Efort Open Reviews最新文献

Background: Stress shielding of the proximal humerus represents an increasing challenge for the implantation of total shoulder arthroplasty (TSA). The literature on this topic is heterogeneous, and many studies analysing its clinical impact are underpowered, justifying a systematic review of current evidence.

Materials and methods: On 1 September 2024, the Cochrane Library, PubMed, and Web of Science were searched for studies on stress shielding in shoulder arthroplasty. All studies meeting inclusion criteria were included in the qualitative review. Clinical significance was assessed through a meta-analysis of studies comparing patients with and without stress shielding using Constant-Murley score (CS) and American Shoulder and Elbow Surgeons (ASES) score.

Results: Of 299 identified studies, 58 studies were included in the qualitative review and 13 studies were included in the meta-analysis. Key risk factors consistently associated with stress shielding were press-fit or long stems and high stem-to-humerus filling ratios (FRs), with threshold values of <0.7 or <0.8. Other potential risk factors include older age, poor bone quality, fracture arthroplasty, and stem length. The meta-analysis showed a statistically significant 5.6-point improvement in Constant scores for the non-stress shielding group at two years, although this fell below the minimal clinically important difference threshold and did not affect revision rates at mid-term follow-up.

Conclusion: Stress shielding is a frequent radiographic finding in TSA and RTSA. Although statistically significant, its clinical impact appears limited, and revision rates remain unaffected in the mid-term. Avoiding high FRs and careful implant selection may help reduce its occurrence and preserve bone stock.

Purposes: Femoral shortening osteotomy is a promising surgical intervention for patients with the sequelae of high hip dysplasia who need a THA. It offers potential benefits such as preserving limb length, reducing joint stiffness, and preventing neurovascular damage. However, it is considered a complex procedure with a high risk of complications. Various techniques are employed, and their relative safety remains unclear. What is the prevalence of complications (e.g. non-union and dislocations) and rates of revision associated with different techniques of femoral shortening osteotomy?

Methods: A systematic review was conducted according to the PRISMA guidelines. Multiple databases were searched for studies reporting complications of various femoral shortening osteotomies. Two independent reviewers selected studies, extracted data, and assessed bias. Proportional meta-analysis was employed to estimate non-union rates, while other complications and revisions were described using alluvial diagrams. The study has been registered in the PROSPERO database (CRD42023488761).

Results: In total, 53 studies (comprising 1,925 hips undergoing osteotomy) were included. The transverse subtrochanteric shortening osteotomy emerged as the most frequently utilized technique. There was an overlapping prevalence of non-union rates among the different osteotomy techniques, ranging from 0% (step-cut osteotomies) to 2% (transverse osteotomies). A higher non-union prevalence was observed with cemented stems in transverse osteotomies (4%, 95% CI: 0-9%). Dislocation rates were similar among techniques. The rate of stem aseptic loosening ranged from 7.14% (Z osteotomy) to 0% (step-cut and V-shaped osteotomies). Oblique osteotomy exhibited the highest infection rate (2.63%).

Conclusion: Overall, comparable rates of non-union were observed across osteotomy techniques. Heterogeneous results for other complications showed a low risk for all osteotomies.

Level of evidence: Level IV, therapeutic study.

Purpose: To conduct a meta-analysis of clinical studies evaluating the efficacy and safety of minimally invasive (MIS) posterior/posterolateral approaches and traditional posterolateral approaches in total hip arthroplasty (THA).

Methods: The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two independent reviewers conducted literature searches based on the PRISMA guidelines. PubMed, Embase, Web of Science, and the Cochrane Library were searched for studies comparing MIS and traditional posterolateral approaches in THA. Harris Hip Score (HHS), visual analog scale (VAS), operation time, incision length, intraoperative blood loss, and complications were analyzed.

Results: Twenty studies with 1,713 patients were included in our meta-analysis. The pooled results showed that MIS approaches resulted in significantly higher HHSs, lower VAS scores, reduced intraoperative blood loss, and shorter incision length compared to the traditional posterolateral approach. While no significant difference was found in operation time and complication between the two groups.

