International Orthopaedics最新文献

{"title":"Influence of parkinson's disease on complications and revisions in total hip and knee arthroplasty: insights from a matched pair analysis.","authors":"Dominik Emanuel Holzapfel, Tobias Kappenschneider, Marie Farina Schuster, Stefano Pagano, Fady Azar, Sabrina Holzapfel, Matthias Meyer","doi":"10.1007/s00264-024-06398-9","DOIUrl":"10.1007/s00264-024-06398-9","url":null,"abstract":"<p><strong>Purpose: </strong>The outcome of elective total joint arthroplasty (TJA) in patients with Parkinson's disease (PD) is controversial due to the concomitant risk profile. This study investigated postoperative complications and revision rates following total hip (THA) and knee arthroplasty (TKA) in patients with PD.</p><p><strong>Methods: </strong>Ninety-six patients with PD undergoing THA or TKA were matched 1:1 with non-PD patients using propensity score matching for age, sex and comorbidity (Charlson Comorbidity index, CCI). Rates of revisions, medical and surgical complications were compared. Univariate and multivariate regression analyses were calculated.</p><p><strong>Results: </strong>PD patients exhibited higher rates of revision-surgeries within 90 days (13.5% vs. 5.2%; p = 0.048), medical complications (68.8% vs. 43.8%; p < 0.001) and surgical complications (40.6% vs. 21.9%; p = 0.005). Multivariate regression analysis confirmed PD as a significant risk factor for complications and long-term revision-surgeries.</p><p><strong>Conclusion: </strong>PD increases the risk of adverse outcomes following THA and TKA. Improvements in pre-operative planning and post-operative care are critical to the improvement of outcomes in this vulnerable population.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"559-572"},"PeriodicalIF":2.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11889065/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143038878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Small changes of femoral torsion in varus or valgus distal femoral osteotomy using patient-specific instruments.","authors":"Lukas Jud, Georgios Neopoulos, Sandro Hodel, Lazaros Vlachopoulos, Sandro F Fucentese","doi":"10.1007/s00264-025-06415-5","DOIUrl":"10.1007/s00264-025-06415-5","url":null,"abstract":"<p><strong>Purpose: </strong>Hinge fractures show a relatively high incidence in varus and valgus distal femoral osteotomy (DFO) and can lead to delayed- or non-union. Another observed complication of a hinge fracture is an unintentional change of the postoperative femoral torsion of up to + 9.5° in conventionally performed DFO. We hypothesize that the change of femoral torsion in case of a hinge fracture is less pronounced when DFO is performed using patient-specific instruments (PSI) compared to the literature of conventionally performed DFO.</p><p><strong>Methods: </strong>All patients who underwent varus or valgus DFO using PSI from January 2014 to September 2023 were included. Radiographs and computed tomography (CT) scans were used to screen for hinge fractures. Pre- and postoperative femoral torsion was measured in CT.</p><p><strong>Results: </strong>Thirty-five medial closing-wedge DFO (MCW-DFO), 27 lateral closing-wedge DFO (LCW-DFO), and 27 lateral opening-wedge DFO (LOW-DFO) were included, resulting in a total of 89 included osteotomies. A total of 55 hinge fractures (61.8%) were observed. The femoral torsion changed significantly from 20.5° ± 7.7° to 15.5° ± 8.1° (p < 0.001) in LOW-DFO with a hinge fracture, whereas the other two techniques showed no significant change of femoral torsion.</p><p><strong>Conclusion: </strong>The use of PSI in varus and valgus DFO showed only small changes of the postoperative femoral torsion, even in case of a hinge fracture. The change of femoral torsion was depending on the type of DFO and was only significant in LOW-DFO, however, not exceeding a mean change of 5°.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"621-627"},"PeriodicalIF":2.