Clinics in Orthopedic Surgery最新文献

Backgroud: Complex acetabular defects (Paprosky II and III) present a challenge in total hip arthroplasty (THA). We used a "cup-in-cup" (CiC) construct wherein a trabecular metal cup (TMC) was press-fit and a dual mobility cup (DMC) was cemented within it. We added a porous acetabular augment (cup-in-cup with augment; CiCA) or a cage (cup-cage-cup; CCC) when required.

Methods: We reviewed patients who underwent complex acetabular reconstruction at our center between January 2012 to December 2021, with 2 to 11 years of follow-up. We assessed radiological restoration of the center of rotation using digital templating software (TraumaCad), functional outcome using the Harris Hip Score (HHS) and Forgotten Joint Score, and evaluated survival of the construct over 2-11 years by examining reoperation rates for any reason.

Results: Among 1,532 THAs performed in 1,448 patients (578 revisions), a TMC was used for acetabular reconstruction in 82 patients: 55 CiC, 15 CiCA, and 12 CCC were done. Eleven hips had Paprosky type IIC, 52 had IIIA, and 19 had IIIB acetabular defects. The mean cup size used was 64.10 ± 4.68 mm, the mean change in vertical and medial offset from the opposite side was 5.27 ± 4.68 mm and -1.21 ± 5.33 mm, respectively. The HHS improved from 49.01 ± 7.10 to 82.45 ± 6.66 at a mean follow-up of 54.7 months. Three-year survival was 96%, and 86% of the constructs survived at the latest follow-up.

Conclusions: The TMC construct is a good option for Paprosky type II and III acetabular defects. Cementing a DMC restored optimal hip biomechanics. Our study provides robust data supporting its selection as the standard of care for addressing complex acetabular defects of all causes.

Background: Septic arthritis is a debilitating diagnosis, and many of these patients elect to undergo total knee arthroplasty (TKA) and total hip arthroplasty (THA). The purpose of this systematic review and meta-analysis is to assess the risk of prosthetic joint infection (PJI) in those who undergo primary TKA or THA with a history of septic joint arthritis. Secondarily, we will evaluate patient-specific or surgical factors that could increase the risk of primary arthroplasty failure.

Methods: A comprehensive search of PubMed, CINAHL Plus, Embase, and Scopus was performed. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for study selection, data extraction, and analysis. From a total of 404 articles, 18 studies were selected for inclusion.

Results: Our final cohort consisted of 1,758 arthroplasties with Staphylococcus species (n = 375 cases, 40%) being the most common causative septic arthritis agent. Male sex (70.5% vs. 51.1%, p = 0.0003) and Gram-negative bacteria cause (11.6% vs. 6.0%, p = 0.02) were associated with an increased risk of PJI following arthroplasty. There was no association found between arthroplasty failure and increasing age or body mass index. There was no difference in PJI rates between 1- and 2-stage arthroplasty (10.9% vs. 10.8%; p = 0.47).

Conclusions: Male sex and resistant organism as causes of septic arthritis were associated with an increased risk of PJI in patients with a history of native septic arthritis. Single- and 2-stage procedures had similar success rates. Future studies should be larger and focus on long-term outcomes in these patients.

Background: Clavicle fractures are a common type of fracture, and the treatment of clavicle shaft fractures involves various implant options and approaches. This study aimed to compare the clinical and radiological outcomes of surgical treatment using the minimally invasive technique versus open reduction plate osteosynthesis with a superior clavicle plate featuring lateral extension for clavicle shaft fractures.

Methods: This retrospective case-control study included 70 consecutive patients who underwent surgery for displaced clavicle shaft fractures between March 2022 and August 2023: group M (n = 20), which underwent a minimally invasive technique, and group C (n = 41), which underwent open reduction plate osteosynthesis. Clinical outcomes, visual analog scale scores, Constant scores, and hypoesthesia in the area supplied by the superior clavicular nerve were assessed 1 year postoperatively. The time to clinical bone union was also measured from surgery to tenderness resolution. Radiological evaluation included assessment of the number of fracture fragments, measurement of the fracture gap interval, and determination of the time to radiographic bone union. Intraoperative exposure time using the C-arm was also recorded.

Results: We observed no significant differences in clinical outcomes and the bone union rates between the 2 groups. However, compared to group C, group M showed a shorter operation time (p = 0.004), less blood loss (p < 0.001), and a lower incidence of hypoesthesia (p < 0.001). Compared to group C, group M had a longer time to achieve radiologic bone union (p < 0.001); however, there was no difference in the clinical bone union time between the 2 groups. Regarding complications, there were 9 cases of hypoesthesia in group C and 1 case of nonunion in group M.

