International Orthopaedics最新文献

{"title":"Letter to the editor on \"Long-term implant survival after debridement, antibiotics and implant retention (DAIR) for acute prosthetic joint infections: is it a viable option beyond four weeks after index arthroplasty?\"","authors":"Pei-Yu Chen, Chia-Hao Hsu","doi":"10.1007/s00264-025-06547-8","DOIUrl":"https://doi.org/10.1007/s00264-025-06547-8","url":null,"abstract":"","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005080","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":"Lateral closing wedge high tibial osteotomy procedure for the treatment of medial knee osteoarthritis: eleven years mean follow up analysis.","authors":"Giacomo Dal Fabbro, Giovanni Balboni, Stefano Di Paolo, Giorgio Varchetta, Alberto Grassi, Giulio Maria Marcheggiani Muccioli, Stefano Zaffagnini","doi":"10.1007/s00264-025-06525-0","DOIUrl":"https://doi.org/10.1007/s00264-025-06525-0","url":null,"abstract":"<p><strong>Purpose: </strong>To assess long term survivorship, patient reported (PROMs) and radiological outcomes, and rate of adverse events and hardware removal after lateral closing wedge high tibial osteotomy (CWHTO) for the treatment of medial knee osteoarthritis (OA) and varus malalignment.</p><p><strong>Methods: </strong>Retrospective analysis of patients who underwent isolated CWHTO for medial OA in varus knee between 2009 and 2019 at the same institution was performed. Surgical failure was defined as conversion to total knee arthroplasty (TKA) or need for osteotomy revision procedure for varus recurrence, while clinical failure was defined by a Lysholm score under 65 points. Lysholm score, Visual Analogue Scale for pain (VAS), and patients' satisfaction with the treatment were evaluated. Radiographic parameters assessed included OA degree with the Kellgren Lawrence scale (KL), hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), joint line convergence angle (JLCA), and posterior tibial slope (PTS). Adverse events and rate of hardware removal procedures were recorded through follow up visits and clinical records. Survival analysis was conducted through Kaplan-Meier method with surgical and clinical failure as endpoints.</p><p><strong>Results: </strong>70 knees (mean age at surgery 43.3 years) were included in the survivorship analysis at a mean follow up of 11.6 ± 3.4 years. A failure rate of 12.85% (9/70) was recorded during the follow up period, with a survivorship of 92% and 75% at ten and 15 years of follow up, respectively. Mean Lysholm score and VAS at follow up were above the PASS threshold reported in literature. The 75.7% of patients were satisfied with the treatment. Radiological follow up indicated a residual mechanical varus of 2.1°, a decrease of 0.7° of intra articular deformity (JLCA), no change in PTS nor in KL index. The adverse events rate recorded was 5.7% (4/70). In nine knees (14.7%) among the patients survived from surgical failure a subsequent hardware removal procedure was performed.</p><p><strong>Conclusion: </strong>CWHTO represents a safe procedure, which resulted in high survivorship (92% and 75% at ten and 15 years follow up, respectively), with satisfactory PROMs and radiological outcomes at long term follow up in patients affected by medial OA and varus malalignment.</p><p><strong>Level of evidence: </strong>5, Case Series.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017439","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":"Better radiological outcomes but equal clinical function of a novel knee arthroplasty robot system: a prospective randomized controlled trial.","authors":"Xiao Geng, Ziyang Dong, Jiazheng Chen, Mengqiang Tian, Yongqing Wang, Yiming Ren, Zhihui Zhao, Yipu Zhang, Xinguang Wang, Cheng Wang, Zijian Li, Hua Tian","doi":"10.1007/s00264-025-06523-2","DOIUrl":"https://doi.org/10.1007/s00264-025-06523-2","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate the early clinical and radiological outcomes of robot assisted total knee arthroplasty, and to determine the efficiency and safety of its bone resection and implant positioning of the novel robot system.