Clinics in Orthopedic Surgery最新文献

Backgroud: The increasing prevalence of cementless total knee arthroplasty (TKA) necessitates a reliable assessment of bone quality. Central bone mineral density (BMD), measured by dual-energy x-ray absorptiometry (DEXA) in the lumbar spine and hip, is conventionally used to estimate bone quality. However, its effectiveness in predicting the actual bone strength at the knee, which is crucial for cementless TKA, is under scrutiny. This study investigated the relationship between central BMD and actual bone strength at the knee.

Methods: This prospective study included 191 knees undergoing standard posterior-stabilized TKA between November 2021 and March 2023. Central BMD was assessed 3 months before TKA, and the failure load of bone fragments collected during box preparation was directly measured using an indentation test. Relationships between central BMD and failure load as a measure of the actual bone strength at the knee were analyzed.

Results: Linear regression analysis revealed a weak correlation between central BMD and the actual bone strength at the knee (R² = 0.146 in all patients; < 0.001 in osteoporosis group; 0.126 in non-osteoporosis group). The correlation suggested by the regression models was particularly insignificant in the osteoporosis subgroup, showing that central BMD is not a reliable predictor of bone strength for cementless TKA.

Conclusions: Central BMD measurements have limited utility in accurately predicting the real bone strength at the knee for cementless TKA. This study highlights the need for more specific and direct methods of assessing bone quality at the knee to ensure the success of cementless TKA.

Backgroud: Heterotopic ossification (HO) is difficult to characterize and classify on simple radiographs. Therefore, we attempted to evaluate intraobserver and interobserver reliability of simple radiography and computed tomography (CT) for detecting and classifying HO after reverse shoulder arthroplasty (RSA). It was hypothesized that CT would provide more reliable results than simple radiography.

Methods: This retrospective study reviewed 30 patients who underwent RSA performed by a single surgeon. Patients were included if they had both postoperative simple radiographs and CT images taken immediately after surgery and at 1 year after surgery and if they had completed clinical assessment at least 1 year after surgery. We first evaluated the intraobserver and interobserver reliability for the detection of the presence of HO and Modified Brooker's classification both on simple radiographs and CT scans with the use of Kappa statistics. Then, we analyzed the correlation of HO observed in simple radiographs and CT scans with clinical outcomes. All radiographic evaluations were performed by 2 independent reviewers in random orders with 3 weeks of intervals.

Results: The intraobserver reliability outcomes of both reviewers in simple radiography and CT were almost perfect or perfect for the detection of HO and classification. However, CT images improved the interobserver reliability for the detection of HO (kappa value for simple radiographs [K_XR] = 0.6018 and kappa value for CT [K_CT] = 0.8316) and classification (K_XR = 0.5300 and K_CT = 0.6964). At a mean follow-up of 25 months (range, 12-54 months), clinical scores were not significantly different according to the presence of HO based on simple radiographs. However, when CT images were used, the University of California, Los Angeles score and physical component score of short-form 36-item health survey were significantly lower in patients with HO than in patients without HO (27.0 vs. 30.4, p = 0.045 and 57.6 vs. 70.7, p = 0.034, respectively).

Conclusions: Both simple radiography and CT provided excellent intraobserver reliability for detecting and classifying HO after RSA. Compared to simple radiography, CT tended to improve interobserver reliability and defined the presence and severity of HO more clearly.

Background: The objective of this study was to investigate the impact of robot-assisted surgery (RA) on the risk of new vertebral compression fracture (NVCF) and bone cement leakage in patients with osteoporotic vertebral compression fractures (OVCF) after percutaneous vertebral augmentation (PVA), including percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP).

Methods: A meta-analysis was performed to evaluate the clinical outcomes and adverse effects of RA-PVA versus fluoroscopy-assisted (FA)-PVA in patients with OVCF. A validation cohort of 385 patients who underwent PVP or PKP was retrospectively analyzed. In addition, we attempted to create well-calibrated nomograms to estimate the risk of NVCF and bone cement leakage.

