Acta orthopaedica Belgica最新文献

The current study aimed to objectively evaluate the fit of a rectangular, tapered stem to the severely dysplastic hips on the basis of the proximal femoral anatomy and the dimensional properties of the stem. It was hypothesized that the stem size planned with accordance to the diaphyseal canal width alone can accommodate the distal femur successfully with no sizing mismatch. Forty-six patients (53 hips) suffering from secondary osteoarthritis due to hip dysplasia scheduled for total hip arthroplasty (THA) with a subtrochanteric transverse shortening osteotomy were included. All hips were Crowe type 4. All patients underwent preoperative computed tomography imaging. Height of femoral head center (HCH) was determined. Medullary canal diameter measurements at different levels were made. These were made at a level (1) 35% of HCH above the lesser trochanter (DT +35), (2) 70% of HCH below the lesser trochanter (DT -70), and (3) at the level of isthmus (Di). Medullary canal flare indices were calculated from the individual parameter ratios. Similar measurements were carried out for the different sizes of the femoral stem. The mean DT +35 was 41.9 ± 6.4 mm, the mean DT-70 was 17.3 ± 2.2 mm, and the mean Di was 12.8 ± 1.9 mm. In all femurs, the width of the isthmus was wider than that of the corresponding femoral stem isthmus. The femoral stem sizes established with respect to the diaphyseal width of the femur were all compatible with the isthmus width of the femur. Tapered and rectangular stems can accommodate the proximal femur above and below the osteotomy level in Crowe type IV hip dyplasia patients, thereby constituting a viable option as the femoral stem in this patient group with technically demanding difficulties.

To date, no Dutch questionnaire exists to administer preoperative patient expectations in patients scheduled to undergo a total shoulder arthroplasty. The aim of this study is to develop a Dutch translation of the Hospital for Special Surgery Expectations Survey using a standardized translation procedure, to use both in clinical practice and in scientific research. Translation is performed on the basis of a forward - backward translation. The clarity of the pre-final Dutch version is tested on 10-30 patients scheduled to undergo a total shoulder arthroplasty. The answers of the patients are studied prospectively at a single time point. All the questions of the Hospital for Special Surgery Expectation Survey are clear to more than 80% of patients, which is the norm value where it can be assumed that the question is clearly understandable. The Dutch version of the Hospital for Special Surgery Expectations Survey can be considered clear, as all questions did not give any ambiguities for 80% of the patients. This study provides a foundation needed for further research to assess the psychometric properties of the Dutch translation of the Hospital for Special Surgery Expectations Survey.

Many options are available concerning the graft fixation in ACL reconstruction, one of them being a suspensory device. Our study aimed to compare the strength of two different devices of fixation (suspensory device vs screw) on the tibia. We enrolled 80 patients older than 18 years with an isolated ACL tear confirmed at the MRI, divided into two comparative groups for a prospective study. The only factor which changed was the tibial fixation. The surgical treatment, performed by a unique surgeon, used the same inside-out technique for the two groups, with a ST4-strand graft. Various intraoperative parameters were studied like the time of the tourniquet, the diameter of the graft or an associated meniscus tear. The AP knee laxity was evaluated at 6 months and 1 year after the surgery by a TELOS test. We also compared the two groups with subjective and objective surveys. We can conclude that the suspensory device can offer the same strengthening.

High tibial osteotomy (HTO) is a widely used procedure for delaying knee arthroplasty, correcting alignment, and relieving symptoms in patients with knee osteoarthritis. Recently, proximal fibular osteotomy (PFO) has emerged as a less invasive and more cost-effective alternative. This study compares the outcomes of HTO and PFO to evaluate whether PFO can deliver results comparable to HTO in similar patient populations. A total of 96 patients treated between 2018 and 2022 were analyzed, with 54 patients undergoing HTO and 42 undergoing PFO. Subgroups were also created based on body mass index (BMI): non-obese HTO, obese HTO, non-obese PFO, and obese PFO. For each patient, we recorded demographic data, preoperative and 1-year postoperative Oxford Knee Scores (OKS), visual analog scale (VAS) scores, medial joint space (MJS) measurements, mechanical axis deviations (MAD), Kellgren- Lawrence grade (KL), medial proximal tibial angle (MPTA), and any complications. Both HTO and PFO led to significant improvements in OKS, VAS, MJS width, and MAD. Age, KL grade distribution, BMI, and MPTA values were comparable across the groups. Overall, HTO showed superior clinical (OKS, VAS) and radiological (MJS, MAD) outcomes, particularly in non-obese patients. Among obese patients, HTO and PFO achieved similar clinical improvements, although HTO maintained a radiological advantage. Importantly, a lower preoperative MPTA was associated with poorer clinical outcomes in the PFO group. In conclusion, while PFO can produce meaningful clinical and radiological improvements, HTO remains the more effective option in terms of both clinical and radiological outcomes in patients with a BMI below 30. For patients with a BMI over 30, HTO preserves its radiological superiority, although its clinical benefits are comparable to those of PFO. Additionally, a low preoperative MPTA is significantly linked to worse OKS scores in patients undergoing PFO.