Conclusions: This minimally invasive technique, using a superior clavicle plate with lateral extension for clavicle shaft fractures, achieved clinical outcomes and bone union rates that were comparable to those of open reduction plate osteosynthesis, while also offering the advantages of shorter operation time, reduced blood loss, and a lower risk of hypoesthesia.

Background: Carpal tunnel release (CTR) effectively relieves symptoms and improves the quality of life for patients with carpal tunnel syndrome (CTS). While studies have explored factors such as age and sex that influence surgical decisions, the roles of socioeconomic factors and insurance coverage remain underexplored. Our study addressed this gap by analyzing a nationwide cohort database in South Korea to understand surgical patterns and potential cost-saving effects based on insurance type and income level. Our hypothesis was that income level and insurance type would influence the decision to undergo surgery in patients with CTS.

Methods: This study selected patients with CTS who underwent CTR from South Korea's National Health Insurance Service-sample cohort and analyzed their demographic and treatment data to assess surgery rates and times to surgery, considering factors such as age, sex, residential district, income, disability status, and insurance type. Regression analysis and analysis of variance were used to determine the influence of these variables on surgical decisions and times to surgery, with statistical significance set at p < 0.05.

Results: Multivariate logistic regression analysis revealed that income level did not significantly influence surgical decision-making. Female patients experienced longer times to surgery than male patients (p = 0.034). Younger patients waited longer, but the trend reversed for those aged ≥ 50 years (p < 0.001). In contrast, patients with public medical aid insurance (p = 0.022) and those with disabilities (p < 0.001) had shorter times to surgery. Income and residential district had no significant impact on times to surgery.

Conclusions: Individuals covered by comprehensive public aid insurance had quicker surgical interventions. Female patients undergo surgery more frequently, but they tend to delay it. The likelihood of undergoing surgery increases with age until the 50s. Individuals with disabilities undergo surgery more frequently and promptly. These findings suggest that physicians should encourage timely surgical interventions among female patients and younger patients who tend to delay surgery. For healthcare policymakers, implementing targeted education programs and maintaining support for public medical aid insurance may facilitate quicker access to surgical care and address delays among specific demographics.

Backgroud: The optimal postoperative immobilization method following triangular fibrocartilage complex (TFCC) foveal repair remains debated. While long-arm casting effectively restricts wrist rotation, it also limits elbow movement and may cause discomfort. The Muenster brace, which allows partial elbow flexion while restricting wrist rotation, has been proposed as an alternative. This study compared clinical outcomes, patient satisfaction, and complication rates between long-arm cast (LAC) and Muenster brace immobilization.

Methods: A retrospective comparative study was conducted on 40 cases from 37 patients who underwent TFCC transosseous foveal repair between March 2021 and February 2024. Patients were categorized into 2 groups: the LAC group (n = 19) and the Muenster brace group (n = 21). Demographics, radiologic assessments, operative details, and pre- and postoperative functional outcomes were analyzed. Pain and function were assessed using a visual analog scale (VAS) and the Disabilities of the Arm, Shoulder and Hand (DASH) score. Patient satisfaction and complications were recorded.

Results: The mean patient age was 29 years, with an average follow-up of 282 days. Preoperative VAS scores (6.3 ± 1.9) improved to 1.2 ± 1.4, and DASH scores improved from 52.6 ± 16.0 to 10.4 ± 12.4. No significant differences were found between groups in demographics, tear classification, operative time, or preoperative functional scores. Postoperative pain relief, functional improvement, grip strength, and satisfaction were comparable. Minor complications included 1 case of transient cubital tunnel syndrome and 1 case of persistent pain requiring revision in the LAC group. In the Muenster group, 1 patient sustained a traumatic re-injury, and another developed distal radioulnar joint instability. No infections, tendon ruptures, or severe stiffness occurred.

Conclusions: Both immobilization methods yielded comparable outcomes and satisfaction. While the Muenster brace improves elbow mobility, its effectiveness in preventing retears was similar to that of LAC.

Background: A limitation of hook plate (HP) fixation for treating acromioclavicular (AC) joint dislocations is reduction loss after plate removal. While the healing of the coracoclavicular (CC) ligament is generally reliable after HP fixation, the healing status of the acromioclavicular ligament complex (ACLC) remains less understood. Our hypothesis was that ACLC healing failure would increase the risk of reduction loss.

