Archives of Orthopaedic and Trauma Surgery最新文献

Introduction

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an increasingly used trauma resuscitation procedure. The purpose of this study is to evaluate the open surgical technique in a cardiac arrest model.

Materials and methods

Thirty-one fresh cadavers were included in the study. 46 times the open arterial cutdown for the emergency procedure REBOA were performed and evaluated by physicians from a level I. trauma center.

Results

For open arterial cutdown time from skin incision to blocking the balloon in averaged 340.6 s (SD: 136.6; range: 178–600) and the balloon was correctly positioned and blocked 37 times (80.4%; 37/46) and failed 9 times (19.6%; 9/46).

Conclusions

This study vividly demonstrates that in patients in severe shock or cardiac arrest condition, the open surgical puncture for the implications of the REBOA catheter is a good and safe alternative to the percutaneous ultrasound-targeted technique.

Level of Evidence

Level V, Cadaveric Study.

Introduction

Pelvic obliquity (PO) in dysplastic hip osteoarthritis (DHOA) can present as either upward or downward tilting of the affected side. This study investigated the influence of preoperative PO direction on postoperative clinical outcomes and hip–spine morphology in patients undergoing total hip arthroplasty (THA).

Materials and methods

Data from 116 (21 men, 95 women) patients with unilateral DHOA, who underwent THA at a single institution between June 2018 and September 2023 and exhibited ≥ 2° of PO, were analyzed. Patients were categorized into two groups: upward PO (U-PO [≥ 2° upward tilt, n = 35]); and downward PO (D-PO [≥ 2° downward tilt, n = 81]). Patient demographic information, surgery-related factors, hip function scores, and radiographic parameters of the hip, lower limbs, and spine were compared between the groups.

Results

Except for the duration of hip disorders, no significant differences were observed in patient background and surgical data between the groups. Preoperatively, the U-PO group exhibited a larger acetabular offset, greater hip adduction angle, longer functional leg length on the affected side, and greater ipsilateral convex lumbar scoliosis than the D-PO group (P = 0.034, P < 0.001, P < 0.001, and P < 0.001, respectively). Postoperatively, a greater hip adduction angle and longer functional leg length discrepancy persisted in the U-PO group compared to those in the D-PO group (P < 0.001 and P = 0.002, respectively). The median (interquartile range) residual PO was greater in the U-PO group (3° [0–4°]) than that in the D-PO group (1° [0–3°]) (P = 0.009). Compared with the D-PO group, the mean postoperative hip Japanese Orthopaedic Association scores were significantly lower in the U-PO group (85 [81–92] vs. 92 [85–96], P = 0.016).

Conclusion

The U-PO group exhibited greater residual hip adduction angles, longer functional leg lengths on the affected side, and less improvement in PO after THA than the D-PO group, resulting in poorer postoperative hip function.

Purpose

The Pericapsular Nerve Group (PENG) block is a regional anaesthesia technique used in hip surgery. However, its effectiveness and analgesic efficiency, especially when compared to other regional anaesthesia techniques, have yet to be fully established. This meta-analysis aimed to determine the functional recovery and pain management following PENG block in Hip surgeries.

Methods

Following PRISMA guidelines, we conducted a meta-analysis of prospective randomised clinical trials that compared the effects of PENG block versus the control group or different regional anaesthesia techniques in hip surgeries. The study was registered on the International Register of Systematic Reviews (PROSPERO) and is available online (www.crd.york.uk/prospero, CRD42024529125).

Results

Nineteen studies encompassing 1682 participants were included for the synthesis after critical evaluation. Ultrasound-guided PENG block improved functional recovery when compared to no block anaesthesia (RR 0.48, 95% Cl 0.24, 0.96, p = 0.04) and different regional anaesthesia techniques (RR 0.45, 95% Cl 0.26, 0.77, p = 0.004).

