Acta Orthopaedica最新文献

Background and purpose:  Standardized reporting on methodology and results in clinical RSA research papers facilitates evaluation of quality and interpretation of results. We aimed to assess the extent to which radiostereometric analysis (RSA) and computed tomography-based RSA (CT-RSA) studies adhered to the items of the new RSA reporting guideline from 2024.

Methods:  A systematic literature search was performed to identify all clinical RSA studies published between January 2012 and February 2024. Studies were eligible for inclusion if prosthesis migration over time was assessed. The adherence of studies to each applicable guideline item (full, partial, or no) was assessed.

Results:  285 studies were included, most of which assessed prosthesis migration in the hip (n = 161) or knee (n = 99). No study reported on all guideline items. The mean (full or partial) adherence of studies to all (applicable) items was 61% (standard deviation [SD] 11). Large variation between the reporting of items was found, ranging from being reported in 1% of the studies to 100%. The least reported items in studies were the mean number and SD of days between surgery and baseline RSA examination (8% of studies), mean number and SD of days between surgery and primary endpoint RSA examination (1%), and consistent- or all-marker method for RSA analysis (3%).

Conclusion:  Current studies on average reported only 61% of the items from the updated RSA guidelines. Adherence to the guidelines in clinical RSA studies on prosthesis migration should be improved, in order to improve the quality of studies and the interpretation of outcomes on implant migration.

To our unpleasant surprise, we discovered that we have mistakenly included incorrect values in Table 2 (Reported accuracy of CT-RSA) for the paper by De Laat et al. (2024). The paper by De Laat (2024) is from our group as well. In the draft version of the systematic review manuscript, we included data from a draft manuscript of the paper by De Laat. Before publication of De Laat (2024) we updated the values for the RMS error for accuracy in translations and rotations based on an increased number of observations. However, we have overlooked to use the updated values for Table 2 of the systematic review. We are sincerely sorry for this mistake. We believe it is important to be transparent and to ensure a correct link between the systematic review and the paper by De Laat. These requested changes do not alter our conclusions of the systematic review. On behalf of all authors Bart Kaptein.

Background and purpose:  Awareness of socioeconomic disparities in outcomes following surgical procedures is increasing. This highlights a critical challenge for clinical practice and public health. We examined whether low socioeconomic position (SEP) was associated with the incidence of revisions due to periprosthetic joint infection (PJI) following total knee arthroplasty (TKA).

Methods:  This cohort study included 75,141 patients undergoing TKA (2010-2021), identified from the Danish Knee Arthroplasty Registry (DKR). Individual-level SEP information, including wealth, living arrangements, and education, was obtained from Danish social and administrative registries. Revisions due to PJI were identified using a method combining the DKR and microbiology data. We calculated the cumulative incidence of revision due to PJI at 90 days and 2 years, and 2-year hazard ratios (aHRs) of revision due to PJI for lower vs. higher SEP groups, adjusted for age, sex, weight, and Charlson Comorbidity Index scores, with 95% confidence intervals (CI).

Results:  The incidence of revision due to PJI after 2 years of follow-up was 1.5% (CI 1.3-1.6) for low-wealth patients vs. 1.2% (CI 1.1-1.3) for high-wealth patients (aHR 1.3, CI 1.1-1.5); 1.5% (CI 1.3-1.7) for patients living alone vs. 1.2% (CI 1.1-1.3) for those cohabiting (aHR 1.4, CI 1.2-1.6); and 1.3% (CI 1.1-1.4) for patients with low education vs. 1.2% (CI 1.0-1.4) for those with high education (aHR 1.0, CI 0.8-1.2).

Conclusion:  Revision due to PJI among low-wealth patients and those living alone versus the corresponding high-SEP group were associated with increased risk of revision due to PJI.

Background and purpose:  We aimed to update reference intervals for anthropometric parameters for the passive joint range of motion (ROM), rotational profile, and angular alignment of the lower limb in typically developing children (TDC), to compare the association of the variables age, left-right sidedness, body mass index (BMI), and sex.

Methods:  We conducted a cross-sectional study in a convenience sample of TDC from the 1st, 5th, and 9th grades (6-17 years) in a randomized selection of Danish primary schools. We examined the anthropometric parameters in a non-clinical setting. Descriptive statistics were used to characterize the data. To explore potential differences across the variables, we utilized Bonferroni-corrected Welch's 2-sample t-tests, one-way analysis of means, and univariable linear regression.

Results:  We analyzed the associations between the variables and the anthropometric parameters in 501 TDC, aged 6 to 17 years. We found a statistically significant, but not clinically meaningful decrease in ROM for the hip, knee, and ankle as well as decreased femoral anteversion and increased tibial torsion with increasing age, but no association with sex or sidedness. However, several associations between BMI and ROM measurements were statistically significant and potentially clinically meaningful, with ROM decreasing by approximately 0.4° to 1.2° per unit increase in BMI, particularly for hip, knee, and ankle flexion movements.

