World Journal of Orthopedics最新文献

Background: We aimed to translate and culturally adapt the LIMB-Q Kids questionnaire for use in the Netherlands. The LIMB-Q Kids is a patient-reported outcome measure designed to assess functional, psychosocial, and aesthetic aspects of living with a limb difference in paediatric populations.

Aim: To investigate the feasibility of a questionnaire in the Netherlands, which was translated into Dutch after having already been successfully translated and validated in several other languages.

Methods: The translation and adaptation process followed best practice guidelines, including forward and backward translation, expert panel review, and cognitive debriefing interviews with patients. The interviews focused on the clarity and comprehensibility of the instructions, response options, and questionnaire items.

Results: The rigorous process resulted in a linguistically and conceptually equivalent Dutch version of the LIMB-Q Kids questionnaire. While some challenges were encountered, no major difficulties were reported. The constructs and cultural relevance were found to be relatable to the Dutch context. Minor adjustments were made based on patient feedback, such as clarifying questions and modifying translations for technical terms.

Conclusion: We demonstrated the successful translation and cultural adaptation of the LIMB-Q Kids questionnaire for use in the Netherlands. By following best practices, the researchers have developed a version that is conceptually and linguistically equivalent to the original English version. The availability of this Dutch version will facilitate the assessment of outcomes in paediatric populations with limb differences, and potentially enable cross-cultural comparisons.

Background: Spondyloarthritis (SpA), a prevalent chronic inflammatory disorder, predominantly impacts the axial skeleton, including the spine and sacroiliac joints. Emerging evidence implicates gut dysbiosis in the pathogenesis of SpA.

Aim: To evaluate the association between gut microbiome alterations and SpA through metagenomic sequencing analyses.

Methods: A systematic review was conducted by querying English-language databases, including PubMed, EMBASE, and Google Scholar, spanning 2000 to 2023. From an initial pool of 150 studies, four articles meeting stringent inclusion and exclusion criteria were selected for analysis.

Results: The reviewed studies identified an enrichment of opportunistic pathogenic bacterial species, such as Clostridium spp., Prevotella spp., and Bacteroides spp., alongside viral families including Gratiaviridae and Quimbyviridae, in individuals with ankylosing spondylitis compared to healthy controls. Dysregulated metabolic pathways were highlighted as potential mediators of chronic inflammation and arthritic manifestations. Notably, treatment with tumor necrosis factor inhibitors demonstrated efficacy in mitigating SpA symptoms and restoring gut microbial balance.

Conclusion: The findings underscore a significant presence of pathogenic gut microbiota in SpA patients, suggesting a pivotal role in disease progression. Future investigations should focus on species-specific microbial targets to develop innovative therapies for preventing and managing SpA and associated gut dysbiosis.

Background: Chronic recurrent multifocal osteomyelitis (CRMO) is a rare autoinflammatory bone disorder primarily affecting children and adolescents. Spinal involvement in CRMO is common and can lead to significant clinical features and complications, including severe chronic back pain and spinal deformities with possible spinal cord compression.

Aim: To summarize the information about vertebral involvement in CRMO patients, including the clinical features, diagnostic approaches, and treatment outcomes.

Methods: Sixty-three manuscripts (2005-2025) were found in PubMed, including case reports, retrospective cohort studies, randomized controlled trials, and imaging studies. The focus was on spinal involvement features, diagnostic imaging, treatment strategies, and long-term outcomes in pediatric CRMO patients.

Results: Spinal involvement in CRMO ranges from 28% to 81% among patients with CRMO. Patients typically present with localized back pain, back stiffness, and, in more severe cases, spinal deformities such as kyphosis or scoliosis. Multifocal lesions are frequently observed, with the thoracic spine being the most commonly affected area. Whole-body magnetic resonance imaging (WBMRI) has emerged as the gold standard for effectively revealing multifocal bone lesions and spinal involvement. However, a bone biopsy is often needed to rule out infection or malignancy. Bisphosphonate treatment showed a high response rate (90.9%), while tumor necrosis factor-alpha (TNF-α) inhibitors were less effective (66.7%). Long-term follow-up is crucial, as relapses and progression of spinal deformities can occur even with treatment.

Conclusion: Spinal involvement in CRMO often leads to chronic pain, vertebral deformities, and rare spinal deformities. Early diagnosis using WBMRI, combined with treatment with bisphosphonates and TNF-α inhibitors, could improve outcomes.

Background: Developmental dysplasia of the hip (DDH) remains a significant public health challenge, particularly in developing countries where cultural factors and limited access to appropriate medical equipment complicate optimal management.

Aim: To evaluate the difficulties encountered in the management of DDH in our healthcare setting.

Methods: A retrospective, single-center study was conducted over nine years (2015-2023), including 20 patients (26 hips) with idiopathic DDH. Patients with post-traumatic or post-infectious hip dislocations were excluded. Data collected included age at diagnosis, laterality, Tönnis classification, duration of traction, and surgical interventions.

