Clinical Orthopaedics and Related Research®最新文献

{"title":"Femoral Trochlear Dysplasia Is Common in Lower Limbs With Hartofilakidis C2 Hip Dysplasia.","authors":"Yijian Huang, Mingfeng Li, Fangxin Zhao, Cheng Wang, Jiafeng Yi, Xiangpeng Kong, Wei Chai","doi":"10.1097/CORR.0000000000003557","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003557","url":null,"abstract":"<p><strong>Background: </strong>Patients with developmental dysplasia of the hip (DDH) can also present with deformities of the patellofemoral joint, such as femoral trochlear dysplasia. Although previous studies have reported that trochlear dysplasia is clinically important in some patients with DDH, the association between DDH and trochlear dysplasia is still unclear.</p><p><strong>Questions/purposes: </strong>(1) Is trochlear dysplasia more common among lower limbs with bilateral DDH, with unilateral DDH, or without DDH (specifically, in the contralateral limb of patients with unilateral DDH)? (2) Is having more severe DDH (as measured by Hartofilakidis classification, Crowe classification, or according to angular measurements) associated with higher odds of having trochlear dysplasia?</p><p><strong>Methods: </strong>This was a single-center retrospective comparative study. Between November 2018 and February 2024, a total of 439 patients with DDH (of whom 56% [248 of 439] had bilateral DDH and the remainder had unilateral DDH) underwent THA in our center. Of those, we considered as potentially eligible patients who were between ages 18 and 50 years, with a history of DDH that did not undergo surgical treatment prior to the THA, and who had available demographic and radiographic data. We then excluded 31% of the patients because 62 of them had a history of hip or knee treatment, 8 had a history of trauma or infection in the hip or knee, 24 had severe knee osteoarthritis, 9 had a history of neuromuscular disease, and the data from 33 patients were incomplete, leaving 303 patients (of whom 50% [152 of 303] had bilateral DDH, while the remainder had unilateral DDH; 455 affected and 151 unaffected limbs, in total) for the analysis. From those, we formed three study groups: 33% (152) of limbs randomly selected from one of the limbs of each patient with bilateral DDH were assigned to the bilateral group, 33% (151) of limbs selected from the ipsilateral side of patients with unilateral DDH were assigned to the unilateral group, and 33% (151) of limbs selected from the contralateral limbs in patients with unilateral DDH were assigned to the contralateral group. There were no differences in demographics, such as sex, age, and BMI, between patients with bilateral DDH and unilateral DDH. All patients underwent CT as a standard component of the preoperative evaluation process for THA. To answer our first question about in which group trochlear dysplasia is more common, we measured anatomic parameters related to the patellofemoral joint by three-dimensional CT, diagnosed trochlear dysplasia using a sulcus angle of ≥ 145° or a femoral trochlear depth of ≤ 4 mm, and classified trochlear dysplasia according to the Dejour classification; the proportions of trochlear dysplasia among the three groups were compared totally or by sex. To answer the second question about whether more severe DDH is associated with a higher likelihood of trochlear dysplasia, Crowe cla","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172981","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: Frailty Is Associated With Increased 30-day Readmissions and Costs After Total Shoulder Arthroplasty.","authors":"Maveric Abella","doi":"10.1097/CORR.0000000000003554","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003554","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198413","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":"Behind the Mask: Attending.","authors":"Steven E Zhang","doi":"10.1097/CORR.0000000000003551","DOIUrl":"10.1097/CORR.0000000000003551","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12190040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: Efficacy of Educational Presentations in the Pediatric Orthopaedics Clinic.","authors":"Bridget K Ellsworth","doi":"10.1097/CORR.0000000000003562","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003562","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198411","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®: Standardized Intraoperative Robotic Laxity Assessment in TKA Leads to No Clinically Important Improvements at 2 Years Postoperatively: A Randomized Controlled Trial.","authors":"John Bartoletta","doi":"10.1097/CORR.0000000000003563","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003563","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172911","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®: How Do Gunshot and Explosive Injuries to the Lower Extremities Differ in Severity and Treatment? A Comparative Study From the Israel-Gaza Conflict.","authors":"Paul J Dougherty","doi":"10.1097/CORR.0000000000003552","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003552","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172895","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 Factors Are Associated With Patella Baja After Internal Fixation of Patellar Fractures?","authors":"Thomas A DeCoster","doi":"10.1097/CORR.0000000000003544","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003544","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172977","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":"Evaluation of Clinical Tests to Diagnose Iliopsoas Tendinopathy.","authors":"Frans-Jozef Vandeputte,Ronald Driesen,Annick Timmermans,Kristoff Corten","doi":"10.1097/corr.0000000000003520","DOIUrl":"https://doi.org/10.1097/corr.0000000000003520","url":null,"abstract":"BACKGROUNDDiagnosing iliopsoas tendinopathy is challenging because of nonspecific pain patterns and clinical signs overlapping with those of other hip conditions. Although peritendinous anesthetic injections provide the best diagnostic accuracy, they are invasive and resource intensive. Conventional clinical tests largely focus on hip flexion, potentially overlooking the diagnostic contribution of the muscle's secondary function-external rotation. A newly described hip-external rotation-flexion-ceiling (HEC) test combines the primary function (hip flexion) with the secondary function (external rotation) of the iliopsoas, potentially