Orthopaedics & Traumatology-Surgery & Research最新文献

{"title":"Return to sport after arthroscopic double endo-button fixation for acute acromioclavicular dislocation: One-year functional outcomes","authors":"Quentin Martial ,&nbsp;Martin Renaud ,&nbsp;Laurent Hubert ,&nbsp;Romain Lancigu ,&nbsp;Louis Rony ,&nbsp;Guillaume David","doi":"10.1016/j.otsr.2025.104425","DOIUrl":"10.1016/j.otsr.2025.104425","url":null,"abstract":"<div><h3>Introduction</h3><div>Acromioclavicular joint dislocation (ACJD) is a common injury among athletes. Few studies have investigated clinical outcomes following arthroscopic surgery for high-grade acute ACJD. This study aims to determine whether arthroscopic stabilization using a double-button fixation system enables an optimal return to sports in terms of timing and level, with a minimum follow-up of one year postoperatively.</div></div><div><h3>Materials and methods</h3><div>This prospective, single-center study included patients who underwent arthroscopic stabilization with a double-button fixation system for severe acute ACJD (Rockwood grade ≥3) between 2016 and 2023. Return-to-sport timing and level of performance were assessed via questionnaire, clinical outcomes were evaluated using the self-reported Constant score, Subjective Shoulder Value (SSV), and a satisfaction score. Radiographic assessments were systematically performed, with a minimum follow-up of one year.</div></div><div><h3>Results</h3><div>A total of 30 patients with Rockwood grade III to V ACJD were included. The mean time to return to sports was 5 months, and the mean self-reported Constant score was 96 at one year postoperatively, with no residual pain or limitations in range of motion. 82% of patients reported returning to a pre-injury level of sports. The average duration of work absence was 3 months. Smoking was identified as a factor correlating to a negative Constant score at the final follow-up.</div></div><div><h3>Conclusion</h3><div>At more than one year of follow-up, arthroscopic surgery for acute ACJD allows a return to sports after an average of 5 months, with clinical outcomes comparable to open techniques. This approach offers a minimally invasive procedure, a single surgical intervention, and precise assessment of shoulder pathology.</div></div><div><h3>Level of evidence</h3><div>IV; Descriptive, single-center, prospective observational study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 1","pages":"Article 104425"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058825","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}

{"title":"Management of patients on long-term oral anticoagulant therapy during primary total hip or knee replacement arthroplasty: A prospective non-interventional comparative study","authors":"David Biau ,&nbsp;Anne Godier ,&nbsp;Anthony Viste ,&nbsp;Didier Hannouche ,&nbsp;Jean-Yves Jenny ,&nbsp;Marie Le Baron ,&nbsp;Simon Marmor ,&nbsp;Pierre-Yves Petit ,&nbsp;Pablo Rodriguez ,&nbsp;Pierre Bentzinger ,&nbsp;David Delahaye ,&nbsp;Wiem Braham ,&nbsp;Maxime Coré ,&nbsp;Xavier Flecher ,&nbsp;Moussa Hamadouche","doi":"10.1016/j.otsr.2025.104561","DOIUrl":"10.1016/j.otsr.2025.104561","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Patients scheduled for primary hip or knee replacement are frequently treated with long-term curative oral anticoagulants (LT-COA), vitamin K antagonists (VKA) or direct oral anticoagulants (DOA). We conducted a prospective, controlled study comparing patients treated with LT-COA undergoing total hip replacement (THR) or total knee replacement (TKR) with patients not treated with LT-COA undergoing the same procedure, in order to estimate the adjusted and unadjusted risks of postoperative haemorrhagic or thrombotic complications associated with LT-COA.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Hypothesis&lt;/h3&gt;&lt;div&gt;The rate of post-operative complications was higher in the group treated with LT-COA.