Pub Date : 2024-11-01DOI: 10.1016/j.otsr.2024.103856
Treatment strategies for periprosthetic distal femoral fracture depend on the type of fracture, level with respect to the prosthesis, and prosthesis fixation. The usual treatment is internal fixation by nail or locking plate. This can be more difficult when the fracture is close to the joint, is destabilizing the prosthesis or is associated with reduced bone stock, and implant exchange should be considered, depending on the patient's health status. The aim is to obtain the fastest possible recovery while limiting complications and minimizing surgery time for often frail and elderly patients. The present study details the implant revision technique in periprosthetic distal femoral fracture, which requires experience in traumatology and prosthetic revision and material adapted to the situation.
{"title":"Revision total knee arthroplasty with periprosthetic distal femoral fracture","authors":"","doi":"10.1016/j.otsr.2024.103856","DOIUrl":"10.1016/j.otsr.2024.103856","url":null,"abstract":"<div><div><span>Treatment strategies for periprosthetic distal femoral fracture<span> depend on the type of fracture, level with respect to the prosthesis, and prosthesis fixation. The usual treatment is internal fixation by nail or locking plate. This can be more difficult when the fracture is close to the joint, is destabilizing the prosthesis or is associated with reduced bone stock, and implant exchange should be considered, depending on the patient's health status. The aim is to obtain the fastest possible recovery while limiting complications and minimizing surgery time for often frail and elderly patients. The present study details the implant revision technique in periprosthetic distal femoral fracture, which requires experience in </span></span>traumatology and prosthetic revision and material adapted to the situation.</div></div><div><h3>Level of evidence</h3><div>V, expert opinion.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"110 7","pages":"Article 103856"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140029615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.otsr.2024.103866
<div><h3>Background</h3><div>Knee periprosthetic femoral fractures (KPPFF) are becoming more frequent due to the increasing number of arthroplasties and the aging population, for whom maintaining autonomy and function remains a challenge. The use of locking plates has improved functional results and promoted the development of “minimally invasive” surgical (MIS) approaches. Despite the availability of literature comparing between different types of osteosynthesis for KPPFF, there is a paucity of information available on the complications of osteosynthesis using locking plates, depending on the approach. We therefore carried out a retrospective multicenter study (nine centers: Dijon, Grenoble, Lille, Marseille, Nice, Paris, Saint-Étienne, Strasbourg, Colmar) as part of a Symposium of the French Society of Orthopedic Surgery and Traumatology (SOFCOT). Following osteosynthesis of KPPFF by locking plates carried out by a standard approach or by a minimally invasive approach (MIS), the objectives were: (1) to compare the complications, (2) to evaluate whether the radiological and clinical results (rate and time of consolidation, resumption of weight bearing, lack of reduction, postoperative autonomy) were comparable in the two groups.</div></div><div><h3>Hypothesis</h3><div>The hypothesis was that performing an MIS approach in these indications does not confer more complications than a standard approach, and rather, the MIS approach offers better functional and radiological results.</div></div><div><h3>Material and method</h3><div>Five hundred and seventy-three patients presented with KPPFF over the periods studied (retrospective series from January 2012 to December 2016, then prospective series from January to December 2019). After applying the inclusion criteria (KPPFF by locking plate) and exclusion criteria (tumor context, infectious, intraoperative fractures, fractures on loose prostheses, other osteosynthesis methods, treatment by prosthetic revision, patients under the age of 18, follow-up less than 1-year, incomplete files), a global series of 306 patients was retained. Two groups were created according to the approach performed: a standard approach group (S, <em>n</em> <!-->=<!--> <!-->228) and a minimally invasive approach group (MIS, <em>n</em> <!-->=<!--> <!-->78). The demographic data of the population were recorded, as was the criteria for autonomy (Parker score, place of living). Postoperative complications were sought (infection, mechanical complication, surgical revision). Finally, the radiological and clinical results were evaluated (rate of, and time to consolidation, resumption of weight bearing, lack of reduction, postoperative autonomy).</div></div><div><h3>Results</h3><div>The comparison of the two subgroups, S and MIS, found complication rates are comparable in the two groups in terms of infections [S group: <em>n</em> <!-->=<!--> <!-->18 (7.9%), MIS group: <em>n</em> <!-->=<!--> <!-->2 (2.6%)], mechanical complications [S: <em
