Archives of Orthopaedic and Trauma Surgery最新文献

Purpose

Unicompartmental knee arthroplasty (UKA) is a viable option for localized osteoarthritis (OA) or avascular osteonecrosis with several advantages over total knee arthroplasty (TKA). UKA implants may feature a tibial component either all-polyethylene (AP) or metal-backed (MB). This study aims to retrospectively compare the clinical outcomes and survivorship of 74 UKAs over 16 years, focusing on comparing the results and survivorship of MB versus AP tibial tray.

Materials and methods

This retrospective study assesses 74 patients who underwent medial unicompartmental knee arthroplasty (UKA) using ACCURIS Uni Knee System (Smith & Nephew, Memphis, TN, USA) implants between January 2003 and December 2008. Patients were divided in two groups: all-polyethylene (AP) tibial implants and metal-backed (MB) tibial components. The two groups were compared at final follow-up regarding survivorship, revision rates and clinical outcomes using the WOMAC score, Oxford Knee Score (OKS) and Forgotten Joint Score (FJS-12).

Results

Between January 2003 and December 2008, 74 medial unicompartmental knee arthroplasties were implanted in 74 patients. Clinical outcomes were assessed with a mean follow-up of 214.4 months. The implant survivorship was 97.3% for the MB-UKAs and 94.6% for the AP-UKAs (p = 0.55). The average OKS in the MB-UKAs was 42, while in the AP-UKAs 41.6 (p = 0.53), with a total of 64.9% of patients exhibiting excellent outcomes (OKS > 41) and 35.1% showing good outcomes (OKS: 34–41). The average FJS-12 at final follow-up was 81.5 for the MB-UKAs and 82.3 for the AP-UKAs (p = 0.34). The average WOMAC score was 20. 9 for the MB-UKAs and 22.4 for the AP-UKAs (p = 0.55). No statistically significant differences were found between AP-UKAs and MB-UKAs in terms of patient demographics, surgical indications, or clinical outcomes.

Conclusions

This research demonstrated outstanding implant durability and favorable outcomes during extended follow-up periods for both cohorts undergoing medial UKA utilizing the original fixed bearing Cartier design. The results regarding both survivorship and PROMs were equivalent the AP group and the MB group.

Developmental dysplasia of the hip is a prevalent condition in newborns. However, predicting the duration of conservative treatment remains challenging. This study aimed to determine the duration of treatment more precisely by analyzing associated factors. We conducted a retrospective analysis and developed a linear regression model based on 503 patients treated at our institution over the last 10 years. A linear regression model (GLM) was used for predicting treatment duration (df residuals 371, df model 3, Pearson Chi2 78.9, Number of iterations 15). The baseline scenario thereby feature a child with an average age at the beginning of treatment (35th day of life), both sides pathologically affected, and a minimum alpha angle of 29 degrees. The GLM identified age at treatment onset, alpha angle, and bilaterality as significant predictors of treatment duration. A four-week delay in treatment initiation extended the duration by one week, while a 5-degree increase in the alpha angle reduced it by two weeks. Bilaterality added 19 days to treatment duration. However, sex and clinical hip instability did not significantly affect the treatment time. These findings enable the calculation of treatment duration based on identified factors, potentially improving the management and planning of conservative therapies for developmental dysplasia of the hip in newborns.

Background

Nosocomial pneumonia is common in trauma patients and associated with an adverse prognosis. We recently externally validated and recalibrated an existing formula to predict nosocomial pneumonia risk. Identifying more potential predictors could aid in a more accurate prediction of nosocomial pneumonia risk in level-1 trauma patients. This study aims to identify predictors of nosocomial pneumonia in level-1 trauma patients available in the emergency department or shortly after, and examine their added predictive value to an existing prediction model by Croce.

Methods

This retrospective cohort study included all consecutive trauma patients (≥ 16 years) admitted for > 24 h to our level-1 trauma center in 2017. Excluded were patients with active infection upon admission, transfer from another hospital, or in-hospital mortality < 48 h. Multiple imputations were used for missing values. Multivariable logistic regression analysis and Ridge penalization were performed to assess the association of predictors with nosocomial pneumonia and evaluate predictor stability. The predictive performance in addition to the existing prediction model was evaluated as well.

