Acta Orthopaedica最新文献

Background and purpose:  The treatment of acetabular fractures remains technically demanding. In the case of reduced bone quality or fracture morphology reducing the amount of bone available for fixation, locking plates should provide considerable advantages. The aim of the present study was to compare conventional and locking plate fixation. It was hypothesized that locking plate fixation provides less displacement and higher construct stiffness.

Methods:  A T-shaped acetabular fracture was simulated in 16 synthetic pelvic models. The fracture was addressed with a biplanar 10-hole 2-column plate buttressing the medial acetabular wall. Optical markers were attached to the fracture sites for motion tracking. Standardization of the acetabulum loading mechanism was performed using a unipolar hemiarthroplasty. The primary outcome measure was displacement at the fracture sites. The secondary outcome measure was the construct stiffness (N/mm).

Results:  Fracture displacement was less in the group of angular stable implants compared with the group fixed with conventional non-locking implants. Under cyclic loading displacement was less in the group of locking plate fixation. No differences in mean initial axial stiffness were detected between locking plate fixation (407 N/mm) and conventional plating (308 N/mm, ∆ 99 N/mm, 95% confidence interval -48 to 245).

Conclusion:  We showed that locking plate fixation buttressing the medial acetabular wall achieved less fracture displacement but showed no differences in axial stiffness compared with conventional plating.

Background and purpose:  The primary aim of this study was to assess the patient's self-reported change in health 1 year after sustaining an acetabular fracture. The secondary objective was to examine differences in patient-reported outcomes (PROMs) based on sex, age groups, injury mechanisms, type of fracture, and treatment.

Methods:  Data was collected from the Swedish Fracture Register (SFR) for patients with acetabular fractures sustained between 2014 and 2021. Patients with additional fractures at the time of injury or during the following 18 months, periprosthetic fractures, or pediatric fractures were excluded. The PROM used was the Short Musculoskeletal Function Assessment (SMFA) wherein the subindices of bother, dysfunction, and mobility were analyzed with a higher score indicating worse outcome. The differences in SMFA and in subindices between the score 1 year after fracture and preinjury (recall) were analyzed.

Results:  Of the 385 included patients with complete PROMs, there was no significant difference in changes in SMFA score between the sexes. Surgically treated patients had significantly higher scores 1 year post-injury compared with non-surgically treated patients with bother index 18.3 (95% confidence [CI] 14.0-22.6) vs 7.2 (CI 4.7-9.8), dysfunction index 15.8 (CI 12.7-18.9) vs 7.0 (CI 5.0-9.0), and mobility index 21.6 (CI 17.9-25.2) vs 9.2 (CI 6.9-11.5).

Conclusion:  Most patients sustaining an acetabular fracture experience a decline in their functional abilities 1 year after the injury compared with before the injury. Younger patients with high-energy injuries and complex fracture types, which typically require surgical intervention, experience the most unfavorable outcomes. The large group of non-surgically treated patients reported minimal functional changes, likely attributable to selection bias.

Background and purpose:  As digital health services become increasingly important in osteoarthritis treatment, understanding patients' digital health literacy (eHL) is crucial, including those undergoing total hip and knee arthroplasty (THA/TKA). We primarily aimed to provide eHL norms in a representative group of Norwegian patients, and secondarily to examine the relationships between eHL and health-related quality of life (QoL).

Methods:  We invited 800 randomly selected THA/TKA patients from the Norwegian Arthroplasty Register to complete a paper-based questionnaire, which included sociodemographic variables. eHL was measured using the eHealth Literacy Questionnaire (eHLQ) with 7 domains: Using technology, Understand, Engage, Control, Motivation, Access, and Needs, scored from 1 (strongly disagree) to 4 (strongly agree). The EuroQol EQ-5D-5L measured health-related QoL. We used multivariable regression to examine relationships between eHL domains and health-related QoL controlling for sociodemographic variables.

Results:  Respondents' (N = 383, 48%) mean age was 70 years (SD 9.0) and 246 (64%) were female. Mean eHLQ and the proportion of patients with low eHL (≤ 2.5) were Technology 2.7 (34%), Understanding 3.0 (14%), Engage 2.7 (28%), Control 3.2 (7.7%), Motivation 2.8 (35%), Access 2.8 (33%), and Needs 2.6 (46%). Low eHL correlated with older age and low education, but not with sex or type of surgery. Regression analyses showed that lower scores on the domains Technology, Engage, Control, Access, and Needs were associated with poorer QoL after adjusting for sociodemographic factors.

Conclusion:  About one-third of THA/TKA patients have low eHL, and low eHL was associated with poor QoL.

