Orthopaedics & Traumatology-Surgery & Research最新文献_第9页

IF 2.2 3区医学 Q2 ORTHOPEDICS

Orthopaedics & Traumatology-Surgery & Research

Pub Date : 2026-02-01 Epub Date: 2025-09-23 DOI: 10.1016/j.otsr.2025.104440

Clémence Pfirrmann , Pierre Journeau , Franck Chotel , Roland Chapurlat

Fibrous dysplasia is a rare, non-malignant bone disorder in which diagnosis may be easy (polyostotic forms) or more difﬁcult (monostotic forms). Complementary radiological examinations (standard X-ray, CT, scintigraphy) are essential to pinpoint the location or locations of bone involvement. In case of diagnostic doubt, bone biopsy screens for GNAS gene mutation. Fibrous dysplasia may be isolated or part of McCune-Albright syndrome. In case of extraosseous involvement, it is essential to investigate the physiology of the various affected tissues (e.g., for phosphate diabetes). International guidelines were issued in 2019, for diagnosis of fibrous dysplasia and McCune-Albright syndrome and for patient management. There is no speciﬁc medical treatment for fibrous dysplasia, but appropriate analgesics and biphosphonates can improve quality of life. In fibrous dysplasia, the bone may be fragile, particularly in the femoral neck, leading to limping, bone deformities and pathological fractures. Orthopedic management ranges from simple monitoring for small monostotic lesions in non-weight-bearing areas to invasive surgery with axial correction and preventive osteosynthesis. In children, fibrous dysplasia lesions can be found at birth on histology, but appear progressively until puberty on X-ray. The impact of skeletal growth, with asymmetric growth due to fibrous dysplasia lesions, lower limb length discrepancy and epiphysiodesis, make surgical management complex. Intramedullary nailing is the surgical technique of choice.

Level of evidence >V

Expert opinion.

纤维结构不良是一种罕见的非恶性骨疾病，诊断容易（多骨增生形式）或较困难（单骨增生形式）。辅助放射检查（标准x线，CT，闪烁成像）对于确定骨骼受累的位置至关重要。如果诊断有疑问，骨活检筛查GNAS基因突变。纤维结构不良可能是孤立的，也可能是麦丘内-奥尔布赖特综合征的一部分。在骨外受累的情况下，有必要研究各种受影响组织的生理学（例如，对于磷酸盐糖尿病）。2019年发布了纤维发育不良和麦昆-奥尔布赖特综合征的诊断和患者管理国际指南。对于纤维结构不良没有特殊的药物治疗，但适当的镇痛药和双膦酸盐可以改善生活质量。在纤维性发育不良的情况下，骨可能很脆弱，尤其是股骨颈，导致跛行、骨畸形和病理性骨折。骨科治疗范围从简单监测非承重区域的小单侧病变到侵入性手术轴向矫正和预防性骨整合。在儿童中，纤维发育不良病变可在出生时在组织学上发现，但在x线上逐渐出现，直到青春期。骨骼生长的影响，由于纤维发育不良病变，下肢长度差异和表皮发育不对称的生长，使手术治疗变得复杂。髓内钉是首选的手术技术。证据等级：b> V：专家意见。

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引用次数: 0

Liposomal bupivacaine after arthroscopic rotator cuff repair moderately decreases early postoperative pain and demonstrates equivocal opioid consumption compared to traditional interscalene nerve blocks: A systematic review and meta-analysis of level 1 studies 与传统的斜角肌间神经阻滞相比，关节镜下肩袖修复术后脂质布比卡因适度减少术后早期疼痛并显示模棱两可的阿片类药物消耗：1级研究的系统回顾和荟萃分析。

IF 2.2 3区医学 Q2 ORTHOPEDICS

Orthopaedics & Traumatology-Surgery & Research

Pub Date : 2026-02-01 Epub Date: 2025-02-17 DOI: 10.1016/j.otsr.2025.104190

Jaden Hardrick , Anna M. Ifarraguerri , Michael S. Collins , David P. Trofa , James E. Fleischli , Nady Hamid , Patrick N. Siparsky , Bryan M. Saltzman

Background

Interscalene nerve blocks (ISNBs) reduce length of stay, postoperative pain, and opioid consumption following arthroscopic rotator cuff repair (ARCR). ISNBs with anesthetic agents like bupivacaine are associated with intense rebound pain, while liposomal bupivacaine (LB) can potentially extend pain relief up to 72 h and reduce opioid consumption. The purpose of this systematic review and meta-analysis is to compare the efficacy of LB versus traditional ISNB for postoperative pain management and opioid consumption following ARCR.