Results

The study included 809 patients [median age 51 (IQR 32–68) years, 66.9% male, median ISS 10 (5–17), median GCS score 15 (14–15)]. Pneumonia incidence was 10.6% (n = 86). Age (OR 1.03 per year), ISS (OR 1.10 per point), GCS score (OR 0.91 per point), pulmonary contusion (OR 2.77), male sex (OR 1.36), hypertension (OR 1.86), diabetes (OR 1.20), number of rib fractures (OR 1.05 per fractured rib), and thoracic spine fracture (OR 1.51) were found to be predictors of nosocomial pneumonia. All variables showed added predictive value in addition to the existing model.

Conclusion

Patient history, injury severity, thoracic trauma, and traumatic brain injury are essential components of nosocomial pneumonia prediction and add to the predictive value of an existing model. Our results further build a basis for more accurate prediction.

Level of evidence

Level III, prognostic/epidemiological.

Objective

The primary research aim was to determine if the use of traditional or 3D printed prosthesis resulted in better functional outcome scores in hip arthroplasty.

Methods

A systematic review and meta-analysis was conducted utilizing the PRISMA 2020 guidelines. Six databases (PubMed, Embase, Scopus, WebOfScience, and Cochrane Library, Google Scholar) were searched yielding 1117 article titles and abstracts. Rayyan.ai was used to detect duplicates (n = 246) and for manual screening for inclusion and exclusion criteria. Included were controlled studies of any publication time that assessed Harris Hip Score (HHS) at baseline and twelve months. Six papers were sought for full text review of which three studies totaling 195 hips met final inclusion.

Results

Mean HHS in the control group went from 38.15 (± 6.02) at baseline to 80.30 (± 4.79) at twelve months follow-up, while the 3D group saw a change from 37.81 (± 5.84) to 90.60 (± 4.49). Significant and large improvements between time points were seen within the control group [p = .02, Cohen’s d = 8.57 (1.48, 15.56)] and 3D group [p < 0.01, Cohen’s d = 9.18 (3.50, 14.86)]. The HHS score of the 3D group improved by 10.64 points more than the HHS score of the control group, which is a statistically insignificant (p = 0.89) amount.

Conclusion

Group differences in pooled mean HHS scores at twelve months follow-up surpassed established minimum differences for clinical importance. High quality research should be further pursued to elucidate these findings.

Introduction

Patellar fractures are rare at 1% incidence of all fractures. However, they can cause significant functional impairments due to the patella’s role in knee joint extension. Current scoring systems lack objectivity in assessing patellar healing. This study aims to validate the Radiographic Union Score for Tibia (RUST) using biplanar radiographs for assessing surgically treated patellar fractures.

Materials and methods

A retrospective analysis of radiological follow-up examinations was conducted on patients undergoing surgical treatment for patellar fractures from January 1st 2013, to June 30th 2023. Thirty patients were randomly selected, yielding 105 postoperative X-rays representing various healing stages. The modified Radiographic Union Score for Tibia (RUST) was applied to these X-rays by three independent trauma surgeons. Radiological follow-up examinations were randomized, pseudonymized, and stored on a hospital server for blinded assessment by three raters. The modified RUST assessed continuity of patellar borders and cortexes, assigning scores based on cortical bridging. Interobserver and intraobserver reliability were evaluated using intraclass correlation coefficients (ICC), adhering to recommended sample size criteria and interpretation guidelines.

Results

The mean modified RUST was 9.1 ± 2.2 points, with scores ranging from 4 to 12 points. The interobserver intraclass correlation coefficient (ICC) was 0.88 (95% CI, 0.81–0.92) and the intraobserver ICC were 0.6 (95% CI, 0.65–0.84), 0.80 (95% CI, 0.71–0.87) and 0.98 (0.98–0.99) respectively, which indicated good to excellent agreement.

