Pub Date : 2025-11-01DOI: 10.1016/j.otsr.2024.104121
Ryu Kyoung Cho, Man Soo Kim, Keun Young Choi, Yong In
Introduction
Although previous studies have shown that severe medial knee osteoarthritis (OA) (Kellgren-Lawrence grade IV) is a risk factor for patient dissatisfaction following medial open-wedge high tibial osteotomy (MOWHTO), it is uncommon to perform arthroplasty as a primary surgical option in patients 55 years of age or younger. Thus, the purpose of our study was to evaluate whether severe medial knee OA is a risk factor for dissatisfaction following MOWHTO depending on patient age based on a cutoff of 55 years.
Material and methods
We retrospectively reviewed the data of 270 consecutive patients who underwent MOWHTO with a minimum of 2 years of follow up. Patients were divided into 2 groups based on satisfaction following surgery, a Satisfied group (new Knee Society Score satisfaction subscore >20) and a Dissatisfied group (≤20). In order to assess risk factors for patient dissatisfaction depending on the age range, a subgroup analysis was conducted based on a cutoff age of 55 years. Preoperative demographics, OA grade, articular cartilage and meniscus status, severity of varus deformity, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and surgical factors were compared.
Results
At 2 years after surgery, binomial logistic regression analysis showed that severe medial knee OA was associated with patient dissatisfaction following HTO in the entire cohort (odds ratio [OR] 4.557, 95% confidence interval [CI] 2.300–9.030, p < 0.001). In subgroup analysis depending on age range, severe medial OA was not a risk factor for dissatisfaction in the age ≤55 years group. However, severe medial knee OA in the age >55 years group was a significant risk factor for dissatisfaction after MOWHTO (OR 6.78, 95% CI 2.979–15.431, p < 0.001).
Conclusion
Severe medial OA was not a risk factor for dissatisfaction in patients age 55 years or younger who underwent MOWHTO. Therefore, surgeons can take this result into account when counseling younger patients considering MOWHTO.
{"title":"Is severe medial knee osteoarthritis a risk factor for dissatisfaction following medial open-wedge high tibial osteotomy in patients 55 years of age or younger?","authors":"Ryu Kyoung Cho, Man Soo Kim, Keun Young Choi, Yong In","doi":"10.1016/j.otsr.2024.104121","DOIUrl":"10.1016/j.otsr.2024.104121","url":null,"abstract":"<div><h3>Introduction</h3><div><span>Although previous studies have shown that severe medial knee osteoarthritis (OA) (Kellgren-Lawrence grade IV) is a risk factor for patient dissatisfaction following medial open-wedge </span>high tibial osteotomy<span><span> (MOWHTO), it is uncommon to perform arthroplasty as a primary surgical option in patients 55 years of age or younger. Thus, the purpose of our study was to evaluate whether severe medial knee </span>OA is a risk factor for dissatisfaction following MOWHTO depending on patient age based on a cutoff of 55 years.</span></div></div><div><h3>Material and methods</h3><div><span>We retrospectively reviewed the data of 270 consecutive patients who underwent MOWHTO with a minimum of 2 years of follow up. Patients were divided into 2 groups based on satisfaction following surgery, a Satisfied group (new Knee Society Score satisfaction subscore >20) and a Dissatisfied group (≤20). In order to assess risk factors for patient dissatisfaction depending on the age range, a subgroup analysis was conducted based on a cutoff age of 55 years. Preoperative demographics, OA grade, </span>articular cartilage<span> and meniscus status, severity of varus deformity<span>, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and surgical factors were compared.</span></span></div></div><div><h3>Results</h3><div>At 2 years after surgery, binomial logistic regression analysis showed that severe medial knee OA was associated with patient dissatisfaction following HTO in the entire cohort (odds ratio [OR] 4.557, 95% confidence interval [CI] 2.300–9.030, p < 0.001). In subgroup analysis depending on age range, severe medial OA was not a risk factor for dissatisfaction in the age ≤55 years group. However, severe medial knee OA in the age >55 years group was a significant risk factor for dissatisfaction after MOWHTO (OR 6.78, 95% CI 2.979–15.431, p < 0.001).</div></div><div><h3>Conclusion</h3><div>Severe medial OA was not a risk factor for dissatisfaction in patients age 55 years or younger who underwent MOWHTO. Therefore, surgeons can take this result into account when counseling younger patients considering MOWHTO.</div></div><div><h3>Level of evidence</h3><div>III.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 7","pages":"Article 104121"},"PeriodicalIF":2.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883608","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 : 2025-11-01DOI: 10.1016/j.otsr.2025.104295
Edoardo Gambuti , Antonio Caldaria , Elisa Spadoni , Nicolò Biagi , Danila Azzolina , Achille Saracco , Maria Vittoria Guerzoni , Leo Massari , Gaetano Caruso
Introduction
Diaphyseal femur fractures are relatively common, and up to 39% of these cases involve a third fragment. These types of fractures present a unique challenge due to their high risk of non-union, reported in up to 14% of cases. Despite their frequency, there is still no consensus on the optimal management of the third fragment in these fractures.
The purpose of this retrospective study was to compare the clinical and radiological outcomes of patients who underwent reduction of the third fragment with those who did not, to determine the characteristics of the third fragment that warrant reduction, and to suggest the best approach.
The hypothesis is that an open reduction of the third fragment is to be avoided as it increases the risk of non-union.
Material and methods
This retrospective monocentric study analysed clinical data from patients diagnosed with diaphyseal femur fractures at our Unit between 2010 and 2022. Radiological data encompassed the length and width of the third fragment, the fracture gap, its proximity to the proximal and distal cortex, the greatest cortex-to-cortex distance, and the orientation of the third fragment. Other factors considered included patient age, BMI, sex, type of surgery performed, fracture fixation method, occurrence of complications, specific complication types, incidence of mortality, and duration of follow-up.