</p><p><strong>Methods: </strong>144 patients who underwent primary TKA were enrolled in this prospective, multicenter RCT conducted in three hospitals. five patients were lost to follow-up at six weeks after surgery. Therefore, 139 patients (73 in the RA TKA group and 66 in the CI TKA group) remained in the final analysis. The primary outcome was the rate of patients whose postoperative alignment was less than 3° deviated from the planned evaluated by full-length weight-bearing X-rays of the lower limb at 12 weeks postoperatively. Secondary outcomes included coronal and sagittal alignment of the components, operation times, blood loss, 12-week range of motion(ROM), 12-week postoperative functional outcomes and satisfaction evaluated by the American Knee Society Score (KSS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and adverse events (AEs).</p><p><strong>Results: </strong>At 12 weeks postoperatively, we found the rate of radiographic inliers was significantly higher in the RA TKA group (90.4% vs. 59.1%; p < 0.05). The difference between planned and postoperative frontal femoral component (FFC) angle, frontal tibia component (FTC) angle and lateral femoral component (LFC) angle are significantly smaller in the RA TKA group (p < 0.05). The operation time was significantly longer in the RA TKA group than in the CI TKA group (133.01 vs. 92.33 min; p < 0.05). There was no significant difference in blood loss, 12-week ROM, 12-week postoperative functional outcomes and satisfaction evaluated by KSS and WOMAC scores. There were no AEs or SAEs that were determined to be \"related\" to the robotic system.</p><p><strong>Conclusion: </strong>The novel robot assisted TKA is safe and more precise in bone resection and implant positioning as demonstrated in this trial.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989445","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":"Functional and radiographic outcomes of talar osteochondral lesions repaired with a combination of autologous bone graft, cell-free hyaluronic acid-based scaffold, bone marrow aspirate concentrate (BMAC) and fibrin glue.","authors":"Nurettin Mantı, Alişan Daylak, Yasin Erdoğan, Esra Çıvgın, Umut Öktem, Mehmet Orçun Akkurt","doi":"10.1007/s00264-025-06542-z","DOIUrl":"https://doi.org/10.1007/s00264-025-06542-z","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the efficacy of acellular hyaluronic acid matrix scaffold, BMAC, and autologous bone graft in providing biomechanical support and optimal microenvironment for OLTs treatment.</p><p><strong>Methods: </strong>A retrospective analysis of 81 ankles from 80 patients treated between 2018 and 2021 was conducted. The inclusion criteria included patients who underwent surgery for osteochondral lesions of the talus (OLTs) and received acellular hyaluronic acid matrix scaffold, bone marrow aspirate concentrate (BMAC) fibrin glue, and autologous bone graft. The exclusion criteria included prior ankle surgery, concurrent lateral instability surgery, malignancy, metabolic bone disease, or related medication. Clinical outcomes were assessed with FAOS, VAS, and SF-36 at a minimum of two years postoperatively. MRI findings were evaluated preoperatively, at six months, and 24 months postoperatively via MOCART. Subgroups were formed on the basis of age (< 45 vs. ≥45), BMI, and full weight bearing mobilization (FWBM) timing (4, 5, 6, or > 6 weeks).</p><p><strong>Results: </strong>Postoperative FAOS and SF-36 scores significantly improved (p = 0.000), whereas VAS scores decreased (p = 0.001). Early FWBM (4th week) was associated with superior FAOS, SF-36, and MOCART scores at 24 months (p = 0.039). Underweight and healthy individuals exhibited lower VAS (p = 0.001) and higher SF-36 scores (p = 0.000) at three months, alongside higher MOCART scores at 24 months compared to overweight patients (p = 0.039).</p><p><strong>Conclusions: </strong>This study highlights the importance of a tailored approach to optimize the microenvironment and biomechanical support in OLTs treatment. Further research is required to refine therapeutic strategies.