International Orthopaedics最新文献

{"title":"Intra-wound vancomycin powder is cost-saving in primary total hip and knee arthroplasty.","authors":"Darius L Lameire, Neil Askew, Iqbal Multani, Graeme Hoit, Amir Khoshbin, Leo M Nherera, Amit Atrey","doi":"10.1007/s00264-025-06501-8","DOIUrl":"10.1007/s00264-025-06501-8","url":null,"abstract":"<p><strong>Purpose: </strong>This study seeks to explore whether intra-wound vancomycin powder (IVP) is a cost-effective adjunct to standard of care (SOC) in patients undergoing total joint arthroplasty (TJA) from a US payor perspective.</p><p><strong>Methods: </strong>A decision-analytic model in the form of a decision tree was developed to compare the cost and outcomes of IVP with those of SOC in preventing periprosthetic joint infections (PJI) in TJA patients. The base case analysis assumes a hypothetical practice with an equal volume (50/50) of THA and TKA procedures in both the IVP + SOC and the SOC arm. Cost and clinical effectiveness data were obtained from published literature. Sensitivity and threshold analyses were used to estimate how changing inputs would impact the cost-effectiveness of IVP.</p><p><strong>Results: </strong>Deterministic results found that in the base case model, IVP as an adjunct to SOC generates a cost saving of $260.38/patient. In scenario analysis, where THA and TKA procedures were separated, the estimated cost saving was $241.50/patient and $279.27/patient, respectively. Break-even analysis showed that the cost of IVP per patient would need to be $244.82-$282.59, or the PJI relative risk (RR) be approximately 0.99. Probabilistic analysis found IVP + SOC was cost-saving in 99.26% of the 10,000 iterations in the base case model.</p><p><strong>Conclusion: </strong>Applying local vancomycin as an adjunct to SOC in primary TJA is not just cost effective, but cost-saving in reducing PJIs, saving an average of $260.38/patient. Depending on individual institution/practice infection rates and revision surgery costs, local vancomycin administration for primary TJA should be considered.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"1017-1026"},"PeriodicalIF":2.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663428","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":"Cutibacterium infections after total hip arthroplasty: does surgical approach play a role?","authors":"Rıfat Şahin, T David Luo, Gianluca Campofreda, Mehmet Kıvrak, Thorsten Gehrke, Mustafa Citak","doi":"10.1007/s00264-025-06500-9","DOIUrl":"10.1007/s00264-025-06500-9","url":null,"abstract":"<p><strong>Purpose: </strong>Cutibacterium species, formerly known as Propionibacterium, are gram-positive, anaerobic bacilli increasingly recognized as a cause of periprosthetic joint infection (PJI) following total hip arthroplasty (THA). This study aimed to compare the incidence of Cutibacterium-associated PJI among different surgical approaches for THA.</p><p><strong>Methods: </strong>A retrospective review was conducted on patients treated for Cutibacterium-associated PJI following THA between 2011 and 2021. Patients were categorized based on the surgical approach: direct anterior (DAA), lateral, or posterior. A total of 211 patients met inclusion criteria, comprising 153 men (72.5%) and 58 women (27.5%).</p><p><strong>Results: </strong>Among the 211 cases of Cutibacterium-associated PJI, 102 (48.3%) underwent THA via DAA, 63 (29.9%) via a lateral approach, and 46 (21.8%) via a posterior approach. There were no significant differences between groups in age, sex, laterality, BMI or fistula formation. The incidence of Cutibacterium PJI was significantly higher with DAA compared to the lateral (P < 0.001) and posterior approaches (P < 0.001), while no significant difference was observed between lateral and posterior approaches (P = 0.059). The rate of Cutibacterium-associated PJI has increased since 2016.</p><p><strong>Conclusion: </strong>Nearly half of all Cutibacterium PJIs were associated with the DAA. Surgeons should be aware of this increased risk and implement appropriate preventive measures when performing THA via DAA.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"1101-1106"},"PeriodicalIF":2.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692178","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":"Percutaneous transforaminal endoscopic decompression versus posterior short-segment fusion for treating degenerative lumbar scoliosis with lumbar spinal stenosis: a cohort study with a minimum five year followup.","authors":"He Song, Aobo Wang, Tianyi Wang, Ning Fan, Peng Du, Qichao Wu, Lei Zang, Shuo Yuan","doi":"10.1007/s00264-025-06479-3","DOIUrl":"10.1007/s00264-025-06479-3","url":null,"abstract":"<p><strong>Purpose: </strong>This retrospective cohort study aimed to compare the clinical outcomes of percutaneous transforaminal endoscopic decompression (PTED) with those of posterior lumbar interbody fusion (PLIF) for the treatment of degenerative lumbar scoliosis (DLS) with lumbar spinal stenosis (LSS).