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Trends and outcomes in the surgical management of young adults with knee osteoarthritis using high tibial osteotomy and unicompartmental knee arthroplasty. 使用胫骨高位截骨术和单关节膝关节置换术对患有膝关节骨性关节炎的年轻成年人进行手术治疗的趋势和结果。
IF 2 3区 医学 Q2 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2024-05-21 DOI: 10.1007/s00402-024-05362-x
Shayom Debopadhaya, Ernesto Acosta, Dionisio Ortiz

Introduction: A significant portion of knee osteoarthritis is diagnosed in patients under the age of 55, where greater activity demands make total knee arthroplasty less desirable. High tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are useful alternatives, but there is little understanding of which procedure is advantageous. Hence, this study examines the utilization, complication, and reoperation rates among the HTO vs. UKA in young patients with primary osteoarthritis.

Methods: A retrospective review of the National Surgical Quality Improvement Program was performed to identify 2318 patients < 55 years of age who received either a HTO or UKA for primary osteoarthritis between 2011 and 2021. Bivariate analyses compared preoperative and intraoperative characteristics among each procedure. Then, multivariate analyses examined if either procedure was associated with worse 30-day postoperative complications or need for reoperation, independent of the statistically significant pre- and intraoperative disparities.

Results: UKAs were performed 14.2 times more commonly than HTOs, and the patients selected for HTO were more likely to be younger, have a lower BMI, have the healthiest ASA Class score, and less likely to have hypertension requiring medication (p < 0.001). HTOs took 17.5% longer to perform and had a longer average length of stay (p < 0.001), while UKAs were more likely to be performed out-patient (p < 0.001). HTOs also had higher rates of serious complications (p = 0.02), overall complications (p = 0.004), and need for reoperation (p = 0.004). Multivariate modelling demonstrated that procedure type was not a predictor of serious complications, but the use of HTO was significantly associated with any complications (odds ratio = 3.63, p = 0.001) and need for reoperation (3.21, p = 0.029).

Conclusion: Although healthier patients were selected for HTOs, UKAs were found to have a lower risk of complications and immediate reoperation. Additionally, UKAs had the advantage of lower operative burden, shorter length of stay, and a higher efficacy in outpatient settings.

导言:膝关节骨性关节炎有很大一部分是在 55 岁以下的患者中确诊的,由于这些患者的活动需求较大,因此不太需要进行全膝关节置换术。胫骨高位截骨术(HTO)和单髁膝关节置换术(UKA)是有用的替代方法,但人们对哪种手术更有优势了解甚少。因此,本研究对年轻的原发性骨关节炎患者使用 HTO 与 UKA 的情况、并发症和再手术率进行了研究:方法:对国家外科质量改进计划进行回顾性研究,确定了 2318 名患者:UKA的实施率是HTO的14.2倍,选择HTO的患者更有可能更年轻、BMI更低、ASA分级最健康、需要药物治疗的高血压患者更少(P 结论:尽管选择UKA的患者更健康,但选择HTO的患者更有可能更年轻、BMI更低、ASA分级最健康、需要药物治疗的高血压患者更少:虽然选择 HTO 的患者更健康,但发现 UKAs 的并发症和立即再次手术的风险更低。此外,UKAs 还具有手术负担低、住院时间短、门诊疗效高等优点。
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引用次数: 0
Infiltration therapy in the context of cartilage surgery. 软骨手术中的浸润疗法。
IF 4.6 3区 医学 Q2 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2023-07-04 DOI: 10.1007/s00402-023-04964-1
Wolfram Steens, Wolfgang Zinser, Philip Rößler, Thomas Heyse

Guideline-based surgical cartilage therapy for focal cartilage damage offers highly effective possibilities to sustainably reduce patients' complaints and to prevent or at least delay the development of early osteoarthritis. In the knee joint, it has the potential to reduce almost a quarter of the arthroses requiring joint replacement caused by cartilage damage. Biologically effective injection therapies could further improve these results. Based on the currently available literature and preclinical studies, intra- and postoperative injectables may have a positive effect of platelet-rich plasma/fibrin (PRP/PRF) and hyaluronic acid (HA) on cartilage regeneration and, in the case of HA injections, also on the clinical outcome can be assumed. The role of a combination therapy with use of intra-articular corticosteroids is lacking in the absence of adequate study data and cannot be defined yet. With regard to adipose tissue-based cell therapy, the current scientific data do not yet justify any recommendation for its use. Further studies also regarding application intervals, timing and differences in different joints are required.

针对病灶软骨损伤的指导性软骨外科疗法提供了非常有效的可能性,可持续减少患者的主诉,预防或至少延缓早期骨关节炎的发展。在膝关节,它有可能减少近四分之一因软骨损伤而需要进行关节置换的关节病。生物有效注射疗法可进一步改善这些结果。根据目前已有的文献和临床前研究,术中和术后注射剂富血小板血浆/纤维蛋白(PRP/PRF)和透明质酸(HA)可能会对软骨再生产生积极影响,如果注射的是透明质酸,则可以认为对临床效果也会产生积极影响。由于缺乏足够的研究数据,目前还无法确定使用关节内皮质类固醇的联合疗法的作用。关于以脂肪组织为基础的细胞疗法,目前的科学数据还不能证明推荐使用这种疗法是合理的。此外,还需要对不同关节的应用间隔、时机和差异进行进一步研究。
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引用次数: 0
Clinical outcomes of patellofemoral arthroplasty: robotic assistance produces superior short and mid-term outcomes. 髌骨关节置换术的临床疗效:机器人辅助手术的短期和中期疗效更佳。
IF 2 3区 医学 Q2 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2024-03-16 DOI: 10.1007/s00402-024-05263-z
Jonathan L Katzman, Weston Buehring, Muhammad A Haider, Patrick Connolly, Ran Schwarzkopf, Ivan Fernandez-Madrid

Introduction: Patellofemoral arthroplasty (PFA) has been shown to provide symptomatic improvement for isolated patellofemoral osteoarthritis (PFOA). The efficacy of robotic-assisted PFA and the most suitable PFA implant design, however, remain ongoing matters of debate. This study sought to compare clinical outcomes between patients who underwent robotic-assisted versus conventional PFAs with inlay and onlay prosthetic designs.

Methods: A single-center retrospective review found 237 knees (211 patients) which underwent PFA between 2011 and 2021. One hundred eighty-four knees were included in the final analysis after cases were excluded for having indications other than osteoarthritis or having less than one year of follow-up. There were 90 conventional PFAs and 94 robotic-assisted PFAs performed. Inlay components were implanted in 89 knees and onlay components were implanted in 95 knees. Propensity score matching was utilized to address demographic differences between groups.