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998219","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":"Letter to the editor regarding the article: Intra-wound vancomycin powder is cost-saving in primary total hip and knee arthroplasty.","authors":"Junkai Feng, Yifan Wang","doi":"10.1007/s00264-025-06535-y","DOIUrl":"https://doi.org/10.1007/s00264-025-06535-y","url":null,"abstract":"","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990076","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":"Letter to the editor regarding the article \"treatment options for persistent lateral femoral cutaneous nerve lesions after total hip arthroplasty via the direct anterior approach: retrospective analysis with clinical assessment\".","authors":"Hongbin Wang, Xutao Fan, Jing Xu","doi":"10.1007/s00264-025-06543-y","DOIUrl":"https://doi.org/10.1007/s00264-025-06543-y","url":null,"abstract":"","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995952","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":"Letter to the editor on \"The role of cannabis on total hip and knee surgeries outcomes: a systematic review and meta-analysis\".","authors":"Yika Mou, Zhizhen Lv, Ruijie Ma","doi":"10.1007/s00264-025-06538-9","DOIUrl":"https://doi.org/10.1007/s00264-025-06538-9","url":null,"abstract":"","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019847","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":"Isolated acetabular cup revision in Metal-on-Metal total hip arthroplasty: a low-complication strategy feasible in only half of cases.","authors":"Cristobal Duda, Pierre-Alban Bouché, Morgan Gauthier, Amanda Gonzalez, Matthieu Zingg, Didier Hannouche","doi":"10.1007/s00264-025-06534-z","DOIUrl":"https://doi.org/10.1007/s00264-025-06534-z","url":null,"abstract":"<p><strong>Purpose: </strong>There is still a debate regarding the removal of the femoral stem due to the risk of trunnion. To answer this question, we conducted a study to compare long terms outcomes of isolated acetabular to total revision of MoM THA using an institutional arthroplasty registry.</p><p><strong>Methods: </strong>From 1996 to 2019, 150 patients (12.5%) of the 1202 revision THAs (rTHA) recorded in Geneva Arthroplasty Registry (GAR) underwent a revision of a MoM THA. After matching the two groups,126 patients were finally included: 63 in each group. The mean age was 64.4 (SD 11.6) years, 48.4% (61/126) were women with a mean BMI of 27.2 (SD 5.5) Kg/m2.</p><p><strong>Results: </strong>The overall survival rate was 88.1% [79.9-97.2%] at ten years. 10-year survival rate was 93.5% [86.2-100.0%] after isolated acetabular rTHA and 79.5% [61.7-100.0%] after total rTHA (p = 0.16). Regarding Hip Harris score and Merle d'Aubigne score, no difference at last follow-up was observed between the two groups (respectively: p = 0.39; p = 0.33). Regarding the chrome, cobalt, and nickel level reduction, no difference was observed between the two groups (respectively, p = 0.38, 0.81 and 0.97).</p><p><strong>Conclusion: </strong>No difference was observed between isolated acetabular and total revision of MoM THAs regarding survival rate and ions levels at long term. It seems advisable to perform an isolated acetabular revision of a MoM THA when it is indicated.</p><p><strong>Levels of evidence: </strong>Level III, case control studies.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017625","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":"The cost of implant waste in trauma orthopaedic surgery and sustainability considerations: an observational study.","authors":"Rasi Mizori, Muhayman Sadiq, Yasser Al Omran, Charmilie Chandrakumar, Thomas Lewis, Omar Musbahi, Karthik Karuppaiah","doi":"10.1007/s00264-025-06532-1","DOIUrl":"https://doi.org/10.1007/s00264-025-06532-1","url":null,"abstract":"<p><strong>Purpose: </strong>Implant wastage in trauma and orthopaedic (T&O) surgery remains an under-reported yet significant issue, contributing to rising healthcare costs and environmental concerns. With increasing surgical demand driven by an ageing population and the growing prevalence of conditions like osteoporosis, this study aimed to quantify implant wastage in T&O procedures at a Level 1 Major Trauma Centre in London, assessing both its frequency and financial impact.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on all weekday T&O procedures performed between 1st December 2023 and 31st January 2024. Two of the authors identified wasted implants using intraoperative implant logbooks, and cross-referencing implant stickers with post-operative radiographs. Data pertaining to patient demographics, procedure types, surgical sites, and implant usage were collected. Cost analysis was performed using procurement data to determine the financial impact of implant wastage.</p><p><strong>Results: </strong>Among 184 procedures analysed, 131 (71.2%) used implants, with wastage observed in 108 (82.4%) cases. A total of 141 implants were wasted, with screws accounting for 92.9% (n = 131) of wasted implants. Locking screws were the most frequently discarded (n = 65; 46.1%). Across ORIF and intramedullary nailing procedures, an overall screw wastage rate of 20% (17-31%) was observed with 2.4 screws wasted per trauma procedure. The financial cost of implant wastage over the 44-day study period amounted to approximately £335 per day and £136 per case.