Archives of Orthopaedic and Trauma Surgery最新文献

Introduction

Two-stage revision is considered the gold standard treatment in chronic periprosthetic joint infection (PJI) but no specific criteria or examination exist to determine infection eradication before reimplantation. This study aimed to assess the diagnostic performance of leukocyte scintigraphy after the first-stage procedure in two-stage revision for chronic PJI.

Material and methods

Patients studied with leukocyte scintigraphy after cement spacer insertion for knee PJI from January 2012 to December 2021 were retrospectively included. Infection was diagnosed using the criteria of the 2018 International Consensus Meeting. When 1 or more minor criteria were positive but the score was < 6, patients were considered not infected if there was no recurrence of infection at least 24 months after the second-stage procedure. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were found.

Results

The final cohort included 67 cases in 61 patients (M: F = 32:35; mean age 74 years). There were 43 true negatives, 8 true positives, 12 false negatives, and 4 false positives. The sensitivity and specificity of leukocyte scintigraphy in diagnosing PJI were respectively 40.0% and 91.5%, PPV was 66.7%, NPV was 78.2%, and accuracy was 76.1%. Staphylococcus Epidermidis was the most frequently isolated microorganism (50%).

Conclusion

Due to the high costs and the difficulty in its execution, LLS should not be used routinely but it could represent an additional criterion in doubtful cases. In any case, a thorough evaluation of other pre- and intra-operative tests is essential to determine whether reimplantation or spacer renewal is the best course of action. Special consideration should be given to positive LLS, as its results are highly specific and have a low rate of false positives. Conversely, in over half of infected patients, LLS could give false negatives, making negative LLS results less relevant.

Introduction

Surgical site infections (SSI) are one of the more severe complications following ankle surgery. It is associated with worse outcomes and re-admissions. Therefore, identification of risk factors is essential. The aim of this study was to identify risk factors for SSI in patients undergoing surgery for ankle fractures.

Materials and methods

A retrospective study was performed in a large cohort (n = 929) of patients who underwent open reduction and internal fixation (ORIF) of ankle fractures between 2015 and 2020 in the Netherlands. The primary outcome variables included rate of SSI (superficial or deep) and deep SSI. Prediction factors were categorized as patient-related, injury-related and treatment-related.

Results

The incidence rate was 9.36% for SSI and 3.55% for deep SSI. Univariate analysis showed significant associations for higher age (p < 0.001), DM (p = 0.018), ASA 2 and 3 (p = 0.013 and p < 0.001), bi- and trimalleolar fractures (p = 0.021 and p = 0.013), open fractures (p = 0.004) and small size plate compared to screw fixation (p = 0.027). The only independent significant risk factor for SSI in multivariate analysis was open fracture. For deep SSI the significant risk factors were DM (p = 0.039), ASA 3 and 4 (p = 0.001 and p = 0.005) and open fracture (p = 0.002). After multivariate analysis, the independent significant risk factors were open fracture and ASA 3 and 4.

Conclusions

Higher age, DM, ASA 2 and 3, bi- and trimalleolar fractures, open fractures and standard plate-size implant placement were identified as significant risk factors for SSI. Open fracture was the only significant independent risk factor for SSI after ORIF of ankle fractures. In deep SSI, there were different risk factors. DM, ASA 3 and 4, and open fractures were significantly associated. Although, open fracture and ASA 3 and 4 were the significant independent risk factors.

Introduction

Total knee arthroplasty (TKA) in valgus knees is challenging. Optimal ligament balance, implant neutral or moderate valgus alignment are crucial but conventional instrumentations usually lead to outliers. Robotic arm assisted TKA (RATKA) advantages could answer this challenge. Objectives were to assess RATKA frontal alignment accuracy for valgus knees, rotational femoral component reliability, revision surgery rate and functional outcomes for this population.

Methods

This study is based on a continuous series of 454 RATKA. Implants were positioned according to a patient-specific alignment and postero-stabilised inserts were used. Valgus values, range of motion, KOOS and revision surgery rates were assessed at one-year postoperative. Femoral component rotation was analysed intraoperatively.

Results

MAKO navigation system confirmed valgus preoperative deformity for 34 patients. Mean postoperative valgus value was − 1.5°±1.53 (range, -5 to 1), 85% patients had a residual valgus between 0 and − 3°, 97% of patients had a difference < 3° between valgus planned and valgus measured at one year postoperatively. Mean femoral rotation was + 2.65°±1.87 (range, 0 to 6.8°) of external rotation related to posterior condylar angle. No revision surgery has been performed. Mean KOOS value at one year was 80.79. 76% of patients (n = 26) had a good (70–80) or excellent (> 80) KOOS score. Mean flexion value was 133°±12 (range, 100 to 140).

Conclusion

RATKA can be applicable in valgus knee, offering high precision in component positioning with very few outliers. It also facilitates component rotation positioning, providing excellent functional results and ROM.

