SICOT-J最新文献

Background: Functional knee positioning (FKP) represents an innovative personalized approach for total knee arthroplasty (TKA) that reconstructs a three-dimensional alignment based on the optimal balance of soft tissue and bony structures, but it has mostly been described for varus knee deformity.

Surgical technique: Valgus deformities present specific challenges due to altered bone remodeling and soft tissue imbalances. Using robotic assistance, FKP enables precise intraoperative assessment and correction of compartmental gaps, accommodating each individual's unique anatomy and laxities. The distal femoral cut is calibrated for 9 mm resection at the intact medial femoral condyle and adjusted on the lateral side to accommodate bone wear, while the tibial plateau resection aims for 8 mm from the medial side and 4-6 mm from the lateral side. Intraoperative evaluations of mediolateral laxities are performed at extension and 90° flexion. Adjustments are made to femoral and tibial cuts to balance gaps, aiming for 0 mm in posterior stabilized implants and minimal discrepancies in cruciate-retaining designs with lateral gap looser in flexion.

Discussion: FKP emphasizes soft tissue-driven adjustments with the use of robotic platforms. Hence, intact soft tissue envelope of the knee is essential. This technique holds significant promise for managing valgus deformities in TKA, but further research is needed to evaluate its functional outcomes.

Background: Total knee arthroplasty (TKA) in patients with prior anterior cruciate ligament reconstruction (ACLR) presents unique challenges due to altered knee kinematics, residual instability, and fixation implants that may interfere with implant positioning. Image-based robotic-assisted TKA enables the functional alignment (FA) strategy that accounts for individual bony anatomy, ligamentous laxities, and anterior compartment characteristics.

Surgical technique: This technique involves a CT-based robotic workflow where femoral and tibial components are planned based on patient-specific alignment and soft tissue balance. Intraoperative assessment with a digital tensioning device guides fine-tuning of flexion and extension gaps, ensuring balanced implant positioning while minimizing soft tissue releases. Fixation implants from prior ACLR are identified using robotic navigation, allowing for targeted adjustments such as selective removal or controlled elevation of components to avoid excessive bone loss. Patellar tracking is dynamically evaluated with a probe, facilitating real-time adjustments to optimize mediolateral tracking and anterior offset.

Discussion: Given the altered biomechanics in post-ACLR knees, FA may provide a physiological alignment by accommodating native laxities and reducing the risk of residual instability. Additionally, robotic guidance allows for precise management of fixation implants, ensuring optimal implant positioning and bone preservation. While further studies are needed, robotic-assisted FA represents a promising approach for enhancing outcomes in TKA for post-ACLR patients.

Introduction: Knee joint stability is influenced by force distribution and ligament structures. High Tibial Osteotomy (HTO) treats knee deformities and redistributes load, reducing further invasive procedures. High Tibial Osteotomy (HTO) is a well-established procedure for addressing knee instability, particularly in cases involving ligament deficiencies such as ACL and PCL insufficiencies. This systematic review aims to evaluate the clinical outcomes and long-term efficacy of HTO in improving knee stability and function.

Methods: A systematic literature search was conducted using Cochrane Central, PubMed, MEDLINE, and ProQuest databases for studies published between 2000 and June 2024. Eligible studies included human subjects with at least six months of follow-up and focused on HTO for knee instability. Exclusion criteria included animal studies, non-knee joint studies, and reviews. Data on patient demographics, follow-up duration, subjective and objective outcomes, and complications were extracted.

Results: Out of 536 studies identified, 11 met the inclusion criteria, encompassing 303 patients. Combining HTO with ACL or PCL reconstruction significantly improved both subjective instability and objective measures, including Lachman and Pivot Shift test grades. Patient satisfaction was high, and functional scores such as Lysholm and Tegner improved markedly. The incidence of complications was low, with minor issues such as infections and delayed union, and no reported graft failures.

