Acta Orthopaedica最新文献

Background and purpose:  In total knee arthroplasty (TKA), an insert with ball-in-socket (BS) medial conformity (MC) and posterior cruciate ligament (PCL) retention restores kinematics closer to native than an insert with intermediate (I) MC. However, high medial conformity might compromise baseplate stability as indicated by maximum total point motion (MTPM). Using the BS MC insert with PCL retention, we aimed to determine whether (i) the baseplate is stable as indicated by mean MTPM < 0.5 mm, (ii) baseplate stability is not strongly correlated to varus baseplate alignment, and (iii) baseplate stability, clinical outcome scores, and flexion are comparable with that of an I MC insert cohort which has demonstrated high stability, clinical outcome scores, and flexion.

Methods:  Unrestricted kinematic alignment (unKA) TKA was performed on a cohort of 35 patients using a cemented baseplate. Biplanar radiographs acquired at timepoints up to 12 months were processed with model-based radiostereometric analysis (RSA) software to determine MTPM.

Results:  At 1 year, mean MTPM of 0.35 mm was significantly below 0.5 mm (P < 0.001). MTPM was not strongly correlated to varus baseplate alignment up to 9° (r = 0.12, 95% confidence interval -0.22 to 0.44). Equivalence analyses revealed that MTPM, Forgotten Joint Score, Oxford Knee Score, and maximum flexion for the sBS MC insert were comparable with the I MC insert.

Conclusion:  Using the new BS MC insert with PCL retention, the tibial baseplate was stable at the group level at 1 year. Baseplate stability was not strongly related to varus baseplate and limb alignment. Comparable patient-reported outcome scores and maximum flexion/extension at 1 year were shown between the 2 insert designs.

Background and purpose:  Despite evolving management strategies for atypical cartilaginous tumors (ACT)-shifting from radical resection to intralesional curettage and "wait-and-scan" approaches-there remains no universal consensus on optimal treatment. We primarily aimed to evaluate disease-specific and progression-free survival following intralesional curettage and adjuvant phenol treatment of ACTs. Secondary aims included assessing surgical complications, the need for additional interventions, and an overview of long-term follow-up.

Methods:  This retrospective cohort study of 388 ACT patients was conducted at a tertiary referral center from 2000 to 2019. Comprehensive data collection included demographics, tumor characteristics, and follow-up outcomes.

Results: Residual disease was observed in 14% (n = 53) of cases, with continued growth on sequential imaging in one-fourth (n = 13 of 53). Postoperative fractures occurred in 10% (n = 37) after a mean of 7 months, and 16% (n = 61) required a second surgery due to pain or joint movement limitations. There was no malignant progression or mortality observed.

Conclusion:  We found that curettage for ACT is not associated with mortality or malignant progression but does carry risks of complications and residual disease. This raises important questions regarding the necessity of surgical intervention. Further research is needed to refine the treatment approach for ACT.

Background and purpose:  We aimed to determine sex differences for periprosthetic joint infections after primary arthroplasty of the hip, knee, ankle, and shoulder in osteoarthritis patients in an international perspective.

Methods:  This is a multinational combined arthroplasty registry study. Each arthroplasty registry performed Cox-regression analysis of their data and reported the crude and adjusted hazard ratios (HR) with an a priori designed data form. A random-effects model was used to pool these HRs to estimate an overall HR with 95% confidence interval (CI). Adjustment was undertaken for patient age, BMI, ASA grade, type of fixation, and type of implant. 9 arthroplasty registries participated. Patients who received primary total joint arthroplasty for primary osteoarthritis were considered: 2,134,313 hip arthroplasties, 2,658,237 knee arthroplasties, 57,889 shoulder arthroplasties, and 8,445 ankle arthroplasties. We calculated hazard ratios (HR) for the overall risk of complete revision due to infection for each implant type and follow-up.

Results: The pooled HR for revision due to infection for men compared with women at 1-year follow-up was 1.60 (95% confidence interval [CI] 1.42-1.80) for hip arthroplasties; 2.06 (CI 1.90-2.46) for knee arthroplasties; 4.51 (CI 2.99-6.80) for shoulder arthroplasties; and 0.87 (CI 0.46-1.62) for ankle arthroplasties. These results remained consistent over time and were identified in both unadjusted and adjusted models.

Conclusion:  Men have a higher risk of revision due to infection than women after primary hip, knee, and shoulder arthroplasty. No evidence of difference was found for ankle arthroplasty. These elevated relative risks persist in the fully adjusted investigations and over the 10-year postoperative period studied.

Background and purpose:  Our primary aim was to compare the early complication rate (< 6 weeks postoperatively) after open or arthroscopic fusion of the subtalar joint. Secondary outcomes included late complications (> 6 weeks postoperatively), function, pain, and patient satisfaction.