Methods

A systematic review following PRISMA guidelines was performed from inception through March 2024. Randomized controlled trials comparing LB and traditional ISNB for postoperative pain management and opioid consumption following ARCR were included. The meta-analysis on each outcome measure was outlined in a forest plot detailing the standard mean difference (SMD) for continuous variables.

Results

Data was extracted from 5 articles on 362 patients who underwent ARCR, 196 of whom received LB and 166 with a control non-LB ISNB. LB interventions had significantly lower pain scores than controls on postoperative day (POD) 1 and POD 2 (SMD −3.45, 95% CI [−5.20, −1.60]; P = 0.0003 and SMD −2.39, 95% CI [−4.01, −0.77]; P = 0.004, respectively). There was a significantly lower oral morphine equivalent dosage consumption in the LB cohort than controls on POD 0, POD 1, POD 2, and POD 3 (SMD −4.66; 95% CI, −7.95 to −1.36; p = 0.006; SMD −3.77; 95% CI, −5.69 to −1.85; p = 0.0001, SMD -3.34 95% CI [−5.13, −1.56]; p = 0.0002, and SMD -3.43; 95% CI, −5.74 to −1.12; p = 0.004, respectively).

Discussion

LB moderately decreased pain scores 24–72 h postoperatively and reduced opioid consumption for up to 96 h following ARCR compared to a control ISNB cohort. However, the clinical difference in opioid usage may not translate to patient benefits or justify the increased cost.

Level of evidence

I.

背景：斜角间神经阻滞（isnb）可减少关节镜下肩袖修复（ARCR）后的住院时间、术后疼痛和阿片类药物消耗。使用布比卡因等麻醉剂的isnb与强烈的反跳疼痛有关，而布比卡因脂质体（LB）可能将疼痛缓解延长至72小时，并减少阿片类药物的消耗。本系统综述和荟萃分析的目的是比较LB与传统ISNB在ARCR术后疼痛管理和阿片类药物消耗方面的疗效。方法：从开始到2024年3月，遵循PRISMA指南进行系统评价。纳入了比较LB和传统ISNB在ARCR术后疼痛管理和阿片类药物消耗方面的随机对照试验。每个结果测量的荟萃分析在森林图中概述，详细说明了连续变量的标准平均差（SMD）。结果：从5篇文章中提取了362例接受ARCR的患者的数据，其中196例接受LB， 166例对照非LB ISNB。术后第1天和第2天，LB干预组的疼痛评分明显低于对照组(SMD -3.45, 95% CI [-5.20, -1.60]；P = 0.0003, SMD = -2.39, 95% CI [-4.01, -0.77]；P = 0.004)。在POD 0、POD 1、POD 2和POD 3上，LB组口服吗啡当量用量明显低于对照组(SMD -4.66；95% CI, -7.95 ~ -1.36；p = 0.006；SMD -3.77;95% CI, -5.69 ~ -1.85；p = 0.0001, SMD = -3.34 95% CI [-5.13, -1.56]；p = 0.0002, SMD -3.43；95% CI, -5.74 ~ -1.12；P = 0.004)。讨论：与对照组ISNB队列相比，LB可适度降低术后24至72小时的疼痛评分，并减少ARCR后长达96小时的阿片类药物消耗。然而，阿片类药物使用的临床差异可能不能转化为患者的益处或证明增加的成本是合理的。证据等级：1。