Conclusion: HTO, particularly when combined with ligament reconstruction, effectively treats knee instability due to ACL or PCL deficiency. The procedure demonstrates strong mid- to long-term outcomes, high patient satisfaction, and a low rate of complications. It remains a viable option for patients with knee instability.

Background: Dementia patients with femoral neck fractures (FNFs) are unable to understand their dislocated limb positioning, which may impair rehabilitation and result in poorer functional recovery. Recently, good clinical results have been reported for the direct anterior approach for total hip arthroplasty (DAA-THA) using a dual mobility cup (DMC) for displaced FNFs. This study aimed to investigate differences in the clinical outcome of THA for displaced FNFs in patients with and without dementia.

Methods: This study was retrospective and included 151 patients who underwent DAA-THA with DMC for displaced FNFs. Patients diagnosed with dementia prior to injury were classified into a dementia group (43 patients) and a non-dementia control group (control group, 108 patients). The evaluation items were age, sex, body mass index (BMI), preoperative Fracture Mobility Score (FMS), waiting period, preoperative anesthetic assessment, blood loss, operation time, complications, 1-year mortality, and 1-year FMS after surgery. The FMS was scored as: walking alone: 1, walking with a cane: 2, walking with a walker: 3, hand-guided walking: 4, and wheelchair: 5.

Results: Significant differences were found in age, weight, BMI, and operation time. Postoperative dislocation was not observed in both groups. FMS was compared before and after injury in three categories: (1) unchanged from before injury, (2) one rank down, and (3) two or more ranks down. No significant differences were found in any of these categories (p = 0.09). Functional outcomes showed no significant difference in mobility recovery. The 1-year mortality rate was 9.35% (16 patients), with no significant difference between the two groups (p = 0.17).

Discussion: DAA-THA using DMC for displaced FNFs may have similar functional outcomes and mortality rates in both patients with and without dementia.

Purpose:  This study aimed to assess hindfoot height (HFH) changes 12 months after posterior arthroscopic subtalar arthrodesis without bone grafting. We hypothesized that HFH reduction would be minimal and would not impact fusion or functional results.

Methods: A retrospective study was conducted on 39 patients who underwent posterior arthroscopic subtalar arthrodesis. HFH was measured on CT scans preoperatively and at 12 months postoperatively. Inter- and intra-observer reliability of the measurement was also assessed as a secondary outcome. Clinical outcomes included pain (numeric analog scale, NAS) and AOFAS Ankle-Hindfoot scores. Subtalar fusion ratios were evaluated via CT.

Results: Mean HFH loss was 0.85 ± 1.1 mm (range, 0-5 mm). The average fusion ratio was 72 ± 30%. Pain and AOFAS scores significantly improved (NAS: -4 ± 2, p < 0.0001; AOFAS: +31 ± 13, p < 0.0001). No correlation was found between HFH loss and fusion ratio or clinical outcomes. HFH loss > 1 mm was more frequent in women and smokers. HFH measurement on CT showed excellent inter- and intra-observer reliability (ICC intra: 0.989; inter: 0.976).

Conclusions: Posterior arthroscopic subtalar arthrodesis without bone graft results in minimal hindfoot height loss, with no negative impact on subtalar fusion or functional outcomes. This technique reliably preserves hindfoot alignment and provides excellent clinical results. While the assessment of hindfoot height on CT demonstrated excellent inter- and intra-observer reliability, this was a secondary finding and supports the utility of CT-based measurements in the postoperative evaluation of subtalar arthrodesis.

Introduction: The understanding of the influence of posterior tibial slope (PTS) on knee kinematics has increased. However, the PTS influence on clinical outcomes remains unclear. The study aimed to evaluate whether a significant change between the native and the prosthetic tibial plateau PTS influences functional results and the risk of complications following total knee arthroplasty (TKA).

