SICOT-J最新文献

Introduction: This study aimed to investigate the anterior-posterior (AP) displacement of the tibial tuberosity (TT) and to assess the difference between closed wedge and opening wedge high tibial osteotomies (OWHTO and CWHTO).

Methods: One hundred consecutive knees with osteoarthritis that underwent OWHTO (50 knees) or CWHTO (50 knees) were investigated retrospectively. The femorotibial angle (FTA) was measured on AP radiographs of the knee. AP displacement of the TT, posterior tibial slope (PTS), the modified Blackburne-Peel index (mBPI), and the modified Caton-Deschamps index (mCDI) were measured on lateral radiographs of the knee.

Results: Patients had a mean correction angle of 12.58 ± 2.84° and 18.98 ± 5.14° (P < 0.001), with a mean AP displacement of TT of 0.84 ± 2.66 mm and 7.78 ± 3.41 mm (P < 0.001) in OWHTO and CWHTO, respectively. The AP displacement of the TT per correction of 1° was significantly greater in CWHTO than in OWHTO (P < 0.001). A significant correlation was found between the correction angle and AP displacement of the TT in CWHTO (r = -0.523, P < 0.001), but not in OWHTO. The change of PTS per correction of 1° was significantly greater in OWHTO than in CWHTO (P < 0.001). The changes of mBPI and mCDI per correction of 1° were significantly greater in CWHTO than in OWHTO (P < 0.001 and P < 0.001, respectively).

Conclusions: There was greater anterior displacement of the TT in CWHTO than in OWHTO, which was correlated with the correction angle. The results suggested that CWHTO would be better than OWHTO when a concomitant anteriorization of TT is required.

Introduction: The lesser trochanter profile (LTP) method is an intraoperative fluoroscopic technique that can assess the femoral version and limit malrotation. The purpose of this study was to directly assess the accuracy and reliability of the LTP method, as well as determine the incidence of malrotation produced by this technique.

Methods: Three groups of observers (fellowship-trained orthopedic surgeons, orthopedic residents, and medical students) utilized the LTP method to replicate pre-imaged rotation angles on a cadaveric femur bone. Recorded outcomes include rotational error and number of attempts. Accuracy and interobserver reliability were assessed by rotational error and the interclass correlation coefficient (ICC), respectively.

Results: Accuracy was within 3° for all three groups. ICC between each group was greater than 0.99. There was no statistical difference between the accuracy of fellowship-trained surgeons, orthopedic residents, and medical students. Medical students on average required more attempts to obtain their final image compared to fellowship-trained surgeons. There was no statistical difference in the number of attempts between residents and fellowship-trained surgeons.

Conclusion: None of the LTP measurements were greater than 15°, the clinical threshold for malrotation. The average error of the observers was less than 3°, demonstrating that the LTP is an effective method of assessing the femoral version. There was no statistically significant difference between the observers, indicating that this technique is reliable and easy to use. Ultimately, the LTP method is easily reproducible for surgeons to avoid femoral malrotation.

Introduction: Limb salvage surgery in children following bone sarcoma resection is a challenging problem because of the small size of the bones, the lack of appropriate size-matched implants, and the risk of limb-length discrepancy once skeletal growth is complete, secondary to the loss of the epiphyseal plate. Although several reconstruction options are available in children with bone sarcomas, such as vascularized fibula, massive bone allograft, extracorporeal devitalized autograft, endoprosthesis, and allograft-prosthesis composite, a consensus has not been reached on the best reconstruction method. The purpose of the present study is to propose an algorithm for reconstruction after resection of bone sarcomas in children.

Methods: In this review, we analyzed reports on limb reconstruction in children following treatment for bone sarcoma, to provide a comprehensive overview of the different reconstruction options in children with bone sarcomas, the outcomes, and the risks and benefits of the different surgical approaches.

Results: Despite a high risk of complications and the necessity for limb-lengthening procedures, prosthetic or biological reconstructions seem to achieve good functional outcomes in children with bone sarcoma. The use of massive bone graft seems to be recommended for intercalary reconstructions, with a free vascularized fibular graft for long defects, while for osteoarticular reconstruction a modular or expandable prosthesis or an allograft-prosthesis composite seems to have good results. For reconstruction of the proximal humerus, modular prosthesis or allograft-prosthesis composite are more commonly used than expandable prosthesis since there are fewer functional constraints related to possible limb-length discrepancy on the upper limb compared to the lower limb.

Discussion: We discuss the advantages and limitations of the different available surgical options for bone reconstruction following tumor resection in children and propose an algorithm of potential surgical treatments for children with bone sarcomas of the extremities.

Introduction: Precise implant positioning during total hip arthroplasty (THA) is an important factor affecting dislocation rate and long-term implant survival. Although a special carbon fiber traction table for THA improves the accuracy of implant positioning, it is too expensive. We aimed to report the accuracy of cup positioning and complication rate in patients undergoing THA using a conventional noncarbon fiber traction table, which is generally used for osteosynthesis of femoral fractures.