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11889048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beta-tricalcium phosphate combined with native bone proteins (β-TCP - NBP): a novel bone graft substitute for ankle and hindfoot arthrodesis.","authors":"Juhana Leppilahti, Mari Kuoppala, Timo Sirola, Lukasz Kolodziej, Katri Ahonen, Mikko Aulamo, Jaakko Niinimäki, Pekka Jalovaara","doi":"10.1007/s00264-025-06429-z","DOIUrl":"10.1007/s00264-025-06429-z","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this prospective, multi-centre study was to assess the performance and safety of a combination of osteoconductive β-tricalcium phosphate and osteoinductive native bone proteins (β-TCP - NBP) used as alternative for autograft in ankle and hindfoot arthrodesis.</p><p><strong>Methods: </strong>Thirty-four patients enrolled underwent ankle or hindfoot arthrodesis with β-TCP - NBP and were evaluated radiographically, clinically, and functionally up to fifty-two weeks. The primary performance endpoint was fusion rate evaluated with CT at six months. Safety was assessed based on the severity and incidence of adverse events. Functional evaluation was performed using the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score and pain was recorded using the Visual Analogue Scale (VAS).</p><p><strong>Results: </strong>CT at 6 months showed that 85.3% had osseous bridging of the joint of ≥ 25%, 52.9% ≥50%, 8.8% <25% and 5.9% showed no bridging. The AOFAS score increased significantly from 60.4 ± 17.6 points at operation to 68.6 ± 17.2 points at six months and to 73.5 ± 17.7 points at 12 months. The group with fusion rate ≥25% showed significantly higher AOFAS score than that with fusion rate < 25% at 12 months. The mean VAS pain score at rest and during weight bearing decreased significantly (p < 0.0001) from operation to six and 12 months.</p><p><strong>Conclusion: </strong>This study demonstrated that β-TCP - NBP is a valuable bone graft substitute for fusion of ankle and hindfoot due to debilitating osteoarthritis and offers an alternative for autograft.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"721-728"},"PeriodicalIF":2.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11889035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of locking plate and conservative treatment in elderly patients with displaced proximal humerus fractures.","authors":"Uğur Bezirgan, Malik Kısmet, Yusuf Kıratlıoğlu, Mehmet Yalçın, Mehmet Armangil","doi":"10.1007/s00264-025-06425-3","DOIUrl":"10.1007/s00264-025-06425-3","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to compare the outcomes of conservative treatment and locking plate osteosynthesis in displaced proximal humerus fractures in elderly patients.</p><p><strong>Methods: </strong>The study included patients over the age of 60 who were admitted to a tertiary trauma centre between 2020 and 2023, all diagnosed with 2-, 3-, or 4-part proximal humerus fractures. A total of 45 patients underwent either conservative management or locking plate fixation. In the older cohort, patients with Neer Type 2-4 fractures were treated conservatively using Velpeau immobilization. Displaced fractures, specifically 3- and 4-part fractures per the Neer classification, were treated surgically with locking plate fixation. Functional outcomes were evaluated using the Constant Shoulder score, the Disabilities of the Arm, Shoulder, and Hand (DASH) score, and the American Shoulder and Elbow Surgeons (ASES) score, with a minimum follow-up period of one year. Radiographic assessment focused on varus collapse, medial cortex displacement, greater tubercle displacement, absence of fracture lines, and callus formation. Complications, including nonunion, malunion, and avascular necrosis, were also recorded.</p><p><strong>Results: </strong>Of the 45 patients, 22 underwent locking plate fixation (Group A), while 23 were managed conservatively (Group B). In terms of fracture type, 20 patients were classified as Neer Type 2, 23 as Neer Type 3, and 2 as Neer Type 4. The mean patient age was 73.38 years. Functional scores (DASH, ASES, and Constant) were similar between the two groups, and no significant differences were observed in radiographic parameters. However, complications were significantly more frequent in the locking plate group compared to the conservative group. Two patients who underwent surgery experienced nonunion at the humeral neck. Additionally, secondary surgery was required in one patient due to postoperative infection and in another due to screw penetration into the joint. While no correlation was found between humeral neck malunions and functional outcomes, a negative correlation was observed between tubercle malunions and functional scores.