Results
Seventy patients were included in the study; 24 patients underwent osteosynthesis with plates and screws, while 46 patients were treated with intramedullary nailing. Descriptive analysis revealed no statistically significant difference in the characteristics of the third fragment between patients who experienced complications and those who did not.
Surgical technique for osteosynthesis (plates and screws Vs intramedullary nailing) also showed no statistically significant differences, conversely the open reduction and synthesis of the third fragment is a statistically significant complication predictor.
Conclusion
The management of the third fragment remains a challenge. In our series of patients third fragment characteristics and type of osteosynthesis did not influence the risk of complications. However, the determining factor was found to be the open reduction of the third fragment.
{"title":"Third fragment femoral shaft fracture: A retrospective analysis of complications and predictive factors for non-union and delayed union","authors":"Edoardo Gambuti , Antonio Caldaria , Elisa Spadoni , Nicolò Biagi , Danila Azzolina , Achille Saracco , Maria Vittoria Guerzoni , Leo Massari , Gaetano Caruso","doi":"10.1016/j.otsr.2025.104295","DOIUrl":"10.1016/j.otsr.2025.104295","url":null,"abstract":"<div><h3>Introduction</h3><div>Diaphyseal femur fractures are relatively common, and up to 39% of these cases involve a third fragment. These types of fractures present a unique challenge due to their high risk of non-union, reported in up to 14% of cases. Despite their frequency, there is still no consensus on the optimal management of the third fragment in these fractures.</div><div>The purpose of this retrospective study was to compare the clinical and radiological outcomes of patients who underwent reduction of the third fragment with those who did not, to determine the characteristics of the third fragment that warrant reduction, and to suggest the best approach.</div><div>The hypothesis is that an open reduction of the third fragment is to be avoided as it increases the risk of non-union.</div></div><div><h3>Material and methods</h3><div>This retrospective monocentric study analysed clinical data from patients diagnosed with diaphyseal femur fractures at our Unit between 2010 and 2022. Radiological data encompassed the length and width of the third fragment, the fracture gap, its proximity to the proximal and distal cortex, the greatest cortex-to-cortex distance, and the orientation of the third fragment. Other factors considered included patient age, BMI, sex, type of surgery performed, fracture fixation method, occurrence of complications, specific complication types, incidence of mortality, and duration of follow-up.</div></div><div><h3>Results</h3><div>Seventy patients were included in the study; 24 patients underwent osteosynthesis with plates and screws, while 46 patients were treated with intramedullary nailing. Descriptive analysis revealed no statistically significant difference in the characteristics of the third fragment between patients who experienced complications and those who did not.</div><div>Surgical technique for osteosynthesis (plates and screws Vs intramedullary nailing) also showed no statistically significant differences, conversely the open reduction and synthesis of the third fragment is a statistically significant complication predictor.</div></div><div><h3>Conclusion</h3><div>The management of the third fragment remains a challenge. In our series of patients third fragment characteristics and type of osteosynthesis did not influence the risk of complications. However, the determining factor was found to be the open reduction of the third fragment.</div></div><div><h3>Level of evidence</h3><div>IV</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 7","pages":"Article 104295"},"PeriodicalIF":2.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129087","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 : 2025-11-01DOI: 10.1016/j.otsr.2025.104220
Ronny Lopes , David Ancelin , Olivier Boniface , Ali Ghorbani , Thomas Amouyel , Michael Andrieu , Alexis Thiounn , The French Arthroscopy Society
Introduction
Insertional Achilles tendinopathy (IAT) is common, affecting 2% of the general population and up to 10% of runners. Despite this, medical and surgical treatments remain debated. When medical treatment fails, a procedure including open debridement, decompression, and reinsertion of the Achilles tendon is the recommended technique. However, this approach involves risks such as infection, shoe discomfort, or failure. In this context, endoscopic techniques have been developed. The primary objective of our study was to compare the outcomes of open and endoscopic surgical treatments for IAT. Our hypothesis was that endoscopic surgery would allow faster recovery (resumption of walking and sports activities) than would open surgery.
Methods
A prospective multicenter study was conducted at 10 French centers specializing in foot and ankle surgery from May 2021 to May 2023. Patients over 18 years of age with IATs resistant to medical treatment for more than 6 months and who underwent decompression/reinsertion surgery were included. Two groups were formed based on surgical approach: open or endoscopic. Demographic data were collected, and functional evaluations were performed preoperatively and at 3, 6, and 12 months postoperatively using the EFAS (European Foot & Ankle Society) and VISA-A (Victorian Institute of Sport Assessment – Achilles tendinopathy questionnaire) scores. Postoperative complications were assessed at 1 month.
Results
Of the 89 patients included, 53 (59.5%) underwent endoscopic surgery, and 36 (40.5%) underwent open surgery. The two groups were comparable preoperatively, except for higher functional scores in the endoscopic group. At 3 months, the VISA-A (p < 0.001), EFAS daily life (p < 0.001), and EFAS sports activity (p < 0.022) scores were significantly better in the endoscopic group. At longer follow-up, all functional scores improved in both groups, with no statistically significant difference. Shoe discomfort at 6 months was reported in 2/53 (3.7%) endoscopic patients and 5/36 (13.8%) open surgery patients (p = 0.099).
Conclusion
Our prospective study reported good functional outcomes for IAT surgery. Endoscopic surgery appeared to allow faster recovery and less shoe discomfort.