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patients and methods&lt;/h3&gt;&lt;div&gt;This was a prospective, comparative, non-interventional study comparing patients undergoing primary THR or TKR arthroplasty who were treated with LT-COA with those who were not treated with curative-dose oral anticoagulants (control group). A total of 325 patients were assessed at 3 months, 215 (66%) in the control group, 123 with THR and 92 with TKR, and 110 (34%) in the LT-COA group, 68 with THR and 42 with TKR. Patients in the control group were more likely to be female, and were also slightly younger and in better pre-operative health. In the LT-COA group, 55 (50%) patients were treated with VKA and 55 (50%) with DOA. The surgical technique, implants and management of perioperative anticoagulants were left to the discretion of the practitioners. The primary endpoint was the occurrence of a HTR (haemorrhagic or thrombotic complications, or revision surgery) complication within 3 months of surgery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Of the 325 patients analysed, 77 (24%) had a HTR complication, 50 (23%) in the control group and 27 (25%) in the LT-COA group (OR = 0.93; 95% CI: 0.54–1.59 (p = 0.80)). In multivariable analysis, the risk of a HTR complication was not significantly different between the groups (adjusted OR = 0.85; 95% CI: 0.45–1.61 (p = 0.62)). Age (p = 0.99) and sex (p = 0.97) were not associated with the occurrence of a HTR complication. In contrast, ASA score (p = 0.017), and type of surgery (THR or TKR, p = 0.019) were significantly associated with the occurrence of a HTR complication in the multivariable analyses.&lt;/div&gt;&lt;div&gt;In the LT-COA group, the rate of HTR complications during hospitalisation was significantly higher (p = 0.0076) for patients who had undergone preoperative relay (discontinuation of anticoagulants and initiation of LMWH (Low Molecular Weight Heparin)) (n = 15 out of 41 patients, 37%) compared with those who had not (n = 9 out of 69 patients, 13%). Similarly, HTR complications during hospitalisation were significantly more frequent (p = 0.0363, Fisher's exact test) for patients treated with VKA (n = 19 out of 55 patients, 35%) compared with those treated with DOA (n = 8 out of 55 patients, 15%).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Discussion&lt;/h3&gt;&lt;div&gt;The rate of HTR complica","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 1","pages":"Article 104561"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145687949","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}

{"title":"Post-traumatic lower-limb amputation: Indications, techniques and results","authors":"Sylvain Rigal ,&nbsp;Alexia Milaire ,&nbsp;Laurent Mathieu ,&nbsp;Nicolas de l’Escalopier","doi":"10.1016/j.otsr.2025.104389","DOIUrl":"10.1016/j.otsr.2025.104389","url":null,"abstract":"<div><div>This study presents a review of traumatic lower-limb amputation, addressing 6 questions. (1) In what circumstances is amputation necessary in traumatology? (2) Are scores and results analyses contributive to decision-making for emergency amputation? Amputation can be primary, when directly caused by the trauma, salvage if limb conservation would be life-threatening, a necessity if functional prognosis is poor, or else necessitated by a mass-casualty context. Score systems and results analysis can help identify patients who would benefit from amputation or salvage, but applications are controversial, and the surgeon’s expertise is a determining factor for treatment option in emergency settings. (3) What are the technical principles of amputation in traumatology? These principles must take account of the limitations imposed by emergency settings, in which the stump cannot always be optimized. In the acute phase, non-closure is the rule, and delayed stump shaping is preferable, to limit complications. (4) What quality of life can the amputee expect? Quality of life is a major issue in traumatic amputation. Prosthetics can restore walking capacity and promote social, occupational and familial autonomy. (5) How can complications be prevented and treated after traumatic amputation? Frequent complications include infection, cover defect, heterotopic ossification and chronic pain. These often require adaptation of the prosthesis or surgery by a specialized team. (6) Apart from surgery, what considerations guide management? Other aspects have to be integrated in the care pathway: regulatory considerations, shared decision-making, multidisciplinary teamwork, and psychological and social factors.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 1","pages":"Article 104389"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979178","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}