{"title":"Minimally invasive surgery of femoral periprosthetic fractures increases the rate of consolidation and decreases time to bone healing without a higher rate of complications","authors":"","doi":"10.1016/j.otsr.2024.103866","DOIUrl":"10.1016/j.otsr.2024.103866","url":null,"abstract":"<div><h3>Background</h3><div>Knee periprosthetic femoral fractures (KPPFF) are becoming more frequent due to the increasing number of arthroplasties and the aging population, for whom maintaining autonomy and function remains a challenge. The use of locking plates has improved functional results and promoted the development of “minimally invasive” surgical (MIS) approaches. Despite the availability of literature comparing between different types of osteosynthesis for KPPFF, there is a paucity of information available on the complications of osteosynthesis using locking plates, depending on the approach. We therefore carried out a retrospective multicenter study (nine centers: Dijon, Grenoble, Lille, Marseille, Nice, Paris, Saint-Étienne, Strasbourg, Colmar) as part of a Symposium of the French Society of Orthopedic Surgery and Traumatology (SOFCOT). Following osteosynthesis of KPPFF by locking plates carried out by a standard approach or by a minimally invasive approach (MIS), the objectives were: (1) to compare the complications, (2) to evaluate whether the radiological and clinical results (rate and time of consolidation, resumption of weight bearing, lack of reduction, postoperative autonomy) were comparable in the two groups.</div></div><div><h3>Hypothesis</h3><div>The hypothesis was that performing an MIS approach in these indications does not confer more complications than a standard approach, and rather, the MIS approach offers better functional and radiological results.</div></div><div><h3>Material and method</h3><div>Five hundred and seventy-three patients presented with KPPFF over the periods studied (retrospective series from January 2012 to December 2016, then prospective series from January to December 2019). After applying the inclusion criteria (KPPFF by locking plate) and exclusion criteria (tumor context, infectious, intraoperative fractures, fractures on loose prostheses, other osteosynthesis methods, treatment by prosthetic revision, patients under the age of 18, follow-up less than 1-year, incomplete files), a global series of 306 patients was retained. Two groups were created according to the approach performed: a standard approach group (S, <em>n</em> <!-->=<!--> <!-->228) and a minimally invasive approach group (MIS, <em>n</em> <!-->=<!--> <!-->78). The demographic data of the population were recorded, as was the criteria for autonomy (Parker score, place of living). Postoperative complications were sought (infection, mechanical complication, surgical revision). Finally, the radiological and clinical results were evaluated (rate of, and time to consolidation, resumption of weight bearing, lack of reduction, postoperative autonomy).</div></div><div><h3>Results</h3><div>The comparison of the two subgroups, S and MIS, found complication rates are comparable in the two groups in terms of infections [S group: <em>n</em> <!-->=<!--> <!-->18 (7.9%), MIS group: <em>n</em> <!-->=<!--> <!-->2 (2.6%)], mechanical complications [S: <em","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"110 7","pages":"Article 103866"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140068897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.otsr.2024.103842
Background
An important aim of total knee arthroplasty is to achieve functional recovery, which includes post-operative increase in walking speed. Therefore, predicting whether a patient will walk faster or slower after surgery is important in TKA, which has not been studied in previous literatures. Who walks faster and who walks slower after TKA? Can we predict these kinds of patients before surgery?
Hypothesis
Whether or not a patient walk faster after total knee arthroplasty can be predicted with preoperative characteristics.
Patients and methods
In this retrospective cohort study, 128 female patients who underwent staged bilateral total knee arthroplasty were analyzed with gait analysis preoperatively and at postoperative two years. These patients were divided into three different groups according to the percentage of gait speed change after total knee arthroplasty: 1) V(+), more than 10% gait speed increase; 2) V(−), more than 10% gait speed decrease; and 3) V(0), those in-between. Gait parameters, mechanical axis angles, WOMAC pain score and Knee Society scores of the two groups (V(+) and V(−)) were compared. Furthermore, a classification model predicting whether a patient walks faster after total knee arthroplasty was designed using a machine learning algorithm.
Results
After total knee arthroplasty, average gait speed increased by 0.07 m/s from 0.87 m/s to 0.94 m/s (p < 0.001) and gait speed increased in 43.8% of the patients (n = 56). However, gait speed decreased in a significant number of patients (n = 17, 13.3%). When V(+) and V(−) groups were compared, gait speed, cadence, sagittal/coronal knee range of motion, and Knee Society Function score were lower in the V(+) group before surgery, but became higher after surgery. Gait speed change could be predicted using three variables (preoperative gait speed, age, and the magnitude of mechanical axis angle). The area under the receiver operating characteristic curve of the machine learning model was 0.86.
Discussion
After total knee arthroplasty, gait speed was maintained or increased in most patients. However, gait speed decreased in a significant number of patients. The machine learning classification model showed a good predictive performance, which could aid in the decision-making and the timing of total knee arthroplasty.