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引用次数: 0

Orthopedic complications of sickle-cell disease in children 儿童镰状细胞病的骨科并发症。

IF 2.2 3区医学 Q2 ORTHOPEDICS

Orthopaedics & Traumatology-Surgery & Research

Pub Date : 2026-02-01 Epub Date: 2025-09-09 DOI: 10.1016/j.otsr.2025.104416

Anne-Laure Simon, Lucrezia Montanari, Cindy Mallet, Brice Ilharreborde

Sickle cell disease is the most common serious genetic disease in the world. It is a systemic disease, characterized by vaso-occlusive phenomena, especially in the bone capillary network. Orthopedic complications are thus the most common, with a strong impact on quality of life. In children, these complications mainly comprise bone infarction, epiphyseal aseptic osteonecrosis, and bone and joint infection: acute or chronic osteomyelitis, osteoarthritis and septic arthritis. Aseptic osteonecrosis mainly involves the proximal extremities of the femur and humerus. It may be completely asymptomatic in childhood, but almost systematically deteriorates during the 3rd decade without early management, while in childhood there are opportunities for revascularization and remodeling. Prognosis is more severe in sickle-cell-related than community-based childhood bone and joint infection, as treatment is often delayed by diagnostic difﬁculties due to the absence of speciﬁc clinical and paraclinical signs differentiating it from an acute vaso-occlusive crisis. The most common pathogens are minor Salmonella and Staphylococcus aureus. Due to high rates of iterative surgery and sequelae, systematic radio-clinical monitoring is required. Any surgery in children with sickle-cell disease requires special precautions, based primarily on preventive measures to avoid dehydration, hypoxia, hypothermia, acute anemia and pain that can trigger a life-threatening vaso-occlusive crisis. All orthopedic complications should be managed in a specialized reference center with experienced multidisciplinary medical-surgical teams.

Level of evidence

: V, expert opinion.

镰状细胞病是世界上最常见的严重遗传性疾病。它是一种全身性疾病，以血管闭塞现象为特征，特别是在骨毛细血管网络中。因此，骨科并发症是最常见的，对生活质量有很大的影响。在儿童中，这些并发症主要包括骨梗死、骨骺无菌性骨坏死和骨和关节感染：急性或慢性骨髓炎、骨关节炎和脓毒性关节炎。无菌性骨坏死主要累及股骨和肱骨的近端。它在儿童时期可能完全无症状，但在没有早期治疗的情况下，在第三个十年期间几乎系统地恶化，而在儿童时期有机会进行血运重建和重塑。镰状细胞相关的儿童骨和关节感染的预后比社区为基础的儿童骨和关节感染更为严重，因为由于缺乏与急性血管闭塞危象区分的特定临床和临床旁体征，诊断困难，治疗往往被延误。最常见的病原体是轻微的沙门氏菌和金黄色葡萄球菌。由于反复手术和后遗症的高发生率，需要系统的放射临床监测。对患有镰状细胞病的儿童进行任何手术都需要特别的预防措施，主要是预防措施，以避免可能引发危及生命的血管闭塞危机的脱水、缺氧、低体温、急性贫血和疼痛。所有骨科并发症应在有经验的多学科医学外科团队的专业参考中心进行管理。证据级别：V，专家意见。

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引用次数: 0

Techniques for correcting major lower limb deformities. Corrections of lower limb deformities 下肢主要畸形矫正技术。下肢畸形矫正。

IF 2.2 3区医学 Q2 ORTHOPEDICS

Orthopaedics & Traumatology-Surgery & Research

Pub Date : 2026-02-01 Epub Date: 2025-09-09 DOI: 10.1016/j.otsr.2025.104417

Franck Launay

Lower limb deformities can be simple when there is only one deformity but can be complex when there are up to four deformities in different planes (angulation, rotation, translation, length). The time frame must be considered because the deformities can be progressive in nature or can recur after the first correction attempt. No single strategy is best for a patient. Several strategies can be proposed to achieve the optimal result. However, strict technical specifications must be followed to achieve the desired correction:

•
Know how to precisely analyze the deformities.
•
Know which pathology is responsible for the deformity and its progressive nature.
•
Know how to correct a complex deformity without creating secondary deformities.
•
Know the potential complications of each technique and how to deal with them.
•
Know how to present the various options to the family in order to commit to a logical strategy, which will be shared by everyone. This strategy can be one where all the deformities are corrected in a single surgery, or one that combines several successive and more simple techniques.

The end goal is optimal correction with the fewest inconveniences for the patient. If the technical speciﬁcations cannot be followed, one should propose the use of orthotics or refer the patient to a team having more experience with these deformities.

Level of evidence

>V.

