Archives of Orthopaedic and Trauma Surgery最新文献

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.

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

Purpose

The two-stage exchange revision represents a pivotal strategy in the management of prosthetic joint infections, wherein the judicious timing of reimplantation serves as a crucial determinant for therapeutic success. At present, attempts have been made to utilize predictive models to establish the optimal timing for reimplantation; however, their predictive accuracy remains unsatisfactory. This inadequacy primarily arises from the lack of dependable predictive indicators, which demonstrate inconsistent effectiveness across various studies and occasionally yield contradictory outcomes. Therefore, identifying solid predictive indicators is in desperate need.

Methods

Studies reporting outcomes of the two-stage exchange revision till June, 2023 were systematically retrieved, screened and subject to quality analysis. Basic characteristics of these studies were firstly summarized. Subsequently, factors of interest regarding clinical information, blood and body fluid test results, pathogen test results of the recurrent and recurrent-free cohorts were extracted and submitted to a fixed or random effects model. Meanwhile, evaluation of publication bias and sensitivity was performed.

Results

After filtering, a total of 45 studies were finally involved. Pooled analysis suggested that the recurrent cohort exhibited elevated incidences of body mass index (BMI) > 30, smoking and alcohol habits, diabetes, sinus tract, positive culture, and G⁻, polymicrobial and drug-resistant infections. Additionally, higher levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), synovial white blood cell (WBC) count, and polymorphonuclear percentage (PMN%) were observed in the recurrent cohort. On the other hand, the results of D-dimer and fibrinogen were ambiguous, and no difference regarding peripheral WBC count was observed. Forest plots suggested a low risk of publication bias. Besides, sensitivity analysis indicated good stability of the aforementioned indicators, except D-dimer and fibrinogen.

Conclusion

To sum up, BMI > 30, smoking and alcohol habits, diabetes, sinus tract, positive culture, and G-, polymicrobial and drug-resistant infections, CRP, ESR, synovial WBC and PMN% exhibited significant differences between recurrent and recurrent-free cohorts. Therefore, these indicators may be considered as potential predictive factors for the further development of a prognostic model that aids the determination of reimplantation timing. Nevertheless, the efficacy of these indicators remains to be further confirmed.

Registration number

Prospero ID: CRD42022296568.

Introduction

Low rates of venous thromboembolism (VTE) have been found in patients with isolated orthopaedic trauma below the knee. Many surgeons routinely provide chemical thromboprophylaxis in these injuries, however. This is not without inherent risks, and this remains a controversial topic in perioperative care in orthopaedic trauma. This systematic review and meta-analysis was performed to look at rates of VTE in patients with isolated orthopaedic fractures below the knee, grouped by whether they received chemical prophylaxis versus no chemical prophylaxis.

Methods

A systematic review was performed comparing VTE with and without chemical thromboprophylaxis following isolated orthopaedic fracture below the knee. A chi-square analysis was then performed on data including patients who received chemical prophylaxis versus those who did not from all 25 included articles. The articles were grouped according to type of study, such as observational versus randomized controlled trial (RCT), and then further subdivided according to surgical intervention status, and whether routine screening for thromboembolism was utilized to diagnose. Risk of bias assessment was performed using the ROBINS-I criteria for cohort studies and the Cochrane RoB 2 tool for randomized controlled trials. A random effects pooled logistic regression and Fisher’s exact tests were then performed.

Results

222,188 patients were found from 25 articles. Chemical prophylaxis was given to 8,666 patients, and VTE was reported in 347 cases (4.0%). 213,522 patients did not receive chemical prophylaxis, and VTE was reported in 2,185 (1.02%) (χ² (1, n = 222,188) = 656.8, p < .00001). Pooled logistic regression revealed that patients receiving prophylaxis were 0.5 times less likely to develop VTE. With a calculated population baseline risk of 1.5% for developing VTE, the number needed to treat (NNT) with chemical prophylaxis is 134 to prevent 1 VTE after fracture below the knee.

Conclusions

In patients with isolated orthopaedic trauma below the knee, indiscriminate use of chemical VTE prophylaxis is not recommended due to the lack of significant benefit and high NNT.

Level of Evidence

Level III.