Archives of Orthopaedic and Trauma Surgery最新文献

Outcome evaluation is of major importance to provide data to analyze the value of the chosen treatment concept. Despite an increasing effort of analyzing outcome after treatment of different pelvic ring injuries, a mixture of different outcome parameters is in use. The Majeed score is most frequently used for mid- to long-term evaluation and the quality of life is analyzed using the SF-36 score. The lack in nearly all studies is that different treatment concepts are used, and only selected evaluation parameters are reported. Until today, no well-accepted standardized measurement instruments are available to analyze the clinical and radiological results after pelvic ring injuries. Overall, stability-based long-term sequelae can be expected with increasing complaints from stable type A injuries to completely unstable type C injuries. Beside a fracture-type specific treatment, concomitant injuries of other injury regions and associated local pelvic injuries (complex pelvic trauma) seem to additionally influence the results. Results of treatment of specific fracture types are sparse as a wide range of different injury types and different treatment concepts are analyzed within these analyses. A sufficient pelvic outcome instrument which addresses relevant pelvic outcome parameters is still missing. Thus, future evaluation of long-term results after pelvic ring. injuries should include prospective, multicenter outcome studies with comparable parameters.

Background

The purpose of this study was to explore the optimal timing and associated risks of spinal deformity surgery during the COVID‑19 pandemic.

Methods

All consecutive surgical cases for spinal deformity between November 2022 and April 2023 were included. The population was divided into several categories according to the time from diagnosis of SARS-CoV-2 infection to the day of surgery: without infection (pre-COVID-19), infection at 0 to 4 weeks (peri-COVID-19), infection at 4 to 8 weeks (early post-COVID-19), and infection over 8 weeks (late post-COVID-19). The primary outcome and secondary outcomes were 90-day complication rate and total hospital stay. Postoperative complications and total hospital stay were analyzed using logistic regression and linear regression models, and we simultaneously showed the results from the crude model, minimally adjusted model and fully adjusted model. In addition, we performed various sensitivity analyses.

Results

A total of 60 consecutive patients were enrolled. The overall complication rate at 90 days postoperatively was 41.6% (25 of 60 patients), and the total hospital stay for all patients was (10.1 ± 3.5) days. In the fully adjusted model, compared with pre-COVID-19 patients, peri-COVID-19 patients had a 5.1-fold increased risk of postoperative complications (OR = 6.1, 95% CI 1.1–31.9, P = 0.030), early post-COVID-19 patients and late post-COVID-19 patients were at essentially equal risk. In terms of total hospital stay, compared with patients not infected with SARS-CoV-2, peri-COVID-19 patients had a 3.1-day longer hospital stay (ꞵ = 3.1, 95%CI 0.3–5.8, P = 0.032), early post-COVID-19 patients also had a 3.1-day longer hospital stay (ꞵ = 3.1, 95%CI 0.3–6.0, P = 0.032), and late post-COVID-19 patients had the similar hospital stay (ꞵ = -0.4, 95%CI -2.9–2.1, P = 0.741). Sensitivity analysis showed that the conclusions were robust.

Conclusions

With careful preoperative screening of patients for COVID-19, spinal deformity surgery can proceed safely during the epidemic. We recommend that spinal deformity surgery be delayed in patients with COVID-19 until 8 weeks after SARS-CoV-2 infection.

Introduction

Preemptive multimodal analgesia (PMA) is commonly employed for pain control after total knee arthroplasty (TKA). However, the optimal timing for initiating PMA remains unclear. This study aimed to compare the efficacy of PMA administered at different time points before TKA.

Materials and methods

In this prospective, double-blind, placebo-controlled, randomized trial, 120 patients who underwent TKA were randomized into three groups. PMA (200 mg celecoxib and 150 mg pregabalin administered every 12 h) was initiated 48 h (group A), 24 h (group B), and 1 h (group C) before surgery. The primary outcome was the postoperative administration of morphine hydrochloride as a rescue analgesic. Secondary outcomes included time to first rescue analgesia, postoperative pain assessed using the visual analog scale (VAS), functional recovery assessed by knee motion range and ambulation distance, time until hospital discharge, and complication rates.