{"title":"Prediction of postoperative gait speed change after bilateral primary total knee arthroplasty in female patients using a machine learning algorithm","authors":"","doi":"10.1016/j.otsr.2024.103842","DOIUrl":"10.1016/j.otsr.2024.103842","url":null,"abstract":"<div><h3>Background</h3><div>An important aim of total knee arthroplasty is to achieve functional recovery, which includes post-operative increase in walking speed. Therefore, predicting whether a patient will walk faster or slower after surgery is important in TKA, which has not been studied in previous literatures. Who walks faster and who walks slower after TKA? Can we predict these kinds of patients before surgery?</div></div><div><h3>Hypothesis</h3><div>Whether or not a patient walk faster after total knee arthroplasty can be predicted with preoperative characteristics.</div></div><div><h3>Patients and methods</h3><div><span>In this retrospective cohort study, 128 </span>female patients<span><span> who underwent staged bilateral total knee arthroplasty were analyzed with gait analysis preoperatively and at postoperative two years. These patients were divided into three different groups according to the percentage of gait speed change after total knee arthroplasty: 1) V(+), more than 10% gait speed increase; 2) V(−), more than 10% gait speed decrease; and 3) V(0), those in-between. Gait parameters, mechanical axis angles, </span>WOMAC<span> pain score and Knee Society scores of the two groups (V(+) and V(−)) were compared. Furthermore, a classification model predicting whether a patient walks faster after total knee arthroplasty was designed using a machine learning algorithm.</span></span></div></div><div><h3>Results</h3><div>After total knee arthroplasty, average gait speed increased by 0.07<!--> <!-->m/s from 0.87<!--> <!-->m/s to 0.94<!--> <!-->m/s (<em>p<!--> </em><<!--> <!-->0.001) and gait speed increased in 43.8% of the patients (<em>n</em> <!-->=<!--> <!-->56). However, gait speed decreased in a significant number of patients (<em>n</em> <!-->=<!--> <!-->17, 13.3%). When V(+) and V(−) groups were compared, gait speed, cadence, sagittal/coronal knee range of motion, and Knee Society Function score were lower in the V(+) group before surgery, but became higher after surgery. Gait speed change could be predicted using three variables (preoperative gait speed, age, and the magnitude of mechanical axis angle). The area under the receiver operating characteristic curve of the machine learning model was 0.86.</div></div><div><h3>Discussion</h3><div>After total knee arthroplasty, gait speed was maintained or increased in most patients. However, gait speed decreased in a significant number of patients. The machine learning classification model showed a good predictive performance, which could aid in the decision-making and the timing of total knee arthroplasty.</div></div><div><h3>Level of evidence</h3><div>III; retrospective cohort study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"110 7","pages":"Article 103842"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139922350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.otsr.2024.103910
<div><h3>Background</h3><div>Reduction of waste and carbon footprint can be optimized. Awareness of carbon sources and quantification of the waste are two key parameters. To our knowledge, there is no study in France on waste production by the surgical team during the operation in orthopedic surgery, in a global scope. Therefore, we performed an observational investigation aiming to: (1) quantify and characterize the weight of the wastes generated after a panel of orthopedic procedures, (2) calculate the CO<sub>2</sub> footprint generated by these wastes and extrapolate the figure at the national scale.</div></div><div><h3>Hypothesis</h3><div>Waste production is highly variable according to the types of procedures and infectious clinical waste is still a predominant source of waste and CO<sub>2</sub> emission.</div></div><div><h3>Materials and methods</h3><div><span><span><span>It is a comparative and prospective study in which a total of 14 procedures were selected as a representative panel: arthroplasties (hip, knee), spine fusions, </span>arthroscopic procedures<span> (shoulder, knee), nerve release, forefoot </span></span>osteotomies, trauma procedures. The main outcome was the average total weight of waste for each of the fourteen categories (280 measurements: 140 times 2, at the end of each procedure), expressed in kilograms (kg), and the proportions of infectious clinical waste (ICW) and household wastes (HW), expressed in percentages. Ten measures were prospectively recorded for each type of procedure in a single teaching hospital from January to September 2022. The theoretical carbon footprint generated by the treatment of the wastes was estimated in kilograms of CO</span><sub>2</sub> equivalent (KgEqCO<sub>2</sub>). The national extrapolation of the carbon footprint was performed by collecting the total number of procedures in France in 2021 using the <em>VisuChir</em> tool.</div></div><div><h3>Results</h3><div>A total of 937<!--> <!-->kg of waste were produced for the 140 procedures, amongst which 514<!--> <!-->kg of ICW (54.8%) and 423<!--> <!-->kg of HW (45.2%). The overall median waste weight was 5.9<!--> <!-->kg (Q1: 4.4, Q3: 8.1), ranging from 1.8<!--> <!-->kg to 18.3<!--> <!-->kg. The overall median waste weight for HW was 2.8<!--> <!-->kg (Q1: 2.5, Q3: 3.4), ranging from 1.8<!--> <!-->kg to 17.8<!--> <!-->kg. The overall median waste weight for ICW was 3.8<!--> <!-->kg (Q1: 2.7, Q3: 4.8), ranging from 0.8<!--> <!-->kg to 7.2<!--> <span>kg. The knee surgeries were responsible for the heaviest waste weight; the least waste-productive procedures were the foot and the carpal tunnel release. The median proportions of ICW varied from 39% for the total knee replacements to 72% for the femoral nails. There was a significant inverse correlation between the total waste weight and the proportion of ICW: r</span> <!-->=<!--> <!-->−0.47, <em>p</em> <!--><<!--> <!-->10<sup>−4</sup>. The total median estimated carbon footprint was 4.3<!-->
