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Bone Bridge Transtibial Amputation by an Innovative Technique. 采用创新技术的骨桥经胫截肢术
IF 2 Q2 ORTHOPEDICS Pub Date : 2024-08-19 eCollection Date: 2024-08-01 DOI: 10.5435/JAAOSGlobal-D-24-00063
Yurii Oleksiiovych Bezsmertnyi, Viktor Ivanovych Shevchuk, Oleksandr Yuriyovych Bezsmertnyi, Oleksandr Yuriyovych Branitsky, Dmytro Vadymovych Bondarenko

We present a case report of synostosis after transtibial amputation because of distraction regenerate formation after decortication of the lateral surfaces of the tibia and fibula, sequential compression, and distraction using the Ilizarov apparatus. Its advantage is that there is no need to shorten bone. The establishment of distal tibia-fibula synostosis (Ertl) in patients with transtibial amputation has been advocated to improve function and prosthetic wear. There are a variety of techniques to create a bone block. This case reports the successful use of an innovative technique to establish bone block. A patient with transtibial amputation underwent revision of residual limb by decorticating the lateral aspect of the distal tibia and the medial aspect of the distal fibula and acutely compressing the distal ends of the 2 bones with the Ilizarov apparatus. The distal fibula is then slowly and progressively distracted laterally, and the bone is formed in the space between the distal fibula and tibia, creating synostosis with an increased distal bone cross-sectional surface area for improved function and prosthetic wear. The follow-up period was 24 months. Within 3 months, synostosis was formed, which increased the area of the supporting surface and allowed temporary and then permanent prosthetics. After 24 months, synostosis did not differ from the structure of tibial stump bones.

我们报告了一例经胫骨和腓骨外侧剥离、连续加压并使用 Ilizarov 仪器牵引后,因牵张再生形成的经胫骨截肢后滑脱的病例。其优点是无需缩短骨骼。在经胫骨截肢患者中建立胫腓骨远端合骨关节(Ertl),以改善患者的功能和假肢磨损,一直是人们所提倡的。制作骨块的技术多种多样。本病例报告了成功使用创新技术建立骨块的案例。一名经胫骨截肢的患者接受了残肢翻修手术,方法是剥离胫骨远端外侧和腓骨远端内侧,并用 Ilizarov 装置急性压迫这两块骨头的远端。然后将腓骨远端缓慢地逐渐向外侧牵开,在腓骨远端和胫骨之间的空隙中形成骨质,形成合体,增加远端骨质横截面积,从而改善功能和假体磨损。随访期为 24 个月。在 3 个月内,合骨形成,增加了支撑面的面积,可以安装临时假体,然后再安装永久假体。24 个月后,突起与胫骨残端骨的结构没有区别。
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引用次数: 0
Vascularized Transfer of Second Metacarpal Base for Treatment of Capitate Osteonecrosis. 血管化转移第二掌骨基底以治疗头状骨坏死。
IF 2 Q2 ORTHOPEDICS Pub Date : 2024-08-19 eCollection Date: 2024-08-01 DOI: 10.5435/JAAOSGlobal-D-24-00095
Amber Leis, Ekaterina Tiourin, Jacqueline Geissler, Milan Stevanovic

Background: Capitate osteonecrosis is a rare condition that mainly presents in young patients with chronic wrist pain. Treatment aims to address pain, arthritic changes, or carpal instability.

Methods: We present the surgical technique and outcomes of using a vascularized pedicled second metacarpal base transferred on the second dorsal metacarpal artery to treat capitate osteonecrosis in a 20-year-old female secretary, former gymnast, and a 25-year-old female student with acute lymphoblastic leukemia. These patients presented with idiopathic chronic wrist pain with MRI showing capitate osteonecrosis with preserved carpal height and intact articular cartilage.

Results: After 2 years of follow-up, both patients endorsed pain resolution and demonstrated preservation of wrist motion and grip strength with evidence of capitate healing on plain radiographs. Case 1 demonstrated grip strength 60 lbs., pinch strength 5 lbs., and wrist flexion-extension arc of 70 to 80°. Case 2 had grip strength 31 lbs., pinch strength 9 lbs., and wrist flexion-extension arc of 40 to 30° on the left.

