World Journal of Orthopedics最新文献

Background: In an era leaning toward a personalized alignment of total knee arthroplasty, coronal plane alignment of the knee (CPAK) phenotypes for each population are studied; furthermore, other possible variables affecting the alignment, such as ankle joint alignment, should be considered.

Aim: To determine CPAK distribution in the North African (Egyptian) population with knee osteoarthritis and to assess ankle joint line orientation (AJLO) adaptations across different CPAK types.

Methods: A cross-sectional study was conducted on patients with primary knee osteoarthritis and normal ankle joints. Radiographic parameters included the mechanical lateral distal femoral angle, medial proximal tibial angle, and the derived calculations of joint line obliquity (JLO) and arithmetic hip-knee-ankle angle (aHKA). The tibial plafond horizontal angle (TPHA) was used for AJLO assessment, where 0° is neutral (type N), < 0° is varus (type A), and > 0° is valgus (type B). The nine CPAK types were further divided into 27 subtypes after incorporating the three AJLO types.

Results: A total of 527 patients (1054 knees) were included for CPAK classification, and 435 patients (870 knees and ankles) for AJLO assessment. The mean age was 57.2 ± 7.8 years, with 79.5% females. Most knees (76.4%) demonstrated varus alignment (mean aHKA was -5.51° ± 4.84°) and apex distal JLO (55.3%) (mean JLO was 176.43° ± 4.53°). CPAK types I (44.3%), IV (28.6%), and II (10%) were the most common. Regarding AJLO, 70.2% of ankles exhibited varus orientation (mean TPHA was -5.21° ± 6.45°). The most frequent combined subtypes were CPAK type I-A (33.7%), IV-A (21.5%), and I-N (6.9%). A significant positive correlation was found between the TPHA and aHKA (r = 0.40, P < 0.001).

Conclusion: In this North African cohort, varus knee alignment with apex distal JLO and varus AJLO predominated. CPAK types I, IV, and II were the most common types, while subtypes I-A, IV-A, and I-N were commonly occurring after incorporating AJLO types; furthermore, the AJLO was significantly correlated to aHKA.

Complex trimalleolar ankle fractures are a major orthopaedic challenge, with an incidence of 4.22 per 10000 person-years in the United States and an annual cost of 3.4 billion dollars. This review synthesizes current evidence on diagnostic protocols and management strategies, highlighting optimal approaches and emerging trends. Initial care emphasizes soft tissue assessment, often guided by the Tscherne classification, and fracture classification systems. External fixation may be required in open injuries, while early open reduction and internal fixation within six days is linked to improved outcomes. Minimally invasive techniques for the lateral malleolus, including intramedullary nailing and locking plates, are effective, while medial malleolus fractures are commonly managed with screw fixation or tension-band wiring. Posterior malleolus fragments involving more than 25% of the articular surface usually warrant fixation. Alternatives to syndesmotic screws, such as cortical buttons or high-strength sutures, reduce the need for secondary procedures. Arthroscopic-assisted open reduction and internal fixation benefits younger, active patients by enabling concurrent management of intra-articular and ligamentous injuries. Postoperative care prioritizes early weight-bearing and validated functional scores. Despite advances, complications remain common, and further research is needed to refine surgical strategies and improve outcomes.

Background: Tuberculous osteitis is a chronic, granulomatous bone infection that frequently results in impaired bone healing following surgery. Despite surgical intervention and prolonged anti-tuberculous therapy, complete bone regeneration often remains unachieved, contributing to subsequent orthopedic complications.

Aim: To investigate the efficacy and safety of pamidronate in promoting bone regeneration following surgical treatment of experimental animal tuberculous osteitis.

Methods: A controlled randomized basic study of rabbit femoral tuberculosis induced by Mycobacterium tuberculosis strain H37Rv included surgical removal of infected tissue and implantation of osteoinductive bone grafts with the following animal allocation to one of three groups: (1) Bisphosphonates alone; (2) Bisphosphonates combined with anti-tuberculous therapy; and (3) Anti-tuberculous therapy alone. The control group consisted of animals that received no surgical or medical treatment. Clinical evaluations, biochemical markers, micro-computed tomography imaging, and histomorphometry analyses were conducted at 3 months and 6 months postoperatively.

