Orthopaedics & Traumatology-Surgery & Research最新文献

Background: Autologous osteochondral transfer (AOT) surgery yields favorable outcomes with appropriate patient selection. Although several factors influencing surgical outcomes have been identified, the effect of meniscal volume and quality on AOT outcomes remains unclear.

Hypothesis: Better meniscal status would be associated with reduced deterioration of cartilage repair over time following AOT.

Materials and methods: Patients who underwent AOT between March 2002 and March 2021 were retrospectively reviewed. Inclusion criteria were: (1) magnetic resonance imaging (MRI) at 1-2 years postoperatively for evaluation of meniscal status, and (2) follow-up MRI after at least 2 years. Meniscal lesions were addressed during surgery, and postoperative residual meniscal status was graded using a 6-point scale (0-3 for volume, 0-3 for quality). Patients were divided into better meniscus (BM) and poorer meniscus (PM) groups using a cutoff score of 2.5, derived from a time-dependent receiver operating characteristic (ROC) curve that maximized early deterioration in the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score after AOT. Follow-up intervals were categorized into early (1-2 years), short-term (2-5 years), mid-term (5-10 years), and long-term (>10 years). Structural outcomes including MOCART scores, joint space width (JSW), and cartilage T2 relaxation times, and patient-reported outcome measurements (PROMs) including Lysholm score, IKDC subjective score, Tegner activity scale, and visual analog scale (VAS) for pain were compared.

Results: A total of 35 patients were finally included in the study, with a mean follow-up of 6.8 ± 5.2 years. Among them, 22 were classified into the BM group and 13 into the PM group. Significant group-by-time interaction effects were observed for MOCART scores (p = .048) and JSW (p = .03); the BM group demonstrated higher MOCART scores from the short-term follow-up (p = .005) and less JSW narrowing from the mid-term follow-up (p = .009). In contrast, no significant group differences were found in T2 relaxation times. Clinically, IKDC (53.5 ± 16.4 to 76.3 ± 11.0; p = .03), Lysholm (66.1 ± 18.3 to 91.7 ± 7.4; p = .02), and VAS pain scores (5.1 ± 2.3 to 1.8 ± 1.8; p = .01) significantly improved from preoperative to early postoperative follow-up and were maintained thereafter. However, no significant group differences were found.

Conclusion: Meniscal lesions should be properly addressed during AOT, as residual meniscal status was associated with cartilage degeneration. However, structural improvements on MRI did not translate into better clinical outcomes, as T2 relaxation times and PROMs were not correlated.

Level of evidence: IV.

Objective: Severe osteoarthritis of the first metatarsophalangeal joint (MTPJ-1) is commonly treated through arthrodesis. Our aim was to evaluate whether percutaneous approaches to perform MTPJ-1 arthrodesis reduce the nonunion and complication (including reoperation) rate as compared to the standard open technique.

Methods: This systematic review was designed as per PRISMA checklist; Pubmed, Cochrane, Scopus and Web of Science databases were analyzed; all studies focused on patients diagnosed with MTPJ-1 osteoarthritis and treated through arthrodesis using exclusively crossed screws. Data related to the cohort (size, age, sex, type of osteoarthritis), the study design (level of evidence and type of study), the technique adopted (the number of screws, open/percutaneous approach, technique of preparation of the joint) and the final outcome (nonunion and complication and reoperation rate) were recorded. The quality of studies included was evaluated through the MINORS score (methodological index for nonrandomized studies). The nonunion, complication and reoperation rates of the percutaneous (PERC) vs the open (OPEN) technique were compared through a proportional meta-analysis.

Results: Overall, nine studies (including 225 arthrodeses in 211 patients) were analyzed (130 cases in the PERC group vs 95 cases in the OPEN group). In the two groups, the mean (± standard deviation) sample size (PERC: 26.6 ± 5.1 cases; OPEN: 23.7 ± 10.2 cases; p = 0.33), sex distribution (PERC: 81% ± 0.6; OPEN: 57% ± 0.2 females; p = 0.17) and length of follow-up (PERC: 20.8 ± 11.6 months; OPEN: 29.5 ± 16.8 months; p = 0.19), mean age (PERC: 62 ± 5.4 years; OPEN: 59.5 ± 5.4 years; p = 0.26), were not significantly different. The pooled nonunion rate (9% vs 5% in PERC vs OPEN; p = 0.57), complication rate (15% vs 23%; p = 0.46) and reoperation rate (3% vs 5%; p = 0.74) were not significantly different. The quality of studies was moderate and comparable in the two groups (mean MINORS at 8.4 ± 1.5 points vs 11.7 ± 4.3 in PERC vs OPEN; p = 0.08).

