SICOT-J最新文献

Physicians often grapple with the delicate balance between providing full disclosure and shielding patients from harsh realities. Honesty, empathy, and patient-centered care are crucial elements influencing patient outcomes and well-being. The revelation process of life-threatening diseases triggers distinct psychological coping stages, emphasizing the need for sensitive communication. Cultural factors further shape communication dynamics, necessitating individualized approaches. As such, this paper discusses the need for truth in the relationships and interactions of doctors and patients, emphasizes adequate information of patients based on honesty and consideration of their expectations, environment, and cultural values, and explores the pivotal role of bioethics education and training in preparing medical professionals to navigate these complex situations. By integrating bioethics education into medical curricula, fostering open and honest communication, and building strong patient-doctor relationships, we can enhance the quality of care and empower patients to embrace their medical journey with dignity and acceptance.

Background: Ankle pain frequently occurs in patients with medial compartment knee osteoarthritis (OA), particularly in those with varus deformity. In these patients, an atypical alignment of the ankle joint line relative to the ground is often observed in the coronal plane. The purpose of this study was to evaluate changes in ankle pain and ankle joint orientation after high tibial osteotomy as a treatment of medial compartment knee OA.

Methods: This prospective work was conducted on 100 patients, aged 40-55 years old, with symptomatic medial compartment knee OA associated with ankle pain, with a good range of motion and intact lateral compartment. All patients treated with high tibial osteotomy fixed by plate. Ankle pain was measured by visual analogue score (VAS) preoperatively and at 3 months, 6 months, 1 year, and 2 years postoperatively. The following parameters were assessed preoperatively and at 3 months postoperatively: the ankle joint line orientation (AJLO), medial proximal tibial angle (MPTA), and the hip-knee-ankle angle (HKA).

Results: The ankle pain significantly improved postoperatively and at last follow-up after HTO; VAS significantly reduced from 5 (4-5) preoperatively to 2 (1-2) at last follow-up (P < 0.001). AJLO was substantially decreased from 9.58 ± 2.74° preoperative to 0.41 ± 1.88° postoperative (P < 0.001). MPTA increased significantly following surgery, from a preoperative value of 85.78 ± 1.84° to a postoperative value of 90.71 ± 1.58° (P  <  0.001). Similarly, HKA improved significantly from -7.73 ± 1.50° preoperatively to 2.43 ± 0.88° postoperatively (P <  0.001). A positive correlation was found between ankle pain improvement via VAS and changes in AJLO, MPTA, and HKA (P < 0.05).

Conclusion: In patients with medial unicompartmental knee OA associated with ankle pain, both ankle pain and ankle joint orientation improved following high tibial osteotomy.

Introduction: Under functional knee positioning (FKPos) principles, residual varus or valgus alignment of the tibia and femur may be maintained, resulting in loading conditions that differ from those observed with mechanical alignment. Consequently, there is a need for evidence regarding implant fixation (cemented or cementless) in this context. This study aimed to evaluate the impact of implant fixation type (cemented versus cementless) on clinical outcomes, complications, and implant survival in robotic-assisted total knee arthroplasty (TKA) guided by FKPos principles.

Methods: A retrospective comparative analysis of 393 patients who underwent robotic-assisted primary TKA was performed. Patients were divided into two groups: cemented (n = 85) and cementless (n =276) fixation. Radiographic alignment, functional outcomes using the Knee Society Score (KSS) and Forgotten Joint Score (FJS), complication rates, and implant survival were assessed at a minimum 2-year follow-up. Subgroup analyses based on femoral and tibial fixation types were also conducted.

Results: Both fixation methods achieved comparable functional outcomes (KSS and FJS) and implant survivorship, with no significant differences in revision rates. Hematomas were significantly more frequent in the cementless group (12.32% vs. 8.24%, p = 0.02). Subgroup analyses of femoral and tibial implants showed no significant differences in functional outcomes.

Discussion: This study is the first to assess the influence of fixation type on outcomes in robotic-assisted TKA performed under FKPos principles. Both cemented and cementless fixation methods are safe and effective.

Introduction: This study evaluates complications associated with the bikini-incision direct anterior approach (DAA) total hip arthroplasty (THA) performed by a single surgeon on a standard operating table, with a focus on cases requiring large acetabular cups (≥56 mm). Secondary objectives include assessing clinical outcomes and implant survivorship.

Methods: A retrospective analysis was conducted on primary bikini-incision DAA THAs performed by a single surgeon between 2013 and 2024. Cases involving acetabular cups ≥56 mm were included, while emergency hip fracture cases and those requiring posterolateral approaches were excluded. Clinical data, radiographs, and Kaplan-Meier survival analysis were used to assess complications, Harris Hip Scores (HHS), and implant survivorship.