{"title":"Do socio-professional categories influence the time to return to work after a primary hip replacement? Insights from a prospective study at a French center","authors":"Vasileios Giovanoulis,&nbsp;Simon Marmor,&nbsp;Antoine Mouton,&nbsp;Thomas Aubert,&nbsp;Luc Lhotellier,&nbsp;Vincent Le Strat,&nbsp;Younes Kerroumi,&nbsp;Wilfrid Graff","doi":"10.1016/j.otsr.2025.104224","DOIUrl":"10.1016/j.otsr.2025.104224","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The factors influencing return to work (RTW) after primary total hip arthroplasty&lt;span&gt; (THA) remain a topic of debate. Understanding these factors is essential for optimizing postoperative recovery and patient counseling. This study aims to determine whether socio-professional status and clinical factors significantly influence the timing of RTW following elective hip replacement. The study addresses the following questions: (1) Does socio-professional status impact the timing of RTW after THA? (2) What clinical factors are associated with delayed RTW? (3) What is the typical length of sick leave for professionally active patients after THA?&lt;/span&gt;&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Hypothesis&lt;/h3&gt;&lt;div&gt;We hypothesize that socio-professional status and specific clinical factors, such as Body Mass Index (BMI) and postoperative complaints, significantly influence the timing of RTW after hip replacement.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;&lt;span&gt;&lt;span&gt;A prospective cohort study was conducted, including 171 professionally active patients aged 18–65 years who underwent primary THA at an &lt;/span&gt;arthroplasty center in France between February 2020 and March 2021. Preoperative data on socio-professional status, job position, and clinical characteristics were collected. Occupations were categorized into six socio-professional groups based on physical demands. RTW status was assessed at 3 and 4 months postoperatively. Statistical analysis involved univariate and multivariate &lt;/span&gt;logistic regression to identify factors influencing RTW.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Among the 171 patients (85 males, 86 females), the median age was 58 years (IQR: 53–61), and the median BMI was 25 kg/m² (IQR: 22–28) (24 (14%) patients had BMI &gt;30 kg/m²). At the three-month follow-up, 136 patients (80%) had returned to work, with a median RTW time of 63 days (IQR: 58–76). The remaining 35 patients required an extended sick leave of 33 days (IQR: 8–42), with an overall median sick leave duration of 66 days (IQR: 60–90). Univariate analysis&lt;span&gt; identified factors significantly associated with delayed RTW, including being an employee (OR = 2.386, 95% CI: 1.067–5.334 (p = 0.034)), higher BMI (OR = 1.114, 95% CI: 1.019–1.218 (p = 0.017)), and persistent postoperative complaints (OR = 4.476, 95% CI: 1.796–11.158 (p = 0.001)). Multivariate analysis confirmed that higher BMI (OR = 1.108, 95% CI: 1.004–1.223 (p = 0.041)) and persistent postoperative complaints (OR = 8.820, 95% CI: 3.172–24.529 (p &lt; 0.001)) remained significant independent predictors of delayed RTW.&lt;/span&gt;&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Higher BMI and persistent postoperative complaints are the primary factors delaying return after total hip replacement, while socio-professional status shows a less significant impact when other factors are considered. These findings highlight the importance of addressing modifiable risk factors to facilitate a timely RTW and optimize patient outco","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 1","pages":"Article 104224"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626947","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}

{"title":"Two-year outcomes of non-conservative treatment of the long head of the biceps tendon in the repair of small supraspinatus tears: A multicenter prospective study","authors":"Aimery Sabelle ,&nbsp;Benjamin Sallé ,&nbsp;Christophe Charousset ,&nbsp;Adrien Jacquot ,&nbsp;François Gadéa ,&nbsp;Jacques Guery ,&nbsp;Thierry Joudet ,&nbsp;Nicolas Bonnevialle ,&nbsp;Xavier Ohl ,&nbsp;Lionel Neyton ,&nbsp;Nicolas Gasse ,&nbsp;Ramy Samargandi ,&nbsp;Johannes Barth ,&nbsp;Maxime Antoni ,&nbsp;Franck Dordain ,&nbsp;David Gallinet ,&nbsp;Julien Berhouet","doi":"10.1016/j.otsr.2025.104451","DOIUrl":"10.1016/j.otsr.2025.104451","url":null,"abstract":"<div><h3>Introduction</h3><div>The management of the long head of the biceps tendon (LHBT) is well established in case of massive, irreparable rotator cuff tears (RCTs). However, its treatment in the context of small RCTs, especially those involving the supraspinatus tendon remain controversial, with ongoing debate over whether tenotomy, tenodesis, or simple preservation is the most appropriate approach. This study hypothesized that a non-conservative treatment (either isolated tenotomy or tenodesis) would yield equivalent functional outcomes, regardless of the macroscopic intraoperative appearance of the biceps tendon.