Results: The meta-analysis revealed that the incidence of NVCF and bone cement leakage was significantly lower in RA-PVA than in FA-PVA. The validation cohort confirmed that RA-PVA provided better results than FA-PVA in terms of NVCF and bone cement leakage.

Conclusions: The meta-analysis and the validation cohort suggest that RA reduced the risk of NVCF and bone cement leakage in patients with OVCF after PVA. The nomograms are accurate and easy-to-implement methods for clinicians to estimate the risk of NVCF and bone cement leakage after PVA.

Cutibacterium acnes, a commensal, lipophilic, anaerobic Gram-positive bacterium, is well known for its potential to cause infections, particularly in the field of orthopedics, notably in the shoulder. However, its indolent strain nature presents challenges in the diagnosis of the bacterium using clinical, laboratory, and culture-based methods. There are controversies surrounding its actual threat as an infection-causing agent, leading to an incomplete consensus on treatment strategies after the infection. Furthermore, research is ongoing to explore preventive procedures before the onset of infection. This review aimed to comprehensively explore the diagnosis and treatment of C. acnes and determine whether it is a risk factor for shoulder joint infections.

Background: Total joint arthroplasty (TJA) is a potent treatment for degenerative joint disorders. Bilateral total joint arthroplasty (BTJA) encompasses both bilateral total knee arthroplasty (BTKA) and bilateral total hip arthroplasty (BTHA). Both BTKA and BTHA can be performed as either a simultaneous procedure or a staged procedure. The goal of this study was to investigate trends in BTJA research, including pertinent authors, journals, countries, and papers. We also evaluated frequent keywords and topics to predict potential future study fields.

Methods: Articles published between 1982 and 2022 were retrieved from the Web of Science Core Collection of Clarivate Analytics. The search query included "hip" OR "knee" (Topic) AND "arthroplasty" OR "replacement" (Topic) AND "bilateral" OR "simultaneous" (Topic) AND 1992-2022 (Year published) AND Article (Document type). Metrics were imported for further analysis with Bibliometrix and VOSviewer.

Results: A total of 736 articles associated with BTJA were retrieved, originating from 44 countries with the United States being the biggest contributor. Top institutions were Cornell University and Ewha Womans University. Kim YH was the most productive and impactful author. The Journal of Arthroplasty had the highest impact and the greatest number of articles and citations. Williams Russo had the most cited article. Co-occurrence visualizations highlighted predominant topics in the literature.

Conclusions: Since 1982, there has been a growing interest in BTJA research. The United States institutions have been the primary providers in global scholarly production. This bibliometric analysis identified previous, present, and emergent tendencies in BTJA with the goal of forecasting new potential hotspots.

Backgroud: Acetabular fractures are rare and challenging to treat, and the surgeon's learning curve for managing these fractures is steep. The incidence of acetabular fractures is low, making it difficult to conduct single-surgeon, single-center studies. Therefore, multi-surgeon and multi-center studies may produce inconsistent outcomes compared to those of single-surgeon, single-center studies. According to the authors' literature investigation, single-surgeon, single-center, large-scale studies on this topic are lacking. Thus, this study investigated the radiological and functional outcomes and prognostic factors in patients with displaced acetabular fractures treated by a single surgeon at a single center and followed up for at least 1 year.

Methods: This retrospective study was conducted on 149 patients treated for acetabular fractures at Chungbuk national university hospital between January 2005 and December 2021. Demographic data, time to surgery, and complications were collected using medical records. The Judet and Letournel classification was confirmed using preoperative radiographs, and Matta's quality of reduction was confirmed using immediate postoperative radiographs. At the latest outpatient follow-up, Matta's radiological outcome grading and the modified Postel Merle d'Aubigné score were confirmed as radiological and functional outcomes, respectively.