The PENG block showed a reduction of postoperative opioid consumption 24 h after surgery when compared to no block anaesthesia (SMD − 0.92, 95% Cl − 1.65, − 0.19; p = 0.01) and when compared to Fascia Iliaca Compartment Block (FICB) (SMD − 0.96, 95% Cl − 1.52, − 0.39, p = 0.0009).

Conclusion

The PENG block improved functional recovery Compared to no-block analgesia and different regional anaesthesia techniques. Also, the PENG block improved analgesic efficacy in hip surgeries compared to no-block anaesthesia and to FICB. However, due to the high heterogeneity of included studies, more high-quality, methodological, and strictly defined RCTs are urgently needed to evaluate the advantages and disadvantages of PENG block for Hip surgeries.

Background

Limb length inequality (LLI) is a leading cause of patient dissatisfaction and litigation after total hip arthroplasty (THA). However, the surgical treatment of this complication remains controversial. In this retrospective and observational study, we evaluated the results obtained from 31 patients who underwent revision surgery for symptomatic LLI after conservative treatment had failed. Our primary endpoint was the radiographic correction of LLI. Secondary endpoints included assessing the improvement in quality of life (QoL) after surgical treatment [using the Harris Hip Score (HHS) and the 12-item Short Form Survey (SF-12)] and tracking possible complications (e.g., dislocation, residual instability).

Materials and methods

Type of surgery, implanted materials, preoperative sciatic nerve deficit, and the development of postoperative complications were recorded. Radiographic assessment was performed by measuring LLI, Femoral Offset (FO), Acetabular Offset (AO), Global Offset (GO), and height of the Center of Rotation (CORL), and calculating the difference with the contralateral side and postoperative measurements. Clinical assessment was performed by having patients answer to the HHS and the SF-12, which comprises a Physical Component Summary (PCS-12) and a Mental Component Summary (MCS-12).

Results

LLI, GO, and CORL showed a statistically significant variation between preoperatory and postoperatory radiographs. The same was found to apply also to clinical results, the HHS, and the SF-12. Linear regression analysis showed a single association between sex and postoperative HHS. No other association was found to be statistically significant.

Conclusions

In selected patients who have symptomatic structural LLI after primary THA, revision surgery can be a valid approach to restore the proper limb length and to improve the clinical outcomes with an acceptable risk of complications and instability.

Introduction

This study compared complications and clinical outcomes between simultaneous bilateral total knee arthroplasty (SBTKA) and unilateral total knee arthroplasty (UTKA) across different age groups.

Materials and methods

This retrospective single-center study included 939 consecutive patients aged 60–89 years who underwent primary total knee arthroplasty between 2019 and 2023. After applying propensity score matching for preoperative deep vein thrombosis (DVT), American Society of Anesthesiologists (ASA) classification, and preoperative functional activity according to the Knee Society Score 2011 (KSS) to 223 patients who underwent SBTKA and 716 patients who underwent UTKA, SBTKA and UTKA were compared in the following age groups: 60s (28 vs. 28), 70s (110 vs. 110), and 80s (60 vs. 60). Perioperative complications and clinical outcomes at 1 year after surgery were compared between SBTKA and UTKA. Lower limb Doppler ultrasound was performed to screen for asymptomatic DVT preoperatively and on postoperative day 7.

Results

Average ASA classification ranged from 2.0 to 2.2 across all age groups, with no difference between SBTKA and UTKA. Compared with UTKA, the decrease in hemoglobin was significantly greater after SBTKA in patients in their 70s and 80s (both p < 0.001). The proportion of blood transfusion showed no significant difference across all age groups. Asymptomatic DVT was more frequent after SBTKA than after UTKA in patients in their 80s (58.3% vs. 40.0%, p < 0.045), but not those in their 60s (42.9% vs. 32.1%) or 70s (50.9% vs. 46.3%). Clinical outcomes (knee symptoms, patient satisfaction, patient expectations, functional activity according to the KSS) were comparable between SBTKA and UTKA across all age groups at 1 year postoperatively.