Conclusion: Based on current evidence, MIS approaches appear to offer superior efficacy compared to traditional posterolateral approaches in THA.

The need to collect objective outcome parameters digitally is increasing in both clinical practice and research. Step count is a frequently utilized digital mobility outcome (DMO) in orthopedic traumatology; however, its usefulness to monitor the patient recovery process remains unclear. The aim of this scoping review is to investigate the application and utility of daily patient step count as a DMO in musculoskeletal injuries. PubMed and consensus.app were queried. Eligibility criteria included the following: articles published within 20 years including patients with orthopedic trauma conditions and utilizing daily step count as an outcome. The type of study, case numbers, conditions investigated, use/usefulness of step count, duration of assessment, sensor use and location, and data harvesting specifics were assessed. Totally, 40 articles were analyzed, revealing an increasing trend in annual publications. The majority of studies were observational (93%), with a mean of 103 participants (range: 9-666). Proximal femur fractures (n = 7), anterior curciate ligament (ACL) injuries (n = 6), and joint replacement (n = 5) were the most frequently investigated conditions. Overall, 30% of studies used step count to demonstrate an association with patient-reported outcome measures, while 27% employed it to identify differences between study groups. Research-grade accelerometers/inertial measurement units (73%) were the most common sensors, with continuous measurement durations from 4 to 14 days. This review indicates an increasing use of step count as an objective DMO in the orthopedic trauma surgery literature. However, the implementation, application, setup, and data acquisition methodologies remain underexplored. This review highlights current trends and identifies key areas requiring further investigation in future research.

Purpose: There is a lack of consensus regarding the optimal intramedullary nailing (IMN) strategy for humeral shaft fractures (HSFs): both antegrade IMN (aIMN) and retrograde IMN (rIMN) are used. We aim to compare both strategies in terms of outcomes and complications.

Methods: MEDLINE, Embase and Cochrane Central Register of Controlled Trials databases were searched for articles in English or Spanish from inception to Nov 23, 2023. All studies reporting on primary treatment of acute HSFs (OTA/AO 12A, 12B, and 12C) with rigid locked IMN, in patients aged 16 years or older, were analyzed. Two independent reviewers screened studies for eligibility, performed data extraction, and used RoB 2, ROBINS-I and JBI's critical appraisal tools to assess bias of the included studies. Stata 18.0 software for data analysis was used. Subgroup analysis was performed to explore heterogeneity. We applied GRADE to appraise our evidence.

Results: Nine studies involving 565 fractures were included. aIMN showed significantly faster operative time than rIMN (MD = -14.40 min (95% CI: -17.75 to -11.04); I 2 = 0%; P < 0.001), and rIMN showed significantly higher odds of intraoperative fractures than aIMN (RD = 0.05% (95% CI: -0.08% to -0.02%); I 2 = 0%; P < 0.005). In contrast, aIMN showed significantly higher odds of worse shoulder function and pain complaints and worse Neer scores than rIMN (P = 0.02, P = 0.03 and P = 0.02, respectively).

Conclusions: Compared with rIMN, aIMN demonstrated a significantly faster operative time and lower rates of intraoperative fractures. Conversely, rIMN demonstrated lower rates of shoulder pain complaints and better shoulder function and Neer score outcomes.

Bone homeostasis, a dynamic equilibrium essential for skeletal development and repair, is coordinately regulated by osteoclasts, osteoblasts, and osteocytes. Hereditary metabolic bone diseases arise from genetic mutations that impair the function of these key bone cells, disrupting the homeostatic balance. This review specifically addresses four prevalent hereditary metabolic bone diseases: osteogenesis imperfecta, Paget's disease of bone, hypophosphatemic rickets, and osteopetrosis. Dysfunction in major signaling pathways - notably the Wnt/β-catenin, RANK/RANKL/OPG, and TGF-β/BMP pathways - plays a central role in the aberrant bone remodeling underlying these disorders. Elucidating the molecular mechanisms involving these cells and pathways is fundamental to understanding disease pathogenesis and is crucial for the development of novel therapeutic interventions, presenting significant promise for future research.

