Clinical Orthopaedics and Related Research®最新文献

{"title":"What Is the Cumulative Incidence of Femoral Stem Revision and Stem Complication in Cemented and Uncemented Hip Arthroplasty for Proximal Femoral Metastatic Bone Disease?","authors":"Joshua M Lawrenz,Stephen W Chenard,Ethan P Winter,Dana G Rowe,Spencer M Richardson,Benjamin M Wright,Michael D Eckhoff,Hakmook Kang,Alexander L Lazarides,John H Alexander,Julia D Visgauss,Christopher D Collier,Lukas M Nystrom,","doi":"10.1097/corr.0000000000003541","DOIUrl":"https://doi.org/10.1097/corr.0000000000003541","url":null,"abstract":"BACKGROUNDHip arthroplasty is often indicated in metastatic bone lesions of the proximal femur, with or without pathologic fracture. Conventional knowledge is that cemented fixation is best, although uncemented fixation has potential advantages of shorter operative time, avoidance of the physiologic stress of cement, and the chance for osseointegration. However, both techniques are options that are employed, and there is no clear evidence to guide this choice.QUESTIONS/PURPOSESIn patients with proximal femoral metastatic bone lesions who were carefully selected either to receive cemented or uncemented fixation based on patient age, bone quality, tumor histology type, and the anatomic location of the lesion, we asked: (1) What is the cumulative incidence of femoral stem revision and stem complication in patients treated with cemented and uncemented hip arthroplasty for proximal femoral metastatic bone disease? (2) Are perioperative radiation and uncemented fixation independently associated with stem complication?METHODSBetween January 2011 and December 2022, six centers performed 337 primary hip arthroplasties (THA or hemiarthroplasty) for proximal femoral metastatic bone disease. While these relative indications for fixation technique varied by center and surgeon, cemented fixation was used in some centers exclusively; where used selectively, it was generally used more frequently in older patients (> 65 years), any patient with poorer radiographic proximal femoral bone quality, or in the setting of pathologic fractures and/or lesions requiring intralesional resection rather than complete resection. Uncemented fixation was often selectively used in younger patients (< 65 years) with adequate radiographic proximal femoral bone quality and often for lesions where all macroscopically visible disease was removed with sufficient remaining bone to accept uncemented fixation. A total of 287 cemented reconstructions (of which 19% [55 of 287] were THAs and 81% [232 of 287] were hemiarthroplasties) and 50 uncemented reconstructions (of which 50% [25 of 50] were THAs and 50% [25 of 50] were hemiarthroplasties) were performed. A total of 66% (190 of 287) and 36% (18 of 50) of patients, respectively, had died before 2 years, and 21% (61 of 287) and 42% (21 of 50), respectively, were lost to follow-up before 2 years but were not known to have died. As expected, the groups were substantially different at baseline, with the uncemented group being younger, less likely to have had a pathologic fracture, more likely to have received attempted wide resection rather than intralesional resection, more likely to have received this fixation technique at certain centers, and more likely to have received a THA, indicating a generally better preoperative functional status. Because of those substantial baseline differences between the fixation groups, we did not compare them but rather will report each separately in terms of survivorship with respect to stem revision and ste","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"228 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295677","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":"Is Displacement of the Lesser Trochanter Associated With Functional Outcome in Older Adults With Intertrochanteric Fractures?","authors":"Napol Ratanasermsub,Chavarin Amarase,Saran Tantavisut,Pathit Sirichuchnin","doi":"10.1097/corr.0000000000003574","DOIUrl":"https://doi.org/10.1097/corr.0000000000003574","url":null,"abstract":"BACKGROUNDLesser trochanter displacement in intertrochanteric fractures has been linked to fracture instability and altered hip biomechanics, with evidence suggesting that proximal or medial displacement of the fragment by ≥ 10 mm may lead to poorer clinical outcomes. However, whether such displacement is associated with multidomain functional outcomes and patient performance remains unclear.QUESTIONS/PURPOSESIn older adults with intertrochanteric fractures treated with internal fixation using a cephalomedullary nail, we asked: (1) Were functional outcome measures, including the Harris hip score (HHS), de Morton Mobility Index (DEMMI), and the Barthel Index, negatively associated with lesser trochanter displacement of ≥ 10 mm? (2) Was lesser trochanter displacement of ≥ 10 mm associated with a decreased ability to complete tasks during performance assessments and inferior performance scores on the Functional Reach Test (FRT), Timed Up and Go test (TUG), and 5 Times Sit-to-Stand (5TSTS) test?METHODSBetween January 2021 and October 2023, four fellowship-trained orthopaedic surgeons at a Level I trauma center treated older adults with intertrochanteric hip fractures. Short cephalomedullary nails were used in approximately 90% of patients, typically for displaced fractures, including both stable and unstable types. Of the 123 patients treated with a cephalomedullary nail, 7% (9) were lost to follow-up before 1 year, 9% (11) died within 1 year, and 12% (15) were excluded based on predefined criteria, leaving 72% (88) of patients for analysis in this retrospective comparative study. There was no evidence of differential loss to follow-up or mortality between the displacement groups. Patients were divided into two groups based on postoperative lesser trochanter displacement: patients with < 10 mm of proximal or medial displacement, including an intact lesser trochanter (n = 44), and patients with displacement of ≥ 10 mm (n = 44). Baseline characteristics, including demographics, American Society of Anesthesiologists classification, and preinjury Barthel Index, did not differ between the groups. Functional outcomes, including the HHS, the DEMMI (which assesses mobility across a range of physical tasks), and the Barthel Index (which measures independence in activities of daily living) were assessed at 3 months and 1 year postoperatively. All three scores range from 0 to 100, with higher scores indicating better function. These capture different domains of recovery, allowing for a more comprehensive evaluation of patient outcomes. Performance tests (FRT, TUG, 5TSTS) were assessed at the same time points by experienced orthopaedic surgeons, and the groups were compared on those endpoints. The minimum clinically important difference (MCID) or minimal detectable change at 95% confidence (MDC95) values were: HHS (MCID = 16 to 18), DEMMI (MCID = 10), Barthel Index (MCID = 8.4), FRT (MDC95 = 6.4 to 8.2 cm), TUG (MCID = 2.9 to 4.9 seconds), and 5TSTS (MCID = 3.6 ","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"33 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295959","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":"High Risk of Venous Thromboembolism With Aspirin Prophylaxis After THA for High-riding Developmental Dysplasia of the Hip: A Retrospective, Comparative Study.","authors":"Kaveh Gharanizadeh,Hadi Ravanbod,Mohammad Poursalehian,Arvin Medhat,Amir Aminian,Maziar Rajei,Mohammad Hassanzadeh,Mansour Abolghasemian","doi":"10.1097/corr.0000000000003482","DOIUrl":"https://doi.org/10.1097/corr.0000000000003482","url":null,"abstract":"BACKGROUNDDespite advancements, THA is still associated with risks, particularly venous thromboembolism (VTE). THA in patients with high-riding developmental dysplasia of the hip (DDH) could potentially be associated with an elevated risk of VTE. We conducted a study to evaluate whether patients with high-riding DDH undergoing THA and receiving aspirin have an increased risk of symptomatic VTE compared with patients undergoing primary THA for other diagnoses. Additionally, we investigated possible risk factors for VTE within this specific patient group.QUESTIONS/PURPOSES(1) Is the risk of symptomatic VTE (all deep vein thrombosis [DVT] plus pulmonary embolism, or proximal DVT plus pulmonary embolism) increased in patients undergoing THA for severe DDH, defined as Crowe type III or IV, compared with patients undergoing THA for other reasons when aspirin is used for prophylaxis? (2) In patients with severe DDH undergoing THA, are there specific identifiable risk factors associated with an increased risk of symptomatic VTE?METHODSBetween June and November 2021, an arthroplasty surgeon performed 153 consecutive primary THAs on 146 patients across two arthroplasty centers. All patients except those with a history of prior VTE or those on chronic anticoagulation received aspirin as pharmacologic prophylaxis for VTE. No routine surveillance for VTE was used. To be eligible for this retrospective comparative study, a chart note documenting any signs or symptoms of symptomatic VTE had to be present at least 3 months postoperatively. Patients were excluded for the following reasons: they had a personal history of VTE (1% [2 of 146]), they were receiving ongoing anticoagulant therapy (2% [3 of 146]), they were out of the age criteria range (2% [3 of 146]), they had undergone same-setting bilateral THAs or the second side of staged bilateral THAs (3% [4 of 146]), or they were lost to follow-up within 90 days after surgery (0% [0]). After exclusions, 134 patients (134 hips) remained. Patients were divided into two groups based