Conclusions

SBTKA had higher risk of asymptomatic DVT in patients in their 80s. With evaluation of risk factors and careful patient selection, SBTKA is a valid option in terms of safety and clinical outcomes in elderly patients with ASA 2.

Purpose

There is limited information regarding how a history of cancer and related treatment with radiation therapy (RT) impacts outcomes after total knee arthroplasty (TKA). Therefore, our study assessed the risk of developing medical and surgical complications following TKA in patients with cancer as well as those with a history of prior RT.

Methods

Within a national federated research network, we conducted a retrospective cohort study, querying for patients who underwent a primary TKA from 2002 to 2022. Amongst these patients, we identified three pairs of cohorts: (1) those with and without a history of RT, (2) those with and without a cancer history, and (3) those with a history of cancer who were treated with and without RT. Following propensity-score matching for comorbidities, surgical and medical complications within the 30-day, 90-day, and 1-year postoperative periods were assessed.

Results

RT was associated with an increased risk of multiple medical complications. When controlling for cancer, patients receiving RT had lower odds of medical complications, and there was no association with these medical complications. Cancer patients had an increased risk of multiple medical complications including venous thromboembolism at all time-intervals. PJI risk was increased at 1-year among cancer patients that received RT compared to those that did not (OR: 1.5, 95% CI: 1.1-2.0).

Conclusions

While RT may not increase the risk of medical complications, a history of cancer was associated with adverse outcomes following TKA. Our findings serve to help educate this patient population and encourage collaboration with patients’ oncologists during the pre-operative optimization process.

Introduction

Current understanding of the outcomes of post-traumatic hip dislocation (PHD) in pediatric patients is limited. The purpose of this study is to evaluate the radiologic, clinical, and functional outcomes of patients with PHD, whether isolated or associated with acetabular (ACF) or proximal femoral fractures (PFF), and to identify potential risk factors for adverse outcomes.

Methods

This is a retrospective study of pediatric patients with PHD who were consecutively enrolled at three different institutions between 01/2016 and 06/2023. Patients were divided into three groups: PHD (PHD group), PHD with ACF (ACF group), and PHD with PFF (PFF group). Standard radiographs were used to classify each PHD and to identify the presence of other associated bone lesions. Clinical and functional outcomes were assessed using the Harris Hip Score (HHS). Avascular necrosis (AVN) was determined according to the Ratliff criteria. The association between outcome and associated injuries, age at trauma (≤ 10 versus > 11 years), traumatic mechanism (low versus high energy), reduction type (open versus closed), and direction of dislocation (posterior versus anterior) was evaluated.

Results

Sixty-six cases of unilateral PHD (63 posterior and 3 anterior) were analyzed, consisting of 43 males and 23 females with a mean age of 10.7 years (1–18). Of these, 24 patients were ≤ 10 years old (36.4%), 16 of whom (66.7%) had low-energy trauma. Meanwhile, 42 patients were > 11 years old (63.6%), of which 26 had high-energy trauma (61.9%; p < 0.05). It was observed that patients in the PHD group were significantly younger than those in the ACF and PFF groups (p < 0.05). ACF group had 2/25 patients with misdiagnosed ACF > 3 weeks after injury (8%) and 3/25 with concomitant ACF and PFF (12%), and PFF group had 4/12 patients with AVN (33.3%). Most patients had a favorable mean HHS score, being 97.3 for the PHD group, 93.8 for the ACF group, and 93.6 for the PFF group.

Conclusion

The outcome of PHD is worse in patients with AVN secondary to PFF, simultaneous ACF and PFF, misdiagnosed ACF, high-energy trauma, and older age at the time of injury. Advanced imaging, such as CT scan or MRI is necessary to rule out ACF in isolated dislocations. Timely diagnosis and treatment of these lesions usually result in a favorable outcome.

Level of evidence

III.

