Archives of Orthopaedic and Trauma Surgery最新文献

Introduction

Dual mobility (DM) design increases the effective femoral head size and improve stability with increased jump distance and without impingement. The purpose of this study was to compare clinical outcomes and revision rate between conventional total hip arthroplasty (THA) and DM.

Materials and methods

Using the Korean National Health Insurance Service database, patients ≥ 19 years who underwent primary THA between 2015 and 2019 (n = 47,119) were identified. Cumulative incidences of dislocation, periprosthetic joint infection (PJI), periprosthetic fracture were evaluated. Multivariable Cox proportional hazard regression ratios (HRs) were used to compare cup revision, stem revision and any revision within 6 years follow-up.

Results

In adjusted analyses, DM showed a lower risk of dislocation (aHR = 0.57, 95% CI = 0.42–0.77) and higher risk of PJI (aHR = 1.46, 95% CI = 1.04–2.05), compared to conventional THA within 1 year, as well as within 30 days, 90 days. There were no significant differences in risk of cup revision (aHR = 0.66, 95% CI = 0.39 to 1.11), stem revision (aHR = 1.38, 95% CI = 0.95 to 2.01) and any revision (aHR = 0.99, 95% CI = 0.76 to 1.30).

Conclusions

We found a lower risk of dislocation and a higher risk of PJI for DM compared with conventional THA. And there was no difference in the overall revision rate between both groups. Our findings suggested that we can recommend DM when used, especially in patients with high risk of dislocation.

Introduction

Revision total knee arthroplasty (rTKA) rates are rising. Novel technologies such as imageless robotic-assisted systems have been created to increase accuracy and precision during these difficult cases, though there is a lack of evidence detailing the effectiveness of these systems. The efficacy of imageless robotic-assisted rTKA in restoring joint line and other radiographic measurements, intra-operative outcomes, clinical outcomes, and patient-reported outcome measures (PROMs) were evaluated in this study.

Materials and methods

This was a retrospective review of patients undergoing rTKA using an imageless robotic-assisted system. Patients undergoing rTKA for both aseptic and septic failures were included. Demographics, intraoperative data, radiographic outcomes, and PROMs including Patient Reported Outcome Measurement Information System (PROMIS) Pain Interference, PROMIS Physical Function, PROMIS Depression and Knee Injury, Visual Analogue Scale (VAS), and Knee Injury and Osteoarthritis Outcome Score (KOOS) were analyzed. All patients received at least 1 year of follow-up. Preoperative and postoperative weight-bearing hip-to-ankle calibrated radiographs were used to assess joint line restoration using the adductor tubercle as a reference point. Posterior condylar offset (PCO) was measured on calibrated preoperative and postoperative lateral weightbearing films.

Results

A total of 84 patients were included. Postoperative mean VAS pain (p < 0.0001), PROMIS Pain Interference (p = 0.03), and PROMIS Depression (p = 0.03) demonstrated improvement compared to preoperative scores. KOOS decreased in the postoperative period (p = 0.0006). The joint line was restored within 5 mm of the contralateral side in 77.4% (n = 65/84 patients) of patients. Postoperative and preoperative PCO to femoral diaphysis ratios were similar (ratio = 0.83 and 0.83, respectively). One-year complication rates were low amongst this patient cohort, with notable mean length of hospital stay of 2.3 ± 2.5 days and 88.1% (n = 74/84) of patients discharging home.

Conclusions

Patients undergoing rTKA with an imageless robotic-assisted system demonstrated adequate joint line restoration, maintenance of the PCO, improvement in pain scores, and low rates of post-operative complications. Further research is needed to directly investigate how imageless robotic-assisted rTKA may lead to quicker, safer discharge from the hospital as compared to conventional rTKA.

Level of evidence

Level III, diagnostic study.

Background

Total hip arthroplasty (THA) with subtrochanteric osteotomy is a common approach for managing Crowe IV developmental dysplasia of the hip (DDH). This study compares the efficacy and safety of S-ROM and Wagner cone prostheses in this procedure.

Methods

A retrospective study analyzed 68 patients (75 hips) with Crowe IV DDH who underwent THA with subtrochanteric osteotomy between 2013 and 2021, with a minimum 3-year follow-up. Patients were divided into two groups: 36 patients (38 hips) received S-ROM prostheses, and 32 patients (37 hips) received Wagner cone prostheses. Outcomes including surgical duration, intraoperative blood loss, postoperative complications, Harris Hip Score (HHS), Visual Analog Scale (VAS) scores, osteotomy healing time, and factors associating healing were compared.

Results

The Wagner cone group had significantly shorter surgical duration and less intraoperative blood loss compared to the S-ROM group. At 3 years, the S-ROM group showed higher HHS and slightly lower VAS scores. Osteotomy healing rates were comparable, but the S-ROM group had shorter healing times. Complication rates were 10.5% (4/38 hips) for S-ROM and 18.9% (7/37 hips) for Wagner cone. Preoperative HHS was an independent predictor of osteotomy healing (OR: 0.611, 95% CI: 0.448–0.832, P = 0.002).

Conclusion

The Wagner cone prosthesis reduces surgical duration and blood loss, while the S-ROM prosthesis offers superior functional outcomes and faster osteotomy healing. Both prostheses demonstrate comparable safety and healing rates, making them suitable for Crowe IV DDH.

Background

Periprosthetic femoral fractures (PPF) following total hip arthroplasty (THA) are a growing clinical challenge, particularly in the elderly. Postoperative mobility is a key determinant of outcome, yet little is known about how surgical treatment and weight-bearing protocols influence functional recovery in this population.

