The Iowa orthopaedic journal最新文献

Background: Aneurysmal bone cysts (ABCs) are rare, benign bone lesions with distinct genetic and pathological characteristics. Secondary ABCs arising from giant cell tumors (GCTs) are associated with higher recurrence rates compared to primary ABCs. This study aimed to evaluate recurrence rates and risk factors for primary ABCs, secondary ABCs in GCT, and GCTs, with a focus on radiologic and clinical predictors.

Methods: This retrospective cohort study analyzed 44 patients with histologically confirmed primary ABC (n=24), secondary ABC in GCT (n=8), or GCT (n=12), treated surgically with adjuvants between 2010 and 2020. Tumors were staged using the Enneking/MSTS system, and recurrence rates were assessed using Kaplan-Meier survival analyses and Chi-square tests. The mean follow-up period was 49.4 months.

Results: The overall recurrence rate was 11%, with a 5-year recurrence-free survival rate of 89%. Recurrence-free survival was 92% for primary ABCs, 92% for GCTs, and 75% for secondary ABCs. Significant risk factors included soft tissue extension in primary ABCs (p = 0.037) and mixed radiologic appearance in GCTs (p = 0.033). Secondary ABCs were more common in patients over 20 years and often presented with multiloculated cystic areas.

Conclusion: Recurrence rates are similar among primary ABCs, secondary ABCs, and GCTs. However, secondary ABCs exhibit recurrence behaviors closer to GCTs, particularly in patients with advanced age and complex radiological features. These findings highlight the importance of meticulous tumor resection and the careful use of adjuvants to reduce the risk of recurrence. Level of Evidence: III.

Background: Total hip arthroplasty (THA) has demonstrated utility in expediting return to function in the management of acetabular fractures. Despite its increased utilization, optimal timing to minimize complications and need for revision remains controversial and is often left to surgeon discretion. This study seeks to determine if timing, acute versus delayed (>30 days) THA for the management of acetabular fracture impacts rate and indications for revision arthroplasty.

Methods: Retrospective review identified 165 patients undergoing primary THA for an acetabular fracture at a Level I Academic Trauma Center from 1997 to 2020. Patients were stratified by performance of acute versus delayed (>30 days) THA. Charts were reviewed for rates and indications for revision arthroplasty. Statistical analyses were performed with α ≤ 0.05.

Results: THA following acetabular fracture had an overall revision rate of 10.9 % (n=18), with an insignificantly increased rate associated with delayed THA (n=15, 13.0%) compared to acute THA (n=3, 6.0%). Prosthetic joint infection (PJI) was the most common indication for revision in delayed THA (n=9, 60.0%) and instability for acute THA (n=2, 66.7%). Patients undergoing acute THA had a higher rate of fracture dislocation (54.0% versus 25.2%, p=.0003) on presentation and increased mean age at time of injury (66.21 ± 10.38 vs 45.43 ± 15.41 years, p <0.0001) and arthroplasty (66.23 ± 10.8 vs 52.54 ± 12.73 years, p<0.0001).

Conclusion: THA timing following acetabular fracture remains equivocal with an insignificant difference in revision rate between acute and delayed THA. Level of Evidence: III.

Background: Injuries during sports and other athletic activities will vary depending on the physical action and physiology of the individual. Specifically, middle-aged individuals, commonly defined as 40-65-years-old, are at a transition period physically. Activities that were previously low risk can be a new source of unanticipated vulnerability and subsequent disability. This is a case of an acute hamstring strain sustained by a 52-year-old physically active female while running the bases during an informal recreational game of Independenceball. The injury was witnessed by three orthopaedic surgeons. The diagnosis was made by mechanism and physical examination and resolved with non-operative treatment with gradual improvement and eventual return to full activity. Injuries such as these are common in middle-aged recreational athletes; individuals should be aware of the risks and attempt to mitigate injury appropriately while retaining a healthy and active lifestyle. Level of Evidence: IV.

