Clinical Orthopaedics and Related Research®最新文献

{"title":"Reply to the Letter to the Editor: Is Proximal Femur Reconstruction With a Vascularized Fibula and Allograft Successful at Reconstructing a Tumor Resection in Children 6 Years of Age or Younger?","authors":"Luca Cevolani, Laura Campanacci","doi":"10.1097/CORR.0000000000003549","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003549","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144539247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: What Are the Medium-term Reciprocal Changes in Cervical Sagittal Alignment After Posterior Correction for Lenke 5C Adolescent Idiopathic Scoliosis?","authors":"Jason Pui Yin Cheung","doi":"10.1097/CORR.0000000000003504","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003504","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: What Factors Are Associated With Implant Revision in the Treatment of Pathologic Subtrochanteric Femur Fractures?","authors":"Zelong Li, Jiaxing Ding, Yanfei Yang, Bo Wang","doi":"10.1097/CORR.0000000000003583","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003583","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Augmenting Irradiated Autografts With Free Vascularized Fibula Graft in Patients With Bone Loss From a Malignant Tumor Achieve Union, Function, and Complication Rate Comparably to Patients Without Bone Loss and Augmentation When Reconstructing Intercalary Resections in the Lower Extremity?","authors":"Arman Vahabi,Hüseyin Kaya,Bakıt Kerekulov,Ahmet Biçer,Burçin Keçeci,Dündar Sabah","doi":"10.1097/corr.0000000000003599","DOIUrl":"https://doi.org/10.1097/corr.0000000000003599","url":null,"abstract":"BACKGROUNDExtracorporeally irradiated autografting is a recognized technique in reconstruction after intercalary resections, but it has drawbacks such as nonunion and graft fracture. Because sterilized autografts lose some of their mechanical properties due to involvement of the cortex with tumor, the curettage, and the adverse effects of irradiation or other sterilization techniques, some have proposed adding vascularized fibula to augment the autograft. Because this potentially adds morbidity, we sought to address the value of adding vascular fibular grafts to reconstruction with irradiated autografts.QUESTIONS/PURPOSESComparing patients who received an extracorporeally radiated autograft alone with those who received such a graft augmented by a free vascularized fibular autograft: (1) Was the proportion of patients who did not achieve union by 12 months higher in the group that received the augmented (vascularized) graft? (2) Did the augmented-graft group demonstrate greater survivorship free from graft loss at 72 months than did the group receiving an irradiated graft alone? (3) Were there between-group differences in functional results? (4) Were there between-group differences in complications, defined as those substantial enough to result in further surgery?METHODSIn our single-center study, conducted in a tertiary academic referral center, we performed a retrospective chart audit of patients undergoing intercalary resections for primary sarcomas of the femur and tibia. Between January 2002 and April 2023, three surgeons (HK, BK, DS) treated 345 patients for bone sarcoma of the femur or tibia. Of those, we considered 25% (85) treated with intercalary resection for primary bone sarcomas as potentially eligible. A further 7% (23 of 345) of patients were excluded because their reconstruction was performed using a technique other than irradiated autografts. Another 2% (6) had died prior to the minimum follow-up period of 24 months, another 1% (3) did not finish the 24-month follow-up, and 1% (3) were lost to follow-up for > 5 years, leaving 14% (50 of 345) for analysis here. Among these, 26% (13 of 50) of patients underwent reconstruction involving an extracorporeally irradiated autograft and augmentation with a vascularized fibula autograft. In the remaining 37 patients, reconstruction was performed using extracorporeally irradiated bone alone. During this period, intercalary resection was typically indicated for patients with primary bone sarcomas located in the metaphyseal or diaphyseal regions without articular involvement, provided that they demonstrated a favorable response to neoadjuvant therapy. In this predominantly young patient cohort, extracorporeally irradiated autografts were our preferred reconstruction method after sarcoma resection. Isolated extracorporeally irradiated autografts were selected for patients with radiologic evidence of adequate bone quality and preserved cortical integrity. In patients who have a tumor with exten","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"40 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144488254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors That Increase the Risk of Prosthetic Joint Infection Within 90 Days After THA and TKA: A Nationwide Population-based Study.","authors":"Cheng-Ming Chou,Tsung-Che Chuang,Chen-Hao Chiang","doi":"10.1097/corr.0000000000003592","DOIUrl":"https://doi.org/10.1097/corr.0000000000003592","url":null,"abstract":"BACKGROUNDProsthetic joint infection (PJI) after THA and TKA is a serious complication. Although previous studies have identified risk factors for overall and late-onset PJI, limited research has focused specifically on infections occurring within the immediate 90-day postoperative period, a time frame critical for assessing surgical quality and early