{"title":"Comparison of endoscopic and open Achilles SpeedBridge techniques in the treatment of insertional Achilles tendinopathy: A prospective multicenter study of 89 patients by the Francophone Arthroscopy Society","authors":"Ronny Lopes , David Ancelin , Olivier Boniface , Ali Ghorbani , Thomas Amouyel , Michael Andrieu , Alexis Thiounn , The French Arthroscopy Society","doi":"10.1016/j.otsr.2025.104220","DOIUrl":"10.1016/j.otsr.2025.104220","url":null,"abstract":"<div><h3>Introduction</h3><div><span>Insertional Achilles tendinopathy (IAT) is common, affecting 2% of the general population and up to 10% of runners. Despite this, medical and surgical treatments remain debated. When medical treatment fails, a procedure including open </span>debridement<span>, decompression, and reinsertion of the Achilles tendon<span> is the recommended technique. However, this approach involves risks such as infection, shoe discomfort, or failure. In this context, endoscopic techniques have been developed. The primary objective of our study was to compare the outcomes of open and endoscopic surgical treatments for IAT. Our hypothesis was that endoscopic surgery would allow faster recovery (resumption of walking and sports activities) than would open surgery.</span></span></div></div><div><h3>Methods</h3><div>A prospective multicenter study was conducted at 10 French centers specializing in foot and ankle surgery<span> from May 2021 to May 2023. Patients over 18 years of age with IATs resistant to medical treatment for more than 6 months and who underwent decompression/reinsertion surgery were included. Two groups were formed based on surgical approach: open or endoscopic. Demographic data were collected, and functional evaluations were performed preoperatively and at 3, 6, and 12 months postoperatively using the EFAS (European Foot & Ankle Society) and VISA-A (Victorian Institute of Sport Assessment – Achilles tendinopathy questionnaire) scores. Postoperative complications were assessed at 1 month.</span></div></div><div><h3>Results</h3><div>Of the 89 patients included, 53 (59.5%) underwent endoscopic surgery, and 36 (40.5%) underwent open surgery. The two groups were comparable preoperatively, except for higher functional scores in the endoscopic group. At 3 months, the VISA-A (<em>p</em> < 0.001), EFAS daily life (<em>p</em> < 0.001), and EFAS sports activity (<em>p</em> < 0.022) scores were significantly better in the endoscopic group. At longer follow-up, all functional scores improved in both groups, with no statistically significant difference. Shoe discomfort at 6 months was reported in 2/53 (3.7%) endoscopic patients and 5/36 (13.8%) open surgery patients (<em>p</em> = 0.099).</div></div><div><h3>Conclusion</h3><div>Our prospective study reported good functional outcomes for IAT surgery. Endoscopic surgery appeared to allow faster recovery and less shoe discomfort.</div><div>Level of Evidence: III.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 7","pages":"Article 104220"},"PeriodicalIF":2.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587999","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 : 2025-11-01DOI: 10.1016/j.otsr.2025.104327
Theo Cordonnier, Victor Germon, Cyril Lemé, Jean Luc Jouve, Franck Launay, Sébastien Pesenti
Introduction
Despite benefits in children, sport practice has been reported with higher risk of fractures. Our objective was to report the characteristics of sport-related fractures in children and to compare them to fractures sustained in a domestic context. Our hypothesis was that sports-related fractures more frequently required surgical treatment, and could therefore be considered more severe
Methods
We conducted a retrospective cohort study including patients under 16 years old, diagnosed with a fracture at the emergency department, excluding skull and face fractures. Demographic data, context of injury and fracture location were collected. Contexts were divided into five categories: domestic, sport-related, motor vehicle accident, school-based, other. In addition, treatment modality was collected and categorized as simple (cast immobilization), reduction and surgery (osteosynthesis).
Results
A total of 4761 patients were included (mean age 8.9 years ± 4.3). There were 3326 patients in the domestic fractures group (mean age 7.8 years +/− 4.3) and 1435 patients in the sport-related fractures group (mean age 11.4 years +/− 3.0 (p < 0.001)). Surgical treatment was more frequent in sport-related fractures (13% vs 8%, p < 0.001). Horse-riding was the sport leading the most frequently to surgical treatment (47%). When taking domestic fractures as reference, we found that surgical treatment was significantly more frequent in most of sport-related fractures. The most at-risk sports were horse-riding (OR = 14.5, p < 0.001) and athletics (OR = 5.7, p < 0.001).
Conclusions
Even though physical activity must be promoted in children regarding their beneficial effects, sport-related fractures require more often a surgical treatment. Horse-riding is particularly at-risk, and children and families must be properly informed on risks, security measures and protection equipment.
{"title":"Frequent location and severity of sports-related fractures in children in a tertiary care-center. A retrospective observational cohort study","authors":"Theo Cordonnier, Victor Germon, Cyril Lemé, Jean Luc Jouve, Franck Launay, Sébastien Pesenti","doi":"10.1016/j.otsr.2025.104327","DOIUrl":"10.1016/j.otsr.2025.104327","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite benefits in children, sport practice has been reported with higher risk of fractures. Our objective was to report the characteristics of sport-related fractures in children and to compare them to fractures sustained in a domestic context. Our hypothesis was that sports-related fractures more frequently required surgical treatment, and could therefore be considered more severe</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study including patients under 16 years old, diagnosed with a fracture at the emergency department, excluding skull and face fractures. Demographic data, context of injury and fracture location were collected. Contexts were divided into five categories: domestic, sport-related, motor vehicle accident, school-based, other. In addition, treatment modality was collected and categorized as simple (cast immobilization), reduction and surgery (osteosynthesis).</div></div><div><h3>Results</h3><div>A total of 4761 patients were included (mean age 8.9 years ± 4.3). There were 3326 patients in the domestic fractures group (mean age 7.8 years +/− 4.3) and 1435 patients in the sport-related fractures group (mean age 11.4 years +/− 3.0 (<em>p</em> < 0.001)). Surgical treatment was more frequent in sport-related fractures (13% vs 8%, <em>p</em> < 0.001). Horse-riding was the sport leading the most frequently to surgical treatment (47%). When taking domestic fractures as reference, we found that surgical treatment was significantly more frequent in most of sport-related fractures. The most at-risk sports were horse-riding (OR = 14.5, <em>p <</em> 0.001) and athletics (OR = 5.7, <em>p</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>Even though physical activity must be promoted in children regarding their beneficial effects, sport-related fractures require more often a surgical treatment. Horse-riding is particularly at-risk, and children and families must be properly informed on risks, security measures and protection equipment.</div></div><div><h3>Level of evidence</h3><div>IV.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 7","pages":"Article 104327"},"PeriodicalIF":2.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576928","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}
Background: Cemented stems are currently recommended for the treatment of displaced femoral neck fractures (FNFs) due to their reduced risk of revision and periprosthetic fractures (PPF). However, cementless stems with a collar may enhance implant stability. This study assessed the effect of collar addition on revision rates and implant survival in conventional total hip arthroplasty (THA), double mobility THA (THA DM) or hemiarthroplasty (HA) for FNFs.