Conclusion: Vascularized pedicled second metacarpal base transferred on the second dorsal metacarpal artery can be successfully used in the management of capitate osteonecrosis and offers advantages over other vascularized bone grafts for capitate osteonecrosis.

背景:帽状骨坏死是一种罕见病,主要出现在慢性腕痛的年轻患者身上。治疗的目的是解决疼痛、关节炎改变或腕关节不稳定等问题:我们介绍了在一名20岁的前体操运动员女秘书和一名患有急性淋巴细胞白血病的25岁女学生身上使用血管化足部第二掌骨基底转移术治疗头状骨坏死的手术技巧和结果。这些患者都有特发性慢性腕痛,核磁共振成像显示头状骨坏死,但保留了腕骨高度和完整的关节软骨:结果:随访两年后,两名患者的疼痛均得到缓解,腕关节活动度和握力均得到保留,平片显示帽状骨愈合。病例 1 的握力为 60 磅,捏力为 5 磅,手腕屈伸弧度为 70 至 80°。病例 2 的握力为 31 磅,捏力为 9 磅,左手腕屈伸弧度为 40 至 30°:结论:在第二掌背动脉上转移的血管化足部第二掌骨基底可成功用于头状骨坏死的治疗,与其他治疗头状骨坏死的血管化骨移植相比具有优势。
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引用次数: 0
Trichorhinophalangeal Syndrome Orthopaedic Manifestations and Management: A Systematic Review. 毛细血管扩张综合征(Trichorhinophalangeal Syndrome)骨科表现与治疗:系统综述。
IF 2 Q2 ORTHOPEDICS Pub Date : 2024-08-19 eCollection Date: 2024-08-01 DOI: 10.5435/JAAOSGlobal-D-24-00010
Emily Ellison, Steven J Grampp, Seth Ellison, Andrea Seeley, Mark Seeley

Trichorhinophalangeal syndrome (TRPS) is an autosomal dominant genetic malformation disorder which is best characterized by both its craniofacial and skeletal abnormalities. The purpose of this paper is to identify the various orthopedic manifestations and management in patients with TRPS. A systematic search of PubMed, Ovid MEDLINE, and Cochrane Library was conducted. They were each individually searched for primary articles yielding information on the orthopedic manifestations and management of patients with TRPS. The goals and results of each of the included studies were described. Data regarding the demographics, orthopedic condition, treatment strategy, and outcomes were extracted and analyzed. 221 unique articles were retrieved, with 13 articles being included in the study. 26 patients with TRPS were identified. Trials of conservative management were reported for 14 patients, and surgical intervention was pursued for 8 patients. The mean age for surgery was 14.1 years. The most common orthopedic manifestations of TRPS are clinodactyly, Perthes-like changes, and coxa magna. Early identification and maintenance of TRPS is important for being able to monitor musculoskeletal health of the patients in order to prevent detrimental outcomes. Additional high-quality research is required regarding the orthopedic manifestations and treatment of this patient population.

毛细血管畸形综合征(TRPS)是一种常染色体显性遗传畸形疾病,其最大特点是颅面和骨骼均异常。本文旨在确定 TRPS 患者的各种矫形表现和治疗方法。本文对 PubMed、Ovid MEDLINE 和 Cochrane 图书馆进行了系统检索。它们分别检索了有关 TRPS 患者骨科表现和治疗方法的主要文章。对每项纳入研究的目标和结果进行了描述。提取并分析了有关人口统计学、骨科状况、治疗策略和结果的数据。共检索到 221 篇文章,其中 13 篇被纳入研究。确定了 26 名 TRPS 患者。14名患者接受了保守治疗,8名患者接受了手术治疗。手术的平均年龄为 14.1 岁。TRPS最常见的骨科表现是clinodactyly、珀尔帖样改变和尾骨。早期识别和维护 TRPS 对于监测患者的肌肉骨骼健康以防止不良后果的发生非常重要。需要对这一患者群体的骨科表现和治疗进行更多高质量的研究。
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引用次数: 0
Tendon Transfers in Reverse Total Shoulder Arthroplasty: A Systematic Review. 反向全肩关节置换术中的肌腱移植:系统回顾
IF 2 Q2 ORTHOPEDICS Pub Date : 2024-08-12 eCollection Date: 2024-08-01 DOI: 10.5435/JAAOSGlobal-D-24-00174
Eric S Warren, Eoghan T Hurley, Mikhail A Bethell, Bryan J Loeffler, Nady Hamid, Christopher S Klifto, Oke Anakwenze