Results: Overall, there was a revision-free survivorship rate of 89.7% with an average time to follow-up of 4.6 years (range 1.2 to 11.1). Twenty-nine knees (15.8%) required various non-conversion procedures. The conventional matched cohort exhibited a higher all-cause revision rate, accounting for revision PFAs and conversions to TKA, (18.8 vs. 6.4%, p = 0.014) and a shorter mean time to revision than the robotic-assisted cohort (3.1 vs. 5.8 years, p = 0.026). A Kaplan-Meier survivorship curve showed differences between the conventional and robotics cohorts (p = 0.041). All revisions following robotic-assisted PFA were caused by progression of osteoarthritis, whereas conventional PFAs also required revision due to aseptic loosening and patellar maltracking. The rate of infection resulting in irrigation and debridement was higher for conventional cases (4.3 vs. 0%, p = 0.041). No significant differences in clinical outcomes between the inlay and onlay prosthetic design matched cohorts were identified.

Conclusion: PFA is an effective treatment for addressing advanced patellofemoral arthritis. Robotic-assisted surgery may lead to improved clinical outcomes.

Level of evidence: III.

简介:髌骨股骨关节置换术(PFA)已被证明可改善孤立性髌骨股骨关节炎(PFOA)的症状。然而,机器人辅助 PFA 的疗效和最合适的 PFA 植入物设计仍是争论不休的问题。本研究试图比较接受机器人辅助和传统PFA的患者的临床疗效,以及内嵌式和外嵌式假体设计:一项单中心回顾性研究发现,2011年至2021年期间,237名膝关节(211名患者)接受了PFA手术。在排除骨关节炎以外的适应症或随访不足一年的病例后,有184个膝关节被纳入最终分析。共进行了90例传统PFA手术和94例机器人辅助PFA手术。89个膝关节植入了内镶组件,95个膝关节植入了外镶组件。采用倾向得分匹配法来解决组间的人口统计学差异:总体而言,无翻修存活率为 89.7%,平均随访时间为 4.6 年(1.2 至 11.1 年不等)。29个膝关节(15.8%)需要进行各种非转换手术。与机器人辅助队列相比,传统匹配队列的全因翻修率较高(18.8% 对 6.4%,P = 0.014),且平均翻修时间较短(3.1 年对 5.8 年,P = 0.026)。卡普兰-梅耶生存率曲线显示,传统手术组和机器人辅助手术组之间存在差异(p = 0.041)。机器人辅助PFA术后的所有翻修都是由于骨关节炎的进展引起的,而传统PFA术后的翻修也是由于无菌性松动和髌骨畸形引起的。传统手术的感染率较高(4.3% 对 0%,P = 0.041),导致灌洗和清创。嵌体和镶嵌假体设计匹配队列的临床结果无明显差异:结论:PFA是治疗晚期髌股关节炎的有效方法。结论:PFA是治疗晚期髌骨关节炎的有效方法,机器人辅助手术可改善临床疗效:证据等级:III。
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引用次数: 0
Clinical and radiological outcome of acute quadriceps tendon repair at 2 - year follow-up. 急性股四头肌肌腱修复术两年随访的临床和放射学结果。
IF 2 3区 医学 Q2 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2024-09-26 DOI: 10.1007/s00402-024-05552-7
Anke Rüttershoff, Dominik Geisel, Lucca Lacheta, Doruk Akgün, Ulrich Stöckle, Oliver Miltner, Adrian Alexander Marth, Suchung Kim

Purpose: Though previous studies on surgical quadriceps tendon repair reported good to satisfactory results its impact on knee extensor strength and patellofemoral joint is unknown. The purpose of the study was to assess the clinical and functional outcome by quantifying subjective knee related outcome, isokinetic extensor strength complemented by magnetic resonance imaging (MRI).

Methods: For this retrospective clinical trial twenty-one patients with a mean age of 59.1 (±14.9) years were carried out for follow-up evaluation. For clinical outcome numeric rating scale for pain (NRS), Kujala anterior knee pain score, Knee osteoarthritis outcome score (KOOS) with its subscores, Tegener Activity Score (TAS), Isokinetic extensor strength testing (ISO) and the Limb symmetry index (LSI) were utilized. Muscle volume (Vmqf), atrophy and cartilage status were assessed on MRI. Tendon integrity and implant loosening were evaluated. Statistical analysis was carried out using Student´s t-test, Pearson and Spearman correlation coefficient.

Results: Mean follow-up was 56.2 (± 17.5) months. Clinical outcomes in mean were as follows: NRS 1.7 (±2.0), Kujala score 75.8 (± 15.8) points; KOOS 62.9 (±30.6) % (Subscores: (KOOSPain 84 (± 18.3)%, KOOSSymptoms 63.4 (± 15.3) %, KOOSADL 79.8% (± 19.4)%, KOOSSports&Rec 61.5 (± 28.8))%, TAS 3.7 (± 1.2). Mean ISO difference was 3.7 (±32.3) %). 41.2% of patients had an LSI < 90% and showed non-significantly (p > 0.05) better outcomes in NRS, Kujala score and KOOS than patients with LSI < 90%. ISO correlated with better subjective outcome (r > 0.5) but not with MRI findings. Vmqf asymmetry > 10% was seen in 41,2% of patients. Degenerative muscle and cartilage changes were few and low grade. One tendon showed partial retear. Patients showed no signs of implant loosening.

Conclusion: Distal quadriceps tendon repair leads to satisfactory subjective outcome in patients with low to moderate activity levels. Tendon integrity was reliably restored. However, extensor strength deficits remain in more than 40% of patients. Atrophy signs of advanced fatty infiltration were recorded in 15% and patellofemoral cartilage defects in 20% of all patients, indicating that previous assessment tools do not display functional outcome adequately.