</div></div><div><h3>Materials and methods</h3><div>In this prospective multicenter study, 210 patients underwent rotator cuff repair for a tear primarily affecting the supraspinatus tendon. A tenotomy or a tenodesis of the LHBT was systematically performed, regardless of its intraoperative appearance (normal or pathologic). Functional outcomes at two years (VAS, Constant score, SSV, ASES score) were collected and compared according to the macroscopic aspect of the tendon. To account for potential confounding factors, a 1:1 propensity score matching was performed. Outcomes were also compared between tenotomy and tenodesis groups. Cuff healing was assessed by ultrasound at the last follow-up.</div></div><div><h3>Results</h3><div>At the two-year follow-up, after propensity-score matching, no statistically significant differences were found between groups in any of the tested score (Constant score, <em>p</em> = 0.96; VAS, <em>p</em> = 0.33; ASES score, <em>p</em> = 0.50).</div><div>Before matching, functional scores were significantly better in patients who underwent tenotomy or tenodesis in combination with cuff repair when the LHBT appeared macroscopically normal during surgery: Constant score (87 ± 8 vs. 83 ± 11, p = 0.003), ASES score (91 ± 19 vs. 85 ± 22, p = 0.002), and SSV (95 ± 9 vs. 79 ± 31, p &lt; 0.001). No statistically significant difference was found in Constant score improvement.</div><div>Tenodesis was associated with better flexion strength, but no statistical differences were observed for other outcomes, including the Popeye deformity. At two years, cuff healing rates were similar between the two groups.</div></div><div><h3>Conclusion</h3><div>After controlling for confounding factors, the macroscopic appearance of the LHBT did not significantly influence clinical outcomes at two years after rotator cuff repair and tenotomy or tenodesis.</div></div><div><h3>Level of evidence</h3><div>III; Prospective non-randomized study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 1","pages":"Article 104451"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260086","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}

{"title":"Socio-professional impact of the hip spica cast for femoral shaft fracture management in children under six","authors":"Edouard de Charnace ,&nbsp;Iseut Line Bunetel ,&nbsp;Margaux Haas ,&nbsp;Charles Senah ,&nbsp;Mohammed Belouadah ,&nbsp;Mohamed Mehrez Kilani ,&nbsp;Delphine Tuton ,&nbsp;Sophie Bourelle","doi":"10.1016/j.otsr.2025.104556","DOIUrl":"10.1016/j.otsr.2025.104556","url":null,"abstract":"<div><h3>Background</h3><div>The treatment of a femoral shaft fracture in children under the age of 6 years old consists in a closed reduction followed by a hip spica cast, which can have a major impact on the family. The aim of this study is to assess the socio-professional impact of the hip spica cast (HSC) on families.</div></div><div><h3>Materials and methods</h3><div>Families of 114 children under 6 years of age treated with a hip spica cast for a femoral shaft fracture were surveyed using a questionnaire created for this study. Additional clinical data were collected on treatment, hospitalization and duration of immobilization.</div></div><div><h3>Results</h3><div>Within the 114 patients included, the mean age was 2.7 years, and the mean duration of immobilisation was 6.6 weeks. The difficulties encountered by the parents in managing the cast were evaluated at 7 out of 10 scale (from 0 very easy to 10 very difficult). Difficulties were significantly greater in relation to the duration of immobilisation and the age of the child (p &lt; 0.05). In 47% of cases, one or both parents had to take time off work. Taking time off work was not correlated with the duration of immobilisation or the age of the child. Families with both parents working (or single parents working) were out of work more often and for longer periods than those with at least one parent at home (p &lt; 0.05). After removal of the immobilisation, 71% of the children had returned to walking within a month.</div></div><div><h3>Conclusions</h3><div>The treatment with hip spica cast has a major socio-economic impact, particularly in terms of parental time off work. However, it is the reference treatment for femoral shaft fractures in children under 6 years of age, with very good results.</div></div><div><h3>Level of evidence</h3><div>IV; retrospective study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 1","pages":"Article 104556"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145642737","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}