Conclusions

This study validated the Radiographic Union Score for Tibia (RUST) for evaluating bone healing in patellar fractures treated with osteosynthesis, demonstrating good intra- and interobserver reliability. The modified RUST can provide a standardized method for assessing healing in patellar fractures, benefiting both clinical practice and clinical trials.

Purpose

The main objective of this prospective study was to assess clinical, radiographic and safety mid-term outcomes after THA with a short cemented stem in an elderly patient cohort. Moreover, the study aimed at investigating the mid-term survivorship of the implant and the incidence of complications.

Methods

96 consecutive patients (100 cases) underwent THA with a short cemented stem. Underlying pathology was primary coxarthrosis in 93% of the cases. The clinical assessment was performed with the Harris Hip Score (HSS) and the Oxford Hip Score (OHS) and the radiographic evaluations were performed preoperatively, and at 45 days, 6, 12, 24 and 60 months postoperatively.

Results

Patients’ mean age at the time of surgery was of 73.4 years (range: 67.2–79.6 years). Mean HHS and OHS registered a significant improvement already 45 days after surgery, with the HHS increasing from 35.9 ± 11.3 (preoperative) to 79.2 ± 8.8 (45 days post-operatively) and the OHS increasing from 10.9 ± 4.8 (preoperative) to 34.1 ± 7.5 at 45 days (p < 0.001). Mean HHS and OHS at 5 years post operatively reached 97.2 ± 5.8 and 47.4 ± 1.4 points respectively. All implants were stable at the final follow-up with no cases of progressive radiolucent lines or osteolysis. No revisions were performed, with a survivorship of 100% at 5 years.

Conclusion

According to excellent clinical and patient-subjective outcomes and to the good implant stability with no component failure up to 5 years, this study suggests that the analysed short cemented stem could be a safe and performing treatment option for THA in elderly population.

Level of Evidence: III.

ClinicalTrials.gov Identifier

NCT04987437

Purpose

Lateral unicompartmental knee arthroplasty (UKA) is relatively less common than medial UKA. There has been no comparative analysis of the constitutional phenotypes of knees that underwent medial and lateral UKA. Therefore, this study aimed to compare the Coronal Plane Alignment of the Knee (CPAK) classification of knees that underwent medial and lateral UKA. Furthermore, the study analyzed whether CPAK phenotypes were maintained or altered after medial or lateral UKA.

Methods

We retrospectively analyzed consecutive patients who underwent UKA. A radiological analysis was conducted using an EOS imaging system, and demographic data of patients undergoing UKA were collected. Performed measurements included the mechanical hip-knee-ankle angle (mHKA), lateral distal femur angle (LDFA), and medial proximal tibia angle (MPTA), which were analyzed both before and after UKA. The CPAK classification was used to classify knee alignment phenotypes.

Results

A total of 310 knees of 244 patients were included in the study that underwent non-robotically assisted, fixed-bearing UKA (279 medial; 31 lateral). Preoperatively, the most common categories for knees were Type I (varus mechanical axis, 53.8%) in medial UKA and Type III (valgus alignment, 77.4%) in lateral UKA. Postoperatively, Type II (neutral mechanical axis) became the most common type for both groups, accounting for 34.1% in the medial UKA group and 25.8% in the lateral UKA group. Only 31.3% preserved their preoperative CPAK classification after the surgery (32.3% and 22.6%, respectively).

Conclusion

The CPAK classification differs significantly between knees that underwent medial and lateral UKA. While 31.3% of knees maintained their native knee phenotype, there is a tendency towards a neutrally aligned classification after surgery for both medial and lateral UKA. The CPAK classification optimizes preoperative categorization and may assist surgeons in tailoring personalized therapies to improve clinical outcomes.

Level of evidence

Level III.

Introduction

Recent studies have increasingly provided evidence that one-stage septic revisions for hip and knee are a safe treatment option for periprosthetic joint infections (PJI) in selected patients. However, there is still a wide treatment variation concerning indications and execution among different practices. This study aimed to describe these differences.