Hypothesis: We hypothesized that the presence of a collar on cementless stems could play a protective role against both all-cause and periprosthetic fracture revision risk in FNFs.
Methods: A total of 5,189 hip procedures for FNFs, recorded by the Swiss National Joint Registry between 2012 and 2023, were included. Patients received Corail™ collarless cementless (n = 900), collared cementless (n = 2,028), and cemented stems (n = 2,261). Cumulative percent revision (CPR) was calculated for all-cause revision and revision for PPF. Hazard ratios (HRs) with 95% confidence interval were estimated with adjustment for age, gender, BMI, ASA scores, approach, and size of stems to compare revision risk among the three groups. Subgroup analyses were performed among implant types: HA, THA DM, and THA.
Results: Cemented stems had a lower all-cause revision rate than collarless stems (3.2 versus 6.9%, p < .001) and for PPF (0.5 versus 2.9%, p < .001). However, no statistical difference was found when cemented stems were compared with collared stems. After adjustment, collarless stems showed a significantly higher risk of all-cause revision (HR: 1.91 (1.30-2.79], p < .001) and PPF (HR: 5.82 (2.68-12.67], p < .001) compared with cemented stems. No significant difference was found between collared and cemented stems. Increased ASA, BMI 30-34.9, and posterior approach also predicted higher revision risk. In subgroup analyses, cemented and collared stems were consistently associated with a lower or equivalent risk of all-cause revision compared to collarless cementless stems regardless of the implant type.
Conclusion: Collared and cemented stems demonstrated equivalent and superior implant survival compared to collarless stems for both all-cause and PPF revisions. Collared stems appear to be a viable alternative to cemented stems when treating FNFs.
Level of evidence: III.
背景：骨水泥柄目前被推荐用于治疗移位性股骨颈骨折（FNFs），因为它们降低了翻修和假体周围骨折（PPF）的风险。然而，带环的无骨水泥茎可以提高种植体的稳定性。本研究评估了在fnf的常规全髋关节置换术（THA）、双活动髋关节置换术（THA DM）或半髋关节置换术（HA）中添加环对翻修率和植入物存活率的影响。假设：我们假设在无骨水泥的假体柄上安装一个环可以对fnf的全因和假体周围骨折翻修风险起到保护作用。方法：纳入2012年至2023年间瑞士国家联合登记处记录的5189例fnf髋关节手术。患者接受了Corail™无领骨水泥治疗（900例）、无领骨水泥治疗（2028例）和骨水泥治疗（2261例）。计算全因修正和PPF修正的累积百分比修正（CPR）。在校正年龄、性别、BMI、ASA评分、方法和茎的大小后，估计具有95%置信区间的风险比（hr），以比较三组间的翻修风险。对植入物类型进行亚组分析：HA、THA DM和THA。结果：骨水泥假体的全因修复率低于无环假体（3.2% vs . 6.9%）。结论：与无环假体相比，有环假体和骨水泥假体在全因修复和PPF修复方面表现出同等和更高的种植体存活率。在治疗fnf时，有圈假体似乎是骨水泥假体的可行选择。证据水平：III。
{"title":"Does a Collar Reduce Revision Rates and Periprosthetic Fractures in Femoral Neck Fractures? A Comparative Cohort Study of 5,189 Stems.","authors":"Ceyran Hamoudi, Fatos Ramadani, Jean-Francois Fischer, Laurent Mustaki, Olivier Husmann, Lada Eberlova, Alexandre Lunebourg","doi":"10.1016/j.otsr.2025.104545","DOIUrl":"10.1016/j.otsr.2025.104545","url":null,"abstract":"<p><strong>Background: </strong>Cemented stems are currently recommended for the treatment of displaced femoral neck fractures (FNFs) due to their reduced risk of revision and periprosthetic fractures (PPF). However, cementless stems with a collar may enhance implant stability. This study assessed the effect of collar addition on revision rates and implant survival in conventional total hip arthroplasty (THA), double mobility THA (THA DM) or hemiarthroplasty (HA) for FNFs.</p><p><strong>Hypothesis: </strong>We hypothesized that the presence of a collar on cementless stems could play a protective role against both all-cause and periprosthetic fracture revision risk in FNFs.</p><p><strong>Methods: </strong>A total of 5,189 hip procedures for FNFs, recorded by the Swiss National Joint Registry between 2012 and 2023, were included. Patients received Corail™ collarless cementless (n = 900), collared cementless (n = 2,028), and cemented stems (n = 2,261). Cumulative percent revision (CPR) was calculated for all-cause revision and revision for PPF. Hazard ratios (HRs) with 95% confidence interval were estimated with adjustment for age, gender, BMI, ASA scores, approach, and size of stems to compare revision risk among the three groups. Subgroup analyses were performed among implant types: HA, THA DM, and THA.</p><p><strong>Results: </strong>Cemented stems had a lower all-cause revision rate than collarless stems (3.2 versus 6.9%, p < .001) and for PPF (0.5 versus 2.9%, p < .001). However, no statistical difference was found when cemented stems were compared with collared stems. After adjustment, collarless stems showed a significantly higher risk of all-cause revision (HR: 1.91 (1.30-2.79], p < .001) and PPF (HR: 5.82 (2.68-12.67], p < .001) compared with cemented stems. No significant difference was found between collared and cemented stems. Increased ASA, BMI 30-34.9, and posterior approach also predicted higher revision risk. In subgroup analyses, cemented and collared stems were consistently associated with a lower or equivalent risk of all-cause revision compared to collarless cementless stems regardless of the implant type.</p><p><strong>Conclusion: </strong>Collared and cemented stems demonstrated equivalent and superior implant survival compared to collarless stems for both all-cause and PPF revisions. Collared stems appear to be a viable alternative to cemented stems when treating FNFs.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104545"},"PeriodicalIF":2.2,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145432977","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 : 2025-10-30DOI: 10.1016/j.otsr.2025.104543
Bernard de Geofroy, Romain Léonard, Margaux Micicoi, Jonggu Shin, Jean-François Gonzalez, Peter K Sculco, Grégoire Micicoi
Background: The integration of artificial intelligence (AI) into hip and knee surgery has been evolving rapidly, with significant implications for diagnostics, surgical planning, and outcome prediction. However, there has been limited literature with comprehensive overview of AI in arthroplasty surgery. This bibliometric analysis aims to identify the 50 most cited articles on AI in hip and knee surgery, highlighting key contributors, research trends, and methodological patterns.