Results

Compared with group C, groups A and B exhibited significantly lower morphine consumption within 24 h after surgery, lower total morphine consumption, longer time to first rescue analgesia, and superior range of knee motion on the day of surgery. Groups A and B did not exhibit significant differences in these outcomes. The three groups did not differ significantly in postoperative VAS pain scores, ambulation distance, length of hospital stay, or complication rates.

Conclusions

In comparison with PMA starting at 1 h preoperatively, initiating PMA at 24 and 48 h preoperatively provided better postoperative pain relief. Considering the aim of minimizing the amount of ineffective medication received by patients, initiating PMA at 24 h preoperatively may be a more favorable option for patients undergoing TKA. However, the clinical significance of our results and the optimal starting time for PMA require further investigation.

Background

The combined anteversion theory is used for implant placement in total hip arthroplasty (THA). While majority of the research emphasizes the precise placement of the acetabular cup, there’s less focus on stem alignment. This study aimed to investigate the impact of the discrepancy between the preoperatively planned femoral neck osteotomy level and the actual osteotomy level during surgery on stem alignment.

Materials and Methods

The study involved 232 patients (258 joints) who had a total hip arthroplasty (THA) between April 2018 and December 2022 at our hospital. They were implanted with either the ACTIS stem (Depuy Synthes) or Taperloc Complete XR 123° (Zimmer Biomet)—147 joints with ACTIS stem and 111 with Taperloc stem. Three-dimensional templating software was used to evaluate preoperative planning and postoperative stem placement angles. The difference between the actual and preoperatively planned osteotomy levels was also measured. The impact of this difference in femoral neck osteotomy level on stem alignment was evaluated.

Results

In the ACTIS stem group, the femoral neck osteotomy level was − 0.3 ± 3.7 mm. The stem alignment had a varus of 1.8 ± 1.9°, extension of 0.1 ± 1.5°, and anteversion of 2.4 ± 5.9°, compared to preoperative plans. A positive correlation was identified between osteotomy level and varus/valgus alignment (r = 0.607, p < 0.01), with a weak correlation for anteversion (r = 0.236, p < 0.01). No correlation existed with flexion/extension. In the Taperloc stem group, osteotomy level was 2.2 ± 3.1 mm. The postoperative stem showed a varus of 1.6 ± 1.5°, extension of 0.5 ± 1.7°, and anteversion of 4.9 ± 6.5°. A correlation was observed between osteotomy level and varus/valgus alignment (r = 0.476, p < 0.01), but not with flexion/extension or anteversion.

Conclusions

The study examined how differences in planned vs. actual femoral neck osteotomy affect stem alignment in THA using ACTIS stem and Taperloc stem. We found that osteotomy level influenced varus/valgus alignment; mildly affected flexion/extension; and had no effect on anteversion.

Background

In total hip arthroplasty (THA), soft tissue retraction is crucial, but traditional methods may cause damage. This study addresses the issue by introducing the Gripper Table Mounted System, a pulley-based retraction system. The research compares THA outcomes with and without the Gripper system, whether reducing soft tissue damage and postoperative pain. The Gripper, with its unique design, aims to minimize tissue damage during surgery.

Materials and methods

The study conducted a retrospective analysis of 180 patients (180 hips) who underwent THA via an antero-lateral approach with the Gripper System or conventional retraction methods. Primary outcomes included gluteus medius cross-sectional area and hip abductor muscle strength. Secondary outcomes were pain VAS, intraoperative bleeding, operative time, laboratory data, and WOMAC score.