当只有一种畸形时，下肢畸形可能是简单的，但当不同平面（角度、旋转、平移、长度）有多达四种畸形时，下肢畸形可能是复杂的。必须考虑时间范围，因为畸形可能是进行性的，也可能在第一次矫正尝试后复发。没有单一的策略对病人来说是最好的。可以提出几种策略来达到最优结果。然而，为了达到理想的矫正效果，必须遵循严格的技术规范：最终目标是在给患者带来最少不便的情况下实现最佳矫正。如果不能遵循技术规范，应建议使用矫形器或将患者转介到对这些畸形有更多经验的团队。证据水平b> V。

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引用次数: 0

Evaluation of intravenous tranexamic acid in total hip arthroplasty for femoral neck fracture: A propensity score-matched, real-world analysis 评价静脉注射氨甲环酸在全髋关节置换术治疗股骨颈骨折：倾向评分匹配，现实世界的分析。

IF 2.2 3区医学 Q2 ORTHOPEDICS

Orthopaedics & Traumatology-Surgery & Research

Pub Date : 2026-02-01 Epub Date: 2025-04-02 DOI: 10.1016/j.otsr.2025.104237

Constance Pinon , Franck Verdonk , Christophe Quesnel , Alain Sautet , Philippe Nguyen

Background

The transfusion-sparing strategy in hip prosthetic surgery (Total Hip Arthroplasty, THA) is crucial. Tranexamic Acid (TXA) is a medication whose effectiveness has been demonstrated in numerous surgical indications to reduce bleeding and prevent the risk of blood transfusion.

Objective

To evaluate the impact of IV TXA on bleeding in THA for femoral neck fracture (FNF) surgery.

Methods

This single-center retrospective cohort study, conducted from January 2020 to September 2021, assessed patients undergoing THA for FNF, comparing those who received 1 g of IV TXA to those who did not, using a matched population through propensity score creation. Analyses were conducted univariately and multivariately.

Results

During the inclusion period, 175 patients underwent THA for FNF, with 87 receiving IV TXA and 88 not receiving TXA. After propensity score matching, the transfusion-free interval was better in the IV TXA treated group (p = 0,03). There was no difference in terms of perioperative bleeding or overall transfusion during hospitalization. There were no differences in the laboratory results at Days 1, 3, and 7.

Conclusion

IV TXA delays the need for transfusion in patients undergoing THA for FNF but does not reduce perioperative bleeding or transfusion during the stay.

Level of evidence

IV; retrospective study.

背景：在髋关节假体手术（全髋关节置换术，THA）中节省输血策略是至关重要的。氨甲环酸（TXA）是一种药物，其有效性已被证明在许多外科指征，以减少出血和防止输血的风险。目的：探讨静脉注射TXA对股骨颈骨折（FNF） THA术后出血的影响。方法：这项单中心回顾性队列研究于2020年1月至2021年9月进行，评估了接受THA治疗FNF的患者，通过倾向评分创建匹配人群，比较了接受1 g IV TXA的患者和未接受1 g IV TXA的患者。进行单因素和多因素分析。结果：在纳入期内，175例患者因FNF接受了THA治疗，其中87例接受了静脉注射TXA， 88例未接受TXA治疗。经倾向评分匹配后，静脉注射TXA组无输血间隔时间更长（p = 0,03）。在围手术期出血或住院期间总输血方面没有差异。在第1、3和7天的实验室结果没有差异。结论：静脉注射TXA延迟了FNF患者的输血需要，但不能减少围手术期出血或住院期间输血。证据等级：四级；回顾性研究。

{"title":"Evaluation of intravenous tranexamic acid in total hip arthroplasty for femoral neck fracture: A propensity score-matched, real-world analysis","authors":"Constance Pinon , Franck Verdonk , Christophe Quesnel , Alain Sautet , Philippe Nguyen","doi":"10.1016/j.otsr.2025.104237","DOIUrl":"10.1016/j.otsr.2025.104237","url":null,"abstract":"<div><h3>Background</h3><div>The transfusion-sparing strategy in hip prosthetic surgery (Total Hip Arthroplasty, THA) is crucial. Tranexamic Acid<span><span> (TXA) is a medication whose effectiveness has been demonstrated in numerous surgical indications to reduce bleeding and prevent the risk of </span>blood transfusion.</span></div></div><div><h3>Objective</h3><div>To evaluate the impact of IV TXA on bleeding in THA for femoral neck fracture (FNF) surgery.</div></div><div><h3>Methods</h3><div>This single-center retrospective cohort study, conducted from January 2020 to September 2021, assessed patients undergoing THA for FNF, comparing those who received 1 g of IV TXA to those who did not, using a matched population through propensity score creation. Analyses were conducted univariately and multivariately.</div></div><div><h3>Results</h3><div>During the inclusion period, 175 patients underwent THA for FNF, with 87 receiving IV TXA and 88 not receiving TXA. After propensity score matching, the transfusion-free interval was better in the IV TXA treated group (p = 0,03). There was no difference in terms of perioperative bleeding or overall transfusion during hospitalization. There were no differences in the laboratory results at Days 1, 3, and 7.</div></div><div><h3>Conclusion</h3><div>IV TXA delays the need for transfusion in patients undergoing THA for FNF but does not reduce perioperative bleeding or transfusion during the stay.</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 104237"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789419","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}

