SICOT-J最新文献

Introduction: Posterior shoulder dislocation with a reverse Hill-Sachs lesion is a rare and complex injury, requiring specialized treatment due to the difficulty in diagnosis, reduction, and addressing both sides of the pathology to reduce the potential for recurrent dislocation.

Purpose: To evaluate the clinical and functional outcomes of closed reduction and arthroscopic McLaughlin procedure with posterior labral repair in patients with neglected locked posterior shoulder dislocation for less than 12 weeks.

Methods: A prospective study was conducted at university hospitals, managing 15 patients with neglected locked posterior shoulder dislocation for less than 12 weeks and concomitant engaging reverse Hill-Sachs lesions of less than 40% of the humeral articular surface. They were treated with closed reduction and arthroscopic McLaughlin procedure with posterior labral repair. Patients' assessments included shoulder range of motion, pain levels using the visual analog scale (VAS) score, and functional outcome using the Oxford instability score and the University of California Los Angeles Shoulder Scale (UCLA) with at least 2 years of postoperative follow-up.

Results: All 15 patients reported no recurrent dislocation and restored shoulder motion at the final follow-up. External rotation significantly improved from 0° to a mean of 65° in adduction, at 90° of abduction, the respective measurement was 85° (p < 0.01). Active forward flexion increased from 35° to 145° (p < 0.01). UCLA and Oxford instability scores Showed marked improvement (p < 0.01).

Conclusion: Closed reduction and arthroscopic McLaughlin procedure with posterior labral repair is a safe and effective way for managing patients with locked neglected posterior shoulder dislocations that have been neglected for less than 12 weeks with engaging reverse Hill-Sachs lesion defect, less than 40% of the humeral head.

Objective: Intertrochanteric femur fractures (ITFF), more so reverse oblique fractures (AO/OTA 31-A3), are the most challenging clinically, with significant morbidity and mortality. Early stable fixation should be achieved to allow early mobilization and reduce complications. This study evaluates the functional and radiological outcomes of three Proximal Femoral Nail (PFN) techniques - PFN alone, Cable + PFN, and Monocortical reconstruction plate (MRP) + PFN- in managing reverse oblique ITFF, to determine the most ideal of them.

Methods: A retrospective analysis was performed on 106 patients treated from 2015 to 2022. The patients were classified by the surgical intervention: Cable + PFN (n = 37), MRP + PFN (n = 29), and PFN (n = 40). The critical parameters analyzed included healing time, quality of reduction, rates of complications, and functional outcomes of Trendelenburg gait.

Results: The bone healing time was significantly faster in the Cable + PFN group and MRP + PFN group as compared to the PFN group, 4.43 ± 0.92 and 4.44 ± 0.90 months versus 6.40 ± 2.41 months, respectively (p < 0.001). Compared with the PFN group, the number of cases with Trendelenburg gait in the Cable + PFN group was significantly lower, 10.8%. The number of patients showing the Trendelenburg gait trended lower in the MRP + PFN group but was insignificant (p = 0.075). Radiological outcomes did not differ significantly among the groups.

Conclusion: The use of Cable + PFN and MRP + PFN techniques has superior outcomes with earlier bone union and far less incidence of Trendelenburg gait than PFN alone. These findings can help hint that perhaps the usage of cables and recon plates enhances the stability and functional restoration in patients who have sustained reverse oblique ITFF.

Level of evidence: III.

Purpose: Controversy exists on the best fixation for total knee arthroplasty (TKA). Non-cemented fixation has been theorized to improve patient outcomes and longevity of implantation but no study has focused on comparison between cemented or cementless posterior-stabilized implants despite being the most commonly or second most frequently utilized implant in most total knee replacement registries.

Methods: Inclusion criteria with observational and interventional papers, and review articles that focused on patients with cementless and cemented PS TKAs were used to analyze outcomes such as implant survivorship, complication, or revision rates. Using a combination of keywords, a systematic search was performed on Medline (PubMed), Embase, and Cochrane Library for Meta-Analysis.

Results: When using the specified criteria, only 8 studies were selected for full-text analysis and meta-analysis after eliminating screening duplicates, titles, and abstracts without full-text access. These eight studies contain 1652 patients, 693 in the non-cemented Group, and 959 in the cemented total knee prosthesis Group. The meta-analysis revealed the advantage of cementless fixation over cemented fixation in implant survivorship, with 0.6% and 2.6% of aseptic loosening in each Group. The cumulative survival at 12 years was 97.4% for the cementless Group and 89.2% for the cemented Group. The subgroup with a stem showed a positive outcome for cementless fixation over cemented fixation regarding implant survivorship. No differences between the cemented and cementless TKAs were observed in patient-reported outcomes, revision rates, or radiolucent line development.

Conclusion: We observed comparable rates for cemented and cementless posterior-stabilized TKAs over a medium-term follow-up period.

