Acta Orthopaedica最新文献

Background and purpose:  Our aim was to study the association between chronic preoperative opioid use and 1-year revision rate, mortality, and patient-reported outcomes (PROs) after primary total knee and hip arthroplasty (TKA/THA). We also investigated whether age, sex, or BMI modified these associations.

Methods:  TKAs and THAs performed for osteoarthritis between 2013 and 2018, originating from the Dutch Arthroplasty Register, were linked to the Dutch Foundation for Pharmaceutical Statistics. Chronic preoperative opioid use was defined as > 1,800 morphine mg equivalent dispensed 1 year before surgery and ≥ 1 opioid prescribed 30 days before surgery. Outcomes were 1-year revision rate, mortality, self-reported physical functioning, pain, and quality of life (QoL). Incidence rates were calculated; Cox regression and linear mixed models were used. We assessed effect modification by assessment of supra-additive effects.

Results:  Preoperative chronic opioid use occurred in 4.5% of 29,739 THAs and 3.4% of 27,873 TKAs. Chronic opioid use doubled mortality and revision rates for both TKAs and THAs (range of hazard ratios 1.7-2.1). The association of preoperative opioid use with 1-year revision rate was larger in males, in patients with a BMI ≤ 30 (THA) and > 30 (TKA), and 66-75-year-olds. Younger patients exhibited a more pronounced association between opioid use and reduced physical functioning and QoL, and increased pain. Sex and BMI had no modifying effects on PROs.

Conclusion:  Preoperative chronic opioid use was associated with a higher likelihood of 1-year revision and mortality and worse PROs. The associations with revision risk were modified by age, sex, and BMI. Age also had a modifying effect on PROs.

Background and purpose:  Deformity correction with pedicle screw instrumentation in adolescent idiopathic scoliosis has been shown to improve the health-related quality of life (HRQoL), while evidence on syndromic scoliosis is limited. Syndromic patients tend to have comorbidities resulting in a higher risk of perioperative complications. We aimed to assess the change in HRQoL in patients with syndromic scoliosis compared with adolescent idiopathic scoliosis after spinal fusion with pedicle screw instrumentation.

Methods:  We conducted a retrospective case-control study in children undergoing segmental pedicle screw instrumentation for syndromic scoliosis between 2009 and 2023 with a 2-year follow-up. For each syndromic patient, 2 controls with adolescent idiopathic scoliosis were matched for sex and age. The Scoliosis Research Society-24 (SRS-24) questionnaire was used to assess HRQoL preoperatively and at follow-up.

Results:  35 syndromic (mean age 14.1 years) and 70 adolescent idiopathic patients (mean age 15.1 years) were included. The SRS-24 total score remained stable from preoperative to 2-year follow-up in both groups (median difference for change 0.05, 95% confidence interval [CI] -0.40 to 0.30). The pain domain improved 0.9 points (standard deviation [SD] 0.9) in syndromic and 1.0 points (SD 0.7) in adolescent idiopathic scoliosis patients. Non-ambulatory patients had greater improvement in pain than ambulatory syndromic patients (mean difference between groups 0.66, CI 0.15-1.24). 8 syndromic patients had complications compared with 3 adolescent idiopathic scoliosis patients (risk ratio 5.3, CI 1.5-19). One syndromic patient died during follow-up.

Conclusion:  The health-related quality of life in patients with syndromic scoliosis was comparable to patients with adolescent idiopathic scoliosis after posterior spinal fusion with segmental pedicle screw instrumentation.

Background and purpose:  An important aspect of orthopedic residency is to gain experience and perform total joint arthroplasties to learn operating skills. For patients, a substantial concern is that resident involvement may result in more adverse events. We performed a systematic review with meta-analysis to evaluate whether resident involvement is associated with a higher complication rate in total hip and knee arthroplasty compared with procedures performed by orthopedic surgeons.

Methods:  PubMed, Embase, Central, Cinahl, and Web of Science were systematically searched until November 2, 2023. Studies were assessed by 2 reviewers independently. All manuscripts were included describing: (i) complications in total hip and/or knee arthroplasty and (ii) comparing procedures with and without resident involvement.