Conclusion:  Anthropometric parameters remain clinically stable after 7 years of age and are affected only by the BMI but not sex or age. We found a statistically significant but not clinically relevant decrease in torsion and joint ROM with increasing age.

Background and purpose:  Pooling data on the performance of total knee (TK) implants across registries is only possible if the same TK implant is used across multiple registries and if used in patients with similar characteristics. We assessed to what extent specific TK implants: (i) are used across multiple registries or only in a single registry; and (ii) differ in patient characteristics between registries.

Methods:  All primary TK implants implanted between January 2020 and December 2021 in the Danish, Dutch, German, and Italian registries were included. We determined the number of registries using a specific TK implant (based on combined femoral-tibial component brand name and fixation/congruency/mobile bearing insert/patella usage). Patient characteristics (age/body mass index [BMI]/sex/diagnosis osteoarthritis) were compared across registries for TK implants used in ≥ 2 registries ≥ 100 times.

Results:  813 different TK implants (577,351 procedures) were used across the 4 registries, of which 53 TK implants (7%) were used in 1 registry (8,000 procedures). 760 different TK implants (569,351 procedures; 99%) were used in ≥ 2 registries of which 47 different TK implants (393,954 procedures; 68%) were used in ≥ 2 registries and ≥ 100 times. Statistically and clinically significant differences in age for the same TK implant across registries were observed for 29 TK implants (62%) and 3 TK implants (6%), respectively; for other characteristics these were for BMI 30 (64%) and 0 (0%) TK implants; for male proportion 23 (49%) and 17 (36%) TK implants; and for diagnosis of osteoarthritis 42 (89%) and 34 (72%) TK implants, respectively.

Conclusion:  Most specific TK implants and TK procedures were used across multiple registries, but they were often used in patients with different characteristics. This has an impact on comparing implant performances between registries.

Background and purpose:  Nontraumatic osteonecrosis of the femoral head (ONFH) patients are at a higher dislocation risk after primary total hip arthroplasties (THAs) than osteoarthrosis patients. It has not been clear how large prosthetic heads should be to reduce dislocation. A nationwide multicenter follow-up cohort study of THAs performed for ONFH aimed to evaluate risk factors associated with dislocation and whether larger head size could reduce the dislocation risk.

Methods:  A multivariable logistic regression model analyzed factors associated with dislocation in 5,983 THAs performed for ONFH between 1996 and 2022 with a median of 7.1 (0.5-27)-year follow-up. Patient age at surgery was 52 years and BMI was 22.9, as medians. A posterior approach was employed in 59%. The head diameter was 22 mm in 4%, 26 mm in 15%, 28 mm in 24%, 32 mm in 36%, and ≥ 36 mm in 21%.

Results:  288 THAs (4.8%) dislocated. Younger (1st quartile, ≤ 41 years) patient age (odds ratio [OR] 1.45 CI [95% confidence interval] 1.02-2.07 vs. 2nd quartile), higher BMI (OR 1.05, CI 1.02-1.08 per 1), posterior approach (OR 3.33, CI 1.96-5.56 vs. anterior or anterolateral approach, OR 2.27 CI 1.59-3.23 vs. lateral approach), and smaller heads were identified as risk factors. However, ≥ 36-mm heads were not different from 32-mm heads (OR 1.06 CI 0.69-1.63).

Conclusion:  Risk factors associated with dislocation were younger patient age, higher BMI, posterior approach, and smaller heads; however, 32-mm heads were large enough to reduce dislocation.

Background and purpose:  Femoral retroversion (FR) is known to be a predisposing factor for femoro-acetabular impingement and is hypothesized to constitute a risk factor for early osteoarthritis of the hip. We performed a systematic review to comprehensively evaluate the evidence for FR being associated with hip osteoarthritis (OA) and the results of early treatment among adolescents and young adults.

Methods:  A systematic literature search was conducted in biomedical databases (PubMed, Scopus, Web of Science, Cochrane, Google Scholar) from 1970 to 2023. Inclusion criteria were studies in English or German. Studies were selected based on predefined criteria and according to PRISMA guidelines.

Results:  Of 37 initial records, 11 studies were included, involving 1,807 patients and 785 cadavers. Most studies were conducted in North America (7), Europe (3), and Australia (1). Diagnostic modalities included clinical examination, radiography, computed tomography, and magnetic resonance imaging. Findings from preclinical and clinical studies suggest an association between FR and hip pain, impingement, and OA. Studies reported that 5-11% of patients requiring total hip replacement exhibited FR and emphasized pain in young adults as a prompt for torsional assessment. However, contradictory results regarding the need for surgical correction were found. Surgery appears effective in relieving hip pain. Concerns exist regarding spontaneous correction at a young age and the risk of overcorrection with surgery.

Conclusion:  Our review underscores the lack of evidence regarding FR as a risk factor for hip osteoarthritis, and contradictory results regarding the need for surgical correction were found.