Hypothesis: We hypothesized that AI has generated a growing body of influential research in hip and knee surgery, with specific trends in applications, geographic distribution, and methodological approaches.
Material and methods: A systematic search was performed in the Web of Science Core Collection (WOSCC) on July 14, 2025, using predefined keywords related to AI and hip/knee surgery. Original research articles were screened and ranked by citation count. Descriptive statistics were used to analyze bibliometric variables including authorship, journal impact factor, country of origin, and AI techniques.
Results: The 50 most cited articles, published between 2016 and 2023, accumulated a total of 7,140 citations (mean: 142.8; range: 59-735). The most cited article received 735 citations. The United States was the most prolific contributor, accounting for 27 articles (54.0%) and 2,772 citations (38.8%). Deep learning was the most frequently used AI technique (29 articles, 58% of articles). Knee-related topics were predominant, addressed in 32 articles (64.0%) while hip-related studies represented 18 articles (36.0%). Thematic focus was predominantly diagnostic with 31 articles (62.0%) centered on radiographic interpretation. There was no significant correlation between journal impact factor and citation count (Pearson's r = 0.21; p = 0.28).
Discussion: This bibliometric analysis outlines the foundational literature driving AI adoption in hip and knee surgery. While the field is rapidly expanding, research remains unevenly distributed, with limited focus on hip surgery and treatment-oriented AI. Future studies should emphasize clinical validation, generalizability, and the integration of explainable AI into orthopedic practice.
Level of evidence: IV.
背景：人工智能（AI）与髋关节和膝关节手术的整合发展迅速，对诊断、手术计划和结果预测具有重要意义。然而，关于人工智能在关节置换术中的全面概述的文献有限。这项文献计量分析旨在确定人工智能在髋关节和膝关节手术中被引用最多的50篇文章，突出了主要贡献者、研究趋势和方法模式。假设：我们假设人工智能已经在髋关节和膝关节手术领域产生了越来越多的有影响力的研究，在应用、地理分布和方法方法方面有特定的趋势。材料和方法：于2025年7月14日在Web of Science Core Collection （WOSCC）中进行系统搜索，使用与AI和髋关节/膝关节手术相关的预定义关键词。对原始研究文章进行筛选，并根据引用次数进行排名。描述性统计用于分析文献计量变量，包括作者身份、期刊影响因子、原产国和人工智能技术。结果：2016 - 2023年间发表的50篇被引次数最多的文章，累计被引次数为7140次，平均142.8次，范围59-735次。被引用次数最多的文章被引用了735次。美国是最多产的贡献者，有27篇文章（54.0%）和2772次引用（38.8%）。深度学习是最常用的人工智能技术（29篇文章，占文章的58%）。膝关节相关的研究占主导地位，有32篇（64.0%），而髋关节相关的研究有18篇（36.0%）。主题焦点主要是诊断性的，有31篇文章（62.0%）集中在放射学解释上。期刊影响因子与被引次数之间无显著相关性（Pearson’s r = 0.21; p = 0.28）。讨论：本文献计量分析概述了推动人工智能在髋关节和膝关节手术中应用的基础文献。虽然该领域正在迅速扩张，但研究仍然分布不均，对髋关节手术和以治疗为导向的人工智能的关注有限。未来的研究应强调临床验证、推广，以及将可解释的人工智能整合到骨科实践中。证据等级：四级。
{"title":"Artificial intelligence in hip and knee surgery: a bibliometric analysis of the 50 most cited articles.","authors":"Bernard de Geofroy, Romain Léonard, Margaux Micicoi, Jonggu Shin, Jean-François Gonzalez, Peter K Sculco, Grégoire Micicoi","doi":"10.1016/j.otsr.2025.104543","DOIUrl":"10.1016/j.otsr.2025.104543","url":null,"abstract":"<p><strong>Background: </strong>The integration of artificial intelligence (AI) into hip and knee surgery has been evolving rapidly, with significant implications for diagnostics, surgical planning, and outcome prediction. However, there has been limited literature with comprehensive overview of AI in arthroplasty surgery. This bibliometric analysis aims to identify the 50 most cited articles on AI in hip and knee surgery, highlighting key contributors, research trends, and methodological patterns.</p><p><strong>Hypothesis: </strong>We hypothesized that AI has generated a growing body of influential research in hip and knee surgery, with specific trends in applications, geographic distribution, and methodological approaches.</p><p><strong>Material and methods: </strong>A systematic search was performed in the Web of Science Core Collection (WOSCC) on July 14, 2025, using predefined keywords related to AI and hip/knee surgery. Original research articles were screened and ranked by citation count. Descriptive statistics were used to analyze bibliometric variables including authorship, journal impact factor, country of origin, and AI techniques.