BMC Musculoskeletal Disorders最新文献

Purpose: To evaluate the safety and efficiency of a novel transarticular trephonic plasty (TTP) technique for establishing the working cannula in uniportal transarticular full-endoscopic lumbar interbody fusion (Endo-LIF).

Methods: A total of 79 patients with single-level lumbar degenerative disease who underwent uniportal transarticular Endo-LIF were retrospectively divided into two groups: the traditional technique (TT) group and the TTP group. The TTP group underwent cannula placement using the new TTP approach, whereas the TT group used the conventional method. Operation time and fluoroscopy exposure during cannula placement, total surgical time, and early postoperative complications were recorded. Clinical outcomes were assessed using the visual analog scale (VAS) for back and leg pain and the Oswestry Disability Index (ODI) at 3 days, 3 months, and 12 months postoperatively.

Results: The TTP group showed significantly shorter cannula placement time compared with the TT group (11.4 ± 5.1 min vs. 31.5 ± 9.4 min, p < 0.000). Total surgical time was also shorter in the TTP group (135.7 ± 16.3 min vs. 163.1 ± 23.3 min, p < 0.000). However, fluoroscopy exposure was lower in the TT group. Complication rates were low and did not differ significantly between groups (p > 0.05). Both groups exhibited significant improvements in VAS and ODI scores at all postoperative time points relative to preoperative baselines, with no significant differences observed between groups (p > 0.05).

Conclusion: The TTP technique is a safe and efficient method for establishing the working cannula in uniportal transarticular Endo-LIF. It improves surgical efficiency without compromising safety and may help reduce the technical threshold for surgeons, thereby facilitating wider adoption of uniportal transarticular Endo-LIF as a minimally invasive treatment for lumbar degenerative disease.

Background: Insufficient quadriceps activation is likely to occur in the early postoperative period after anterior cruciate ligament reconstruction (ACLR). Transcranial magnetic stimulation (TMS) has a positive effect on the activation and contractility of the quadriceps femoris. To investigate the effect of repetitive transcranial magnetic stimulation (rTMS) on quadriceps femoris function in participants during the early postoperative period following anterior cruciate ligament reconstruction (ACLR).

Methods: Fifty six participants received rehabilitation education and a recommended routine training and knee flexion and extension exercise plan. In addition to this, the REAL group received 2 weeks of transcranial magnetic stimulation treatment. The resting motor threshold (RMT), root mean square (RMS) value, difference in knee extension angle between the healthy and affected sides, visual analog scale (VAS) score, and difference in the circumference of the vastus medialis oblique between the healthy and affected sides were assessed at baseline and 2 weeks after treatment.

Results: Compared with those in the SHAM group, the improvements in the RMT and RMS value of the vastus medialis oblique, the difference in the knee extension angle between the healthy and affected sides, and the VAS score in the REAL group were more significant (p < 0.001). There was no significant between-group difference in the difference in the circumference of the vastus medialis oblique between the healthy and affected sides (p > 0.05).

Conclusion: The use of rTMS, the goal of which is to increase the excitability of the corticospinal pathway, can promote the activation of the quadriceps femoris, prevent muscle atrophy, and accelerate the recovery of muscle strength in participants in the early postoperative period after ACLR.

Trial registration: The Registration number of the Chinese Clinical Trial Registry is ChiCTR2300076522, 11/10/2023.

Background: Despite advancements in total knee arthroplasty (TKA), some patients remain dissatisfied postoperatively, potentially due to subjective perceptions of knee appearance. This study investigated whether visual feedback on improved knee alignment and appearance after TKA influences pain perception and patient-reported outcomes.

Methods: In this prospective, double-blind, randomized controlled trial, 60 patients undergoing primary TKA were randomized into intervention or control groups (n = 30 each). Pre- and postoperative radiographs, photographs, and gait videos were collected. Patient-reported outcomes were measured using the Visual Analogue Scale (VAS), Oxford Knee Score (OKS), and SF-36 survey. Three months postoperatively, the intervention group received visual feedback via their pre/post images and gait videos, while the control group received routine follow-up only.