引用次数: 0

Instability after total hip arthroplasty: Analysis of combined anteversion and patient-related clinical parameters 全髋关节置换术后不稳定：联合前倾和患者相关临床参数分析。

IF 2.2 3区医学 Q2 ORTHOPEDICS

Orthopaedics & Traumatology-Surgery & Research

Pub Date : 2026-02-01 Epub Date: 2025-09-13 DOI: 10.1016/j.otsr.2025.104428

Joseph Attas , Régis Bernard de Dompsure , Lolita Micicoi , Lillia Gharbi , Michael Lopez , Nicolas Bronsard , Jean-François Gonzalez , Grégoire Micicoi

Introduction

While outcomes after total hip arthroplasty (THA) are generally excellent, prosthetic dislocation remains a multifactorial complication. This study hypothesized that differences in combined anteversion (CA) exist between patients with and without dislocation. The objectives were to (1) compare postoperative alignment parameters between dislocated and stable hips, (2) assess differences of alignement according to surgical approach, and (3) evaluate patient-related risk factors for dislocation.

Materials and methods

In this retrospective case-control study, 37 dislocated hips were matched to 74 stable hips by sex, age, body mass index, and surgical approach. Postoperative CT scans measured acetabular anteversion, femoral anteversion, CA, and cup inclination. Alignment was assessed relative to Lewinnek’s safe zone (acetabular anteversion 15 ° ± 10 °, inclination 40 ° ± 10 °) and Jolles’ target zone for CA (50 ° ± 10 °).

Results

Mean CA did not differ between dislocated and stable hips (45.9 ° vs 48.5 °, Δ = 2.6 °, p = 0.35). Target CA was achieved in 51% of dislocated and 54% of stable hips (p = 0.80). Cup inclination, acetabular anteversion, and femoral anteversion also showed no significant differences. Achievement of Lewinnek’s safe zone was similar between groups, except for acetabular inclination (67.6% in dislocated vs 83.8% in stable hips, p = 0.04). Surgical approach (direct anterior vs posterior) was not associated with alignment differences. In multivariate analysis, ASA (American Society of Anesthesiologists) score ≥3 (OR = 2.5, p = 0.04) and degenerative lumbar spine symptoms (OR = 3.2, p < 0.01) were independently associated with dislocation risk.

Conclusion

CA did not differ between dislocated and stable hips, suggesting that implant orientation alone does not explain instability. Instead, acetabular inclination, high ASA score, and lumbar spine pathology emerged as significant risk factors, underscoring the multifactorial nature of dislocation after THA.

Level of evidence

III; case-control study

导言：虽然全髋关节置换术（THA）后的预后通常很好，但假体脱位仍然是一个多因素并发症。本研究假设合并前倾（CA）在脱位患者和非脱位患者之间存在差异。目的是(1)比较脱位髋关节和稳定髋关节的术后对齐参数，(2)评估不同手术入路的对齐差异，(3)评估脱位患者相关的危险因素。材料和方法：在这项回顾性病例对照研究中，根据性别、年龄、体重指数和手术入路，将37个脱位髋关节与74个稳定髋关节进行匹配。术后CT扫描测量髋臼前倾、股前倾、CA和髋臼杯倾斜度。相对Lewinnek安全区（髋臼前倾15°±10°，倾斜40°±10°）和Jolles CA目标区（50°±10°）评估对齐。结果：脱位髋和稳定髋的平均CA无差异（45.9°vs 48.5°，Δ = 2.6°，p = 0.35）。51%脱位髋和54%稳定髋达到了目标CA （p = 0.80）。杯子倾斜度、髋臼前倾、股前倾也无显著差异。Lewinnek安全区的实现在两组之间相似，除了髋臼倾斜（脱位组67.6% vs稳定组83.8%,p = 0.04）。手术入路（直接前路vs后路）与对齐差异无关。在多变量分析中，ASA评分≥3分（OR = 2.5, p = 0.04），腰椎退行性症状（OR = 3.2, p）。结论：髋脱位和髋稳定之间CA无差异，提示单靠植入物定位不能解释髋不稳定。相反，髋臼倾斜、高ASA评分和腰椎病理成为重要的危险因素，强调了THA后脱位的多因素性质。证据等级：III；病例对照研究。