Purpose: The purpose of this study was to evaluate clinical outcomes after tendon transfers in the setting of reverse total shoulder arthroplasty (RTSA).

Methods: PubMed and Embase were searched according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines to find primary clinical studies of any type of tendon transfer in the setting of RTSA.

Results: Overall, 17 studies (level of evidence [LOE] I: 1, LOE II: 0, LOE III: 3, LOE IV: 13) met inclusion criteria, with 300 shoulders. Most patients were female (56.7%), with an average age of 68.7 years (range 19 to 89) and a mean follow-up of 46.2 months (range 6 to 174). 11 studies reported outcomes after combined latissimus dorsi and teres major transfer (LDTM) while eight studies reported on latissimus dorsi transfer only (LD). Improvements in commonly reported subjective and functional outcome measures were as follows: external rotation +32° (LDTM) and +30° (LD), flexion +65° (LDTM) and +59° (LD), Visual Analog Score -5.4 (LDTM) and -4.5 (LD), subjective shoulder value +43.8% (LDTM) and +46.3% (LD), and overall Constant score +33.8 (LDTM) and +38.7 (LD). The overall complication rate was 11.3%, including tendon transfer ruptures (0.7%), instability (3.0%), infection (2.0%), and nerve injury (0.3%). The all-cause repeat operation rate was 7.3%, most commonly for arthroplasty revision (5.3%). Subgroup analysis revealed that lateralized implants with tendon transfer resulted in markedly greater improvements in Constant score, flexion, ER1, and ER2 while medialized implants with tendon transfer had markedly greater improvements in Visual Analog Score, subjective shoulder value, and abduction.

Conclusion: Patients undergoing tendon transfer of either combined LDTM or latissimus dorsi alone in the setting of RTSA have markedly improved subjective and functional outcomes. A moderate incidence of complications (11.3%) was noted in this patient population.

目的:本研究旨在评估反向全肩关节置换术(RTSA)中肌腱转移后的临床效果:根据《系统综述和Meta分析首选报告项目》指南,对PubMed和Embase进行了检索,以找到在RTSA中进行任何类型肌腱转移的主要临床研究:共有17项研究(证据级别[LOE] I:1;LOE II:0;LOE III:3;LOE IV:13)符合纳入标准,共涉及300个肩部。大多数患者为女性(56.7%),平均年龄为 68.7 岁(19 至 89 岁不等),平均随访时间为 46.2 个月(6 至 174 个月不等)。11项研究报告了背阔肌和大圆肌联合转移(LDTM)后的疗效,8项研究仅报告了背阔肌转移(LD)后的疗效。通常报告的主观和功能结果指标的改善情况如下:外旋+32°(LDTM)和+30°(LD),屈曲+65°(LDTM)和+59°(LD),视觉模拟评分-5.4(LDTM)和-4.5(LD),肩部主观值+43.8%(LDTM)和+46.3%(LD),总体恒定评分+33.8(LDTM)和+38.7(LD)。总体并发症发生率为11.3%,包括肌腱转移断裂(0.7%)、不稳定(3.0%)、感染(2.0%)和神经损伤(0.3%)。全因重复手术率为7.3%,最常见的是关节成形术翻修(5.3%)。亚组分析显示,采用肌腱转移的外侧化植入物在Constant评分、屈曲度、ER1和ER2方面有明显改善,而采用肌腱转移的内侧化植入物在视觉模拟评分、肩部主观价值和外展方面有明显改善:结论:接受联合 LDTM 或单独背阔肌肌腱转移的 RTSA 患者的主观和功能结果均有明显改善。该患者群体的并发症发生率为中等(11.3%)。
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引用次数: 0
Can Large Language Models (LLMs) Predict the Appropriate Treatment of Acute Hip Fractures in Older Adults? Comparing Appropriate Use Criteria With Recommendations From ChatGPT. 大语言模型 (LLM) 能否预测老年人急性髋部骨折的适当治疗?比较适当使用标准和 ChatGPT 的建议。
IF 2 Q2 ORTHOPEDICS Pub Date : 2024-08-09 eCollection Date: 2024-08-01 DOI: 10.5435/JAAOSGlobal-D-24-00206
Katrina S Nietsch, Nancy Shrestha, Laura C Mazudie Ndjonko, Wasil Ahmed, Mateo Restrepo Mejia, Bashar Zaidat, Renee Ren, Akiro H Duey, Samuel Q Li, Jun S Kim, Krystin A Hidden, Samuel K Cho

