SICOT-J最新文献

Introduction: Restoration of the anterior knee compartment is increasingly studied with the development of personalized surgery. However, evaluating the patellar tracking during the surgery is still subjective and at the surgeon's discretion. This study aimed 1) to describe the assessment of the patellar tracking during robotic-assisted total knee arthroplasty (TKA), 2) to describe a new measurement technique for evaluating the evolution of this patellar tracking, and 3) to assess its reliability and repeatability.

Method: This monocentric study assessed the evolution of patellar tracking for 20 robotic-assisted TKA. The sharp probe was used to perform patellar tracking in all the arcs of knee flexion before and after the bone cuts. The patella positioning was recorded every 10° of flexion between the full extension and 90° knee flexion and was assessed in the coronal and sagittal planes. For the measurements of the patellar tracking, we used a sagittal view and a coronal view of the knee on the MAKO software. From these two views, the difference between the patellar tracking before and after the bone cuts with the definitive implants was measured. Two independent reviewers performed the measurements to assess their reliability. To determine intraobserver variability, the first observer performed the measurements twice.

Results: The mean age was 68.7 years old ± 5.2 [61; 75], the mean body mass index was 28.8 kg/m² ± 4.2 [21.4; 36.2], the mean HKA angle was 176.3° ± 3.7° [174.1.4; 179.7]. The radiographic measurements showed very good to excellent intra-observer and inter-observer agreements (0.60 to 1.0).

Conclusion: This new measurement technique assessed the evolution of patellar tracking after TKA with good inter and intra-observer reliability.

Background: Joint-preserving hip operations can help relieve pain and delay the need for long-term joint arthroplasty. Previous research has not identified procedures that can compromise outcomes following total hip arthroplasty (THA). This meta-analysis aims to evaluate the effect of joint-preserving hip operations on outcomes following subsequent THA.

Methods: MEDLINE, EMBASE and Scopus databases were searched from the date of inception until February 2024. All studies comparing outcomes following THA in individuals with (PS) and without prior surgery (NPS) of the femur or pelvis were included. Data on operative time, blood loss, intra- and post-operative complications, functional outcomes, and implant survivorship were extracted.

Results: 16 studies, comprising 2576 patients were included (PS = 939, NPS = 1637). The PS group was associated with significantly longer operative time [MD: 8.1, 95% CI: 4.6-11.6], significantly greater blood loss [MD: 167.8, 95% CI: 135.6-200.0], and a higher risk of intra-operative peri-prosthetic fracture [RR: 1.9, 95% CI: 1.2-3.0], specifically, with prior femoral osteotomy. There were no differences in terms of risks of dislocation [RR: 1.8, 95% CI: 1.0-3.2], implant loosening [RR: 1.0, 95% CI: 0.7-1.5], or revision surgery [RR: 1.3, 95% CI: 1.0-1.7] between the two groups. The PS group was associated with significantly poorer improvements in functional outcome [MD: -5.6, 95% CI: -7.6-(-3.5)], specifically, with prior acetabular osteotomy. Implant survivorship in the two groups was comparable after one year [HR: 1.9, 95% CI: 0.6-6.2] but significantly inferior in the PS group after five years [HR: 2.5, 95% CI: 1.4-4.7], specifically, with prior femoral osteotomy.

Conclusion: Joint-preserving hip operations are associated with greater intra-operative challenges and complications. In subsequent joint arthroplasty, prior acetabular procedures affect functional outcomes while prior femoral procedures influence implant survivorship. Hip pain due to the morphological sequelae of pediatric hip pathology can be debilitating at a young age. Surgical decision-making at that time needs to consider the survivorship of a THA implanted at that young age against the consequences of hip preservation surgery on further THA.

Introduction: The COVID-19 pandemic has significantly affected access to timely care for patients with hip osteoarthritis requiring total hip replacement (THR). This study aimed to assess the changes in surgical activity, outpatient treatment, length of stay (LOS), discharge destinations, readmission rates, clinical outcomes, and patient satisfaction before and after the pandemic at our institution.

