Archives of Bone and Joint Surgery-ABJS最新文献

Periprosthetic joint infection (PJI) is a serious complication that can occur after joint arthroplasty, significantly affecting both the healthcare system and patients due to high costs and mortality rates. Managing PJI is complex and presents significant challenges in orthopedic surgery because there is no standardized definition for PJI and no universally accepted diagnostic gold standard. Despite various preventive measures taken before and during surgery, PJIs still occur. Many treatment options are available, but the best management is still highly debated, and the best treatment choice depends on several factors. Notably, all of these treatments are taken after the occurrence of PJI, while modern strategies, such as coating methods with various materials, must be relied upon to control and prevent the occurrence of PJI. This review focuses on the precise concept of PJIs, treatment options, and novel strategies to prevent PJIs.

Objectives: Knee osteoarthritis (KO) is a leading contributor to disability years, with a prevalence ranging from 22% to 39%. Tibia stress fractures (TSFs) are well-described for end-stage arthritis patients undergoing TKA. Literature is ambiguous, with a wide range of management options. This study primarily aims to compare and determine the clinical, functional, and radiological outcomes of TSFs in end-stage KO treated with TKA by propensity score-based matching.

Methods: It is a retrospective, single-center, comparative study conducted at University Teaching Hospital. The institutional medical records (IMRs) database was inquired. The TSF group included all patients of end-stage KO who underwent primary TKA with TSFs, and the TKA group included matched patients without TSF. Cases were 3:1 (TKA: TSF) propensity score-matched (PSM). The primary outcome was a PSM comparison of patient-reported outcome measures (PROMs) and 1-year Postoperative Complications and Adverse Events (POCAE). PROMs included the knee society score (KSS), patient satisfaction (PS), and KSS functional activities (FA) score.

Results: Study includes thirty-seven patients. Both groups showed no statistically significant difference in KSS FA and KSS PS scores. At the final follow-up, MCID for KSS FA was achieved by 31 patients (96.9%) in the TSF group compared to 92 patients (95.83%) in the TKA group. MCID for KSS PS was achieved by 29 patients (90.63%) in the TSF group compared to 91 patients (94.79%) in the TKA group.

Conclusion: End-stage KO patients with coexisting TSFs who undergo primary TKA with stem/ plate fixation as per fracture location may expect favorable PROMs, POAECs, radiological outcomes, and rates of achieving the MCID at a minimum 2-year follow-up. Accurate management of such cases results in excellent outcomes and minimized revision rates. All patients achieved complete bone union. These results were comparable to the PSM control group.

Objectives: To evaluate the factors influencing medical students' specialty choices for orthopedics at the University of Hail, Saudi Arabia.

Methods: The cross-sectional study used a self-administered questionnaire and collected data from students who satisfied the research criteria.

Results: The study included 108 participants and identified several key factors influencing medical students' choice of orthopedic specialties, such as job opportunities, lifestyle in the specialty, family responsibilities, training hours, and expected income in 94%, 83%, 83%, 80.6%, and 81%, respectively. A statistically significant association was observed between having relatives in the health professions and choosing an orthopedic specialty (P = 0.003), indicating that this factor was important in their decision-making. However, no significant association was found regarding gender or academic year concerning the selection of orthopedic specialty (P > 0.05). The study also revealed a statistically significant difference between female and male students concerning the influence of specialty reputation on their choice (P = 0.033). Despite this, no significant differences were noted between genders regarding the impact of the other factors.

Conclusion: Medical students' choice of orthopedic specialty was primarily driven by job prospects, lifestyle, family responsibilities, training hours, expected income, and having a relative in health professions. In addition, more male students chose orthopedics due to its reputation associated with the specialty.

Objectives: Radial head fractures often require prosthetic replacement, but post-surgical complications like radial neck osteolysis, capitellum osteopenia, and ulnohumeral osteoarthritis can arise due to altered elbow biomechanics. This study used the finite element method to evaluate how radial head prostheses (RHPs) shape and material affect elbow joint biomechanics.

Methods: A 3D elbow model was developed, including bones, ligaments, and cartilage. Implants featuring two geometries (anatomical vs. axisymmetric) and three materials (polymethylmethacrylate [PMMA], polyether ether ketone [PEEK], and Cobalt) were tested. Bones were considered isotropic and heterogeneous, ligaments and implants linear elastic, and cartilages were considered hyperplastic materials. Stress distributions, contact stresses, and contact areas were assessed during elbow flexion and forearm rotation.

Results: During forearm rotation, Cobalt RHPs exhibited lower stresses in the radial neck, indicating higher stress shielding, and all axisymmetric implants showed increased edge loadings. In rotation, only the PMMA anatomic RHP showed close contact stresses to the intact model, while all other models resulted in lower stress levels. In flexion, anatomical designs produced more uniform stress distributions in the radial neck that resembled intact conditions and matched intact capitellum contact stresses, in contrast to axisymmetric designs. The reduction in the contact area in the ulnohumeral cartilage was most noticeable with all axisymmetric RHPs in flexion.