Results

The study compared outcomes between those using the Gripper System (Gripper + group, n = 58) and those without (Gripper - group, n = 122). Both groups exhibited no significant differences in demographics or operative parameters. Gripper + group showed enhanced recovery in gluteus medius cross-sectional area and hip abductor muscle strength, with significant analgesia at various postoperative time points. No complications were noted in either group.

Conclusions

The Gripper system proved effective in early analgesia, swift recovery of hip strength, and preserving muscle area. Its single-use, sterile, and compact design offers advantages over traditional retractor holders or human assistance, potentially reducing soft tissue damage and postoperative pain. This study concluded the Gripper system’s value in reducing pain and restoring strength in THA.

Level of evidence

Therapeutic Level III.

Trial registration

The University Hospital Medical Information Network (UMIN) registration number UMIN000052948.

Purpose

This study aimed to assess the long-term results of THA patients who received a cementless short stem regarding clinical outcomes, bone changes, complications, and incidence of femoral revision.

Methods

A retrospective evaluation of the first 100 THA employing a type 2B cementless stem (Mini hip stem, Corin, Cirencester, United Kingdom) by the same surgeon at one institution. We only include patients with 18 years or more, and with a minimum follow up of 8 years. Patient’s Harris hip score (HHS), the University of California, Los Angeles activity score (UCLA), and radiographic outcomes were evaluated.

Results

A total of 100 primary hip arthroplasties with Mini Hip stems were performed on 84 patients, with an average age of 47 years old. The median follow-up was 120 months (IQR 57.5-136.5), with 47 patients having a minimum 10-year follow-up. The patient’s HHS improved significantly (p < 0.001) and UCLA’s score was 7 (SD 1.7) at the final follow-up. Only one patient suffered an intraoperative lateral cortical perforation, which was treated on the same day with revision of the short stem to a conventional metaphysodiaphyseal fixation stem. Three incomplete fractures of the calcar occurred intraoperative, of which only one required wire cerclage and unloading partial during the 30 days after surgery. No osteolysis, radiolucency, thigh pain, periprosthetic or ceramic fractures were observed. Only 6% hips experience squeaking without the need for revision. Two acetabular components were revised early, but no stem failures were recorded, yielding an incidence density rate of 0% (95% CI 0-0.05%) over 10 years.

Conclusion

This study showed that the MiniHip short stem is a reliable option for THA in younger patients, with a high implant survival rate and excellent functional outcomes over the long term.

Background

Cement fixation for total hip arthroplasty (THA) remains a controversial topic. While cemented stems are associated with lower risk of periprosthetic fractures (PPF), cementless stems may offer superior biological fixation. This study analyzed peri-operative and short-term outcomes of cemented vs. cementless stem fixation in THA.

Methods

A retrospective review was conducted on 15,012 patients who underwent primary elective THA at an academic medical center from 2011 to 2021. Of these patients, 429 were cemented. Patients were stratified into 3 age cohorts (25–69, 70–79 and ≥ 80 years). Cemented stem patients were 1:1 propensity-score matched to cementless stem patients for baseline characteristics. Perioperative and short-term outcomes were compared.

Results

The mean operative time for cemented cases was significantly longer across all age cohorts (25–69, P = 0.005; 70–79, P < 0.001; ≥80, P < 0.001). In the 70–79 and ≥ 80 cohorts, cemented patients demonstrated a significantly shorter length of stay (LOS) compared to cementless patients (2.2 vs. 2.6 days, P = 0.017; 3.0 vs. 3.4, P = 0.041, respectively). In the 70–79 and ≥ 80 cohorts, cemented patients were significantly more likely to be discharged home when compared to cementless patients (88.2 vs. 80.5%, P = 0.031; 64.0 vs. 54.2%, P = 0.046, respectively). Across age cohorts, there were no differences in all-cause revision rates (Cohort 1: 5.4% vs. 1.1%, P = 0.108; Cohort 2: 3.0% vs. 1.8%, P = 0.362; Cohort 3: 1.8% vs. 1.2%, P = 0.714). The ≥ 80 cohort demonstrated increased rates of PPF in the cementless cohort compared to cemented (1.2 vs. 0%, P = 0.082, respectively), but it did not reach significance.