Results: Forty-nine patients were included in the final analysis. Baseline characteristics were similar. After the intervention, the VAS score was significantly lower in the intervention group than in the control group [1.00 (1.00, 2.00) vs. 2.00 (1.25, 3.00), P < 0.05], and SF-36 physical health scores improved significantly. Within-group analysis showed significant improvements in VAS, OKS, and SF-36 in the intervention group, while only OKS improved in the control group. Change-score analysis revealed a significantly greater reduction in pain in the intervention group [ΔVAS 1.00 (1.00, 2.00) vs. 0.00 (0.00, 0.00), P < 0.01].

Conclusions: Visual feedback on postoperative knee alignment may improve pain perception and patient satisfaction after TKA. Incorporating standardized image and gait documentation into follow-up recovery may enhance patient satisfaction and perceived outcomes.

Trial registration: chictr.org.cn, ChiCTR2300076318, Registration date: 01 October 2023.

Background: This study aimed to conduct a systematic review and meta-analysis to assess the impact of extended postoperative oral antibiotic prophylaxis (EPOAP) on the risk of reinfection following two-stage exchange arthroplasty for hip and knee periprosthetic joint infection (PJI).

Methods: A comprehensive search of PubMed, Embase, and the Cochrane Library was conducted on January 11, 2025. Studies reporting reinfection rates in patients receiving EPOAP after two-stage exchange arthroplasty, compared to those who did not, were included. A random-effects model was used to calculate pooled risk ratios (RRs) and subgroup analyses were performed based on the duration of EPOAP use (> 2 weeks vs. ≤2 weeks) and the joint site (hip or knee).

Results: Five studies, including four retrospective cohort studies and one randomized controlled trial, with a total of 486 knees and 444 hips, were included. The meta-analysis demonstrated that EPOAP significantly reduced the risk of reinfection following two-stage exchange arthroplasty (pooled RR: 0.52; 95% confidence interval [CI]: 0.35, 0.75; p = 0.0006). Subgroup analyses yielded similar findings, with significant reductions in reinfection risk for EPOAP duration > 2 weeks (pooled RR: 0.51; 95% CI: 0.34, 0.78; p = 0.002), hip arthroplasty (pooled RR: 0.37; 95% CI: 0.20, 0.70; p = 0.002), while knee arthroplasty showed a borderline nonsignificant reduction (pooled RR: 0.64; 95% CI: 0.39, 1.04; p = 0.07). Only one cohort study reported a decreased risk of reinfection with EPOAP use ≤ 2 weeks. Two studies assessed adverse events related to EPOAP. No complications were observed among 22 patients in one cohort study, whereas 6 of 22 patients (27%) in an RCT experienced mild gastrointestinal or dermatologic reactions that led to treatment discontinuation. Additionally, another cohort study reported that 16 of 24 reinfection cases (67%) involved organisms resistant to EPOAP.

Conclusions: This meta-analysis suggests that EPOAP is associated with a reduced risk of reinfection following two-stage exchange arthroplasty for hip arthroplasty, while further research is warranted for knee cases. This approach may improve patient outcomes and help optimize post-operative antibiotic management.

Background: Giant cell tumor of bone (GCTB) occurring in the femoral head and neck region presents significant therapeutic challenges due to its complex anatomy and aggressive biological behavior. This study aimed to analyse the clinical outcomes of preoperative denosumab therapy combined with curettage after surgical dislocation of the hip in the treatment of GCTB at the femoral head and neck region.