Background

Wearable activity sensors offer valuable insights into physical activity and are increasingly used in clinical and rehabilitation settings. However, most are designed for healthy individuals, necessitating a thorough evaluation of their applicability for pathological gait patterns. This study aims to assess the accuracy of commercially available wearables in measuring gait patterns among patients with lower limb injuries compared to healthy individuals.

Methods

A prospective cohort study enrolled 40 participants divided into four groups: Group A (younger patients with lower limb injuries with age < 75y), Group B (younger healthy individuals with age 75y), Group C (elderly patients with lower limb injuries and age 75y), and Group D (elderly healthy individuals with age > 75y). Mobility was assessed in real-world scenarios using four wearable devices (Apple Watch Series 4, Fitbit Charge 3, ActivPal 4, and StappOne Insoles V1.0) across three gait speeds in a gait laboratory, with GAITrite mats and video as gold standards.

Results

Accuracy varied significantly between devices. The accelerometer-based wearables (Apple Watch Series 4, Fitbit Charge 3 and ActivPal 4™) underestimated cumulative step count compared to pressure-based Stappone v1. 0, especially for slow and restricted gait patterns (Groups C and D). Relative Difference of Wearables Measurements to the true numbers of steps (Group C: AW -21.83%, FB -28.99%, AP -20.00% versus SO 0.00% - Group D: AW -8.51%, FB -14.29%, AP -20.00% versus SO 4.55%). Zero measurements occurred frequently with wrist-worn devices, highlighting their limitations in detecting slow or restricted movements. In contrast, pressure-based StappOne Insoles demonstrated superior accuracy, with minimal deviations across all groups and gait speeds. The inaccuracy was exacerbated by factors such as the use of mobility aids, partial weight-bearing, and postoperative restrictions, which altered arm and leg movements.

Conclusions

Accelerometer-based wearables require algorithmic improvements to address the challenges of slow and pathological gait patterns. The frequent occurrence of zero measurements with wrist-worn devices underscores their limited utility in clinical populations. Practical challenges, such as altered movement patterns due to mobility aids and partial weight-bearing, further limit their accuracy. Pressure-based systems, while accurate, face practicality issues for daily use. These findings emphasize the need for tailored wearable technologies for orthopedic and trauma patients.

Level of evidence

Prospective cohort study, Level of Evidence 2.

Background

Total hip arthroplasty (THA) accuracy has improved significantly with various advances in computer-assisted equipment (CAE), including robotic systems, computed tomography (CT) navigation, and portable navigation. However, no studies have directly compared the accuracy of acetabular cup placement and its impact on patient-reported outcome measures (PROMs) across these three CAE systems. In this study, we aimed to evaluate cup placement accuracy and PROMs in THA using different CAE systems.

Methods

This retrospective analysis included 196 patients (202 hip joints) who underwent THA with three CAE systems from May 2021 to August 2023. Patients were categorized into the robotic system (73 hips), CT navigation (83 hips), and portable navigation (46 hips). Postoperative CT scans measured cup placement angles—radiographic inclination (RI) and radiographic anteversion (RA) —and compared them with preoperative target angles. Anterior-posterior (AP) cup position differences were evaluated by measuring the distance between the acetabular and cup center in the axial view of the postoperative CT scans. PROMs were evaluated using the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) at 3 and 12 months.

Results

Demographic characteristics, including age, sex, primary disease, and Body Mass Index, were similar across groups. The robotic system exhibited significantly smaller deviations in ΔRI and ΔRA compared to CT navigation and portable navigation. AP cup position differences were also smaller in the robotic system versus portable navigation; however, the difference between the robotic and CT navigation systems was not statistically significant. Despite the superior precision of cup placement in the robotic system, no significant differences in JHEQ scores were observed among the groups at 3 and 12 months.

Conclusion

Robotic systems demonstrated superior accuracy in cup placement. However, short-term PROMs did not significantly differ, suggesting that PROMs may not solely depend on accurate cup placement. Future research should investigate additional factors influencing PROMs.