Background: Acute hip fractures are a public health problem affecting primarily older adults. Chat Generative Pretrained Transformer may be useful in providing appropriate clinical recommendations for beneficial treatment.

Objective: To evaluate the accuracy of Chat Generative Pretrained Transformer (ChatGPT)-4.0 by comparing its appropriateness scores for acute hip fractures with the American Academy of Orthopaedic Surgeons (AAOS) Appropriate Use Criteria given 30 patient scenarios. "Appropriateness" indicates the unexpected health benefits of treatment exceed the expected negative consequences by a wide margin.

Methods: Using the AAOS Appropriate Use Criteria as the benchmark, numerical scores from 1 to 9 assessed appropriateness. For each patient scenario, ChatGPT-4.0 was asked to assign an appropriate score for six treatments to manage acute hip fractures.

Results: Thirty patient scenarios were evaluated for 180 paired scores. Comparing ChatGPT-4.0 with AAOS scores, there was a positive correlation for multiple cannulated screw fixation, total hip arthroplasty, hemiarthroplasty, and long cephalomedullary nails. Statistically significant differences were observed only between scores for long cephalomedullary nails.

Conclusion: ChatGPT-4.0 scores were not concordant with AAOS scores, overestimating the appropriateness of total hip arthroplasty, hemiarthroplasty, and long cephalomedullary nails, and underestimating the other three. ChatGPT-4.0 was inadequate in selecting an appropriate treatment deemed acceptable, most reasonable, and most likely to improve patient outcomes.