</p><p><strong>Conclusion: </strong>In elderly patients with proximal humerus fractures, no significant differences in functional outcomes were observed between locking plate fixation and conservative treatment. However, locking plate fixation was associated with a higher incidence of complications and secondary surgeries. Thus, it appears that locking plate fixation does not offer superior outcomes compared to conservative management in this patient population.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"737-745"},"PeriodicalIF":2.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11889038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolated MASON type-III radial head fractures: radial head arthroplasty or open reduction and internal fixation - clinical and radiological outcomes with five to fourteen years of follow up.","authors":"Lyliane Ly, Thibault Druel, Aram Gazarian, Arnaud Walch","doi":"10.1007/s00264-025-06445-z","DOIUrl":"10.1007/s00264-025-06445-z","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to assess functional and radiological outcomes of radial head arthroplasty (RHA) compared to open reduction and internal fixation (ORIF) in isolated Mason type-III fractures with a minimum of five years follow-up.</p><p><strong>Methods: </strong>This was a retrospective single-center study of closed isolated Mason type-III radial head fractures operated between January 2008 and December 2017. Nineteen patients were included in group RHA and 35 patients in group ORIF. The mean age was 51 years old in group RHA and 41 years old in group ORIF (p = 0.02). Functional and radiological outcomes were evaluated.</p><p><strong>Results: </strong>Mean follow up was eight years (range, 5-14). Clinical results and functional scores showed no significant differences, except a better pronation in group RHA (p = 0.04). Two secondary radial head resection or implant removal were performed in each group (p = 0.56) with poor functional outcomes in group ORIF. There was less heterotopic ossification in group RHA (15.8% vs. 42.8%; p = 0.03). Capitulum wear was found in 63% in group RHA against 25.7% in group ORIF (p < 0.05).</p><p><strong>Conclusion: </strong>Functional results of RHA and ORIF were comparable for isolated Mason type-III fractures at a mean follow-up of eight years. We recommend to perform RHA for isolated Mason type-III fracture if articular reduction or stability of the fixation is not satisfying.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"767-777"},"PeriodicalIF":2.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11889027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for the development of premature physeal closure after a McFarland fracture in children.","authors":"Yuancheng Pan, Yuchen Pan, Tianpeng Dai, Chentao Xue, Federico Canavese, Shunyou Chen","doi":"10.1007/s00264-025-06428-0","DOIUrl":"10.1007/s00264-025-06428-0","url":null,"abstract":"<p><strong>Purpose: </strong>In 1931, McFarland reported on medial malleolar physeal fractures and resulting deformities, which were later classified as Salter-Harris Type III and IV fractures of the medial malleolus. Ongoing controversy surrounding the factors that increase the risk for PPC in children with McFarland (MF) fracture.The retrospective study aimed to investigate the radiological and clinical outcomes of children treated surgically for MF fracture and evaluate the potential factors that increase the risk for premature physeal closure (PPC).</p><p><strong>Methods: </strong>We retrospectively reviewed 48 children who were surgically treated for MF fracture. Demographic data, including age at injury, gender, mechanism of injury, laterality, initial displacement, fracture type, time from injury to surgery, method of reduction, fixation method, time of hardware removal, and whether or not the patient developed PPC, were retrieved from the charts.</p><p><strong>Results: </strong>PPC occurred in 35.4% (17/48) of the patients. Our analysis revealed that patients with PPC were significantly younger than those without PPC (P < 0.001). Furthermore, our analysis revealed age and initial displacement as independent factors that increased the risk for PPC. Notably, age less than 11.5 years and initial displacement of more than 4.5 mm represented the cut-off points for an increased incidence of PPC. Overall, 11 out of 48 patients had limited ankle range of motion (ROM); mean ankle ROM in patients with PPC was lower than those without PPC (P = 0.006). Lower limb discrepancy was 2.5 cm in children, although three patients with PPC had a lower limb discrepancy measuring more than 2 cm, and five patients with PPC complained of postoperative pain.