Acta orthopaedica Belgica最新文献

The spine's unique anatomical structure presents elevated challenges and risks in surgical procedures. Robot-assisted spinal surgeries developed rapidly in recent years. The robot-assisted techniques demonstrate promising outcomes, including the remarkable reliability, safety, efficacy, and decreased gamma exposure in spinal surgery, especially for the area of pedicle screw placement. The robot-assisted techniques are more and more popular all over the world, with the advantages like precision navigation and visualization, real-time feedback, and remote surgery. Despite significant achievements and promising prospects, the current clinical application of robot-assisted surgery remains relatively limited, with the navigation and pedicle screw insertion functions mostly used. This article reviews the current progress and outlines the future development direction in robot-assisted spine surgery.

Pathological femoral fractures resulting from primary or metastatic tumors represent a complex clinical challenge for orthopedic surgeons, often requiring individualized treatment strategies. This retrospective study aimed to evaluate and compare the outcomes of different surgical approaches used in the management of pathological femoral fractures secondary to metastatic disease. A total of 46 patients (52 femoral fractures) who underwent surgical treatment between 2020 and 2023 were included in the study. Data collected encompassed demographic characteristics, tumor histology, surgical techniques employed, and clinical outcomes. Statistical analysis was conducted using appropriate parametric and non-parametric tests, depending on data distribution. Of the patients included, 51% underwent tumor resection followed by endoprosthetic reconstruction, 40% were treated with intramedullary nailing, and 9.4% underwent plate osteosynthesis. The highest postoperative mortality rate was observed among patients with lung cancer metastases. Blood transfusions were necessary in 66% of cases. The overall mean survival time following surgery was 4.5 months, with significant variation according to tumor type and metastatic burden. The findings of this study underscore the importance of a multidisciplinary approach in the surgical management of pathological femoral fractures caused by metastatic tumors. Surgical interventions such as intramedullary nailing, plate fixation, and endoprosthetic reconstruction can effectively restore mechanical stability and contribute to improved patient quality of life. Selection of the optimal surgical technique should be guided by tumor histopathology, anatomical location and extent of bone involvement, number of metastatic lesions, and overall patient prognosis. Timely and appropriate surgical intervention remains critical to minimizing complications and enhancing survival outcomes in this patient population.

The prevalence of osteoarthritis continues to increase, driven by our ageing population and the growing obesity epidemic, leading to a rise in arthroplasties. Enhanced recovery programmes have been developed to optimise perioperative care and reduce length of stay (LOS). Our aim was to investigate the effect of an enhanced perioperative protocol at a high-volume regional elective hospital on readmission rate, LOS and adverse events. We compared elective arthroplasties from June to December 2022 (cycle 1, pre-protocol) to those from the same period in 2023 (cycle 2, post-protocol). Data included demographics, surgical procedures, and perioperative management, with a primary outcome of 30-day readmissions and secondary outcomes of revisions, LOS, and postoperative complications. Cycle 1 included 973 patients, mean age 69.9, standard deviation (SD 9.8), and cycle 2 included 1114 patients, mean age of 69.2 (SD 10). The mean LOS decreased from 2.26 days (SD 1.73) to 1.95 days (SD 2.67) (p<0.01), with 5.1% discharged on the day of surgery. Our 30-day readmission rate post intervention was 2.3% in cycle 2 compared to 0.6%, (p<0.01). There were no inpatient mortalities on first admission, however 1 reported death during readmission in cycle 2. There was no difference in surgical site infections (1.2% compared to 1.1%, p=0.74) and two cases of pulmonary embolism in cycle 2. The 24-hour arthroplasty perioperative protocol effectively reduced LOS, there was a small increase in 30-day readmissions.

Aim: This study aimed to adapt the Goodman score to Turkish culture and evaluate its validity and reliability among Turkish patients undergoing total knee and hip arthroplasty.

Methods: A methodological, cross-sectional study was conducted with 100 primary osteoarthritis patients who underwent total knee and hip arthroplasty. The original Goodman score was first translated into Turkish and culturally adapted, after which the psychometric properties of the Turkish version were evaluated through assessment of content validity, construct validity, criterion validity, internal consistency, test-retest reliability, item-total correlation, and item discrimination.