背景:急性髋部骨折是主要影响老年人的公共卫生问题。Chat Generative Pretrained Transformer(聊天生成预训练转换器)可能有助于为有益的治疗提供适当的临床建议:目的:通过比较 Chat Generative Pretrained Transformer (ChatGPT)-4.0 与美国矫形外科医师学会(AAOS)适当使用标准(Appropriate Use Criteria)在 30 种患者情况下对急性髋部骨折的适当性评分,评估 Chat Generative Pretrained Transformer (ChatGPT)-4.0 的准确性。"适当性 "表示治疗的意外健康益处远远超过预期的负面影响:方法:以 AAOS 适当使用标准为基准,用 1 到 9 的数字分数来评估适当性。对于每种患者情况,要求 ChatGPT-4.0 为处理急性髋部骨折的六种治疗方法打分:结果:对 30 个患者场景进行了评估,得出 180 个配对分数。将 ChatGPT-4.0 与 AAOS 评分进行比较,发现多枚套管螺钉固定、全髋关节置换术、半关节置换术和长头髓内钉呈正相关。只有长头髓内钉的评分之间存在统计学意义上的差异:结论:ChatGPT-4.0评分与AAOS评分不一致,高估了全髋关节置换术、半关节置换术和长头髓内钉的适宜性,低估了其他三种手术的适宜性。ChatGPT-4.0 不足以选择被认为可接受、最合理、最有可能改善患者预后的适当治疗方法。
{"title":"Can Large Language Models (LLMs) Predict the Appropriate Treatment of Acute Hip Fractures in Older Adults? Comparing Appropriate Use Criteria With Recommendations From ChatGPT.","authors":"Katrina S Nietsch, Nancy Shrestha, Laura C Mazudie Ndjonko, Wasil Ahmed, Mateo Restrepo Mejia, Bashar Zaidat, Renee Ren, Akiro H Duey, Samuel Q Li, Jun S Kim, Krystin A Hidden, Samuel K Cho","doi":"10.5435/JAAOSGlobal-D-24-00206","DOIUrl":"10.5435/JAAOSGlobal-D-24-00206","url":null,"abstract":"<p><strong>Background: </strong>Acute hip fractures are a public health problem affecting primarily older adults. Chat Generative Pretrained Transformer may be useful in providing appropriate clinical recommendations for beneficial treatment.</p><p><strong>Objective: </strong>To evaluate the accuracy of Chat Generative Pretrained Transformer (ChatGPT)-4.0 by comparing its appropriateness scores for acute hip fractures with the American Academy of Orthopaedic Surgeons (AAOS) Appropriate Use Criteria given 30 patient scenarios. \"Appropriateness\" indicates the unexpected health benefits of treatment exceed the expected negative consequences by a wide margin.</p><p><strong>Methods: </strong>Using the AAOS Appropriate Use Criteria as the benchmark, numerical scores from 1 to 9 assessed appropriateness. For each patient scenario, ChatGPT-4.0 was asked to assign an appropriate score for six treatments to manage acute hip fractures.</p><p><strong>Results: </strong>Thirty patient scenarios were evaluated for 180 paired scores. Comparing ChatGPT-4.0 with AAOS scores, there was a positive correlation for multiple cannulated screw fixation, total hip arthroplasty, hemiarthroplasty, and long cephalomedullary nails. Statistically significant differences were observed only between scores for long cephalomedullary nails.</p><p><strong>Conclusion: </strong>ChatGPT-4.0 scores were not concordant with AAOS scores, overestimating the appropriateness of total hip arthroplasty, hemiarthroplasty, and long cephalomedullary nails, and underestimating the other three. ChatGPT-4.0 was inadequate in selecting an appropriate treatment deemed acceptable, most reasonable, and most likely to improve patient outcomes.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11319315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141976915","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
Variable Efficacy of Tranexamic Acid in Geriatric Hip Fractures Treated With Arthroplasty Versus Cephalomedullary Nails. 氨甲环酸在老年髋部骨折关节置换术与头髓内钉治疗中的不同疗效
IF 2 Q2 ORTHOPEDICS Pub Date : 2024-08-08 eCollection Date: 2024-08-01 DOI: 10.5435/JAAOSGlobal-D-24-00157
Sarah R Blumenthal, George W Fryhofer, Matthew K Stein, Steven E Zhang, Sean Looby, Samir Mehta

Introduction: Geriatric hip fractures are associated with high rates of disability and mortality. Many of these patients require perioperative and postoperative allogeneic blood transfusions, which carry several noteworthy risks. A growing body of literature supports the efficacy of tranexamic acid (TXA) in geriatric hip fractures, without sufficient data examining which subgroups are likely to benefit the most.

Methods: In this study, we sought to evaluate whether TXA was associated with reduced blood loss and transfusions in a geriatric population undergoing hip fracture fixation at our institution during a 2-year period. The first year's data were collected in a retrospective fashion before the introduction of a quality control initiative encouraging TXA administration for all geriatric hip fractures. The second year's data were collected prospectively. A subgroup analysis was conducted for patients who underwent arthroplasties.

Results: Among the pooled cohort of patients undergoing surgery, TXA showed no benefit over control subjects for reducing blood loss or transfusion requirements. However, the subgroup of patients undergoing arthroplasty procedures showed a notable decrease in total blood loss and total units transfused during hospitalization.

Discussion: These results suggest that TXA may be most beneficial when targeted to arthroplasties performed for geriatric hip fractures.