Background: Hinged knee prostheses are a potentially beneficial treatment approach in complex primary and revision total knee arthroplasty (TKA). Previous reports have demonstrated good long-term outcomes and survivorship with appropriate indications. However, adequate restoration of joint line and limb alignment remain challenging, with the implant design playing a significant role. Optimal limb alignment is generally within 0° to 3° of the mechanical axis. However, little data exists on limb alignment results following hinged knee procedures. The aim of this study was to evaluate the limb alignment of patients following hinged TKA.

Methods: A retrospective review was performed of 117 operations in 114 patients who received a TKA with hinged prosthesis at one academic institution between 2008 and 2021. Ten were excluded due to inadequate follow-up or imaging, leaving 107 procedures in 104 patients for analysis. Demographics, indications, and postoperative weight-bearing radiographs were analyzed. Alignment measurements included the mechanical axis (hip-knee-ankle angle) and anatomic tibiofemoral axis.

Results: Mean patient age was 67.6 years (range: 36-90), 59% were female. Mean BMI was 35.2 kg/ m2. Mean mechanical alignment was 0.53° ± 3.33 valgus (range 12.55° valgus to 8.42° varus) and 6.18° ± 2.82 valgus (range 16.3° valgus to 1.62° varus) for anatomic. Nineteen patients (18%) had a postoperative mechanical alignment >3 degrees valgus, and 9 patients (8%) were greater than 3 degrees varus.

Conclusion: The incidence of valgus malalignment is greater than varus following TKA with a hinged prosthesis. Future studies should focus on the impact of alignment on patient reported outcomes. Level of Evidence: IV.

Background: Several studies have found the 5-item modified frailty index (mFI-5) to be a reliable indicator of poor postoperative outcomes following various surgical procedures. This study aims to evaluate whether the mFI-5 continues to serve as a reliable predictor for patients undergoing patella fracture repair.

Methods: The NSQIP database was queried to identify patients ages 50 or older who underwent surgery for patella fractures between 2006-2019. The mFI-5 was calculated based on the presence of the following 5 comorbidities: diabetes, CHF, hypertension, COPD, and dependent functional status. Frailty scores were stratified based on number of comorbidities: mFI-5 = 0, 1, and ≥ 2. Bivariate and multivariate analyses were used to compare the complication rates among the mFI-5 scores.

Results: A total of 2,917 patients with an average age of 67 years were included. As the mFI-5 score increased from 0 to 1, patients had an increased risk of readmission (OR 2.94), reoperation (OR 2.15), urinary tract infection (OR 3.49), and discharge to a non-home location (OR 1.41). In addition to these risks, patients with a score of 2 or greater also had an increased risk of mortality (OR 4.40), wound (OR 3.37), pulmonary (OR 8.69), and sepsis complication (OR 5.58), bleeding requiring transfusion (OR 4.56), and length of stay > 7 days (OR 2.48) when compared with patients with a score of 0.

Conclusion: Increasing mFI-5 scores were significantly associated with increased morbidity and mortality following patella fracture repair. Level of Evidence: III.

Background: Clinical and radiographic follow-up after total hip arthroplasty allows early detection of wear or failure and is particularly important in the younger THA population given potentially increased demands on implants. The purpose of this study is to characterize patient compliance with follow-up in the young hip arthroplasty population.

Methods: Patients ≤50 years who underwent primary THA at a single institution were included. Patients were given verbal instruction to schedule and attend follow up visits at years 1, 2, and 4-to-6 post- operatively. Multivariate analysis using Poisson regression was conducted to identify predictors associated with compliance. There were 344 patients with average age 38.0 years (range, 13-50). 55.5% of the patients were female.

Results: There were 178 (51.7%), 101 (29.4%), and 44 (12.6%) patients who complied recommendations at years 1,2, and 4-to-6 years, respectively. Females were more likely to attend 2-year follow up (p = 0.04) then males. Patients with post-op complications were more likely to attend 2-year follow up. (p = 0.01). There was no association between other studied variables and follow-up compliance at 1, 2, or 4-to-6-years post op.

Conclusion: Patient compliance was around 50% at 1 year follow-up after surgery and declined substantially over time in this young population. Overall, these data indicate that patients less than 50 years at the time of surgery are mostly noncompliant with follow-up recommendations and may not require routine surveillance or need improved methods of surveillance such as telemedicine or electronic surveys. Level of Evidence: III.