Purpose: The use of intravenous (IV) tranexamic acid (TXA) in arthroscopic shoulder surgery remains controversial. This meta-analysis aimed to evaluate the efficacy of IV TXA in improving perioperative outcomes during shoulder arthroscopy.

Methods: The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive systematic search was conducted in PubMed, Embase, Cochrane Library, and Web of Science from inception to February 2025. Randomized-controlled trials (RCTs) comparing IV TXA with group without TXA in patients undergoing arthroscopic shoulder surgery were included. Data were synthesized using random-effects models, with results presented as weighted mean differences (WMDs) and standardized mean differences (SMDs), with 95% confidence intervals (CIs).

Results: Eleven RCTs involving 904 patients were included. Overall, seven trials were rated as high quality, while four trials were rated as moderate quality. Pooled results showed no statistically differences between TXA and control groups in terms of visual clarity (SMD: 0.25, 95% CI: -0.21 to 0.70), visual analog scale score (WMD: -0.33, 95% CI: -0.76 to 0.10), operative time (WMD: -4.48 min, 95% CI: -10.25 to 1.28), irrigation volume (SMD: -0.14, 95% CI: -0.52 to 0.24), estimated blood loss (SMD: -0.62, 95% CI: -1.86 to 0.61), and mean arterial pressure (WMD: -0.10 mmHg, 95% CI: -3.05 to 2.86). No complications were reported in either group across six studies.

Conclusions: Current evidence does not support a significant clinical benefit of IV TXA in arthroscopic shoulder surgery. Further high-quality RCTs are needed to clarify its role under standardized protocols.

Staphylococcus aureus is the most common pathogen in periprosthetic joint infections (PJIs), capable of biofilm formation and resistance mechanisms, complicating diagnosis and treatment. PJIs remain a leading cause of total joint arthroplasty failure and are associated with significant morbidity, mortality, and healthcare and economic burdens. Biofilm formation by S. aureus on prosthetic materials is central to PJI persistence and antibiotic resistance. Novel treatment strategies, including copper-coated implants, show promise as adjunct therapies but require further clinical validation.

Purpose: Diagnosing ligament injuries remains a challenge for musculoskeletal clinicians due to the lack of standardized classification, evaluation, and management protocols. Machine learning (ML) and deep learning (DL) models offer potential to improve diagnostic accuracy. This study aimed to evaluate the diagnostic performance of various ML and DL models in identifying ligament injuries across different medical imaging modalities.

Methods: A meta-analysis was conducted following the PRISMA 2020 checklist. Searches were performed in PubMed, SCOPUS, Web of Science, and the Cochrane Library. Study quality was assessed using the QUADAS-2 tool and Robvis software. Diagnostic performance measures - true positive, true negative, false positive, and false negative - were analyzed. A random-effects model was applied, and heterogeneity and subgroup analyses were conducted. Statistical and graphical analyses were performed using R. The study was registered in PROSPERO (CRD42025646317).

Results: Fifty-nine ML and DL algorithms from 23 studies were analyzed. Pooled sensitivity and specificity were 0.890 (95% CI: 0.829-0.938) and 0.926 (95% CI: 0.820-0.959), respectively. Pooled estimates for PLR, NLR, lnDOR, and AUC were 1,644.37 (95% CI: 73.56-3,215.18), 0.179 (95% CI: 0.095-0.263), 4.130 (95% CI: 3.570-4.700), and 95%, respectively, with P < 0.001.

Conclusion: ML and DL models demonstrate high diagnostic accuracy in detecting ligament injuries. Their strong performance supports ongoing integration into clinical practice, offering valuable support for musculoskeletal specialists in image interpretation and diagnosis.