Background and purpose:  External validation is a crucial step after prediction model development. Despite increasing interest in prediction models, external validation is frequently overlooked. We aimed to evaluate whether joint registries can be utilized for external validation of prediction models, and whether published prediction models are valid for the Dutch population with a total hip arthroplasty.

Methods:  We identified prediction models developed in patients undergoing arthroplasty through a systematic literature search. Model variables were evaluated for availability in the Dutch Arthroplasty Registry (LROI). We assessed the model performance in terms of calibration and discrimination (area under the curve [AUC]). Furthermore, the models were updated and evaluated through intercept recalibration and logistic recalibration.

Results:  After assessing 54 papers, 19 were excluded for not describing a prediction model (n = 16) or focusing on non-TJA populations (n = 3), leaving 35 papers describing 44 prediction models. 90% (40/44) of the prediction models used outcomes or predictors missing in the LROI, such as diabetes, opioid use, and depression. 4 models could be externally validated on LROI data. The models' discrimination ranged between poor and acceptable and was similar to that in the development cohort. The calibration of the models was insufficient. The model performance improved slightly after updating.

Conclusion:  External validation of the 4 models resulted in suboptimal predictive performance in the Dutch population, highlighting the importance of external validation studies.

Background and purpose:  Safety notices for medical devices such as total knee arthroplasty (TKA) implants may indicate problems in their design or performance that require corrective action to prevent patient harm. Safety notices are often published on national Ministries of Health or regulatory agencies websites. It is unknown whether problems triggering safety notices identify the same implants as those identified by registries as "outlier." We aimed to assess the extent to which safety notices and outlier identification in registries signal the same or different TKA implants.

Methods:  The CORE-MD tool, an automated web scraper tool, was used to collect safety notices related to TKA implants on 13 national Ministries of Health websites and regulatory agencies. Safety notices were defined according to the Medical Device Regulation (MDR) as "a communication sent by a manufacturer to users or customers in relation to a field safety corrective action." Identified TKA outliers, defined as having a significantly higher revision risk than other comparable TKA implants, were extracted from registry reports.

Results:  787 safety notices for 38 TKA implants and 35 TKA outliers were identified, together identifying 47 unique TKA implants. 26 (55%) TKA implants had safety notices and were also outliers, 12 (26%) TKA implants had only safety notices, and 9 (19%) were outliers only. TKA implants with safety notices only had similar types of problems to TKA outliers with safety notices, with "Manufacturing/Packaging/Shipping" problems being most frequent (44%). Cumulative revision risks (1/5/10 years) were lower for TKA implants with safety notices only than for TKA outliers with safety notices.

Conclusion:  55% of the TKA with a safety notice were identified as outliers in the registry, whereas around 25% of TKA outliers are not the subject of publicly released safety notices, with safety notices pointing to TKA implants not identified by registries as potentially having a higher risk of failure. This suggests that safety notices and registry outlier data measure different aspects of safety and performance.

Background and purpose:  Acetabular fractures in osteoporotic bone are associated with substantial joint impaction and comminution, previously shown to be prognostic for a poor result. A combined procedure of open reduction, internal fixation (ORIF), and total hip arthroplasty (THA) can be a good option, allowing for immediate weightbearing as tolerated. We report short- to medium-term outcome and complications of the results of patients treated with this combined procedure.

Methods:  48 cases treated with ORIF and acute THA from 2000 to 2019 were identified from our local pelvic fracture registry, from which follow-up data was extracted. Descriptive statistics were used and Kaplan-Meier survival curves were calculated. Primary outcome was HHS at 1 year. Secondary outcomes were implant survival, complications requiring surgery, and mortality at 3 months.

Results:  There were 37 men and 11 women treated in the study period. Mean age was 68 (37-87) years. 6 patients died within 3 months of surgery, leaving 42 cases available for follow-up. Mean follow-up (FU) was 2.8 (1-16) years. The most common mechanism of injury was fall from standing height (n = 36). Medical comorbidities were common. Mean Harris Hip Score (HHS) was 83 (51-100) at 1-year follow-up. There were 7 reoperations: 6 for postoperative infection and 1 closed reduction of implant dislocation. 38 had their implant intact at latest FU. At the latest FU, 28 patients were ambulatory without a walking aid.

Conclusion:  Our results indicate that ORIF and acute THA can be performed with good functional results in patients with unreconstructable displaced acetabular fractures, but with a significant risk of infection and revision.

Background and purpose:  12-18% of patients encounter adverse events after distal radius fracture (DRF) surgery with volar locking plates (VLPs). Risk factors for which preventive measures could be administered are currently scarce. We aimed to examine the incidence of postoperative adverse events and assess the causes and risk factors for the adverse events after VLP fixation of DRFs.