Conclusion: The lower contact areas, higher contact stresses, and lower stresses at the radial neck observed in the presence of most axisymmetric RHPs and anatomic Cobalt RHP can be correlated to postoperative complications. The findings suggest that polymeric anatomical RHPs may be superior to conventional metallic axisymmetric options in preserving elbow biomechanics and reducing postoperative complications. However, their long-term effects need to be further explored.

Objectives: Accurate diagnosis and characterization of rotator cuff tendon (RCT) tears are crucial for optimal treatment planning. This study compared the diagnostic performance of 3D Multiple Echo Recombined Gradient Echo (MERGE) MRI with conventional 2D MRI for the assessment of RCT tears and surgical planning.

Methods: Sixty-two patients with suspected RCT tear underwent shoulder MRI using standard 2D and 3D MERGE protocols, followed by arthroscopic evaluation. RCT tears were classified as crescent, longitudinal, or massive. The sensitivity, specificity, and accuracy of 3D MERGE and 2D MRI were calculated using arthroscopy as the reference standard. Inter-observer agreement was assessed using kappa statistics.

Results: Arthroscopy confirmed crescent tears in 25 patients (40%), longitudinal tears in 9 patients (15%), and massive tears in 28 patients (45%). 3D MERGE MRI demonstrated higher accuracy for tear shape classification compared to 2D MRI (90.5% vs. 79.6%, P < 0.05). Sensitivity and specificity were markedly improved with 3D MERGE MRI, particularly for crescent tears (sensitivity 88.2% vs. 70.6%, specificity of 94.6% vs. 86.5%, P < 0.05). The inter-observer agreement was excellent for 3D MERGE MRI (kappa = 0.91) and good for 2D MRI (kappa = 0.76).

Conclusion: 3D MERGE MRI exhibited superior diagnostic performance and reliability compared to 2D MRI in characterizing RCT tears. The enhanced accuracy of 3D MERGE MRI may facilitate preoperative assessment and surgical decision-making for RCT tears.

Objectives: Osteoarthritis (OA) is the most common form of arthritis resulting in joint deterioration. Currently, OA treatment primarily focuses on symptom management. The development of tools suitable for diagnosis is needed to support a paradigm shift towards the prevention of OA rather than treatment. Therefore, having effective diagnostic tools for early detection of OA is crucial.

Methods: The present study aimed to develop a rapid, inexpensive, and reliable detection method using attenuated total reflection Fourier transform infrared (ATR-FTIR) spectroscopy and chemometrics using synovial fluid (SF) for the early diagnosis of osteoarthritis (OA). A preliminary sample consisting of 10 participants in the OA group and 10 in the non-OA group was used to establish the feasibility of the method. All synovial fluid samples were handled uniformly, using fresh drops of 50 µL from each sample ten times, resulting in a total of 200 infrared spectra collected and analysed, revealing significant differences that effectively separated the OA and non-OA groups, demonstrating the potential of this approach for future larger-scale studies.

Results: A significant discrepancy seen in distinguishing SF samples from different categories via variance spectra specifically highlighted by wavenumber 551 cm-1. The predictive model achieved an accuracy rate of 85%, demonstrating promising results.

Conclusion: Our findings suggest that a discriminative model using the ATR-FTIR spectrum could enhance early diagnosis of human OA, providing superior results compared to using serum. This approach reflects the localized joint condition more accurately than serum, which reflects systemic condition.

Objectives: Transtibial pullout repair provides significant clinical improvement in individuals with meniscal root tears; however, there is no consensus on radiological outcomes. In this research, meniscal extrusion and clinical status were evaluated in a homogeneous series of subjects with degenerative medial meniscus posterior root tears (MMPRT).

Methods: This retrospective-prospective study was conducted on 16 subjects with degenerative posterior root tears of the medial meniscus who underwent transtibial pullout repair at Shafa Yahyaian Hospital from March 2017 to February 2021. The study population included two males and 14 females. The average age of the study participants was 50.9 ± 11 years. ‏The patients were followed up for an average of ‏‎19.7±14.8‎‏ months. ‏The Lysholm knee scoring scale was used for clinical evaluation of the knee. MRI (magnetic resonance imaging) was used both before and after surgery to assess the improvement in meniscal extrusion. ‎.

Results: The average total Lysholm knee score increased from ‎49.6±10.5 to 79.1±11.1 (P<0.001). The knee status was poor in one subject, fair in ten subjects, good in two subjects, and excellent in three subjects. In the last follow-up session, all subscales of the Lysholm Knee Scoring Scale showed improvement. The mean meniscal extrusion was 5.7±1.8 mm before surgery and 3.4±2.5 mm after surgery based on MRI results (P=0.008). Improvement in Lysholm score was not correlated with improvement in meniscal extrusion.

Conclusion: Transtibial pullout ‎repair provides significant clinical improvement in degenerative meniscal root tears, even in individuals in whom the meniscal extrusion is not reversed.