Background and purpose:  Outcome after gastrocsoleus lengthening in cerebral palsy (CP) is reported to be influenced by type of lengthening, age, CP subtype, and preoperative range of motion (ROM). We examined the development of ankle and knee ROM after 3 types of isolated gastrocsoleus lengthening.

Methods:  This is a register-based longitudinal cohort study based on data from the Swedish Cerebral Palsy follow Up Program, of children born 2000-2011 who underwent isolated gastrocsoleus lengthening. ROM development was analyzed using mixed-effects modeling. Event limits were defined as ankle ROM ≤ 0° or ≥ 20° and knee extension deficit ≤ -10° and described in Kaplan-Meier curves and Cox regression analyses. The study protocol was published at clinicaltrials.gov.

Results:  184 children were included. The mean differences in ankle ROM 10 years postoperatively between open tendo Achilles lengthening (OTAL) and percutaneous tendo Achilles lengthening (PTAL) was -2.3° (95% confidence interval [CI] -7.4 to 2.7), and between gastrocnemius lengthening (GCL) and PTAL -4.4° (CI -10.4 to 1.5). The adjusted hazard ratio (aHR), adjusted for baseline ROM, Gross Motor Function Classification System level, and CP subtype, comparing ankle event rates between OTAL and PTAL was 2.5 (CI 1.1-5.7). GCL was also associated with a higher event rate compared with PTAL, aHR 2.0 (CI 0.85-4.6). The adjusted mean difference in knee ROM at 10 years between OTAL and PTAL was 5.1° (CI 0.4-9.8), and between GCL and PTAL 1.9° (CI -3.6 to 7.6). Comparing event rates for the knee yielded uncertain results.

Conclusion:  PTAL appears at least as effective as OTAL and GCL for favorable ankle and knee ROM development in children with CP.

Background and purpose:  Qualitative research on individuals with massive rotator cuff tears (MRCT) is scarce. This study aims to identify the perceptions, concerns, and treatment outcomes relevant to individuals with MRCT of the shoulder, as expected before treatment or experienced afterward.

Methods:  A qualitative study was designed using a hermeneutic phenomenological methodology. Purposive sampling was employed to identify potentially eligible patients (diagnosed with MRCT and aged 60-85 years) in the trauma and orthopedic outpatient clinics of 3 hospitals in Spain. The study employed 2 segmentation criteria: type of treatment and timing (before/after treatment). 16 interviews were conducted to capture the patients' perspective: 9 were semi-structured and 7 were in-depth. Interpretative phenomenological analysis was used, and triangulation was performed by 3 researchers with diverse backgrounds.

Results:  The mean age of participants (10 women and 6 men) was 71 years, with most having their dominant limb affected. The analysis revealed 4 themes (13 subthemes): MRCT impact on daily living (shoulder-derived functional limitation, pain, and emotional disturbance); treatment outcomes (recovering independence, pain relief, and social participation); clinical management (communication with health professionals, duration of the diagnostic/therapeutic process, and participation in decision-making); and characteristics of the individual (sex, work, and comorbidity). Special unmet needs were identified for women, with more prolonged diagnostic and therapeutic processes while bearing most household responsibilities.

Conclusion:  Recovering independence and pain relief were the principal outcomes from the perspective of patients with MRCT, and social participation and emotional well-being were closely linked. Measuring these outcomes could improve shared decision-making, while addressing systemic barriers to enhance patient participation.

Background and purpose:  This study introduces an innovative research design in the field of orthopedics, using a target trial emulation approach. We aimed to assess the causal effects of total hip arthroplasty (THA) compared with nonoperative treatment in reducing patient-reported hip disability at 3 months in patients with osteoarthritis, using real-world data.

Methods:  We emulated a target trial using real-world data of 2 Dutch hospitals between April 2020 and January 2022. Patients diagnosed with hip osteoarthritis and eligible for primary THA were included in the study. During the COVID-19 pandemic, THA was often cancelled due to external factors (i.e., limited operating room capacity, or surgeon unavailable due to quarantine rules), resulting in an arbitrary allocation of patients to THA (n = 132) or non-THA (n = 60). We compared changes in hip disability, measured using the Hip disability and Osteoarthritis Outcome Score Physical function Short form (HOOS-PS), between the THA group at 3 months postoperatively and the non-THA group at ≥3 months post waiting-list. Linear regression analysis, adjusting for potential confounders, was used to compare between-group differences.

Results:  THA showed preferable outcomes compared with non-THA, indicated by a difference of -33 points (95% confidence interval [CI] -37 to -28) on the HOOS-PS. Patients in the THA group demonstrated a clinically significant improvement in hip function, with a mean change of -27 points (CI -31 to -24), while the control group showed no improvement with a mean change of 7 points (CI 3-11) on the HOOS-PS.

Conclusion:  THA significantly improves hip function in osteoarthritis patients, surpassing the outcomes observed in the non-surgery group.