Methods:  In this prospective randomized controlled trial, patients listed for subtalar joint fusion were included and randomized for open or arthroscopic fusion. Complications were assessed at scheduled visits at 2 and 6 weeks, 3, 6, and 12 months postoperatively. Functional scores, pain scores, and patient satisfaction were assessed at 3, 6, and 12 months postoperatively, and PROMS at baseline (preoperatively), 3, 6, and 12 months postoperatively. The scores were compared over time between the groups using Fisher's exact test and linear mixed models.

Results:  51 patients were included between 2013 and 2020, of whom 25 were allocated to open and 26 to arthroscopic fusion. 3 early complications (2 sural nerve lesions, 1 infection) occurred in the open fusion group (12%; 95% confidence interval [CI] 3-32) and 3 (2 wound healing problems, 1 screw exchange) in the arthroscopic group (12%; CI 3-31). Late complications included screw removal (n = 5) in the open fusion group versus screw removal (n = 5), non-union (n = 2), bony prominence/calcification removal (n = 1), sural nerve lesion (n = 1), lesion of the calcaneal branch of the tibial nerve (n = 1), complex regional pain syndrome type II (n = 1), and secondary plantar fasciitis (n = 1) in the arthroscopic fusion group. No superiority of arthroscopic over open fusion was found regarding early (P = 1.0) and late complications (P = 0.2), function and pain scores, and patient satisfaction over 12 months Conclusion: Arthroscopic fusion did not result in fewer early complications compared with open fusion. Secondary outcomes did not differ significantly between the approaches.

Background and purpose:  We aimed to compare the effect of calcium sulphate (CS) beads loaded with antibiotics on infection eradication in debridement, antibiotics, and implant retention (DAIR) of periprosthetic joint infection relative to DAIR without local antibiotics delivery.

Methods:  176 patients with hip or knee arthroplasty undergoing DAIR were retrospectively identified and divided into a bead group (n = 102) and a control group (n = 74). Infections were classified as early postoperative, acute hematogenous, and chronic. Logistic regression analyses were performed on the use of CS beads. Revision-free and infection-free survival was estimated using Kaplan-Meier analysis.

Results:  Reinfection occurred in 36% of the bead group, and 39% of the control group (odds ratio [OR] 0.9, 95% confidence interval [CI] 0.5- 1.6); reoperation rates were 34% and 43% (OR 0.7, CI 0.4-1.3). Kaplan-Meier analysis showed no statistically significant difference between the 2 groups regarding infection-free (HR 1.1, CI 0.7-1.8) and revision-free (HR 1.1, CI 0.7-1.9) survival rates. In acute hematogenous PJIs, reinfection (29% vs 56%, OR 0.3, CI 0.1-1.1) and reoperation rates (25% vs 61%, OR 0.2, CI 0.1-0.8) were reduced when CS beads were used; Kaplan-Meier analysis revealed higher infection-free (HR 0.5, CI 0.2-1.4) and revision-free (HR 0.5, CI 0.2-1.3) survival rates in the bead group but not of statistical significance. Wound drainage was not increased by CS beads use (OR 1.0, CI 0.99-1.01), but hypercalcemia was seen in 9% in the bead group.

Conclusion:  DAIR with antibiotic-loaded CS beads did not improve outcome in early postoperative and chronic PJIs, but reduced the reoperation rate in acute haematogenous infections with similar results compared with early postoperative PJIs.

Background and purpose:  The heterogeneous outcomes used in lower-limb lengthening surgery (LLLS) complicate evidence synthesis, weakening systematic reviews and clinical recommendations, and reducing research impact. This scoping review maps the outcomes and outcome measurement instruments (OMIs) used in LLLS.

Methods: This pre-registered review systematically identified studies reporting outcomes in adults or children who underwent LLLS. Outcomes and OMIs were extracted verbatim, and experts grouped outcome terms under headings using the COMET taxonomy.

Results:  The search found 5,308 unique hits, including 149 studies from 2020-2024. They reported 2,939 verbatim outcomes, which were consolidated into 92 outcome headings and 27 subheadings. "Life impact" accounted for 13%, while "Clinical outcomes" represented 83% of all outcomes. Among the clinical outcomes, "Musculoskeletal and connective tissue" was the most reported outcome domain (68% of all outcomes). The most frequently reported outcomes were "Lengthening," "Bone healing," "Range of motion," "Limb alignment", and "Complications."

Conclusion:  Outcomes reported for people undergoing LLLS are heterogeneous and vary widely in the definitions and measurement tools used to collect them. Outcomes likely to be important to patients (life impact outcomes), such as quality of life and measures of physical function, are rarely reported.