Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews最新文献

Introduction: Hip-spine syndrome is a complex condition characterized by concurrent degenerative pathologies of the hip and lumbar spine, often leading to significant morbidity. Accurate radiographic measurements are critical for diagnosing and managing this syndrome, particularly in the context of total hip arthroplasty. This study aimed to evaluate the interobserver reliability of sacral slope measurements on pelvic radiographs in healthy individuals to enhance diagnostic accuracy and treatment strategies.

Methods: This cross-sectional study included 30 healthy volunteers (15 male, 15 female) aged 25 to 50 years, with no history of spinal, hip, or pelvic pathology. Lateral pelvic radiographs were taken in both standing and sitting positions. Sacral slope was measured by four independent observers, including radiologists and orthopaedic surgeons. Intraclass correlation coefficients with 95% confidence intervals (CIs) were calculated using linear mixed-effects models to assess interobserver reliability. Data analysis was performed using SAS and SPSS software.

Results: The mean sacral slope measurements for standing and sitting positions were as follows: observer 1 (standing: 39.59° ± 6.67°, sitting: 26.83° ± 10.84°), observer 2 (standing: 38.02° ± 6.76°, sitting: 22.11° ± 10.71°), observer 3 (standing: 41.15° ± 6.63°, sitting: 26.04° ± 12.48°), and observer 4 (standing: 39.53° ± 6.93°, sitting: 24.80° ± 12.00°). The intraclass correlation coefficient for standing sacral slope was 0.956 (95% CI, 0.916 to 0.978) and for sitting sacral slope was 0.974 (95% CI, 0.944 to 0.988), both indicating excellent interobserver reliability.

Discussion: Sacral slope measurements on lateral pelvic radiographs exhibit excellent interobserver reliability, making them reliable indicators of pelvic orientation. This reliability is crucial for the clinical utility of sacral slope as a metric for assessing spinopelvic alignment, particularly in the management of hip-spine syndrome and in patients undergoing total hip arthroplasty.

Background: Placement of the acetabular cup, particularly regarding medialization of the cup, remains debated today. The purpose of this study was to evaluate whether medialization of the acetabular cup during total hip arthroplasty (THA) using modern day implants affects the outcome of aseptic loosening.

Methods: Retrospective analysis of patients who underwent THA between 2007 and 2013 was done. Acetabular offset (AO) was measured on preoperative and postoperative radiographs. Change in AO was defined as the postoperative minus the preoperative measurement.

Results: One hundred forty-nine total patients were included, consisting of 117 patients with long-term (10 years minimum) follow-up who did not require revision surgery and 31 patients who required revision due to aseptic loosening of the cup an average of 7.7 years after THA. Patients with no change or increase in AO (corresponding to no change or lateralization of hip center) had 2.9 times (95% confidence interval, 1.3 to 6.6; P = 0.0097) increased odds of aseptic loosening compared with those with a decrease in AO (corresponding to medialization of hip center). Patients who underwent revision for aseptic loosening had significantly greater change in AO compared with patients without revision surgery by 2.6 mm (0.7 mm increase in the revision group vs. 1.9 mm decrease in the nonrevision group; P = 0.013). Similarly, multivariate regression controlling for diabetes and Body Mass Index demonstrated a difference of 2.6 mm in mean AO change (P = 0.018).

Conclusion: Aseptic loosening was markedly associated with increased AO after THA, with nearly three times increased odds of aseptic loosening compared with those with decreased AO after THA.

Introduction: Hinge-knee megaprostheses are frequently used in complex revision surgeries and are known to have higher complication and revision rates than primary total knee arthroplasties. However, the in vivo damage to the metal and polymer components of megaprostheses remains poorly understood. We, therefore, investigated the damage modes, their severity, and how they varied by implant manufacturer.

Method: Forty megaprostheses and associated clinical data were collected from an institutional review board-exempt retrieval program, including implants from three manufacturers. We semiquantitatively scored the in vivo damage modes on polymer and metal megaprostheses components using the Kahlenberg method. The Goldberg score was used to classify corrosion for metal-on-metal interfaces. We then analyzed the differences between damage types and device manufacturers using nonparametric statistics.

Results: We identified and classified scratching, pitting, and burnishing as major damage modes on polyethylene inserts and abrasion, delamination, surface deformation, and embedded debris as minor damage modes. Minor damage modes markedly differed between implant cohorts (P < 0.001), whereas major damage modes did not (P > 0.05). On metal components, scratching was more prevalent than burnishing and discoloration (P < 0.001). Damage to metal tibial components differed by manufacturer (P < 0.01) and corrosion was present in varying degrees across cohorts.

Conclusion: In vivo damage occurred on both metal and polyethylene megaprostheses components. Within modular taper junctions, mechanics combined with chemically based processes generated corrosion. We found minimal differences between manufacturers, except for minor polyethylene damage and tibial component damage. The rotating hinge may release metal debris when unprotected by a polyethylene bumper evidenced by burnishing.