recovery outcomes.QUESTIONS/PURPOSESWhat patient and clinical factors are associated with the development of PJI within 90 days after primary THA or TKA?METHODSThis was a retrospective, controlled study drawn from a longitudinally maintained, large, national database (the Taiwan National Health Insurance Research Database [NHIRD]). The NHIRD, covering > 99% of the population, provides comprehensive data for reliably identifying and tracking postoperative complications such as PJIs. Patients who underwent THA or TKA between January 2016 and December 2017 were identified. Only patients with complete follow-up data for at least 90 days after surgery, based on insurance records, were eligible for inclusion. The primary outcome was PJI within 90 days, defined as the presence of an ICD-10-Clinical Modification (CM) diagnosis code for PJI recorded in claims within 90 days of the index THA or TKA procedure. A total of 13,442 patients who underwent THA and 40,245 patients who underwent TKA were included. The PJI rate within 90 days was 0.61% (82 of 13,442) for THA and 0.58% (232 of 40,245) for TKA. Cox regression analyses were used to estimate associations between potential demographic and clinical factors and the risk of PJI within 90 days.RESULTSAfter adjusting for age, sex, diabetes, and other clinically relevant factors, we found that the adjusted HR (aHR) for PJI within 90 days after THA was higher among patients who were male (aHR 2.49 [95% confidence interval (CI) 1.38 to 4.48]; p < 0.01), had a longer length of stay (aHR 1.06 [95% CI 1.04 to 1.09]; p < 0.01), had osteoarthritis (aHR 0.48 [95% CI 0.27 to 0.87]; p = 0.01) or avascular necrosis of the femoral head (aHR 0.43 [95% CI 0.22 to 0.84]; p = 0.01), had diabetes mellitus (aHR 3.72 [95% CI 2.21 to 6.26]; p < 0.01), had hepatitis B infection (aHR 2.44 [95% CI 1.11 to 5.36]; p = 0.03), and had hepatitis C infection (aHR 2.76 [95% CI 1.14 to 6.66]; p = 0.02). The aHR for PJI within 90 days after TKA was higher for patients who were younger than 65 years (aHR 1.57 [95% CI 1.18 to 2.08]; p < 0.01), male (aHR 2.05 [95% CI 1.55 to 2.71]; p < 0.01), had a longer length of stay (aHR 1.09 [95% CI 1.08 to 1.11]; p < 0.01), had osteoporosis (aHR 1.44 [95% CI 1.08 to 1.92]; p = 0.01), and had chronic kidney disease (aHR 1.50 [95% CI 1.06 to 2.11]; p = 0.02). The aHR was lower for patients who had bilateral TKA (aHR 0.31 [95% CI 0.12 to 0.84]; p = 0.02) compared with those who had unilateral TKA only.CONCLUSIONMale sex, diabetes, hepatitis C, osteoporosis, chronic kidney disease, and younger age after TKA were associated with a higher risk of PJI within 90 day","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"55 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144488306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: Standardized Intraoperative Robotic Laxity Assessment in TKA Leads to No Clinically Important Improvements at 2 Years Postoperatively: A Randomized Controlled Trial.","authors":"Feng Guo,Yu Chen,Jianping Chen,Yanli Yang","doi":"10.1097/corr.0000000000003576","DOIUrl":"https://doi.org/10.1097/corr.0000000000003576","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"51 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144488255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Forward Movement: Amplifying Black Voices on Race and Orthopaedics- Reclaiming True Merit.","authors":"Kwadwo Owusu-Akyaw","doi":"10.1097/corr.0000000000003595","DOIUrl":"https://doi.org/10.1097/corr.0000000000003595","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"48 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144488256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cochrane in CORR®: Stem Cell Injections for Osteoarthritis of the Knee.","authors":"Kim Madden","doi":"10.1097/corr.0000000000003593","DOIUrl":"https://doi.org/10.1097/corr.0000000000003593","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"8 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144488257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Does Anterior Vertebral Body Tethering Compare to Posterior Spinal Fusion for Thoracic Idiopathic Scoliosis? A Nonrandomized Clinical Trial.","authors":"Carina Lott,Anthony Capraro,Catherine Qiu,Divya Talwar,James Gordon,John M Flynn,Jason B Anari,Patrick J Cahill","doi":"10.1097/corr.0000000000003575","DOIUrl":"https://doi.org/10.1097/corr.0000000000003575","url":null,"abstract":"BACKGROUNDRecently, there has been an increased interest in alternative surgical options for treating idiopathic scoliosis. For instance, anterior vertebral body tethering (AVBT) is an emerging surgical solution used in lieu of posterior spinal fusion (PSF). This technology has been gaining in popularity because of its potential benefits of preservation of spinal growth, motion, and functional activity. Although prior retrospective studies have indicated the potential efficacy of AVBT in patients with primary thoracic curves, a direct comparison to PSF, the most widely used definitive treatment for pediatric scoliosis, has yet to be conducted. Differences in efficacy, quality of life, and revision risk may exist across the techniques.QUESTIONS/PURPOSESWe compared AVBT to PSF in terms of (1) the proportion of patients whose main thoracic curve was corrected to < 50° without a return to the operating room for revision within 2 years, (2) residual thoracic and lumbar curve magnitude at 2 years, (3) health-related quality of life (HRQoL) scores, and (4) the frequency