Total hip arthroplasty (THA) is a very successful operation. Once the problem of implant fixation was solved with the use of bone cement, the next development steps focused on improving the bearing. Weber, a Swiss surgeon, introduced the first modular heads in THA. His design improved reconstruction of the patients’ anatomy using various neck lengths, eased revision as well-fixed stems could be preserved, and also reduced wear due to a cylindrical, rotating connection between the head and neck. The features and results of this exceptional design are reviewed. However, as newer material combinations greatly mitigated the problem of wear and as the dimensions of the cylindrical connection limit range of motion, it was supplanted by the nowadays well-established Morse taper connection, which also is less complex to manufacture. As Weber’s design was associated with good long-term results, the technical features of this technical solution should not be forgotten.

Background

Traumatic hip dislocations are associated with high morbidity and overall limitations of daily living activities. Residual disability inhibits returning to work after severe injuries and minimizes financial independence and social involvement, which are both related to well-being and good health. The aim of this study was to analyze epidemiological and socioeconomic status following traumatic hip dislocations to identify predictors for return to work.

Patients and methods

Patients with traumatic hip dislocations from three level one trauma centers from 2009 to 2021 were followed up in terms of epidemiological data, return to work, change of work, and predictors of socioeconomic outcome. Inclusion criteria were age ≥ 18 years, employed patients, and a minimum follow-up of ≥ 2 years. Patients with incomplete or missing medical records, including radiological imaging and retired patients, were excluded. 107 patients met the inclusion criteria and 67 (63%) patients were available for follow-up.

Results

A total of 81 male and 26 female patients with a mean age of 41.82 years (SD ± 15.65) were finally evaluated. A work-related accident was found in 28 patients (26%). Demographic data and treatment course did not differ significantly between the work-related and non-work-related accidents. Sixty-seven (63%) patients (51 male and 16 female) with a mean age of 42 years (SD ± 15.79) were included in the follow-up. Eighteen patients (27%) had not returned to their previous job and 12 patients (18%) had reduced income. Higher age and Body Mass Index (BMI) were significantly associated with a lower return rate to the pre-accident job (p < 0.05). Furthermore, lower Tegner Activity Scale, pain score, and modified Harris Hip Score were also significantly associated with lower return to work rate (p < 0.001) and reduced income.

Conclusion

Traumatic hip dislocations are associated with high rates of work-related injury and unsatisfactory low rates of return to previous work. Younger age, lower BMI, higher Patient reported outcome measures and lower pain levels may predict a successful return to previous job and a reduced risk of reduction in earning capacity. Understanding the predictive factors is crucial to identify patients at risk of not returning to work and to develop strategies that may help improve their chances of successfully returning to their previous employment.

Introduction

Periprosthetic joint infection (PJI) following total hip arthroplasty (THA) remains a devastating complication for patients and surgeons. Given the implications of these infections and the current paucity of risk calculators utilizing machine learning (ML), this study aimed to develop an ML algorithm that could accurately identify risk factors for developing a PJI following primary THA using a national database.

Materials and methods

A total of 51,053 patients who underwent primary THA between 2013 and 2020 were identified using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Demographic, preoperative, intraoperative, and immediate postoperative outcomes were collected. Five ML models were created. The receiver operating characteristic curves, the area under the curve (AUC), calibration plots, slopes, intercepts, and Brier scores were evaluated.

Results

The histogram-based gradient boosting (HGB) model demonstrated good PJI discriminatory ability with an AUC of 0.88. The test-specific metrics supported the model’s performance and validation in predicting PJI (calibration curve slope: 0.79; intercept: 0.32; Brier score: 0.007). The top five predictors of PJI were the length of stay (> 3 days), patient weight at the time of surgery (> 94.3 kg), an American Society of Anesthesiologists (ASA) class of 4 or higher, preoperative platelet count (< 249,890/mm3), and preoperative sodium (< 139.5 mEq/L).

Conclusion

This study developed a highly specific ML model that could predict patient-specific PJI development following primary THA. Considering the feature importance of the top predictors of infection, surgeons should counsel at-risk patients to optimize resource utilization and potentially improve surgical outcomes.

Introduction

Rhizarthrosis, or osteoarthritis of the trapeziometacarpal joint, predominantly affects women over 50, with up to 30% experiencing some degree of arthritis in this joint. Traditional surgical approaches, such as trapeziectomy with ligament reconstruction, can result in some patients in persistent pain or limited functionality. TMC ball-in-socket arthroplasty, with a cup placed in the distal scaphoid, offers a promising alternative to traditional arthrodesis or resection-suspension arthroplasty.

Materials and Methods

This study involved 11 patients with treated 13 hands who had persistent symptoms after previous TMC-1 surgeries. Procedures included a bilateral scaphometacarpal implantation in two cases. Main symptoms were pain, thumb shortening, and reduced grip strength. The Touch^® ball-in-socket prosthesis was used, with specific considerations for implant selection, surgical steps and customization based on the patient-specific case.