Background: Opioid misuse is a leading cause of unintentional adolescent injury. Prescribing opioids for postoperative pain management in pediatric supracondylar humerus fracture fixation is controversial. This study compares opioid pain medication versus non-opioid pain medication use in outpatient pain control after such fixation.

Methods: This retrospective review involved subjects <18 years old who underwent closed reduction and percutaneous pinning (CRPP) of Gartland type II-IV supracondylar humerus fractures. Two cohorts received differing postoperative pain control: opioid medication and non-opioid medication based on standard of care for the practitioner. Exclusions included patients requiring open reduction, distracting injuries, or complications like compartment syndrome or vascular compromise. Primary outcomes were the number of call-ins for pain and pain rating at the first postoperative visit. Secondary variables included demographics, Gartland classification, return to the emergency department, and complications. Categorical variables were compared between groups using Chi-square tests. Continuous variables were compared between groups using t-tests, if normally distributed, or Wilcoxon Rank Sum tests if not. Between group differences in number of call-ins as well as postop ED and clinic visits were evaluated using Cochran-Armitage trends tests.

Results: The study included 399 participants prescribed opioids and 48 participants prescribed non-opioids. Demographic comparisons showed a near-equal sex distribution (p=0.28). The most common fracture was Gartland type III (opioid cohort: 57.6%, non-opioid cohort: 52%). Most subjects reported no pain at the first postoperative visit (opioid: 93.5%, non-opioid: 95.8%; p=0.75) and did not call-in regarding pain (opioid: 87.5%, non-opioid: 85%; p=0.89). The complication rate was similar between cohorts (opioid: 22.3%, non-opioid: 16.7%; p=0.37). The opioid cohort had a 3.5% early return to the emergency department, while the non-opioid cohort had no early returns (p=0.38).

Conclusion: Displaced supracondylar humerus fractures, a common pediatric orthopedic injury, are typically treated surgically. Opioid medications are often prescribed at hospital discharge. This study demonstrates nearly all patients achieved adequate pain control without opioids. Non-opioid pain medication provided effective pain management at the first postoperative visit, with no increase in emergency department returns or pain-related phone calls. These results suggest non-opioid pain medications can adequately control pain after CRPP of supracondylar humerus fractures. Level of Evidence: III.

Background: In the United States, cementless fixation is the gold standard for elective total hip arthroplasty (THA). Many modern cementless stem designs have re-introduced collared stem options in recent years which have demonstrated a lower risk of fracture. Minimal studies, however, outline radiographic performance of this novel stem design. As such, the primary purpose of this single-center study was to determine the radiographic performance, including defining patterns of radiographic incorporation and remodeling, associated with this novel, single stem design.

Methods: Data within the institutional data repository was queried for patients who underwent a primary or conversion THA between January 1st, 2016 and July 31st, 2022. Patients were included in the study if they were 18 years of age or older and had a minimum of a one-year follow-up visit. Patients were excluded if they did not have a radiograph at the one-year follow-up or if the stem was placed in a revision setting. Continuous data were reported as means and standard deviations (± SD), and categorical data were reported as number of cases (n) and percentages (%).

Results: A total of 592 encounters (562 patients) were included in the final analyses. At the one-year postoperative visit, no stems met the criteria for radiographic loosening, 502 (85.2%) patients had distinct radiographic osseointegration of their stem as defined by at least one radiographic spot weld. There was an 18.7% incidence of calcar-collar gaps on initial radiographs and 66.7% of these filled in by one-year. The intraoperative fracture rate was 0.7% without any cases of secondary stem revision or loosening and only 0.8% of stems showed subsidence (i.e., all less than 5 mm) without loosening or revision. Thigh pain within the first year was reported in 1.7% of patients. The all-cause stem revision at one-year was 0.2%.

Conclusion: This study demonstrated excellent rates of healing of this novel stem design. Additionally, this novel stem was associated with low rates of periprosthetic fracture, stem revision, and thigh pain. Level of Evidence: IV.