Results: The mean age at diagnosis was 35.6 months (4 months to 10.8 years). Dislocation was unilateral in 70% of cases; 69.2% were classified as Tönnis stage 3 or 4. The average traction duration was 57.5 days. Surgery was performed in 8 hips. Among 16 patients with regular follow-up, 10 showed good outcomes, 3 excellent, and 3 fair according to the McKay score. Older age at treatment (> 1 year), bilateral dislocation, and higher severity (Tönnis stages 3 and 4) were associated with worse functional outcomes. No significant correlation was found between functional and radiological results. Residual dysplasia occurred in 3 patients, and 1 re-dislocation was noted.

Conclusion: Delayed diagnosis and advanced severity at presentation are key challenges in managing DDH in our context. Nevertheless, appropriate management can achieve generally favorable outcomes, despite complications linked to prolonged treatment and resource limitations.

Background: Ankle normative values are limited compared to isokinetic knee assessments. Chronic ankle instability correlates with agonist-antagonist imbalances, decreased evertor/invertor ratio, and plantar flexion deficits. Strengthening programs targeting evertor/invertor and dorsiflexor/plantar flexor balance help reduce injury recurrence. Bilateral neuromuscular deficits compromise the contralateral side, rendering healthy limbs unsuitable as recovery references. Defining normative healthy ankle parameters is crucial for establishing precise limits in non-surgical treatments and sports return criteria. While the limb symmetry index (LSI) is used for knees with a cutoff of > 90%, no such standardization exists for the ankle.

Aim: To comprehensively evaluate isokinetic ankle strength profiles in non-athletic individuals.

Methods: This is a cross-sectional study. Two hundred ankles were evaluated using the Biodex 3 System to assess eversion, inversion, dorsiflexion, and plantar flexion. Healthy individuals with an active lifestyle and no previous injuries were evaluated. The Maximum Torque, Agonist/Antagonist Ratio, LSI, and Muscular Deficiency Index (MDI) and the correlation with demographic variables were evaluated.

Results: The mean age (mean ± SD) was 38.5 ± 13.5 years, and the body mass index (BMI) was 25.8 ± 4.2 in 69 men and 31 women. The mean maximum torque values by gender were (mean ± SD): 22.3 ± 6.6 female (F) and 33.4 ± 9.9 male (M) N/m for eversion; 30.10 ± 10.0 (F) and 37.0 ± 11.6 N/m (M) for inversion, 37.4 ± 10.0 (F) and 53.6 ± 13.0 N/m (M) for dorsiflexion, and 100.4 ± 37.2 (F) and 158.1 ± 33.4 (M) N/m for flexion. There was no correlation between age or BMI and maximum torque. The evertors/invertors ratio was 88.8%, and the dorsiflexors/plantar flexors ratio was 36.1%. The MDI and LSI were balanced between sides for every movement, having an average global difference of less than 10%.

Conclusion: These findings provide gender-specific normative isokinetic values for the ankle in healthy, physically active adults. These reference parameters-especially LSI and MDI above 90%-can support clinical decision-making in rehabilitation planning and return-to-sport assessment, offering objective benchmarks for functional recovery.

The VISA-P originally developed to assess patellar tendinopathy severity, is increasingly being applied to patellofemoral pain (PFP) assessment. This editorial examines the expanding role of VISA-P within the context of existing patient-reported outcome measures (PROMs) for PFP, such as the Kujala Anterior Knee Pain Scale and the Knee injury and Osteoarthritis Outcome Score for Patellofemoral Pain and Osteoarthritis. While VISA-P offers advantages in brevity, readability, and temporal stability, its original design targeting athletic populations with patellar tendinopathy limits its specificity and comparability when applied broadly to heterogeneous PFP populations. Moreover, VISA-P currently lacks validated diagnostic thresholds to guide clinical decision-making. Although the recent validation of VISA-P in Spanish-speaking populations enhances accessibility, caution is advised in its widespread adoption without clear delineation of its role relative to other PROMs. The editorial argues for careful contextual use of VISA-P, emphasizing the need for tools that balance specificity, efficiency, and universality to capture the complex spectrum of PFP across diverse populations.

Background: Although opioids and non-steroidal anti-inflammatory drugs are commonly used as preemptive analgesics in total knee arthroplasty (TKA), their side effects are a major concern. Tapentadol, a synthetic opioid analgesic, is noted for its higher potency, lower abuse potential, and better gastrointestinal tolerability compared to traditional opioids. However, its efficacy and safety as preemptive analgesia in TKA have not been evaluated.

Aim: To hypothesize that preemptive use of tapentadol significantly reduces postoperative pain and rescue analgesic consumption in TKA patients. Clinically, this may reduce opioid burden and improve recovery protocols.

Methods: Ninety patients undergoing unilateral TKA were randomized to receive either tapentadol (single dose of 100 mg sustained-release, n = 45) or a matched placebo 1 hour before surgery. Postoperative pain was assessed using the visual analog scale (VAS), and total pain reduction scores were recorded. Total rescue analgesic consumption and side effects were monitored for 24 hours. Blood samples were collected 6 hours postoperatively to measure plasma levels of cholecystokinin (CCK) (a potential biomarker of pain) and tapentadol using enzyme-linked immunosorbent assay and high-performance liquid chromatography, respectively.