Results: The Turkish version of the Goodman score showed psychometric characteristics similar to those of the original version, with strong internal consistency (Cronbach's alpha = 0.925) and test-retest reliability (intraclass correlation coefficient: 0.501). Additionally, criterion validity analysis revealed significant correlations between the Turkish Goodman score and the Oxford Knee Score and Oxford Hip Score.

Conclusion: The Turkish-adapted Goodman score is a valid, reliable, and applicable tool for assessing patient satisfaction in Turkish-speaking patients following primary total knee and hip arthroplasty.

Chondroblastoma is an infrequent benign cartilaginous bone tumor. The gold standard surgical treatment is intralesional curettage with or without local adjuvant therapy, such as high-speed burring, electrocauterization, or intralesional phenol application. Bone grafting or cementation is usually applied to fill the defective area after curettage. This study aimed to retrospectively review a 36-year experience with chondroblastoma at our institution and to investigate the factors affecting recurrence rates. The medical records of 48 consecutive patients who were treated between April 1986 and October 2020 were retrospectively analyzed, with a mean follow-up of 48.3 months. The study included 29 male (60.4%) and 19 female (39.5%) patients, with a mean age of 18.5 years. All patients underwent intralesional curettage; the resulting cavity was filled with bone grafting in 40 cases (83.3%) and with bone cement in 4 cases (8.3%). Arthrodesis was performed in 4 patients (8.3%). Adjuvant therapy with electrocauterization or high- speed burring was used in 25 cases (52.1%). The overall local recurrence rate was 16.7% (8 cases). The recurrence rate was significantly lower in patients who received adjuvant therapy (p=0.020), whereas it was higher (75.0%) in those older than 30 years (p=0.012). No correlation was found between tumor size, radiologic stage, and recurrence rates. In conclusion, intralesional curettage followed by bone grafting was effective for local control in most cases, while electrocauterization or high-speed burring as local adjuvant therapy was associated with lower recurrence rates.

Vitamin D deficiency has been suggested as a potential contributing factor in the development of Complex Regional Pain Syndrome (CRPS). This study aimed to investigate the association between serum vitamin D levels and CRPS using a retrospective case-control design. The study included 306 individuals divided into three groups: CRPS patients (n=102), fracture patients without CRPS (n=102), and healthy controls (n=102). Only patients whose vitamin D levels were measured during June, July, or August were included to minimize seasonal variation. Mean serum vitamin D levels were significantly lower in the CRPS group (10.2 ng/mL) compared to the fracture group (20.4 ng/mL) and control group (26.3 ng/mL) (p<0.001). The prevalence of vitamin D deficiency was highest in the CRPS group, followed by the fracture group, and lowest in the control group. Binary logistic regression analysis confirmed that vitamin D deficiency was independently associated with the presence of CRPS (OR: 14.57, 95% CI: 5.48-38.73, p<0.001), while age and sex were not significant predictors. No significant correlation was observed between serum vitamin D levels and other biochemical parameters. Vitamin D deficiency was more frequently observed in patients with CRPS than in fracture patients and healthy controls. These findings suggest an association between low vitamin D levels and the presence of CRPS. Further prospective studies are warranted.

Introduction: The treatment of Galeazzi fractures is definitely surgical. However, the choice of therapeutic strategy remains controversial. The aim of this study was to report our results of surgical treatment of Galeazzi fractures.

Patients and methods: A retrospective descriptive study was carried out over 3 years. Were included 32 patients operated for Galeazzi fracture. The average age was 32 years. Front and lateral forearm x-rays were used for lesion diagnosis and measurements. The radius fracture was located in the middle third for 71% of cases. The average distal radio- ulnar index was 3.6 mm. Osteosynthesis of the radius was carried out using a screwed plate before stability testing of the distal radio-ulnar joint. In case of instability, ulno-radial pin fixation wirst in supination was done for 45 days. At the mean follow-up of 38 months, all patients were evaluated using Mestdagth score.

Results: Bone consolidation was achieved within an average time of 75 days. At a mean follow-up of 38 months, internal fixation by radial plate and ulno-radial pinning achieved a good functional result in 73.7% of cases (p=0.03). Patients treated only by pinning without use of plate had a poor functional score.

Conclusion: The treatment of Galeazzi fractures using a radial screwed plate and radioulnar pinning provides satisfactory results and a low complication rate.

