Archives of Orthopaedic and Trauma Surgery最新文献

Introduction: Rhizarthrosis, or osteoarthritis of the trapeziometacarpal joint, predominantly affects women over 50, with up to 30% experiencing some degree of arthritis in this joint. Traditional surgical approaches, such as trapeziectomy with ligament reconstruction, can result in some patients in persistent pain or limited functionality. TMC ball-in-socket arthroplasty, with a cup placed in the distal scaphoid, offers a promising alternative to traditional arthrodesis or resection-suspension arthroplasty.

Materials and methods: This study involved 11 patients with treated 13 hands who had persistent symptoms after previous TMC-1 surgeries. Procedures included a bilateral scaphometacarpal implantation in two cases. Main symptoms were pain, thumb shortening, and reduced grip strength. The Touch^® ball-in-socket prosthesis was used, with specific considerations for implant selection, surgical steps and customization based on the patient-specific case.

Results: We included 11 patients with 13 thumbs, with a mean follow-up time of 16 months (range: 4-49 months). All patients showed significant improvements in thumb function. Grip strength, as measured by dynamometry, showed an average recovery to 80-90% of the contralateral side. Thumb opposition according to the Kapandji score averaged 9 out of 10. Radiographs demonstrated good osseointegration of the implants, with no signs of prosthetic loosening or dislocation. Complications included one case of persistent mild hypesthesia of the radial nerve's superficial branch, which did not impair function, and one scaphoid fracture 4 weeks post-implantation during cast immobilization.

Conclusion: The scapho-metacarpal dual mobility prosthesis is a feasible and effective option for patients with persistent TMC-1 symptoms after failed surgeries. It uniquely preserves both thumb mobility and length, unlike alternatives like arthrodesis and tendon suspensionplasty, which remain options if the prosthesis fails. Further research and long-term studies are necessary to determine the definitive role of this approach in complex TMC-1 cases.

Purpose: The purpose of this study was to assess clinical and radiological outcome in patients after proximal hamstring tendon repair. We hypothesized that there is a significant correlation among subjective clinical outcome and interlimb asymmetries in muscle strength, fatty infiltration, and hamstring volume.

Methods: This retrospective monocentric case series included patients with surgical repair after proximal hamstring tendon rupture. Clinical outcome was assessed utilizing: Healthy Days Core Module (CDC HRQOL-4), numeric pain rating scale (NRS), modified Harris Hip Score (mHHS), Tegner Activity Scale (TAS), return to pre-injury activity level (RTPA), and patient satisfaction score. Postoperative hamstring strength was measured using a handheld dynamometer and radiological outcome was determined by postoperative magnetic resonance imaging (MRI).

Results: Twenty-seven patients with a mean age of 51.2 (± 12.6) years were available for follow-up at a mean of 41.11 (± 18.4) months. Patients state a mean of 10.6 (± 11.5) days in the unhealthy days (UHD) index and 88.9% show "good health" in the simple summary score (SSS). Mean subjective outcome scores were as follows: NRS 1.1 (± 2.4), mHHS 90.3 (± 14.8) and TAS 5.7 (± 2.2). A total of 59.3% RTPA and 88.9% state to be somewhat or very satisfied with their surgery. Mean interlimb strength ratio was 0.88 (± 0.21). MRI demonstrated a fully restored muscle-tendon unit, significantly greater fatty infiltration in the injured hamstrings (p = 0.009, d = 0.558), and a mean interlimb hamstring volume ratio of 0.94 (± 0.11). With respect to the 10% benchmark, patients had no significant asymmetries in muscle strength (p = 0.677, d = 0.084) or hamstring volume (p = 0.102, d = - 0.34). Correlation analysis revealed moderate correlation among asymmetries in strength and volume (p = 0.073, r = 0.373). In patients with the operated side inferior to the healthy side (n = 15), there was strong correlation among asymmetries in strength and volume (p = 0.002, r = 0.725). Statistically significant correlation was found between interlimb muscle volume atrophy and increase in fatty infiltration (p = 0.015, r = 0.481).

Conclusion: Proximal hamstring repair results in good clinical outcome with satisfactory recovery of hamstring strength and volume. Interlimb asymmetries, in terms of muscle strength, fatty infiltration, and hamstring volume do not correlate with clinical outcome.

Study type: Retrospective cohort study; Level of evidence, 3.

Background: Two-stage revision in infected total knee arthroplasty increases the risk of blood loss and the need for transfusion. The present study aimed to test the hemostatic efficacy of a bipolar sealer to reduce blood loss and transfusion requirements after the first stage in patients affected by peri-prosthetic knee infections.