{"title":"Average total weight of surgical waste and CO2 carbon footprint of orthopedic surgery in France, estimated on the basis of a representative panel","authors":"","doi":"10.1016/j.otsr.2024.103910","DOIUrl":"10.1016/j.otsr.2024.103910","url":null,"abstract":"<div><h3>Background</h3><div>Reduction of waste and carbon footprint can be optimized. Awareness of carbon sources and quantification of the waste are two key parameters. To our knowledge, there is no study in France on waste production by the surgical team during the operation in orthopedic surgery, in a global scope. Therefore, we performed an observational investigation aiming to: (1) quantify and characterize the weight of the wastes generated after a panel of orthopedic procedures, (2) calculate the CO<sub>2</sub> footprint generated by these wastes and extrapolate the figure at the national scale.</div></div><div><h3>Hypothesis</h3><div>Waste production is highly variable according to the types of procedures and infectious clinical waste is still a predominant source of waste and CO<sub>2</sub> emission.</div></div><div><h3>Materials and methods</h3><div><span><span><span>It is a comparative and prospective study in which a total of 14 procedures were selected as a representative panel: arthroplasties (hip, knee), spine fusions, </span>arthroscopic procedures<span> (shoulder, knee), nerve release, forefoot </span></span>osteotomies, trauma procedures. The main outcome was the average total weight of waste for each of the fourteen categories (280 measurements: 140 times 2, at the end of each procedure), expressed in kilograms (kg), and the proportions of infectious clinical waste (ICW) and household wastes (HW), expressed in percentages. Ten measures were prospectively recorded for each type of procedure in a single teaching hospital from January to September 2022. The theoretical carbon footprint generated by the treatment of the wastes was estimated in kilograms of CO</span><sub>2</sub> equivalent (KgEqCO<sub>2</sub>). The national extrapolation of the carbon footprint was performed by collecting the total number of procedures in France in 2021 using the <em>VisuChir</em> tool.</div></div><div><h3>Results</h3><div>A total of 937<!--> <!-->kg of waste were produced for the 140 procedures, amongst which 514<!--> <!-->kg of ICW (54.8%) and 423<!--> <!-->kg of HW (45.2%). The overall median waste weight was 5.9<!--> <!-->kg (Q1: 4.4, Q3: 8.1), ranging from 1.8<!--> <!-->kg to 18.3<!--> <!-->kg. The overall median waste weight for HW was 2.8<!--> <!-->kg (Q1: 2.5, Q3: 3.4), ranging from 1.8<!--> <!-->kg to 17.8<!--> <!-->kg. The overall median waste weight for ICW was 3.8<!--> <!-->kg (Q1: 2.7, Q3: 4.8), ranging from 0.8<!--> <!-->kg to 7.2<!--> <span>kg. The knee surgeries were responsible for the heaviest waste weight; the least waste-productive procedures were the foot and the carpal tunnel release. The median proportions of ICW varied from 39% for the total knee replacements to 72% for the femoral nails. There was a significant inverse correlation between the total waste weight and the proportion of ICW: r</span> <!-->=<!--> <!-->−0.47, <em>p</em> <!--><<!--> <!-->10<sup>−4</sup>. The total median estimated carbon footprint was 4.3<!--> ","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"110 7","pages":"Article 103910"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141089070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.otsr.2024.103901
Introduction
Obesity is a growing public health concern. In ankle osteoarthritis, non-conservative treatment in advanced stages consists in ankle fusion, or else total ankle replacement, for which obesity is a relative contraindication. One of main complications of ankle fusion is non-union. Devascularization, obesity and fixation material are all factors involved in postoperative non-union, and have to be taken into account in surgical strategy for reliable results. The objective of this study was to compare the rate of ankle non-union in obese patients using quadruple screwing or a dedicated locking plate. The hypothesis was that the locking plate limits the risk of non-union in this population.
Methods
All patients were obese (BMI > 30 kg/m2) and presented ankle osteoarthritis with > 10° intra-articular deformity. The approach and joint preparation were performed via an anteromedial approach. Group S was composed of 32 patients, operated on by quadruple screwing; group P comprised 10 patients operated on using a dedicated locking plate. The main endpoint was a significant difference in the rate of non-union between the 2 groups. The secondary endpoint was improvement in pre- and 6-month postoperative AOFAS score.
Results
Group S presented 31% non-union (10/32) and group P 0% (0/10) (p < 0.05). Postoperative AOFAS score was significantly higher in group P: 67.8 ± 10.4 [range, 40–92] vs. 83.1 ± 8.0 [range, 64–92] (p < 0.05).
Conclusion
The dedicated anterior locking plate is a technique of choice for ankle fusion in obese patients with intra-articular deformity > 10°, to limit the risk of non-union.