Results: Pamidronate treatment significantly reduced early implant resorption, increased osteoblastic activity, improved trabecular bone regeneration, and maintained graft integrity compared to the anti-tuberculous therapy-only group. Histologically, pamidronate led to enhanced vascular remodeling and increased bone matrix formation. Crucially, bisphosphonate therapy demonstrated safety, compatibility with anti-tuberculous medications, and did not exacerbate tuberculous inflammation. Furthermore, micro-computed tomography analysis revealed a significant increase in trabecular thickness and density in pamidronate-treated groups, underscoring the anabolic effects of bisphosphonates. Morphometric evaluation confirmed a marked reduction in osteoclast number and activity at graft interfaces. These combined radiological, histological, and biochemical data collectively demonstrate the efficacy of pamidronate as an adjunctive agent in enhancing bone repair outcomes following surgical intervention for tuberculous osteitis.

Conclusion: A single intravenous dose of pamidronate significantly enhances bone regeneration and prevents implant resorption following surgical treatment of tuberculous osteitis. The following prospective studies are needed.

Leg-length discrepancy (LLD) in individuals experiencing total hip arthroplasty (THA) is related to a substantially higher fall risk, length of post-operative hospital in-patient stay, elevated implant-related adverse events, and earlier revision. Therefore, it is essential to try to avoid LLD when implanting a THA. Several studies focus on this issue, including the following: Accelerometer-based portable navigation system, preoperative digital templating, robot-assisted surgery, the anatomical marker positioning method (shoulder-to-shoulder) and the artificial intelligence-based three-dimensional planning software system. The aforementioned methods should be familiar to surgeons who perform THA procedures, as a fundamental objective of this surgical intervention is to avoid LLD.

Background: Ankle fractures are well-documented in snow sports, but concomitant Achilles tendon and peroneal tendon ruptures are rare. This case report presents a previously unreported combination of Achilles tendon rupture, peroneal tendon rupture, and fibular fracture in a snowboarder, highlighting the complex nature of diagnosis, management, and rehabilitation.

Case summary: A 50-year-old male snowboarder presented with severe right ankle pain following a high speed tumbling crash. Initial evaluation revealed an Achilles tendon rupture and a non-displaced distal lateral malleolus fracture. Subsequent magnetic resonance imaging confirmed complete tears of the Achilles tendon and both peroneus longus and brevis tendons, along with a Weber A lateral malleolus fracture. Surgical intervention included a 4-suture core Kraków repair of the Achilles tendon with calcaneal docking, open reduction and internal fixation of the distal fibula fracture, and primary repair of both peroneal tendons. Post-operatively, a modified Achilles repair protocol was implemented. At 16 weeks post-surgery, radiographs showed a well-healed fibular fracture, and physical examination confirmed intact Achilles and peroneal tendon repairs. By 6 months, the patient had regained full daily and work activities, including recreational pursuits.

Conclusion: This case underscores the importance of maintaining a high index of suspicion for concomitant injuries in high-energy ankle trauma during snow sports. Timely advanced imaging and a comprehensive surgical approach are crucial for optimal outcomes in such complex cases.

Background: Salvage of the infected long stem revision total knee arthroplasty is challenging due to the presence of well-fixed ingrown or cemented stems. Reconstructive options are limited. Above knee amputation (AKA) is often recommended. We present a surgical technique that was successfully used on four such patients to convert them to a knee fusion (KF) using a cephalomedullary nail.

Case summary: Four patients with infected long stem revision knee replacements that refused AKA had a single stage removal of their infected revision total knee followed by a KF. They were all treated with a statically locked antegrade cephalomedullary fusion nail, augmented with antibiotic impregnated bone cement. All patients had successful limb salvage and were ambulatory with assistive devices at the time of last follow-up. All were infection free at an average follow-up of 25.5 months (range 16-31).

Conclusion: Single stage cephalomedullary nailing can result in a successful KF in patients with infected long stem revision total knees.

Background: Recovering from anterior cruciate ligament (ACL) reconstruction can be challenging. While standard rehabilitation helps restore knee function, many patients still face a slow or incomplete recovery. Extracorporeal shockwave therapy (ESWT) has recently gained attention as a potential way to speed up healing and improve outcomes when added to traditional rehab.

Aim: To explore whether combining ESWT with standard postoperative rehabilitation truly leads to better recovery compared with rehab alone.

