SICOT-J最新文献

Background: To evaluate whether the use of patient-specific instrumentation (PSI) or conventional instrumentation (CI) is associated with superior implant positioning and knee alignment in total knee arthroplasty (TKA).

Methods: Clinical data, pre- and post-operative knee X-rays of 95 patients, who underwent TKA with use of either patient-specific instrumentation (group PSI) or conventional intra-/extramedullary cutting guides (group CI) were retrospectively collected. Preoperative measurements of knee alignment were done by assessing the femorotibial axis, the lateral femoral distal angle, and the medial tibial proximal angle. Postoperative measurements of the mechanical TKA alignment were performed by assessing the relative position of components to the femur and tibia and the femorotibial axis angle. Only when all three parameters were within generally accepted limits was the postoperative radiological outcome considered optimal.

Results: Preoperative measurements and demographics were similar among the two groups. No statistically significant differences were found between postoperative radiographic findings in patients operated on with PSI or CI. A restoration of the femorotibial axis was achieved in 87.8% and 87.0% of patients treated with PSI and CI, respectively (p = 0.583). Coronal alignment of the femoral component was within acceptable limits in 97.6% and 94.4% (p = 0.631) of patients of the PSI and CI groups, respectively. The respective percentages for the tibial component were 85.3% and 83.3% (p = 0.510) of patients. An accurate coronal plane radiological outcome was achieved in 82.9% and 77.8% of patients treated with PSI and CI, respectively (p = 0.611) Conclusions: The use of PSI does not increase the accuracy of component positioning and leg axis restoration compared to CI in TKA in patients with mild deformity.

Purpose: The primary aim of this study is to determine the rectus abdominis tendon (RAT) insertional anatomy and consequently clarify the extension of secure mobilization of the tendon from the pubic bone in the setting of anterior approaches in pelvic and acetabular reconstruction surgery.

Materials and methods: Eleven fresh frozen cadaveric pelvises were dissected by two fellowship-trained orthopaedic trauma surgeons utilizing the anterior intrapelvic approach (AIP). The RAT at the pubic body was dissected, and its footprint on the pubic bone was defined, marked, and measured.

Results: Nineteen (19) RAT insertions were analyzed. The average total medial vertical length was 33 mm (range 26-42 mm), and the average total lateral vertical length was 36.5 mm (range 26-46 mm). The total width of the proximal insertion on both sides was measured at an average of 20.42 mm (range 14-24 mm). The average width of the tendon at the transition area between the cranial and caudal areas of the pubic bone was 16.45 mm (range 12-22 mm). The average distal insertion width of the RAT was less than the proximal and middle widths, measuring 10.45 mm (range 8-13 mm).

Conclusion: The tendon can be safely mobilized up to an average total medial vertical length of 33 mm (and in no case more than 42 mm) and to an average total lateral vertical length of 36.5 mm (and in no case more than 46 mm). This piece of anatomical information will equip orthopaedic surgeons with a better understanding of the insertional anatomy of the RAT and subsequent safer surgical release when performing anterior approaches to the pelvic ring.

Introduction: This study analyzed complication rates in two-stage bilateral Total Hip Arthroplasty (THA) across three distinct inter-stage intervals to determine the optimal timing for minimizing risk.

Methods: This was a retrospective, multicentre, analytic study. The three intervals evaluated were <2 weeks (Group A), 2-12 weeks (Group B), and >12 weeks (Group C). The primary outcomes were blood transfusions, thromboembolic events (TVE), and coronary events, and the secondary outcomes were hospital stay, respiratory complications, reintervention, and mortality. The associations between demographic characteristics and complications and the risk hazard of complications were determined.

Results: A total of 331 patients were included: 86 in Group A, 47 in Group B, and 198 in Group C. Blood transfusions after the second THA were performed in 29.1%, 14.9%, and 7.6% of the time interval groups respectively (p = 0.000). One TVE (1.1%) was recorded in group A and 4 (2%) in group C (p = 0.613).

Conclusions: Two-stage bilateral THA with a time interval between both surgeries of <2 weeks presented a significantly higher rate of blood transfusions than longer time intervals between surgeries, with an HR of 2.4 (CI: 95% 1.7-3.3, p = 0.000). The incidences of thromboembolic and coronary events were similar between the different timeintervals, demonstrating that two-stage bilateral THA is safe when performed with an interval of at least 2 weeks between both surgeries.