{"title":"Dedicated locking plate reduces non-union risk in open ankle fusion in obese patients","authors":"","doi":"10.1016/j.otsr.2024.103901","DOIUrl":"10.1016/j.otsr.2024.103901","url":null,"abstract":"<div><h3>Introduction</h3><div>Obesity is a growing public health concern. In ankle osteoarthritis, non-conservative treatment in advanced stages consists in ankle fusion, or else total ankle replacement, for which obesity is a relative contraindication. One of main complications of ankle fusion is non-union. Devascularization, obesity and fixation material are all factors involved in postoperative non-union, and have to be taken into account in surgical strategy for reliable results. The objective of this study was to compare the rate of ankle non-union in obese patients using quadruple screwing or a dedicated locking plate. The hypothesis was that the locking plate limits the risk of non-union in this population.</div></div><div><h3>Methods</h3><div>All patients were obese (BMI<!--> <!-->><!--> <!-->30<!--> <!-->kg/m<sup>2</sup>) and presented ankle osteoarthritis with<!--> <!-->><!--> <!-->10° intra-articular deformity. The approach and joint preparation were performed via an anteromedial approach. Group S was composed of 32 patients, operated on by quadruple screwing; group P comprised 10 patients operated on using a dedicated locking plate. The main endpoint was a significant difference in the rate of non-union between the 2 groups. The secondary endpoint was improvement in pre- and 6-month postoperative AOFAS score.</div></div><div><h3>Results</h3><div>Group S presented 31% non-union (10/32) and group P 0% (0/10) (<em>p</em> <!--><<!--> <!-->0.05). Postoperative AOFAS score was significantly higher in group P: 67.8<!--> <!-->±<!--> <!-->10.4 [range, 40–92] vs. 83.1<!--> <!-->±<!--> <!-->8.0 [range, 64–92] (<em>p</em> <!--><<!--> <!-->0.05).</div></div><div><h3>Conclusion</h3><div>The dedicated anterior locking plate is a technique of choice for ankle fusion in obese patients with intra-articular deformity<!--> <!-->><!--> <!-->10°, to limit the risk of non-union.</div></div><div><h3>Level of evidence</h3><div>IV; retrospective study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"110 7","pages":"Article 103901"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140853597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.otsr.2023.103657
Introduction
Acute patellar dislocation is a common but serious injury that can significantly impact a patient's functional prognosis. The objective of this retrospective study is to evaluate the clinical outcomes of arthroscopic medial patellofemoral ligament (MPFL) reconstruction and plication of the medial patellar retinaculum using suture anchors in adolescent patients with first-time acute patellar dislocation (APD) and MPFL insertion injury.
Hypothesis
Tightening repair of the medial retinaculum complex can result in favorable clinical and functional outcomes in this patient population.
Materials and methods
A total of 84 adolescent patients with first-time APD and with an average age of 15.5 years (10-22) were included in the study. Of these patients, 61 (7 male and 54 female) underwent arthroscopic suture anchor plication for medial patellar retinaculum, while the other 23 were successfully treated non-operatively. Radiographic outcomes, including the congruence angle (CA), lateral patellofemoral angle (LPA), and patellar tilt angle (PTA), were evaluated preoperatively and at the last follow-up visit in the surgical group. Functional outcomes were assessed using the Lille Patello-Femoral Score, Lysholm Score, and Kujala Score at the same time points. In addition, the surgical and non-operative treatment success groups were compared in terms of both radiographic and functional outcomes.
Results
Mean follow-up was 40.9 months (24–60). Fifty-nine knees showed excellent or good results postoperatively, 2 patients had a recurrent patellar subluxation. The Lille Patello-Femoral Score was 96.9 ± 4.7 at the last follow-up. The subjective Lysholm Score and Kujala Score improved significantly, from 58.6 to 91.9 and from 60.4 to 88.9, respectively. The radiographic CA, LPA and PTA improved significantly, from 19.8 ± 2.1° to –6.7 ± 1.7°, from –7.4 ± 2.2° to 5.7 ± 1.8° and from 23.8 ± 2.9° to 12.3 ± 2.3°, respectively. There was no statistically significant difference in functional and radiographic assessments between the success with non-operative treatment group and the surgery group.
Conclusion
The results of this study suggest that arthroscopic MPFL insertion reconstruction and plication using suture anchors, which is less invasive and improves patella stability, can lead to favorable clinical and functional outcomes in adolescent patients with first-time acute patellar dislocation and insertion injury. This treatment approach should be considered as a viable option for this patient population.
{"title":"Original surgical technique for the treatment of patellofemoral instability after failure of conservative treatment","authors":"","doi":"10.1016/j.otsr.2023.103657","DOIUrl":"10.1016/j.otsr.2023.103657","url":null,"abstract":"<div><h3>Introduction</h3><div><span>Acute patellar dislocation<span> is a common but serious injury that can significantly impact a patient's functional prognosis. The objective of this retrospective study is to evaluate the clinical outcomes of arthroscopic medial patellofemoral ligament (MPFL) reconstruction and </span></span>plication<span> of the medial patellar retinaculum using suture anchors in adolescent patients with first-time acute patellar dislocation (APD) and MPFL insertion injury.</span></div></div><div><h3>Hypothesis</h3><div>Tightening repair of the medial retinaculum complex can result in favorable clinical and functional outcomes in this patient population.</div></div><div><h3>Materials and methods</h3><div>A total of 84 adolescent patients with first-time APD and with an average age of 15.5 years (10-22) were included in the study. Of these patients, 61 (7 male and 54 female) underwent arthroscopic suture anchor plication for medial patellar retinaculum, while the other 23 were successfully treated non-operatively. Radiographic outcomes, including the congruence angle (CA), lateral patellofemoral angle (LPA), and patellar tilt angle (PTA), were evaluated preoperatively and at the last follow-up visit in the surgical group. Functional outcomes were assessed using the Lille Patello-Femoral Score, Lysholm Score, and Kujala Score at the same time points. In addition, the surgical and non-operative treatment success groups were compared in terms of both radiographic and functional outcomes.</div></div><div><h3>Results</h3><div><span>Mean follow-up was 40.9 months (24–60). Fifty-nine knees showed excellent or good results postoperatively, 2 patients had a recurrent patellar subluxation. The Lille Patello-Femoral Score was 96.9</span> <!-->±<!--> <!-->4.7 at the last follow-up. The subjective Lysholm Score and Kujala Score improved significantly, from 58.6 to 91.9 and from 60.4 to 88.9, respectively. The radiographic CA, LPA and PTA improved significantly, from 19.8<!--> <!-->±<!--> <!-->2.1° to –6.7<!--> <!-->±<!--> <!-->1.7°, from –7.4<!--> <!-->±<!--> <!-->2.2° to 5.7<!--> <!-->±<!--> <!-->1.8° and from 23.8<!--> <!-->±<!--> <!-->2.9° to 12.3<!--> <!-->±<!--> <!-->2.3°, respectively. There was no statistically significant difference in functional and radiographic assessments between the success with non-operative treatment group and the surgery group.</div></div><div><h3>Conclusion</h3><div>The results of this study suggest that arthroscopic MPFL insertion reconstruction and plication using suture anchors, which is less invasive and improves patella stability, can lead to favorable clinical and functional outcomes in adolescent patients with first-time acute patellar dislocation and insertion injury. This treatment approach should be considered as a viable option for this patient population.</div></div><div><h3>Level of evidence</h3><div>IV; monocentric retrospective descriptive study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"110 7","pages":"Article 103657"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9856454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.otsr.2024.103835
Introduction
Treating complex calcaneus fractures remains challenging. This study evaluated the influence of 3D printing and simulation on precision screw insertion into the calcaneus sustentaculum tali (ST).