Results:  29 studies could be included with a MINORS score ranging from 10 to 17. Resident involvement could not be associated with an increased overall and surgical complication rate in 9 (n = 51,442 patients) and 12 studies (n = 37,789 patients), respectively. The meta-analysis for deep infection showed an association with resident involvement (RR 1.55, 95% confidence interval 1.09-2.20, P = 0.01, 18 studies). In single studies, associations were seen for any urologic complication and sepsis. All other complications could not be related to resident involvement.

Conclusion:  This systematic review could not find evidence that resident involvement was associated with more overall complications or surgical site complications except for deep infection. As previous studies showed an increased infection risk with prolonged duration of the procedure, consultants in teaching hospitals should be aware of this risk and be alert to teaching time to limit the risk for patients.

Background and purpose:  Anatomic total shoulder arthroplasty (aTSA) is an effective treatment for glenohumeral osteoarthritis, but loosening of the glenoid component is a common cause for revision. Our primary aim was to analyze migration of a hybrid glenoid component in aTSA using marker-based radiostereometric analysis (RSA). Second, we aimed to compare early migration with later revision.

Methods:  Patients with primary glenohumeral osteoarthritis treated with a hybrid glenoid aTSA had tantalum markers inserted in the scapular bone and the glenoid component from 2017 to 2020. We used hybrid glenoid fixation techniques combining cementation with bone in-growth. Patients were followed with RSA radiographs for 24 months. Migration analyses included translation, rotation, and MTPM (maximum total point of motion). Data regarding revisions was retrieved from the Danish Shoulder Arthroplasty Register.

Results:  72 patients were included (mean age 69 [SD 8] years, 41 females, 37 left shoulders). The mean MTPM at 24 months was 0.97 mm (95% confidence interval [CI] 0.85-1.1), but migration occurred mainly within the first 6 months (MTPM 0.88 mm, CI 0.78-0.98). The predominant movement was valgus rotation. 2 cases were revised and both had positive cultures. 1 of these had major migration and was found to be loose at revision.

Conclusion:  The hybrid glenoid components migrated mainly within the first 6 months (initial seating). Thereafter the components reached a plateau phase and stabilized. Due to the few observations and the relatively short study period, association between early migration and later revision could not be evaluated.

is missing (Erratum) This Erratum relates to the following article: https://doi.org/10.2340/17453674.2025.42999.

Background and purpose:  Limited population-based data is available concerning traumatic joint dislocations in children and adolescents. We aimed to determine the incidence, typical locations, and demographic patterns of joint dislocations in a pediatric population.

Methods:  This retrospective, population-based study analyzed pediatric joint dislocations in the Helsinki University Hospital catchment area from 2009 to 2021. Data was retrieved from electronic health records using ICD-10 codes and radiological keywords. Primary radiographs were reviewed to confirm diagnoses. Incidences were calculated using population data, and trends were analyzed by age, sex, and dislocation site. 2,741 traumatic dislocations were included.

Results:  The overall annual incidence of joint dislocations was 69 per 100,000 children, with a higher incidence in boys than in girls (72 vs 66 per 100,000, odds ratio 1.1, 95% confidence interval 1.02-1.2). The peak incidence occurred at 16 years of age for boys and 15 years of age for girls. Patellar (49%), elbow (19%), finger (12%), and glenohumeral (10%) dislocations accounted for 90% of cases with respective mean incidence; 35, 13, 8.4 and 7.1 per 100,000.

Conclusion:  The annual incidence averaged 69 per 100,000 children. Joint dislocations in children predominantly affect the patellar, elbow, finger, and glenohumeral joints, with adolescence being the most vulnerable period.

Background and purpose:  Reliable assessment of fracture healing remains a clinical challenge as radiographs and clinical examination provide only indirect information. Inducible fracture micromotion, defined as fragment displacement under load, may offer a more direct surrogate for healing. Radiostereometric analysis (RSA) can measure micromotion with high precision, but its clinical use for fracture assessment remains limited and heterogeneous. This scoping review aimed to map the existing literature on RSA for inducible fracture micromotion and summarize methodological approaches to guide future research.