目的:尽管之前关于股四头肌肌腱手术修复的研究报告显示效果良好或令人满意,但其对膝关节伸肌力量和髌股关节的影响尚不清楚。本研究的目的是通过量化与膝关节相关的主观结果、等速伸肌力量以及磁共振成像(MRI)来评估临床和功能结果:在这项回顾性临床试验中,21 名平均年龄为 59.1 (±14.9) 岁的患者接受了随访评估。临床结果采用疼痛数字评分量表(NRS)、Kujala 膝关节前部疼痛评分、膝关节骨关节炎结果评分(KOOS)及其子评分、Tegener 活动评分(TAS)、等动伸肌力量测试(ISO)和肢体对称性指数(LSI)。核磁共振成像对肌肉体积(Vmqf)、萎缩和软骨状况进行了评估。对肌腱完整性和植入物松动情况进行了评估。统计分析采用学生 t 检验、皮尔逊和斯皮尔曼相关系数:平均随访时间为 56.2 (± 17.5) 个月。平均临床结果如下NRS为1.7(±2.0)分,Kujala评分为75.8(±15.8)分;KOOS为62.9(±30.6)%(分值:KOOS疼痛84(±18.3)%,KOOSS症状63.4(±15.3)%,KOOSADL为79.8%(±19.4)%,KOOSS运动和康复61.5(±28.8)%),TAS为3.7(±1.2)分。平均 ISO 差异为 3.7 (±32.3) %)。41.2%的患者在NRS、Kujala评分和KOOS方面的结果优于LSI为0.05的患者,但核磁共振成像结果却不尽相同。41.2%的患者Vmqf不对称程度大于10%。肌肉和软骨的退行性病变很少且程度较轻。一条肌腱出现部分再撕裂。患者没有出现假体松动的迹象:结论:股四头肌远端肌腱修复术对中低活动量患者的主观疗效令人满意。肌腱的完整性得到了可靠的恢复。然而,超过 40% 的患者仍存在伸肌力量不足的问题。在所有患者中,15%的患者有晚期脂肪浸润的萎缩迹象,20%的患者有髌骨软骨缺损,这表明以往的评估工具不能充分显示功能结果。
{"title":"Clinical and radiological outcome of acute quadriceps tendon repair at 2 - year follow-up.","authors":"Anke Rüttershoff, Dominik Geisel, Lucca Lacheta, Doruk Akgün, Ulrich Stöckle, Oliver Miltner, Adrian Alexander Marth, Suchung Kim","doi":"10.1007/s00402-024-05552-7","DOIUrl":"10.1007/s00402-024-05552-7","url":null,"abstract":"<p><strong>Purpose: </strong>Though previous studies on surgical quadriceps tendon repair reported good to satisfactory results its impact on knee extensor strength and patellofemoral joint is unknown. The purpose of the study was to assess the clinical and functional outcome by quantifying subjective knee related outcome, isokinetic extensor strength complemented by magnetic resonance imaging (MRI).</p><p><strong>Methods: </strong>For this retrospective clinical trial twenty-one patients with a mean age of 59.1 (±14.9) years were carried out for follow-up evaluation. For clinical outcome numeric rating scale for pain (NRS), Kujala anterior knee pain score, Knee osteoarthritis outcome score (KOOS) with its subscores, Tegener Activity Score (TAS), Isokinetic extensor strength testing (ISO) and the Limb symmetry index (LSI) were utilized. Muscle volume (V<sub>mqf</sub>), atrophy and cartilage status were assessed on MRI. Tendon integrity and implant loosening were evaluated. Statistical analysis was carried out using Student´s t-test, Pearson and Spearman correlation coefficient.</p><p><strong>Results: </strong>Mean follow-up was 56.2 (± 17.5) months. Clinical outcomes in mean were as follows: NRS 1.7 (±2.0), Kujala score 75.8 (± 15.8) points; KOOS 62.9 (±30.6) % (Subscores: (KOOS<sub>Pain</sub> 84 (± 18.3)%, KOOS<sub>Symptoms</sub> 63.4 (± 15.3) %, KOOS<sub>ADL</sub> 79.8% (± 19.4)%, KOOS<sub>Sports&Rec</sub> 61.5 (± 28.8))%, TAS 3.7 (± 1.2). Mean ISO difference was 3.7 (±32.3) %). 41.2% of patients had an LSI < 90% and showed non-significantly (p > 0.05) better outcomes in NRS, Kujala score and KOOS than patients with LSI < 90%. ISO correlated with better subjective outcome (r > 0.5) but not with MRI findings. V<sub>mqf</sub> asymmetry > 10% was seen in 41,2% of patients. Degenerative muscle and cartilage changes were few and low grade. One tendon showed partial retear. Patients showed no signs of implant loosening.</p><p><strong>Conclusion: </strong>Distal quadriceps tendon repair leads to satisfactory subjective outcome in patients with low to moderate activity levels. Tendon integrity was reliably restored. However, extensor strength deficits remain in more than 40% of patients. Atrophy signs of advanced fatty infiltration were recorded in 15% and patellofemoral cartilage defects in 20% of all patients, indicating that previous assessment tools do not display functional outcome adequately.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":" ","pages":"4483-4490"},"PeriodicalIF":2.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142340085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Efficacy and safety of platelet-rich plasma and hyaluronic acid combination therapy for knee osteoarthritis: a systematic review and meta-analysis. 富血小板血浆和透明质酸联合疗法治疗膝骨关节炎的有效性和安全性:系统回顾和荟萃分析。
IF 2 3区 医学 Q2 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2024-07-07 DOI: 10.1007/s00402-024-05442-y
Jiahao Gao, Yang Ma, Jinshuo Tang, Jinrui Zhang, Jianlin Zuo

Background: This study aimed to evaluate whether a combination of platelet-rich plasma (PRP) and hyaluronic acid (HA) is more effective and safer than injection alone for treating KOA.

Materials and methods: MEDLINE (PubMed), the Cochrane Library, EMBASE, and Web of Science databases were systematically searched for articles published until January 2024, and gray literature and bibliographic references were searched. All published randomized controlled trials (RCTs) compared pain, functional outcomes, and adverse events (AEs) associated with PRP + HA therapy vs. PRP or HA treatments. Two independent researchers extracted the pertinent data and evaluated the methodological quality following the PRISMA guidelines. The primary outcomes were pain, functional outcomes, and AEs. A fixed-effects model was used for data analysis in cases with low heterogeneity (P > 0.10 and I2 < 50%). Otherwise, a random effects model was used.

Results: Ten RCTs involving 943 patients were included in the analysis. The statistical findings did not differ between the treatment of PRP + HA and PRP alone, while a discernible enhancement in treatment efficacy was observed when compared to HA monotherapy: the visual analog scale scores at 1- (mean difference[MD], -1.00; 95% CI: -1.37 - -0.62; P < .001), 6- (MD, -1.87; 95% CI: -3.46 - -0.28; P = .02), 12-months (MD, -2.07; 95% CI: -3.77 - -0.38; P = .02), and the Western Ontario and McMaster Universities Arthritis Index total scores at 12-months (MD, -8.82; 95% CI: -14.48 - -3.16; P = .002). The incidence of adverse events was notably lower with PRP + HA than with HA alone (OR, 0.37; 95% CI: 0.19 - 0.69; P = .00) or PRP alone (OR, 0.51; 95% CI, 0.30 - 0.87; P = .01).

Conclusions: PRP + HA therapy resulted in more pronounced pain and functional improvement in symptomatic KOA patients than HA treatments, and combination therapy may have higher clinical safety than PRP or HA monotherapy.