Methods: This retrospective study included 62 patients who received primary THA via the direct anterior approach using a conventional traction table with fluoroscopy between July 2022 and December 2023. Two observers recorded radiological outcomes using postoperative anteroposterior X-rays. The intraclass correlation coefficients of cup positioning angles were evaluated (inclination: 0.92, anteversion: 0.88 for intra-observer agreement; inclination: 0.91, anteversion: 0.84 for inter-observer agreement). Complications were defined as dislocation, periprosthetic fracture, ankle fracture, implant loosening, nerve injury, surgical site infection, deep vein thrombosis, and revision surgery for any reason.

Results: Radiographic analysis showed an average cup inclination of 38.5° ± 4.3° (98.4% within Lewinnek's safe zone). The average cup anteversion was 12.6° ± 4.6° (100% within Lewinnek's safe zone). None of the patients experienced any complications.

Discussion: A conventional traction table could be a feasible alternative to a carbon fiber traction table for performing THA via the direct anterior approach using fluoroscopy at general hospitals.

Introduction: Although single-stage bilateral total knee arthroplasty (BTKA) presents several advantages, higher perioperative blood loss is a potentiate drawback that is still inevitable. Cruciate retaining (CR) TKA may theoretically result in less blood loss, offer better proprioception, and more physiologic kinematics compared to posterior stabilized (PS) TKA. The objective of this study was to compare perioperative blood loss and recovery among patients who underwent CR and PS BTKA.

Methods: A cohort of 46 CR BTKA and 80 PS BTKA performed by a single surgeon were retrospectively evaluated. Identical surgical techniques and perioperative care were provided to all patients. Propensity score matching was utilized to compare blood loss, a visual analog scale (VAS) for postoperative pain level, morphine consumption, knee flexion arc, and length of stay (LOS).

Results: Comparing CR BTKA and PS BTKA, drain output was 206.44 mL vs. 194.89 mL (p = 0.47), calculated blood loss was 886.23 mL vs. 724.89 mL (p = 0.05), and blood transfusion rate was 18% vs. 17% (p = 1.00). Additionally, CR BTKA had higher VAS than PS BTKA, at 6 h: 5.74 vs. 3.78 (p < 0.001), and at 12 h: 5.80 vs. 4.74 (p = 0.02). CR BTKA group had higher morphine consumption (26.87 mg vs. 19.74 mg; p = 0.01) in the first 48 h. CR BTKA showed significantly less knee flexion angle during 48-72 h postoperative.

Conclusions: The use of the CR prosthesis in BTKA could not demonstrate a superiority over the PS design in terms of blood loss, and recovery of knee function during the acute postoperative period.

Introduction: A variety of techniques have been described for femoral fixation in medial patellofemoral ligament reconstruction (MPFLr). The aim of this study was to compare the biomechanical performance of the most used methods for graft fixation in the femur using human cadaveric tissue. We wondered what is the best fixation method for femoral fixation in MPFL reconstruction?

Hypothesis: A suspensory fixation device provides the best femoral fixation.

Material and method: Twenty cadaveric knees were tested. Four femoral fixation methods were compared (5 knees per group): interference fixation with a Biosure© RG 5 mm and a 7 mm, suture anchor (Healicoil Regenesorb 4.75 mm ©) and suspensory fixation with the Ultrabutton©. The testing was divided in preconditioning, cyclic loading and load to failure. Load to failure, elongation, stiffness and mode of failure were recorded and compared.

Results: The Ultrabutton© had the highest mean ultimate load (427 ± 215 N (p = 0.5)), followed by Healicoil anchor © (308 ± 44 N (p > 0.05)) and the interference screw of 7 mm (255 ± 170 N (p > 0.05)). Mean stiffness was similar in the Ultrabutton© and 4.75 mm. Healicoil anchor © groups (111 ± 21 N/mm and 119 ± 20 N/mm respectively), and lowest in 7 mm Biosure© screw fixation group (90 ± 5 N/mm). The Biosure© 5 mm RG screw presented 100% of premature rupture because of tendon slippage. The Ultrabutton© presented the lowest premature rupture (40%).

Discussion: A suspensory fixation for the femur had the lowest number of graft failures and highest load to failure. This study has implications for surgeons' choice of graft fixation in MPFLr. It is the first study to test the most commonly femoral used fixation methods, allowing direct comparisons between each method.