</p><p><strong>Conclusions: </strong>Age and initial displacement are independent factors that increase the risk for PPC in children with MF fracture. Specifically, children aged under 11.5 years and those with initial displacement exceeding 4.5 mm are at a higher risk for PPC.</p><p><strong>Level of evidence: </strong>Observational study.</p><p><strong>Level of evidence iii: </strong></p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"661-669"},"PeriodicalIF":2.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lunate bone excision and scaphocapitate arthrodesis in late stages of Kienböck's disease: a long-term prospective study.","authors":"Amro A Fouaad, Galal Hegazy, Mohammed Alnahas, Gamal ElSawy, Yasser Saqr, Elsayed Shaheen, Mohamed Gamal, Mohamed Nasr Akl, Ahmed Darweash","doi":"10.1007/s00264-025-06458-8","DOIUrl":"https://doi.org/10.1007/s00264-025-06458-8","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to evaluate the outcomes of scaphocapitate arthrodesis with lunate excision in patients with stage IIIB and IIIC Kienböck's disease.</p><p><strong>Method: </strong>Between September 2013 and April 2024, 106 consecutive patients were screened, with 64 consenting to participate. Final analysis included 56 patients (32 stage IIIB and 24 stage IIIC) who underwent scaphocapitate arthrodesis with lunate excision, utilizing distal radius bone grafting stabilized by Herbert compression screws. Preoperative and postoperative assessments (6, 18, 36, and 84 months) included VAS score for pain, ROM, grip strength, MMWS, PRWE scores, and radiographic evaluations including RS angle, CHR, CUDR, and ulnar variance.</p><p><strong>Results: </strong>The mean operative time was 75 ± 11 min, and the average follow-up was 86 ± 2.5 months. The union rate was 91% with a mean time to union of 10 ± 2 weeks. Preoperative mean VAS scores (63 ± 4 mm) significantly decreased to 25 ± 9 mm at 6 months and 12 ± 4 mm at 36 months (p = 0.001), with a slight increase to 22 ± 5 mm at 84 months. ROM improved from 46% ± 9% of the healthy side preoperatively to 59% ± 3.2% at 36 months (p = 0.001) but slightly decreased to 58% ± 3% at 84 months. Grip strength improved from 48% ± 8% preoperatively to 89% ± 6.4% at 36 months (p = 0.001) and remained stable at 88% ± 4% at 84 months. The mean MMWS increased from 46 ± 7 to 75 ± 5 (p = 0.001), while PRWE scores decreased from 68 ± 8 to 23 ± 6 (p = 0.001). The mean RS angle decreased from 59° ± 8° preoperatively to 50° ± 3° at 36 months (p = 0.001). There was no significant change in CHR (0.44 ± 0.04 to 0.46 ± 0.03, p = 0.251), while CUDR decreased from 31 ± 3 mm to 25 ± 2 mm (p = 0.021). Ulnar variance remained stable (p = 0.325). Degenerative changes were noted in 13 patients (23%) at the RS joint, with six showing Grade I, 5 Grade II, and 1 Grade III degeneration. Additionally, 5 patients (9%) exhibited changes at the STT joint, comprising three with Grade I and 2 with Grade II degeneration.</p><p><strong>Conclusion: </strong>Scaphocapitate arthrodesis with lunate excision can improves pain, ROM, grip strength, and functional scores in patients with stage IIIB and IIIC Kienböck's disease. Over time, improvements in VAS scores and functional metrics were notable, though there was a slight decline in pain relief and ROM at 84 months. These changes are critical to understanding the potential degenerative complications, particularly at the RS joint, where some patients developed osteoarthritis.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experience excellence: celebrate ninety six years of SICOT, fifty years of International Orthopaedics, and orthopaedic history in Spain at SICOT Madrid 2025!","authors":"Phillipe Hernigou, Andrés Combalia, Luis Lopez Duran Stern, Marius M Scarlat","doi":"10.1007/s00264-025-06459-7","DOIUrl":"10.1007/s00264-025-06459-7","url":null,"abstract":"","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"529-540"},"PeriodicalIF":2.