Brucellosis, caused by a facultative intracellular gram-negative coccobacillus, is one of the most common zoonotic infections worldwide. Very rarely, brucellosis can cause periprosthetic joint infections (PJI). In this case-based literature review, we summarize the current medical literature regarding Brucella PJI, with the aim to raise awareness among clinicians, particularly in non-endemic areas. We report a case of a woman with a 3 weeks history of increasing hip pain, who was eventually diagnosed with Brucella PJI. We searched multiple databases to identify all case reports on Brucella PJI in humans published from February, 1983 to December, 2023. A total of 42 cases from 38 published articles were retrieved and summarized, along with our case. Mean age was 65.5 years, with sex ratio nearly one. Almost all patients presented with local symptoms and 56% with systemic symptoms. Only knee (n=30) and hip (n=13) prosthetic joint were involved. If performed, culture showed positive results on synovial fluid (74%), intra- operative tissue (79%), and/or blood (38%). Serological confirmation was obtained in 97%. Antimicrobial treatment consisted of a combination of doxycycline and rifampin in most cases, with in nearly half of the cases the addition of an aminoglycoside. The majority of patients (n=24) were surgically treated with a two stage exchange arthroplasty; although other options were successful as well. Brucella PJI is a rare but potentially severe manifestation of brucellosis. Brucella PJI must be considered in patients from endemic areas, especially when another causative agent has not been isolated. If culture results remain negative, PCR or serology should be performed. To date, there is no uniform recommendation for the duration of antimicrobial therapy nor the preferred surgical procedure. Relapse is possible even with adequate therapy.

This study was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta- Analyses) guidelines. PubMed and Medline databases were searched in October 2023 for studies reporting outcomes of arthroscopic anterior cruciate ligament (ACL) reconstruction and stable medial meniscal ramp lesion treatment. Studies focused on diagnostic approaches, biomechanical properties, unstable ramp lesions, isolated ramp lesions, and concomitant intraarticular/extraarticular pathologies other than ACL rupture are excluded. A total of 314 studies were obtained after the initial search. Six studies met the inclusion criteria. Data from 186 stable medial meniscal ramp lesions that were left unrepaired were retrieved. At the last follow-up, mean preoperative Lysholm and IKDC scores were significantly improved and similar with repair patients and no ramp lesion patients, postoperatively. Healing rate was reported between 58.6% and 87.8%. Knee stability was similar in repaired and nonrepaired patients and a ramp existed and no ramp lesion patients. Although the return to sports rate was similar between ramp existed and no ramp lesion patients, the time to return to sports was higher in ramp existed patients than no ramp patients. Improved functional outcome scores, similar healing rates, knee stability, and return to sports rates can be obtained in repaired and nonrepaired patients as well as ramp lesions existing and no ramp lesion patients when the stable ramp lesions are left unrepaired. The time to return to sport is significantly higher than no ramp lesion patients. Level of Evidence III.

The aim of this paper is to identify if there is a difference in length of stay following hip fractures when using rehabilitation beds. Prospective data was collected on all hip fracture admissions in patients over 50 years from May 2016 to February 2018 from ISD NHS Scotland to identify length of stay. It was found that patients discharged home via rehabilitation wards were less likely to have returned to their own home by 30 days post admission and were also significantly more likely to stay in hospital for 40 days or more when compared to patients discharged directly home. In conclusion, the use of community rehabilitation units has been thought to improve functional outcome scores for activities of daily living compared to discharge from surgical wards. This study has highlighted increased length of stay using rehabilitation beds also that further analysis is required for care pathways to make the best use of resources available to minimise hospital stay, bed usage/cost of care and quicker return to the patient's place of residence. It has also highlighted the huge variation across Scotland in the process of hip fracture care.

