Acta orthopaedica Belgica最新文献

The objectives were to evaluate the effectiveness and safety of a single preoperative dose of intravenous tranexamic acid (TXA) in reducing perioperative blood loss and requirement for transfusion in patients undergoing hip hemiarthroplasty for femoral neck fracture. A double-blind randomized controlled trial was conducted in 140 patients with hip fracture. After randomization, 68 patients received a single dose of 1 gr of intravenous TXA at the start of the surgery (TXA group), and 72 received a placebo treatment (placebo group). TXA group had a significant decrease in blood loss (p < 0.001) and requirement for transfusion (p < 0.001) compared with the placebo group. There were seven thromboembolic events, all in the placebo group (p = 0.014). Mortality within 1-year postoperatively was not significantly different between groups (p = 0.297).The use of a single dose of intravenous TXA at the start of the surgery significantly reduces blood loss and requirement for transfusion without increasing the risk of thromboembolic events in patients with femoral neck fracture undergoing hip hemiarthroplasty.

Large-diameter heads (LDHs) in total hip arthroplasty (THA) enhance range of motion but require thinner liners. Monoblock acetabular components with ceramic liners could reduce liner fracture risks during modular acetabular component assembly. This study aims to confirm the safety and clinical performance of the monoblock Maxera Cup in THA. The study included 198 consecutive patients who received 214 primary monoblock acetabular components with an LDH ceramic-on-ceramic (CoC) bearing between March 2012 and December 2013. We collected Harris hip scores (HHS), Oxford hip scores (OHS), EuroQoL-5D scores (EQ-5D), and conducted radiographic evaluations. Seven patients (3.5%) died for reasons unrelated to the intervention. A single patient (0.3%) underwent cup revision due to recurrent dislocation from trauma. Another patient needed cup revision six years post-surgery due to squeaking. Mean follow-up time was 36.2 ± 27.9 months. Kaplan-Meier survivorship rate at 96 months for any component loosening was 100%, and the cup revision survivorship rate for any reason was 96.8% (95% CI, 87.8-99.5%). At final follow-up, mean HHS was 93.6 ± 9.9, OHS was 16.2 ± 5.9, and EQ-5D was 0.94 ± 0.09. LDH CoC THA using a monoblock cup yielded excellent medium-term functional outcomes. This approach eliminates liner fracture risk during insertion and reduces implant impingement risk.

Avascular necrosis (AVN) is a known complication during the management of developmental dysplasia of the hip (DDH). It has the potential to alter the growth of the head or acetabulum and prevent the best outcomes. While past literature has evaluated the risks of AVN and strategies to avoid it, studies on the impact of AVN on the outcomes are scarce. In this systematic review, we aim to study the extent of the effects of AVN on the outcomes, in the management of DDH. In this systematic review series for 1990 to 2021 were pooled. The clinical and radiological outcomes of the AVN and non-AVN groups were compared. The effects of other modifying factors were also evaluated. A total of 170 AVN and 585 non-AVN hips from 21 papers were compared. The analysis did not show any statistically significant difference between the AVN and non-AVN groups in terms of clinical or radiological parameters. Interestingly patients who had the index surgery at a younger age had a higher risk of further surgery, with acetabular osteotomy being the most common secondary procedure. The negative impact of AVN may not be as severe as previously thought. Thus, the fear of AVN should not take precedence over the primary goal of DDH management i.e. obtaining a stable concentric mobile hip.

The purpose of the present study was to evaluate and compare the clinical outcomes of two groups of patients subject to bi-cruciate retaining (BCR) or posterior-stabilized (PS) implants. It was hypothesized that patients treated with BCR prostheses would present higher flexion and better clinical and functional results than those treated with PS implants. This prospective study included thirty-two patients treated for primary knee osteoarthritis and assigned to two matched groups for their demographic characteristics and comorbidities. Those with functioning cruciate ligaments received bi- cruciate retaining prostheses. In the case of ligaments' insufficiency, the posterior-stabilised design was selected. The primary outcome was knee flexion, and secondary outcomes included the patient's reported outcomes as recorded by the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire, visual analogue scale (VAS) for pain, treatment- related complications, and surgical time. Complete data were recorded for all patients with a minimum of 2 years of follow-up. This study found a statistically significant improvement in all the analysed clinical and functional assessment tools from baseline to the latest follow-up (p<0.05) for both groups. However, no statistically significant difference was found between the two groups. Furthermore, bi-cruciate retaining design is surgical time. There was no evidence of clinical superiority of bi-cruciate retaining compared to posterior stabilized knee implants. Therefore, further randomized studies with more participants and a longer follow-up on comparing bi-cruciate retaining and posterior stabilized implants in primary knee osteoarthritis could be rewarding.

