Acta Orthopaedica最新文献

Background and purpose:  Data on distal radius fractures (DRFs) with concomitant metaphyseal distal ulna fractures is limited. We aimed to determine whether a combined DRF and distal ulna fracture (DRUF) predicts a worse patient-reported outcome, measured by the Disabilities of the Arm, Shoulder, and Hand (DASH) score, 1 year after injury.

Methods:  This prospective registry-based cohort study included 5,536 adult patients with a DRF between 2003 and 2018. The 1-year DASH scores were recorded. All DRUFs were identified. Multivariable binary logistic regression assessed whether the presence of a distal ulna fracture predicted a 1-year DASH score > 35, indicating severe upper-extremity symptoms.

Results:  259 of 5,536 patients (4.7%) had a DRUF. Their mean age was 73 years (SD 15), and 86% were women. The median 1-year DASH score was higher in the combined fracture group compared with those with a DRF only (23, interquartile range [IQR] 5-45] vs 9, IQR 2-27, P < 0.001). A DRUF increased the odds of a 1-year DASH > 35 by 97% (OR 1.97, 95% confidence interval [CI] 1.40-2.75, P < 0.001). Surgical fixation of the DRF in DRUF patients was associated with lower odds of a worse outcome (OR 0.44, CI 0.23-0.85, P = 0.02). Distal ulna fracture fixation did not affect 1-year DASH (P = 0.7).

Conclusion:  The odds of having a DASH > 35, indicating severe symptoms, almost doubled at 1 year in patients with a DRUF compared with those with a DRF only.

Background and purpose:  An important quality indicator of perioperative care is the all-cause 30-day mortality. Little is known about early mortality after foot and ankle fracture repair. We aimed to assess the all-cause 30-day mortality associated with surgical repair of foot and ankle fractures in Sweden during 2017-2022 and its seasonal variation.

Methods:  Foot and ankle fracture patients aged ≥ 18 years registered in the Swedish Perioperative Quality Register (SPOR) between 2017 and June 30, 2022 were included in the analysis (n = 26,404). Patient characteristics, perioperative observations, and early mortality were collected. Seasonal variation was analyzed for summer, autumn, winter, and spring. Perioperative mortality rate and odds ratio (OR) are reported with 95% confidence intervals (CI).

Results:  The all-cause 30-day mortality rate was 58 of the 26,404 studied patients (0.22%, CI 0.17-0.28). There was no change in mortality rate over the study period including the COVID-19 pandemic year. Increased adjusted odds ratio (OR) for 30-day mortality was seen among the elderly, age > 80 years, OR 22 (CI 9.2-50), and those with low health status, ASA class 3-4, OR 4.2 (CI 2.3-7.9), while surgery during summer was associated with a lower adjusted OR 0.4 (CI 0.1-0.9).

Conclusion: The all-cause 30-day mortality rate after foot and ankle fracture surgery in Sweden is reassuringly low with expected higher OR for mortality associated with age and health status, while surgery during summer months was associated with lower mortality.

Background and purpose:  Periacetabular osteotomy (PAO) is a major surgical procedure, yet data on early postoperative complications and hospitalizations remains limited. We aimed to report postoperative complications within 90 days using the modified Clavien-Dindo classification system. Our secondary aim was to report the peri- and postoperative complications observed in patients with length of hospital stay (LOS) exceeding 4 days or readmitted within 90 days following PAO.

Methods:  We identified patients who underwent PAO at a single institution between 2006 and 2021. Patient characteristics, LOS, in-hospital complications, and readmissions within 90 days postoperatively were obtained from our institutional database, patient files, and the Danish National Patient Registry to ensure complete follow up. Minor complications were defined as Clavien-Dindo grades 1 and 2, while major complications were defined as grades 3 and 4.

Results:  1,356 consecutive PAO procedures were performed in 1,096 patients with a mean age of 29.3 years (SD 11.1) and 77% females. Minor complications occurred in 499 hips (37%, 95% confidence interval [CI] 35-39) within 90 days of PAO. Only 16 (1.2%, CI 0.6-1.8) major complications were observed. LOS exceeded 4 days in 244 cases (18%) most frequently linked with nausea and emesis in 40 (2.9%). The 90-day readmission rate was 4.4% (CI 2.6-6.2), most commonly linked with pain in 11 (1.0%) and wound infection requiring antibiotics also in 11 (1.0%).

Conclusion:  PAO was associated with 37% minor complications within 90 days, while major complications were rare, occurring in only 1.2% of cases. After 18% of PAO procedures, LOS exceeded 4 days, and the 90-day readmission rate was 4.4%.

Background and purpose:  Arthroplasty registries report revision risk, but patient-reported outcomes may also measure implant performance. We aimed to evaluate (i) change in patient-reported outcome measures (PROMs) across multiple total knee arthroplasty (TKA) designs in a regional registry, (ii) the association of patellar resurfacing on the change in PROMs, and (iii) the variation in PROMs change within implants with or without patellar resurfacing.

Methods:  This is a cohort of primary TKAs from Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) performed between January 1, 2017 and September 30, 2021. The dependent measure was change in KOOS JR. Independent variables were implant name and patellar resurfacing. Multivariate modeling adjusted for patient-level factors. A previous report suggests a change of 23 points in KOOS JR as clinically relevant in achieving acceptable pain/function levels. A clinically relevance ratio (CRR) of those achieving the threshold of 23 points to the overall group was calculated for each implant.