背景:本研究旨在评估富血小板血浆(PRP)和透明质酸(HA)联合治疗KOA是否比单独注射更有效、更安全:系统检索了MEDLINE(PubMed)、Cochrane图书馆、EMBASE和Web of Science数据库中截至2024年1月发表的文章,并检索了灰色文献和参考文献。所有已发表的随机对照试验(RCT)都比较了 PRP + HA 治疗与 PRP 或 HA 治疗相关的疼痛、功能结果和不良事件(AEs)。两名独立研究人员按照 PRISMA 指南提取了相关数据并评估了方法学质量。主要结果包括疼痛、功能性结果和 AEs。对于异质性较低的病例(P > 0.10 和 I2 结果),采用固定效应模型进行数据分析:共有 10 项研究纳入分析,涉及 943 名患者。统计结果显示,PRP + HA治疗与单纯PRP治疗之间没有差异,但与HA单药治疗相比,疗效有明显提高:1-时的视觉模拟量表评分(平均差[MD],-1.00;95% CI:-1.37 --0.62;P 结论:PRP + HA治疗比单纯PRP治疗更有效:与 HA 治疗相比,PRP + HA 治疗可使有症状的 KOA 患者的疼痛和功能得到更明显的改善,与 PRP 或 HA 单药治疗相比,联合疗法可能具有更高的临床安全性。
{"title":"Efficacy and safety of platelet-rich plasma and hyaluronic acid combination therapy for knee osteoarthritis: a systematic review and meta-analysis.","authors":"Jiahao Gao, Yang Ma, Jinshuo Tang, Jinrui Zhang, Jianlin Zuo","doi":"10.1007/s00402-024-05442-y","DOIUrl":"10.1007/s00402-024-05442-y","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate whether a combination of platelet-rich plasma (PRP) and hyaluronic acid (HA) is more effective and safer than injection alone for treating KOA.</p><p><strong>Materials and methods: </strong>MEDLINE (PubMed), the Cochrane Library, EMBASE, and Web of Science databases were systematically searched for articles published until January 2024, and gray literature and bibliographic references were searched. All published randomized controlled trials (RCTs) compared pain, functional outcomes, and adverse events (AEs) associated with PRP + HA therapy vs. PRP or HA treatments. Two independent researchers extracted the pertinent data and evaluated the methodological quality following the PRISMA guidelines. The primary outcomes were pain, functional outcomes, and AEs. A fixed-effects model was used for data analysis in cases with low heterogeneity (P > 0.10 and I<sup>2</sup> < 50%). Otherwise, a random effects model was used.</p><p><strong>Results: </strong>Ten RCTs involving 943 patients were included in the analysis. The statistical findings did not differ between the treatment of PRP + HA and PRP alone, while a discernible enhancement in treatment efficacy was observed when compared to HA monotherapy: the visual analog scale scores at 1- (mean difference[MD], -1.00; 95% CI: -1.37 - -0.62; P < .001), 6- (MD, -1.87; 95% CI: -3.46 - -0.28; P = .02), 12-months (MD, -2.07; 95% CI: -3.77 - -0.38; P = .02), and the Western Ontario and McMaster Universities Arthritis Index total scores at 12-months (MD, -8.82; 95% CI: -14.48 - -3.16; P = .002). The incidence of adverse events was notably lower with PRP + HA than with HA alone (OR, 0.37; 95% CI: 0.19 - 0.69; P = .00) or PRP alone (OR, 0.51; 95% CI, 0.30 - 0.87; P = .01).</p><p><strong>Conclusions: </strong>PRP + HA therapy resulted in more pronounced pain and functional improvement in symptomatic KOA patients than HA treatments, and combination therapy may have higher clinical safety than PRP or HA monotherapy.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":" ","pages":"3947-3967"},"PeriodicalIF":2.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141544499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
"Heterotopic ossification after total hip arthroplasty through direct anterior approach without a dedicated orthopaedic table or direct lateral approach: a quasi-randomized single-center study". "通过无专用矫形台的直接前路或直接侧路进行全髋关节置换术后的异位骨化:一项准随机单中心研究"。
IF 2 3区 医学 Q2 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2024-09-23 DOI: 10.1007/s00402-024-05510-3
Raffaele Iorio, Matteo Romano Cantagalli, Edoardo Viglietta, Federico Corsetti, Yuri Gugliotta, Leonardo Previ, Salvatore Gagliardo, Simone Fenucci, Nicola Maffulli

Introduction: Heterotopic ossifications (HO) are common after total hip arthroplasty (THA). The invasiveness of surgical approaches plays a relevant role in HO development. The aims of this study were to assess the development of HO 6 months after THA through direct lateral approach (DLA) or direct anterior approach (DAA) without a dedicated orthopaedic table and to assess the clinical impact of HO.

Methods: This is a single-center IRB-approved, quasi-randomized prospective cohort, observational imaging study. Fifty patients underwent primary THA through DLA and 50 through DAA. Age, sex, BMI and side of the affected hip were collected. At the 6 post-operative month the Harris Hip Score (HHS) and the presence of HO (scored through the Brooker classification system) were assessed.

Results: There was no significant difference in the demographic data between groups. Operative time was significantly higher in the DAA group (72 ± 10 min vs. 58 ± 8 min: p < 0.03). At 6 post-operative months the incidence of HO was 14% in the DAA group and 32% in the DLA group (p = 0.02). Severe HO (Brooker 3-4) were significantly more common in the DLA group (p = 0.04). There was no significant difference in the HHS of patients with HO between the DAA and DLA groups. There was no association between poorer clinical outcomes and the severity of HO.

Conclusion: The DAA without a dedicated orthopaedic table is associated with a significant lower incidence of HO than the DLA 6 months after elective THA. Except for the surgical approach, no other factors correlated with the occurrence of HO. Even though a lower HHS was found with severe HO, the correlation between severity of HO and clinical outcomes did not reach statistical significance.