Managing greater tuberosity (GT) fractures, especially those with glenohumeral (GH) dislocations, poses a challenge in balancing stable fixation while promoting early mobilization. While surgical fixation is often required for significant displacement, the optimal fixation technique remains debated due to the risk of complications and inconsistent outcomes. This study aimed to evaluate the outcomes of the Modified Hook Wiring (MHW) technique for open reduction and internal fixation of isolated displaced GT fractures. Thirteen patients with a mean age of 49.4±4.7 years were treated using the MHW technique, with 84.6% presenting concomitant GH dislocations. The mean follow-up was 16±3.3 months. The functional evaluation using the Constant-Murley and ASES scores yielded averages of 77.9±16.9 and 83.1±19.6 at one year, with no relevant changes at the final follow-up. The average range of motion showed forward flexion of 148°±31° and abduction of 142.3°±26.2°. The mean subjective shoulder value reached 81.5%±13.6%, while the mean visual analog scale score was 1.46±1.7. Radiographic analysis confirmed complete fracture healing in all cases by 9.7±1.3 weeks, with no evidence of displacement or malunion. Two patients (15.3%) experienced postoperative stiffness, and one developed a superficial wound infection. The results suggest that the MHW technique offers stable fixation, reliable union, and satisfactory shoulder function, making it a promising alternative for treating displaced GT fractures, particularly in the setting of GH dislocation. Its facilitation of early shoulder mobilization and low complication profile highlight potential benefits over conventional fixation methods. This study provides Level IV evidence. Trial registration: NCT05403879.

Osteoarthritis (OA) is the most common joint disorder and the microstructural changes in trabecular bone remain unclear. The present study aimed to evaluate the fractal dimensions of the trabecular bone structure of the femoral neck on pelvic radiograph images of patients with unilateral end-stage hip OA. The trabecular structures of the femoral neck of 130 patients (57 with right-sided hip joint OA and 73 with left-sided hip joint OA) were evaluated and compared with the Fractal Analysis Method, taking into account gender and hip joint orientation. The fractal dimension calculated from the femoral neck on the right and left sides was similar to the healthy side in individuals with OA (p=0.647, p=0.929, respectively). When OA and healthy joints were compared separately on the right and left sides, the value on the osteoarthritic side was found to be significantly lower (p<0.05). When examined without distinguishing between the right and left sides, the fractal dimensions were found to be significantly lower in osteoarthritic joints than in the healthy side (p=0.001). When gender was taken into account, the fractal dimension calculated in both healthy individuals and individuals with OA was found to be similar in women and men (p>0.05). The fractal dimensions of the femoral neck trabecular structure of the osteoarthritic hip joint that was evaluated in pelvis radiography were low on the osteoarthritic side. With its cost-free and harmless use, the Fractal Analysis Method can be used by clinicians in planning therapeutic procedures in OA in the medical examination of OA patients.

Chondral and osteochondral lesions of the knee in skeletally immature patients, can result in serious long-term sequelae, such as early knee arthrosis. While there is an abundance of studies concerning chondral repair techniques, there have been relatively few studies that have examined outcomes following cartilage repair in skeletally immature patients. Therefore, we planned to answer the following question: does the AMIC® technique result in positive outcomes for the repair of cartilage lesions in the knee in adolescent patients ? Our hypothesis was that the AMIC® technique improves outcomes for skeletally immature patients with an ICRS stage III or IV osteochondral lesion two year after the surgery. This was an European retrospective, multicenter study, including 27 patients aged from 12 to 19 years. We included adolescents with open epiphysis on x-ray, with an ICRS stage III or IV symptomatic lesion of the knee. The average defect size was 2.3 cm2. All patients had been treated with the surgical technique AMIC®. Post-operative outcomes were assessed by the Knee injury and Osteoarthritis Outcome Score (KOOS). Results showed a significant improvement at a mean follow-up of 2.6 years (min 2; max 6 years) across all KOOS domains: 55 vs. 69% (p<0.001) on symptoms, 58 vs. 87% (p<0.001) on pain, 31 vs. 71% (p<0.001) on quality of life, 29 vs. 73% (p<0.001) on sports and leisure activities, and 67 vs. 90% (p<0.001) on activities of daily life. AMIC® technique performed for the repair of stage III or IV ICRS articular cartilage lesions in the knees of adolescent patients, provides clinical improvements 2.6 years after surgery, but results are not perfect with adolescents who may still symptomatic.