Methods

We conducted a retrospective cohort study of 186 patients aged ≥ 65 years treated surgically for Vancouver type B or C PPF between January 2017 and August 2023 at a level 1 trauma center. Patients underwent either open reduction and internal fixation (ORIF) or revision arthroplasty. Postoperative weight-bearing protocols were categorized as full weight bearing (FWB) or partial weight bearing (PWB). The primary outcome was mobility status at hospital discharge. Binary logistic regression was used to identify independent risk factors for immobility.

Results

Of the 186 patients included (mean age 82.4 ± 7.4 years), 64.5% were mobilized with FWB. In the ORIF group, patients allowed FWB were significantly older (85.5 ± 7.4 vs. 80.2 ± 6.3 years, p < 0.001). No significant differences in mobility, complication rates, revision surgery, or in-hospital mortality were observed between weight-bearing regimens, regardless of the type of surgery. Logistic regression identified intraoperative blood transfusion (OR = 3.17) and higher ASA scores (ASA III: OR = 9.10; ASA IV: OR = 32.03) as independent predictors of postoperative immobility. Neither the postoperative weight-bearing protocol nor the surgical procedure had a significant impact on mobility outcomes.

Conclusion

This study examines postoperative weight-bearing strategies on clinical outcomes in patients with periprosthetic hip fractures and simultaneously identifies independent risk factors associated with postoperative immobility. Our findings suggest that mobility outcomes are more influenced by patient-related factors than by surgical procedure. Our findings support the safe implementation of full weight-bearing protocols in elderly patients following periprosthetic femoral fractures, regardless of the type of surgical intervention.

Purpose

With the rising use of alternative nicotine delivery systems such as e-cigarettes and nicotine pouches, this study aims to evaluate the effect of NTND on outcomes following operative fixation of tibial shaft fractures.

Methods

TriNetX was queried to identify patients aged 18 and older who underwent operative fixation of closed tibial shaft fractures between January 2004 and January 2024. Open fractures and polytrauma patients were excluded. Patients were categorized into two cohorts: those with preoperative NTND and those with no history of nicotine use. Cohorts were propensity-matched by age, gender, race, ethnicity, BMI, and comorbidities. Ninety-day major medical complications and two-year procedure-related complications were assessed.

Results

A total of 25,528 patients undergoing operative fixation of tibial shaft fractures were identified, of which 2,701 had a documented history of NTND. After 1:1 propensity score matching, both cohorts included 2,570 patients. Within the 90-day postoperative period, the NTND group experienced significantly higher rates of deep surgical site infection (RR 1.60, 95% CI 1.05–2.43; p = 0.026) and ED visits (RR 1.68, 95% CI 1.44–1.96; p < 0.001). No differences in the rates of deep vein thrombosis, pulmonary embolism, myocardial infarction, superficial surgical site infection, compartment syndrome, or death were noted. At 2-year follow-up, rates of deep surgical site infection (RR 1.55, 95% CI 1.17–2.07; p = 0.002), osteomyelitis (RR 2.16, 95% CI 1.47–3.18; p < 0.001), hardware removal (RR 1.28, 95% CI 1.10–1.48; p = 0.002), hardware failure (RR 1.54, 95% CI 1.12–2.18; p = 0.007), and death (RR 1.90, 95% CI 1.43–2.53; p < 0.001) were higher amongst the NTND group. No difference was observed in the rates of malunion, nonunion, or revision surgery.

Conclusion

NTND is associated with significantly increased rates of deep surgical site infection, hardware-related complications, and mortality following operative fixation of tibial shaft fractures.

Level of evidence

Prognostic Level III.

The lunate bone plays a central role in force transmission, proximal carpal row integrity, and kinematics of the wrist. In cases of irreparable pathologies to the lunate bone, prosthetic replacement is appealing to avoid salvage procedures. Previous attempts at lunate replacement yielded inconsistent results due to non-anatomical implant design and lack of ligament reconstruction, which posed a risk of dislocation and carpal collapse. Nowadays, the CAD design process and 3D printing of bio-compatible materials such as titanium make it possible to manufacture patient-specific lunate implants. We present a technique and first clinical results of a patient-specific lunate replacement that includes reconstruction of the most important perilunate ligaments to suspend the implant and restore carpal integrity.

Introduction

Hop distance tests are commonly used to determine when it is safe to return to sports (RTS), but symmetrical test results do not necessarily indicate the absence of biomechanical deficiencies. Three-dimensional motion analysis may quantify ongoing lower extremity instability following anterior cruciate ligament reconstruction (ACLR).

Materials and methods

We estimated the instantaneous knee rotation axis during the landing phase of the triple hop test. The angular deviation in the orientation of the knee rotation axis between two successive instants was computed and used as a variability measure at the knee joint rotation in three dimensions.

Results

Knee flexion was less, the duration of the landing interval was shorter, and the variation at the knee rotation axis orientation over landing duration was higher on the operated side. We then classified the participants into two groups due to the threshold (above versus below 90%) defined at the Range of Motion-Limb Symmetry Index. Significantly shorter landing intervals and higher variation at the knee rotation axis orientation over the landing period at the operated side persisted in the below-threshold group only.

Conclusion

We suggest an assessment of the variation in the orientation of the knee rotation axis over the hop test landing duration, which has the potential to be utilized for decisions in RTS at ACLR.