Reconstruction of the anterior cruciate ligament (ACL) using hamstring autograft presents a greater risk of surgical site infection than other transplants (0.5% to 1.5%). Various prophylactic methods have been evaluated, such as double antibiotic protection with intravenous Cefazolin and soaking of the transplant with vancomycin, which results in a near- zero infection rate. This soaking method has only been studied in vitro, confirming the absence of toxicity of vancomycin on tenocytes. The primary objective of our study was to assess the mechanical quality of vancomycin-soaked tendon transplants at 6 months post-operatively. The secondary objective was to assess the rate of new rupture at 1 year. This is a retrospective, single-center study including patients who underwent ACL reconstruction using a vancomycin- soaked hamstring autograft at Rennes University Hospital between December 2018 and February 2021. An objective assessment of joint laxity by means of the GNRB® at 134N was performed at 6 months post-operatively and a clinical evaluation (Lysholm and subjective IKDC questionnaires) at 1 year were performed. Fifty-three patients aged between 18 and 57 years were included. At 6 months, GNRB® of the operated knee joints was significantly different compared with the non-operated ones but was below the threshold for complete or partial rupture according to the manufacturer's clinical significance threshold (3 mm for a complete rupture and 1.5 mm for a partial rupture). At one year, 3.8% of our population had an early rupture, the reason for which was technical defects in the positioning of the graft. The stability of knees reconstructed with a Vancomycine soaked ACL graft is comparable with that of the contralateral knee with an intact ACL. Level of evidence : IV, retrospective study.

Prospective study of femoral neck system (FNS) vs. cannulated compression screw (CCS) fixation has not been appropriately reported. We prospectively investigate the efficacy of FNS vs. CCS fixation combined with ERAS in the treatment of unstable intracapsular FNF. 70 consecutive patients with unstable intracapsular femoral neck fracture met the inclusion criteria were randomly divided into FNS group and CCS group (each 35 cases). ERAS was applied in both groups. The perioperative period and follow-up results were compared. The operation time, fluoroscopy time, fracture reduction quality and follow-up time were not significantly different between the two groups (P > 0.05). The blood loss in the FNS group was significantly more than that in CCS group whereas the time to start weight-bearing, fracture healing time, internal fixation failure in the FNS group were significantly less than those in the CCS group (P < 0.05). The neck shortening and revision surgery of the FNS group showed a trend of superiority to CCS group but the difference was not significantly different (P > 0.05). The AVN in the two groups was similar. At the last follow-up, the Harris hip score in the FNS group was higher than that in the CCS group (P < 0.05). Hence, FNS fixation with ERAS for FNF can provide earlier weight-bearing, fewer complications related to the implant, faster healing and better functional recovery than CCS fixation with ERAS, which is consistent with the better biomechanical properties of FNS.

Several studies suggested that total hip arthroplasty (THA) was more technical demanding following previous pelvic osteotomy (PO), resulting in poor outcomes compared with primary THA. However, the other studies regarding this topic had reported contradictory results. Therefore, we conducted this meta-analysis to compare the clinical results and other parameters between total hip arthroplasty following pelvic osteotomy and primary total hip arthroplasty. We systematically searched PubMed, the Cochrane Library, EMBASE, Web of Science, Scopus, EBSCO and Web of science from inception to September 2020. This study compared the outcomes between THA following previous PO and primary THA with respect to operative time, blood loss, Harris hip score (HHS), revision rates, complication rates, cup position, cup size, cup coverage and hip joint center. 14 studies with 3913 participants were included. The THA after PO group had longer operative time (MD, 13.8 mins; 95% CI, 4.73 to 22.87 mins; P=0.003), greater blood loss (MD, 82.21 ml; 95% CI, 27.94 to 136.48 ml; P=0.003), worse HHS (MD, -2.79 points; 95% CI, -4.08 to -1.50 points; P<0.00001), smaller acetabular anteversion angle (MD, -3.98°; 95% CI, -6.72 to -1.24°; P=0.004), larger cup size (MD, 1.52 mm; 95% CI, 0.75 to 2.28 mm; P=0.0001), more lateral (MD, 2.83 mm; 95% CI, 1.22 to 4.43 mm; P=0.0005) and superior (MD, 2.26 mm; 95% CI, 1.11 to 3.40 mm; P=0.0001) hip joint center. No statistically significant differences were demonstrated between the THA after PO group and primary THA group in revision rates, complication rates, acetabular abduction angle, cup coverage. THA after pelvic osteotomy was associated with inferior intraoperative outcomes, lower functional scores and worse inferior positioning of acetabular component compared with primary THA. Due to the alerted anatomical structure after PO, the findings of current study implicated that preoperative assessment such as computed tomography scan should be conducted in order to achieve satisfactory results.