</p><p><strong>Methods: </strong>In this study, 143 DLS patients who met the inclusion criteria from January 2016 to March 2019 were retrospectively analyzed and divided into the PTED and PLIF groups. The propensity score matching (PSM) method was used to adjust for imbalanced confounding variables between the groups. The visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were then used to compare the clinical outcomes between the two groups. Furthermore, changes in radiological characteristics and surgical complications were assessed.</p><p><strong>Results: </strong>After PSM, 86 patients were included in the study with a followup duration of at least five years. Postoperative VAS and ODI scores were significantly improved in both groups at all time points compared with preoperative values (p < 0.001). However, the PTED group had higher VAS scores for back pain and ODI scores than the PLIF group at five years postoperatively (p < 0.05). For radiological parameters, the Cobb angle decreased in the PLIF group but increased in the PTED group at the final followup (p < 0.05). A decrease in the adjacent disc height was observed in the PLIF group at the final followup (p < 0.001).</p><p><strong>Conclusion: </strong>Both PTED and PLIF achieved relatively satisfactory outcomes in treating DLS with LSS after a minimum five year followup. However, further studies are required to better determine the characteristics of spinal deformities amenable to each procedure.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"1211-1222"},"PeriodicalIF":2.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597066","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":"Treatment options for persistent lateral femoral cutaneous nerve lesions after total hip arthroplasty via the direct anterior approach: retrospective analysis with clinical assessment.","authors":"Jakob Hax, Louis Leuthard, Selina Nauer, Vincent A Stadelmann, Michael Leunig, Hannes A Rüdiger","doi":"10.1007/s00264-025-06512-5","DOIUrl":"10.1007/s00264-025-06512-5","url":null,"abstract":"<p><strong>Purpose: </strong>The direct anterior approach (DAA) in total hip arthroplasty (THA) has a risk of lateral femoral cutaneous nerve (LFCN) injury. Long-term outcomes and therapeutic options for such injuries are poorly investigated. This study evaluates the impact of iatrogenic LFCN lesions on long-term outcomes and investigates treatments like ultrasound-guided nerve infiltration or neurolysis.</p><p><strong>Methods: </strong>Our institutional database of primary THAs (2014-2022) was searched for patients with iatrogenic LFCN lesions after DAA, confirmed via ultrasound or electroneurography. First, retrospective analysis of the effects of ultrasound-guided nerve infiltration and neurolysis. Second, clinical-radiological assessment of pain, function, incision, and affected skin area. Patient-reported outcomes (OHS, COMI Hip, UCLA) were compared to a matched non-LFCN injury control group.</p><p><strong>Results: </strong>Of 8136 patients, 29 (0.36%) met inclusion criteria, with 22 undergoing ultrasound diagnostics. Eighteen received nerve infiltration (improvement after one (n = 7), two (n = 3) or three (n = 1) infiltrations), and two had neurolysis. After a mean follow-up of 4.95 years, 13 patients were assessed. Common symptoms included hypesthaesia (11), dysesthesia (6), and tingling (3), with a mean affected area of 253cm² ± 64.8. 24-months questionnaires for the LFCN group (OHS 39.2 ± 8.6, COMI Hip 2.4 ± 2.7, UCLA 6.5 ± 1.6) were worse than the control group (OHS 46.2 ± 2.3, COMI Hip 0.6 ± 0.8, UCLA 7.2 ± 1.5), though differences were not statistically significant.</p><p><strong>Conclusion: </strong>Instrumentally proven LFCN lesions after DAA THA are rare but lead to worse long-term outcomes. Ultrasound-guided nerve infiltration shows favorable results for symptom management.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"1107-1117"},"PeriodicalIF":2.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12003511/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719296","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":"Letter to editor on \"Hydrodilatation: a comparison between diabetics and non-diabetics with adhesive capsulitis\".","authors":"Xiangji Liu, Hao Wu","doi":"10.1007/s00264-025-06483-7","DOIUrl":"10.1007/s00264-025-06483-7","url":null,"abstract":"","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"1259-1260"},"PeriodicalIF":2.