SICOT-J最新文献

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.

Purpose: Intraoperative periprosthetic femoral fracture (IPFF) is a known complication during hemiarthroplasty (HA), which may lead to inferior outcomes. Few studies have assessed the outcomes of IPFF in HA for displaced femoral neck fractures (FNF). This study aims to evaluate the incidence of IPFF in cementless HA for displaced FNF and compare long-term outcomes between patients with and without IPFF.

Methods: We retrospectively reviewed institutional surgical data of patients who underwent cementless HA for displaced FNF from January 2010 to January 2022. The presence, location, and treatment of IPFF, as well as the effect of IPFF on postoperative weight-bearing, status were assessed. Mortality, readmission, and revision rates were compared between the IPFF and non-IPFF group.

Results: A total of 1,586 patients were included in the study. 104 patients (6.6%) in the IPFF group vs. 1,482 patients (93.4%) in the non-IPFF group. The IPFF location was mostly the calcar (59.6%), followed by the greater trochanter (35.5%) and the femoral shaft (8.6%). Most fractures were treated with fixation (92.3%) and full weight-bearing postoperatively (95.1%). Surgery duration was longer in the IPFF group (p < 0.001). However, there were no significant differences between groups regarding 30-day, 90-day, and 1-year mortality rates, 90-day readmission rates, or revision rates at the latest follow-up. A multivariate binary logistic regression found similar long-term results.

Conclusions: While IPFF remains a recognized complication of cementless HA for displaced FNF, its occurrence does not adversely affect long-term outcomes when appropriately managed.

Background: Proximal femoral megaprosthetic reconstruction is a well-established solution for extensive bone loss in the hip region. Despite its utility in limb salvage, it carries notable complication rates, reported between 30% and 40%, along with increased morbidity and mortality. This study evaluated implant and patient survival, failure modes, and associated risk factors.

Methods: We retrospectively reviewed 165 patients who underwent proximal femoral megaprosthetic reconstruction between 2003 and 2023. Indications included primary bone tumors (n = 67), metastatic bone disease (n = 60), and non-oncologic conditions (n = 38). A total of 57 METS (Stanmore) and 108 MUTARS (Implantcast) implants were used. Median follow-up was 5 years (range: 0.25-17 years).

Results: Mean implant survival was 5.13 years (range: 0.2-17 years), with an overall complication rate of 30.9%. The most common failure modes were type 1 (11.5%) and type 4 (13.3%) per Henderson classification. Five-year implant survival ranged from 60% to 70% across indications. Independent risk factors for type 4 failure included prolonged hospitalization (OR = 1.07, p = 0.020) and longer operative time (OR = 1.01, p = 0.023). Silver-coated implants showed a trend toward reduced infection (OR = 0.18, p = 0.29), though not statistically significant. METS implants were associated with lower type 1 failure risk (OR = 0.09, p = 0.020), with a soft-tissue failure rate of 3.5% versus 15.7% for MUTARS.

Conclusion: Proximal femoral megaprostheses remain effective for limb salvage but are linked to a substantial complication burden. Recognition of modifiable and patient-specific risk factors may improve surgical outcomes and reduce failure rates.

Background: The lateral approach in total knee arthroplasty (TKA) is indicated primarily for patients with valgus knee deformity, as it allows direct access to the lateral anatomy and systematic correction of associated pathologies.

Surgical technique: This technique involves strategic lateral soft tissue releases, which improve exposure to the posterolateral corner, enhance tibial rotation, and support patellar alignment without compromising medial vascularity or requiring a tibial tubercle osteotomy for joint exposure. Critical steps in the lateral TKA approach include maintaining a capsular-synovial overlap and preserving the Hoffa fat pad for optimal joint closure, releasing the lateral soft-tissue structures, and using a contralateral tibial cutting guide for enhanced access and protection of the patellar tendon.

Discussion: These techniques collectively allow for a balanced, stable joint with effective alignment and soft tissue management. Outcomes of the lateral approach in valgus TKA are comparable to those of the medial approach, with similar functional outcomes, range of motion, and surgical time. Some studies even report superior patellar tracking and function scores with the lateral approach. Complication rates are low, though attention is required to avoid peroneal nerve injury in severe deformities. Future research involving large, randomized controlled trials is recommended to substantiate these favorable outcomes and guide long-term treatment strategies for valgus TKA.

Introduction: Extraarticular deformity (EAD) with knee arthritis is a complex condition involving tri-planar bone deformity with pathological malalignment and chronic soft tissue contracture or laxity in the knee joint. Intraarticular correction by TKA, which was previously performed with conventional manual jig by mechanical alignment technique, had its limits and difficulties especially extensive soft tissue release and risk of jeopardizing the collateral ligaments. Robotic technology allows for reproducible and precise execution of surgical plan and allows adjustment to various new personalised alignment philosophy including functional alignment (FA). FA technique involves the adjustment of components positioning that least compromise the soft tissue envelope while restoring the limb alignment and joint obliquity to create a balanced knee. The aim is to study the outcome of intra-articular correction by robotic assisted TKA using Functional Alignment (FA) technique.

Methodology: This is a single surgeon series of 8 patients with extraarticular deformity who underwent robotic assisted total knee arthroplasty (TKA) with FA technique. Soft tissue release was gradually released and followed by adjustments of implant positioning in order to achieve a balanced medio-lateral gap.

Results: Postoperatively, the lower limb alignment of all patients were restored within 6° (mean 4.54°) based on functional alignment boundaries. Knee phenotype and joint line obliquity (JLO) were restored in comparison to contralateral lower limb. There were 6 varus and 2 valgus malalignment. 7 patients were implanted with posterior stabilized implants while 1 was implanted with cruciate retaining implant. Arc of knee flexion and extension improved (P = 0.002). There was a large postoperative improvement in the Knee Society Score (KSS) (P < 0.001).

Discussion: Intraarticular correction by TKA for EAD with knee arthritis is technically reliable with robotic technology. It allows intraoperative adjustment following functional alignment philosophy, thereby, restoring pre-arthritic alignment, knee phenotype and joint line obliquity.

Ceramic fractures in total hip arthroplasty (THA) are rare complications that pose significant challenges for revision surgery. This case report describes a 68-year-old male who experienced a spontaneous alumina (ceramic) insert and head fracture four years after the initial THA. The first revision with cobalt-chrome and polyethylene components led to severe metallosis, including subcutaneous tissue discoloration. A second revision utilized a ceramic-on-ceramic (CoC) bearing couple, resulting in excellent functional outcomes and resolution of symptoms. Cutaneous pigmentation post-THA is rare and has not been previously reported following a ceramic fracture. The case underscores the need for careful material selection in revision surgery to minimize complications such as metallosis. The decision to use a ceramic-on-ceramic bearing couple in this case proved effective, ensuring durability and reducing the risk of third-body wear, which can result from inadequate management of ceramic fractures and lead to joint, systemic, or cutaneous complications.