简介:异位骨化(HO)是全髋关节置换术(THA)后的常见疾病。手术方法的侵袭性在异位骨化的发展中起着相关作用。本研究的目的是评估通过直接外侧入路(DLA)或直接前方入路(DAA)进行全髋关节置换术(THA)后 6 个月异位骨化的发展情况,不使用专用矫形手术台,并评估异位骨化的临床影响:这是一项经 IRB 批准的单中心准随机前瞻性队列观察成像研究。50名患者通过DLA接受了初级THA,50名患者通过DAA接受了初级THA。研究人员收集了患者的年龄、性别、体重指数和患侧髋关节情况。术后6个月时,对Harris髋关节评分(HHS)和是否存在HO(通过Brooker分类系统评分)进行评估:结果:两组的人口统计学数据无明显差异。DAA组的手术时间明显较长(72±10分钟 vs. 58±8分钟:P 结论:DAA组的手术时间明显较长(72±10分钟 vs. 58±8分钟:P 结论:DAA组的手术时间明显较短:在选择性 THA 术后 6 个月,无专用矫形手术台的 DAA 与 DLA 相比,HO 的发生率明显较低。除手术方式外,其他因素均与HO的发生无关。尽管严重HO的HHS较低,但HO严重程度与临床结果之间的相关性并未达到统计学意义。
{"title":"\"Heterotopic ossification after total hip arthroplasty through direct anterior approach without a dedicated orthopaedic table or direct lateral approach: a quasi-randomized single-center study\".","authors":"Raffaele Iorio, Matteo Romano Cantagalli, Edoardo Viglietta, Federico Corsetti, Yuri Gugliotta, Leonardo Previ, Salvatore Gagliardo, Simone Fenucci, Nicola Maffulli","doi":"10.1007/s00402-024-05510-3","DOIUrl":"10.1007/s00402-024-05510-3","url":null,"abstract":"<p><strong>Introduction: </strong>Heterotopic ossifications (HO) are common after total hip arthroplasty (THA). The invasiveness of surgical approaches plays a relevant role in HO development. The aims of this study were to assess the development of HO 6 months after THA through direct lateral approach (DLA) or direct anterior approach (DAA) without a dedicated orthopaedic table and to assess the clinical impact of HO.</p><p><strong>Methods: </strong>This is a single-center IRB-approved, quasi-randomized prospective cohort, observational imaging study. Fifty patients underwent primary THA through DLA and 50 through DAA. Age, sex, BMI and side of the affected hip were collected. At the 6 post-operative month the Harris Hip Score (HHS) and the presence of HO (scored through the Brooker classification system) were assessed.</p><p><strong>Results: </strong>There was no significant difference in the demographic data between groups. Operative time was significantly higher in the DAA group (72 ± 10 min vs. 58 ± 8 min: p < 0.03). At 6 post-operative months the incidence of HO was 14% in the DAA group and 32% in the DLA group (p = 0.02). Severe HO (Brooker 3-4) were significantly more common in the DLA group (p = 0.04). There was no significant difference in the HHS of patients with HO between the DAA and DLA groups. There was no association between poorer clinical outcomes and the severity of HO.</p><p><strong>Conclusion: </strong>The DAA without a dedicated orthopaedic table is associated with a significant lower incidence of HO than the DLA 6 months after elective THA. Except for the surgical approach, no other factors correlated with the occurrence of HO. Even though a lower HHS was found with severe HO, the correlation between severity of HO and clinical outcomes did not reach statistical significance.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":" ","pages":"4225-4232"},"PeriodicalIF":2.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11564372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Treatment of anterior knee pain due to chondromalacia patellae with platelet-rich plasma and hyaluronic acid in young and middle-aged adults, a cohort study. 一项队列研究:用富血小板血浆和透明质酸治疗中青年髌骨软化症引起的膝关节前部疼痛。
IF 2 3区 医学 Q2 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2024-05-23 DOI: 10.1007/s00402-024-05363-w
Marko Ostojic, Hassan Tarek Hakam, Bruno Lovrekovic, Nikolai Ramadanov, Robert Prill

Introduction: Anterior knee pain commonly affects young women resulting in the declination of the quality of life. One of the possible pathologies causing this symptom is chondromalacia patellae (CMP). Although CMP is used to describe the softening of patellar articular cartilage, it remains a general descriptive term as it cannot be associated with a specific pathophysiologic mechanism. The objective of this study is to investigate the effect of injectable PRP on patients with anterior knee pain in absence of altered patellofemoral joint anatomy.

Methods: For this purpose, 43 patients of the affected population were recruited to participate in this non-randomized controlled trial, 28 patients in the injection group and 15 in the only-physiotherapy group. While patients in the experimental group received three PRP injections and one injection of hyaluronic acid (HA), comparators received the standard physical therapy regimen. The treatment choice was based on patients own decree. Patients between the ages of 18 to 50 years with anterior knee pain and positive Clarke´s sign were eligible for inclusion. Patients with evident anatomical abnormalities, chronic conditions affecting the knee and severe symptoms such as blocking, were excluded from the study. Patient related measures (PROMS) in the form of the VAS and the Kujala scores were the main outcome of interest. All outcomes were measured at baseline, and after 3 and 6 months after the treatment.

Results: Although an improvement was seen in both groups, a statistically significant difference favoring the injection of PRP over the physiotherapy-only group was observed (p < 0.001). The superiority of the therapeutic modality under investigation was observed at 3 and 6 months after the initial diagnosis was made. Furthermore, the results of this study revealed a significant improvement at 3 and 6 months when compared to baseline measures. The analysis of the patients age showed a negative correlation when baseline values were compared to measures at 3 and 6 months, meaning younger patients had more benefit from the treatment.

Discussion: The main results of this study affirm the positive effects of PRP and HA for the treatment of anterior knee pain described by previous research and the subsequent improvement of the quality of life. Relatively little information was found in the literature search regarding the therapeutic effects of PRP on anterior knee pain and chondropathies. While a previous radiologic study found no evidence regarding the effect of PRP, this study found a benefit when comparing PROMs between patient groups.