Methods: Patients who underwent HP fixation within 2 weeks of injury and had preoperative and post-HP removal magnetic resonance imaging (MRI) from May 2018 to May 2023 for acute Rockwood type III or V AC joint dislocations were retrospectively reviewed. Reduction loss was defined as a coracoclavicular distance (CCD) ratio (CCD of the injured side / uninjured side × 100) greater than 150 at final follow-up. Ligament healing was assessed using the Ihara grade, with grades 1 and 2 considered healed. The tear sites of the ACLC were identified with bony attachment and mid-substance site.

Results: A total of 33 patients were included. CC ligaments healed in all cases. The mean follow-up period was 11.8 ± 4.1 months. The mean time to HP removal was 3.4 ± 0.8 months postoperatively. ACLC healing was observed in 21 patients, and non-healing in 12 patients. Reduction loss was significantly more frequent in the non-healing group (83.3%, 10 / 12) than in the healing group (23.8%, 5 / 21) (OR, 16.0; 95% CI, 2.59-98.77; p = 0.001). The ACLC healing failure rate was significantly higher in the bony attachment tear group (52.6%, 10 / 19) than in the mid-substance tear group (14.3%, 2 / 14) (OR, 6.67; 95% CI, 1.16-38.94; p = 0.024). Reduction loss was also significantly more frequent in bony attachment tears (63.2%, 12 / 19) than in mid-substance tears (21.4%, 3 / 14) (OR, 6.29; 95% CI, 1.29-30.54; p = 0.017).

Conclusions: Reduction loss after HP fixation for treating AC joint dislocations was associated with the healing status and tear sites of the ACLC. Particularly, bony attachment site tears demonstrated lower healing potential and a higher risk of reduction loss, suggesting that additional procedures beyond HP fixation should be considered when such tears are identified preoperatively on MRI.

Background: This study investigates how age and sex influence the morphology of the infra-acetabular screw (IAS) corridor by examining its anatomical features and relationships with adjacent critical structures across diverse age and sex cohorts. Additionally, surgical simulations were performed to identify reliable anatomical landmarks and refine intraoperative fluoroscopic images.

Methods: A retrospective analysis (2016-2024) was performed on 178 unilateral acetabular fracture cases (105 males, 73 females; mean age, 55.74 ± 15.0 years). Participants were stratified into 4 groups based on sex and age (threshold: 60 years): young males (n = 57), elderly males (n = 48), young females (n = 36), and elderly females (n = 37). Pelvic models were reconstructed using Mimics 21.0 software to measure infra-acetabular corridor diameter (IACD) and obturator groove depth (OGD). IAS placement was simulated to determine the entry point, screw dimensions, and minimum distances to adjacent structures. Simulated fluoroscopic images assessed the sensitivity and specificity for cortical breach detection at incremental screw diameters.

Results: Young males demonstrated marginally greater distances to the eminentia iliopectinea compared to elderly males (13.04 ± 1.86 vs. 12.32 ± 1.20 mm, p < 0.05). Elderly females had a significantly larger IACD than young females (4.98 ± 0.95 vs. 4.51 ± 0.58 mm, p < 0.05), and female OGD exceeded that of males (11.16 ± 2.10 vs. 9.66 ± 1.98 mm, p < 0.05). A strong negative correlation was identified between IACD and OGD (r = 0.842): IACD = 8.730-0.358 OGD. The modified iliac-outlet view reduced false positives from 76.4% to 44.38% and improved sensitivity.

Conclusions: The IAS entry point should be more medial in young males than in elderly males. Elderly females exhibited a larger IACD. The negative correlation between IACD and OGD results in a narrower IACD in females. The modified iliac-outlet view improved sensitivity and reduced false positives for cortical breach detection.

Backgroud: This study aimed to compare the outcomes of reverse total shoulder arthroplasty (rTSA) and anatomic total shoulder arthroplasty (aTSA) in patients with rotator cuff-intact osteoarthritis, assessing revision and complication rates, patient-reported outcomes, and postoperative range of motion.

Methods: This systematic review and meta-analysis included comparative studies with levels I-III evidence that assessed rTSA and aTSA in patients with rotator cuff-intact osteoarthritis. Inclusion criteria required studies to report postoperative revision rates, complication rates, patient-reported outcomes, or range of motion with a minimum follow-up of 2 years. Studies focusing on noncomparative designs, biomechanical analyses, or case series were excluded. A comprehensive search of PubMed, Ovid Medline, and Scopus databases was conducted from their inception through December 2024. Odds ratios (ORs) with 95% CI were used for dichotomous outcomes, and mean differences (MDs) with 95% CI were used for continuous outcomes.