Methods: This was a retrospective, monocentric comparative study. Clinical and radiological data from 793 knees were collected from a prospective surgical database. Inclusion criteria were patients operated with a posterior-stabilized TKA (PS-TKA) for primary tibiofemoral osteoarthritis, with or without associated patellofemoral osteoarthritis, or osteonecrosis of the femoral condyle or tibial plateau, with a minimum follow-up of 5 years. Range of motion and International Knee Society (IKS) score as well as radiological measurements were collected preoperatively and postoperatively at each follow-up visit. Two groups were composed according to the change in PTS between pre- and post-op (Group 1: ≤10°, n = 703; Group 2: >10°, n = 90).

Results: The mean follow-up was 75.5 months ± 9.1. The mean change in PTS from preoperative was 4.96° ± 3.24 in group 1 and 12.7° ± 1.87 in group 2. There was no significant difference in the mean IKS Knee subscore (89.5 ± 10.7 and 89.7 ± 10.2, p = 0.89) and mean IKS Function subscore (88.2 ± 15.7 and 86.3 ± 16.6, p = 0.33) in groups 1 and 2, respectively. Postoperative maximum flexion was very satisfactory in both groups with no clinically relevant difference (120.0 ± 11.9 and 123.0 ± 8.3, p = 0.026). The complication rate was 5.0% (n = 40) (5.5% in group 1; 1.1% in group 2; p = 0.07) while the most common complication requiring further procedure was deep infection (n = 9, 1.1%) and the second most common was stiffness (n = 6, 0.8%).

Discussion: PTS did not influence postoperative maximum flexion or clinical scores and was not associated with a higher complication rate at a minimum 5-year follow-up after PS-TKA.

Introduction: The two-stage management of hip Prosthetic Joint Infection (PJI) is faced with a high rate of dislocation. Dual mobility (DM) cups have proved effective in reducing the risk of dislocation, but few data are available on the two-stage management of hip PJI. The objectives of this retrospective cohort study were to analyze the rate of dislocation, and the rate of recurrent dislocation and to identify risk factors for dislocation. Our hypothesis was that the use of a DM cup during a two-stage replacement had a low instability rate.

Methods: Data from 70 two-stage changes with DM cup reimplantation performed in our centre between 2011 and 2020 were retrospectively collated. The mean age was 69 years [18-93], with a mean follow-up of 3.4 years [1.5-9.6]. Dislocation rates and risk factors for prosthetic instability were collected. Univariate and multivariate analyses were performed to identify risk factors favouring prosthetic instability.

Results: The rate of dislocation at the last follow-up was 8.6% (6/70), including 4.3% (3/70) in patients with no infection recurrence. The rate of recurrent dislocation was 0% when infection was controlled. The occurrence of spacer dislocation, the presence of immunosuppressive and antiaggregant medication, the local grade of the McPherson score and infection treatment failure were associated with the occurrence of a dislocation. No risk factors were identified in the multivariate analysis.

Discussion: Compared with the rates reported in the literature, the use of a DM cup seems indicated in this context in order to lower the risk of recurrent dislocation. Preventing spacer dislocation and infection recurrence seems to be essential to avoid the risk of instability of the future prosthetic hip.

Introduction: Revision Total Knee Arthroplasty (RTKA) is complex, and induced bone loss might endanger implant fixation and joint stability. Intramedullary stems improve fixation throughout stress redistribution. The current study aims to compare the performance of short tibial stems with long tibial stems, investigating their intermediate-term radiographic and survival outcomes in RTKA. The main hypothesis is that the two types of tibial stems would exhibit similar complication and revision rates in mid-term follow-up.

Methods: Patients who underwent RTKA for all causes in a specialized arthroplasty center from 2010 to 2022 with minimum 2-year follow-up were included in this study. Patients receiving mega prosthesis or implants associated with sleeves or cones were excluded. The final groups consisted of 234 knees: 110 patients with short stems (SS) and 124 with long stems (LS). The mean age at surgery was 65.96 ± 8.73 years in SS and 67.07 ± 8.64 years in LS. The mean Body Mass Index (BMI) was 28.95 is SS and 30.88 in LS (p < 0.05). The average follow-up for SS group was 4.24 years and for LS 5.16 years (p < 0.05).