简介膝关节前部疼痛通常会影响年轻女性的生活质量。髌骨软化症(CMP)是导致这一症状的可能病因之一。虽然 CMP 被用来描述髌骨关节软骨的软化,但它仍然是一个笼统的描述性术语,因为它无法与特定的病理生理机制联系起来。本研究旨在探讨在髌股关节解剖结构未发生改变的情况下,注射 PRP 对膝关节前部疼痛患者的影响:为此,研究人员招募了 43 名患者参与这项非随机对照试验,其中注射组 28 人,单纯物理治疗组 15 人。实验组患者接受了三次 PRP 注射和一次透明质酸(HA)注射,而对比组患者则接受了标准物理疗法。治疗方案的选择取决于患者自己的意愿。年龄在 18 至 50 岁之间、患有膝关节前部疼痛和克拉克氏征阳性的患者均可参加。有明显解剖异常、影响膝关节的慢性疾病和严重症状(如阻塞)的患者不在研究范围内。以 VAS 和 Kujala 评分为形式的患者相关指标(PROMS)是研究的主要结果。所有结果均在基线、治疗后 3 个月和 6 个月后进行测量:结果:尽管两组患者的病情都有所改善,但注射 PRP 组与单纯物理治疗组相比,差异有统计学意义(P 讨论):本研究的主要结果肯定了以往研究中描述的 PRP 和 HA 治疗膝关节前侧疼痛的积极效果,以及随后生活质量的改善。在文献检索中,关于 PRP 对膝关节前侧疼痛和软骨病的治疗效果的信息相对较少。虽然之前的一项放射学研究没有发现 PRP 效果的证据,但本研究在比较不同患者组的 PROMs 时发现了 PRP 的益处。
{"title":"Treatment of anterior knee pain due to chondromalacia patellae with platelet-rich plasma and hyaluronic acid in young and middle-aged adults, a cohort study.","authors":"Marko Ostojic, Hassan Tarek Hakam, Bruno Lovrekovic, Nikolai Ramadanov, Robert Prill","doi":"10.1007/s00402-024-05363-w","DOIUrl":"10.1007/s00402-024-05363-w","url":null,"abstract":"<p><strong>Introduction: </strong>Anterior knee pain commonly affects young women resulting in the declination of the quality of life. One of the possible pathologies causing this symptom is chondromalacia patellae (CMP). Although CMP is used to describe the softening of patellar articular cartilage, it remains a general descriptive term as it cannot be associated with a specific pathophysiologic mechanism. The objective of this study is to investigate the effect of injectable PRP on patients with anterior knee pain in absence of altered patellofemoral joint anatomy.</p><p><strong>Methods: </strong>For this purpose, 43 patients of the affected population were recruited to participate in this non-randomized controlled trial, 28 patients in the injection group and 15 in the only-physiotherapy group. While patients in the experimental group received three PRP injections and one injection of hyaluronic acid (HA), comparators received the standard physical therapy regimen. The treatment choice was based on patients own decree. Patients between the ages of 18 to 50 years with anterior knee pain and positive Clarke´s sign were eligible for inclusion. Patients with evident anatomical abnormalities, chronic conditions affecting the knee and severe symptoms such as blocking, were excluded from the study. Patient related measures (PROMS) in the form of the VAS and the Kujala scores were the main outcome of interest. All outcomes were measured at baseline, and after 3 and 6 months after the treatment.</p><p><strong>Results: </strong>Although an improvement was seen in both groups, a statistically significant difference favoring the injection of PRP over the physiotherapy-only group was observed (p < 0.001). The superiority of the therapeutic modality under investigation was observed at 3 and 6 months after the initial diagnosis was made. Furthermore, the results of this study revealed a significant improvement at 3 and 6 months when compared to baseline measures. The analysis of the patients age showed a negative correlation when baseline values were compared to measures at 3 and 6 months, meaning younger patients had more benefit from the treatment.</p><p><strong>Discussion: </strong>The main results of this study affirm the positive effects of PRP and HA for the treatment of anterior knee pain described by previous research and the subsequent improvement of the quality of life. Relatively little information was found in the literature search regarding the therapeutic effects of PRP on anterior knee pain and chondropathies. While a previous radiologic study found no evidence regarding the effect of PRP, this study found a benefit when comparing PROMs between patient groups.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":" ","pages":"3969-3976"},"PeriodicalIF":2.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141080073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Reliability and validity of the Paprosky classification for acetabular bone loss based on level of orthopedic training. 基于骨科培训水平的 Paprosky 髋臼骨缺损分类的可靠性和有效性。
IF 2 3区 医学 Q2 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2024-09-23 DOI: 10.1007/s00402-024-05524-x
Daniel A Driscoll, Robert G Ricotti, Michael-Alexander Malahias, Allina A Nocon, Troy D Bornes, T David Tarity, Kathleen Tam, Ajay Premkumar, Wali U Pirzada, Friedrich Boettner, Peter K Sculco

Background: Reliability and validity of the Paprosky classification for acetabular bone loss have been debated. Additionally, the relationship between surgeon training level and Paprosky classification accuracy/treatment selection is poorly defined. This study aimed to: (1) evaluate the validity of preoperative Paprosky classification/treatment selection compared to intraoperative classification/treatment selection and (2) evaluate the relationship between training level and intra-rater and inter-rater reliability of preoperative classification and treatment choice.

Methods: Seventy-four patients with intraoperative Paprosky types [I (N = 24), II (N = 27), III (N = 23)] were selected. Six raters (Residents (N = 2), Fellows (N = 2), Attendings (N = 2)) independently provided Paprosky classification and treatment using preoperative radiographs. Graders reviewed images twice, 14 days apart. Cohen's Kappa was calculated for (1) inter-rater agreement of Paprosky classification/treatment by training level (2), intra-rater reliability, (3) preoperative and intraoperative classification agreement, and (4) preoperative treatment selection and actual treatment performed.

Results: Inter-rater agreement between raters of the same training level was moderate (K range = 0.42-0.50), and mostly poor for treatment selection (K range = 0.02-0.44). Intra-rater agreement ranged from fair to good (K range = 0.40-0.73). Agreement between preoperative and intraoperative classifications was fair (K range = 0.25-0.36). Agreement between preoperative treatment selections and actual treatments was fair (K range = 0.21-0.39).

Conclusion: Inter-rater reliability of Paprosky classification was poor to moderate for all training levels. Preoperative Paprosky classification showed fair agreement with intraoperative Paprosky grading. Treatment selections based on preoperative radiographs had fair agreement with actual treatments. Further research should investigate the role of advanced imaging and alternative classifications in evaluation of acetabular bone loss.

