Archives of Bone and Joint Surgery-ABJS最新文献

Objectives: Tranexamic acid (TXA) effectively reduces blood loss in total knee arthroplasty (TKA) without raising thromboembolism risk, though the best administration route is still debated. This study aimed to classify patients based on bleeding risk factors and determine whether intravenous (IV) alone or combined IV and intraarticular (IA) administration of TXA provides the greatest benefit.

Methods: This study included 200 patients who underwent TKA, with 100 patients with IV administration only and 100 with combined IV and IA administration. The bleeding risk stratification criteria were based on patient body mass index, age, the use of increased anticoagulant doses in patients with atrial fibrillation, and cases where synovectomy was performed. The primary outcomes measured were tube drainage volume, hemoglobin (Hb) and hematocrit (Ht) levels, and blood transfusion rates. Secondary outcomes included wound complications, symptomatic deep vein thrombosis (DVT), and symptomatic pulmonary embolism (PE).

Results: Combined IV and IA administration showed better outcomes in terms of Hb reduction (difference of 0.98 g/dl, 95%CI: 0.69 to 1.26, P<0.0001), Ht reduction (difference of 2.66%, 95% CI: 1.78 to 3.54, P<0.0001), tube drainage (294 vs 358 ml, 95% CI: 11.58 to 115.93, P=0.0170) and shorter hospitalization stay (difference of 0.53 days, 95% CI: 0.16 to 0.90, P=0.0050) compared to only IV administration. Patients who underwent synovectomy had lower tube drainage with combined TXA administration compared to IV only (355.42 ± 161.68 ml vs. 429.79 ± 268.48 ml). Neither group experienced any cases of symptomatic (i.e. DVT) or pulmonary embolism (PE).

Conclusion: The combined administration of TXA (IV and IA) in patients undergoing TKA was more effective than IV-only administration.

Objectives: We aimed to assess the impact of post-reduction radiographic evaluation on treatment decisions by fellowship-trained hand and general orthopedic surgeons. We also evaluated the trend in distal radius fracture treatment between hand surgeons and general orthopedic surgeons.

Methods: We collected postero-anterior (PA) and lateral radiographs of a consecutive series of 72 patients with six potential treatment options to be reviewed by the surgeons in three steps. First, they reviewed the patients' age, sex, laterality, hand dominance, and pre-reduction radiographs. Two weeks later, they reviewed the same patients' post-reduction PA and lateral radiographs in different order. Finally, after another two weeks, they reviewed the patients' pre-reduction and post-reduction PA and lateral radiographs simultaneously.

Results: A total of 1,080 responses were analyzed without missing data. Treatment plans remained consistent across pre-reduction, post-reduction, and simultaneous presentations, indicating that post-reduction radiographs did not improve treatment agreement. Fellowship-trained hand surgeons were significantly more likely to select internal fixation than general orthopedic surgeons (P < 0.001). Within-group agreement was low (Kappa = 0.2), reflecting substantial variability in treatment choices. Intra-observer reliability between pre- and post-reduction presentations was nearly perfect (Kappa = 0.9, P = 0.402). Treatment decisions remained unchanged for 70% of hand surgeons and 72% of general orthopedic surgeons, while 13% opted for more invasive and 16% for less invasive approaches. The final treatment decisions in simultaneous presentations closely resembled those in post-reduction presentations for general orthopedic surgeons and pre-reduction presentations for hand surgeons, though the differences were not statistically significant.

Conclusion: Although there is a significant trend among hand surgeons toward internal fixation for distal radius fractures, there is great variance among hand surgeons and general orthopedic surgeons about the recommended treatment method for distal radius fractures. Additionally, post-reduction radiographs did not improve variation among surgeons.

Objectives: The existing literature does not provide a clear definition of the outcomes of total knee arthroplasty (TKA) and prosthesis constraint in patients with severe varus deformity. In this study, for the first time, we evaluated the outcomes of TKA and the relationship between prosthesis constraint and these outcomes in patients with severe varus deformity (>30 degrees).

