Journal of Orthopaedic Surgery最新文献

Background: The effectiveness of arthroscopic treatment for knee osteoarthritis (OA) has been controversial. This study compares the clinical outcomes of the arthroscopic cartilage regeneration facilitating procedure (ACRFP) and conservative treatment.

Methods: During the year of 2016, 524 patients (882 knees) who were older than 40 years of age and diagnosed with different stages of knee OA were scheduled for ACRFP under the protocol of knee health promotion option (KHPO) for knee OA. Of those, 259 patients (413 knees) eventually received ACRFP (the ACRFP group), and 265 patients (469 knees) didn't receive ACRFP but received conservative treatment (the non-ACRFP group). A telephone questionnaire was used to evaluate the subjective satisfaction and the incidence of receiving arthroplasty for these patients.

Results: After the mean follow-up period of 61.6 months (SD 4.5), there were 220 patients (374 knees, 90.6%) in the ACRFP group and 246 patients (431 knees, 90.0%) in the non-ACRFP group completed the outcome study. The satisfactory rate was statistically higher for the ACRFP group (90.64%) than for the non-ACRFP group (70.3%) and the difference in subjective satisfaction was more obvious in patients with more advanced knee OA. As for the incidence of patients having subsequently received arthroplasty, it was higher (13.46%) in the non-ACRFP group than in the ACRFP group (4.28%).

Conclusion: Compared with conservative treatment, ACRFP could satisfy more patients with knee OA and modify their natural course by decreasing the incidence of subsequent arthroplasty.

Lateral ankle instability is one of the most common problems seen in the orthopaedic setting. Proper diagnosis is essential in order to provide the ideal treatment for these patients. All patients are subjected to nonoperative management in the form of functional rehabilitation. For those, however, who did not respond well to therapy, surgical treatment is then recommended. There are several surgical techniques available which have been meticulously studied and discussed in previous articles. The focus of this paper is on the author's perspective on choosing the surgical technique based on the quality of the anterior talofibular ligament and calcaneofibular ligament remnants. All patients are subjected to a diagnostic arthroscopy, where the remnant is assessed. The procedure then of doing an all-arthroscopic, open Modified Brostrom or anatomic reconstruction is then chosen based on this initial assessment.

Background: Dexamethasone is a corticosteroid with powerful anti-inflammatory effects. This study aimed to explore whether combining intravenous and topical dexamethasone could improve postoperative pain, swelling, and function recovery after total knee arthroplasty (TKA).

Methods: In this prospective, double-blind, randomized controlled study, 90 patients undergoing primary unilateral TKA were randomized into a dexamethasone group, which received dexamethasone (10 mg) by periarticular infiltration during surgery, as well as intravenous dexamethasone (10 mg) before tourniquet release and at 12 h postoperatively; or a control group, which received equal volumes of isotonic saline instead of dexamethasone. The primary outcome was postoperative pain, as assessed on the visual analogue scale (VAS). Secondary outcomes were postoperative consumption of morphine hydrochloride for rescue analgesia, postoperative swelling ratio of the thigh, knee, and tibia; functional recovery in terms of total range of motion (ROM) of knee and daily ambulation distance; postoperative inflammation biomarkers levels of C-reactive protein and interleukin-6; and postoperative complications.

Results: Resting VAS scores at postoperative 6, 12, and 24 h, and VAS scores during motion at postoperative 2, 6, 12, and 24 h were significantly lower in the dexamethasone group. The dexamethasone group also showed significantly less morphine consumption during the first 24 h after surgery and cumulatively during hospitalization, milder limb swelling at 24 and 48 h postoperatively, greater flexion and total ROM on postoperative day 1, and longer ambulation distance on postoperative days 1 and 2, and lower levels of inflammatory biomarkers on postoperative days 1 and 2. The dexamethasone group had significantly lower incidence of postoperative nausea and vomiting.

Conclusion: Compared with placebo, the combination of intravenous and topical dexamethasone can reduce pain, swelling, and inflammation after TKA, it also can improve functional recovery and reduce the incidence of postoperative nausea and vomiting.

Purpose: Knee osteoarthritis (OA) may be comorbid with diabetes mellitus (DM), and physical activity is a recommended lifestyle strategy for both diseases. The present study investigated the physical activity differences by intensity between knee OA patients with or without DM, and evaluated if physical activity was associated with the presence of DM in knee OA patients.

Methods: A total of 183 patients (mean age 74.9 ± 6.4 years) with moderate-to-severe knee OA underwent evaluation of knee function (i.e., knee flexion/extension range-of-motion, knee-extension muscle strength, and knee pain), the timed up-and-go (TUG) test, and physical activity measurement using an accelerometer. Physical activity by intensity was compared between knee OA patients with and without DM. The association between physical activity, including knee function and the TUG test time, and DM was assessed.

Results: The 2 groups (with or without DM) did not differ significantly in knee OA severity or age. Compared to knee OA patients without DM, knee OA patients with DM had a significantly lower average daily step count (p < 0.001), and significantly shorter times spent performing light-intensity physical activity (LPA; p < 0.001) and moderate-to-vigorous-intensity physical activity (MVPA; p = 0.006). After adjusting for age, sex, and body mass index, we found that a lower average daily step count and shorter LPA time significantly correlated with DM (β = -0.200, p = 0.006; β = -0.216, p = 0.004, respectively) and a longer TUG test time (β = -0.196, p = 0.014; β = -0.208, p = 0.011, respectively). A shorter MVPA time significantly correlated with lower contralateral knee-extension muscle strength (β = 0.187, p = 0.032).