Conclusions: The nonunion and complication (including reoperation) rate after percutaneous vs open first metatarsophalangeal joint arthrodesis (fixed using screws) are comparable at 2 years of follow-up. Only moderate-quality evidence is available so far in this area. Further comparative and prospective studies with a robust design are needed to clarify which strategy allows to obtain the best outcome after MTPJ-1 arthrodesis.

Level of evidence: IV.

Backgound: Some studies have explored the influence of theatre staff familiarity on surgical performance, but none have focused specifically on orthopedic surgery. Therefore, we performed a retrospective study aiming to: 1) compare complication rates following total hip arthroplasty (THA) performed at a surgeon's familiar site versus an unfamiliar one, 2) to compare patient-reported outcomes at one year and procedure-related outcomes as well as evaluating other surgical-related factors such as length of stay, operative time.

Hypothesis: Our hypothesis is that performing THA in a familiar versus an unfamiliar environment does not affect the occurrence of early complications.

Methods: Of the 182 cases eligible before propensity score matching, 138 elective THAs performed through the direct anterior approach were retained after matching (69 per group). In the unfamiliar group, the same experienced surgeons performed THAs at a different orthopedic center during the COVID-19 period. The mean age was 70.9 ± 12.8 years, 54.3% (75/138) were women, and the mean BMI was 26.4 ± 4.9 kg/m². Surgical complications were assessed using the CUSUM test.

Results: A total of 12 surgical complications occurred (8.7%,12/138) and no significant difference (familiar group:11.6%, (8/69) versus unfamiliar group: 5.8% (4/69) (p = 0.37)) was observed between groups. Applying the CUSUM test, for peroperative complications, surgical performance remained stable in both groups. For postoperative surgical complications only in the familiar group, the limit has been reached at the 15th procedure and remained stable thereafter. At one year postoperatively, the University of California and Los Angles activity score was significantly higher in the unfamiliar group compared to the familiar group (5.8 vs. 4.8 (p =  0.03)). No statistically significant differences were observed for other patient reported outcomes at one year and for improvement in patient reported outcomes: VAS pain (1.1 vs. 1.1 (p = 0.61)), SF-12 Mental (49.9 vs. 50.3 (p = 0.61)) and Physical (42.8 vs. 46.4 (p = 0.13)), Oxford Hip Score (39.8 vs. 43.0 (p = 0.10)), WOMAC pain (86.6 vs. 89.3 (p = 0.27)) and function (81.9 vs. 88.9 (p = 0.11)). The length of stay (4.8 vs. 6.6 days (p < 0.01)) and operative time (71.1 vs. 79.2 min (p < 0.01)) were significantly lower in the unfamiliar group.

Conclusion: Changing the orthopedic surgeon's environment has no effect on surgical performance when performing elective THA by experienced arthroplasty surgeons.

Level of evidence: III; Case-control study.

Introduction: Femoral neck fractures in the elderly require immediate postoperative weight bearing to preserve autonomy. Cementless stems rely on primary stability with close cortical contact. However, perioperative fracture may occur, and secondary subsidence remains a concern. The primary objective of this study was to assess early subsidence of a cementless femoral stem. Secondary objectives were to identify predictive factors for subsidence, dislocation, and perioperative fracture.

Material and methods: We conducted a retrospective study in patients over 65 years of age who underwent systematic implantation of an uncemented Avenir-Müller® stem. Epidemiological and radiological data were collected at 6 weeks and 3 months postoperatively. Subsidence was measured relative to the greater trochanter and expressed both as an absolute value and as a categorical variable (<2 mm or ≥2 mm). Morphological risk factors included the Canal Flare Index (CFI), Metaphyseal-Diaphyseal Index (MDI), Cortical Thickness Index (CTI), and Cortical Bone Ratio (CBR10).

Results: A total of 117 patients were evaluated, including 94 women, with a mean age of 83.1 years (range 65-103). Mean subsidence at 6 weeks was 1.1 ± 1.5 mm (median 0.6, range 0-9.1), and at 3 months 1.4 ± 1.6 mm (median 0.9, range 0-9.2). At 3 months, 22 patients (18.8%) had subsidence ≥ 2 mm. Dislocation occurred in 9 patients, with no association with subsidence ≥ 2 mm (p = 0.33). Five perioperative fractures were observed, with no identifiable predictive factor. No correlation was found between subsidence and preoperative autonomy (Rho = -0.2, p = 0.37) or surgeon experience (p = 0.66). A CTI ≤ 0.40 was predictive of subsidence (absolute value, p = 0.046; group ≥ 2 mm, p = 0.002).

Conclusion: Early subsidence of cementless stems in patients over 65 years of age undergoing hip arthroplasty for fracture is minimal. Severe osteoporosis, indicated by a CTI ≤ 0.40 on preoperative imaging, should prompt consideration of a cemented stem.

Level of evidence: IV; retrospective study.