International Orthopaedics最新文献

{"title":"Roman surgery in Armorica.","authors":"Thomas Daoulas, Muriel Pardon-Labonnelie","doi":"10.1007/s00264-025-06550-z","DOIUrl":"10.1007/s00264-025-06550-z","url":null,"abstract":"<p><strong>Purpose: </strong>To identify evidence of surgical practice in Armorica during the Roman period.</p><p><strong>Methods: </strong>Various sources were examined to search for potential traces of surgical activity during the Roman era. The objective was to identify archaeological artifacts that could be associated with ancient surgical instruments. Once identified, the objects of interest were examined in different archaeological repositories in Brittany by an independent observer.</p><p><strong>Results: </strong>Between March 2021 and December 2022, 995 excavation reports were analyzed. Twenty-one documents mentioned a potentially surgical object. One of the analyzed artifacts was referenced in an excavation report containing the keyword \"scalpel,\" originating from the site of Ploufragan (22240, Côtes d'Armor, Brittany, France). Following an in-depth investigation, the artifact was successfully retrieved. The object, measuring 14 cm in length, was made of oxidized bronze. Its tapered handle had an octagonal cross-section. At one end, the handle broadened and flattened into a pointed spatula. The opposite end featured a slit containing an iron component, which was heavily corroded. According to Ralph Jackson, former curator of the British Museum and a specialist in Roman medical instrumentation, this scalpel handle is most likely from the Roman period, dating back to the first to third century CE. The presence of this scalpel suggests that relatively advanced surgical practices were performed by Armorican practitioners in Antiquity. This study provides evidence that operative medicine, as conceptualized in the Greco-Roman tradition, extended to Armorica during Antiquity.</p><p><strong>Conclusion: </strong>While the study of \"beautiful objects\" and monumental remains gives a biased image of a given society, the analysis of everyday artifacts can yield significant insights into the habits and routines of a population. This principle also applies to the study of surgical practice in Antiquity. The examination of small objects provides crucial information on the dissemination of medical and surgical knowledge during this period. This work shows the extent to which the history of surgery cannot be conceived without interdisciplinarity.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"1747-1752"},"PeriodicalIF":2.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990168","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":"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":"1633-1643"},"PeriodicalIF":2.0,"publicationDate":"2025-07-01","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}

{"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":"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":"1645-1653"},"PeriodicalIF":2.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12178963/pdf/","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":"OA","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":"10.1007/s00264-025-06538-9","url":null,"abstract":"","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"1759-1760"},"PeriodicalIF":2.0,"publicationDate":"2025-07-01","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":"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":"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":"1579-1585"},"PeriodicalIF":2.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12179003/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vancomycin-soaking of the graft significantly reduces the incidence of septic arthritis following anterior cruciate ligament reconstruction: comparison of cohorts from the Single-Centre database.","authors":"Tomislav Kottek, Barbara Kunovac, Goran Vrgoč, Alan Ivković, Saša Janković","doi":"10.1007/s00264-025-06594-1","DOIUrl":"https://doi.org/10.1007/s00264-025-06594-1","url":null,"abstract":"<p><strong>Purpose: </strong>Presoaking of hamstrings autograft in vancomycin solution has been associated with significant reduction of post-operative septic arthritis rate after anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to evaluate this effect by comparison of cohorts from the single-centre database.</p><p><strong>Methods: </strong>In a period between January 2018 and November 2023, 1329 patients underwent ACL reconstruction surgery at our institution, with a newly introduced technique of soaking the hamstrings autografts in a 5-mg/ml vancomycin solution. Data was retrospectively analysed to identify post-operative knee septic arthritis rate amongst this group. Results were compared with the results from our previous study, which included 1891 patients from January 2007 to December 2017, when ACL reconstruction surgery was made at our institution without soaking the autografts in vancomycin solution.</p><p><strong>Results: </strong>Results showed that one (0,07%) out of 1329 patients who underwent ACL reconstruction with vancomycin-soaking of the graft developed knee joint infection after the surgery, while using the old method the infection rate was 1,4%. Statistical analysis showed that there is a significant difference in the infection rate between two groups (OR, 0,05 [95% CI, 0.0073-0.3982]; p < 0.01).</p><p><strong>Conclusion: </strong>Presoaking of the hamstrings graft for ACL reconstruction in 5 mg/ml vancomycin solution as an addition to standard pre-operative intravenous antibiotic prophylaxis is associated with significant reduction of post-operative infection rate.