Joint diseases and related surgery最新文献

Objectives: This study aims to evaluate 30-day postoperative complications and hospital readmissions across different body mass index (BMI) categories and diabetic statuses following primary total knee arthroplasty (TKA).

Patients and methods: Between January 2013 and December 2022, a total of 502 patients (100 males, 402 females; mean age: 68.8±7.7 years; range, 45 to 91 years) who underwent primary TKA for knee osteoarthritis were retrospectively analyzed. Data collected included basic demography, BMI, diabetes mellitus (DM) status, and 30-day postoperative complications such as venous thromboembolism (VTE), infections, neurological events, cardiac events, and renal issues. Readmissions due to operative or medical complications were recorded.

Results: Of the patients, 141 (28.1%) had DM and 186 (37.1%) patients were classified as obese. The obese group experienced the highest incidence of VTE (1.6%), whereas overweight patients exhibited a higher rate of renal events (1.0%). All non-diabetic underweight patients (n=2) developed postoperative hypoglycemia. Diabetic patients had significantly increased odds of VTE compared to non-diabetics (odds ratio=6.74; p=0.009). Normal BMI diabetic patients demonstrated the highest incidence of surgical site infections (7.4%), while normal BMI non-diabetic patients were more prone to foot drop (1.1%) and cardiac events (4.5%).

Conclusion: Elevated BMI and DM independently or in combination, contribute to higher rates of postoperative complications and readmissions following TKA.

Objectives: This study aims to evaluate the mid- to long-term outcomes of the tension-band suture technique for small- and medium-sized rotator cuff tears.

Patients and methods: Between January 2015 and January 2022, a total of 36 patients (21 males, 15 females; median age: 55 years; range, 35 to 65 years) with small- and medium-sized tears, classified according to Cofield, who were treated with the arthroscopic modified tension-band method were retrospectively analyzed. Functional outcomes were assessed using the American Shoulder and Elbow Surgeon (ASES) shoulder scores, and structural evaluations were conducted via ultrasound. Patient satisfaction was measured using the ASES Index score. Concomitant biceps pathology and the number of anchors used were also recorded.

Results: The overall median follow-up was 49.9 (range, 22 to 100) months. There was a significant postoperative improvement in functional outcomes, with the median preoperative ASES score of 18.5 (range, 8 to 32) improving to 89 (range, 68 to 100). However, patient satisfaction, as measured by the ASES Index score (median: 4.4), declined after 52 months. Retears occurred in six patients, primarily after 52 months, indicating long-term issues. No correlation was found between outcomes and patient age, biceps tendon pathology, or the number of anchors used.

Conclusion: Our study results highlight the arthroscopic modified tension-band technique as a viable option for small- to medium-sized rotator cuff tears, offering favorable functional outcomes, but raising concerns about long-term patient satisfaction.

Objectives: This study aims to evaluate the biomechanical stability of three pin configurations for transverse supracondylar humerus fractures at various levels using finite element analysis (FEA).

Materials and methods: Computed tomography data from a six-year-old child were used to generate a humerus bone model. Four different fracture levels (low, transolecranon, high, and ultrahigh) and three pin fixation techniques (one lateral and one medial cross-pin [1-1M], two lateral capitellar pins [1-1C], and three lateral capitellar pins [2-1C]) were designed for the study. Translational stiffness and rotational stiffness in all directions were analyzed in the mesh models. Convergence data and stiffness data were obtained in the FEA.

Results: The translational and rotational stiffness values varied across fracture levels and pin configurations. Under valgus loading, the 1-1M configuration provided the highest stability in ultrahigh fractures (3289 N/mm), while the 2-1C configuration showed superior valgus and varus stability in low and transolecranon fractures. During extension and flexion loading, the 1-1M configuration yielded the highest stiffness values for transolecranon and high fractures, while the 2-1C configuration demonstrated increased stability in low and ultrahigh fractures. For rotational loading, 1-1M produced the highest inward and outward stiffness values in low-level fractures (9175 and 11035 N·mm/degree, respectively), whereas 2-1C displayed greater rotational stiffness in ultrahigh fractures.

Conclusion: This preliminary study suggests that no single pin configuration is ideal for all fracture types, and the choice should be based on the specific fracture case.

Objectives: This meta-analysis aims to explore the treatment effects and safety of different doses of febuxostat and allopurinol in patients with gout.

Materials and methods: We systematically searched electronic databases and included randomized-controlled trials (RCTs) evaluating the effects of different doses of febuxostat and allopurinol on the number of patients with serum uric acid (SUA) levels ≤6.0 mg/dL, as well as on SUA levels, gout attack incidence and adverse events (AEs) in patients with gout. We calculated pooled effect sizes, including standardized mean differences (SMDs), relative risks (RRs) or risk differences (RDs), using a random-effects model, and estimated the range of effects using 95% confidence intervals (CIs). A total of 16 RCTs involving 19,683 patients were included.