Results: The radiological outcome was excellent or good in 131 patients (87.9%) and fair or poor in 18 (12.1%) and influenced by age (p = 0.009), quality of reduction (p < 0.001), and the Judet and Letournel classification (p = 0.025). Functional outcome was excellent or good in 121 patients (81.2%) and fair or poor in 28 (18.8%); this was influenced by the quality of reduction (p < 0.001) and the Judet and Letournel classification (p = 0.030).

Conclusions: Our radiological and functional outcomes of acetabular fractures were comparable with those of other single-surgeon, single-center studies regarding the follow-up period. Poor prognostic factors for radiological outcomes included age > 65 years, associated patterns, and poor quality of reduction. Associated patterns and poor quality of reduction were factors associated with poor functional outcomes.

Background: Posterior long-segment instrumentation (PLSI) enables the stable repair of thoracolumbar fractures (TLFx) and is thus widely used. However, patients with highly unstable fractures may experience implant failure and related complications (e.g., pain and kyphosis) despite PLSI. Few studies have considered the implant failure rate and risk factors associated with PLSI for TLFx.

Methods: This study reviewed 162 consecutive patients with TLFx who underwent PLSI and completed > 1 year of follow-up between April 2011 and December 2019. Implant failure was defined as rod breakage, cap dislodgement, or screw breakage. Risk factors for implant failure were evaluated by multivariate regression analysis that included demographic, injury-related, and surgical factors.

Results: There were 15 cases (9.3%) of implant failure at the final follow-up (mean, 28.0 ± 18.0 months). Current smoker at the time of injury, fracture level, load sharing score, and anterior compression ratio (ACR) significantly differed between the implant failure and control groups (all p < 0.05). Multivariate logistic regression identified current smoker at the time of injury (adjusted odds ratio [aOR], 5.924; 95% CI, 1.405-24.988), mid to low lumbar fracture (aOR, 15.977; 95% CI, 4.064-62.810), and ACR (aOR, 1.061; 95% CI, 1.009-1.115) as predictors of implant failure.

Conclusions: This study demonstrated a high implant failure rate in patients with TLFx treated with PLSI. Smoking at the time of injury, mid to low lumbar fracture, and higher ACR were identified as significant risk factors for implant failure. These findings can help guide treatment decisions and improve patient outcomes in TLFx surgery.

Background: As the importance of meniscus in joint function becomes more apparent, there is a growing interest in meniscus repair techniques. Notably, biological augmentation methods have shown promising results for meniscus healing, despite their challenges in practical implementation. The purpose of this study was to evaluate meniscus healing and clinical outcomes of meniscus repair with bone marrow aspirate for horizontal or radial tears.

Methods: This study retrospectively reviewed patients who underwent arthroscopic meniscal repair with bone marrow aspirate from the iliac crest. A total of 30 patients with horizontal or radial meniscus tears confirmed by magnetic resonance imaging (MRI) were included, excluding those with insufficient data or concurrent surgeries. Patient demographic characteristics, operative data, and clinical outcomes including pain numeric rating scale, International Knee Documentation Committee score, Lysholm score, and Tegner activity scale were evaluated. For radiographic evaluation, knee x-rays, preoperative MRIs, and postoperative 3-month MRIs were evaluated.

Results: Thirty patients (15 women and 15 men) with a mean age of 46.8 ± 15.2 years were followed up for a mean of 25.1 ± 3.4 months. Of these patients, 22 (73%) had horizontal meniscal tears, while 8 (27%) had radial tears. Clinical outcomes were significantly improved over the time from the initial to 2 years after surgery. Meniscus healing was 60% on MRI at 3 months after surgery. There was no correlation between changes in clinical scores and healing rate. Furthermore, there was no statistically significant difference in the healing rate or changes in clinical scores according to tear patterns. Retears were observed in 2 patients, who were non-compliant with rehabilitation and were managed conservatively.