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative study of outcomes with total knee arthroplasty: medial pivot prosthesis vs posterior stabilized implant. Prospective randomized control.","authors":"Bogdan Obada, Madalina Gabriela Iliescu, Dan Ovidiu Costea, Lucian Petcu, Andrei Ion Popescu","doi":"10.1007/s00264-025-06420-8","DOIUrl":"10.1007/s00264-025-06420-8","url":null,"abstract":"<p><strong>Purpose: </strong>Total knee arthroplasty (TKA) is an effective procedure for pain relief and restoration of function in patients with symptomatic end-stage knee arthritis. Kinematic problems due to conventional implant design have been postulated. The objective of this study is to determine if there was any difference in postoperative ROM and outcomes between patients undergoing MP-TKA vs PS-TKA.</p><p><strong>Methods: </strong>We prospectively colected the records of 600 consecutive patients with TKA performed by six senior orthopaedic surgeons between 2017 - 2021. We compared the ROM and patient-reported outcomes (Western Ontario McMaster Osteoarthritis Index WOMAC, Oxford Knee Score OKS, Knee Society Score KSS, Forgotten Joint Score FJS) between MP TKA and PS TKA.</p><p><strong>Results: </strong>There were no specific criteria for implant selection as the two groups were consecutive cohorts of patients and implant selection depended on surgeon preference. Demographics, comorbidities, diagnosis and severity of osteoarthritis were similar between MP and PS groups. The trend for OKS in our study is the same in both groups, but with higher mean values in the MP group. The trend of WOMAC pain, stiffness and disability score is the same in both groups, but with higher mean values in the PS group at one year and two years. KSS clinical and functional score is the same in both groups, but with higher mean values in the MP group. The most important score is forgetten joint score which is favourable for the MP group.</p><p><strong>Conclusion: </strong>The patients who underwent the MP-TKA scored better than those who underwent the PS-TKA, particularly regarding deep knee flexion and stability of the prosthesis. This may be related to better replication of natural knee kinematics with MP-TKA.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"629-639"},"PeriodicalIF":2.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11889026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proximal versus distal tenotomy of the iliopsoas tendon in the surgical treatment of developmental dysplasia of the hip: a randomized clinical trial.","authors":"Jagar Doski","doi":"10.1007/s00264-025-06416-4","DOIUrl":"10.1007/s00264-025-06416-4","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to compare the release of the iliopsoas tendon at two levels: proximally at the pelvic brim and distally near the lesser trochanter.</p><p><strong>Methods: </strong>The study was a randomized clinical trial. It was done to check the equivalence between two parallel groups of patients with DDH of grade 2 or more who underwent open reduction operations for their hips: Group 1, division of the iliopsoas tendon at the pelvic brim, and Group 2, division of the tendon at the lesser trochanter level. All the operations were done through the anterior approach.</p><p><strong>Results: </strong>Thirty-eight patients (24 females and 14 males) with 54 hips (cases) operated, 27 cases in each group. The mean follow-up period of the cases was 2.4 years (SD 0.6). In the third month postoperatively, children of both groups had grade 2 hip flexion strength. Later, a statistically significant difference (p-value 0.007) occurred between them in the 24th month (Group 1 reached grade 5 and Group 1 to grade 4). More complications, 13 out of 27 (48.2%%), were recorded in Group 2. The complications were active bleeding due to injury to medial circumflex femoral vessels (5 cases) and avascular necrosis of the femoral epiphysis (8 cases). Group 1 had only four cases of avascular necrosis of the femoral epiphysis.</p><p><strong>Conclusion: </strong>Patients who underwent a DDH operation with a division of the iliopsoas tendon proximally at the pelvic brim regained hip flexion strength earlier and achieved a better grade with fewer complications.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"581-588"},"PeriodicalIF":2.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143033128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}