on their preoperative diagnosis: (1) high-riding DDH of Crowe type III or IV (35% [47 of 134] of hips) and (2) all other diagnoses, including primary or inflammatory arthritis, Crowe type I or II DDH, fracture, and osteonecrosis (65% [87 of 134] of hips). A comprehensive records review was conducted to determine the incidence of symptomatic VTE, including distal DVT, proximal DVT, or pulmonary embolism. Patients' demographics, surgical details, and outcomes were compared between the groups. The high-riding group had longer operations and a higher percentage of patients having general anesthesia, acetabular bone grafting, transfusions, or restricted weightbearing postoperatively. Univariable analysis was performed to compare the high-riding DDH group with the control group and to evaluate associations between potential risk factors and symptomatic VTE. Subsequently, multivariable logistic regression was conducted to identify independent ","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"19 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144320350","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":"Is There Any Association Between Orientation of the Lumbar Facet Joints and Increasing Age in White and Black Patients?","authors":"Hiroyuki Yoshihara, Colm Mulvany, Harleen Kaur, Evan Horowitz, Daisuke Yoneoka","doi":"10.1097/CORR.0000000000003540","DOIUrl":"10.1097/CORR.0000000000003540","url":null,"abstract":"<p><strong>Background: </strong>Numerous studies have found an association between sagittally oriented facet joints and degenerative lumbar spondylolisthesis. Several studies have found sagittalization of lumbar facet joints with aging in various Asian patients. However, there is a paucity of evidence on the association between orientation of the lumbar facet joints and age in White and Black patients. If there are differences, this might be important because it may provide a clue for the difference in the prevalence of degenerative lumbar spondylolisthesis among races.</p><p><strong>Question/purpose: </strong>Is there any association between orientation of the lumbar facet joints and increasing age in White females, Black females, White males, and Black males?</p><p><strong>Methods: </strong>This is a retrospective study drawn from a large, longitudinally maintained database. We sought to include CT scans from patients aged 20 to 79 years who underwent abdominal and pelvic CT for trauma screening in the New York City area and whose race was classified as White or Black on an emergency department questionnaire between March 2019 and March 2020; we believed that period would provide a sufficient number of CT scans to achieve the desired sample size of 45 measurements at each facet level (after excluding those scans in which the angles could not be measured because of arthritic changes) for each of the two study groups. A total of 1343 patients were included (650 White patients [339 females and 311 males] and 693 Black patients [355 females, 338 males]). The facet joint orientation angle of both sides was measured at L1-L2, L2-L3, L3-L4, L4-L5, and L5-S1 in the axial planes on CT images, and a mean of both sides was taken as the facet joint orientation. The smaller this angle, the more sagittally oriented the facet joint. Associations between the angle and age were analyzed.</p><p><strong>Results: </strong>Facet joint angles slightly increased with aging at L1-L2 in White females (R = 0.11; p < 0.05) and decreased slightly with aging at all levels in Black females (R = -0.18, -0.24, -0.13, -0.25, and -0.21 at the level of L1-L2, L2-L3, L3-4, L4-L5, and L5-S1, respectively; p < 0.05 for all). Facet joint angles increased slightly with aging at L1-L2 in White males (R = 0.14; p = 0.02) and decreased slightly with aging at L1-L2, L2-L3, L3-L4, and L4-L5 in Black males (R = -0.14, -0.17, -0.20, and -0.15, respectively; p < 0.05 for all). At L4-L5, the largest decreasing trend of facet joint angles with aging (R = -0.25; p < 0.01) was shown in Black females, and the mean facet joint angle was the smallest in Black females who were 70 years of age.</p><p><strong>Conclusion: </strong>Lumbar facet joint angles slightly decreased with aging in Black females and males, whereas they did not in White females or males. At L4-L5, the largest decreasing trend of facet joint angles with aging was shown in Black females. Our results may help future authors to ascer","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257503","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":"Editor's Spotlight/Take 5: Artificial Intelligence Shows Limited Success in Improving Readability Levels of Spanish-language Orthopaedic Patient Education Materials.","authors":"Seth S Leopold","doi":"10.1097/corr.0000000000003559","DOIUrl":"https://doi.org/10.1097/corr.0000000000003559","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"37 