Results: The baseline characteristics of both groups were comparable. The 24-hour VAS scores, the primary outcome, were significantly lower in the tapentadol group median [interquartile range (IQR)] [1.0 (1.0-3.0)] compared to the placebo group [3.5 (2.0-5.0)]. Significant differences in VAS scores were observed at 4 hours, 6 hours, and 12 hours postoperatively (P < 0.05). Requests for rescue analgesia were significantly delayed in the tapentadol group (P = 0.01), and the total dose of analgesics used was significantly lower [median (IQR): 3 (2-4)] compared to the placebo group [4.5 (3-5), P = 0.001]. No major adverse events were observed in either group. Plasma tapentadol concentrations correlated well with pain intensity, whereas no correlation was found between CCK levels and pain intensity.

Conclusion: A preemptive single dose of 100 mg oral tapentadol is safe, effective, and significantly reduces postoperative pain and rescue analgesic requirements in TKA patients. This approach may reduce opioid dependence and support enhanced recovery protocols.

Background: In 2017, our institution implemented a high efficiency (HE) pathway for lower limb orthopedic surgery. The employed strategy included patient selection, surgical instrument standardization, preoperative surgical nerve blocks, avoidance of general anesthesia and bypassing phase one recovery. We conducted a historic cohort study whose primary outcome was the postoperative recovery time between the HE and traditional (T) pathway.

Aim: To determine whether the implementation of a HE pathway was correlated with a reduction in postoperative recovery time.

Methods: Patients who had unilateral elective lower limb orthopedic procedures through the T and HE pathway were screened between 2017 to 2019. Patients were at least 18 years old, and American Society of Anesthesiologists (ASA) Physical Status I to III without major systemic comorbidities were included. Propensity score was generated using multivariable regression taking age, body mass index, sex, ASA class and surgical type as covariates using nearest neighbour methods between the two pathways. Mann Whitney U test were used to analyzed total postoperative time.

Results: There was an associated reduction in total postoperative recovery time of 63 minutes (95%CI: -69 to -57) in the HE group. The operating room time and total length of stay also had an associated decrease of 20 minutes (95%CI: -23 to -17) and 84 minutes (95%CI: -92 to -75) respectively.

Conclusion: Utilizing multifaceted strategies to improve perioperative efficiency was associated with a reduction in the postoperative recovery time in our retrospective study. This model can be a potential strategy to deal with surgical backlog in the face of ongoing human resource challenges.

Phantom limb pain (PLP), a common sequela of amputation, affects up to 86% of amputees and significantly impairs quality of life. PLP is thought to stem from complex central and peripheral nervous system plasticity. Current treatments, including pharmacological and non-pharmacological approaches, have limited efficacy. Recently, extended reality technologies have emerged as promising tools for PLP management, leveraging immersive sensory input to modulate cortical reorganization. Of note, emerging neural modulation techniques also offer promising alternatives, including peripheral nerve stimulation, repetitive transcranial magnetic stimulation and transcranial direct current stimulation. These approaches demonstrate clinical efficacy in relieving pain, improving functional outcomes and reducing opioid usage. Future research could prioritize large-scale trials to validate the efficacy of nerve stimulation techniques and explore their integration with extended reality technologies for PLP.

Background: Total hip arthroplasty is a safe and effective procedure. To improve survivorship, ultrahigh molecular weight polyethylene hip liners with antioxidants have been developed. Additive antioxidant was deployed to reduce oxidation and consequential wear, loosening, or osteolysis. A unique manufacturing process was utilized for two such hip liners, the Novation^® and Alteon^® XLE hip liners and this research represents the first large series on this specific material. The study hypothesis was that Novation and Alteon XLE hip liners have similar short-term survivorship as other manufacturers' antioxidant liners according to procedure and outcome data from the American Joint Replacement Registry (AJRR).

Aim: To demonstrate similar short-term survivorship of XLE antioxidant hip liners compared to all antioxidant hip liners in AJRR.

Methods: Utilizing total hip arthroplasty data from the AJRR, a retrospective review was performed for subjects who underwent implantation of Novation XLE (n = 461), Alteon XLE (n = 989), or any other antioxidant hip liner (termed the aggregate antioxidant group; n = 39964) as of March 31, 2022. Survivorship at three years and revision rates were compared statistically between the Novation group and the aggregate antioxidant group as well as the Alteon group and the aggregate antioxidant group.

Results: Survivorship at three years post-surgery was 99.09% for Novation, 97.73% for Alteon, and 97.69% for the aggregate antioxidant group. There were no reports of failure due to wear in either the Novation or Alteon groups. Among the revision categories (fracture, infection, aseptic loosening, instability, mechanical complications, wear, pain, hematoma/wound complications, or other), there were no significant differences identified in either comparison. There were also no significant differences in cumulative percent revision rates up to three years post-surgery for the Novation vs aggregate antioxidant group or the Alteon vs aggregate antioxidant group.

Conclusion: Novation and Alteon XLE hip liner revision rate and survivorship are equivalent to other antioxidant hip liners in the short term.