Methods: Twenty-four patients undergoing 2-stage arthroplasty for infected TKA using a bipolar sealer (Haemodiss, Kylix, Naples, IT) were compared with 24 patients of a historical control group in which conventional electrocautery was used. Transfusion data, clinical information, and operative data were evaluated. The primary outcome measure was estimated blood loss at the time of the lowest hemoglobin level (nadir). The secondary outcome measures were the transfusion requirement and the number of units transfused.

Results: The total blood loss was significantly lower in the prospective bipolar sealer group than the control group (1.19 (IQR 1.03-1.93) vs. 1.75 (IQR 1.13-2.07) L; p = 0.022). The transfusion rate was 8% in the bipolar sealer group, whereas 33% in the control group (p = 0.036). Furthermore, the mean number of blood units transfused was higher in the control group (0.4 ± 0.7 vs. 0.08 ± 0.3; p < 0.01). The Baseline Hematocrit and Operative time were directly associated with blood loss, whereas the bipolar use represented inverse predictor using multiple linear regression analysis.

Conclusion: After the first stage of a two-stage exchange for periprosthetic knee infection, several factors influence postoperative blood loss, including preoperative HCT level and operative time. The bipolar sealer effectively supports hemostasis, thus reducing blood loss and the need for transfusions.

Introduction: As a result of increased incidence of anterior cruciate ligament (ACL) injury in young athletes, there is a rise in the indications surgical ACL reconstruction procedures. The value of anterolateral ligament (ALL) reconstruction emerges as a proposed solution to prevent graft failures and improve stability in this high demanding category of patients. The purpose of this study is to present our experience with a novel hamstring auto-grafting technique, the single antegrade sling graft (SASG), for combined reconstruction of both ACL and ALL using autologous gracilis (GR) and semitendinosus (ST) grafts utilizing a single femoral tunnel and double tibial tunnels.

Materials and methods: From January 2020 to December 2021, 21 soccer players were operated utilizing the SASG technique, a modification of the technique of SANTI study group. Inclusion criteria were participating in pivoting sport, high-grade pivot shift examination (Grade 2-3), and evidence of a lateral femoral notch sign or Segond's fracture on preoperative imaging. Patients were assessed for 2 years postoperatively by Lachman's test for anteroposterior laxity and pivot shift test for rotational laxity. The postoperative outcomes were assessed by Tegner-Lysholm and International knee documentation committee scores. Also, the postoperative complications such as stiffness, infection and graft failure were reported.

Results: 21 male soccer players with a mean age 26.4 years were included in this study. After 2 years follow up there was a statistically significant improvement in the both post-operative functional scores, P value < 0.001. Fifteen patients (71.4%) could return to their preoperative sport activity level with no giving-way symptoms. Only one case of graft failure was reported in the follow up.

Conclusions: The single antegrade sling graft (SASG), for combined reconstruction of both ACL and ALL yielded good results in terms of stability and return to sports. The technique is reproducible, and results are comparable to the available published literature.

Purpose of the study: Rhizarthrosis-osteoarthritis of the thumb carpometacarpal (CMC) joint is usually a primary idiopathic disease. Total joint arthroplasty (TJA) is one of the surgical treatment options for symptomatic advanced thumb CMC arthritis. This retrospective study aims to evaluate the mid-term functional and radiological results of TJA with the minimum follow-up period of 3 years after the surgery.

Material and methods: Presented are the results of 136 total trapeziometacarpal joint replacements in the group of 105 patients consisted of 96 women and 9 men. Used prostheses were ELiS^® implant (27 cases), Ivory^® implant (42 cases), Touch^® Dual mobility (67 cases). The follow-up period was minimally 3 years postoperatively. In all the patients, along with range of motion and radiologic evaluation of implant position, the function and pain of operated joint were evaluated using DASH and VAS score at regular intervals pre- and postoperatively.

Results: At a mean of 85 months (range 38-126 months) post-operatively, patients in 116 cases (85%) reported full satisfaction and absence of symptoms and difficulties. In 12 cases (9%) some slight residual post-exercise pain was reported. In eight cases (6%) patients suffered from episodic rest-pain, but with a lower intensity than in the preoperative period. Postoperatively, the patients declared subjective improvement in hand function. The total DASH score and VAS score decreased in all patients, while ROM increased. The course of all of TJA surgeries was complication-free. Five patients needed revision surgery. In two patients a dislocation has occurred and in three cases a loosening of the cup's implant was reported. The most frequent postoperative complication was the occurrence of transient paraesthesias of the thumb in eight cases (6%).

Conclusions: TJA is the method of choice in management of advanced symptomatic osteoarthritis of the thumb CMC joint. Mastering surgical technique, TJA represents safe and effective treatment method in advanced degenerative changes of the thumb CMC joint and it's benefits exceed possible perioperative and postoperative risks.