</p><p><strong>Conclusion: </strong>This study highlights the substantial economic burden associated with implant wastage in T&O surgery, with screws, particularly locking screws, being the primary contributors. Targeted interventions, including improved preoperative planning, precision-based implant selection, and enhanced intraoperative decision-making, are essential to reducing waste and improving cost-efficiency and sustainability in surgical practices. Further research should explore the broader economic and environmental impact of implant wastage, incorporating factors such as operative time and carbon footprint to develop comprehensive waste-reduction strategies.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023878","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":"Is operative revision associated with favourable clinical outcomes in arthrofibrosis following total hip arthroplasty (THA)? A retrospective, single-centre data analysis of forty two cases.","authors":"Christian Lausmann, Navid Memarnia, Jochen Salber, Amir Sandiford, Mustafa Citak, Thorsten Gehrke, Philip Linke","doi":"10.1007/s00264-025-06533-0","DOIUrl":"https://doi.org/10.1007/s00264-025-06533-0","url":null,"abstract":"<p><strong>Purpose: </strong>There is a paucity of clinical studies examining outcomes following surgical revision in cases of histologically confirmed arthrofibrosis after total hip arthroplasty (THA). Consequently, the aim of this study is to present the clinical outcomes and to identify risk factors for poor clinical and functional outcome following surgical intervention for histologically confirmed arthrofibrosis following THA.</p><p><strong>Methods: </strong>This study included 51 patients (51 hips) with histologically confirmed arthrofibrosis of the hip based on the synovial-like interface membrane (SLIM) criteria. These were selected from 7983 revision THA cases performed during the study period After exclusion criteria were applied, 42 cases (59.5% women) with an average age of 63.6 years were included. The mean duration of follow up was 70 months (range 30-122 months). Of these, 73.8% underwent index surgery after primary THA implantation. The primary indication for revision surgery was predominantly the clinical suspicion of arthrofibrosis (n = 35). The Harris Hip Score (HHS) and the EQ-5D-3 L scores were calculated for all cases at the time of follow-up. For the risk analysis of a poor clinical outcome, two groups were divided according to the Harris Hip Score. The group with a poor clinical outcome was defined as a HHS < 55.</p><p><strong>Results: </strong>Open arthrolysis was performed in all cases with a modular component being replaced in 73.8% of cases (n = 31) and only two cases requiring additional revision of the femoral and acetabular components due to aseptic loosening.The mean pre op Harris Hip Score (HHS) was 53.2 before revision surgery. This increased to 65.7 post op (p < 0.001). Only 34.1% of patients achieved the minimum clinical significance difference (MCID) of 18 HHS points after surgical revision. The EQ-5D Visual Analogue Scale (VAS) score and the Time Trade-Off (TTO) score averaged 0.226 (SD 0.245) and 0.221 (SD 0.37). Complications occurred in seven cases (16.7%,), with dislocation in 2 cases and persistent AF symptoms in 3 cases. Six cases required further revision surgery (14.3%). In three cases, a further open arthrolysis was performed due to persistent symptoms. Increased BMI (30.1 vs. 26.7 BMI, p < 0.05) or higher body weight (88.4 kg vs. 78.7 kg, p = 0.086), smoking and a lower preoperative HHS (p = 0.022) were identified as risk factors for a poor clinical outcome, defined as HHS < 55.</p><p><strong>Conclusion: </strong>Results of this study suggest that mid-term clinical results following surgical intervention for arthrofibrosis following THA show a moderate to poor postoperative outcome with an acceptable complication rate. Risk factors for a poor outcome such as increased weight, BMI or smoking should be considered and critically assessed preoperatively.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995792","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}