</p><p><strong>Results: </strong>The 50 most cited articles, published between 2016 and 2023, accumulated a total of 7,140 citations (mean: 142.8; range: 59-735). The most cited article received 735 citations. The United States was the most prolific contributor, accounting for 27 articles (54.0%) and 2,772 citations (38.8%). Deep learning was the most frequently used AI technique (29 articles, 58% of articles). Knee-related topics were predominant, addressed in 32 articles (64.0%) while hip-related studies represented 18 articles (36.0%). Thematic focus was predominantly diagnostic with 31 articles (62.0%) centered on radiographic interpretation. There was no significant correlation between journal impact factor and citation count (Pearson's r = 0.21; p = 0.28).</p><p><strong>Discussion: </strong>This bibliometric analysis outlines the foundational literature driving AI adoption in hip and knee surgery. While the field is rapidly expanding, research remains unevenly distributed, with limited focus on hip surgery and treatment-oriented AI. Future studies should emphasize clinical validation, generalizability, and the integration of explainable AI into orthopedic practice.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104543"},"PeriodicalIF":2.2,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145427206","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 : 2025-10-30DOI: 10.1016/j.otsr.2025.104544
Mathias Hengartner, Marc-Olivier Kiss, Vincent Massé, Pierre Rousseau, Martin Lavigne, Pascal-André Vendittoli
Background: An optimized anesthetic protocol for joint arthroplasty should provide effective surgical anesthesia, promote early motor function recovery, and minimize postoperative pain and adverse effects. To meet these goals, we developed the SOLIS anesthesia protocol, which combines chloroprocaine short-acting Spinal anesthesia, an Opioid- and benzodiazepine-free anesthesia, large doses of Local anesthetics for Infiltration, and propofol Sedation. The objectives of this descriptive quality-improvement report were to determine whether the SOLIS protocol would provide effective anesthesia, enhance recovery, offer adequate postoperative pain control and be satisfactory for patients undergoing hip or knee replacement.
Hypothesis: It was hypothesized that the SOLIS protocol would meet these four objectives.
Patients and methods: We reviewed 906 unilateral joint replacements: 265 total knee arthroplasties (TKAs), 32 unicompartimental knee arthroplasties (UKAs), and 609 total hip arthroplasties (THAs). The protocol efficacy was assessed by the rate of conversion to general anesthesia and the mean motor block duration, time to ambulation, the failure to ambulate on the day of surgery, and patient reported postoperative pain. Adverse events and complications were collected, and a subjective questionnaire was used to assess patients' satisfaction.
Results: There were no conversions to general anesthesia. The mean motor block duration was 89.7 ± 20.9 (88.0, 47.0-198.0) min, exceeding the mean time from injection to the end of surgery of 74.5 ± 16.5 (71.0, 39.0-140.0) min. On the day of surgery, only 1.3% of patients failed to ambulate. In the post-anesthesia care unit (PACU), the mean pain score was 1.7/10 ± 2.2 (1.0, 0.0-10.0), with 162 (17.9%) patients requiring opioids, which were oral for 85 (53%). Main complications were urinary retention requiring catheterization in eight (0.9%), orthostatic hypotension during the first ambulation was observed in 42 (4.6%). Deep vein thrombosis occurred in two (0.2%), and pulmonary embolism in one (0.1%). Patients rated at 98% their satisfaction with the anesthesia protocol and 96% for the postoperative pain management.
Conclusion: SOLIS is a very effective anesthesia protocol for hip and knee replacement, promoting enhanced recovery with low postoperative pain, and achieving a very high patient satisfaction rate. However, implementing this protocol may require a dedicated arthroplasty team and environment.
Level of evidence: IV; continuous case series with no comparison group.