offering enhanced diagnostic reliability.QUESTIONS/PURPOSESThis study aimed to (1) determine the diagnostic accuracy of the HEC test and 10 conventional physical examination tests for iliopsoas-related groin pain; (2) detect \"good\" and \"poor\" tests for diagnosing iliopsoas tendinopathy based on three diagnostic performance criteria before and after anesthetic injection (mean pain reduction, optimal cutoff value for pain reduction, and area under the curve [AUC]); and (3) rank all tests, based on the same criteria, to identify the best diagnostic tool.METHODSIn this retrospective study at a high-volume arthroplasty community hospital, we reviewed 48 consecutive fluoroscopy-guided iliopsoas tendon injections performed for persistent groin pain between October 2023 and May 2024. After excluding four patients without any data on the clinical tests performed, a population of 44 participants (mean age 48 ± 15 years; 34% male) remained, which included both native hips (52%) and patients who had undergone THA (48%). Eleven clinical tests-including the novel HEC test and 10 conventional tests (such as resisted hip flexion seated and straight leg raise [SLR] in neutral and external rotation)-were performed before and after a fluoroscopy-guided iliopsoas injection, with an improvement in their characteristic groin pain serving as the diagnostic gold standard. A test was considered \"good\" if it met all three criteria: (1) a significant mean VAS pain score reduction of ≥ 3 points after injection, (2) a significant optimal cutoff value for pain reduction of ≥ 4, and (3) a significant AUC of ≥ 0.80. A test meeting none of these three criteria was considered \"poor.\" Using the same three criteria, each clinical test with at least 30 valid observations received a ranking position for each criterion, and these three ranks were summed to produce a total score. The test with the lowest total score was deemed the best, followed by the tests with higher scores. Statistical analysis involved estimating sensitivity, specificity, AUC, and optimal cutoff values using receiver operating characteristic curves and the Youden J statistic.RESULTSIn 82% (36 of 44) of patients who experienced pain reduction after injection and who were diagnosed with iliopsoas tendinopathy, the following tests had the most clinically important pain reduction after inf","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"31 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144097710","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":"Serum Amyloid A Is a Promising Tool for Screening Periprosthetic Joint Infection.","authors":"Xiaohui Zhang,Fan Lu,Bin Geng,Baolin Zhang,Laiwei Guo,Yayi Xia","doi":"10.1097/corr.0000000000003547","DOIUrl":"https://doi.org/10.1097/corr.0000000000003547","url":null,"abstract":"BACKGROUNDAlthough the modified Musculoskeletal Infection Society (MSIS) criteria are commonly used, the accurate and timely diagnosis of periprosthetic joint infection (PJI) remains challenging. Serum amyloid A, like C-reactive protein (CRP), is an acute-phase reactant and widely serves as a diagnostic tool for infectious diseases in adults and children. However, the role of serum amyloid A in diagnosing PJI has not been fully explored.QUESTIONS/PURPOSES(1) What were the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) of serum amyloid A as a diagnostic test for PJI? (2) How did the diagnostic performance of serum amyloid A compare with that of other commonly used serum biomarkers?METHODSBetween October 2020 and October 2023, three surgeons performed 137 revision THA or TKA procedures. All were considered potentially eligible, but we excluded 20% (28 of 137) because of reimplantation, missing blood biomarker data, and periprosthetic fracture, leaving 80% (109) for analysis in this retrospective study. Those were divided into two groups: those believed to have PJI (62) based on the modified 2018 MSIS criteria and those who did not meet 2018 MSIS criteria (non-PJI, n = 47). The PJI group comprised 56% males (median age 66 years) with 23 hips and 39 knees affected, while the non-PJI group included 17% males (median age 66 years) involving 25 hips and 22 knees. All 47 revisions in the non-PJI group were followed for at least 1 year to make sure that they were not false negatives. No patients were lost to follow-up during this period. Diagnostic accuracy was assessed using receiver operating characteristic (ROC) curve analysis. Sensitivity, specificity, PPV, NPV, and AUC were calculated for all four routine tests (serum amyloid A, CRP, erythrocyte sedimentation rate [ESR], and fibrinogen) to determine their diagnostic capacity for PJI.RESULTSFor the diagnosis of PJI, with a cutoff value of 14 based on the Youden index, serum amyloid A had a sensitivity of 85% (95% confidence interval [CI] 74% to 93%), a specificity of 96% (95% CI 86% to 100%), a PPV of 96% (95% CI 87% to 99%), and an NPV of 83% (95% CI 73% to 90%). Using the optimal cutoffs for the AUC of the ROC as calculated by the Youden index for each test, serum amyloid A was more accurate than the ESR (0.96 versus 0.85; p = 0.005) and plasma fibrinogen (0.96 versus 0.84; p = 0.002) but no different from the CRP (0.96 versus 0.93; p = 0.17).CONCLUSIONOur study established serum amyloid A as a promising high-accuracy biomarker for PJI screening, demonstrating superior performance to ESR and fibrinogen while being comparable with the diagnostic performance of CRP. This provides surgeons with a novel tool for screening suspected PJI, particularly when interpreting ambiguous CRP and ESR results or requiring rapid decision-making, as its combination of rapid kinetics, cost-efficiency, short turnaround time, and high specificity","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"18 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144097750","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":"Editorial: What Should We Do if There is No Minimum Clinically Important Difference Defined for a Key Study Endpoint?","authors":"Seth S Leopold, Mark C Gebhardt, Terence J Gioe, Paul A Manner, Raphaël Porcher, Clare M Rimnac, Montri D Wongworawat","doi":"10.1097/CORR.0000000000003545","DOIUrl":"10.1097/CORR.0000000000003545","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"483 7","pages":"1177-1179"},"PeriodicalIF":4.2,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12190073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}