Conclusions: Augmentation with bone marrow aspirate harvested from the iliac crest for meniscal repair of horizontal or radial tears yields favorable healing rates in MRI and clinical outcomes, highlighting its potential for addressing challenging meniscal repair.

Background: Deep vein thrombosis (DVT) is a common complication in orthopedic surgery and has the potential to lead to fatal complications such as pulmonary thromboembolism. However, the precise incidence and risk factors for DVT in the foot and ankle fields remain unclear. This study aimed to analyze the prevalence of DVT and identify its risk factors after foot and ankle surgery.

Methods: Between September 2020 and July 2023, screening duplex ultrasonography was performed on 278 patients who underwent foot and ankle surgery and required immobilization. The findings from screening duplex ultrasonography were assessed in conjunction with the symptoms present at the time of diagnosis. Heterogeneous demographic data that could serve as potential risk factors for DVT, including diagnosis, body mass index, and other medical histories, were examined alongside pertinent surgery-related data, such as tourniquet time.

Results: Among the 278 individuals, DVT occurred in 41 patients (14.7%). Among these, 92.7% originated at the calf level and the majority were asymptomatic. The cases originating above the calf accounted for 3 cases, representing 7.3% of patients diagnosed with DVT (1.1% of the entire screened population). Acute trauma, history of previous DVT, and old age were identified as statistically significant risk factors for DVT occurrence, with odds ratios of 2.44 (p = 0.04), 6.40 (p = 0.02), and 1.16 (p = 0.03), respectively.

Conclusions: After foot and ankle surgery, DVT occurred in 14.7% of cases. Acute trauma, history of DVT, and old age were identified as risk factors for DVT. These findings highlight the necessity of careful monitoring and appropriate prophylactic interventions for high-risk patients. Further investigation is required to determine effective prophylactic strategies for this patient population.

Backgroud: Distal radius fractures with complete intra-articular involvement and diaphyseal extension pose significant challenges for stable fixation. Treatment options vary, with no single method demonstrating superiority. This study analyzed the outcomes of fixing these type of fractures with volar locking plates, which are widely used worldwide, and the fracture length according to plate type to determine when an extra-long plate should be used.

Methods: This retrospective review analyzed 89 consecutive patients surgically treated for Association of Osteosynthesis (AO) classification type C distal radius fractures with diaphyseal extension, excluding open fractures. The plate length was determined to be long enough accordingly to avoid placing screws in the fracture site. Radiographic evaluation and clinical outcomes were analyzed.

Results: According to the AO system, C3 type fractures comprised 50%, C1 type 28%, and C2 type 22%. The average distance from the radiocarpal joint to the most proximal fracture line was 41.1 mm, with articular step off and gap of 1.7 mm and 3.7 mm, respectively. Concomitant distal ulna fractures were present in 81%. At final follow-up, the mean radial height was 10.9 mm, radial inclination was 22.8°, volar tilt was 5.7°, and ulnar variance was 0.6 mm. Fracture union occurred on average at 2.6 months. The average Disabilities of the Arm, Shoulder, and Hand score was 12.0 and the average Modified Mayo Wrist Score was 83.6. Regarding the average wrist range of motion, extension was 63.8°, flexion was 53.7°, ulnar deviation was 25.1°, and radial deviation was 16.7°. Complications included delayed wound healing in 3% and delayed union in 1 patient, who eventually achieved union at 10 months after surgery. APTUS Wrist Distal Radius Plates XL 2.5 and 2.4-mm Variable Angle LCP Two-Column Volar Distal Radius Plates showed a statistically significant difference in fracture length, with the former being longer than the latter (62 mm vs. 35 mm, p < 0.001).

Conclusions: If the fracture length from the articular surface to the diaphysis exceeds 60 mm, we recommend preparing an extra-long distal radius plate. Volar plate fixation with appropriate length selection has yielded favorable functional outcomes and few minor complications in distal radius fractures with complete intra-articular involvement and diaphyseal extension.