背景:Paprosky分类法对髋臼骨丢失的可靠性和有效性一直存在争议。此外,外科医生的培训水平与Paprosky分类准确性/治疗选择之间的关系也未得到很好的界定。本研究旨在(1)与术中分类/治疗选择相比,评估术前Paprosky分类/治疗选择的有效性;(2)评估培训水平与术前分类和治疗选择的评分者内和评分者间可靠性之间的关系:方法: 选择了74例术中Paprosky分型[I型(24例)、II型(27例)、III型(23例)]的患者。六名评分员(住院医师(2 名)、研究员(2 名)、主治医师(2 名))利用术前放射影像独立提供帕普洛斯基分型和治疗方法。分级人员两次审查图像,每次间隔 14 天。科恩卡帕(Cohen's Kappa)计算了:(1) 按培训级别(2)、评分者内部可靠性、(3) 术前和术中评分一致性、(4) 术前治疗选择和实际治疗的评分者间帕普洛斯基分级/治疗一致性:结果:同一培训级别的评分者之间的评分者间一致性为中等(K 范围 = 0.42-0.50),治疗选择的评分者间一致性大多较差(K 范围 = 0.02-0.44)。评分者内部的一致性从一般到良好不等(K 范围 = 0.40-0.73)。术前和术中分类的一致性一般(K 范围 = 0.25-0.36)。术前治疗选择与实际治疗之间的一致性一般(K 范围 = 0.21-0.39):结论:在所有培训级别中,Paprosky 分级的评分者之间的可靠性从较差到中等不等。术前帕普洛斯基分级与术中帕普洛斯基分级的一致性尚可。根据术前X光片选择治疗方法与实际治疗方法的一致性尚可。进一步的研究应探讨先进的成像技术和其他分类方法在评估髋臼骨质流失中的作用。
{"title":"Reliability and validity of the Paprosky classification for acetabular bone loss based on level of orthopedic training.","authors":"Daniel A Driscoll, Robert G Ricotti, Michael-Alexander Malahias, Allina A Nocon, Troy D Bornes, T David Tarity, Kathleen Tam, Ajay Premkumar, Wali U Pirzada, Friedrich Boettner, Peter K Sculco","doi":"10.1007/s00402-024-05524-x","DOIUrl":"10.1007/s00402-024-05524-x","url":null,"abstract":"<p><strong>Background: </strong>Reliability and validity of the Paprosky classification for acetabular bone loss have been debated. Additionally, the relationship between surgeon training level and Paprosky classification accuracy/treatment selection is poorly defined. This study aimed to: (1) evaluate the validity of preoperative Paprosky classification/treatment selection compared to intraoperative classification/treatment selection and (2) evaluate the relationship between training level and intra-rater and inter-rater reliability of preoperative classification and treatment choice.</p><p><strong>Methods: </strong>Seventy-four patients with intraoperative Paprosky types [I (N = 24), II (N = 27), III (N = 23)] were selected. Six raters (Residents (N = 2), Fellows (N = 2), Attendings (N = 2)) independently provided Paprosky classification and treatment using preoperative radiographs. Graders reviewed images twice, 14 days apart. Cohen's Kappa was calculated for (1) inter-rater agreement of Paprosky classification/treatment by training level (2), intra-rater reliability, (3) preoperative and intraoperative classification agreement, and (4) preoperative treatment selection and actual treatment performed.</p><p><strong>Results: </strong>Inter-rater agreement between raters of the same training level was moderate (K range = 0.42-0.50), and mostly poor for treatment selection (K range = 0.02-0.44). Intra-rater agreement ranged from fair to good (K range = 0.40-0.73). Agreement between preoperative and intraoperative classifications was fair (K range = 0.25-0.36). Agreement between preoperative treatment selections and actual treatments was fair (K range = 0.21-0.39).</p><p><strong>Conclusion: </strong>Inter-rater reliability of Paprosky classification was poor to moderate for all training levels. Preoperative Paprosky classification showed fair agreement with intraoperative Paprosky grading. Treatment selections based on preoperative radiographs had fair agreement with actual treatments. Further research should investigate the role of advanced imaging and alternative classifications in evaluation of acetabular bone loss.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":" ","pages":"4267-4273"},"PeriodicalIF":2.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Specific tibial landmarks to improve to accuracy of the tibial cut during total knee arthroplasty. A case control study. 提高全膝关节置换术中胫骨切口准确性的特定胫骨地标。病例对照研究。
IF 2 3区 医学 Q2 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2024-07-05 DOI: 10.1007/s00402-024-05428-w
Sébastien Parratte, Zakee Azmi, Jeremy Daxelet, Jean-Noël Argenson, Cécile Batailler

Introduction: More personalized alignment techniques in total knee arthroplasty (TKA) have recently been described particularly for the young and active patients. Performing the ideal tibial cut might be challenging with a conventional ancillary. Therefore the aims of this study were: (1) to describe specific tibial landmarks to optimize the tibial cut in TKA; (2) to compare the accuracy of the tibial cut with these landmarks compared to a conventional technique.

Methods: This retrospective case-control study compared primary TKAs performed using a conventional technique with extramedullary guide associated with specific tibial landmarks. For each case, one control patient was matched based on body mass index (BMI), age, preoperative Hip Knee Ankle (HKA) angle, and Medial Proximal Tibial Angle (MPTA). All control patients were operated by the same surgeon and similar conventional technique but without landmarks. The MPTA target was to reproduce preoperative deformity with a 3° of varus limit. 34 TKA were included in each group. There was no preoperative difference between both groups. Mean age was 63 years old ± 8. Mean BMI was 32 kg/m2 ± 5. Mean HKA was 170.6° ± 2.5. Mean MPTA was 85.1° ± 2.3. The radiographic assessment was performed preoperatively and at 2 months: HKA, mechanical Medial Distal Femoral Angle (mMDFA), MPTA, tibial slope, restoration of the joint line-height.

Results: The tibial landmarks corresponded to the line of insertion of the deep medial collateral ligament fibers extended to the capsular insertion above the Gerdy tubercle. The postoperative MPTA was significantly more varus (87.2° ± 1.6 in landmark group versus 88.3° ± 2.2; p = 0.027) and closer to preoperative bone deformity in landmark group (p = 0.002) with significantly less outliers than in the conventional group. There was no significant difference between both groups postoperatively for HKA (175.4° ± 2.3 versus 175.9° ± 2.5; p = 0.42); mMDFA (88.9° ± 2.3 versus 88.2° ± 2.1; p = 0.18); tibial slope (82.6° ± 1.9 versus 82.4° ± 2.6; p = 0.67), the restoration of the joint line-height (1.5 mm ± 2 versus 1.8 mm ± 2; p = 0.56).

Conclusion: Specific tibial landmarks during TKA can be used to increase the accuracy of the tibial cut when using personalized alignment techniques in TKA.

Level of evidence: IV.

导言:最近,在全膝关节置换术(TKA)中出现了更多个性化的对位技术,尤其是针对年轻好动的患者。使用传统辅助工具进行理想的胫骨切口可能具有挑战性。因此,本研究的目的是(1)描述特定的胫骨地标,以优化 TKA 中的胫骨切口;(2)与传统技术相比,比较使用这些地标进行胫骨切口的准确性:这项回顾性病例对照研究比较了使用传统技术和与特定胫骨地标相关的髓外引导进行的初次 TKA。根据体重指数(BMI)、年龄、术前髋膝踝(HKA)角度和胫骨内侧近端角度(MPTA),为每个病例匹配一名对照患者。所有对照组患者均由相同的外科医生进行手术,采用类似的传统技术,但没有地标。MPTA 的目标是再现术前畸形,外翻限制为 3°。每组包括 34 名 TKA 患者。两组患者术前无差异。平均年龄为63岁±8岁。平均体重指数为 32 kg/m2 ± 5。平均 HKA 为 170.6° ± 2.5。平均 MPTA 为 85.1° ± 2.3。术前和术后两个月进行放射学评估:结果:结果:胫骨地标与内侧副韧带深层纤维插入线相对应,延伸至Gerdy结节上方的关节囊插入处。术后 MPTA 的曲度(地标组为 87.2° ± 1.6,常规组为 88.3° ± 2.2;P = 0.027)明显高于常规组,且地标组更接近术前骨畸形(P = 0.002),离群值明显低于常规组。术后两组在 HKA(175.4° ± 2.3 对 175.9° ± 2.5;p = 0.42)、mMDFA(88.9° ± 2.3 对 88.2° ± 2.1;p = 0.18);胫骨斜度(82.6° ± 1.9 对 82.4° ± 2.6;p = 0.67);关节线高度的恢复(1.5 mm ± 2 对 1.8 mm ± 2;p = 0.56):结论:在TKA中使用个性化对位技术时,可以利用特定的胫骨地标来提高胫骨切口的准确性:证据级别:IV。
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引用次数: 0
Sport and sexual recovery after total hip arthroplasty in young adults: a retrospective cohort study. 年轻人全髋关节置换术后的运动和性功能恢复:一项回顾性队列研究。
IF 4.6 3区 医学 Q2 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2024-09-23 DOI: 10.1007/s00402-024-05544-7
Alberto Di Martino, Chiara Di Censo, Matteo Brunello, Valentino Rossomando, Claudio D'Agostino, Giuseppe Geraci, Francesco Traina, Cesare Faldini