The object is to objectively identify the 100 most influential scientific publications in total knee arthroplasty (TKA) and provide an analysis of their main characteristics. The Clarivate Analytics Web of Knowledge database was used to obtain data and metrics of TKA research. The search list was sorted by the number of citations, and articles were included or excluded based on relevance to TKA. The information extracted for each article included author name, publication year, country of origin, journal name, article type, and the level of evidence. These 100 studies generated a total of 35,399 cita- tions, with an average of 355.9 citations per article. The most-cited article was cited 1273 times. The 100 studies included in this analysis were published between 2000 and 2017. 23 different journals published these 100 publications. Majority of the publications were from United States (n = 52), followed by UK (n = 10) and Canada (n = 8). The most prevalent study designs were case series (n = 32) and cohort studies (n = 30). The 100 most influential articles in TKA were cited a total of 35,399 times. The study designs most prevalent were case series and cohort studies. This article serves as a reference to direct orthopedic surgeons to the 100 most influential studies in total knee arthroplasty. More than half of the studies are from North America, and three journals hold two-thirds of the 100 most cited publications on the topic.

This meta-analysis focuses on the controversial efficacy and safety of microfragmented adipose tissue (MFAT) as compared with platelet-rich plasma (PRP) in the clinical treatment of knee osteoarthritis (KOA). We have attempted to provide an evidence-based medicine protocol for the conservative treatment of KOA. Researchers collected and compared randomized controlled trials (RCTs) that used microfragmented adipose tissue and platelet-rich plasma to treat knee osteoarthritis. We searched CNKI, Wanfang Database, CMJD, PubMed, Sinomed, Cochrane Library, and Embase for studies published up to May 31, 2023. Two investigators independently screened literature, extracted data, and assessed bias risk using the Cochrane bias risk tool. The researchers then performed a meta-analysis using Revman 5.4 statistics software provided by the Cochrane Library. A total of 4 randomized controlled trials involving 266 patients (326 knees) were included. There were 161 knees in the MFAT group and 165 knees in the PRP group. Meta-analysis showed a statistically significant difference in VAS scores between the MFAT group and the PRP group at 12 months after treatment [MD=0.99, 95% CI (0.31, 1.67), P=0.004]. This result showed that VAS scores were lower in the PRP group than in the MFAT group, and that PRP injection reduced pain more effectively than MFAT injection. At 6 months after treatment, Tegner activity scale scores in the MFAT group were higher than that in the PRP group [MD=0.65, 95% CI (0.11, 1.19), P=0.02], and the difference was statistically significant. There were no significant differences in the remaining indicators between the two groups. Based on this meta-analysis, PRP appears to be more effective than MFAT in treating KOA in terms of long-term pain relief. However, MFAT was superior to PRP in improving short-term activity function. Overall, there was no significant difference between MFAT and PRP in the treatment of KOA. In addition, MFAT does not increase the risk of adverse events compared to PRP. However, at present, there are few clinical studies on MFAT and PRP, which need to be verified by more rigorously designed clinical trials.

Proximal humeral fractures (PHF), ranking as the third most common osteoporotic fractures, pose a significant challenge in management. With a rising incidence in an aging population, controversy surrounds surgical versus nonoperative treatments, particularly for displaced 3- and 4-part fractures in older patients. Locking plates (LP) and proximal intramedullary nails (PHN) are primary choices for surgical intervention, but both methods entail complications. This retrospective study of 132 patients undergoing surgery for PHF (LP or PHN) aims to identify risk factors for postoperative complications. Results reveal a 31% complication rate, including secondary loss of reduction (17%) and intra-articular screw penetration (13%). Alcohol abuse emerges as the sole patient characteristic linked to complications. Non-anatomical surgical reduction, calcar comminution, and humeral shaft displacement over 10 mm also contribute to increased risks. LP and PHN show comparable complication rates, aligning with existing literature. The study underscores the pivotal role of achieving anatomical surgical reduction in minimizing complications. Surgical technique, fracture pattern, and patient characteristics significantly influence outcomes. Notably, alcohol abuse surfaces as a critical risk factor. The findings emphasize the importance of a nuanced approach to PHF management, tailoring interventions based on fracture characteristics and patient factors. Future research should explore these aspects, particularly in younger patient populations, to enrich our understanding of surgical outcomes in diverse age groups.