Introduction: Worldwide, more than 1 million Total Hip Arthroplasties (THAs) are performed annually, with this number predicted to increase by 37.7% by the year 2060. This places a significant financial burden on the healthcare system, with the average cost of a THA being approximately $40,000. Several factors ultimately contribute to patient outcomes and complications, including surgical approach, surgeon's experience, patient age, BMI, and most importantly, the preoperative diagnosis. Our paper aimed was to describe the various aetiologies of hip pathologies in patients presenting for primary elective THA to a tertiary academic sub-Saharan African institution.

Materials and methods: We retrospectively reviewed 1400 consecutive patients presenting for elective primary THA between January 2015 and December 2021. Patients' preoperative clinical notes, radiological records, and intraoperative results were independently assessed by two examiners to diagnose the hip pathology. A comparison of the presenting preoperative aetiologies was made between those seen in developed countries and those seen in more developing countries.

Results: 2176 pathological hips were evaluated. Bilateral pathology was present in 56% of patients, of which 92% had the same pathology. There were 427 (31%) males and 973 (69%) females, with an average patient age of 58 ± 14.13 years and an average BMI of 31.01 ± 15.13 kg/m². The preoperative aetiologies included primary osteoarthritis (OA) (n = 406 [29%]) and avascular necrosis of the femoral head (AVN) (n = 322 [23%]), of which (n = 162 (58%) had bilateral pathology. The primary cause of AVN was HIV (49%). Patients presenting with AVN were significantly younger (p < 0.0001) and had a lower BMI (p < 0.0001) in comparison to patients presenting for other pathologies.

Conclusion: This study underscores the significance of aetiology in THA outcomes and highlights the unique challenges faced in developing countries. By identifying the specific causes of hip pathology in this population, healthcare providers can better allocate resources and develop tailored treatment strategies to improve outcomes in resource-limited settings.

Background: Pedicle screw fixation in the thoracolumbar spine has become more widely accepted with advancements in instrumentation and clinical efficacy have been made. The optimal way to interpret pedicle screw cortical breaches had the subject of a great deal of research. None of the previous classifications and grading systems include full neurological deficits that may result from screw misplacement and do not provide clear guidance for the management of screw violations, which is crucially needed in the literature.

Objectives: Our study aimed to evaluate the reliability and validity of the use of a new scoring system (the Meshtawy Pedicular Screw Malposition - MPSM) for evaluating pedicle screw misplacement by a detailed clinical-radiographic comprehensive scoring system (MPSM) with sharp guidance for treating injurious violations by assessing the correlation between the neurological data of patients and computed tomography (CT) findings.

Patients and methods: This prospective case series included 100 patients (508 pedicular screws) who underwent transpedicular fixation at Orthopedic department Al-Azhar University Hospital, Assiut branch, Egypt 255 (50.2%) screws were inserted on the right side, while 253 (49.8%) were inserted on the left side. Intra-observer reliability was examined by calculating Cronbach's alpha intraclass correlation coefficient, which compares three measurements obtained by each observer at different time points. Inter-observer reliability was also examined by calculating Cronbach's alpha intraclass correlation coefficient and comparing the average measurements obtained by each observer.

Results: The MPSM demonstrated excellent (100%) intra-observer reliability for each observer regarding the violation score and total MPSM score. A strong positive and statistically significant correlation (Pearson test, P < 0.05) was found between severe neurological deficits and a greater degree of screw-pedicle violation.

Conclusion: MPSM scoring is a valid and reliable system for evaluating pedicular screw violations and their possible neurological consequences in the thoracic and lumbosacral spine from D7 to S1. Moreover, grades obtained from the MPSM score are helpful for making clear decisions for management.

Introduction: The learning curve associated with adopting new surgical systems in total knee arthroplasty (TKA) can significantly impact surgical efficiency and patient outcomes. This study aimed to evaluate the evolution of operative time with the KNEO^® (Groupe Lépine, Genay, France) posterior stabilized knee system and to analyze the learning curve for postoperative complications to achieve surgical proficiency.

Method: This retrospective, multicentric study analyzed 481 patients who underwent primary TKA with the KNEO^® implant in a high-volume university center between 2020 and 2024. The evolution of operative time and postoperative complications requiring reoperation surgery were evaluated, with a follow-up period extending until January 2025, during which complications were monitored. The study included 481 patients with a mean age of 71.7 ± 8.0 years and a mean Body Mass Index of 29.0 ± 4.0 kg/m². The cohort comprised 308 female (64%) and 173 male (36%) patients.

Results: The mean operative time significantly decreased from 83.5 min in the initial case to 63.0 min after 481 cases (p < 0.001). The learning curve showed an initial learning phase with high variability, followed by stabilization around 150 procedures and subsequent optimization. Postoperative complication rates showed a 31.9% reduction per group of 100 patients (β = -0.3848, p = 0.0075), indicating improved surgical proficiency and patient safety over time.