Results: Complications and re-revisions did not differ significantly between two groups (p > 0.05). Pathological radiolucency was present in 20.91% in SS group and 33.87% in LS group (p < 0.02). Time-to-re-revision was shorter in SS group and occurred at a mean of 3.1 years, while LS failed at a mean of 5.1 years (p < 0.001).

Conclusions: The SS and LS may be comparable in terms of complications and re-revision. SS significantly fails almost 2 years earlier than long stem (p < 0.001). Additionally, there is a higher tendency for re-revision due to loosening in patients who present pathological radiolucency in SS group. To obtain the benefits of short stem and improve the longevity of the construct; adjuvant zone II (metaphyseal) fixation might be the clue.

Introduction: Simultaneous bilateral total knee arthroplasties (SBTKA) are common in Asia, but surgeons may have a body mass index (BMI) threshold for performing these procedures. However, no guidelines regarding patient weight and SBTKA exist in the literature. We hypothesized that SBTKA can be performed safely and efficiently for morbidly obese patients. We aimed to compare 1) the rate of complications within one year after surgery, 2) operative time, blood loss, and length of stay, and 3) clinical outcomes at one year after SBTKA in patients with BMI < 30 versus 30 < BMI < 40 and BMI > 40.

Methods: In this retrospective comparative matched (age, ASA score) study, we evaluated 113 patients who underwent SBTKA (posterior stabilized cemented TKA), between 2019 and 2022. The patient population was grouped based on their BMI: BMI < 30 (33 patients), 30 < BMI < 40 (43 patients), and BMI > 40 (37 patients). A complication was defined as an event that could be classified as a grade > 3 according to the Clavien-Dindo classification within one year of surgery. Data on complication rate, operation time, blood loss, and preoperative and post-operative function KSS at one year were compared.

Results: No significant difference in the occurrence of early complications between the three groups was observed. One patient was readmitted for periprosthetic fracture in the BMI < 30 group. There was no significant difference in operative time, blood loss, and KSS score at one year between the three groups. A significant functional improvement was observed in all three groups at the one-year follow-up.

Discussion: This study suggests that SBTKA in patients with a BMI > 40 is safe, with no increased complications, similar surgical time, and blood loss. Significant functional improvement was observed at one year postoperatively. While promising, further multi-center studies are needed to confirm these findings and evaluate long-term outcomes.

Background: Correcting severe scoliosis is challenging due to curve rigidity and risks to cardiopulmonary and neurologic function. Osteotomy techniques offer greater correction but carry higher complication rates, while non-osteotomy methods may be safer but less effective. This systematic review compares outcomes between osteotomy and non-osteotomy approaches in treating severe idiopathic scoliosis.

Methods: A systematic search was conducted in PubMed, EMBASE, and the Cochrane Library using MeSH terms related to "idiopathic adolescent scoliosis", "AIS", "severe scoliosis", and "surgical outcome". The review followed PRISMA guidelines.

Results: An initial search yielded 565 studies, of which 23 studies (n = 932 patients) met the inclusion criteria. The Vertebral Column Resection (VCR) group achieved the greatest spinal correction, with a mean Cobb angle of 106.7 ± 9.7° and a correction rate of 62.1%, but also had the highest complication rate at 24%. Non-osteotomy methods provided similar correction (107.0 ± 9.1°, 61.5%) with a slightly lower complication rate of 19.6%. The Ponte osteotomy group had the lowest complication rate (4%) with a moderate level of correction (107.4 ± 10.5°, 60.3%). In terms of functional outcomes, the non-osteotomy group reported the highest SRS-22r scores, averaging 4.3.

Conclusion: VCR offers the most significant curve correction, but with a higher complication rate. Ponte osteotomy provides a safer alternative with acceptable clinical outcomes. In contrast, non-osteotomy techniques strike a balance between correction and risk, with favorable functional results.