Accurate survival prediction of patients with long-bone metastases is challenging, but important for optimizing treatment. The Skeletal Oncology Research Group (SORG) machine learning algorithm (MLA) has been previously developed and internally validated to predict 90-day and 1-year survival. External validation showed promise in the United States and Taiwan. To ensure global generalizability, the algorithm remains to be validated in Europe. We therefore asked: does the SORG-MLA for long-bone metastases accurately predict 90-day and 1-year survival in a European cohort? One-hundred seventy-four patients undergoing surgery for long-bone metastases between 1997-2019 were included at a tertiary referral Orthopaedic Oncology Center in the Netherlands. Model performance measures included discrimination, calibration, overall performance, and decision curve analysis. The SORG-MLA retained reasonable discriminative ability, showing an area under the curve of 0.73 for 90-day mortality and 0.77 for 1-year mortality. However, the calibration analysis demonstrated overestimation of European patients' 90- day mortality (calibration intercept -0.54, slope 0.60). For 1-year mortality (calibration intercept 0.01, slope 0.60) this was not the case. The Brier score predictions were lower than their respective null model (0.13 versus 0.14 for 90-day; 0.20 versus 0.25 for 1-year), suggesting good overall performance of the SORG-MLA for both timepoints. The SORG-MLA showed promise in predicting survival of patients with extremity metastatic disease. However, clinicians should keep in mind that due to differences in patient population, the model tends to underestimate survival in this Dutch cohort. The SORG model can be accessed freely at https://sorg-apps.shinyapps.io/extremitymetssurvival/.

The aim of this comparative study was to examine the possible benefits of a dedicated Orthopaedic Trauma Room (DOTR) and in the care of patients with proximal femur fractures. A retrospective study of all orthopaedic cases with a hip fracture from 2020 to 2022 at CHC Montlegia has been undertaken, the group is compared to patients with the same impairment from 2018-2020 admitted to Saint Joseph/Esperance CHC hospitals (before the merge and the existence of a DOTR). The delay between the arrival at the emergency department and transfer to the operating room, as well as the mortality are evaluated. The length of hospital stay, the operating time, the ASA score, and the Charlson Index were also examined. A total of 734 cases were analysed, with 384 patients pre-DOTR and 350 patients post-DOTR. The 2 groups were compara- ble in gender, age, fracture type, Asa-score and Charlson Index. The time to the operating room (OR) has been reduced by 14h36 (37h35 vs 23h09, p< 0,001). There was no statistical difference detected in mortality after implementation of an DOTR, not after 3 months, neither a year. Novel oral anticoagulants (NOAC) intake showed no significant effect on the mortality postoperatively. The Length of hospital stay in your study was decreased by 1, 54 days (p< 0,001). A dedicated orthopaedic trauma room reduced the time to OR and the length of hospital stay. There was no statistical difference detected in mortality after implementation of an DOTR, not after 3 months, neither a year. With a DOTR, the care of trauma patients can be optimized and should become a standard of care.

This retrospective study was designed to assess two fixed bearing total knee design concepts and their clinical outcomes, particularly in Forgotten Joint Score-12 (FJS-12). Patients were assessed clinically using the Knee Society Score (KSS). Participants completed an FJS-12 and a short form of the Knee Injury and Osteoarthritis Outcome Score (KOOS-PS). A total of 216 knees -76 with Genesis II and 150 with Vanguard total knee arthroplasties - were included. Patients in the Vanguard group had significantly better postoperative FJS-12 scores (by 10.1 points, p = 0.019). Differences in KSS subscores also reached the level of statistical significance. KOOS-PS did not differ significantly. Statistically significant differences between the two knee designs on FJS-12, KS and FS assessments were revealed, but overall, these differences may not reach the threshold of clinical significance.