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597063","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":"Wear patterns of compartments in varus knee osteoarthritis among an asian population: A cross-sectional study with radiographic and intraoperative analysis.","authors":"Kwong Weng Loh, Khairul Anwar Ayob, Fahrudin Che-Hamzah, Azhar Mahmood Merican, Shahrul Hisham Sulaiman, Joo Ann Lee, Sei Kern Tiew","doi":"10.1007/s00264-025-06549-6","DOIUrl":"https://doi.org/10.1007/s00264-025-06549-6","url":null,"abstract":"<p><strong>Purpose: </strong>Osteoarthritis (OA) of the knee significantly impairs mobility and quality of life. Knee arthroplasties have dramatically improved patient outcomes, allowing individuals to regain independence. Unicompartmental knee arthroplasty (UKA) is a surgical option for patients with isolated single-compartment disease, offering the benefits of reduced surgical time and minimized surgical risks. However, the appropriateness of UKA is often underestimated. Therefore, this study aims to determine the proportion of patients with varus knee OA who are suitable candidates for UKA.</p><p><strong>Methods: </strong>A prospective cross-sectional study was conducted on 207 knees undergoing knee arthroplasty surgery for varus knee OA. Pre-operative radiographs were graded using both the Kellgren-Lawrence (KL) and modified Keyes classifications. Intra-operatively, the knees were inspected, and photographs of the tibial cut were reviewed by a neutral observer. The appropriateness of UKA was determined based on these evaluations.</p><p><strong>Results: </strong>The lateral compartment was not involved in 169 (81.6%) knees. Only six (2.9%) knees had a KL grade 4 involvement of the lateral compartment. After excluding patients with isolated medial compartment OA, no radiographic evidence of lateral and patellofemoral involvement, and a grade 1 on the modified Keyes classification, we found that 79 (38.2%) patients were suitable candidates for a medial UKA. Intraoperatively, 84 (40.6%) patients had a functional ACL with no observable wear in the lateral and patellofemoral joint (PFJ) compartments.</p><p><strong>Conclusion: </strong>In patients with varus knee OA, a significant proportion have wear patterns suitable for management with a UKA. Identifying these patients requires targeted examinations and specific radiographic views.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143983118","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":"Alterations in coagulation profile of patients with periprosthetic joint infections.","authors":"Augusto Carlos Maciel Saraiva, Alan de Paula Mozella, Hugo Alexandre de Araujo Barros Cobra, Osamu de Sandes Kimura, João Antonio Matheus Guimarães, Helton Defino, Ana Carolina Leal","doi":"10.1007/s00264-025-06537-w","DOIUrl":"10.1007/s00264-025-06537-w","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to evaluate changes in the coagulation profile of patients with knee periprosthetic infections (PJI) and determine its diagnostic value in this complication.</p><p><strong>Methods: </strong>A prospective study was conducted with 112 patients who underwent revision surgery for total knee arthroplasty in a single tertiary hospital between January 2021 and December 2022.</p><p><strong>Results: </strong>51 patients were diagnosed with PJI. D-dimer (p = 0.001), fibrinogen (p = 0.0007), platelets (0.01), and international normalized ratio (p = 0.01) were significantly higher in patients with PJI.</p><p><strong>Conclusions: </strong>Patients with PJI display altered coagulation profile. The evaluation of coagulation-related markers has limited value for diagnosing PJI. Further studies are needed to understand the impact of such alterations on patients' outcomes.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989860","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":"Response to the letter regarding the article: \"Comprehensive comparison between conservative therapy and surgical management for completely displaced and comminuted midshaft clavicle fractures\".","authors":"Xiao Han, Yufu Zhang, Xigong Zhang, Jie Tan","doi":"10.1007/s00264-025-06536-x","DOIUrl":"https://doi.org/10.1007/s00264-025-06536-x","url":null,"abstract":"","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995911","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":"Deep learning-assisted detection of meniscus and anterior cruciate ligament combined tears in adult knee magnetic resonance imaging: a crossover study with arthroscopy correlation.","authors":"Julien Behr, Christophe Nich, Gaspard D'Assignies, Catalin Zavastin, Pascal Zille, Guillaume Herpe, Ramy Triki, Charles Grob, Nicolas Pujol","doi":"10.1007/s00264-025-06531-2","DOIUrl":"https://doi.org/10.1007/s00264-025-06531-2","url":null,"abstract":"<p><strong>Aim: </strong>We aimed to compare the diagnostic performance of physicians in the detection of arthroscopically confirmed meniscus and anterior cruciate ligament (ACL) tears on knee magnetic resonance imaging (MRI), with and without assistance from a deep learning (DL) model.