinent information for orthopaedic exam candidates Legg-Calvé-Perthes 病：骨科考试考生的相关信息

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2024-11-01 DOI: 10.1016/j.mporth.2024.10.004

Samuel W King

Legg–Calvé–Perthes (LCP) disease is a common topic for final professional examinations. It is an important differential diagnosis to recognize in children presenting with a limp. Its diagnosis requires the exclusion of diagnoses requiring more immediate action, such as infection or malignancy. It may also present with subtle, or no, signs on routine investigations. LCP disease may resolve spontaneously without long term sequelae or result in debilitating hip pathology requiring operative management. Its aetiology and most appropriate management are topics for debate, and knowledge of the classical papers and commonly used classification systems allow candidates to discuss these in more depth.

Legg-Calvé-Perthes (LCP) 病是期末专业考试的常见题目。对于出现跛行的儿童，这是一个重要的鉴别诊断。诊断时需要排除感染或恶性肿瘤等需要立即采取行动的诊断。在常规检查中，它也可能表现为不明显的体征或无体征。LCP 疾病可能会自愈，不会留下长期后遗症，也可能导致髋关节病变，需要手术治疗。其病因和最合适的治疗方法是争论的话题，了解经典文献和常用分类系统可以让候选人更深入地讨论这些问题。

引用次数: 0

Congenital lower limb differences: an overview and common presentations 先天性下肢差异：概述和常见表现形式

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2024-11-01 DOI: 10.1016/j.mporth.2024.10.002

Jemma Oberman, Olivia Byrne, Maheshi P Wijesekera, Patrick Foster

Congenital lower limb differences are rare but can cause significant effects on the developing child. The term encompasses a broad spectrum of conditions, with varying degrees of severity. When evaluating these conditions, children should be managed on an individual basis due to the variety of presentations. This review provides the reader with an introduction to congenital limb differences of the lower limb, describing the common presentations, classifications and the orthopaedic management of these conditions.

先天性下肢畸形非常罕见，但会对发育中的儿童造成重大影响。先天性下肢畸形包括多种情况，严重程度各不相同。在评估这些疾病时，由于表现形式多种多样，应根据儿童的具体情况进行管理。本综述向读者介绍了先天性下肢畸形，描述了这些疾病的常见表现、分类和矫形管理。

引用次数: 0

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