Materials and methods: This retrospective study encompassed patients undergoing primary THR through the direct anterior approach at a single university hospital. Data on demographic characteristics, surgical technique, perioperative management, LOS, discharge destinations, complications, and clinical outcomes were collected. Furthermore, a comparative analysis between the pre-pandemic (2019) and post-pandemic (2022) periods was conducted.

Results: There was a 14% increase in surgical activity post-pandemic, with 214 patients undergoing surgery in 2019 versus 284 in 2022. The percentage of patients managed as outpatients significantly increased from 0.5% in 2019 to 29.6% in 2022 (p < 0.001). LOS decreased from 2.7 ± 1 [0-8] days to 1.4 ± 1.1 [0-12] days (p < 0.001), and the rate of discharge to rehabilitation centres declined from 21.5% to 8.8% (p < 0.001). No significant increase in the readmission rates was observed (1.4% in both periods). At two months postoperatively, the mean HHS and satisfaction rates were comparable between the two groups (p = 1 and p = 0.73, respectively).

Discussion: Despite the challenges posed by the COVID-19 pandemic, surgical activity at our institution demonstrated an increase compared to the pre-pandemic levels by expanding outpatient care, reducing LOS, and increasing rates of home discharges. Importantly, these changes did not adversely affect rehospitalization rates or early clinical outcomes.

Level of evidence: IV.

Introduction: To prevent infection after limb-sparing surgery for primary malignant bone tumors, it is important to cover the megaprosthesis with muscle tissue that has sufficient blood flow. Coverage with a lateral gastrocnemius flap has been reported in cases of distal femoral replacement in which the vastus lateralis and vastus intermedius muscles have been resected; however, the risk of peroneal nerve palsy is reportedly high because the muscle flap passes near the peroneal head. This study was performed to examine the postoperative outcomes of patients with primary malignant bone tumors of the distal femur who underwent wide resection (including the vastus lateralis and vastus intermedius muscles) followed by reconstruction with a megaprosthesis and coverage of the lateral side of the prosthesis with a sartorius muscle flap.

Methods: We retrospectively analyzed three patients who underwent reconstruction with a megaprosthesis after wide resection of a primary malignant bone tumor of the distal femur involving the vastus lateralis and vastus intermedius muscles and reconstruction of the soft tissue defect on the lateral side of the prosthesis with a sartorius muscle flap.

Results: The average defect size was 6 × 13 cm, the average time required for a sartorius muscle flap was 100 min, and the average implant coverage was 93%. The average postoperative follow-up period was 35 months, during which no postoperative complications such as infection, skin necrosis, or nerve palsy occurred.

Discussion: The distally based sartorius muscle flap is easy to elevate in the supine position, has minimal functional loss after harvesting, and has minimal risk of nerve palsy. It can be advocated as the first option for coverage of soft tissue defects lateral to distal femoral replacement.

Introduction: There is controversy about the management of unicompartmental knee osteoarthritis (OA) in young, active patients with anterior cruciate ligament (ACL) insufficiency. This study compares the subjective, radiological, and functional results of total knee replacement (TKR) vs. combined medial unicompartmental knee replacement (UKR) with ACL reconstruction.

Method: Twelve patients suffering from medial OA and ACL deficiency with varus knee deformity and/or tibial slope <10° and absence of patellofemoral-related problems were eligible for combined UKR and ACL reconstruction (Group A). Twenty-six patients matched for age, male/female ratio and body mass index who received TKR in the same time frame were included as a control group (Group B). Oxford Knee Score (OKS), WOMAC index of osteoarthritis, Knee Osteoarthritis Outcome Score (KOOS), and routine X-rays were used for assessment.

Results: Ten years after surgery, the mean overall KOOS score, OKS, WOMAC index increased from preoperatively, showing a statistically significant difference (p < 0.001). In terms of KOOS, OKS, or WOMAC scores at the most recent follow-up, there was no discernible difference between the groups (p = n.s.). Three years following surgery, one female patient in group A received revision TKR due to the lateral compartment's osteoarthritis developing and the patient's pain persisting. Concerning radiographic assessment, at the most recent follow-up (average 7.9 years in group A and 8.8 years in group B), there were no radiographic indications of implant loosening or proof of pathologic radiolucent lines.