Methods

We set out an online questionnaire among members of the European Bone and Joint Infection Society (EBJIS) in September 2023. The questionnaire consisted of questions investigating indications, execution, and preferences regarding one-stage hip and knee septic revisions. Descriptive analysis was performed of all results and Chi-squared tests were used to test for differences in opinions between subgroups of respondents.

Results

Sixty-five orthopaedic revision arthroplasty surgeons completed the questionnaire. 68% prefer to standardly perform two-stage revisions and only do one-stage revisions in selected patients. However, there was no consensus on which (contra-)indications should be used to select these patients. The most important reason to not perform one-stage revisions was fear of a higher reinfection risk, partly due to inconclusive literature. There was also no consensus on which perioperative antimicrobial measures should be applied.

Conclusions

Notable differences in indications for and execution of one-stage septic revisions persist. We encourage others to share their experiences with this procedure. Moreover, clinical trials should be undertaken to provide stronger evidence for the safety of one-stage septic revisions and to provide clear and uniform guidelines.

Purpose

The use of patient-reported outcome measures (PROMS) is the cornerstone of clinical research for surgical disciplines, but the use in daily routine can be challenging. One of the most widespread PROMS in knee surgery is the International Knee Documentation Committee (IKDC) questionnaire. The purpose of the present study was to investigate the potential correlation of the IKDC score with a patient’s subjective assessment of the knee using a single question. We hypothesized a correlation between the IKDC score and single question score.

Methods

A prospective, single center study in a comprehensive knee outpatient clinic was performed. Patients willing to participate, presenting in the clinic for the first time were asked to complete the IKDC questionnaire and to answer the question: ”How does your knee know compare to when you were 16 years old, in percentage?” Pearson correlation coefficient and linear regression were used to analyze the IKDC score and the single-question percentage.

Results

After application of inclusion and exclusion criteria, 310 patients were included. The mean age of the participants was 43.3 ± 9.6 years, and 45.2% of the patients were female. Mean IKDC score was 41.11 ± 13.13, compared to the mean score of the single-question 40.90 ± 22.7 (p = 0.887). The correlation between the IKDC score and the single-question was significant (p < 0.001), however, the person coefficient was 0.460, indicating moderate correlation. The linear regression analysis was also statistically significant (p < 0.001), but with a model fitness of r² = 0.211 and B = 0.266. From the 310 patients, 305 (98.4%) found the single-question of more relevance than the IKDC score.

Conclusion

IKDC score and a simple, subjective, knee self-evaluation using a single question demonstrate moderate correlation. The single question can be used for better understanding of discrepancy between the objective score and the patients’ subjective perception of knee function or as a fast, single question proxy score.

Introduction

Although sesamoid-preserving procedures have been attempted to complement sesamoidectomy for hallux sesamoid fracture nonunion, few reports document the results. Accordingly, the objective of this study was to review the outcomes of patients with hallux sesamoid fracture nonunion who underwent screw fixation with autogenous bone grafting.

Materials and methods

Medical records of patients who underwent surgery between January 2013 and September 2022 were reviewed. Outcomes were assessed using the foot function index (FFI) and the visual analog scale (VAS) for pain. Fracture union was assessed using plain radiographs and computed tomography scans.

Results

Ten patients (4 males and 6 females) were enrolled. The mean age was 39.4 years (standard deviation [SD], 14.0), and the mean follow-up duration was 23.4 months (SD, 14.5). The FFI score improved from 72.3 (SD, 8.7) preoperatively to 8.2 (SD, 10.7) 12 months postoperatively and to 6.6 (SD, 8.3) at the final follow-up (p < 0.01, respectively). The VAS score improved from 67.8 (SD, 13.5) preoperatively to 2.2 (SD, 3.8) 12 months postoperatively, finally improving to 3.6 (SD, 4.8) at the final follow-up (p < 0.01, respectively). Union was achieved in all patients 3 months postoperatively. Although no complications were observed, hardware removal was performed in two patients owing to discomfort and psychological anxiety.

Conclusion

Given that the symptoms improved in all patients without complications, as observed in this study, screw fixation with autogenous bone grafting appears to be a viable option for treating hallux sesamoid fracture nonunion.