Hypothesis
3D printing and simulation improve the treatment for calcaneal fracture.
Patients and methods
This retrospective cohort study included 85 patients admitted with 93 Sanders type II–IV intra-articular fractures from January 2015 to June 2020. Multi-slice computed tomography (MSCT) images were used in the conventional group, and MSCT data were used to construct a 3D model of the calcaneus to simulate screw insertion and verify parameter accuracy in the 3D group.
Results
The designed parameters (upward and backward oblique angles and screw-path length) were similar to the actual values in the 3D group (p = 0.428,0.287,0.585) but not in the conventional group (p = 0.01,0.002,0.023). The Maryland foot functional score, accuracy rate, and average screw number were higher and operative time was shorter in the 3D group (p = 0.005,0.007,0.000,0.000).
Discussion
Preoperative simulation using the 3D printing model helped guide the screws into the ST more accurately, lending better-quality treatment for Sanders type II–IV calcaneal fractures.
{"title":"Three-dimensional printing technique aids screw insertion into the sustentaculum tali of the internal fixation of intra-articular calcaneal fractures","authors":"","doi":"10.1016/j.otsr.2024.103835","DOIUrl":"10.1016/j.otsr.2024.103835","url":null,"abstract":"<div><h3>Introduction</h3><div>Treating complex calcaneus fractures<span> remains challenging. This study evaluated the influence of 3D printing and simulation on precision screw insertion into the calcaneus sustentaculum tali (ST).</span></div></div><div><h3>Hypothesis</h3><div>3D printing and simulation improve the treatment for calcaneal fracture.</div></div><div><h3>Patients and methods</h3><div>This retrospective cohort study included 85 patients admitted with 93 Sanders type II–IV intra-articular fractures from January 2015 to June 2020. Multi-slice computed tomography (MSCT) images were used in the conventional group, and MSCT data were used to construct a 3D model of the calcaneus to simulate screw insertion and verify parameter accuracy in the 3D group.</div></div><div><h3>Results</h3><div>The designed parameters (upward and backward oblique angles and screw-path length) were similar to the actual values in the 3D group (<em>p</em> <!-->=<!--> <!-->0.428,0.287,0.585) but not in the conventional group (<em>p</em> <!-->=<!--> <!-->0.01,0.002,0.023). The Maryland foot functional score, accuracy rate, and average screw number were higher and operative time was shorter in the 3D group (<em>p</em> <!-->=<!--> <!-->0.005,0.007,0.000,0.000).</div></div><div><h3>Discussion</h3><div>Preoperative simulation using the 3D printing model helped guide the screws into the ST more accurately, lending better-quality treatment for Sanders type II–IV calcaneal fractures.</div></div><div><h3>Level of proof</h3><div>III; Retrospective case-control study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"110 7","pages":"Article 103835"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139736717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.otsr.2024.103858
The rate of refractory chronic pain after total knee replacement (TKR) is 20–25%, with no identifiable etiology in 6% of cases. Without an etiologic diagnosis, the surgeon is unlikely to consider revision, but pain poses a therapeutic challenge for achieving satisfaction and an acceptable quality of life. Genicular nerve radiofrequency ablation (GNRFA) was recently developed as a non-drug analgesic option. It is minimally invasive and safe, with few adverse effects, opening a new perspective for management of refractory chronic pain after TKR.