Conclusions: UKR combined with ACL restoration offers clinical and radiographic outcomes comparable to TKR 10 years following surgery with no elevated risk of complications.

Background: Peri-megaprosthetic joint infections (PJI) in tumor surgery are complex and challenging complications that significantly impact the outcomes of the patients. The occurrence of PJI poses a substantial threat to the success of these operations. This review aims to identify and summarize the risk factors associated with PJI in tumor surgery with megaprosthetic reconstruction as well as to determine the overall risk of PJI in limb salvage surgery.

Methods: A thorough examination of published literature, scrutinizing the incidence of PJI in tumor prostheses after limb salvage surgery was done. Research studies that documented the incidence of PJI in tumor patients who underwent limb salvage surgery, and explored the risk factors associated with the occurrence of PJI were deemed eligible.

Results: A total of 15 studies were included in the analysis and underwent comprehensive examination. After the exploration of key parameters, several significant risk factors for PJI concerning the type of implant coating, surgical site characteristics, patient demographics, and procedural factors were recorded.

Discussion: The findings underscore the need for a nuanced approach in managing tumor patients undergoing limb salvage surgery and megaprosthetic reconstruction, with emphasis on individualized risk assessments and individualized preventive strategies.

Background: Total knee arthroplasty (TKA) for patients with a large preoperative deformity (more than 10° varus or valgus) remains a challenge leading to a high rate of outliers, unsatisfactory functional results, or early prosthetic loosening. Robotic arm-assisted TKA (RATKA) has shown improvements in implant positioning accuracy. This study aimed to assess RATKA implant positioning accuracy and functional results at one year postoperative for patients with a large preoperative deformity.

Methods: From November 2019 to July 2022, 500 RATKA were performed. About 74 patients with more than 10° of varus or valgus global deformity were included. Each patient received a semi-constrained implant. The difference between the valgus or varus value planned intra-operatively and the varus or valgus measured on one-year postoperative X-rays has been assessed. Functional outcomes (VAS, range of motion, KOOS) have also been evaluated.

Results: For varus, the mean difference was 0.54 ± 1.21°, all patients (100%) had a difference of less than 3° at one-year post-operative. For valgus, the mean difference was 0.63 ± 1.29°, most patients (92%) had a difference of less than 3° at one year postoperative. Overall, 98.6% (n = 73) of cases had a difference of less than 3° at one-year postoperative. The mean VAS was 1.6 ± 1.4 [1;4]. Mean flexion was 132 ± 7.6° [100;145]. A total of 69 patients (93%) had a good or excellent KOOS score (KOOS total > 70) at one year post-operative.

Conclusion: For large preoperative deformities, RATKA provides a high degree of accuracy in implant positioning, permitting it to fit the desired alignment without compromising knee stability, and giving the possibility of using semi-constrained implants. At one year postoperative, functional results are encouraging and most patients have recovered an optimal range of motions.

Introduction: Robot-assisted instrumentation during total hip arthroplasty (THA) has the potential to improve acetabular cup positioning. This study aimed to evaluate the precision of robotic-arm-assisted THA (rTHA) and assess whether the system can provide accurate cup positioning comparable to conventional THA (cTHA).

Methods: A single-center prospective cohort study consisting of 151 patients who underwent THA (108 rTHA and 43 cTHA). The robotically assisted system was used to match the postoperative computed tomography (CT) image of the pelvis with the planned and intraoperative anatomical landmarks. The cTHA cohort underwent hip replacement using the standard manual procedure, with acetabular component locations assessed during and after surgery.

Results: The rTHA cohort was significantly younger, but no other significant differences were found between the two cohorts in preoperative baseline data. In rTHA cohort, the planned inclination (40.0 ± 0.3°) closely matched the intraoperative (40.2 ± 2.7°; p = 0.54) and postoperative (40.7 ± 4.0°; p = 0.07) measurements. However, anteversion showed a significant increase from planned (19.4 ± 1.5°) to postoperative CT scan (28.7 ± 7.0°; p < 0.001). There was evidence of proportional bias in the measurements (p < 0.001). In the cTHA cohort, the mean inclination (43.1 ± 5.1°) did not show any significant change between the preoperative plans and postoperative assessments (p = 0.12); however, there was a remarkable change in the mean anteversion (17.6 ± 6.4°) between postoperative measurements and the preoperative plans (p < 0.001). The average anteversion in the preoperative plans did not differ remarkably between the rTHA and cTHA cohorts. However, the average inclination was substantially different between the two cohorts (p < 0.001). Both groups had no significant differences in the proportion of cups outside the referenced safe zones.