Methods:  We systematically searched Medline, Embase, and Scopus. Clinical studies applying RSA to assess inducible fracture micromotion were eligible. 2 reviewers independently screened and extracted data on study design, patient population, fracture location, loading protocols, thresholds for motion, and outcomes.

Results:  7 clinical studies were included, comprising feasibility studies, prospective cohorts, and 1 imaging study. Sample sizes ranged from 6 to 16 patients, with fractures of the distal radius, femur, proximal tibia, and pelvis. All studies required intraoperative implantation of tantalum markers. Most applied differentially loaded RSA, typically comparing unloaded and loaded conditions using weightbearing platforms, force plates, or voluntary grip dynamometry. Despite varied protocols and small, single-center designs, RSA consistently detected small-scale inducible motion and, in some studies, distinguished union from non-union.

Conclusion:  This scoping review identified 7 clinical studies using RSA to assess inducible fracture micromotion, with heterogeneous methods across fracture types. These findings may guide the development of standardized approaches and support future research on RSA in fracture healing.

Background and purpose:  Contemporary data on the risk of chronic pain after total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) is limited. Therefore, we aimed to investigate the incidence of chronic pain, pain characteristics, patterns of analgesic use, patient satisfaction, and willingness to undergo the same surgery again, 1 year after primary TKA and UKA for osteoarthritis.

Methods:  We conducted a nationwide online survey among unselected patients who underwent primary TKA or medial UKA for primary osteoarthritis in Denmark. At 1 year postoperatively, we assessed the incidence of moderate to severe pain (≥ 4 on the 0-10 numerical rating scale), frequency of pain, pain interference with everyday life, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain domain, the Douleur Neuropathique 4 interview (DN4i), use of analgesics, satisfaction, and willingness to undergo the same surgery again.

Results:  We sent survey invitations to 2,580 TKA patients and 1,007 UKA patients who underwent surgery in 2022. Of the 70% TKA respondents, 25% had moderate to severe chronic pain, 82% were satisfied/very satisfied with the result of surgery, and 86% indicated that they would choose to undergo surgery again. Of the 75% UKA respondents, 23% had moderate to severe chronic pain, 86% were satisfied/very satisfied, and 88% would undergo the same surgery again.

Conclusion: In Denmark, 25% of TKA patients and 23% of medial UKA patients experienced moderate to severe knee pain after 1 year. These numbers were higher than most previous estimates. Most patients were satisfied with the result of surgery and would undergo the same surgery again.

Background and purpose: Cemented fixation is widely recommended during arthroplasty for hip fractures, yet it has not been universally adopted by all surgeons and hospitals. We aimed to identify which factors were associated with a higher likelihood of cemented fixation.

Methods: We identified patients ≥ 55 years old with hip fractures treated with primary arthroplasty in Canada between 2012 and 2022. We determined fixation method along with several surgeon and hospital characteristics from the Canadian Joint Replacement Registry and other Canadian databases. We used logistic regression to estimate the odds ratios (ORs) of the association between these covariates and cemented fixation.

Results: We identified 65,823 patients who underwent arthroplasty for hip fractures. The proportion of cases with cemented fixation for hemiarthroplasty increased by 30 percentage points over the study period; the proportion for total hip arthroplasty (THA) remained relatively stable. High-volume hospitals (≥ 500 annual hip arthroplasties with ≥ 25% of these for fractures) were least likely to cement, OR = 0.30; 95% confidence interval (CI) 0.27-0.34 vs low-volume hospitals (< 500 cases/< 25% for fractures). High volume surgeons (≥ 50 hips/year, ≥ 16/year for fractures) had an OR of 0.80 (CI 0.75-0.84) compared with < 50 hips/year surgeons. Teaching hospitals were more likely to cement, OR = 1.16 (CI 1.10-1.22). The OR of cemented fixation for hemiarthroplasty (vs THA) rose from 1.13 (CI 0.99-1.29) at the start of the study period to 2.17 (CI 2.02-2.33) at the end.

Conclusion: The use of cemented fixation in hip fracture arthroplasty has increased across Canada over the last decade. However, surgeons and hospitals that treat more hip fracture patients are less likely to cement. The proportion of cemented fixation increases with patient age. Cement use is more common in hemiarthroplasty than in THA.