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144320366","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":"Modic Changes Are Associated With Increased Pain Intensity, Greater Disability, and Reduced Quality of Life in Low Back Pain: A Cross-Sectional Study.","authors":"Daishui Yang, Bernhard U Hoehl, Lukas Schönnagel, Lukas Mödl, Tianwei Zhang, Sihai Liu, Sandra Reitmaier, Lena Fleig, Matthias Pumberger, Hendrik Schmidt","doi":"10.1097/CORR.0000000000003565","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003565","url":null,"abstract":"<p><strong>Background: </strong>Low back pain (LBP) is a common health problem and a major contributor to disability. Modic changes, or vertebral marrow changes visible on MRI, are frequently observed in individuals with LBP. However, there is inconsistent evidence assessing the relationship between Modic changes and LBP, pain-related disability, and quality of life.</p><p><strong>Questions/purposes: </strong>(1) Are Modic change parameters, including their type, number, and extent, positively associated with the characteristics of LBP, particularly when classified into intermittent LBP and chronic LBP? (2) Are Modic change parameters associated with participant-reported longer duration and higher intensity of LBP? (3) Are Modic change parameters associated with worsened pain-related disability and poorer quality of life?</p><p><strong>Methods: </strong>This study was a Phase III, single-center, cross-sectional analysis drawing its data from the ongoing Berlin Back Study (research unit FOR5177). A total of 1218 participants who met the inclusion and exclusion criteria were recruited between January 2022 and January 2024. Of these, 18% (217 of 1218) were excluded because of the lack of results from orthopaedic clinical examination and MRI evaluation. After clinical examination and completion of questionnaires, another 24% (289 of 1218) were excluded because of pain in other locations or pain experienced in the past, leaving 58% (712 of 1218) of participants in our study. The individuals included in this study had a mean age of 42 ± 11 years, with 57% women and 43% men. Data on demographic characteristics, LBP features, pain-related disability, and quality of life were collected using structured questionnaires and clinical evaluations. Three independent evaluators, blinded to the participants' demographic information and health status, assessed the Modic change parameters, referring to signal alterations in the vertebrae's endplate. The relationship between Modic change parameters and individual health status was assessed using multiple regression analysis after adjustment for age, gender, BMI, smoking and alcohol consumption, disc herniation, facet joint degeneration, and spinal instability.</p><p><strong>Results: </strong>Among the common Modic change parameters, when Type I Modic changes were observed, we found higher odds of chronic LBP (OR 7.3 [95% confidence interval (CI) 3.1 to 17.0]; p < 0.001) and intermittent LBP (OR 4.9 [95% CI 1.7 to 14.0]; p = 0.003) after adjusting for potential confounders. However, when greater depth and area of Modic changes were observed, we found higher odds of chronic LBP (OR 3.1 [95% CI 1.3 to 7.3]; p = 0.01 and OR 1.3 [95% CI 1.0 to 1.7]; p = 0.03, respectively) but not of intermittent LBP (OR 1.2 [95% CI 0.4 to 4.1]; p = 0.72 and OR 1.0 [95% CI 0.7 to 1.3]; p = 0.86, respectively). In the chronic LBP subgroup, we found that Type I Modic changes were associated with slightly higher maximum pain intensity (β 1.","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233384","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":"Do Cumulative Revision Rate and First-time Re-revision Rate Vary Between Short and Standard Femoral Stem Lengths? A Multinational Registry Study.","authors":"Karin Rilby, Mirthe H W van Veghel, Maziar Mohaddes, Liza N van Steenbergen, Peter L Lewis, Johan Kärrholm, Berend W Schreurs, Gerjon Hannink","doi":"10.1097/CORR.0000000000003354","DOIUrl":"10.1097/CORR.0000000000003354","url":null,"abstract":"<p><strong>Background: </strong>Advocates of short-stem THA suggest that these devices preserve proximal femoral bone for future revisions. This contention is as yet unsupported by robust evidence, and ultimately, it will be irrelevant if short-stem THA increases the overall risk of premature revision. To our knowledge, large, registry-based efforts have yet to explore the types of stems used in first-time stem revision as well as the survivorship of short versus standard-length femoral stems in THA.</p><p><strong>Questions/purposes: </strong>(1) Which stems are used in the first stem revision of primary short-stem and standard-stem THAs? (2) What is the overall cumulative revision rate (CRR) of primary short-stem THAs compared with primary standard-stem THAs? (3) What is the overall cumulative re-revision rate of primary short-stem THAs compared with primary standard-stem THAs?