{"title":"Ultrasound-guided thermal radiofrequency ablation of the genicular nerves after total knee replacement","authors":"","doi":"10.1016/j.otsr.2024.103858","DOIUrl":"10.1016/j.otsr.2024.103858","url":null,"abstract":"<div><div><span>The rate of refractory chronic pain after total knee replacement (TKR) is 20–25%, with no identifiable etiology in 6% of cases. Without an etiologic diagnosis, the surgeon is unlikely to consider revision, but pain poses a therapeutic challenge for achieving satisfaction and an acceptable </span>quality of life<span>. Genicular nerve radiofrequency ablation (GNRFA) was recently developed as a non-drug analgesic option. It is minimally invasive and safe, with few adverse effects, opening a new perspective for management of refractory chronic pain after TKR.</span></div></div><div><h3>Level of evidence</h3><div>IV.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"110 7","pages":"Article 103858"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140051007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.otsr.2024.103851
Background
Total knee arthroplasty (TKA) is a common surgical procedure performed to alleviate pain and improve functional outcomes in patients with knee osteoarthritis and rheumatoid arthritis who have failed conservative treatments. Arthrofibrosis has been extensively studied due to its negative impact on TKA outcomes. Losartan, an angiotensin receptor blocker (ARB), has the potential to improve TKA outcomes by inhibiting TGF-β and decreasing fibrosis. This study aims to analyze a large-scale, real-world healthcare database to investigate the association between losartan potassium prescription and postoperative outcomes such as readmissions, ED visits, and the need for MUA or revision TKA.
Hypothesis
Based on previous literature and the nature of ARBs, it is expected that the addition of losartan will aid in better outcomes for patients following a primary TKA.
Patients and methods
In this retrospective observational study, the TriNetX Research Network (TriNetX) database was queried as of June 21, 2023. All patients who underwent a primary total knee arthroplasty (TKA) prior to June 21, 2022 were included. Patients were then divided into two cohorts by whether they had an active losartan potassium prescription within the year prior to their surgery to within 90 days postoperatively. Patients were then propensity-matched to eliminate differences in demographics and comorbidities.
Results
Losartan TKA patients were 1.18 [OR: 0.85 (95% CI: 0.79–0.90), p < 0.001] times less likely to be readmitted within 90 days and were 1.15 (OR: 0.87 (95% CI: 0.79–0.96); p = 0.009) times less likely to undergo a manipulation under anesthesia (MUA) within the 1-year postoperative period. There were no statistically significant differences in rates of emergency department (ED) visits at 90 days postoperatively or revision TKAs at 1 year postoperatively.
Discussion
In conclusion, patients with an active losartan prescription prior to TKA had a significantly lower likelihood of readmission within 90 days and a lower likelihood of undergoing MUA within the 1-year postoperative period compared to patients not taking losartan. This presents an opportunity for further clinical investigation to explore the value of losartan in TKA.
{"title":"The association between losartan potassium prescription and postoperative outcomes following total knee arthroplasty: A TriNetX analysis","authors":"","doi":"10.1016/j.otsr.2024.103851","DOIUrl":"10.1016/j.otsr.2024.103851","url":null,"abstract":"<div><h3>Background</h3><div><span><span><span>Total knee arthroplasty (TKA) is a common surgical procedure performed to alleviate pain and improve functional outcomes in patients with </span>knee osteoarthritis and </span>rheumatoid arthritis<span><span> who have failed conservative treatments. Arthrofibrosis has been extensively studied due to its negative impact on TKA outcomes. </span>Losartan, an </span></span>angiotensin receptor blocker<span><span> (ARB), has the potential to improve TKA outcomes by inhibiting TGF-β and decreasing fibrosis<span>. This study aims to analyze a large-scale, real-world healthcare database to investigate the association between losartan potassium<span> prescription and postoperative outcomes such as readmissions, ED visits, and the need for </span></span></span>MUA<span> or revision TKA.</span></span></div></div><div><h3>Hypothesis</h3><div>Based on previous literature and the nature of ARBs, it is expected that the addition of losartan will aid in better outcomes for patients following a primary TKA.</div></div><div><h3>Patients and methods</h3><div><span>In this retrospective observational study, the TriNetX Research Network (TriNetX) database was queried as of June 21, 2023. All patients who underwent a primary total knee arthroplasty (TKA) prior to June 21, 2022 were included. Patients were then divided into two cohorts by whether they had an active losartan potassium prescription within the year prior to their surgery to within 90</span> <!-->days postoperatively. Patients were then propensity-matched to eliminate differences in demographics and comorbidities.</div></div><div><h3>Results</h3><div><span>Losartan TKA patients were 1.18 [OR: 0.85 (95% CI: 0.79–0.90), </span><em>p</em> <!--><<!--> <!-->0.001] times less likely to be readmitted within 90<!--> <!-->days and were 1.15 (OR: 0.87 (95% CI: 0.79–0.96); <em>p</em> <!-->=<!--> <span>0.009) times less likely to undergo a manipulation under anesthesia (MUA) within the 1-year postoperative period. There were no statistically significant differences in rates of emergency department (ED) visits at 90</span> <!-->days postoperatively or revision TKAs at 1<!--> <!-->year postoperatively.</div></div><div><h3>Discussion</h3><div>In conclusion, patients with an active losartan prescription prior to TKA had a significantly lower likelihood of readmission within 90<!--> <!-->days and a lower likelihood of undergoing MUA within the 1-year postoperative period compared to patients not taking losartan. This presents an opportunity for further clinical investigation to explore the value of losartan in TKA.</div></div><div><h3>Level of evidence</h3><div>III; an observational cohort study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"110 7","pages":"Article 103851"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140013722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.otsr.2024.103898
Background
Medial open-wedge high tibial osteotomy (OWHTO) is performed for isolated medial compartment osteoarthritis or osteonecrosis of the knee and correction of varus deformity of the full lower extremity. OWHTO may induce sagittal parameter changes, including these in the tibial posterior slope (TPS), patellar height (PH), and patellofemoral joint problems. This study aimed to identify radiographic parameters associated with patellofemoral cartilage damage after OWHTO.
