Archives of Orthopaedic and Trauma Surgery最新文献

Background

To assess the long-term outcomes (minimum 10 years) of total hip arthroplasty (THA) using a large head diameter metal-on-metal (MoM) acetabular prosthesis.

Methods

In total, 108 primary THAs (98 patients) were performed using a Cormet MoM acetabular prosthesis. Clinical hip function, radiographic evaluation and revision rate were evaluated.

Results

Of the 98 patients, 15 (16 hips) followed up for < 10 years were excluded. Among the remaining 92 hips (83 patients), 35 (38.0%) had pseudotumors (PTs) detected by MRI at an average of 5.0 years after the initial THA. On radiographic evaluation, osteolysis (OL) was noted in 10 hips (10.8%) on the cup side and six hips (6.5%) on the stem side. Loosening was observed in six hips (6.5%) on the cup side, whereas no loosening was noted on the stem side. Twenty-three hips (22 patients) were switched to metal-on-polyethylene articulation between 1.2 and 14.7 years (mean: 6.3 years) postoperatively due to pain, swelling, infection, and/or implant failure. In this analysis, cup failure (OL, loosening, or both) was the highest in patients with revision surgery compared to those with PTs but not revision surgery and those without PTs.

Conclusions

The prevalence of PTs was 38.0%, and that of revision surgery was 25%. Some cases required revisions even after 10 years following surgery. We advise against its continued use and recommend regular clinical surveillance, such as MRI, to detect adverse reactions to metal debris and periprosthetic joint infection early.

Introduction

Medial unicompartmental knee arthroplasty results in good postoperative motion and high patient satisfaction. However, inaccurate bone resection during manual procedures can cause tibial fractures, implant subsidence, or lateral compartment osteoarthritis. To improve accuracy, we performed medial unicompartmental knee arthroplasty using an image-free navigation system, with a target postoperative alignment of 2°–5° varus. This study evaluated midterm clinical outcomes and safety.

Materials and methods

This single-center retrospective case series included 144 consecutive knees (25 in men and 119 in women; mean age, 72.2 years) that underwent medial unicompartmental knee arthroplasty for varus osteoarthritis between 2011 and 2021, with at least three years of follow-up (mean, 63.1 months). A fixed-bearing implant (Triathlon PKR; Stryker) was used in all cases. The navigation system guided tibial and femoral resections to achieve a hip–knee–ankle angle of 2°–5° varus, while minimizing tibial resection. Pre- and postoperative outcomes were compared for range of motion, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), ability to sit in the seiza position, implant survival, and complications.

Results

Mean knee extension improved from − 5.7° to − 0.6°, flexion from 141.6° to 145.9°, and the mean WOMAC score improved from 41.5 ± 9.9 to 4.9 ± 3.5. The number of patients able to sit in the seiza position increased significantly. Four knees underwent lateral unicompartmental knee arthroplasty for progression of lateral osteoarthritis, and one was converted to total knee arthroplasty for infection. No tibial fractures or implant subsidence occurred. The Kaplan–Meier implant survival rate, with failure defined as reoperation for any cause, was 96.5%.

Conclusions

Alignment-guided medial unicompartmental knee arthroplasty targeting 2°–5° varus using image-free navigation achieved favorable midterm outcomes without major complications.

Level of evidence

Level IV.

Purpose

Medial open-wedge high tibial osteotomy (MOWHTO) is widely used to treat varus knee osteoarthritis, but its impact on patellofemoral biomechanics remains incompletely understood. In particular, the sagittal tibial tubercle–trochlear groove (sTT-TG) distance, a novel parameter linked to patellofemoral contact pressure, has not been evaluated in this context. This study aimed to assess changes in sTT-TG following MOWHTO and identify anatomical predictors of its postoperative magnitude.

Methods

In this retrospective study, 34 knees from 33 patients (mean age 36.6 ± 9.5 years, mean BMI 26.2 ± 4.3 kg/m²) undergoing ascending biplanar MOWHTO with pre- and postoperative MRI and radiographs were analyzed. The sTT-TG, Caton–Deschamps Index (CDI), posterior tibial slope (PTS), and tibiofemoral rotation angle (TFRA) were measured. Correlation and multivariable regression analyses were performed to identify predictors of postoperative sTT-TG.

Results

MOWHTO significantly decreased the sTT-TG distance from 6.25 ± 5.34 mm to 3.74 ± 6.81 mm (p = .009), indicating anteriorization of the tibial tubercle. Patellar height (CDI) decreased from 1.14 ± 0.20 to 0.99 ± 0.15 (p < .001), and TFRA was reduced from 4.74 ± 5.54° to 2.62 ± 5.50° (p = .017). Multivariable regression identified preoperative sTT-TG, postoperative medial PTS, and CDI as independent predictors of postoperative sTT-TG (adjusted R² = 0.697). A steeper medial PTS and lower patellar height were associated with greater tibial tubercle anteriorization.

Conclusion

MOWHTO resulted in a significant anteriorization of the tibial tubercle in the sagittal plane. Postoperative sTT-TG is strongly influenced by tibial slope and patellar height, emphasizing the need to account for these factors during surgical planning, particularly in patients with patellofemoral cartilage changes. Future biomechanical studies should explore the clinical relevance of these changes on joint loading.

Introduction

Large quantities of bone specimens are required for the mechanical testing of orthopedic and trauma implants. Currently, fresh-frozen or chemically preserved bones—such as formalin-fixed—are commonly used. This study aimed to evaluate the effects of different conservation methods on mechanical bone stability under standardized conditions.

