Archives of Orthopaedic and Trauma Surgery最新文献

Introduction: Patello-femoral osteoarthritis is a degenerative condition causing anterior knee pain, stiffness, and functional impairment due to cartilage degeneration in the patello-femoral compartment. This systematic review summarises the clinical and functional outcomes of robotic-assisted patello-femoral arthroplasty (RA-PFJA), focusing on pain relief and complication rates, and includes a meta-analysis of reoperation and revision rates from comparative studies between RA-PFJA and conventional PFJA.

Materials and methods: A meta-analysis was performed for revision and reoperation rates, while other outcomes were summarised descriptively. This research was conducted across multiple databases according to the Cochrane Handbook and PRISMA guidelines. Eight studies met the inclusion criteria. Outcomes assessed included Oxford Knee Score (OKS), Kujala score, Knee Society Score (KSS), visual analogue scale (VAS), length of hospital stay (LOS), complication, revision, and reoperation rates.

Results: Eight studies with a total of 992 patients treated with RA-PFJA were included (641 with Mako, 166 with Navio, 175 with unspecified systems). The mean follow-up was 47.5 ± 29.4 months. RA-PFJA showed excellent final function (Kujala: 87.4 ± 14.1; OKS: 39.6 ± 5.4; KSS: 81.0 ± 14.2) and significant pain reduction (p < 0.001). Compared to conventional PFJA, RA-PFJA had a lower overall complication rate (15% vs. 30%), lower reoperation rate (6.3% vs. 8.6%; OR 0.67; p = 0.02), lower revision rate for implant-related causes (0.7% vs. 1.9%; OR 0.32; p = 0.01), and shorter LOS (mean difference: -0.34 days; p = 0.01).

Conclusion: RA-PFJA offers excellent functional outcomes, effective pain relief, and lower revision and complication rates at short to mid-term follow-up. While promising, further high-quality studies are needed to assess long-term results and cost-effectiveness. As robotic systems become more widespread, continued innovation and comparative research will be critical to define their role in orthopaedic surgery.

Introduction: This study aimed to compare short to mid-term functional outcomes and perioperative blood loss in patients undergoing total hip arthroplasty (THA) due to primary osteoarthritis versus those with a history of childhood open surgery for developmental dysplasia of the hip (DDH).

Materials and methods: This retrospective study included 216 patients who underwent THA between 2019 and 2024. Group 1 consisted of 72 patients with a history of open surgery for developmental dysplasia of the hip, and Group 2 included 144 patients with primary osteoarthritis matched at a 1:2 ratio based on body mass index (caliper width ± 2 kg/m²). Hemoglobin and hematocrit levels were recorded preoperatively and on postoperative days 0, 1, and 2. Perioperative trends were analyzed using linear mixed-effects models. Functional outcomes (Harris Hip Score-HHS, Oxford Hip Score, and The University of California Los Angeles-UCLA) were assessed preoperatively and at final follow-up. Transfusion decisions followed a standardized threshold (Hb < 7 g/dL or symptomatic anemia), and transfusion units were recorded. Radiographic leg-length discrepancy was measured on standardized AP pelvic radiographs. All patients were followed for at least one year.

Results: Group 1 patients were younger and had lower preoperative functional scores. Both groups demonstrated significant postoperative improvements and the magnitude of functional gain was comparable. Mixed-effects modeling showed significant time effects for hemoglobin and hematocrit (p < 0.001), with no time × group interaction. Transfusion rates were higher in Group 1 (15.2% vs. 6.2%; risk ratio 2.44, 95% CI 1.06-5.63), largely attributable to lower preoperative Hb. No significant differences were observed in post-operative complications or leg length discrepancies.

Conclusion: Postoperative functional outcomes after THA are primarily influenced by preoperative functional status rather than prior DDH surgery. Early postoperative blood loss is not significantly affected by previous open surgery. These findings underscore the importance of thorough preoperative counseling and expectation management.

Introduction: With increasing reliance on computed tomography (CT) in trauma care, the use of anteroposterior (AP) pelvis radiographs has declined. This study examined whether omitting an initial AP pelvis film affected time to hip reduction and the need for additional CT imaging in patients with traumatic hip dislocations.

Methods: We conducted a retrospective review at a Level I trauma center (2005-2016). Eligible patients were adults (> 17 years) with native hip dislocations evaluated under the Advanced Trauma Life Support (ATLS) protocol. Patients with incomplete records or irreducible hips requiring operative reduction were excluded. Data collected included patient demographics, AP pelvis use, CT imaging, time to reduction, and presence of acetabular or proximal femur fractures.