Methods: This prospective cohort study was conducted on 41 patients (54 knees) with varus deformity greater than 30 degrees who underwent TKA between April 2013 and April 2019. The patients were divided into two groups based on the type of prosthesis (high constraint and low constraint). Surgical outcomes were evaluated using the Knee Society Score (KSS), Oxford Knee Score (OKS), range of motion (ROM), and postoperative complications.

Results: High-constrained prostheses (HCP) and low-constrained prostheses (LCP) were used in 44 and 10 knees, respectively. The mean follow-up duration was 77.11 ± 6.55 months. The mean KSS, KSS function, OKS, and ROM significantly improved after surgery compared to preoperative values (P<0.05). The mean improvement in the KSS function score after surgery was significantly higher in patients with HCP compared to those with LCP (p = 0.021). No significant differences were observed for the other variables. No cases required revision.

Conclusion: This prospective non-randomized study, conducted on 41 patients (54 knees) with severe varus deformity (>30º) who underwent total knee arthroplasty (TKA), demonstrated that the mean improvement in the Knee Society Score (KSS) function score after surgery was greater for high-constrained prostheses (HCP, N = 44) compared to low-constrained prostheses (LCP, N = 10). The HCP group included 40 Legacy Constrained Condylar Knees (LCCK) and four hinged knee prostheses, while the LCP group included posterior-stabilizing (PS) prostheses. The mean follow-up duration was 6.5 years. Given the small sample size, randomized clinical trials are needed to validate our preliminary findings.

This study aimed to assess mobile applications (apps) designed for physiotherapy targeting low back pain (LBP) and neck pain (NP) using the Mobile Application Rating Scale (MARS). The study employed an evaluation design, in which three reviewers conducted searches in English and Persian on Google Play in October 2024 to identify apps related to LBP and NP. After initial screening, the included apps were downloaded and installed on smartphones for further evaluation. The MARS questionnaire was utilized to evaluate apps. The total score obtained from the MARS questionnaire, along with the rating on the Google Play Store, was used to assess the quality and effectiveness of the apps. Eighteen apps, consisting of eight for NP and ten for LBP, were included in this study. Among LBP apps, the application "Back Pain Relief Exercises at Home" received the highest score (3.79/5). Moreover, the app "Lia - AI Posture Trainer" achieved the highest score among NP apps at 4.25/5. The findings showed that the apps available for NP and LBP are limited and low-quality. Given the increasing number of individuals suffering from these conditions, there is a clear need for up-to-date and high-quality software to provide daily patient support. These apps must be developed based on scientific studies and incorporate user feedback.

Objectives: Vitamin C has anti-inflammatory, antioxidant, and analgesic properties, yet its specific impact on perioperative and postoperative outcomes after total hip and knee arthroplasty remains unclear.

Methods: A PRISMA-compliant, PROSPERO-registered systematic review and meta-analysiss was conducted. Randomized controlled trials (RCTs) evaluating oral or intravenous vitamin C in primary hip or knee arthroplasty were searched in MEDLINE, Embase, Web of Science, and Scopus up to May 2025.Risk of bias was evaluated using the Cochrane RoB tool. Meta-analyses were performed with RevMan version 5.4.1. Effect sizes were expressed as weighted mean differences (WMDs) with 95% confidence intervals (CIs). The certainty of evidence was assessed using the GRADE approach. Statistical heterogeneity was examined using the I² statistic (I² ≥ 50% indicating substantial heterogeneity) and the chi-square test. A fixed-effect model was applied when I² < 50%; otherwise, a random-effects model based on the DerSimonian and Laird method was used.