{"title":"SOLIS protocol, a specific anesthesia technique for hip and knee arthroplasty: Clinical results of 906 cases.","authors":"Mathias Hengartner, Marc-Olivier Kiss, Vincent Massé, Pierre Rousseau, Martin Lavigne, Pascal-André Vendittoli","doi":"10.1016/j.otsr.2025.104544","DOIUrl":"10.1016/j.otsr.2025.104544","url":null,"abstract":"<p><strong>Background: </strong>An optimized anesthetic protocol for joint arthroplasty should provide effective surgical anesthesia, promote early motor function recovery, and minimize postoperative pain and adverse effects. To meet these goals, we developed the SOLIS anesthesia protocol, which combines chloroprocaine short-acting Spinal anesthesia, an Opioid- and benzodiazepine-free anesthesia, large doses of Local anesthetics for Infiltration, and propofol Sedation. The objectives of this descriptive quality-improvement report were to determine whether the SOLIS protocol would provide effective anesthesia, enhance recovery, offer adequate postoperative pain control and be satisfactory for patients undergoing hip or knee replacement.</p><p><strong>Hypothesis: </strong>It was hypothesized that the SOLIS protocol would meet these four objectives.</p><p><strong>Patients and methods: </strong>We reviewed 906 unilateral joint replacements: 265 total knee arthroplasties (TKAs), 32 unicompartimental knee arthroplasties (UKAs), and 609 total hip arthroplasties (THAs). The protocol efficacy was assessed by the rate of conversion to general anesthesia and the mean motor block duration, time to ambulation, the failure to ambulate on the day of surgery, and patient reported postoperative pain. Adverse events and complications were collected, and a subjective questionnaire was used to assess patients' satisfaction.</p><p><strong>Results: </strong>There were no conversions to general anesthesia. The mean motor block duration was 89.7 ± 20.9 (88.0, 47.0-198.0) min, exceeding the mean time from injection to the end of surgery of 74.5 ± 16.5 (71.0, 39.0-140.0) min. On the day of surgery, only 1.3% of patients failed to ambulate. In the post-anesthesia care unit (PACU), the mean pain score was 1.7/10 ± 2.2 (1.0, 0.0-10.0), with 162 (17.9%) patients requiring opioids, which were oral for 85 (53%). Main complications were urinary retention requiring catheterization in eight (0.9%), orthostatic hypotension during the first ambulation was observed in 42 (4.6%). Deep vein thrombosis occurred in two (0.2%), and pulmonary embolism in one (0.1%). Patients rated at 98% their satisfaction with the anesthesia protocol and 96% for the postoperative pain management.</p><p><strong>Conclusion: </strong>SOLIS is a very effective anesthesia protocol for hip and knee replacement, promoting enhanced recovery with low postoperative pain, and achieving a very high patient satisfaction rate. However, implementing this protocol may require a dedicated arthroplasty team and environment.</p><p><strong>Level of evidence: </strong>IV; continuous case series with no comparison group.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104544"},"PeriodicalIF":2.2,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145427161","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 : 2025-10-29DOI: 10.1016/j.otsr.2025.104526
Diane Ji Yun Yoon, Pascaline Boudou-Rouquette, Sarah Kreps, Frédérique Larousserie, Valérie Dumaine, Antoine Feydy, Morad Abou Al Ezz, Sixtine de Percin, Virginie Audard, Camille Tlemsani, Victoire Cladière, François Goldwasser, Philippe Anract, David Biau
Introduction: Soft tissue sarcomas (STS) are malignant tumors of connective tissue, characterized by a wide heterogeneity in their presentations, resulting in variable therapeutic strategies between reference centers. However, clinical outcomes from an orthopedic and trauma surgery department of university hospitals are poorly documented. We evaluated the 5-year local recurrence rate of patients managed according to our local strategy and operated in our department, which is certified for the management of both soft tissues and bone sarcomas. We also assessed overall survival, metastasis and reoperation rates, as well as risk factors associated with these events.
Hypothesis: Our hypothesis was that our results were relatively similar to those from other reference centers.
Materials and methods: We analyzed 466 cases of STS of the limbs and trunk operated on between 2012 and 2019. The median patient age was 57 years, including 259 men (56%). Among them, 351 tumors (75%) were treatment-naïve; 18 patients (4%) had lymph node involvement, and 33 patients (7%) presented with metastases at initial management. There were 315 sarcomas larger than 5 cm (72%). Sarcomas were located deep in 385 cases (83%) and in the proximal lower limb in 352 cases (76%). A total of 216 sarcomas (52%) were grade 3. The most frequent histologic subtypes were undifferentiated pleomorphic sarcoma (n = 104, 22%), myxofibrosarcoma (n = 82, 18%), synovial sarcoma (n = 45, 10%), and myxoid and/or round cell liposarcoma (n = 42, 9%). Regarding treatments, 414 patients (89%) underwent limb-sparing surgery, 261 (56%) received radiotherapy, and 138 (30%) received chemotherapy.
Results: At 5 years of follow-up, the local recurrence rate was 14% (95% confidence interval [CI] = 10-18%). Independent risk factors were non-naïve presentation (hazard ratio [HR] = 1.80, 95% CI = 1.04-3.11, p = 0.037), superficial tumor location (HR = 2.14, 95% CI = 1.20-3.83, p = 0.01), grade 3 histology (HR = 1.86, 95% CI = 1.22-2.83, p = 0.004), positive surgical margins (HR = 2.47, 95% CI = 1.44-4.24, p = 0.001), and administration of chemotherapy (HR = 0.51, 95% CI = 0.30-0.87, p = 0.014). Overall survival was 60% (95% CI = 55-66%). The incidence of metastases was 28% (95% CI = 23-33%), and the rate of reoperations was 40% (95% CI = 36-45%).
Conclusion: In our university orthopedic and trauma surgery department, the oncological outcomes were comparable to those reported in the literature from other specialized centers, whether with exclusively oncologic activity or not.
Level of evidence: IV; retrospective study.