Results:  18 implant designs met the inclusion criteria. There were 51,606 cases with complete preoperative and postoperative KOOS JR matched pairs. There was variation in improvement from preoperative to postoperative unadjusted KOOS JR scores across implant designs (P < 0.001), ranging from 18.7 (95% confidence interval [CI] 16.8-20.6) to 27.0 (CI 24.9-29.2). Patellar resurfacing resulted in greater KOOS JR improvement 1.0 (CI 0.5-1.5, P < 0.001). Of the cases with resurfaced patellae, the CRR was 50.2% (CI 49.7-50.7). For cases without resurfaced patellae, the CRR was 47.2% (CI 45.9-48.5). The association of implant design persisted whether the patella was resurfaced or not, evident in the adjusted mean change in KOOS JR (P < 0.001), ranging from 20.1 (CI 17.6-22.6) to 25.5 (CI 24.3-26.7) for resurfaced and from 17.0 (CI 13.9-20.1) to 23.3 (CI 20.3-26.2) for not resurfaced, and the CRR difference (P < 0.001), ranging from 45.8% (CI 42.5-48.6) to 55.8% (CI 50.4-60.8) for resurfaced and from 37.9% (CI 27.4-44.7) to 51.4% (CI 43.9-56.6) for not resurfaced.

Conclusion:  Implant design and patellar resurfacing both show an association with KOOS JR improvement. Variations in implant design persist whether the patella is resurfaced or not. Implant selection and patellar resurfacing may be associated with patient outcomes.

Background and purpose:  Ankle arthroscopy is being increasingly utilized, but its potential benefits and harms remain unclear. This umbrella review aimed to assess the quality of systematic reviews and meta-analyses comparing ankle arthroscopy with equivalent open procedures or nonoperative options.

Methods:  A comprehensive search of MEDLINE, Embase, and CENTRAL was conducted on March 22, 2025. 2 reviewers independently screened abstracts and full texts, with conflicts resolved by a third reviewer. Systematic reviews assessing ankle arthroscopy versus any surgery or nonoperative treatment were included. The methodological quality of the reviews was evaluated using AMSTAR 2 criteria, along with an evaluation of whether the GRADE tool was appropriately applied.

Results: The literature search identified 430 studies, of which 29 systematic reviews were included after the screening process. These reviews covered various conditions, including lateral ankle instability, osteoarthritis, fractures, and osteochondral defects. None of the systematic reviews included RCTs comparing arthroscopic procedures with nonoperative treatment. A methodological assessment using AMSTAR 2 criteria identified multiple critical flaws across all reviews, leading to an overall confidence rating of "critically low" for each. 1 study adequately applied the GRADE approach to assess the certainty of the evidence.

Conclusion:  The efficacy of ankle arthroscopic procedures remains based solely on observational evidence. Given the critically low methodological quality of existing reviews, conclusions suggesting benefits of ankle arthroscopy, particularly over open procedures, are unreliable and insufficient to inform clinical recommendations. RCTs comparing ankle arthroscopy with nonoperative treatments or sham surgery are urgently needed.

Background and purpose:  Tourniquet use in total knee arthroplasty (TKA) provides a bloodless surgical field, which may lead to a better cementation but reduced function and increased pain. We aimed to investigate the effect of a tourniquet during TKA on implant survival, implant loosening, infection, and mortality.

Methods:  Data from 24,249 TKAs, collected by the Norwegian Arthroplasty Register between 2019 and 2023, was included. Among these, 14,926 were operated on with tourniquet and 9,323 without tourniquet. Cumulative revision rates (CRRs) were estimated using 1 minus Kaplan-Meier estimates for all revision causes and Cumulative Incidence Function (CIF) for specific revision causes at 3 years of follow-up. Cox regression analyses estimated hazard rate ratios (HRRs) for all revisions and Fine and Gray analyses estimated sub-hazard ratios (SHRs) for specific revision causes. Both were adjusted for age, sex, diagnosis, ASA score, fixation, implant type, and tranexamic acid use.

Results:  At 3 years of follow-up CRR was lower for the tourniquet group at 2.49% (95% confidence interval [CI] 2.21-2.81) vs 3.59% (CI 3.14-4.10) for the non-tourniquet group. We found an increased risk of revision in the non-tourniquet group (HRR 1.81, CI 1.46-2.46) after 3 months. CIF demonstrated a lower CRR for aseptic tibial loosening for the tourniquet group (0.08%, CI 0.04-0.15) compared with the non-tourniquet group (0.39%, CI 0.25-0.58). There was a higher risk of aseptic tibial loosening for non-tourniquet TKAs (SHR 6.06, CI 3.06-12.00), but no association with aseptic femoral loosening. There was no difference in infection or mortality.

Conclusion:  Tourniquet use during TKA was associated with reduced risk of tibial loosening after 3 years but without increased risk of infection, femoral loosening, or mortality.

Antimicrobial resistance (AMR) is rising globally and is a threat and challenge for orthopedic surgery, particularly in managing prosthetic joint infections (PJIs). This review first explores several AMR mechanisms from a microbiological point of view, including selective pressure, horizontal gene transfer, and further dissemination. Second, the variation in the rise of AMR across countries is highlighted, including its impact on PJI. While countries with the highest AMR rates are expected to experience the most significant burden, no country will be immune to the increasing prevalence of PJI. Third, this review stresses that multidimensional strategies are needed to combat AMR's challenges in orthopedic surgery. These include raising awareness across all sectors, including healthcare professionals, the public, healthcare policymakers, and even politicians; advancing diagnostic technologies for early infection detection and classification of resistant or susceptible strains; promoting antibiotic stewardship; and developing new material technologies to prevent or cure PJI. This review highlights the urgent need for a coordinated response from clinicians, researchers, and policymakers to avoid AMR-related complications in PJI cases.