</p><p><strong>Methods: </strong>Patients with short-stem THAs, defined as a short stem with mainly metaphyseal fixation, registered in the Australian Orthopaedic Association National Joint Replacement Register (AOANJRR), the Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Interventies [LROI]), or the Swedish Arthroplasty Register (SAR) between January 2007 and December 2022 were included (n = 15,771), as well as a propensity score-matched cohort (1:2) with standard-stem THAs, defined as a stem with a standard length (n = 31,542). Groups were matched on sex, age, year of procedure, diagnosis, bearing material, and surgical approach. After matching, the groups did not differ in terms of age (mean ± SD 63 ± 11 versus 64 ± 11 years), sex (48% [7546 of 15,771] male versus 48% [15,093 of 31,542] male), and diagnosis (93% [14,655 of 15,771] osteoarthritis [OA] versus 94% [29,585 of 31,542] OA). We used those three registries because all are high-quality national arthroplasty registries with high levels of completeness. Also, the AOANJRR is the only registry globally that reports on short-stem THA as its own entity. The type of stem used in revision surgery was classified as standard stem (< 160 mm) or long stem (≥ 160 mm). Overall CRR of primary THAs at 12 years of follow-up and overall CRR of all first-time revisions at 5 years were calculated using Kaplan-Meier survival analyses. Any type of revision was used as endpoint.</p><p><strong>Results: </strong>In first-time stem revisions of the short-stem THAs, a standard stem was used more often (58% [116 of 201]) than in the revision of standard-stem THAs (46% [149 of 322]; p = 0.01). The 12-year overall CRRs between primary short-stem and standard-stem THAs did not differ (4.7% [95% confidence interval (CI) 4.0% to 5.5%] versus 5.1% [95% CI 4.5% to 5.7%], respectively; p = 0.20). The overall CRR for a second revision at 5 years also did not differ when primary short-stem THAs were compared with standard-stem THAs (20.9% [95% CI 16.8% to 25.8%]) versus 20.4% [95% CI 17.3% to 23.9%]; p = 0.80).</p><p><strong>Concl","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"1010-1019"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101400","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":"How To Improve Patient Selection in Individuals With Lower Extremity Amputation Using a Bone-anchored Prosthesis.","authors":"Charlotte van Vliet-Bockting, Robin Atallah, Jan Paul M Frölke, Ruud A Leijendekkers","doi":"10.1097/CORR.0000000000003369","DOIUrl":"10.1097/CORR.0000000000003369","url":null,"abstract":"<p><strong>Background: </strong>Many patients with a lower limb socket-suspended prothesis experience socket-related problems, such as pain, chronic skin conditions, and mechanical problems, and as a result, health-related quality of life (HRQoL) is often negatively affected. A bone-anchored prosthesis can overcome these problems and improve HRQoL, but these prostheses have potential downsides as well. A valid and reliable tool to assess potential candidates for surgery concerning a favorable risk-benefit ratio between potential complications related to bone-anchored prostheses and improvements in HRQoL is not available yet. Having this information may inform treating physicians and patients when deciding whether to pursue bone-anchored prostheses.</p><p><strong>Questions/purpose: </strong>In this study, we asked: (1) What is the difference in HRQoL at 6, 12, and 24 months among patients who underwent lower limb bone-anchored prosthesis treatment after using a socket-suspended prosthesis preoperatively? (2) What factors are associated with change in HRQoL 24 months after lower limb bone-anchored prosthesis treatment? (3) Which complications occurred within 24 months after lower limb bone-anchored prosthesis treatment? (4) What factors are associated with minor to severe complications within 24 months after lower limb bone-anchored prosthesis treatment?</p><p><strong>Methods: </strong>A total of 206 patients who underwent lower limb bone-anchored prosthesis treatment (femoral or tibial) at the Radboud University Medical Center between May 2014 and September 2020 were included in this study. Of those, 8% (17 of 206) were lost to follow-up at 24 months without meeting a study endpoint (not attending the clinic unrelated to the bone-anchored prosthesis, re-amputation), and another < 1% (1 of 206) died prior to 24 months, leaving 92% (189 of 206) of the original group who had a follow-up time of at least 24 months. The mean ± SD age was 54.3 ± 12.7 years, and 72% were men. Amputation levels included 64% (139 of 218) transfemoral amputation, 3% (7 of 218) knee exarticulation, 32% (70 of 218) transtibial amputation, 