of serious complications and healthcare resource utilization.METHODSFrom 2017 to 2022, patients (n = 87) were assessed for eligibility to participate in an FDA-approved investigational device exemption clinical trial for AVBT based on presenting to the clinic with a diagnosis of adolescent idiopathic scoliosis that had entered into surgical range. Based on clinical characteristics and the family's stated goals of care, AVBT and PSF were both discussed, but ultimately the patient and their family selected their preferred treatment. Under guidance from the FDA, a sample of 20 patients who met the inclusion criteria of a Lenke Type 1 or 2 curve classification, a thoracic curve between 35° and 60°, a lumbar curve < 35°, and a skeletal maturity score of either Risser 0 or Sanders bone age of ≤ 4 were eligible to participate in the trial and undergo AVBT. Patients with Lenke 1 and 2 curves who elected to undergo PSF (n = 27) were prospectively analyzed for comparison. No patients who underwent AVBT and 22% (n = 6) of those who underwent PSF were lost prior to the minimum study follow-up of 2 years, leaving 100% (20) and 78% (n = 21) in each group, respectively, for analysis. All patients in the PSF group who were lost to follow-up did not report any complications at 1 year. Patients who underwent AVBT (80% [16] girls) were generally younger, more skeletally immature, and had smaller preoperative curvature at the time of surgery compared with patients who underwent PSF (81% [17] girls). No differences in gender, height, or revised Scoliosis Research Society-22 (SRS-22) patient questionnaire scores were observed across the two groups at baseline. Patients in both cohorts were followed at the preoperative, first erect, and 2-year time points. Radiographic, health-related quality of life, unplanned return to the operating room, complications, and healthcare resource utilization outcomes were compa","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"236 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolated Limb Perfusion Can Avert Amputation Indication in Initially Nonsalvageable Sarcomas of the Extremities.","authors":"Jan Lesensky,Ondrej Blecha,Ana C Belzarena,Michal Vočka,Miroslav Špaček","doi":"10.1097/corr.0000000000003584","DOIUrl":"https://doi.org/10.1097/corr.0000000000003584","url":null,"abstract":"BACKGROUNDBecause of their aggressive nature and limited treatment options, soft tissue sarcomas present a significant challenge for patients. Isolated limb perfusion with tumor necrosis factor α and melphalan (TM-ILP) has emerged as a promising modality against soft tissue sarcomas aimed at downstaging tumors with significant local invasion, offering a localized approach to deliver high doses of chemotherapy directly to the affected limb while minimizing systemic toxicity. However, its feasibility in centers with limited experience and its true impact on limb salvage remain unclear. Our study aims to address these knowledge gaps by evaluating outcomes in a diverse patient population and assessing factors that influence treatment success and limb preservation.QUESTIONS/PURPOSES(1) What was the cumulative incidence of amputations at 12 months after TM-ILP in patients with tumors that were initially considered nonsalvageable? (2) What proportion of patients treated with this approach developed early severe complications, defined as death of the patient, compartment syndrome of the treated extremity, or a treatment reaction leading to limb amputation within 30 days from the ILP procedure? (3) What was the all-cause survivorship and survivorship free from local recurrence in patients treated with TM-ILP?METHODSA retrospective observational study was conducted on patients who underwent TM-ILP for a soft tissue sarcoma that was deemed not amenable for limb salvage between July 2016 and June 2023. During this time, among a total of 528 patients treated for soft tissue sarcoma, 36 patients not considered candidates for a limb salvage procedure by a multidisciplinary tumor board were recommended for TM-ILP. The determination of limb nonsalvageability was based on the feasibility of achieving negative surgical margins and adequate soft tissue coverage after resection. Two patients declined TM-ILP, and a total of 34 patients were included in the study. After the TM-ILP treatment, an MRI was performed, and the feasibility of a limb salvage procedure was reassessed by the same multidisciplinary team against the same initial criteria. There were 12 females and 22 males, and the mean ± SD age was 55 ± 17 years. The most common sarcomas were of the lower extremity (62% [21 of 34]). The most frequent diagnoses were undifferentiated pleomorphic sarcoma (18% [6]) and myxoid liposarcoma (18% [6]). Seventy-six percent (26 of 34) of patients completed ILP followed by surgery, which took place between 2 and 3 months from TM-ILP. For the remaining eight patients, in four patients ILP could not be completed (two attributed to leaks, one attributed to arterial blockage, and one attributed to insufficient venous return), and the additional four patients elected not to proceed with surgery because of systemic disease progression. Seventy-nine percent (27 of 34) of patients were alive and had a documented follow-up of at least 1 year after treatment. To estimate the cumulati","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"183 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144320345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}