Conclusion: The findings suggest that the KNEO^® system follows a measurable learning curve, with operative efficiency and complication rates improving as case volume increases. These results emphasize the importance of structured training and experience accumulation in optimizing patient outcomes when implementing new implant technologies.

Unicompartmental knee arthroplasty (UKA) compared to total knee arthroplasty, offers several benefits, though it is associated with a higher revision rate, primarily due to suboptimal implant positioning. Recent advances in robotic-assisted techniques have contributed to more personalized and reproducible procedures. Functional Positioning (FP), a three-dimensional alignment concept, introduces a tailored approach based on a surgical technique that is both effective and reproducible. This article presents a step-by-step surgical technique for medial UKA 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 achieving congruent contact points between the femur and tibia under load across the full range of motion, positioning the implant based on the compliance of the medial soft tissues, planning for a targeted laxity that results in an "eagle-wing" appearance, and the use of robotic tools to map cartilage for optimal resurfacing. Future studies will help refine FP strategies and further optimize outcomes in these patients.

Introduction: Osteoporotic vertebral fractures (OVFs) are the most common type of fragility fractures. They have a significant and usually detrimental impact on the patient's functional status and mortality rate, constituting a substantial burden for the patients, their families, and the healthcare system. This narrative review aims to summarize the current knowledge of osteoporotic vertebral fractures and secondary fracture prevention.

Methods: A comprehensive literature search was conducted across major medical databases, including PubMed, Scopus, and Web of Science. Relevant studies, guidelines, and reviews published were analyzed to provide a broad perspective on the topic.

Results: Diagnosis of OVFs is based on history, clinical examination, and plain lateral radiographs of the spine. Their management is mainly non-operative, with surgery being reserved for specific indications. Successful management of osteoporotic vertebral fractures entails alleviating pain, early restoration of mobility, and secondary fracture prevention. Prevention of the next osteoporotic fracture is paramount and should be an integral element of their management. The Fracture Liaison Service (FLS) is the main contemporary service that serves this purpose.

Discussion: Diagnosis of OVFs is simple but requires vigilance from the clinicians. Early, accurate diagnosis is essential to initiate appropriate treatment and provide the opportunity for secondary fracture prevention.

Patellofemoral arthroplasty (PFA) is useful and effective option for treating patients with isolated patellofemoral osteoarthritis. The concept of functional positioning (FP) in PFA focuses on resurfacing the trochlea and restoring normal patellar tracking, while keeping the joint anatomy and kinematics. Even though the patellar liner cannot yet be placed with robotic assistance, robotic tools still help surgeons manage and optimize patellar tracking during surgery. This surgical technique highlights how the image-based robotic system assists the surgeon in improving patellar positioning and patellar tracking during a PFA. This technique could contribute to reduce complications, although its actual benefits remain to be validated. It may help prevent patellar instability through direct tracking assessment and reduce fracture risk by preserving more patellar bone. Accurate placement of the patellar button and evaluation of anterior offset might alleviate anterior knee pain. A tailored resection could also help protect the patellar vascular supply. Image-based planning may assist in avoiding malpositioning, potentially leading to fewer revisions.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) remains a significant concern in orthopedic surgery, particularly in total knee replacement (TKR), where infection can lead to severe complications. In procedures like TKR, where implants act as a foreign body and potential surface for biofilm formation, infections can lead to severe complications, including delayed healing, and implant failure, and often need multiple revision surgeries. Screening for MRSA before surgery has become a standard practice in many hospitals to reduce the risk of infection. This study aims to evaluate the prevalence of MRSA in patients undergoing TKR and analyze demographic characteristics.

Methods: A retrospective analysis was conducted on patients scheduled for TKR. Demographic data, including age, gender, and other relevant clinical information, were extracted from the patient's medical records. MRSA screening was performed as part of the preoperative protocol, and the results were recorded. Descriptive statistics were used to summarize the data and calculate the prevalence of MRSA.

Results: A total of 938 patients underwent MRSA screening prior to TKR. The mean age was 67.25 years (median: 68; range: 33-87). The majority of patients were female, accounting for 706 (75.0%), while 232 (25.0%) were male. MRSA test results revealed that 938 (99.3%) patients tested negative, whereas 6 (0.7%) tested positive. Among MRSA-positive patients, all were aged 60 years or older, suggesting a potential correlation between advanced age and MRSA positivity.

Conclusion: This study found a low MRSA prevalence (0.7%) in TKR patients, with all cases occurring in individuals aged ≥60 years. The findings advocate prioritizing preoperative screening in older patients to optimize resource use in low-prevalence settings and highlight the need to investigate TKR-specific risk factors for tailored infection control strategies.