介绍:老年髋部骨折的致残率和死亡率都很高。其中许多患者需要在围手术期和术后进行异体输血,而异体输血存在一些值得注意的风险。越来越多的文献支持氨甲环酸(TXA)在老年髋部骨折中的疗效,但没有足够的数据来研究哪些亚组可能受益最大:在这项研究中,我们试图评估在我院接受髋部骨折固定术的老年人群中,氨甲环酸是否能在两年内减少失血和输血。第一年的数据是以回顾性的方式收集的,在此之前,我们采取了一项质量控制措施,鼓励对所有老年髋部骨折患者使用 TXA。第二年的数据是前瞻性收集的。对接受关节置换术的患者进行了分组分析:在接受手术的患者群体中,与对照组相比,TXA 在减少失血量或输血需求方面没有优势。然而,在接受关节置换手术的患者分组中,住院期间的总失血量和总输血量明显减少:讨论:这些结果表明,针对老年髋部骨折进行关节置换术时,TXA 可能最有益处。
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引用次数: 0
Adolescent Idiopathic Scoliosis in Siblings Treated by Surgical Deformity Correction. 通过手术矫正畸形治疗同胞青少年特发性脊柱侧凸。
IF 2 Q2 ORTHOPEDICS Pub Date : 2024-08-07 eCollection Date: 2024-08-01 DOI: 10.5435/JAAOSGlobal-D-24-00160
Hong Jin Kim, Javier Pizones, Dong-Gune Chang

Adolescent idiopathic scoliosis (AIS) in siblings reflects genetic hypothesis; however, few studies have been published. Furthermore, to the best of our knowledge, there have been no reports in the literature of both siblings with AIS who underwent deformity corrections. A 15-year-old adolescent girl visited our clinic with back pain after recognition of the incidental findings of a scoliotic curve in the spine. Whole spine radiographs detected Lenke classification type 3CN. The patient underwent deformity correction with posterior instrumented fusion from T4 to L3 with thoracoplasty of the right 7th to 10th rib. Four years later, her 16-year-old younger brother also visited our clinic with back pain after recognition of the incidental findings of a scoliotic curve in the spine. Whole spine radiographs detected Lenke classification type 2AN. The patient underwent deformity correction with posterior instrumented fusion from T5 to L2 with thoracoplasty of the right 8th to 10th rib. In conclusion, we report on two siblings with AIS who underwent surgical treatment for different types of curves. They showed favorable outcomes after performing deformity correction with posterior instrumented fusion. Our rare case supports the underlying basis of genetic heterogeneity as a complex polygenic model.

同胞青少年特发性脊柱侧凸(AIS)反映了遗传假说;然而,相关研究却鲜有发表。此外,据我们所知,文献中还没有关于同胞兄弟姐妹同时患有 AIS 并接受畸形矫正的报道。一名 15 岁的少女在偶然发现脊柱侧弯后,因背部疼痛到我院就诊。全脊柱X光检查发现了伦克分类 3CN 型。患者接受了从 T4 到 L3 的后路器械融合术和右侧第 7 到第 10 根肋骨的胸廓成形术,从而矫正了畸形。四年后,她 16 岁的弟弟也因背痛来我院就诊,偶然发现脊柱有侧弯。全脊柱X光检查发现了伦克分类 2AN 型。患者接受了从 T5 到 L2 的后路器械融合术和右侧第 8 到第 10 根肋骨的胸廓成形术,从而矫正了畸形。总之,我们报告了两个患有 AIS 的兄弟姐妹,他们因不同类型的弯曲而接受了手术治疗。他们在通过后路器械融合进行畸形矫正后,均取得了良好的疗效。我们的罕见病例证明了遗传异质性是一个复杂的多基因模型。
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引用次数: 0
Periprosthetic Femoral Fractures-Beyond B2. 股骨假体周围骨折--超越 B2。
IF 2 Q2 ORTHOPEDICS Pub Date : 2024-08-06 eCollection Date: 2024-08-01 DOI: 10.5435/JAAOSGlobal-D-23-00135
Chika Edward Uzoigwe, Arun Thor Watts, Praise Briggs, Tom Symes