This review brings together a multidisciplinary, multinational team of experts to discuss the current state of knowledge in the detection and treatment of hip displacement in cerebral palsy (CP), a global public health problem with a high disease burden. Though common themes are pervasive, different views are also represented, reflecting the confluence of traditional thinking regarding the aetiology and treatment of hip displacement in CP with emerging research that challenges these tried-and-true principles. The development of hip displacement is most closely related to gross motor function, with radiographic surveillance programs based on the Gross Motor Function Classification System (GMFCS), the goal being early detection and timely treatment. These treatments may include non-operative methods such as abduction bracing and Botulinum Neurotoxin A (BoNT-A), but outcomes research in this area has been variable in quality. This has contributed to conflicting opinions and limited consensus. Soft tissue lengthening of the hip adductors and flexors has traditionally been employed for younger patients, but population-based studies have shown decreased survivorship for this treatment when performed in isolation. Concerns with the identification of hip displacement in very young children are raised, noting that early reconstructive surgery has a high recurrence rate. This has prompted consideration of viable minimally invasive alternatives that may have better success rates in very young children with CP, or may at least delay the need for osteotomies. Recent reports have implicated the role of abnormal proximal femoral growth and secondary acetabular dysplasia as a primary cause of hip displacement, related to ambulatory status and abductor function. As such, guided growth of the proximal femur has emerged as a possible treatment that addresses this purported aetiology, with promising early results.

Background: Reverse shoulder arthroplasty (RSA) is popular for the treatment of degenerative glenohumeral joint disease. Bone remodeling around the humeral stem related to stress shielding (SS) has been described. This review focuses on the specific radiological characteristics, risk factors, and clinical consequences of SS in RSA.

Methods: A meticulous review was conducted of articles published between 2013 and 2023. Data on the definition, risk factors, and clinical impact of stress shielding were recorded.

Results: Twenty-eight studies describing 2691 patients who had undergone RSA were included. The mean age of patients ranged from 63 to 80 years with mean follow-up periods of 12 months to 9.6 years. The prevalence of SS reached up to 39% at a 2-year follow-up. Females and elderly are typically at higher risk due to osteopenia. SS was more frequent with the use of long stems(>100 mm) compared to short stems(<100 mm). Stem design, onlay or inlay, and neck-shaft-angle did not influence SS. Frontal misalignment and a high filling ratio are riskfactors for SS. Biological factors also contribute to SS, associated with scapular notching. No correlation was found between SS and clinical outcomes.

Conclusions: SS is common in patients with cementless implants after RSA, especially in female and elderly patients. It can be limited by implanting stems with a low diaphyseal filling-ratio, in correct coronal alignment. Risk factors for polyethylene debris, primarily scapular notching, should be avoided. The authors found no clinical consequences of stress shielding, but longer-term follow-up studies are required to confirm these findings.

Purpose: Medial meniscus posterior root tears (MMPRT) pull-out repair aims to restore the meniscus' anatomical structure. Different implants are utilized for thread fixation in the pull-out repair technique for MMPRT. However, biomechanical evidence comparing the fixation strengths of these implants remains unavailable. This study investigated the tensile strength of three fixation implants in porcine knee models of MMPRT pull-out repair.

Methods: This study categorized 30 porcine MMPRT models undergoing pull-out repair into three groups (10 specimens each) based on the implant utilized for fixation, including double spike plate, metallic interference screw (IFS), and resorbable IFS fixed group. A tensile tester was used to track the suture wire threaded to the medial meniscus anterior root. The displacement length was recorded after 10 and 20 loading cycles (10-30 N, 100 mm/min cross-head speed). Each specimen was then stretched to failure (50 mm/min cross-head speed), failure modes were recorded, and structural properties (maximum load, linear stiffness, elongation at failure, and elongation at yield) were compared. Fisher's exact test and one-way analysis of variance were utilized to assess the differences.

Results: No significant differences in displacement length, upper yield load, maximum load, linear stiffness, elongation at yield, elongation at failure, and frequency of failure mode were observed between the three groups.

Conclusion: All implants were comparable in terms of fixation strength. Thus, resorbable interference screws may be particularly useful in this technique and does not require implant removal surgery.

Level of evidence: IV.

Finite element analysis (FEA) is a fundamental tool that can be used in the orthopaedic world to simulate and analyze the behaviour of different surgical procedures. It is important to be aware that removing more than 20% of the meniscus could increase the shear stress in the cartilage and enlarge the risk of knee joint degeneration. In this fact, the maximal shear stress value in the medial cartilage increased up to 225% from 0.15 MPa to 0.5 MPa after medial meniscectomy. Also, meniscal root repair can improve meniscal biomechanics and potentially reduce the risk of osteoarthritis, even in cases of a loose repair. FEA has been used to better understand the biomechanical role of cruciate ligaments in the knee joint. ACLr with bone-patellar tendon-bone graft at 60 N of pretension and double-bundle PCLr were closer to that of a native knee in terms of biomechanics. The addition of a lateral extra-articular augmentation technique can reduce 50% of tibial translation and internal rotation, protecting the graft and minimizing the risk of re-rupture. Interestingly, anatomic and non-anatomic medial patellofemoral ligament reconstruction increased the pressure applied to the patellofemoral joint by increasing patellar contact pressure to 0.14 MPa at 30° of knee flexion using the semitendinosus as a graft. After all the advances in medical imaging technologies, future studies should take into consideration patient-specific data on both anatomy and mechanics, in order to better personalize the experimental model.