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引用次数: 0

Claude Vielpeau 克劳德Vielpeau

IF 2.2 3区医学 Q2 ORTHOPEDICS

Orthopaedics & Traumatology-Surgery & Research

Pub Date : 2026-02-01 Epub Date: 2026-01-17 DOI: 10.1016/j.otsr.2026.104582

Olivier Courage , Christophe Hulet

引用次数: 0

Effectiveness of 3D-printed femoral positioning guides in Oxford Unicompartmental Knee Arthroplasty: A randomized controlled trial with femoral mechanical-anatomical angle subgroup analysis. 3d打印股骨定位导向器在牛津单室膝关节置换术中的有效性：一项随机对照试验，股骨机械解剖角度亚组分析。

IF 2.2 3区医学 Q2 ORTHOPEDICS

Orthopaedics & Traumatology-Surgery & Research

Pub Date : 2026-01-22 DOI: 10.1016/j.otsr.2026.104620

Hui Feng, Mingli Feng, Jingbo Cheng, Wei Wang, Shuai An, Haicheng Tao, Hongchen Ren

Background: Knee osteoarthritis (KOA) is a common degenerative disease impairing elderly mobility. Oxford Unicompartmental Knee Arthroplasty (OUKA) is effective for unicompartmental degenerative osteoarthritis, yet traditional intramedullary alignment methods may cause inaccuracies, compromising outcomes. The purpose of this study was to assess the safety and accuracy of a 3D-printed intramedullary femoral positioning guide in Oxford Unicompartmental Knee Arthroplasty (OUKA), with subgroup analysis by femoral mechanical-anatomical angle (FMA).

Methods: A prospective randomized controlled trial enrolled 120 patients with severe medial knee osteoarthritis undergoing OUKA. Patients were randomly divided into two groups: the experimental group (n = 60) used a 3D-printed intramedullary femoral positioning guide, while the control group (n = 60) employed traditional femoral intramedullary localization. The primary outcome measures were femoral component valgus/varus angle (FCVA) and femoral component posterior slope angle (FCPSA). Secondary outcomes included operative time, tourniquet time, and early postoperative complications. Stratified analyses were performed based on the femoral mechanical-anatomical angle (FMA) using cutoff values of < 5°, 5-7 °, and > 7°.

Results: Among the 119 patients with complete data (one lost to follow-up), no significant differences in FCVA (experimental: -0.63 ° [-2.46 ° to 1.60 °]; control: 2.31 ° [-4.17 ° to 3.12 °], P = 0.438) or FCPSA (9.72 ° [7.24 ° to 11.64 °] vs. 6.93 ° [3.96 ° to 15.70 °], P = 0.401) were observed overall. However, subgroups with FMA <5° or >7° showed significant improvements in FCVA (mean difference: -2.42 °, 95% CI: -3.12 ° to -1.72 °) and FCPSA (3.79 °, 95% CI: 2.45 ° to 5.13 °, both P < 0.05). No differences in operative time, complications, or functional scores were noted. Safety outcomes, including rates of deep vein thrombosis, infection, and prosthesis-related complications, were comparable between groups, with no severe adverse events reported.

Conclusion: 3D-printed guides improve prosthesis alignment in OUKA for patients with FMA <5° or >7° but not for FMA 5-7 °. Clinicians should consider patient-specific anatomical variations when deciding whether to use 3D-printed guides in OUKA.

Level of evidence: I; Randomized controlled trial.