Hip arthroscopy is a rapidly evolving field in orthopedics, offering diagnostic and therapeutic benefits for a range of hip pathologies. This review outlines a comprehensive guide to initiating hip arthroscopy safely and effectively using evidence-based practices. Optimal surgical outcomes depend on correct indications for surgery, in particular in the presence of borderline dysplasia and degenerative joint diseases. Proper patient counseling and setting realistic expectations are crucial for satisfactory outcomes and recovery. Physical examination, radiographs, MRI, and CT scans are essential for accurate diagnosis. In case of diagnostic uncertainty, the use of intra-articular injections can help confirm the diagnosis before surgery. Techniques for hip arthroscopy include central compartment first, peripheral compartment first, and outside-in approaches. Each technique has advantages, and the optimal approach depends on the specific case. Finally, Proper operating room setup, meticulous patient positioning, and precise portal placement are critical for a successful procedure. A thorough understanding of the safe zone anatomy for portal placement is essential to minimize the risk of neurovascular complications. In conclusion, this manuscript provides a detailed, evidence-based framework for starting hip arthroscopy, emphasizing the importance of technical proficiency, patient selection, and a multidisciplinary approach to ensure patient safety and procedure efficacy.

Introduction: There is a wide range of commercially produced revision implants for adequate reconstruction of acetabular large bone defects today, however, it is not always possible to achieve long-term survival of these implants. There is an increasing number of scientific publications concerning the use of custom-designed 3D components, which make it possible not only to achieve stable fixation and connect the pelvic bones but also to restore hip joint biomechanics.

Objectives: To evaluate the positioning of 3D acetabular implants after revision hip arthroplasty and its impact on clinical and functional outcomes.

Methods: we analyzed results in 48 patients with bone defect types IIIA and IIIB Paprosky types, after revision hip arthroplasty. A prospective study was conducted from 2017 to 2023. Revision arthroplasty due to aseptic loosening of the components was performed in 30 cases and as a second stage of periprosthetic infection treatment in 18 cases.

Results: We did not achieve a statistically significant difference when using additional flanges and clinical and functional results. In 2 cases we faced aseptic loosening in patients using flanges. In no case were we able to install an implant with 100% adherence to porous structure compared to preoperatively planned adherence. According to the WOMAC and VAS scales, increasing the contact area of the components showed a slight statistical difference in the improvement of clinical and functional results and the reduction of pain.

Conclusions: When acetabular 3D components adhered to the bone by more than 68%, we did not register a single complication in the postoperative period, and acetabular 3D components adhered to the bone by less than 68%, a total of 8 (16.6%) complications were registered.

Purpose: The current study aimed to investigate the correlation between the grade of radiographic hip osteoarthritis (OA) and the fracture pattern observed in fragility fractures of the proximal femur. The information may help in cases of occult hip fractures.

Methods: In this retrospective study all 448 patients treated with fragility fractures of the proximal femur in the years 2014-2018 were included. Patients were allocated into two groups: Group I) intracapsular (femoral neck) fractures and Group II) extracapsular (pertrochanteric and subtrochanteric) femoral fractures. The radiographic grade of OA was determined according to Kellgren and Lawrence's classification. One single observer examined all radiographs.

Results: Patients' age ranged between 52 and 104 years with a mean of 80.0 years. There was a significant difference in mean age between the two groups (76.9 years intracapsular vs. 83.1 years extracapsular fractures). A total of 250 (55.8%) fractures were intracapsular (femoral neck) and 198 (44.2%) were located extracapsular (pertrochanteric, subtrochanteric). A significant correlation between the degree of OA to fracture pattern was observed: Higher degrees of OA were related to extracapsular fractures and lower degrees of OA to intracapsular fractures.

Conclusion: The results of this study support the hypothesis that hip osteoarthritis affects the fracture pattern in proximal femur fractures. More severe hip OA is associated with extracapsular fractures that can be treated surgically with lower complication rates compared to intracapsular fractures.

Introduction: Lateral fractures of proximal femur are the most frequent fractures in elderly people. Internal fixation using medullary nails is the gold standard of treatment (Gamma 3 nail is the most implanted device) due to reduced incidence of complications than other devices. We report our experience in treating this kind of fractures with Gamma 3 nail, between January 2015 and December 2021.

Methods: We performed a retrospective cohort study of patients treated in our orthopaedic department; level of clinical care is III: 559 patients (431 females and 128 males, with an average age of 85.3 years) with lateral femoral neck fracture. All patients were surgically treated with Gamma 3 standard nail (SGN). We evaluated preliminary X-rays to classify fractures, according to AO-OTA classification and post-operative X-ray to verify cephalic screw position site, according to areas described by Cleveland in 1959: we measured tip-to-apex distance (TAD) and tip-to-apex calcar referred distance (CalTAD). Finally Chang reduction quality criteria (CRQC) for fracture reduction of trochanteric fractures were determined using preoperative or postoperative Antero-Posterior (AP) and lateral radiographs in a Picture Archiving and Communication System (PACS). Incidence of cut-out was evaluated in relation with these parameters. Patients were divided into 2 groups: first group had cephalic screw in optimal positions (5-8-9), the other group had cephalic screw in other positions.