0.5% (1 of 218) foot amputation, and 0.5% (1 of 218) osseointegration implant after primary amputation. Causes of amputation included 52% (108 of 206) trauma, 8% (17 of 206) oncology, 19% (38 of 206) dysvascular, 12% (25 of 206) infection, 1% (2 of 206) congenital, and 8% (16 of 206) other. Primary outcomes were generic HRQoL (Short-Form 36 health survey mental component summary [MCS] and physical component summary [PCS] scores), disease-specific HRQoL (Questionnaire for Persons with a Transfemoral Amputation global score), and complication occurrence (infection, implant complications such as loosening or breakage, stoma-related problems, periprosthetic fracture, and death). Multivariable multiple regression was used to develop association models. These models demonstrated which group of characteristics were associated with change in HRQoL a","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"1075-1092"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143032445","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":"CD177, MYBL2, and RRM2 Are Potential Biomarkers for Musculoskeletal Infections.","authors":"Taiwo Samuel Agidigbi, Brianna Fram, Ilda Molloy, Matthew Riedel, Daniel Wiznia, Irvin Oh","doi":"10.1097/CORR.0000000000003402","DOIUrl":"10.1097/CORR.0000000000003402","url":null,"abstract":"<p><strong>Background: </strong>Biomarkers of infection are measurable indicators that reflect the presence of an infection in the body. They are particularly valuable for detecting infections and tracking treatment responses. Previous transcriptome analysis of peripheral blood mononuclear cells (PBMCs) collected from patients during the active phase of diabetic foot infection identified the upregulation of several genes, including a neutrophil-specific cell surface glycoprotein, CD177, an Myb-related transcription factor 2 (MYBL2), and ribonucleotide reductase regulatory subunit M2 (RRM2). We aimed to investigate whether these observations in diabetic foot infections could be extrapolated to other musculoskeletal infections.</p><p><strong>Questions/purposes: </strong>(1) Are the protein concentrations of CD177, MYBL2, and RRM2 elevated in serum or PBMCs of patients with musculoskeletal infections? (2) Do serum and PBMC concentrations of CD177, MYBL2, and RRM2 decrease in response to antibiotic therapy? (3) Can these biomarkers give diagnostic accuracy and differentiate patients with musculoskeletal infections from controls?</p><p><strong>Methods: </strong>From April 2023 to June 2024, we treated 26 patients presenting with clinical symptoms and signs of acute musculoskeletal infections, including elevated inflammatory markers (white blood cell [WBC] and C-reactive protein [CRP]) and local changes such as swelling, erythema, tenderness or pain, warmth, purulent drainage, sinus tract, or wound leading to bone or hardware. Diagnosis included periprosthetic joint infection (PJI), foot and ankle infection (FAI), fracture-related infection (FRI), and septic arthritis of the native joints. Patients with chronic recurrent osteomyelitis, PJI, or FRI were excluded from the study. Among the 26 patients deemed potentially eligible, 19% (5) were excluded for the following reasons: prison inmate (1), unable to provide consent because of severe sepsis (1), mental illness (1), and declined to participate (2). Of the 81% (21) of patients who provided consent, cultures from 9.5% (2) were negative. These two patients were ultimately diagnosed with inflammatory arthritis: gout (1) and rheumatoid arthritis (1); thus, the musculoskeletal infection group for analysis consisted of 73.1% (19 of 26) of patients. A control group of 21 patients undergoing elective foot or ankle deformity correction surgery without infections or systemic inflammation was included. Because foot or ankle deformity is highly unlikely to influence the immunologic profile of the subjects, we believed that these patients would serve as an appropriate control group. Other than the absence of infection and the lower prevalence of diabetes mellitus, the control group was comparable to the study group in terms of demographics and clinical factors, including age and sex distribution. We collected blood samples from both patients and controls and quantified CD177, MYBL2, and RRM2 RNA transcription leve","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"1062-1071"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363976","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®: CD177, MYBL2, and RRM2 Are Potential Biomarkers for Musculoskeletal Infections.","authors":"Amanda Mener","doi":"10.1097/CORR.0000000000003443","DOIUrl":"10.1097/CORR.0000000000003443","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"1072-1074"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584906","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}