简介：软组织肉瘤（STS）是结缔组织的恶性肿瘤，其特点是其表现具有广泛的异质性，导致不同参考中心的治疗策略不同。然而，大学医院骨科和创伤外科的临床结果记录很少。我们评估了根据我们的局部策略治疗的患者的5年局部复发率，并在我科进行了手术，我科在软组织和骨肉瘤的治疗方面都获得了认证。我们还评估了总生存率、转移率和再手术率，以及与这些事件相关的危险因素。假设：我们的假设是我们的结果与其他参考中心的结果相对相似。材料与方法：分析2012年至2019年466例四肢和躯干STS手术病例。患者中位年龄为57岁，包括259名男性（56%）。其中351例（75%）为treatment-naïve；18例（4%）患者有淋巴结受累，33例（7%）患者在初始治疗时出现转移。大于5cm的肉瘤315例（72%）。385例（83%）肉瘤位于深部，352例（76%）位于下肢近端。3级肉瘤216例（52%）。最常见的组织学亚型为未分化多形性肉瘤（n = 104, 22%）、黏液纤维肉瘤（n = 82, 18%）、滑膜肉瘤（n = 45, 10%）和黏液样和/或圆细胞脂肪肉瘤（n = 42, 9%）。在治疗方面，414例患者（89%）接受保肢手术，261例（56%）接受放疗，138例（30%）接受化疗。结果：随访5年，局部复发率为14%（95%可信区间[CI] = 10-18%）。独立危险因素为non-naïve表现（风险比[HR] = 1.80, 95% CI = 1.04-3.11, p = 0.037）、浅表肿瘤位置（HR = 2.14, 95% CI = 1.20-3.83, p = 0.01）、3级组织学（HR = 1.86, 95% CI = 1.22-2.83, p = 0.004）、手术切缘阳性（HR = 2.47, 95% CI = 1.44-4.24, p = 0.001）和化疗管理（HR = 0.51, 95% CI = 0.30-0.87, p = 0.014）。总生存率为60% （95% CI = 55-66%）。转移发生率为28% (95% CI = 23-33%)，再手术率为40% （95% CI = 36-45%）。结论：在我校骨科创伤外科，无论是否有专门的肿瘤活动，肿瘤结果与其他专业中心的文献报道相当。证据等级：四级；回顾性研究。
{"title":"Orthopedic Surgical Management of Soft Tissue Sarcomas in a Referral Center: 5-Year Oncological Outcomes.","authors":"Diane Ji Yun Yoon, Pascaline Boudou-Rouquette, Sarah Kreps, Frédérique Larousserie, Valérie Dumaine, Antoine Feydy, Morad Abou Al Ezz, Sixtine de Percin, Virginie Audard, Camille Tlemsani, Victoire Cladière, François Goldwasser, Philippe Anract, David Biau","doi":"10.1016/j.otsr.2025.104526","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104526","url":null,"abstract":"<p><strong>Introduction: </strong>Soft tissue sarcomas (STS) are malignant tumors of connective tissue, characterized by a wide heterogeneity in their presentations, resulting in variable therapeutic strategies between reference centers. However, clinical outcomes from an orthopedic and trauma surgery department of university hospitals are poorly documented. We evaluated the 5-year local recurrence rate of patients managed according to our local strategy and operated in our department, which is certified for the management of both soft tissues and bone sarcomas. We also assessed overall survival, metastasis and reoperation rates, as well as risk factors associated with these events.</p><p><strong>Hypothesis: </strong>Our hypothesis was that our results were relatively similar to those from other reference centers.</p><p><strong>Materials and methods: </strong>We analyzed 466 cases of STS of the limbs and trunk operated on between 2012 and 2019. The median patient age was 57 years, including 259 men (56%). Among them, 351 tumors (75%) were treatment-naïve; 18 patients (4%) had lymph node involvement, and 33 patients (7%) presented with metastases at initial management. There were 315 sarcomas larger than 5 cm (72%). Sarcomas were located deep in 385 cases (83%) and in the proximal lower limb in 352 cases (76%). A total of 216 sarcomas (52%) were grade 3. The most frequent histologic subtypes were undifferentiated pleomorphic sarcoma (n = 104, 22%), myxofibrosarcoma (n = 82, 18%), synovial sarcoma (n = 45, 10%), and myxoid and/or round cell liposarcoma (n = 42, 9%). Regarding treatments, 414 patients (89%) underwent limb-sparing surgery, 261 (56%) received radiotherapy, and 138 (30%) received chemotherapy.</p><p><strong>Results: </strong>At 5 years of follow-up, the local recurrence rate was 14% (95% confidence interval [CI] = 10-18%). Independent risk factors were non-naïve presentation (hazard ratio [HR] = 1.80, 95% CI = 1.04-3.11, p = 0.037), superficial tumor location (HR = 2.14, 95% CI = 1.20-3.83, p = 0.01), grade 3 histology (HR = 1.86, 95% CI = 1.22-2.83, p = 0.004), positive surgical margins (HR = 2.47, 95% CI = 1.44-4.24, p = 0.001), and administration of chemotherapy (HR = 0.51, 95% CI = 0.30-0.87, p = 0.014). Overall survival was 60% (95% CI = 55-66%). The incidence of metastases was 28% (95% CI = 23-33%), and the rate of reoperations was 40% (95% CI = 36-45%).</p><p><strong>Conclusion: </strong>In our university orthopedic and trauma surgery department, the oncological outcomes were comparable to those reported in the literature from other specialized centers, whether with exclusively oncologic activity or not.</p><p><strong>Level of evidence: </strong>IV; retrospective study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104526"},"PeriodicalIF":2.2,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410621","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 : 2025-10-29DOI: 10.1016/j.otsr.2025.104527
Valérie Dumaine
Initially indicated for tumor surgery only, the reliability and modularity of megaprostheses of the knee, and in particular of the distal femur, have broadened indications for revision of standard knee prostheses with significant bone destruction and for trauma surgery, particularly in elderly patients. In oncologic surgery, implant survival is 80% at 5 years, but almost half will be revised by 15 years, sometimes with multiple revision. Complications are numerous; infection is the most common and the main cause of amputation. Mechanical stress is significant and, despite technological progress, no ideal implant exists. Although design is simple, the technique is demanding, to limit risk of loosening, fracture and patellar complications. Managing these complications requires good knowledge of knee prostheses in general and of techniques specific to megaprostheses. Level of evidence: V; expert opinion.
{"title":"Complications of distal femur megaprostheses.","authors":"Valérie Dumaine","doi":"10.1016/j.otsr.2025.104527","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104527","url":null,"abstract":"<p><p>Initially indicated for tumor surgery only, the reliability and modularity of megaprostheses of the knee, and in particular of the distal femur, have broadened indications for revision of standard knee prostheses with significant bone destruction and for trauma surgery, particularly in elderly patients. In oncologic surgery, implant survival is 80% at 5 years, but almost half will be revised by 15 years, sometimes with multiple revision. Complications are numerous; infection is the most common and the main cause of amputation. Mechanical stress is significant and, despite technological progress, no ideal implant exists. Although design is simple, the technique is demanding, to limit risk of loosening, fracture and patellar complications. Managing these complications requires good knowledge of knee prostheses in general and of techniques specific to megaprostheses. Level of evidence: V; expert opinion.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104527"},"PeriodicalIF":2.2,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423459","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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