Results: A total of 14 studies, encompassing 4,819 cases, were included in the analysis. rTSA demonstrated a significantly lower revision rate compared to aTSA (OR, 0.43; 95% CI, 0.29 to 0.65; p < 0.001), while both procedures yielded similar Constant scores (MD, -2.23; 95% CI, -5.80 to 1.33; p = 0.22), simple shoulder test (MD, 0.11; 95% CI, -0.30 to 0.52; p = 0.59), American Shoulder and Elbow Surgeons scores (MD, -1.51; 95% CI, -4.91 to 1.90; p = 0.39), subjective shoulder values (MD, 2.16; 95% CI, -2.44 to 6.75; p = 0.36), visual analog scale for pain (MD, -0.25; 95% CI, -0.72 to 0.21; p = 0.29), and ranges of motion, except for external rotation, where aTSA demonstrated superiority (MD, -11.28; 95% CI, -14.95 to -7.61; p < 0.001).

Conclusions: In patients with rotator cuff-intact osteoarthritis, rTSA is associated with a lower revision rate compared to aTSA, while achieving comparable clinical outcomes and range of motion, with the exception of external rotation.

Background: To investigate the clinical effects and biomechanical properties of various coronal plane angulations during foraminoplasty in transforaminal endoscopic lumbar discectomy.

Methods: From December 2018 to December 2020, 72 patients who underwent transforaminal endoscopic lumbar discectomy were enrolled retrospectively. The patients were divided into 3 groups according to the different coronal plane angulations during foraminoplasty: group A, 0° < coronal plane angulation ≤ 10°; group B, 10°< coronal plane angulation ≤ 30°; and group C, 30° < coronal plane angulation ≤ 50°. The 3 groups were compared in terms of general data, clinical outcomes, and imaging parameters. In addition, a standard L4-5 3-dimensional finite element model was established and validated. A trephine with an 8.5-mm diameter was designed to simulate foraminoplasty at angles α1 = 10°, α2 = 30°, and α3 = 50° with the coronal plane of the normal model. Three foraminoplasty models were constructed. The differences in range of motion and L4-5 intradiscal pressure were compared among the models.

Results: There were 13 cases in group A, 43 cases in group B, and 16 cases in group C. Sex, age, surgical segment, length of hospital stay, duration of operation, intraoperative bleeding, time of fluoroscopy, and preoperative, postoperative, and 1-year follow-up clinical outcome scores and imaging parameters did not differ significantly between the 3 groups (p > 0.05). However, as the coronal plane angulation increased, postoperative foraminal height tended to decrease, as did the proportion of lumbar instability. There was no significant difference in foraminal height and width at 1 year postoperatively compared to preoperative values in group A (p > 0.05), but there was in groups B and C (p < 0.05). All groups showed a statistically significant decrease in intervertebral space height when compared to preoperative values (p < 0.05). The finite element analysis results were consistent with the clinical results. When compared to the normal model, the range of motion and intradiscal pressure of foraminoplasty models were significantly increased with extension, left bending, and left rotation, and the increasing trend was α1 < α2 < α3.

Conclusions: When performing foraminoplasty, reducing coronal plane angulation and depressing the trephine to a near horizontal position could be considered an operative technique that protects lumbar stability.

Backgroud: In this study, we aimed to investigate the effects of osteoporosis medication use and prescription duration on the rates of reprocedures for re-fractures in patients who underwent vertebral augmentation (VA).

Methods: This retrospective cohort study was conducted using data collected from the National Health Insurance Service database of South Korea. Patients aged 50 years or older who underwent VA in 2012 were included in this study. A reprocedure was defined as an additional VA performed for re-fractures during a follow-up period of up to 5 years. Patients were categorized based on medication type (bisphosphonates, selective estrogen receptor modulators [SERMs], calcium supplements, or vitamin D supplements) and prescription duration (incomplete, complete, or absolute complete). The results were statistically analyzed using Cox regression and Kaplan-Meier survival analyses.

Results: Among 9,070 patients included, 678 patients (7.5%) underwent reprocedures for re-fractures, with 41.0% of reprocedures performed within 6 months after VA. The reprocedure rate was higher in patients prescribed calcium or vitamin D supplements (13.3%) than in those prescribed bisphosphonates (7.7%) or SERMs (8.6%). Multivariate analysis revealed that prolonged prescription duration was associated with higher reprocedure rates, reflecting greater disease severity. The absolute complete prescription group showed a 9.07 times higher hazard ratio for reprocedure than the no-medication group.

Conclusions: These findings highlight the potential of osteoporosis medication use and prescription duration as predictive factors for reprocedure rates after VA. Although patients with more severe osteoporosis require longer treatment, adherence to therapy may help reduce the risk of additional interventions over time.