Results: The study cohort consisted of 50 patients, 76% male (n = 38), with a mean age of 33 years (range, 18-68). High-energy motor vehicle accident or motorcycle crash accounted for 90% (n = 45) of injuries, and 94% (n = 47) were posterior dislocations. Associated fractures were present in 76% (n = 38). Patients were divided into those who had no AP pelvis radiograph prior to CT scan (N-APP group, n = 8; 16%) and those who obtained an initial AP pelvis radiograph on presentation (APP group, n = 42; 84%). All patients in the N-APP group received an additional CT pelvis scan, while none in the APP group did. Average time to reduction was significantly shorter in the APP group compared with the N-APP group (69 vs. 216 min, p < 0.05).

Conclusions: Obtaining an initial AP pelvis radiograph provided a rapid and reliable means of diagnosing hip dislocations. Adherence to ATLS guidelines by performing a pelvic film before CT shortened time to reduction and prevented unnecessary repeat CT imaging in adult patients with traumatic native hip dislocations.

Purpose: To compare re-rupture rates and clinical outcomes between bone-patellar tendon-bone (BTB) and hamstring tendon (HT) grafts in anterior cruciate ligament (ACL) reconstruction according to patient risk levels.

Methods: This retrospective cohort study included patients who underwent primary ACL reconstruction at a single institution between 2018 and 2022, with outcomes assessed at a fixed 2-year postoperative follow-up. The primary endpoint was graft re-rupture, defined as a traumatic graft failure confirmed clinically and by magnetic resonance imaging, and the secondary endpoint was the Knee injury and Osteoarthritis Outcome Score (KOOS). High-risk status was defined as the presence of all three risk factors: age ≤ 20 years, posterior tibial slope. (PTS) ≥ 12°, and participation in pivoting sports. For patients with two or fewer risk factors, propensity score matching was performed using age, sex, body weight, generalized joint laxity, knee hyperextension, participation in pivoting sports, and PTS as covariates to compare outcomes between BTB and HT grafts.

Results: In the high-risk group, the BTB graft showed a significantly lower re-rupture rate compared to the HT graft (12.9% vs. 35.7%, p = 0.03), with no significant difference in KOOS overall score (96.3 ± 3.7 vs. 96.6 ± 6.3, p = 0.85). In the lower-risk group after matching, the BTB graft showed a similar re-rupture rate compared to the HT graft (6.9% vs. 5.2%, p = 0.99), with no significant difference in KOOS overall score (92.6 ± 6.9 vs. 94.8 ± 5.7, p = 0.10).

Conclusion: BTB grafts reduced re-rupture rates compared to HT grafts in high-risk ACL reconstruction patients, while clinical outcomes were similar. In lower-risk patients, no significant differences were observed between graft types in either re-rupture rates or KOOS overall score.

Level of evidence: Level III.

Background: Varying degrees of flexion contracture appear commonly in total knee arthroplasty (TKA) patients and can be corrected using increasing distal femoral bone resection. Robotic-assisted (RA) technology aims to avoid ligament release through optimized bony resections. This study evaluated the influence of preoperative flexion contracture on the magnitude of resections surgeons perform to balance knees in RA-TKA.

Materials and methods: We reviewed 789 primary RA-TKAs from 2023 to 2024 using cruciate-retaining (CR) implants. The cohort was divided by native flexion deformity into three groups: <0° flexion ("hyperextension", n = 157), 0-9.9° flexion ("minimal contracture", n = 457), and ≥ 10° flexion ("clinically important contracture", n = 175). Mean preoperative flexion contracture was - 3.8, 4.1, and 13.5° for the hyperextension, minimal contracture, and clinically important contracture cohorts, respectively. Demographics, implants, and intraoperative data were collected and analyzed. The arithmetic hip-knee-ankle (aHKA) angle was used to determine native deformity groups for additional subanalyses.

Results: Significant differences were found between cohorts for mean distal femur and proximal tibia resections, with the clinically important contracture group having the largest resections. After accounting for implanted polyethylene thickness, differences in mean tibia resections were quite small, varying by 0.9 millimeters (mm) laterally and 0.7 mm medially. Similarly, the mean distal femoral resection varied by only 1.4 mm laterally and 0.7 mm medially between the hyperextension and clinically important contracture cohorts. Indeed, 85% of cases with clinically important contractures were managed with less than 2 mm of additional distal femoral resection compared to the minimal contracture cohort.

Conclusion: With robotic-assisted TKA, bone resections can be guided by collateral ligament tension in flexion and extension. Our data suggest that surgeons can follow this strategy and successfully address flexion contractures with very small increases in resection magnitudes, which may help to maintain the joint line.