Methods: Between 2016 and 2023, a total of 16 patients with GCTB in the femoral head and neck were treated at the authors' institution, of whom 14 eligible and included in the study (6 males/8 females, aged 17-35 years). All patients received three cycles of Denosumab therapy preoperatively, with treatment response monitored and therapeutic efficacy was assessed according to Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria. Subsequently, surgical dislocation of the hip combined with curettage of the lesion was performed. Regular postoperative follow-up was conducted to monitor for complications. Imaging studies were used performed to evaluate surgical site status, local recurrence, and distant metastasis. Limb function and hip joint function were assessed preoperatively and at 1 year postoperatively using the Musculoskeletal Tumor Society (MSTS) score and Harris Hip Score (HHS), respectively.

Results: All 14 patients underwent a full course of preoperative denosumab therapy and underwent successful surgery, with a follow-up period of 24-50 months (mean 38.2 ± 9.0 months). No postoperative complications observed. Imaging revealed shrinkage of residual cavities, blurred boundaries, progressive bone sclerosis, and trabecular bone regeneration at the surgical site. Functional assessments demonstrated significant improvements in MSTS scores (preoperative: 22.3 ± 1.3 compared with postoperative: 27.6 ± 1.2, P <0.001) and HHS (preoperative: 72.4 ± 3.1 compared with postoperative: 88.9 ± 4.3, P <0.001). All patients achieved excellent functional status (MSTS >25, HHS >82) with preserved joint mechanics. Preoperative denosumab therapy achieved partial remission (PR) in 79% (11/14) and stable disease (SD) in 21% (3/14) patients according to RECIST 1.1 criteria. At final follow-up, no patients experienced local recurrence or metastatic progression.

Conclusions: Denosumab treatment combined with curettage after surgical dislocation of the hip successfully treated GCTB in the femoral head and neck. The safety profile of denosumab as adjuvant therapy was favorable, with no drug-related complications observed. Postoperatively, native hip joints were preserved in all patients, with satisfactory functional outcomes and no evidence of tumor recurrence or metastasis.

Background: The European Working Group on Sarcopenia in Older People (EWGSOP2) recommends establishing population-specific cutoff points for muscle mass and function to diagnose sarcopenia globally. However, cutoff points adapted for the Brazilian population in detecting sarcopenia through physical tests remain unknown. This study aimed to evaluate the diagnostic accuracy of the Timed Up and Go (TUG) and sit-to-stand chair (5xSTS) tests in identifying sarcopenia in community-dwelling older women.

Methods: Body composition was assessed via Dual X-ray Absorptiometry, muscle strength using a Jamar dynamometer, and physical performance through the TUG and 5xSTS tests. The Sarcopenia diagnosis followed EWGSOP2 guidelines. Group comparisons were made using Mann-Whitney U test or t-test. Logistic regression was used to analyze the association between sarcopenia and performance in physical tests. The discriminatory capacity of the tests was analyzed using an ROC curve, and the cutoff points were obtained using the Youden index. Statistical significance was obtained with a p-value < 0.05.

Results: Among 138 older women, 42.8% were diagnosed with sarcopenia. Women with sarcopenia were significantly older (77.1 ± 7.6 years; p < 0.001), had lower body weight (54.8 ± 8.3 kg; p < 0.001), and lower body mass index (25.1 ± 4.1 kg/m²; p < 0.001), regarding physical performance, worse on both the TUG (14.1 ± 6.5 s; p < 0.001) and the 5xSTS (16.3 ± 5.6 s; p = 0.02) compared to those without sarcopenia. In logistic regression analysis, higher age (OR = 1.12; 95% CI: 1.06-1.19) and slower TUG performance (OR = 1.25; 95% CI: 1.10-1.43) were associated with sarcopenia. ROC curve analysis demonstrated that only TUG test had acceptable accuracy for detecting sarcopenia (AUC = 0.703; 95% CI: 0.61-0.79; p < 0.001), with a cutoff point of 9.8 s.

Conclusion: These results demonstrate that cutoff points for screening or diagnosing sarcopenia using the TUG differ substantially between populations and provide an alternative that may be useful for assessing sarcopenia in community-dwelling older women.