Results: In 328 patients (58.7%) screw was in positions 5-8-9, in 231 patients (41.2%) screw was in not-optimal position. Median TAD was 19.1 ± 7.0 mm (range = 0.0-50.5); in 463 patients (82.8%) TAD was ≤ 25 mm. Median CalTAD was 21.4 ± 4.7 mm (range = 5.7-39.2); in 105 patients (79.4%) CalTAD was ≤ 25 mm. Cut-out was observed in 8 cases (1.43%). Multivariate analysis showed a significant correlation (p < 0,05) between incidence of cut-out and fracture type 31A2 and with TAD values >25 mm. Cephalic screw position did not influence incidence of cut-out.

Discussion: In order to obtain fracture healing with a low risk of failure, in particular cut-out, it is necessary to obtain good reduction of fracture and optimal lag screw position in order to achieve a TAD inferior to 25 mm.

The integration of artificial intelligence (AI) into orthopaedic care has gained considerable interest in recent years, evidenced by the growing body of literature boasting wide-ranging applications across the perioperative setting. This includes automated diagnostic imaging, clinical decision-making tools, optimisation of implant design, robotic surgery, and remote patient monitoring. Collectively, these advances propose to enhance patient care and improve system efficiency. Musculoskeletal pathologies represent the most significant contributor to global disability, with roughly 1.71 billion people afflicted, leading to an increasing volume of patients awaiting planned orthopaedic surgeries. This has exerted a considerable strain on healthcare systems globally, compounded by both the COVID-19 pandemic and the effects of an ageing population. Subsequently, patients face prolonged waiting times for surgery, with further deterioration and potentially poorer outcomes as a result. Furthermore, incorporating AI technologies into clinical practice could provide a means of addressing current and future service demands. This review aims to present a clear overview of AI applications across preoperative, intraoperative, and postoperative stages to elucidate its potential to transform planned orthopaedic care.

Introduction: This retrospective cohort study aimed to evaluate the impact of kick-off time on the risk of injury for professional soccer players in the first German Bundesliga. It was hypothesized that late kick-off times would have a negative effect on muscle and ligament injuries to the ankle and knee.

Methods: Kick-off times and injury data were collected over 5 consecutive seasons (1530 matches; 2014-2019) from two media-based registries (transfermarkt.de^® und kicker.de^®). The kick-off times were assorted into three groups: Afternoon kick-off between prior to 3:30 pm (988 matches), evening kick-off between 5:30 to 6:30 pm (303 matches), and night kick-off after 8 pm (239 matches).

Results: A total of 1327 match injuries were recorded over 5 seasons in 510 different male elite soccer players. The injuries affected muscles in 32.1%, ankle ligaments in 7.8%, and knee ligaments in 5.6%. There was no significant difference in injury rates when comparing different kick-off time groups (p > 0.05), however, the mean of time attributed to muscle and ankle ligament injuries suffered in games with a late kick-off time was significantly longer (p < 0.05).

Conclusion: This study shows that there is no significant (p > 0.05) association between three different kick-off time groups and injury risk in the first German Bundesliga. However, significant (p < 0.05) differences in the lay-off times attributed to muscle and ankle ligament injuries differed with different kick-off times assorted into the three groups. Reasons for this observation could be found in the circadian muscle rhythms and muscle fatigue.

Background: Correct acetabular component placement plays a critical role in reducing early revisions after dislocations in total hip arthroplasty (THA). Although the transverse acetabular ligament (TAL) guides anteversion, inclination can only be accurately guided by navigation. In order to overcome the initial disadvantages with navigation, an imageless, easy-to-use inertial navigation system has been recently introduced. This study aims to analyze the accuracy of inclination with this navigation system compared to the standard manual technique.

Methods: Two cohorts, manual technique (MT) and navigation (NAV) cohorts, consisted of 83 and 95 patients, respectively, after exclusion criteria were applied. Inclination target was 38° and anteversion was guided by TAL. Demographic data were collected, and anteroposterior (AP) pelvic and cross-table lateral radiographs were obtained 6 weeks post-operatively. Inclination and anteversion were determined on the AP pelvic and cross-table lateral radiograph, respectively.

Results: A mean inclination of 41.8° (±6.8°) and 38.9° (±4.4°) was found in the MT and NAV cohorts, respectively. There was no statistical difference in gender, age, and BMI. If the inclination was set within 10° of the target (i.e., 38°), 88% of the MT cohort and 97% of the NAV cohort were within the target zone. Accuracy decreased to 53% and 83%, respectively, if the target zone range was narrowed down to ± 5°.

Conclusion: Combining inertial imageless navigation for inclination and TAL as a landmark for anteversion is significantly more accurate compared to the manual technique, without having the limitations and disadvantages of current standard navigational techniques.