Materials and methods

Porcine metatarsals were divided into seven groups based on the preservation technique: fresh, fresh-frozen (− 18 °C), frozen with repeated freeze-thaw cycles, vacuum-sealed and refrigerated (4 °C), and chemically fixed using formalin, Thiel-fixation, or glycerol-based methods. All specimens underwent three-point bending tests to assess mechanical stability. Following induced fractures, bones were stabilized with a plate osteosynthesis (DCP^® small fragment set, Synthes^®, Germany) and retested. Bone mineral density (BMD) was also measured via dual-energy X-ray absorptiometry (DXA).

Results

Results revealed no significant differences in BMD, maximum load, or breaking strength between groups. However, chemically fixed bones—especially formalin and glycerol—showed significantly reduced deformation, indicating increased stiffness. Additionally, chemically fixed specimens exhibited more consistent fracture patterns compared to fresh or physically preserved bones. After osteosynthesis, bones preserved with glycerol showed a significant increase in both maximum load and breaking strength.

Conclusions

While physical preservation methods had no notable effect on mechanical stability, chemically fixed bones exhibited altered deformation characteristics and should therefore be used selectively, depending on the research question.

Rhizarthrosis is a common degenerative disorder of the carpometacarpal joint of the thumb, significantly impairing hand function due to pain and loss of mobility. While conservative and joint-preserving measures are the first-line treatment in early stages, advanced disease often requires surgical intervention. The aim of this study was to evaluate and compare the clinical outcomes, functional results, and complication profiles of resection arthroplasty versus latest generations of thumb carpometacarpal joint prostheses. Resection arthroplasty has proven to be a reliable therapy, providing effective pain relief and high patient satisfaction. Latest generations of thumb carpometacarpal joint prostheses demonstrate low rates of loosening and dislocation, along with advantages such as faster rehabilitation, preservation of thumb length, and good functional outcomes. The choice of procedure should be individualized, considering age, activity level, and functional requirements.

Introduction

Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are associated with bleeding events following orthopaedic surgery. However, their effect on total shoulder arthroplasty (TSA) outcomes is unknown.

Methods

Patients undergoing primary anatomic or reverse TSA in the United States were identified in the TriNetX database using Current Procedural Terminology (CPT) and International Classification of Disease (ICD-10) codes. TSA for fracture was excluded. Two cohorts were created based on preoperative serotonergic antidepressant use. Cohorts were matched to 14 demographic, comorbidity, laboratory and medication parameters. Outcomes were analyzed at one week, one month and three months postoperatively. Significance was set at p < 0.05.

Results

7,374 matched patients were included per cohort. The SSRI/SNRI cohort had significantly higher odds for post-hemorrhagic anemia and transfusion on the day of surgery (Anemia - OR 1.50, 95%CI 1.28–1.76; Transfusion - OR 2.55, 95%CI 1.27–5.13), at seven-days post-op (Anemia - OR 2.78, 95%CI 1.68–4.58; Transfusion - OR 2.58, 95%CI 1.39–4.79) and at one month post-op (Anemia - OR 2.73, 95%CI 1.37–5.46; Transfusion - OR 2.31, 95%CI 1.09–4.88). From one through three-months post-operatively, the two cohorts did not differ in rates of postoperative anemia, hematoma/hemorrhage, or reoperation.

Conclusions

Serotonergic antidepressants were associated with a higher rate of bleeding events within 30 days postoperatively after TSA. These results are seen even when propensity matching for PT/PTT and platelet function. Complications normalize after 30 days and do not appear to pose a long-term risk.

Introduction

Surgical repair of proximal hamstring tendon ruptures has demonstrated encouraging outcomes and satisfaction rates, superior to non-operative management. This study sought to investigate injury, surgical and post-operative factors associated with clinical outcome and satisfaction 2-years after proximal hamstring tendon repair of acute tendon injuries.

Methods

This study included 59 patients undergoing proximal hamstring repair for acute tendon ruptures. Clinical assessment pre-operatively and 2-years post-operatively included the Perth Hamstring Assessment Tool (PHAT), Lower Extremity Functional Scale (LEFS) and Tegner Activity Scale (TAS). Regression analysis assessed the contribution of pre-operative patient (age, sex, body mass index, TAS), injury/surgery (time from injury to surgery, injury mechanism, semimembranosus and conjoint tendon retraction) and post-operative (peak isokinetic knee flexor strength) variables, to the 2-year PHAT and reporting complete satisfaction.

Results

From baseline to 2-years, the PHAT improved by 47.1 points (95% CI, 41.9 to 52.3; p < 0.001), with 97.1% of patients meeting the PHAT minimal important change of 8.6 points by 2 years post-surgery. Furthermore, the LEFS improved by 44.5 points (95% CI, 39.9 to 49.1; p < 0.001) and TAS by 2.6 points (95% CI, 2.1 to 3.2; p < 0.001). Forty-six (78.0%) patients were ‘very satisfied’ with their 2-year outcome. Univariable analysis indicated that age (p = 0.004), baseline TAS (p = 0.006), a sport/recreation injury mechanism (p < 0.001) and 6-month normalized knee flexor torque (p = 0.030) were associated with the 2-year PHAT. In the final multivariable model, only the baseline TAS (p = 0.021) and a sport/recreation injury mechanism (p = 0.001) remained. No variable was significantly associated with being ‘very satisfied’ with 2-year surgical outcome.

Conclusions

Clinical scores improved significantly from baseline to 2 years after proximal hamstring repair. While pre-operative TAS and a sport/recreation injury mechanism were associated with the 2-year PHAT, no variables were associated with being ‘very satisfied’ with the 2-year outcome.

Level of evidence

Prospective cohort study, Level of evidence 3.