Conclusion: The results suggest that while robotic-assisted guidance ensures consistent cup inclination, there may be more variability in achieving the planned anteversion, which warrants further investigation into the factors influencing postoperative changes in acetabular orientation.

Introduction: Mesenchymal chondrosarcoma (MCS) is a malignant, biphasic, high-grade, primitive mesenchymal tumor that has a well-differentiated, organized hyaline component. MCS has a poor prognosis, and treatment recommended for localized MCS is based on wide resection while controversy remains regarding the efficacy of adjuvant chemotherapy and radiotherapy. In this study, we aimed to investigate the prognostic factors of MCS, especially the efficacy of adjuvant chemotherapy and radiotherapy for localized MCS.

Methods: Eighty patients with MCS pathologically diagnosed between 2006 and 2022 from the Japanese National Bone and Soft Tissue Tumor Registry database were analyzed retrospectively.

Results: Patients with distant metastases at presentation (n = 23) had significantly shorter survival than those without (n = 57) (5-year disease-specific survival 19.9% [95% confidence interval (CI): 5.6-50.7] vs. 79.8% [95% CI: 62.4-90.4]; p < 0.0001). In the group without distant metastasis at presentation (n = 57), R1 or R2 surgical margin was a risk factor for unfavorable local recurrence (hazard ratio (HR): 17.44 [95% CI: 2.17-139.98]; p = 0.007). There was no correlation between adjuvant radiotherapy and local recurrence rate (HR 5.18 [95% CI: 0.99-27.12]; p = 0.051). R1 or R2 surgical margin was a risk factor for unfavorable disease-specific survival (HR 17.42 [95% CI: 2.18-138.90]; p = 0.007). There was no correlation between adjuvant chemotherapy and disease-specific survival (HR 0.99 [95% CI: 0.28-3.47]; p = 0.990).

Discussion: Patients with MCS and distant metastases at presentation have a poor prognosis, and wide resection is important for the treatment of localized MCS. The efficacy of adjuvant radiotherapy and chemotherapy could not be determined because of the small number of patients.

Introduction: Posterior shoulder dislocation with a reverse Hill-Sachs lesion is a rare and complex injury, requiring specialized treatment due to the difficulty in diagnosis, reduction, and addressing both sides of the pathology to reduce the potential for recurrent dislocation.

Purpose: To evaluate the clinical and functional outcomes of closed reduction and arthroscopic McLaughlin procedure with posterior labral repair in patients with neglected locked posterior shoulder dislocation for less than 12 weeks.

Methods: A prospective study was conducted at university hospitals, managing 15 patients with neglected locked posterior shoulder dislocation for less than 12 weeks and concomitant engaging reverse Hill-Sachs lesions of less than 40% of the humeral articular surface. They were treated with closed reduction and arthroscopic McLaughlin procedure with posterior labral repair. Patients' assessments included shoulder range of motion, pain levels using the visual analog scale (VAS) score, and functional outcome using the Oxford instability score and the University of California Los Angeles Shoulder Scale (UCLA) with at least 2 years of postoperative follow-up.

Results: All 15 patients reported no recurrent dislocation and restored shoulder motion at the final follow-up. External rotation significantly improved from 0° to a mean of 65° in adduction, at 90° of abduction, the respective measurement was 85° (p < 0.01). Active forward flexion increased from 35° to 145° (p < 0.01). UCLA and Oxford instability scores Showed marked improvement (p < 0.01).

Conclusion: Closed reduction and arthroscopic McLaughlin procedure with posterior labral repair is a safe and effective way for managing patients with locked neglected posterior shoulder dislocations that have been neglected for less than 12 weeks with engaging reverse Hill-Sachs lesion defect, less than 40% of the humeral head.