Archives of Orthopaedic and Trauma Surgery最新文献

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.

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

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

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.

Background

Indications for primary total knee arthroplasty (TKA) have become more inclusive of morbidly obese patients, however, higher rates of complications and lower implant survival have also been reported in this population. The purpose of this study was to investigate the mid-term survival, clinical, and radiographic outcomes of a cementless trabecular metal monoblock tibial component in severely obese patients.

Methods

This was a retrospective study of class II and III obese (BMI > 35) patients who received a cementless primary TKA. Standing radiographs were assessed for the presence of progressive tibial radiolucent lines (RLL), and clinical measures were assessed at least 2 years post-operative via the Oxford Knee Score (OKS), UCLA Activity and Satisfaction Score, and the Euro-QoL 5-dimension (EQ-5D-5L) index and visual analogue scale (EQ-VAS) health status.

Results

Patients (n = 176) were 61.2 ± 8.3 years of age, BMI 44.9 ± 6.5 kg/m², and were predominantly female (n = 118, 66.7%). Mean follow-up was 59.2 ± 17.1 months. There were two total revisions at 6- and 57-months post-operative, respectively, and the 5-year survival estimate was 98.3% (95% confidence interval: 93.0%, 99.6%). Patient satisfaction was 93.9% and the post-operative OKS, EQ-5D-5L index, and EQ-VAS were 40.2 ± 7.9, 0.856 ± 0.205, and 73.6 ± 14.7, respectively. No cases of radiolucent lines were detected.

Conclusions

At 6 years this cementless monoblock tibial component demonstrated excellent survival without radiographic indications of aseptic loosening in a population of severely obese patients.

Objectives

Distal femur fractures (DFF) are frequently treated surgically with single traditional constructs (STC), such as with a lateral plate or intramedullary nail, although nail-plate combination constructs (NPCC) are gaining attention. The purpose of this study is to compare outcomes between NPCC and STC for surgical fixation of DFF to guide surgeon decision-making.

Methods

Data Sources: This study is a systematic review and meta-analysis using PubMed, CINAHL, MEDLINE, Web of Science, Science Direct, and SPORTDiscus from database inception until January 10th, 2024. Study Selection: Inclusion criteria were comparative studies that examined clinical outcomes and complications for NPCC versus STC for DFF in adult patients. Data Extraction: Data included operative time, estimated blood loss (EBL), length of stay (LOS), as well as likelihood of total complications, total unplanned reoperations, and malunion. Data Synthesis: Statistical analysis included a random-effects model using unstandardized mean difference or odds ratio (OR).

Results

Five retrospective comparative studies (n = 1,368 patients; mean age: 52.3 ± 8.1 years; 134 patients in the NPCC group) were included. There was no statistically significant difference in operative time (p = 0.696), EBL (p = 0.408), or LOS (p = 0.963) between patients in the NPCC group as compared to patients in the STC group after DFF. Patients in the NPCC group had a statistically significant lower number of total complications (p = 0.009; OR: 0.31; 10.6% versus 16.0%) and total unplanned reoperations (p = 0.027; OR: 0.42; 8.2% versus 14.8%) as compared to patients in the STC group after DFF. However, there was no statistically significant difference in the number of malunion cases between groups (p = 0.130), although the NPCC group had far fewer cases than the STC group (2.9% versus 10.5%).

Conclusion

Patients treated with NPCC had significantly fewer cases of total complications and total unplanned reoperations without significant differences in operative time, EBL, or LOS as compared to patients treated with STC for DFF, although these associations are limited by sample size.

Level of evidence

Level IV.

Aims

This study presents clinical outcomes, functional results, and return to sports after anterior cruciate ligament (ACL) reconstruction using quadruple hamstring tendon autograft or peroneus longus tendon autograft in a randomized controlled trial.

Patients and methods

Between February 2018 and July 2019, patients who underwent ACL reconstruction were randomly assigned to two groups: hamstring and peroneus longus. Patient related outcome measurements and pain intensity were evaluated using IKDC, Lysholm, and visual analog scores at 3 and 6 months, 1, 2, and 5 years after the surgery. At the 5 year follow-up, anterior stability was tested using the 3D printable Knee Arthrometer. In addition, in the peroneus longus group, ankle functional assessment was performed using the American foot and ankle score. Additionally, data on the return to sports/activities was collected for both groups at the last follow-up.

Results

Sixty patients, with 30 in the hamstring group and 30 in the peroneus group, were included in the study. Patients were predominately male and with low activity demands. After five years of follow-up, there was no significant difference in functional assessment scores (IKDC and Lysholm) between the two groups (P n.s). The median graft diameter was 7.9 ± 0.4 mm in the hamstring tendon group and 8.9 ± 0.2 mm in the PL group (P < 0.001). The improvement in Arthrometer testing measurements (AMT) for the operated knees in the hamstring and peroneus longus groups were similar. In the peroneus longus group, the mean postoperative foot and ankle score was 98.6 ± 3.9 (range = 85–100).

Conclusion

Using Peroneus longus tendon autograft for arthroscopic ACL reconstruction is a feasible alternative as studied in this cohort of predominately male patients with low activity demands. The graft diameter in this study was sufficient, and the results regarding laxity and patient related outcome measurements were similar to those achieved with hamstring tendon autografts.

Level of evidence

Level I

Trial registration

ChiCTR2000036989