Results: The results showed that compared to allopurinol, febuxostat significantly increased the number of patients with SUA levels ≤6.0 mg/dL, particularly at doses of 40-80 mg/day (RR=1.14, 95% CI: 1.00, 1.30) and >80 mg/day (RR=2.75, 95% CI: 1.68, 4.49). Febuxostat also significantly improved SUA levels (SMD=-0.70, 95% CI: -1.02, -0.37), but had no significant effect on gout attack risk (RR=1.13, 95% CI: 0.94, 1.35). The risk of any-grade AEs was lower in the febuxostat group than in the control group (RR=0.95, 95% CI: 0.93, 0.98), but there were no significant differences in treatment-related AEs (RR=0.99, 95% CI: 0.92, 1.07) and serious AEs (RD=-0.01, 95% CI: -0.02, 0.00).

Conclusion: Overall, compared to allopurinol, febuxostat significantly improves SUA levels in patients with gout and has a certain safety profile. However, more high-quality studies are needed to further explore its efficacy.

Objectives: This study aims to investigate the efficacy and safety of a reconstruction nail combined with a percutaneous reductor-T tape pin for treating ipsilateral femoral neck and shaft fractures.

Patients and methods: Between January 2013 and December 2021, a total of 25 adult patients (19 males, 6 females, mean age: 32.8±10.9 years; range, 19 to 57 years) who sustained concurrent ipsilateral femoral neck and shaft fractures were included. The patients underwent internal fixation using a reconstruction nail with the assistance of a reductor-T tape pin, employing percutaneous techniques. The operation time, reduction time, fluoroscopy time, blood loss, preoperative and postoperative Visual Analog Scale (VAS) scores, fracture union time, Harris scores of the healthy and affected sides after fracture union, complications and lower limb functional outcomes two years post-surgery were recorded.

Results: All patients underwent successful surgery with the assistance of the reductor-T tape pin using percutaneous techniques without the need for open reduction. The mean operation time from skin incision to wound closure was 80.0±15.0 (range, 55 to 105) min. The mean fracture reduction time was 22.0±4.0 (range, 15 to 28) min. The mean fluoroscopy time was 16.0±3.8 (range, 9 to 25) sec. The mean blood loss was 335.0±142.0 (range, 150 to 550) mL. The postoperative VAS score of the affected limb was significantly lower than the preoperative score (p<0.01). The mean healing time of femoral neck fractures was 4.0±0.3 (range: 3.2 to 4.8) months. The mean healing time of femoral shaft fractures was 4.8±0.9 (range, 4.1 to 7.5) months. All patients were followed for over two years. No cases of delayed healing of femoral neck fractures or femoral head necrosis were observed. However, delayed union of femoral shaft fractures occurred in three patients. There was no statistically significant difference in Harris scores between the affected and healthy sides at the time of fracture healing (p>0.05).

Conclusion: The use of a reconstruction nail assisted by the percutaneous reductor-T tape pin demonstrated successful reduction of ipsilateral femoral neck and shaft fractures, with favorable postoperative functional outcomes. The reductor-T tape pin facilitates the reduction of femoral neck fractures and provides a safe environment for the reduction and fixation of femoral shaft fractures.

Objectives: This study aims to investigate the association between the preoperative Controlling Nutritional Status (CONUT) score and two important postoperative outcomes, surgical site infection (SSI) and prolonged hospital stay, in patients aged 60 years and older undergoing total knee arthroplasty (TKA).

Patients and methods: Between February 2019 and December 2023, a total of 268 patients (54 males, 214 females; mean age: 68.2±5.9 years; range, 60 to 87 years) aged ≥60 years who underwent elective primary TKA were retrospectively analyzed. The nutritional status was assessed using the CONUT score, and patients were categorized as at nutritional risk (CONUT ≥2) or normal (CONUT 0-1). Primary outcomes were postoperative infection and length of hospitalization. Multivariate logistic regression was used to adjust for confounding variables including age, body mass index (BMI), American Society of Anesthesiologists (ASA) score, Visual Analog Scale (VAS), hemoglobin, C-reactive protein (CRP), and surgery duration.

Results: Of the patients, 27.2% (n=73) were at nutritional risk. These patients had significantly higher rates of postoperative infection (11% vs. 3.1%, p=0.010) and longer hospital stays (5.5±1.7 vs. 1.5±0.5 days, p<0.001). A higher CONUT score was independently associated with increased risk of infection (adjusted odds ratio [OR]=4.12; 95% confidence interval [CI]: 1.33-12.7; p=0.014) and prolonged hospitalization (adjusted OR=4.03; 95% CI: 3.75-4.30; p<0.001).

Conclusion: The CONUT score is a valuable tool for preoperative risk assessment in TKA. High CONUT scores are associated with an increased risk of postoperative infection and prolonged hospitalization. Routine nutritional assessment using the CONUT score prior to surgery in older adults may help improve surgical outcomes, reduce complications and lower healthcare costs.

Objectives: The aim of this study was to evaluate the efficacy of pericapsular nerve group block (PENG) and genicular neurolysis performed with ethyl alcohol in the management of pain associated with hip or knee osteoarthritis or persistent postoperative pain following arthroplasty.