{"title":"Degenerative spondylolisthesis: A significant risk factor for adverse spinopelvic mobility and impingement in patients undergoing total hip arthroplasty","authors":"Thomas Aubert ,&nbsp;Guillaume Rigoulot ,&nbsp;Philippe Gerard ,&nbsp;Guillaume Riouallon","doi":"10.1016/j.otsr.2025.104342","DOIUrl":"10.1016/j.otsr.2025.104342","url":null,"abstract":"<div><h3>Background</h3><div>Analysing the hip‒spine relationship allows the identification of risk factors for adverse spinopelvic mobility or impingement, including degenerative lumbar pathologies. Spondylolisthesis prevalence appears to increase with age, but the association of spondylolisthesis with pelvic mobility has not been studied.</div></div><div><h3>Hypothesis</h3><div>Our hypothesis was that the presence of a degenerative spondylolisthesis on the preoperative lateral spine radiograph analysis before total hip arthroplasty was associated with a higher rate of adverse spinopelvic mobility, and that this exposed patients to a greater risk of prosthetic impingement when using a systematic implant positioning strategy.</div></div><div><h3>Methods</h3><div>The clinical data of 605 consecutive patients who underwent total hip arthroplasty were retrospectively analysed. We evaluated the presence of degenerative spondylolisthesis on lateral lumbar spine radiographs, its potential associations with adverse spinopelvic mobility (Δspinopelvic tilt (SPT) ≥20 °), and the risk factors associated with a ΔSPT ≥20 ° in the overall population. Secondarily, we analysed the in-silico risk of impingement with the standard orientation of the cup at 40/20 ° and the safe zone without impingement.</div></div><div><h3>Results</h3><div>The ΔSPT ≥20 ° rates were 40% and 15% in patients with and without spondylolisthesis, respectively (odds ratio (OR) = 3.76; confidence interval (CI) [2.13; 6.64]; p &lt; 0.001). In the multivariable analysis, the following independent predictors of ΔSPT ≥20 ° were identified: SPT ≤−15 ° (OR = 3.9, [1.58; 9.65], p = 0.003), PI-LL ≥20 ° (OR = 3.14, [1.34; 7,34], p = 0.008), low PI/low lordosis and distal apex of lumbar lordosis (OR = 2.08, [1.24; 3.48], p = 0.005) and spondylolisthesis OR = 4.16, [2.31; 7.51], p &lt; 0.001). The impingement rates with an orientation of the cup at 40 ° and 20 ° were 49,3% and 24.35%, respectively, in patients with and without spondylolisthesis (OR = 3.2; [1.91; 5.37]; p &lt; 0.001). The median anteversion safe zone was 17.0 (interquartile range (IQR) = 25.0) in patients with spondylolisthesis and 27.0 (IQR = 17.0) in patients without spondylolisthesis (median Δ = −10.0; p &lt; 0.001). A total of 23.88% patients with a spondylolisthesis had no anteversion safe zone, compared with 9.12% of patients without spondylolisthesis (OR = 3.12; [1.66; 5.89]; p = 0.001).</div></div><div><h3>Conclusion</h3><div>Degenerative spondylolisthesis, a common degenerative condition, is a risk factor for adverse spinopelvic mobility and prosthetic impingement in patients undergoing total hip arthroplasty. The identification of spondylolisthesis on lateral spine radiographs should prompt adjustments in implant orientation.</div></div><div><h3>Level of evidence</h3><div>IV; retrospective study</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 1","pages":"Article 104342"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719119","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}

{"title":"Return to driving after surgical treatment of proximal humerus fractures","authors":"Vinh Le Thai ,&nbsp;Maxime Antoni ,&nbsp;Philippe Clavert","doi":"10.1016/j.otsr.2025.104346","DOIUrl":"10.1016/j.otsr.2025.104346","url":null,"abstract":"<div><h3>Introduction</h3><div>There are few data available about how patients resume car driving after proximal humerus fracture. The aim of this study was to evaluate return to car driving after surgical treatment of proximal humerus fracture. Secondary aims were to identify factors associated with return to driving.