Hypothesis
The patellofemoral joint cartilage worsens after OWHTO and is adversely affected by PH changes.
Patients and methods
Twenty patients (25 knees) who underwent primary OWHTO and subsequent implant removal surgery, including second-look arthroscopy for evaluation of the patellofemoral cartilage condition were enrolled. The patients were received 12 to 35 months of postoperative follow-up, and categorized into two groups according to whether patellofemoral cartilage damage worsened. TPS and PH parameters, including the Insall–Salvati, Blackburne–Peel, Caton–Deschamps, and modified Blumensaat (MBI) indices, were measured on lateral knee radiographs. The hip-knee-ankle and medial proximal tibial angles were measured using an anteroposterior radiograph of the full lower extremity. The extent of change from preoperative to postoperative (Δ) was calculated for all indices.
Results
Eleven knees (44%) had worsening cartilage conditions in the femoral trochlear groove, with > 1-degree of deterioration in the International Cartilage Repair Society grade. The radiographic measure for predicting patellofemoral cartilage deterioration was ΔMBI (95% confidence interval [CI]: 3.53 × 10–14–0.812, p = 0.047). PF cartilage damage tended to progress in ΔMBI < –0.145. The postoperative TPS and HKAA in patients with deterioration in patellofemoral cartilage damage was greater than that in patients without deterioration in patellofemoral cartilage damage (p = 0.037 and 0.038, respectively).
Discussion
The patellofemoral cartilage damage tends to progress after OWHTO. ΔMBI is a factor for predicting worsening patellofemoral cartilage condition. However, attention should be paid to the excessive posterior slope as high TPS and valgus alignment as valgus HKAA because intraoperative control of MBI is impossible.
{"title":"Femoral trochlear groove cartilage damage after open-wedge high tibial osteotomy is associated with the change in patellar height relative to the femoral condyle","authors":"","doi":"10.1016/j.otsr.2024.103898","DOIUrl":"10.1016/j.otsr.2024.103898","url":null,"abstract":"<div><h3>Background</h3><div>Medial open-wedge high tibial osteotomy<span><span> (OWHTO) is performed for isolated medial compartment osteoarthritis<span> or osteonecrosis of the knee and correction of </span></span>varus deformity<span> of the full lower extremity. OWHTO may induce sagittal parameter changes, including these in the tibial posterior slope (TPS), patellar height (PH), and patellofemoral joint problems. This study aimed to identify radiographic parameters associated with patellofemoral cartilage damage after OWHTO.</span></span></div></div><div><h3>Hypothesis</h3><div>The patellofemoral joint cartilage worsens after OWHTO and is adversely affected by PH changes.</div></div><div><h3>Patients and methods</h3><div>Twenty patients (25 knees) who underwent primary OWHTO and subsequent implant removal surgery, including second-look arthroscopy for evaluation of the patellofemoral cartilage condition were enrolled. The patients were received 12 to 35 months of postoperative follow-up, and categorized into two groups according to whether patellofemoral cartilage damage worsened. TPS and PH parameters, including the Insall–Salvati, Blackburne–Peel, Caton–Deschamps, and modified Blumensaat (MBI) indices, were measured on lateral knee radiographs. The hip-knee-ankle and medial proximal tibial angles were measured using an anteroposterior radiograph of the full lower extremity. The extent of change from preoperative to postoperative (Δ) was calculated for all indices.</div></div><div><h3>Results</h3><div>Eleven knees (44%) had worsening cartilage conditions in the femoral trochlear groove, with<!--> <!-->><!--> <!-->1-degree of deterioration in the International Cartilage Repair Society grade. The radiographic measure for predicting patellofemoral cartilage deterioration was ΔMBI (95% confidence interval [CI]: 3.53<!--> <!-->×<!--> <!-->10<sup>–14</sup>–0.812, <em>p</em> <!-->=<!--> <!-->0.047). PF cartilage damage tended to progress in ΔMBI<!--> <!--><<!--> <!-->–0.145. The postoperative TPS and HKAA in patients with deterioration in patellofemoral cartilage damage was greater than that in patients without deterioration in patellofemoral cartilage damage (<em>p</em> <!-->=<!--> <!-->0.037 and 0.038, respectively).</div></div><div><h3>Discussion</h3><div>The patellofemoral cartilage damage tends to progress after OWHTO. ΔMBI is a factor for predicting worsening patellofemoral cartilage condition. However, attention should be paid to the excessive posterior slope as high TPS and valgus alignment as valgus HKAA because intraoperative control of MBI is impossible.</div></div><div><h3>Level of evidence</h3><div>IV, retrospective study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"110 7","pages":"Article 103898"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140856992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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