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527948","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":"Variation in hip replacement rates and surgical workforce across Nordic European countries.","authors":"Ioannis Christofides, Job N Doornberg, Cees C Verheyen","doi":"10.1007/s00264-025-06587-0","DOIUrl":"https://doi.org/10.1007/s00264-025-06587-0","url":null,"abstract":"","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527949","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":"Neurologic and psychiatric disorders as risk factors following hip arthroplasty: results from the German arthroplasty registry.","authors":"Nele Wagener, Alexander Grimberg, Yinan Wu, Sebastian Hardt, Carsten Perka","doi":"10.1007/s00264-025-06593-2","DOIUrl":"https://doi.org/10.1007/s00264-025-06593-2","url":null,"abstract":"<p><strong>Purpose: </strong>We investigated whether neurologic and psychiatric disorders (ICD-10 F00-F99, G00-G99) increase postoperative complications and mortality after hip arthroplasty and identified subgroups with distinct complication patterns, including dislocations, loosening, fractures, and elevated mortality.</p><p><strong>Methods: </strong>We analyzed 190,340 primary cementless hip arthroplasties from the German Arthroplasty Registry (2012-2024). Patients with relevant diagnoses were compared to matched controls (1:1 Mahalanobis distance) across subgroups F00-F99 and G00-G99, adjusting for age, sex, BMI, Elixhauser Index, and arthroplasty type. Primary endpoints were implant survival (time to revision) and all-cause mortality over up to eight years. Revision causes including periprosthetic fracture, infection, dislocation, loosening, and others were systematically recorded.</p><p><strong>Results: </strong>Most subgroups showed significantly higher revision rates (p < 0.0001 for F00-F09, F10-F19, F30-F39, G20-G26, G40-G47, G60-G64). Mortality was also significantly higher (p < 0.0001 for F00-F09, F10-F19, F30-F39). Schizophrenia (F20-F29) increased revision (p < 0.0001) and mortality (p < 0.0001). Organic mental disorders (F00-F09) showed markedly elevated revision and mortality rates, with more frequent dislocations and fractures (p < 0.0001). Extrapyramidal disorders (G20-G26) mainly increased dislocation risk (p = 0.00032), while degenerative diseases (G30-G32) raised mortality (p < 0.0001). Episodic/paroxysmal disorders (G40-G47) increased loosening (p = 0.0041) and revision (p < 0.0001). Polyneuropathies (G60-G64) were linked to joint instability and dislocations (p = 0.0008).</p><p><strong>Conclusion: </strong>Neurologic and psychiatric disorders significantly elevate revision and mortality risks following hip arthroplasty. Subgroup-specific vulnerabilities, dislocations/fractures (F00-F09), high complication and mortality (F10-F19), and joint instability (G60-G64), highlight the need for individualized perioperative strategies and close postoperative monitoring to improve outcomes.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144496652","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":"Nonoperative versus surgical treatment of displaced midshaft clavicle fractures in adolescents: a systematic review and meta-analysis of comparative studies.","authors":"María Galán-Olleros, Melisa L Stitzman-Wengrowicz, Sergio Martínez-Álvarez, Matilde Molina-Corbacho, Paloma Manzarbeitia-Arroba, María Del Carmen Pulido García, Yaiza Lopiz","doi":"10.1007/s00264-025-06589-y","DOIUrl":"https://doi.org/10.1007/s00264-025-06589-y","url":null,"abstract":"","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484372","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":"What is the influence of tibial component posterior slope on clinical and radiographic outcomes following cemented medial unicompartmental fixed-bearing knee arthroplasty? A retrospective study with a minimum follow-up of five years.","authors":"Maksym Polt, Titus Thut, David Alexander Graf, Naeder Helmy, Octavian Andronic","doi":"10.1007/s00264-025-06579-0","DOIUrl":"https://doi.org/10.1007/s00264-025-06579-0","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate how changing the native posterior tibial slope (PTS) through implantation of a cemented medial unicompartmental knee arthroplasty (UKA) impacts clinical and radiographic outcomes, specifically whether it correlates with the occurrence of tibial periprosthetic radiolucency or tibial aseptic loosening (AL).</p><p><strong>Methods: </strong>This retrospective study analyzed 63 patients with cemented medial UKAs with a minimum follow-up of five years. Patient-reported outcomes (PROMs) included the Oxford Knee Score (OKS). Radiographic parameters assessed were: PTS, mechanical axis, prosthetic joint space height, tibial component obliquity, intraprosthetic divergence, and tibial periprosthetic radiolucency. Partial Pearson correlation and multiple linear regression analyses were used to evaluate the relationship between tibial periprosthetic radiolucency and demographic or radiographic parameters.</p><p><strong>Results: </strong>Of 63 patients (mean age 68.9 ± 7.9 years, follow-up 62.5 ± 8.8 months), 5 knees (7.9%) demonstrated tibial periprosthetic radiolucency ≥ 2 mm. The mean postoperative PTS change was 3.8 ± 2.6°, mechanical axis change: 2.5 ± 1.8°, prosthetic joint space height: 9.2 ± 3.1 mm, tibial component obliquity: 2.5° ± 3°, and intraprosthetic divergence angle: 5° ± 4°. OKS averaged 43.9 (range 22-48), with a mean knee flexion of 123.4 ± 6.8°. Statistical analysis showed no significant associations between tibial periprosthetic radiolucency and demographics, radiographic parameters, or PROMs. Changes in PTS did not correlate with a range of motion (ROM), PROMs, or radiolucency.</p><p><strong>Conclusion: </strong>In our cohort, the deviation from native PTS following implantation of the cemented tibial component did not show a significant correlation with tibial periprosthetic radiolucency, PROMs, or ROM at mid-term follow-up.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484375","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}