Results: This study included 215 THA procedures performed on 210 male patients (mean age 67 years, BMI 28.6), with an average follow-up of 3.9 years. The primary indication was osteoarthritis (88.4%). The mean preoperative HHS was 41.8, which significantly improved to 92.6 postoperatively (p < 0.001). Complications included lateral femoral cutaneous nerve (LFCN) neuropraxia (2.3%), periprosthetic fractures (0.93%), and femoral stem subsidence (0.93%). The revision rate was 0.93%, with Kaplan-Meier analysis indicating a 99% survival rate for the stem and 100% survival for the acetabular cup at the final follow-up.

Discussion: The bikini-incision DAA THA using a standard operating table provides excellent short- to mid-term functional outcomes and implant survivorship for patients requiring large acetabular cups (≥56 mm). The approach is associated with low complication and revision rates, supporting its safety and efficacy in this cohort.

Introduction: Total knee arthroplasty (TKA) utilizing deep-dish tibial inserts has gained interest due to its high congruency and enhanced stability. However, due to the advent of more personalized alignment philosophies, the combination of a rotating-platform deep-dish TKA design with restricted kinematic alignment (rKA) might improve patient satisfaction. Therefore, this study evaluated the five-year clinical and functional outcomes of rKA with a deep-dish TKA design.

Methods: A retrospective analysis was conducted on patients who underwent primary TKA with a rotating-platform deep-dish design and rKA. Of 143 eligible patients, 123 completed five-year follow-up. Clinical and radiographic assessments included the five-year postoperative results: Knee Society Score (KSS), patient satisfaction, range of motion, coronal limb and implant alignment, postoperative complications and implant survivorship. Statistical analyses compared preoperative and postoperative outcomes with paired analyses.

Results: Median KSS Knee and Function scores significantly improved from 70 (IQR 5) and 60 (IQR 26) preoperatively to 90 (IQR 20) and 93 (IQR 21) postoperatively (p < 0.001). Postoperative coronal alignment in this study encompassed a hip-knee-ankle angle was 178.1° ± 3.5, a Lateral Distal Femoral Angle of 89.9° ± 2.6, and a Medial Proximal Tibial Angle of 88.6° ± 2.2. At five years, 94% of patients were either satisfied or very satisfied. The revision-free survival rate was 98%. Periprosthetic joint infection and arthrofibrosis were the most common complications (1.6% for both groups separately), followed by aseptic loosening of a cementless femoral component (0.8%) and patellar dislocation (0.8%).

Discussion: Rotating-platform deep-dish TKA with restricted kinematic alignment results in excellent functional outcomes, high patient satisfaction, and low complication rates at five-year follow-up. These findings support its viability as a surgical strategy, though long-term studies are warranted to assess implant durability and survivorship beyond 10 years.

Introduction: Combined C1-C2 fractures are common upper cervical injuries with high morbidity and mortality. Controversy exists regarding which patients benefit from surgery because this is an understudied population with only class III evidence available. We examined surgical intervention and its impact on outcomes in patients with C1-C2 fractures.

Methods: This retrospective cohort study of the National Trauma Data Bank included patients admitted between 1/2017 and 1/2023 for combined C1-C2 fractures (ICD-10 diagnosis codes S12.0 and S12.1). Exclusions were admission to a level III-V or non-trauma center, not admitted (died or discharged from the ED), and non-index/readmission. The first aim was to identify predictors of surgical intervention (vertebral fusion or internal fixation); multivariate backward regression included the following covariates: Patient demographics, injury severity, concomitant injuries, and specific C1 and C2 fractures. The second aim was to compare hospital outcomes between operative and nonoperative groups utilizing a propensity-matched (1:1) analysis: Mortality, ICU admission, complications, and hospital and ICU LOS.

Results: There were 19,264 patients, and 3,759 (19.5%) were surgically managed. The adjusted odds of surgical intervention were greater with unstable injuries (displaced C1 fracture, displaced C2 fracture, spinal cord injury, vertebral ligament dislocation), specific C1 and C2 fractures (odontoid fracture, Jefferson burst fracture, posterior arch fracture), whereas surgical intervention odds decreased for frailty (mFI ≥2), ED hemodynamic instability, ED Glasgow coma score ≤8, and increasing age quintile. Propensity matching resulted in 6,710 well-matched patients. After matching, surgical intervention was associated with lower mortality (4.8% vs. 11.3%, p < 0.001) but higher ICU rates, longer LOS, and greater complication rates compared to the nonoperative group.

Conclusion: This study of nearly 20,000 patients with combined C1-C2 fractures provides class II evidence for surgical intervention, highlighting the balance between injury characteristics and patient resilience. Surgical intervention was associated with a significant survival benefit, emphasizing its role in select patients.

Background: Hinge fracture on the lateral part of the tibia (LHF) is a common complication of medial Open Wedge High Tibial Osteotomy (OWHTO). Many factors have been described as risks for these fractures, but no study has compared an osteotome or an oscillating saw to prevent LHF following OWHTO.

Methods: This "propensity-score-matched" (PSM) study was conducted from data obtained in the literature from 1974 to November 2024. A total of 10,368 knees with OWHTO were identified. After 1:1 matching based on correction amount, posterior slope change, surgeon's experience, the osteotome and oscillating groups comprised 2760 knees each.