Knee dislocations are rare but severe injuries, often resulting from high-energy trauma and commonly associated with vascular and neurologic damage. In low-income settings, the evaluation and management of these injuries are especially challenging because of limited access to advanced imaging, surgical implants, and structured rehabilitation services. This review aims to provide a practical, evidence-based framework for managing knee dislocations in resource-constrained environments. A focused literature review was conducted on studies published in the past decade that address diagnosis, treatment strategies, and system-level barriers in underserved regions. Key topics include simplified diagnostic approaches using clinical evaluation and basic imaging, early detection of vascular and nerve injuries without advanced tools, and cost-effective surgical techniques. These include the use of autografts, external fixators, and implantless fixation methods such as press-fit and bone bridges, as well as the use of the same tunnels and fixation devices for more than one ligament. Rehabilitation strategies are also adapted, with emphasis on simplified protocols that consider social and logistical barriers to follow-up. Despite notable limitations, appropriate prioritization, creative use of available materials, and staged reconstructions can ensure acceptable outcomes. This article offers orthopaedic surgeons working in low-resource environments practical guidance to maintain standards of care through adaptable, cost-conscious decision-making.

Introduction: The precise role of distal femoral varus osteotomy (DFVO) in managing lateral compartment gonarthrosis remains incompletely defined, particularly concerning the extent of joint degeneration that supports or contraindicates the procedure at different stages of arthritis. This systematic review synthesizes recent comparative studies to evaluate the indications, functional outcomes, survivorship rates, and complication profiles associated with both closing wedge and opening wedge techniques. Given the scarcity of controlled trials and direct comparative analyses, this review aims to provide evidence-based insights into the clinical efficacy of DFVO.

Methods: This systematic review evaluated studies primarily focused on DFVO for valgus knees with lateral compartment osteoarthritis, published in PubMed, Medline, Embase, or Cochrane databases since 2000. Only English-language studies reporting clinical outcomes with a minimum follow-up of 2 years in human patients were included. After duplicate removal and screening-based on title, abstract, and full-text review, following the Preferred Reporting Items for Systematic Reviews and Meta-analyses methodology-the methodologic quality of the included studies was assessed using the Newcastle-Ottawa Scale.

Results: A total of 18 studies met the inclusion criteria, with six evaluating closing wedge DFVO and 12 focusing on opening wedge DFVO. Among these studies, the highest reported conversion rate to total knee arthroplasty was 48.4%, with lateral cortex injury identified as the most common complication. Two studies reported no minor or major complications. Long-term clinical and radiologic follow-up, along with functional assessments, demonstrated substantial efficacy and acceptable safety for DFVO. The reported survival rates at 5, 10, and 15 years ranged from 74% to 88%, 74% to 90%, and 45% to 79%, respectively.

Discussion: This systematic review indicates that DFVO provides acceptable long-term survival, favorable functional outcomes, and a manageable complication profile, supporting its role as a viable treatment option for valgus knees with lateral compartment osteoarthritis. Recent studies suggest that when osteotomy is done at the precise site of the deformity, both closing wedge and opening wedge techniques achieve comparable survivorship rates.

Conclusion: Current evidence supports that DFVO yields favorable functional outcomes and acceptable survival rates in the management of valgus knee osteoarthritis affecting the lateral compartment. When performed at the precise site of deformity, both closing wedge and opening wedge techniques exhibit comparable survivorship and functional results. Additional randomized studies are necessary to refine surgical techniques and optimize patient selection criteria.

Introduction: To solve barriers to simulation-based training of residents, we have developed a three-dimensional (3D) printed anatomic shoulder simulator that is low cost and deployable worldwide. The purpose of our study was to evaluate the educational and construct validity of a novel 3D-printed shoulder simulator (3DP) for arthroscopy of the shoulder and compare it to a commercially available shoulder simulator (control).

Methods: In this institutional review board-approved randomized controlled trial, 20 participants were divided into four groups: five senior medical students and five expert surgeons for each simulator. Participants completed four arthroscopic tasks, which were videorecorded and assessed using the Arthroscopic Surgery Skill Evaluation Tool (ASSET) and time to task completion. Pre- and posttask anatomy tests were also administered.

Results: The expert surgeon group was faster to complete arthroscopic tasks than the medical student group for both the control (P = 0.003) and 3DP (P = 0.046). The ASSET scores were markedly higher for expert surgeons versus medical students on the 3DP (P = 0.017), with no difference on the control (P = 0.533). After task completion, medical students improved scores on an anatomy test from an average of 52% to a 76% on the control and from 52% to 84% on the 3DP.

Conclusion: The 3D printed arthroscopic shoulder simulator demonstrated construct validity based on time and ASSET scores, while also demonstrating educational value. The commercially available shoulder simulator demonstrated construct validity based on time; however, it was not able to differentiate skill level based on arthroscopic skills assessment.