Conclusion: Knee OA patients with DM had significantly lower physical activity levels than those without DM. Furthermore, the presence of DM correlated with a lower step count and a shorter LPA time in knee OA patients.

Background: The medial plantar artery perforator (MPAP) flap is widely used to reconstruct the weight-bearing area of the foot. Traditionally, its donor site is closed using a skin graft, which is associated with several complications, including walking disability. This study aimed to examine our experience with using a super-thin anterolateral thigh (ALT) flap to reconstruct the MPAP flap donor site.

Methods: We examined 10 patients who underwent reconstruction of the MPAP flap donor site using a super-thin ALT flap between August 2019 and March 2021. The vascular pedicle was anastomosed to the proximal end of the medial plantar vessels or the end of the posterior tibial vessels.

Results: All reconstruction flaps survived and all patients were satisfied with the aesthetic appearance. No blisters, ulcerations, hyperpigmentation, or contractures occurred. All patients gained protective sensation in the super-thin ALT flap. The average visual analog scale score for the aesthetic appearance of the reconstructed foot was 8.5 ± 0.7 (range, 8-10). All patients were able to ambulate without aids and could wear regular shoes. The average revised Foot Function Index score was 26.4 ± 4.1 (range, 22-34).

Conclusion: Reconstruction of the MPAP flap donor site using a super-thin ALT flap is reliable and provides satisfactory functional recovery, aesthetic appearance, and protective sensation while minimizing postoperative morbidity.

Purpose: This study aimed to conduct a large-scale population-based study to understand the epidemiological characteristics of Primary Malignant Bone Tumors (PMBTs) and determine the prognostic factors by concurrently using the classical statistical method and data mining methods.

Methods: Patients included in this study were extracted from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) database: "Incidence-SEER Research Data, 18 Registries, Nov 2020 Sub". Patients with unclassified and incomplete information were excluded. This search algorithm resulted in a dataset comprising 6234 cases. Survival analyses were performed with Kaplan-Meier curves and the Log-rank test. Multivariate Cox regression analysis determined the independent prognostic factors of PMBT. A decision tree-based data mining technique was used in this study to confirm the prognostic factors.

Results: 5-years survival rate was 63.6% and 10-years survival rate was 55.3% in the patients with PMBT. Sex, age, median household income, histology, primary site, grade, stage, metastasis, and the total number of malignant tumors were determined as independent risk factors associated with overall survival (OS) in the multivariate COX regression analysis. The prognostic factors resulting in five terminal nodes in the decision tree (DT) included stage, age, and grade. The stage was the most important determining factor for vital status. The terminal node with the shortest number of surviving patients included 801 (72.3%) deaths in 1102 patients with distant stage, and hazard ratio was calculated as 5.4 (95% CI: 4.9-5.9; p < .001). These patients had a median survival of only 17 months.

Conclusions: Rules extracted from DTs provide information about risk factors in specific patient groups and can be used by clinicians making decisions on individual patients. We recommend using DTs in combination with COX regression analysis to determine risk factors and the effect of these factors on survival.

Lateral ankle instability is a common condition which responds well to non-surgical management. However, the chronic symptomatic instability may require surgical intervention. The acceptable and practiced procedure is the Brostom Gould modification and it has a high patient satisfaction score. However, the current understanding and newer techniques for stabilising the lateral ligament complex has resulted in arthroscopic repairs, augmentation and tendon graft reconstructions. The literature does not provide an answer to the efficacy of these new techniques but there is some preliminary information favouring some of the latest procedures. It is now accepted practise to include ankle arthroscopy as a pre repair step. Augmentation of anatomical repair is also favoured in a select group of patients. This article provides an up to date account of the newer techniques for lateral ankle stabilisation.

Purpose: 3D-printed models rapidly evolving in orthopaedic. Studies show that 3D-printed models used for preoperative planning improve a better understanding of fracture morphology and reduce operative time, blood loss and frequency of fluoroscopy, but there are no studies that investigated possible advantages in the outcomes and complications for the treatment of distal radius fracture (DRF). Our study aims to evaluate short-term functional results and complications between two groups treated DRF using 3D-printed models for preoperative planning and without. We hypothesize that the addition of 3D-printed models would improve functional outcomes and reduce complication rates.

Methods: 66 randomized cases of DRF AO/OTA C type were enrolled and divided into "Control group" (n = 33) and "3D-printed model group" (n = 33). Personalized 3D-printed models were created. The primary outcomes were: Patient-Rated Wrist Evaluation questionnaire, Quick Disabilities of the Arm, Shoulder and Hand Score questionnaire, and complications. The secondary outcomes were: measurement of the range of motions, grip strength, radiological evaluation, and the visual analogue scale. Assessments were measured at 6 weeks, 3 months, and 6 months intervals.

Results: We found that the integration of the 3D-printed model in preoperative planning decreased complication incidence significantly - from 30.3% in the "Control group" to 6.1% in the "3D-printed model group", p = .022. But we did not find a difference in functional and radiological outcomes.

Conclusion: The 3D-printed models for preoperative planning surgically treating DRF AO/OTA C type can help minimize the complication rate, however, they can't improve functional outcomes in the short-term results.

Level of evidence: Level I randomized controlled study.