</p><p><strong>Methods: </strong>We obtained preoperative MR images from 88 knees of patients who underwent arthroscopic meniscal repair, with or without ACL reconstruction. Ninety-eight MR images of knees without signs of meniscus or ACL tears were obtained from a publicly available database after matching on age and ACL status (normal or torn), resulting in a global dataset of 186 MRI examinations. The Keros^® (Incepto, Paris) DL algorithm, previously trained for the detection and characterization of meniscus and ACL tears, was used for MRI assessment. Magnetic resonance images were individually, and blindly annotated by three physicians and the DL algorithm. After three weeks, the three human raters repeated image assessment with model assistance, performed in a different order.</p><p><strong>Results: </strong>The Keros^® algorithm achieved an area under the curve (AUC) of 0.96 (95% CI 0.93, 0.99), 0.91 (95% CI 0.85, 0.96), and 0.99 (95% CI 0.98, 0.997) in the detection of medial meniscus, lateral meniscus and ACL tears, respectively. With model assistance, physicians achieved higher sensitivity (91% vs. 83%, p = 0.04) and similar specificity (91% vs. 87%, p = 0.09) in the detection of medial meniscus tears. Regarding lateral meniscus tears, sensitivity and specificity were similar with/without model assistance. Regarding ACL tears, physicians achieved higher specificity when assisted by the algorithm (70% vs. 51%, p = 0.01) but similar sensitivity with/without model assistance (93% vs. 96%, p = 0.13).</p><p><strong>Conclusions: </strong>The current model consistently helped physicians in the detection of medial meniscus and ACL tears, notably when they were combined.</p><p><strong>Level of evidence: </strong>Diagnostic study, Level III.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143980692","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 analysis of anterior lumbar interbody fusion and transforaminal lumbar interbody fusion in clinical outcomes: ALIF associated with lower rates of adjacent segment degeneration (ASD) in a long-term follow-up study.","authors":"Peipei Huang, Bin Ye, Fang Xie, Jie Zhou, Zhijun Tan, Zhuojing Luo, Xueyu Hu","doi":"10.1007/s00264-025-06546-9","DOIUrl":"https://doi.org/10.1007/s00264-025-06546-9","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the long-term efficacy of anterior lumbar interbody fusion (ALIF) and posterior transforaminal lumbar interbody fusion (TLIF) in treating lumbar degenerative diseases.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 57 patients with lumbar degenerative diseases who underwent either ALIF or TLIF from March 2003 to October 2007. Patients were divided into an ALIF group (n = 27) and a TLIF group (n = 30). Pain was evaluated using the visual analogue scale (VAS), and the Oswestry Disability Index (ODI) was used to assess clinical outcomes. Radiographic adjacent segment degeneration (rASD) was evaluated using the Modified Pfirrmann Scale. Three-dimensional CT was used to assess the fusion rate at the last follow-up.</p><p><strong>Results: </strong>Follow-up duration ranged from 58 to 120 months, with an average of 90.6 months. No significant difference was observed in VAS and ODI scores between the two groups (P > 0.05). However, significant differences were noted before and after the operation (P < 0.05). The intervertebral disc height (IDH) and lumbar lordosis (LL) increased after the operation and during follow-ups. The IDH and LL in the ALIF group were significantly higher than those in the TLIF group both postoperatively and at follow-ups (P < 0.05). At the last follow-up, the incidence of rASD in the ALIF group was significantly lower than in the TLIF group (P < 0.05).</p><p><strong>Conclusions: </strong>Both ALIF and TLIF provide satisfactory long-term outcomes for lumbar degenerative diseases. ALIF more effectively restores and maintains lumbar intervertebral height and lumbar lordosis, potentially reducing the incidence of adjacent segment degeneration.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144002609","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}