Archives of Orthopaedic and Trauma Surgery最新文献

Introduction: Periprosthetic joint infections (PJI) represent a major complication of total joint arthroplasty. While most infections are caused by staphylococci species, a notable proportion involves gram-negative bacteria. Due to the smaller numbers, outcome reports in literature are scarce and heterogenous success rates have been reported. This study aimed to (1) evaluate the overall treatment success of gram-negative PJI and (2) identify the most suitable surgical treatment strategy in eradicating gram-negative PJI.

Materials and methods: Seventy-two cases of gram-negative PJI treated between 2010 and 2022 were analyzed in this retrospective cohort study. The median follow-up (IQR) was 18.0 (46.0) and at least 12 months. Outcomes were assessed based on the 2013 Delphi consensus on PJI outcome. PJI was defined according to the EBJIS-criteria.

Results: The overall infection-free and revision-free survival rate was 43.1% (31/72) and 56.9% (41/72). 32 out of 41 treatment failures (78.0%) appeared within the first 3 months. Among the causative pathogens, Pseudomonas aeruginosa-related PJI had the poorest outcome resulting in an infection-free survival of only 18.2% (2/11), whereas infections caused by Enterobacter cloacae had the highest success rate of 58.3% (7/12); (p = 0.12). Success rates were 65.0% (13/20) for two-stage revision, 38.1% (8/21) for multi-stage revision, 36.0% (9/25) for DAIR and 16.7% (1/6) for single-stage revision. In total, 6 amputations, 2 knee arthrodesis, and 8 resection arthroplasties were required for definitive infection eradication.

Conclusion: Gram-negative PJI may follow a more aggressive course with earlier and higher failure rates than previously thought. DAIR may be an option in selected cases, while two-stage revision showed a trend towards a more favorable infection-free survival in comparison to single- and multi-stage revisions. The results suggest pathogen-specific differences may influence outcomes and support individualized treatment strategies, warranting confirmation in large, prospective, multicenter studies.

Research background and purpose: Unicompartmental knee arthroplasty (UKA) is well-established for mild varus deformity, but its application in moderate to severe varus cases remains technically challenging. This study aims to preliminarily evaluate whether adopting the traditional medial parapatellar approach in UKA procedures for these complex deformities can yield acceptable early outcomes.

Methods: A retrospective study was conducted. Between January 2023 and March 2024, 9 patients with moderate to severe varus deformity underwent medial UKA using a cemented fixed-bearing Link prosthesis by medial parapatellar approach. The cohort included 1 male and 8 females with a mean age of 65.3 years and mean weight of 60.6 kg. All procedures were performed by a single surgeon. Preoperative and final follow-up assessments included bilateral full-length standing radiographs for hip-knee-ankle angle (HKA), The Angle between the femoral mechanical axis and the tibial mechanical axis (hip-knee-ankle angle, HKA) was measured by software and recorded. The hip-knee-ankle (HKA) angle was reported directly as the angle between the femoral and tibial mechanical axes. The normal alignment range was defined as 178°-182°, with values below 178° indicating varus deformity and those above 182° indicating valgus deformity. Knee range of motion (ROM), Hospital for Special Surgery (HSS) score, and Knee Society Score (KSS). Statistical analysis was performed using SPSS 26.0, with P < 0.05 considered statistically significant.

Results: The follow-up of 15.20 ± 1.95 months, all patients demonstrated primary wound healing without perioperative complications. Significant improvements were observed in all measured parameters: HSS score improved from 50.11 ± 3.41 to 92.11 ± 2.37 95% CI: (40.12, 43.88); KSS score from 59.89 ± 3.55 to 88.78 ± 2.49 95% CI: (27.65, 30.13); KSS function score from 44.44 ± 6.82 to 76.67 ± 7.07 95% CI: (28.33,36.12); ROM from 94.22 ± 1.92° to 122.67 ± 2.83° 95% CI: (26.60, 30.29); and HKA from 164.58 ± 4.16° to 176.64 ± 2.20°95% CI: (10.16, 13.98). All improvements were statistically significant (P < 0.001). No cases of aseptic loosening, unexplained pain, or polyethylene liner dislocation were observed during follow-up.

Conclusion: This preliminary experience suggests medial parapatellar approach for UKA in moderate to severe varus deformity may represent a technical option for carefully selected cases. However, these observations are limited by the small sample size and relatively short follow-up. Further validation through larger-scale studies with extended follow-up is warranted to establish long-term efficacy and safety.

Introduction: Patello-femoral osteoarthritis is a degenerative condition causing anterior knee pain, stiffness, and functional impairment due to cartilage degeneration in the patello-femoral compartment. This systematic review summarises the clinical and functional outcomes of robotic-assisted patello-femoral arthroplasty (RA-PFJA), focusing on pain relief and complication rates, and includes a meta-analysis of reoperation and revision rates from comparative studies between RA-PFJA and conventional PFJA.

Materials and methods: A meta-analysis was performed for revision and reoperation rates, while other outcomes were summarised descriptively. This research was conducted across multiple databases according to the Cochrane Handbook and PRISMA guidelines. Eight studies met the inclusion criteria. Outcomes assessed included Oxford Knee Score (OKS), Kujala score, Knee Society Score (KSS), visual analogue scale (VAS), length of hospital stay (LOS), complication, revision, and reoperation rates.

Results: Eight studies with a total of 992 patients treated with RA-PFJA were included (641 with Mako, 166 with Navio, 175 with unspecified systems). The mean follow-up was 47.5 ± 29.4 months. RA-PFJA showed excellent final function (Kujala: 87.4 ± 14.1; OKS: 39.6 ± 5.4; KSS: 81.0 ± 14.2) and significant pain reduction (p < 0.001). Compared to conventional PFJA, RA-PFJA had a lower overall complication rate (15% vs. 30%), lower reoperation rate (6.3% vs. 8.6%; OR 0.67; p = 0.02), lower revision rate for implant-related causes (0.7% vs. 1.9%; OR 0.32; p = 0.01), and shorter LOS (mean difference: -0.34 days; p = 0.01).

Conclusion: RA-PFJA offers excellent functional outcomes, effective pain relief, and lower revision and complication rates at short to mid-term follow-up. While promising, further high-quality studies are needed to assess long-term results and cost-effectiveness. As robotic systems become more widespread, continued innovation and comparative research will be critical to define their role in orthopaedic surgery.