背景：膝关节骨关节炎（KOA）是一种常见的影响老年人活动能力的退行性疾病。牛津单室膝关节置换术（OUKA）对单室退行性骨关节炎是有效的，但传统的髓内对齐方法可能导致不准确，影响结果。本研究的目的是评估3d打印股骨髓内定位指南在牛津单室膝关节置换术（OUKA）中的安全性和准确性，并通过股骨机械解剖角（FMA）进行亚组分析。方法：一项前瞻性随机对照试验纳入120例接受OUKA治疗的严重膝关节内侧骨关节炎患者。患者随机分为两组，实验组（n = 60）使用3d打印的股骨髓内定位导轨，对照组（n = 60）使用传统的股骨髓内定位。主要观察指标为股骨外翻角（FCVA）和股骨后斜角（FCPSA）。次要结果包括手术时间、止血带时间和术后早期并发症。根据股骨力学解剖角（FMA）进行分层分析，临界值为< 5°、5-7°和bbb7°。结果：119例资料完整的患者（1例失访）中，FCVA（实验组：-0.63°[-2.46°~ 1.60°]；对照组：2.31°[-4.17°~ 3.12°],P = 0.438）和FCPSA（9.72°[7.24°~ 11.64°]vs. 6.93°[3.96°~ 15.70°],P = 0.401）总体无显著差异。然而，FMA 7°的亚组在FCVA（平均差值：-2.42°，95% CI: -3.12°至-1.72°）和FCPSA（3.79°，95% CI: 2.45°至5.13°）和FCPSA方面均有显著改善。P结论：3d打印导向器改善了FMA 7°患者的OUKA假体对齐，但对FMA 5-7°没有改善。当决定是否在OUKA中使用3d打印导尿管时，临床医生应考虑患者特定的解剖变化。证据等级：一级；随机对照试验。

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引用次数: 0

Working Through Knee Arthroplasty Recovery: Impact of Socio-Professional Categories on Return to Work After Knee Arthroplasty. A Prospective Study of 120 Patients. 通过膝关节置换术恢复工作：社会专业类别对膝关节置换术后重返工作的影响。120例患者的前瞻性研究。

IF 2.2 3区医学 Q2 ORTHOPEDICS

Orthopaedics & Traumatology-Surgery & Research

Pub Date : 2026-01-22 DOI: 10.1016/j.otsr.2026.104622

Baptiste Bouyge, Simon Marmor, Vasileios Giovanoulis, Eleftherios Tsiridis, Antoine Mouton, Thomas Aubert, Vincent Le Strat, Younes Kerroumi, Wilfrid Graff

Background: Knee osteoarthritis increasingly affects active adults under 65 years of age. As total and unicompartmental knee arthroplasty (TKA/UKA) become common treatments, return to work (RTW) emerges as a key milestone in recovery. While age, obesity, and comorbidities have been identified as predictors, the specific impact of professional occupation remains underexplored. This prospective study addresses this gap by investigating (1) how socio-professional category (SPC) influences the duration of sick leave after knee arthroplasty; and (2) whether physically demanding jobs; higher body mass index (BMI), age, and/ or other demographic or clinical factors are associated with prolonged sick leave.

Hypothesis: The authors hypothesized that the type of profession is the most significant predictor of extended sick leave following knee arthroplasty.

Methods: A prospective, single-center study was conducted involving 120 professionally active patients aged 18-65 years who underwent TKA or UKA between February 2020 and December 2023. Sociodemographic data, job classification (using PCS-ESE 2017), job physical demands, and clinical characteristics were collected. RTW status was evaluated at three months postoperatively, with an additional follow-up at four months for patients with extended sick leave (> 90 days). Univariate and multivariate logistic regression analyses were performed to identify predictors of prolonged sick leave (> 90 days).

Results: While patients in SPC-3 (executives and intellectual professions) and SPC-5 (employees) were significantly associated with prolonged sick leave in univariate analysis (OR = 0.35; 95% CI: 0.15-0.81; p = 0.014 and OR = 3.95; 95% CI: 1.73-8.98; p = 0.001, respectively), neither association was confirmed in multivariate analysis (SPC-3: OR = 1.52; 95% CI: 0.47-4.88; p = 0.484; SPC-5: OR = 2.41; 95% CI: 0.89-6.51; p = 0.0837). Secondly, physically demanding jobs strongly predicted extended sick leave, with nearly a fivefold increase in risk (OR = 4.58 95% CI:1.63-12.87; p = 0.0038). Thirdly, while a trend was observed for higher BMI to be associated with longer sick leave (OR = 1.09; 95% CI: 0.99-1.19; p = 0.060), no significant associations were found for sex, age, ASA score, length of hospital stay, discharge modality, or caregiver availability.