Methods:  We performed a single-center retrospective cohort study evaluating all adult DRF patients treated with VLP fixation between 2009 and 2019 at Helsinki University Hospital. Patients with previous disabilities or ulnar fractures, other than styloid process fractures, in the affected extremity were excluded. We examined each patient's treatment using the electronic medical records system and identified postoperative adverse events defined as any deviation from the ordinary postoperative course, showcasing clinical symptoms. We used multivariable binary logistic regression to assess the risk for adverse events.

Results:  2,790 cases of DRF were included. The incidence of adverse events was 16%. Hardware complications (8.3%), predominantly intra-articular screws (4.9%), were the most commonly encountered adverse events. Other frequent adverse events included carpal tunnel syndrome (2.8%), tendon complications (2.8%), and surgical site infections (1.5%). In the multivariable analysis, smoking, higher body mass index (BMI), alcohol abuse, C-type fractures, residual intra-articular displacement, and dorsal tilt were found as risk factors for adverse events.

Conclusion:  The incidence of adverse events was 16% after VLP fixation of DRFs. We identified several new risk factors for adverse events, which included residual dorsal tilt, intra-articular dislocation, insufficiently corrected inclination, smoking, alcohol abuse, and higher BMI.

Background and purpose:  National joint replacement registries were developed for prospective monitoring of outcomes and post-market surveillance of implants. Increasingly registry data informs practice. However, analysis of a registry can only be as good as the data it captures on the population of interest. We aimed to analyze completeness of reporting of hip and knee replacement procedures for all national registries worldwide.

Methods: We analyzed annual reports and data provided following written requests to all active national hip and knee replacement registries. Coverage was defined as the proportion of hospitals in the country that participate in the registry. Procedure completeness was defined as the proportion of procedures successfully captured by the registry.

Results:  14 national registries were included, spanning years 2004 to 2022. Coverage was complete in 10. Median procedure completeness for primary hip and knee replacement across all years was 96.5% (interquartile range [IQR] 94.0-97.7%). Median procedure completeness for revisions was 88.5% (IQR 81.0-92.5%). The terminology used and method of calculation of completeness estimates in the registries were variable.

Conclusion:  National hip and knee replacement registry data generally reflects excellent coverage (full in 10 of 14 registries) and completeness (primary procedures 96.5% and revisions 88.5%) over the last 2 decades.

Background and purpose:  Physical function and pain are the most important outcomes following total knee arthroplasty (TKA). These can be evaluated by patient-reported outcome measures (PROMs), or by an anchor question. The primary aim of the study was to evaluate whether a simple anchor question can replace KOOS-PS in assessing postoperative knee function until 1-year follow-up, evaluated by analyzing the agreement between the 2 methods using the diagnostic odds ratio (DOR). Secondary aims were pain (NRS) at rest and during mobilization.

Methods:  This is a diagnostic accuracy study with primary TKAs performed between 2010 and 2022. The surgeries were categorized as improved (I) or worsened (W) based on a dichotomized anchor question related to self-perceived change in physical function, and the dichotomized change in KOOS-PS until 1-year follow-up. This led to 4 groups: (II, IW, WI, and WW).

Results:  Agreement was found with a DOR of 11.3 (CI 7.9-16.2). 2,335 (94%) reported improved function on the anchor question and 143 (6%) worsened function. Among those with improved anchor 2,132 (91%) had improved KOOS-PS, but among those with worsened anchor only 74 (52%) had worsened KOOS-PS. Pain at 1-year follow-up was lower in the groups reporting improved anchor.

Conclusion:  The KOOS-PS can be replaced with an anchor question to assess change in function until 1 year. However, the KOOS-PS might be a valuable supplement in patients reporting worsened anchor as only half of those had worsened KOOS-PS.

We would like to inform of an error in the reported incidences in our published article, Regional variation in low-value musculoskeletal surgery: a nationwide study from the Finnish Care Register. Specifically, the incidences for rotator cuff repair, partial meniscectomy, ankle arthroscopy, distal radius fracture fixation, and wrist arthroscopy surgeries were calculated using a too small population size. Accordingly, corrected calculations resulted in higher incidence values for these surgeries, impacting Table 3 and Figure 3, which now show accurate incidence rates. We have also updated Figure 6 and the corresponding sections of the results accordingly. These corrections did not affect any other figures or tables, not the overall conclusions, and the text in the discussion section remains unchanged. The correct data further emphasizes the findings in our original article. We apologize for any confusion caused by these errors and appreciate the opportunity to correct the publication.