The proliferation of hip arthroplasty has seen concomitant increases in periprosthetic femoral fractures (PFFs). The most common pattern involves fracture at the level of a loose prosthesis (B2). B2 PFFs have a unique mechanopathogenesis linked to the tendency of polished taper-slip cemented stems to subside in the cement. Such stems carry a much higher PFF risk than other cemented designs. Mega-data, consistent across national registries, suggest that increasing application of the taper-slip principle has resulted in the emergence of highly polished, very low friction cemented prostheses. These have the propensity to migrate within the cement, increasing B2 PFF risk. This would explain the strong association between cobalt-chromium stems and PFF. Is PFF the mode of failure of polished taper-slip stems rather than aseptic loosening? Established wisdom teaches that B2 PFFs should be managed with revision surgery. There is a large body of new evidence that, in certain instances, fixation results in outcomes at least equivalent to revision arthroplasty, with shorter surgical time, decreased transfusion requirements, and lower dislocation risk. This is so in B2 PFFs around cemented polished taper-slip stems with an intact bone-cement interface. We outline advances in understanding of B2 PFF with special reference to mechanopathogenesis and indications for fixation.

随着髋关节置换术的普及,股骨假体周围骨折(PFF)也随之增加。最常见的模式是松动假体(B2)水平骨折。B2 PFF具有独特的机械发病机制,与抛光锥形滑动骨水泥柄在骨水泥中下沉的趋势有关。与其他骨水泥设计相比,这种骨水泥柄的PFF风险要高得多。各国登记处的大量数据一致表明,锥滑原理的应用日益广泛,导致了高抛光、极低摩擦的骨水泥假体的出现。这些假体有在骨水泥内移位的倾向,增加了 B2 PFF 风险。这就解释了钴铬基台与PFF之间的密切联系。PFF是抛光锥滑柄的失效模式而非无菌性松动吗?已有的观点认为,B2 PFF 应通过翻修手术来处理。大量新证据表明,在某些情况下,固定的结果至少与翻修关节成形术相当,手术时间更短、输血需求更少、脱位风险更低。在骨水泥界面完整的骨水泥抛光锥形滑动柄周围的 B2 PFF 就是如此。我们概述了对B2 PFF的认识进展,特别提到了力学发病机制和固定适应症。
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引用次数: 0
Elevated Titanium Levels After Revision Total Hip Caused by Previously Unreported Mechanism. 翻修全髋关节后钛含量升高,原因是之前未报告的机制。
IF 2 Q2 ORTHOPEDICS Pub Date : 2024-08-06 eCollection Date: 2024-08-01 DOI: 10.5435/JAAOSGlobal-D-24-00001
Brian G Josephson, Timothy A Damron

Introduction: Metallosis from total hip arthroplasty is usually due to trunnionosis and is associated with elevated serum cobalt and chromium levels. Titanium levels usually remain normal.

Methods: Here, we report two rare cases of elevated titanium levels, both with the same mechanism, which is a previously unreported cause of titanium metallosis.

Results: In these cases, contact between cables and the titanium stem were the source.

Discussion: Reports of isolated high titanium levels associated with total hip arthroplasty are rare. These cases illustrate a new mechanism from which this situation may arise.

导言:全髋关节置换术引起的金属中毒通常是由腱鞘炎引起的,与血清钴和铬水平升高有关。方法:在此,我们报告了两例罕见的钛含量升高病例,这两例病例的发病机制相同,都是以前未报道过的钛金属中毒原因:在这些病例中,电缆和钛杆之间的接触是病因:讨论:与全髋关节置换术相关的孤立高钛金属含量报告非常罕见。这些病例说明了这种情况可能产生的新机制。
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引用次数: 0
Predictors of Patient-Reported Outcomes After Hyaluronic Acid Injections: Effect of Expectations and Psychological Stress. 透明质酸注射后患者报告结果的预测因素:期望和心理压力的影响。
IF 2 Q2 ORTHOPEDICS Pub Date : 2024-08-02 eCollection Date: 2024-08-01 DOI: 10.5435/JAAOSGlobal-D-23-00152
Anya Hall, Donghoon Lee, Richard Campbell, Ryan Paul, Morgan Leider, Brandon Smith, Kevin Freedman, Fotios Tjoumakaris

Introduction: Hyaluronic acid (HA) injections are a common nonsurgical treatment of knee osteoarthritis (OA). Patient expectations and psychological stress are believed to affect outcomes after orthopaedic procedures.