Conclusion: Physically demanding occupations and not professional status are the main factors delaying return to work after knee arthroplasty. In contrast, traditional demographic factors such as sex, BMI and ASA score appear less influential. These findings highlight the importance of integrating occupational context and modifiable risk factors into preoperative planning to facilitate earlier RTW and optimize patient recovery trajectories.

Level of evidence: II; prospective study.

背景：膝关节骨关节炎越来越多地影响65岁以下的活跃成年人。随着全膝关节置换术和单室膝关节置换术（TKA/UKA）成为常见的治疗方法，重返工作岗位（RTW）成为康复的关键里程碑。虽然年龄、肥胖和合并症已被确定为预测因素，但职业的具体影响仍未得到充分探讨。本前瞻性研究通过调查(1)社会专业类别（SPC）如何影响膝关节置换术后病假的持续时间来解决这一差距；(2)是否从事体力要求高的工作；较高的身体质量指数（BMI）、年龄和/或其他人口统计学或临床因素与长时间病假有关。假设：作者假设职业类型是膝关节置换术后延长病假最显著的预测因子。方法：一项前瞻性、单中心研究，纳入120名年龄在18-65岁的职业活跃患者，他们在2020年2月至2023年12月期间接受了TKA或UKA。收集社会人口统计数据、工作分类（使用PCS-ESE 2017）、工作身体需求和临床特征。术后3个月评估RTW状态，4个月时对延长病假（90天）的患者进行随访。进行单因素和多因素logistic回归分析，以确定延长病假（90天）的预测因素。结果：在单因素分析中，SPC-3（高管和智力职业）和SPC-5（员工）的患者与延长病假显著相关（OR = 0.35; 95% CI: 0.15-0.81; p = 0.014和OR = 3.95; 95% CI: 1.73-8.98; p = 0.001），但在多因素分析中，两者均未被证实（SPC-3: OR = 1.52; 95% CI: 0.47-4.88; p = 0.484; SPC-5: OR = 2.41; 95% CI: 0.89-6.51; p = 0.0837）。其次，体力要求高的工作强烈地预示着延长病假，其风险增加了近五倍（OR = 4.58 95% CI:1.63-12.87; p = 0.0038）。第三，虽然观察到高BMI与较长病假相关的趋势（OR = 1.09; 95% CI: 0.99-1.19; p = 0.060），但性别、年龄、ASA评分、住院时间、出院方式或护理人员可用性没有发现显著关联。结论：体力要求高的职业和职业状态不佳是影响膝关节置换术后恢复工作的主要因素。相比之下，传统的人口统计因素，如性别、体重指数和ASA评分似乎没有那么大的影响。这些发现强调了将职业背景和可改变的风险因素纳入术前计划的重要性，以促进早期RTW和优化患者的康复轨迹。证据等级：II；前瞻性研究。

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引用次数: 0

S-shaped capsulotomy-in DDH: better hip exposure and more robust capsulorrhaphy. s型包膜切开DDH：更好的髋关节暴露和更坚固的包膜缝合。

IF 2.2 3区医学 Q2 ORTHOPEDICS

Orthopaedics & Traumatology-Surgery & Research

Pub Date : 2026-01-22 DOI: 10.1016/j.otsr.2026.104619

Mohamed Laklouk, Ahmed Fathy Sadek, Mohamed Sayed Khamies

Developmental dysplasia of the hip (DDH) is one of the most frequent pediatric disorders. Management of DDH is age-related. While an outpatient orthopedic treatment may be initiated during the neonatal period, open reduction with/out pelvic and/or femoral osteotomy is reserved for cases of failed closed reduction or late presentation. Open reduction aims at stable concentric hip reduction, with capsulorrhaphy enhancing stability. An S-shaped capsulotomy is proposed for 10 patients with an average follow-up 9.4 months, to enhance hip joint access and provide a more secure, double-layered capsulorrhaphy. LEVEL OF EVIDENCE: V; Technical note.

髋关节发育不良（DDH）是最常见的儿科疾病之一。DDH的管理与年龄有关。虽然门诊骨科治疗可以在新生儿期开始，但开放复位合并骨盆和/或股骨截骨术保留给闭合复位失败或晚期出现的病例。切开复位的目的是稳定的同心圆髋关节复位，与包膜缝合增强稳定性。10例患者平均随访9.4个月，建议进行s形囊切开术，以增强髋关节通路并提供更安全的双层囊缝合。证据等级：v；技术报告。

引用次数: 0