Results: Among the 5520 knees of the PSM population, the prevalence of LHF was 6.1% in the osteotome alone group (168 cases), and 22% in the oscillating saw group (607 cases). The osteotome group had a significant lower prevalence of hinge fracture than the oscillating saw group (OR, 0.23; 95% CI, 0.19 to 0.27; p < 0.0001) and a lower rate of clinically relevant hinge fractures with revision (OR, 0.34; 95% CI, 0.25 to 0.45; p < 0.001.

Discussion: The osteotome may be an appropriate method for preventing hinge fractures following OWHTO.

Patello-femoral arthroplasty (PFA) is an effective treatment option for isolated patello-femoral osteoarthritis. However, challenges remain regarding implant positioning and patellar tracking. Recent advances in implant design and robotic-assisted techniques have contributed to more personalized and reproducible procedures. Functional positioning (FP), a three-dimensional alignment concept, introduces a customized approach to optimize trochlear resurfacing and restore joint kinematics of the anterior compartment. This article presents a step-by-step surgical technique for PFA using FP principles in combination with an image-based robotic system. The technique ensures accurate preoperative planning, real-time intraoperative adjustments, and precise component placement. The key steps of this surgical technique include trochlear resurfacing assisted by an image-based robotic system and the restoration of patellar tracking, following a step-by-step approach that is both effective and reproducible. The use of FP enables personalized anterior compartment restoration, avoiding overstuffing and improving patellar tracking. Future studies will help refine FP strategies and further optimize outcomes in these patients.

Introduction: Dedifferentiated chondrosarcoma (DDCS) is a high-grade subtype of chondrosarcoma with a poor prognosis. Treatment for localized DDCS generally involves wide resection; the effectiveness of adjuvant radiotherapy and chemotherapy is questionable. This research was designed to find prognostic factors for DDCS and evaluate the impact of adjuvant therapies on localized cases.

Methods: One hundred thirty-two patients with DDCS diagnosed by pathology in the period 2006 to 2022 were identified in the Japanese National Bone and Soft Tissue Tumor Registry database and were retrospectively analyzed.

Results: Patients with distant metastases at diagnosis (n = 34) had significantly poorer survival than those without metastases (n = 98), with a 5-year disease-specific survival (DSS) of 9.7% vs. 37.1% (P < 0.0001). For patients without distant metastasis at diagnosis, uni- and multivariate analysis showed that R1 or R2 surgical margin was an independent risk factor linked with unfavorable local recurrence (hazard ratio [HR] 3.39 [95% CI: 1.35-8.52]; P = 0.010). Adjuvant radiotherapy was not associated with local recurrence (HR 2.41 [95% CI: 0.87-6.64]; P = 0.090). Larger size (HR 1.13 [95% CI: 1.06-1.19]; P < 0.001) and no surgery (HR 3.87 [95% CI: 1.61-9.28]; P = 0.002) were independent risk factors for unfavorable DSS. Previous surgery (HR 0.19 [95% CI: 0.04-0.84]; P = 0.028) and adjuvant chemotherapy (HR 0.36 [95% CI: 0.16-0.77]; P = 0.009) were independent risk factors for favorable DSS.

Discussion: Survival may have been improved by chemotherapy, but the effect of adjuvant radiotherapy in controlling the local spread of the tumor appears to have been limited in DDCS cases that were localized.

Purpose: The Anterior Cruciate Ligament Return to Sports after Injury scale (ACL-RSI) has been translated and culturally adapted into the Thai version. This study aimed to evaluate the reliability and validity of the Thai ACL-RSI for athletes recovering from ACL reconstruction.

Methods: This study was a cross-sectional study. Forward-backward translation, cultural adaptation, and validation of the Thai ACL-RSI were performed and tested in 40 athletes (8 females, 32 males; mean age 30.2 ± 7.32 years; mean body weight 70.7 ± 13.36 kg; mean height 170.1 ± 6.53 cm; mean body mass index 24.5 ± 3.74 kg/m²; mean time from surgery to evaluation 8.43 ± 1.83 months). Participants completed the translated Thai ACL-RSI and the validated Thai Tampa Scale of Kinesiophobia (TSK). The Thai ACL-RSI underwent content validity, internal consistency, reliability, and construct validity assessment.

Results: The Thai ACL-RSI demonstrated commendable content validity (item-objective congruence index [IOC] 0.91), internal consistency (Cronbach's alpha coefficient 0.84), and test-retest reliability (intraclass correlation coefficient [ICC] 0.75). There was a significant negative correlation with TSK (r = -0.67, p < 0.001).

Conclusion: The Thai ACL-RSI is validated, reliable, and consistent with the Thai TSK. This instrument can potentially measure psychological factors influencing preparedness for sports participation after ACL reconstruction. The evaluation of return-to-sport readiness should involve a multidisciplinary approach, including surgeons, physiotherapists, and psychologists, to ensure a comprehensive assessment of physical, functional, and psychological factors.