Results

We included 11 patients with 13 thumbs, with a mean follow-up time of 16 months (range: 4–49 months). All patients showed significant improvements in thumb function. Grip strength, as measured by dynamometry, showed an average recovery to 80–90% of the contralateral side. Thumb opposition according to the Kapandji score averaged 9 out of 10. Radiographs demonstrated good osseointegration of the implants, with no signs of prosthetic loosening or dislocation. Complications included one case of persistent mild hypesthesia of the radial nerve’s superficial branch, which did not impair function, and one scaphoid fracture 4 weeks post-implantation during cast immobilization.

Conclusion

The scapho-metacarpal dual mobility prosthesis is a feasible and effective option for patients with persistent TMC-1 symptoms after failed surgeries. It uniquely preserves both thumb mobility and length, unlike alternatives like arthrodesis and tendon suspensionplasty, which remain options if the prosthesis fails. Further research and long-term studies are necessary to determine the definitive role of this approach in complex TMC-1 cases.

Purpose

The purpose of this study was to assess clinical and radiological outcome in patients after proximal hamstring tendon repair. We hypothesized that there is a significant correlation among subjective clinical outcome and interlimb asymmetries in muscle strength, fatty infiltration, and hamstring volume.

Methods

This retrospective monocentric case series included patients with surgical repair after proximal hamstring tendon rupture. Clinical outcome was assessed utilizing: Healthy Days Core Module (CDC HRQOL-4), numeric pain rating scale (NRS), modified Harris Hip Score (mHHS), Tegner Activity Scale (TAS), return to pre-injury activity level (RTPA), and patient satisfaction score. Postoperative hamstring strength was measured using a handheld dynamometer and radiological outcome was determined by postoperative magnetic resonance imaging (MRI).

Results

Twenty-seven patients with a mean age of 51.2 (± 12.6) years were available for follow-up at a mean of 41.11 (± 18.4) months. Patients state a mean of 10.6 (± 11.5) days in the unhealthy days (UHD) index and 88.9% show “good health” in the simple summary score (SSS). Mean subjective outcome scores were as follows: NRS 1.1 (± 2.4), mHHS 90.3 (± 14.8) and TAS 5.7 (± 2.2). A total of 59.3% RTPA and 88.9% state to be somewhat or very satisfied with their surgery. Mean interlimb strength ratio was 0.88 (± 0.21). MRI demonstrated a fully restored muscle–tendon unit, significantly greater fatty infiltration in the injured hamstrings (p = 0.009, d = 0.558), and a mean interlimb hamstring volume ratio of 0.94 (± 0.11). With respect to the 10% benchmark, patients had no significant asymmetries in muscle strength (p = 0.677, d = 0.084) or hamstring volume (p = 0.102, d = − 0.34). Correlation analysis revealed moderate correlation among asymmetries in strength and volume (p = 0.073, r = 0.373). In patients with the operated side inferior to the healthy side (n = 15), there was strong correlation among asymmetries in strength and volume (p = 0.002, r = 0.725). Statistically significant correlation was found between interlimb muscle volume atrophy and increase in fatty infiltration (p = 0.015, r = 0.481).

Conclusion

Proximal hamstring repair results in good clinical outcome with satisfactory recovery of hamstring strength and volume. Interlimb asymmetries, in terms of muscle strength, fatty infiltration, and hamstring volume do not correlate with clinical outcome.

Study Type

Retrospective cohort study; Level of evidence, 3.

Introduction

As a result of increased incidence of anterior cruciate ligament (ACL) injury in young athletes, there is a rise in the indications surgical ACL reconstruction procedures. The value of anterolateral ligament (ALL) reconstruction emerges as a proposed solution to prevent graft failures and improve stability in this high demanding category of patients. The purpose of this study is to present our experience with a novel hamstring auto-grafting technique, the single antegrade sling graft (SASG), for combined reconstruction of both ACL and ALL using autologous gracilis (GR) and semitendinosus (ST) grafts utilizing a single femoral tunnel and double tibial tunnels.

Materials and methods

From January 2020 to December 2021, 21 soccer players were operated utilizing the SASG technique, a modification of the technique of SANTI study group. Inclusion criteria were participating in pivoting sport, high-grade pivot shift examination (Grade 2–3), and evidence of a lateral femoral notch sign or Segond's fracture on preoperative imaging. Patients were assessed for 2 years postoperatively by Lachman’s test for anteroposterior laxity and pivot shift test for rotational laxity. The postoperative outcomes were assessed by Tegner-Lysholm and International knee documentation committee scores. Also, the postoperative complications such as stiffness, infection and graft failure were reported.

Results

21 male soccer players with a mean age 26.4 years were included in this study. After 2 years follow up there was a statistically significant improvement in the both post-operative functional scores, P value < 0.001. Fifteen patients (71.4%) could return to their preoperative sport activity level with no giving-way symptoms. Only one case of graft failure was reported in the follow up.

Conclusions

The single antegrade sling graft (SASG), for combined reconstruction of both ACL and ALL yielded good results in terms of stability and return to sports. The technique is reproducible, and results are comparable to the available published literature.