Methods: A systematic review and meta-analysis were conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, evaluating participant status following ACL reconstruction with standard rehabilitation and without augmented ESWT. This meta-analysis included six studies (five randomized controlled trials, one non-randomized clinical study). The outcome measures were the Lysholm score, International Knee Documentation Committee score, visual analog score, and KT-1000 measurements. To compare the control and intervention groups, the weighted mean differences were calculated along with the 95% confidence intervals. The heterogeneity of the studies and publication bias were analyzed.

Results: ESWT modestly improved Lysholm scores (weighted mean difference: 3.72; 95% confidence interval: -0.27 to 7.71) with high heterogeneity (I ²: 96%, P < 0.001) when compared with standard rehabilitation. Focused ESWT showed greater benefits compared with radial ESWT. No significant differences were found in the International Knee Documentation Committee scores, visual analog score, or KT-1000 measurements. Substantial variability and publication bias were noted.

Conclusion: ESWT improved Lysholm scores but did not show other significant benefits. Due to the limited evidence, further standardized, placebo-controlled trials are needed to confirm its effectiveness in ACL reconstruction.

Due to the increasing ageing population, femoral neck fracture (FNF) is a common and significant public health issue in the elderly, as it significantly impacts patients' quality of life, frequently leading to severe disability. Undoubtedly, hip replacement is the standard current of care for displaced FNF in this population, as it can provide pain relief and allow immediate return to mobility. However, hip arthroplasty may present severe specific complications, such as implant dislocation and infection, which may increase mortality and morbidity, especially in more frail patients. Therefore, in this particular population, alternative treatments should be considered. Girdlestone resection arthroplasty, which includes excision of the femoral head, is a salvage procedure which was first described for the management of chronic tuberculous coxitis, and then widely used in uncontrolled infected hip replacements. This article provides an updated outcome analysis of hip resection arthroplasty as a primary definitive treatment for FNF in frail non-ambulatory patients.

Pedicle screw fixation remains the gold standard for stabilizing unstable thoracolumbar fractures. However, ensuring long-term instrumentation stability continues to challenge both surgeons and implant designers. The study by Bokov et al contributes significantly to this discussion, identifying predictors of pedicle screw loosening such as low bone radiodensity, longer fixation constructs, and extensive decompression. Adjunctive strategies - auxiliary posterior fusion, anterior column reconstruction, and intermediate screw usage - support an individualized, biomechanically sound surgical plan. In this article, we explore the clinical relevance of these findings within spinal trauma care. We emphasize the role of preoperative bone quality assessment, including computed tomography-based Hounsfield unit analysis and magnetic resonance imaging-derived vertebral bone quality score, as modifiable predictors of long-term outcomes. We also discuss innovations in screw design, surface coatings, and patient-specific planning to reduce failure risk. Furthermore, emerging technologies such as finite element modeling and 3D-printed instrumentation may refine patient-specific strategies. By integrating biomechanical principles with personalized surgical planning, future approaches may enhance fixation durability. Ultimately, aligning mechanical stability with biological sustainability is critical to reducing implant failure in complex thoracolumbar trauma cases.

Background: In this aging population, lumbar spinal stenosis (LSS) reduces walking distance and impairs functionality. The definitive treatment is still controversial.

Aim: To assess the efficacy of physical therapy and surgery in improving function and reducing pain levels in patients with LSS, both in the short and long term.

Methods: This prospective study screened patients aged 50-80 years with LSS and divided them into two groups based on certain criteria: Surgical and conservative. The conservative group received a supervised physical therapy and exercise program for 45 minutes, five days a week, for one month. The surgery group underwent micro endoscopic decompression surgery based on their LSS levels. Assessments, conducted before treatment and at one-month and one-year intervals, included the participants' walking distance, pain level using the visual analog scale, functionality using the Istanbul low back pain disability index (ILBDI) and Swiss Spinal Stenosis Questionnaire (SSS) Scale, and activities of daily living level using the Nottingham Extended Activities of Daily Living.

Results: The study comprised 40 participants, equally divided into surgical and conservative treatment groups, with no significant demographic differences. After one year, both groups exhibited similar changes in walking distance and pain levels. However, the conservative group demonstrated significantly greater improvements in sub-parameters of functional activity and symptom severity of the SSS. After one year, the surgical group showed greater functionality, as assessed by ILBDI, and superior improvement in activities of daily living compared to the conservative group.

Conclusion: Both treatments showed comparable efficacy in core outcomes (pain, walking distance). However, complementary advantages were observed: Conservative management demonstrated superior improvement in SSS functional subscales, while surgery yielded greater gains in daily living activities and low-back-pain-related disability.