</div></div><div><h3>Methods</h3><div>This retrospective monocentric study included 155 patients (mean age 64.3 ± 11.7 years), operated on for a traumatic proximal humerus fracture. Among them, 59% were treated by ORIF by nail, 18% by ORIF by plate and 23% by a reverse shoulder arthroplasty. All patients had a driver’s license and used to drive a car preoperatively, on a regular basis. Modalities for resuming driving after surgery were collected retrospectively. Primary endpoint was the postoperative time to return to car driving. Secondary endpoints were: return to driving rates at 3, 6, 12, 24 months, the time to be back to driving with a shoulder free of pain. Influence of different potential factors on the primary endpoint was evaluated with multivariate analysis. A p-value of less than 0.05 was considered significant.</div></div><div><h3>Results</h3><div>The 3 groups were comparable with regard to gender, age, medical history, side affected, frequency of pre-operative driving. Postoperative time to return to driving was 15.9 ±11.3 weeks and time to be back to driving with a shoulder free of pain was 31.9 ±13.8 weeks. At 2 years follow-up, 71% of patients had resumed car driving. In multivariate analysis, the following factors were associated with a delayed return to driving: Neer 4 fracture (delayed by 10.2 weeks, <em>p</em> = 0.001); reverse shoulder arthroplasty (delayed by 8.0 weeks, <em>p</em> = 0.02); occurence of a postoperative complication (delayed by 8.9 weeks, <em>p</em> = 0.013). A high SSV score at 3 months was associated with a shortened delay to return to driving (<em>p</em> = 0.035). We did not find any statistical correlation between delay to return to driving and the other potential factors evaluated.</div></div><div><h3>Conclusion</h3><div>After surgical treatment of proximal humerus fracture, 71% of patients were able to resume car driving, at 2 years follow-up. Mean postoperative time to resume car driving was 15.9 weeks.</div></div><div><h3>Level of evidence</h3><div>III; retrospective case-control study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 1","pages":"Article 104346"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859938","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}

{"title":"Dislocation after anterior-approach THA: High prevalence of spinopelvic risk factors","authors":"Camille Vorimore,&nbsp;Vincent Le Strat,&nbsp;Simon Marmor,&nbsp;Wilfrid Graff,&nbsp;Antoine Mouton,&nbsp;Thomas Aubert","doi":"10.1016/j.otsr.2025.104315","DOIUrl":"10.1016/j.otsr.2025.104315","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;&lt;span&gt;Hip dislocation remains one of the most frequent complications of &lt;/span&gt;total hip arthroplasty (THA). To minimize the risk of dislocation, cup placement has traditionally been guided by a defined \"safe zone\". However, dislocations still occur even when the implant components are positioned within this zone, which may be due to the influence of spinopelvic motion on THA stability. This study aimed to (1) compare spinopelvic risk factors for dislocation between patients who experienced dislocations and those who did not after anterior-approach surgery and (2) analyze the risk factors associated with anterior versus posterior dislocations.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Hypothesis&lt;/h3&gt;&lt;div&gt;Our hypothesis was that patients with dislocation of a total hip arthroplasty after the anterior approach had a higher rate of risk factors for adverse spinopelvic mobility and that implant versions, as well as hip lengths and offsets, play an important role in anterior and posterior dislocations.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patients and methods&lt;/h3&gt;&lt;div&gt;Patient with dislocation were prospectively collected from August 2018 to August 2022. Out of a total of 6,166 THAs, 35 dislocations were recorded, and 7 patients were excluded. This single-center study included a prospective cohort of 28patients who experienced dislocations (19 anterior, 9 posterior) compared with a consecutive control cohort of 278 patients who did not, all of whom underwent primary THA via the anterior approach. Preoperative spinopelvic parameters such as lumbar flexion (LF), spinopelvic tilt (SPT), pelvic incidence (PI), and pelvic mobility (change in SPT [ΔSPT]) were analyzed in the control group using pelvic-femoral computed tomography and lateral X-rays. Patients who experienced dislocation underwent advanced postoperative functional analysis, in which spinopelvic parameters, implant version, hip length discrepancy, and femoral offset were assessed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The prevalence of spinopelvic risk factors was greater in the dislocation cohort than in the control cohort [SPT≤−10°: 42.5% vs. 10.5% (p &lt; 0.001); LF ≤ 35°: 46.1% vs. 11.9% (p &lt; 0.001); PI–lumbar lordosis (LL) ≥ 10°: 33.9% vs. 14.8% (p = 0.003); ΔSPT ≥ 20 ° from standing to seated: 50% vs. 8.3% (p &lt; 0.001); and ΔSPT ≤−13 ° from supine to standing: 21.4% vs. 6.7% (p = 0.012)]. The mean combined anteversion (CA) was 35 ° (7°–53 °) in the anterior dislocation group and 24 ° (15°–30 °) in the posterior dislocation group.