Methods: This was a prospective cohort study seeking to identify factors predictive of greater patient-reported outcomes after HA injections, particularly expectations and psychological stress. 250 patients receiving a series of HA injections for knee OA were enrolled, with 196 being included for analysis. Demographics, surgical history, and preoperative Kellgren-Lawrence severity scores were collected, and patients completed the Knee Osteoarthritis Outcome Score (KOOS) questionnaire, a modified KOOS questionnaire assessing their 6-month postinjection expectations, and the Perceived Stress Scale before the first injection. Outcomes were assessed at 3 weeks and 3 and 6 months after the final injection.

Results: KOOS scores improved from preinjection to 6-month follow-up but did not meet patients' expectations or minimal clinically important difference. Expectations correlated with 6-month KOOS pain, activities of daily living, sport, and quality of life subscales (ρ = 0.19 to 0.34), but not the symptom subscale (P = 0.10). Expectations (ρ = 0.31 to 0.37), younger age (ρ = -0.17 to -0.18), and greater perceived stress (ρ = 0.23) correlated with greater improvement from baseline KOOSs. Lower body mass index (ρ = -0.19 to -0.22), male sex (ρ = -0.17), and greater preinjection function (ρ = 0.37 to 0.46) correlated with greater 6-month outcomes. Stress measured on the Perceived Stress Scale did not correlate with 6-month KOOSs (P ≥ 0.27). Lower Kellgren-Lawrence severity score was weakly associated with greater 6-month KOOS activities of daily living and sport scores (ρ = -0.15 to -0.16) and greater improvement in the KOOS symptom score (ρ = -0.15).

Discussion: This study identified that higher expectations, lower body mass index, younger age, male sex, lower radiographic severity, greater preinjection function, and greater perceived stress are associated with greater patient outcomes after HA injection. Physicians should consider these factors when counseling patients with knee OA about viscosupplementation.

Study type: Prospective Cohort Study (Level of Evidence II).

导言:透明质酸(HA)注射是治疗膝关节骨关节炎(OA)的一种常见非手术疗法。患者的期望和心理压力被认为会影响矫形手术后的疗效:本研究是一项前瞻性队列研究,旨在确定患者报告的 HA 注射后更大疗效的预测因素,尤其是期望值和心理压力。250名患者因膝关节OA接受了一系列HA注射,其中196人被纳入分析。研究人员收集了患者的人口统计学资料、手术史和术前 Kellgren-Lawrence 严重程度评分,并在首次注射前完成了膝骨关节炎结果评分 (KOOS) 问卷、评估注射后 6 个月期望值的改良 KOOS 问卷和感知压力量表。最后一次注射后 3 周、3 个月和 6 个月时对结果进行评估:结果:KOOS评分从注射前到6个月随访期间均有所改善,但未达到患者的期望值或最小临床重要差异。期望值与 6 个月的 KOOS 疼痛、日常生活活动、运动和生活质量分量表相关(ρ = 0.19 至 0.34),但与症状分量表无关(P = 0.10)。期望值(ρ = 0.31 至 0.37)、年龄(ρ = -0.17 至 -0.18)和感知到的压力(ρ = 0.23)与 KOOSs 从基线得到更大改善相关。体重指数较低(ρ = -0.19至-0.22)、性别为男性(ρ = -0.17)和注射前功能较强(ρ = 0.37至0.46)与6个月后的改善程度相关。用感知压力量表测量的压力与 6 个月的 KOOSs 无关(P ≥ 0.27)。较低的 Kellgren-Lawrence 严重程度评分与较高的 6 个月 KOOS 日常生活活动和运动评分(ρ = -0.15 至 -0.16)以及较高的 KOOS 症状评分(ρ = -0.15)呈弱相关:本研究发现,较高的期望值、较低的体重指数、较年轻的年龄、男性、较低的放射学严重程度、较强的注射前功能和较大的感知压力与患者注射 HA 后的较好疗效相关。医生在向膝关节 OA 患者提供有关粘度补充剂的咨询时应考虑这些因素:研究类型:前瞻性队列研究(证据等级 II)。
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Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews
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