Patients and methods: Between October 2023 and June 2024, a total of 89 ambulatory adult patients (70 males, 19 females; median age: 75.5 [IQR: 62.6 to 81.3] years; range: 46.7 to 92.8 years) who visited our pain clinic were retrospectively analyzed. The PENG or genicular nerve neurolysis was performed as appropriate using ethyl alcohol. Median and maximum level of pain according to patient self-report was registered before and after the interventions.

Results: A total of 33 patients presenting with hip pain and 56 patients presenting with knee pain were treated. Considering the reported median pain, the median intensity reduced from 7.5 to 3.5 for hip pain, whereas in the knee group the median intensity of pain was 7.0 before the intervention and 3.0 after the procedure. The median intensity of reported maximal pain reduced from 10 to 6.8 for the hip, and from 8.8 to 6.5 for the knee pain.

Conclusion: Alcoholic neurolysis offers a promising, cost-effective new approach for the management of pain in the absence of radiofrequency. It provides sustained pain relief until surgical arthroplasty of the hip or knee joint and is also beneficial in the management of persistent pain following surgery or for patients who are ineligible for surgical intervention.

Objectives: This study aims to evaluate kinesiophobia and anxiety levels in patients with benign and benign-aggressive bone tumors located in the lower extremities.

Patients and methods: Between January 2022 and June 2024, a total of 54 patients (23 males, 31 females; mean age: 35.2±14.5 years; range, 15 to 67 years) who underwent surgery for benign and benign-aggressive bone tumors in the lower extremities were retrospectively analyzed. Of the patients, 16 developed pathological fractures and 38 did not. Kinesiophobia was assessed using the Tampa Kinesiophobia Scale (TKS), and anxiety levels were measured using the State-Trait Anxiety Inventory (STAI-I and STAI-II).

Results: Pathological fractures occurred in 29.6% of cases. The most common tumor types were enchondroma (44.4%), giant cell tumor (18.5%), and aneurysmal bone cyst (11.2%). Patients with pathological fractures had significantly higher TKS, STAI-I, and STAI-II scores than those without fractures (p<0.001, p=0.034, and p<0.001, respectively).

Conclusion: In benign and benign-aggressive musculoskeletal lesions of the lower extremity, implementing prophylactic surgical intervention by predicting fracture risk reduces patients' levels of kinesiophobia and anxiety. Preventing pathological fractures in weight-bearing long bones allows for early mobilization, prevents fracture-related complications, and helps to preserve psychological well-being.

Animal bites, particularly from domestic cats, represent a significant public health concern, accounting for a substantial number of emergency room visits annually. However, osteomyelitis of the metacarpal bone following a cat bite is a rare and underreported complication which presents unique diagnostic and therapeutic challenges. A 35-year-old male patient developed metacarpal osteomyelitis following a housecat bite, despite receiving early empirical antibiotic therapy. Unlike conventional osteomyelitis, cat bite-related osteomyelitis can progress insidiously due to rapid wound closure, creating an anaerobic environment that fosters deep-seated infection. This case underscores the importance of early radiological evaluation, aggressive surgical debridement, and prolonged targeted antibiotic therapy in managing such infections. In conclusion, the report highlights the need for heightened clinical suspicion and tailored management strategies to prevent delayed diagnosis and complications in similar cases.

Objectives: This study aims to assess the incidence and risk factors for avascular necrosis (AVN) in kidney transplant recipients (KTRs) under modern immunosuppression.

Patients and methods: Between January 1993 and April 2023, a total of 769 KTRs (496 males, 273 females; mean age: 38.15±12.29 years) who underwent transplantation were retrospectively analyzed. The diagnosis of AVN was established using X-rays and magnetic resonance imaging to evaluate patients presenting with pain in one or more joints. Risk factors for AVN were analyzed in a cohort of 290 transplant recipients after 2007 under tacrolimus-based treatment to standardize immunosuppression (178 males, 112 females; mean age: 40.6±12.0 years).

Results: The incidence of AVN was 8.2% (n=21) from 1993 to 2007 and 4.1% (n=21) from 2008 to 2023, retrospectively. The median duration from transplantation to the diagnosis of AVN was 15 (range, 1 to 68) months, with the femoral head being the predominant site affected. The reduction in AVN incidence, along with the replacement of cyclosporine by tacrolimus and the reduction in total corticosteroid dosage, was evident in recent era. The increased body mass index (BMI) (p=0.005), the onset of late acute rejection (p=0.024), and the administration of greater cumulative corticosteroid doses at both three (p=0.001) and 12 months (p<0.001) were correlated with the incidence of AVN in recipients undergoing tacrolimus-based maintenance immunosuppression. Multivariate analysis indicated that an elevated BMI (odds ratio [OR]=1.130, 95% confidence interval [CI]: 1.013-1.261; p=0.028) and a cumulative methylprednisolone dosage exceeding 4.5 g within 12 months (OR=12.692, 95% CI: 2.146-75.069; p=0.005) were significant predictors of AVN.

Conclusion: The incidence of AVN in kidney transplant recipients has significantly diminished in the modern immunosuppressive era and the elevated total corticosteroid dosage remains the principal risk factor for AVN among kidney transplant recipients. The implementation of preventive strategies and screening in high-risk populations should be coordinated between transplant specialists and orthopedic surgeons.