Introduction: Total Hip Arthroplasty (THA) is the main treatment for end-stage degenerative hip arthrosis in the elderly, while became increasingly performed as treatment of secondary arthrosis in younger patients, a population at high functional requests in terms of resumption of physical activity and resumption of sexual activity. This study evaluates the physical, sports recovery and the sexual quality of life in young patients undergoing primary THA.

Materials and methods: Patients undergoing primary THA aged between 18 and 45, operated in a 10 year timeframe, were selected. Demographic, clinical, and radiological data were collected. The Harris Hip Score (HHS) was assessed before and after the surgery. The UCLA Activity Score was collected, sport participation in pre and post-operative period was acquired. The quality of sexual activity (SQoL) before and after surgery was analysed through a qualitative questionnaire. Collected data were also compared on the surgical approach, namely Direct Anterior (DAA), Postero-Lateral (PL) and Direct lateral (DL).

Results: The population consisted of 242 THA implanted in 232 patients, including 143 males and 89 females, with an average age of 37.4. The mean follow-up period was 51.0 months, with a minimum of 2.9 months and a maximum of 122.6 months. Postoperatively, the average HHS was 90.29 ± 0.9 points, compared to 62.43 ± 1.34 points preoperatively (p < 0.001). The UCLA Activity Score in the postoperative period was 7.17 ± 0.17 matching to intermediate impact sport activity. The 64% of patients reported an improvement in SQoL after-surgery, 73% of which being females that show a significant improvement in SQoL compared to males (p = 0.046). By surgical approach comparison, DAA patients demonstrated better UCLA Activity Score (p = 0.037) and Return to sport (p = 0.027) compared to PL and DL.

Conclusion: Primary THA surgery in young adults can improve the level of physical activity and promote the involvement of subjects in moderate impact sports. Patients showed a better quality of sexual life compared to the preoperative period, an effect more evident in female patients.

导言:全髋关节置换术(THA)是治疗老年终末期退行性髋关节病的主要方法,同时也越来越多地用于治疗年轻患者的继发性关节病变。本研究评估了接受原发性髋关节置换术的年轻患者的身体、运动恢复和性生活质量:选取年龄在 18 岁至 45 岁之间、在 10 年内接受过原发性 THA 手术的患者。收集了人口统计学、临床和放射学数据。对手术前后的哈里斯髋关节评分(HHS)进行评估。收集了加州大学洛杉矶分校的活动评分,以及术前和术后的运动参与情况。通过定性问卷对手术前后的性活动质量(SQoL)进行了分析。收集的数据还对手术方式进行了比较,即直接前路(DAA)、后外侧(PL)和直接外侧(DL):研究对象包括 232 名患者的 242 例 THA 植入术,其中男性 143 例,女性 89 例,平均年龄 37.4 岁。平均随访时间为 51.0 个月,最短 2.9 个月,最长 122.6 个月。术后的平均 HHS 为 90.29 ± 0.9 分,而术前为 62.43 ± 1.34 分(P 结论:术后的平均 HHS 为 90.29 ± 0.9 分,而术前为 62.43 ± 1.34 分:青壮年原发性 THA 手术可以提高运动水平,促进患者参与中等强度的运动。与术前相比,患者的性生活质量有所提高,这种效果在女性患者中更为明显。
{"title":"Sport and sexual recovery after total hip arthroplasty in young adults: a retrospective cohort study.","authors":"Alberto Di Martino, Chiara Di Censo, Matteo Brunello, Valentino Rossomando, Claudio D'Agostino, Giuseppe Geraci, Francesco Traina, Cesare Faldini","doi":"10.1007/s00402-024-05544-7","DOIUrl":"10.1007/s00402-024-05544-7","url":null,"abstract":"<p><strong>Introduction: </strong>Total Hip Arthroplasty (THA) is the main treatment for end-stage degenerative hip arthrosis in the elderly, while became increasingly performed as treatment of secondary arthrosis in younger patients, a population at high functional requests in terms of resumption of physical activity and resumption of sexual activity. This study evaluates the physical, sports recovery and the sexual quality of life in young patients undergoing primary THA.</p><p><strong>Materials and methods: </strong>Patients undergoing primary THA aged between 18 and 45, operated in a 10 year timeframe, were selected. Demographic, clinical, and radiological data were collected. The Harris Hip Score (HHS) was assessed before and after the surgery. The UCLA Activity Score was collected, sport participation in pre and post-operative period was acquired. The quality of sexual activity (SQoL) before and after surgery was analysed through a qualitative questionnaire. Collected data were also compared on the surgical approach, namely Direct Anterior (DAA), Postero-Lateral (PL) and Direct lateral (DL).</p><p><strong>Results: </strong>The population consisted of 242 THA implanted in 232 patients, including 143 males and 89 females, with an average age of 37.4. The mean follow-up period was 51.0 months, with a minimum of 2.9 months and a maximum of 122.6 months. Postoperatively, the average HHS was 90.29 ± 0.9 points, compared to 62.43 ± 1.34 points preoperatively (p < 0.001). The UCLA Activity Score in the postoperative period was 7.17 ± 0.17 matching to intermediate impact sport activity. The 64% of patients reported an improvement in SQoL after-surgery, 73% of which being females that show a significant improvement in SQoL compared to males (p = 0.046). By surgical approach comparison, DAA patients demonstrated better UCLA Activity Score (p = 0.037) and Return to sport (p = 0.027) compared to PL and DL.</p><p><strong>Conclusion: </strong>Primary THA surgery in young adults can improve the level of physical activity and promote the involvement of subjects in moderate impact sports. Patients showed a better quality of sexual life compared to the preoperative period, an effect more evident in female patients.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":" ","pages":"4427-4436"},"PeriodicalIF":4.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11564370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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Archives of Orthopaedic and Trauma Surgery
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