Results: Of 4,776 records, 3,585 titles/abstracts were screened and 19 full texts assessed; ten RCTs (n=1,162) met inclusion for qualitative synthesis, and three were pooled quantitatively. Vitamin C administration significantly reduced total morphine use after surgery (WMD = -1.41 mg; 95% CI [-2.32, -0.50]; P = 0.002; I² = 0%). It also lowered C-reactive protein (CRP) levels (WMD = -11.32 mg/L; P = 0.0007) and interleukin-6 (IL-6) concentrations (WMD = -8.27 pg/mL; P < 0.0001) at 24 hours, although these effects diminished by 48 hours. No significant differences in postoperative pain scores were observed at either 24 or 48 hours.

Conclusion: This review indicates that vitamin C may be associated with reduced opioid consumption, attenuation of inflammatory responses, and decreased perioperative blood loss among patients undergoing joint arthroplasty. However, the overall strength of evidence remains limited due to heterogeneity in dosage, timing, and routes of administration across the included studies.

Objectives: Malalignment of the lower limb, such as varus deformity, can impair function by altering joint biomechanics and gait. However, the effect of the center of rotation of angulation (CORA) location on joint mechanics in varus deformity remains unclear.

Methods: This study proposed an approach to enhance the accuracy and efficiency of joint kinetics and kinematics estimation during gait by incorporating precise CORA positioning along the femur. Simulations were performed using inverse kinematics and dynamics for a 10° varus deformity. The deformities were modeled with CORA located at fractions ranging from 1/6 to 5/6 of femoral length (measured from the hip to the knee joint), and were compared with a baseline representing normal lower-limb alignment.

Results: The findings indicated that varus deformity had a minimal effect on the subtalar angle but substantially altered the subtalar moment during stance. CORA placement near the hip joint increased both ankle plantar-/dorsiflexion and knee flexion/extension angles. Proximal CORA positioning also influenced joint reaction forces, producing higher forces at the ankle and reduced forces at the hip. While hip abduction/adduction moments showed only minor changes, hip rotation moments varied considerably across CORA locations, particularly during stance.

Conclusion: Incorporating CORA into deformity modeling enables more accurate simulation of pathological alignment, providing detailed insights into joint kinetics and kinematics. Such information can help surgeons better understand patient-specific conditions and develop more precise surgical plans.

The purpose of this in brief article was to determine the current role of intraarticular injections of hyaluronic acid (HA) and platelet-rich plasma (PRP) for the treatment of painful KOA. It has been reported that the average duration of effectiveness (pain relief) of one injection of extended-release HA is around one year. Kellgren-Lawrence grade (I-II versus III-IV), male gender, and older age are associated with a longer duration of effectiveness. Cartilage degeneration might be improved with a higher number of injections of HA. Intraarticular injections of HA alleviate pain, function, and diminish non-steroidal anti-inflammatory drugs (NSAIDs) consumption. In addition, several studies have indicated that the combination of HA and PRP is more effective than HA alone. Finally, other studies seemed to demonstrate that PRP was more effective than HA.

Objectives: Total joint arthroplasty is an effective treatment for end stage osteoarthritis. As perioperative protocols are developed, outpatient arthroplasty has been gaining traction to facilitate earlier recovery and same day discharge. The aim of this manuscript is to analyze the trends in outpatient arthroplasty over a 17-year duration. This analysis seeks to predict emerging themes in the literature on patient optimization and outcomes in outpatient arthroplasty.

Methods: This study conducted a literature review on outpatient arthroplasty with the Web of Science Core Collection over a 17-year period between 2005 and 2022. Bibliometric data was imported and analyzed with Bibliometrix and VOSviewer.

Results: 198 articles were identified demonstrating an annual growth of 19.61% with notable bursts in 2017 and 2021. United States was the top global contributor followed by Canada and European nations. There were significant contributions across 219 institutions and 758 authors, with the Journal of Arthroplasty being the most productive and influential journals. Key themes identified include the feasibility of outpatient surgery, pain management, and perioperative complications and costs.

Conclusion: This bibliometric analysis highlights the ongoing growth and development within outpatient arthroplasty since 2005. The United States remain the global leader within outpatient related arthroplasty research. Previous, current, and ongoing trends are highlighted within this field for further development as hotspots.