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Patients with dislocations presented a high prevalence of spinopelvic risk factors. Anterior dislocations were linked to spinopelvic abnormalities rather than excessive CA. In contrast, posterior dislocations occurred in patients with low CA, especially at the expense of stem version and spinopelvic risk factors. Therefore, in patients undergoing anterior-approach THA, restricting implant anteversion may not be the primary factor","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 1","pages":"Article 104315"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295321","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}

{"title":"Should Ceramic-on-Ceramic or Ceramic-on-Polyethylene Bearings Be Preferred in Revision Total Hip Arthroplasty After Ceramic Head or Liner Fracture? A Retrospective Multicenter Case-Control Study of 33 Cases","authors":"Robin Oger ,&nbsp;Christophe Hulet ,&nbsp;Martin Tripon ,&nbsp;Julien Dunet ,&nbsp;Philippe-Alexandre Faure ,&nbsp;Julien Dartus ,&nbsp;Gaelle Maroteau ,&nbsp;Henri Migaud","doi":"10.1016/j.otsr.2025.104426","DOIUrl":"10.1016/j.otsr.2025.104426","url":null,"abstract":"<div><h3>Introduction</h3><div>Fracture of ceramic components in total hip arthroplasty (THA), although rare, remains a major concern. The optimal bearing choice in revision surgery following such fractures is still debated. Few studies have specifically compared ceramic-on-polyethylene (CoP) to ceramic-on-ceramic (CoC) in this context. Therefore we built up a retrospective comparative study aiming to compare the two bearing surfaces regarding: (1) complication rates, (2) implant survival, and (3) functional outcomes.</div></div><div><h3>Hypothesis</h3><div>The use of CoP with a monoblock (single-mobility) design is associated with fewer complications than CoC bearings in revision THA for ceramic component fracture.</div></div><div><h3>Materials and methods</h3><div>A retrospective multicenter analysis was conducted on 33 patients treated for ceramic component fractures (17 femoral heads, 16 liners), which occurred at a mean of 6 years and 8 months (range, 2 months to 25 years) after the index procedure. Sixteen patients received CoC bearings and 17 received CoP bearings. Patients were assessed at a mean follow-up of 8 years and 10 months (range, 1–21 years).</div></div><div><h3>Results</h3><div>At a mean follow-up of 8.9 years, the CoC group (mean follow-up 9.1 years) experienced significantly more complications than the CoP group (mean follow-up 8.7 years): 10/16 cases (62.5%) in the CoC group versus 3/17 cases (17.6%) in the CoP group (p = 0.013). Complications in the CoC group included: 5 dislocations (31%), 2 cases of squeaking (13%), 2 recurrent ceramic head fractures (13%), and 1 infection (6%). In the CoP group, complications included 2 dislocations (12%) and 1 aseptic loosening (6%). Mean Oxford Hip Scores at final follow-up were 21.7/60 (range, 12–47) for the CoP group and 23.1/60 (range, 12–45) for the CoC group, with no significant difference (p = 0.5).</div></div><div><h3>Discussion</h3><div>The strength of this study lies in the direct comparison of CoC and CoP bearing surfaces, with a significantly lower complication rate observed in the CoP group. However, these results should be confirmed in larger cohorts to help standardize current practices, which are often guided by expert opinion rather than scientific evidence. CoC bearings did not prevent dislocations, squeaking, or recurrent fractures. CoP monoblock constructs may offer both durability and a reduced complication profile in these high-risk revision scenarios.</div></div><div><h3>Level of evidence</h3><div>III; Retrospective comparative study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 1","pages":"Article 104426"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058821","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}