Background: Bioinductive collagen implants (BCIs) have been growing in popularity for use in rotator cuff repair (RCR) over the past several years, but recent literature has raised concerns about the implants contributing to postoperative stiffness. The purpose of this study was to investigate the incidence of stiffness over a decade of experience with the BCI.

Methods: A retrospective review was conducted of all cases of RCR using a BCI performed between September 2014 and December 2023. The primary outcome measure was postoperative range of motion, with significant stiffness defined by parameters in the existing literature. The secondary outcome measure was any revision procedure for stiffness.

Results: After application of inclusion and exclusion criteria to 522 cases of RCR, there were 432 cases (390 individual patients) available for outcome analysis with an average follow-up of 34.9 months (range, 6 months to 9.25 years). There were only 12 cases (2.8%) of significant postoperative stiffness. All of them required additional operative intervention for stiffness, and all but two patients had at least one risk factor for stiffness. Stiffness rates were 4 of 291 (1.4%) for full-thickness tears and 8 of 141 (5.7%) for partial-thickness tears (P = 0.0149).

Conclusion: This study, the largest single cohort to date analyzing BCIs in RCR, found a low incidence of significant postoperative stiffness in cases associated with the use of the implant. Stiffness rates were markedly higher for repairs of partial-thickness tears. To further improve understanding of postoperative stiffness after RCR with BCI, better definitions and prospective comparative studies across larger groups are needed.

Level of evidence: Level IV, retrospective cohort with no comparison group.

A 71-year-old woman presented with acute onset left knee pain and decreased range of motion (ROM) 1.5 years after total knee arthroplasty (TKA) at an outside institution. She underwent arthroscopic lysis of adhesions and manipulation under anesthesia. Intraoperatively, a displaced bucket-handle tear of the lateral meniscus was encountered and excised. At 12-month follow-up, clinical outcomes and ROM were markedly improved. The persistence of meniscus tissue after TKA is rare and should be considered as a possibility for pain and decreased ROM after TKA. This case highlights the value of meticulous removal of meniscus tissue during primary arthroplasty.

Introduction: Modular dual mobility designs (MDM) are designed to reduce the risk of postoperative dislocations following primary total hip arthroplasty (THA). This study investigated both the usage and outcomes (ie, patient-reported outcomes and complications) associated with MDM hips compared with conventional implant designs.

Methods: Patients who underwent a THA at a single, tertiary, orthopaedic specialty hospital between January 2019 and June 2022 were included. Primary outcomes of interest were compared between MDM and conventional hip designs and included complication rates, dislocation rates, clinical outcomes, and the hip disability and osteoarthritis outcome score for joint replacement (HOOS, JR).

Results: A total of 2869 patients (88% conventional THA) were included in this study. Modular dual mobility hip utilization increased 117% during the study period. Patients in the MDM group were often older females (P < 0.001) with concomitant lumbar pathology (P = 0.034). None of the MDM hips dislocated in the first 30 days post THA compared with 0.4% of the conventional hips. Despite markedly lower hip disability and osteoarthritis outcome score for joint replacement scores in the MDM group, the number of patients reaching the minimally clinically important difference was similar (P = 0.915).

Conclusion: MDM patients experience lower rates of dislocation compared with those receiving conventional implants. Despite worse clinical outcomes and increased all-cause emergency department utilization in the MDM group, multivariate regression suggests that these outcomes were associated with the implant being used in an older, sicker population instead of the implant itself. The results suggest similar overall outcomes and a lower dislocation rate for patients who received an MDM hip.

Background: The American Orthopaedic Association initiated the "Own the Bone" program in 2009 to promote a more active involvement of orthopaedic surgeons in managing osteoporosis after fragility fractures. This study investigates the effectiveness of the program by examining the changes in yearly DEXA scan rates and diphosphonate prescriptions since the program's inception.

Methods: Patients aged 50 to 85 years who sustained a femoral neck fracture requiring surgery from 2010 to 2019 were tracked using the PearlDiver database. The study examined annual DEXA scans within 1 year of fracture and diphosphonate treatment within 6 weeks and 1 year. Age, sex, obesity, tobacco, and alcohol use were also analyzed.

Results: In total, 201,499 patients met inclusion criteria (67.0% female). Younger, predominantly female patients more often underwent DEXA scans within 1 year of fracture. Tobacco users, alcohol abusers, and obese patients were also more likely to receive scans. Annual DEXA scan rates from 2010 to 2019 ranged narrowly from 4.66% in 2012 to 5.82% in 2010, ending at 4.87% in 2019. Diphosphonate prescriptions within 1-year postfracture dropped from 5.12% in 2010 to 2.98% in 2019, with early (≤6 weeks) treatment falling from 1.07% to 0.66%, showing no sustained increase over time. Those prescribed bisphosphonates were younger, more likely female, obese, and tobacco users.

Conclusion: The Own the Bone program has not successfully modified orthopaedic surgeons' approaches to managing osteoporosis. This stagnation in practice change could be due to a lack of sufficient incentives or a limited knowledge base that prevents surgeons from providing thorough osteoporosis counseling postfracture.