Conclusion

Patient age has a substantial impact on perioperative outcomes following cemented versus cementless stem THA. Patients > 70 with a cemented femoral stem had improved perioperative outcomes such as shorter LOS, increased discharge to home and reduced rates of PPF compared to their cementless stem counterparts. Patient age should be considered prior to selecting a stem fixation strategy.

Level of evidence

III, Therapeutic Study.

Introduction

Leg length is an important consideration in total hip arthroplasty (THA) as leg length discrepancies (LLD) after THA cause poor outcomes and medical litigation. This study aimed to investigate the accuracy of computed tomography (CT)-based navigation with augmented reality (AR) technology for measuring intra-operative leg length change using anteroposterior radiography (two-dimensional, 2D) and CT (three-dimensional, 3D).

Materials and methods

This study included 71 patients (75 hips) who underwent primary cementless THA in the supine position between June 2022 and November 2023 using the HoloNavi One. To assess the accuracy of the HoloNavi One based on 2D and 3D measurements, the absolute error between the intra-operative leg length change and the 2D and 3D measurements was evaluated, and the correlations were investigated. Additionally, factors affecting the absolute error were examined using multivariate analysis.

Results

The mean intra-operative leg length change when using the HoloNavi One was 6.5 ± 5.0 mm, while the mean leg length change on the 2D and 3D measurements were 5.9 ± 4.8 mm and 4.6 ± 5.7 mm, respectively. The mean absolute errors were 2.3 ± 2.7 mm between the HoloNavi One and 2D measurements, and 3.8 ± 3.3 mm between HoloNavi One and 3D measurements. The absolute errors in leg length changes for the 3D measurements were greater than those for the 2D measurements (p < 0.01). Positive correlations of leg length changes were found between the HoloNavi One and the 2D and 3D measurements. In the multiple regression analysis, no significant factors affecting the absolute error were identified in either the 2D or 3D measurements.

Conclusions

CT-based navigation with AR technology in the supine position provided acceptable accuracy for leg length change measurements.

Introduction

: With the advancement of porous surface processing technology, cementless total knee arthroplasty (TKA) has once again garnered attention. Cementless TKA lacks cement sealing, raising concerns regarding potential blood loss. Recently, patient blood management (PBM) protocols have been introduced to mitigate postoperative blood loss and transfusions. In this systematic review, we aimed to address whether cementless TKA leads to increased blood loss and transfusion rates as compared with cemented TKA. Additionally, we explored the impact of contemporary PBM protocols on post-TKA hemodynamics.

Methods

This systematic review included prospective randomized trials and retrospective studies that compared blood loss and PBM between cementless and cemented TKA. A comprehensive literature search for publications from 1980 onwards was conducted using databases such as PubMed, MEDLINE, and EMBASE. Furthermore, we conducted a thorough examination of the bibliographies of all relevant articles that were retrieved. Studies that met our inclusion criteria were assessed carefully for pertinent data. This systematic review followed the Preferred Reporting Items for Systematic Re-views and Meta-Analyses (PRISMA) statement and was registered in the PROSPERO register (CRD42024507236).

Results

A total of twelve studies were included in this study. Among these, six papers reported lower blood loss in cemented TKA, while the other six papers found no significant difference in perioperative blood loss between the two groups. From the perspective of PBM, seven studies applied PBM protocols including systematic and topical tranexamic acid, autogenous transfusion, strict transfusion threshold and drain clamping, while the remaining five studies did not. If PBM protocols were implemented, no significant difference in blood loss was observed based on the implant fixation method.

Conclusion

In the context of recent studies implementing PBM protocols, the choice of implant fixation method appears to have no relevant impact on post-TKA blood loss. Nevertheless, it is important to note that the reporting of outcomes and PBM protocols exhibit considerable variation and heterogeneity.