Journal of Orthopaedic Surgery and Research最新文献

{"title":"Correction: Mir-381-3p aggravates ovariectomy-induced osteoporosis by inhibiting osteogenic differentiation through targeting KLF5/Wnt/βcatenin signaling pathway.","authors":"Yingwei Zhao, Jingsong Liu, Yubo Zhang, Min Liang, Rui Li, Yindong Song, Yansong Wang","doi":"10.1186/s13018-024-05185-x","DOIUrl":"10.1186/s13018-024-05185-x","url":null,"abstract":"","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"19 1","pages":"702"},"PeriodicalIF":2.8,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11523997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546043","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":"Predictors for 1-year mortality in geriatric patients following fragile intertrochanteric fracture surgery.","authors":"Xiuguo Han, Liang Han, Fenglong Chu, Baorui Liu, Fuqiang Song, Dailiang Jia, Haibin Wang","doi":"10.1186/s13018-024-05219-4","DOIUrl":"10.1186/s13018-024-05219-4","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the risk factors influencing 1-year mortality after intramedullary nail fixation for fragile intertrochanteric fracture in elderly individuals.</p><p><strong>Methods: </strong>The medical records of 622 consecutive elderly patients (aged ≥ 65 years) with fragile intertrochanteric fractures treated with proximal femoral nail anti-rotation (PFNA) and followed-up were retrospectively analyzed. The patients were divided into death and survival groups according to their survival status within 1 year after surgery, and the differences in age, sex, region of residence, tobacco use, alcohol use, body mass index (BMI), comorbidities (hypertension, diabetes mellitus, coronary heart disease, stroke, dementia, chronic obstructive pulmonary disease, pneumonia), preoperative hemoglobin, preoperative albumin, deep vein thrombosis, fracture type (AO classification), injury-to-surgery time, American Society of Anesthesiologists (ASA) score, anesthesia modality, duration of surgery, intraoperative blood loss, and blood transfusion were compared. The Kaplan-Meier method was used for univariate analysis to screen for statistically significant differences between the two groups, and the data were entered into the Cox proportional hazards model for multivariate analysis to determine independent risk factors affecting 1-year postoperative mortality. For subgroup analysis, we explored the varying effects of hypoproteinemia and being underweight in patients of different genders, as well as the effects of different age ranges, different injury-to-surgery times, and different blood transfusion volumes on 1-year postoperative mortality.</p><p><strong>Results: </strong>The mortality rates at 1, 3, and 6 months, and 1 year after surgery were 3.9%, 7.2%, 10.1%, and 15.3%, respectively. Univariate analysis showed that advanced age, male sex, tobacco use, underweight (BMI < 18.5), coronary heart disease, stroke, dementia, pneumonia, number of comorbidities ≥ 3, hypoproteinemia and injury-to-surgery time ≤ 2 days were associated with the 1-year postoperative survival status (P < 0.1). Multivariate analysis revealed that advanced age, male sex, dementia, number of comorbidities ≥ 3, hypoalbuminemia, and being underweight were independent risk factors for 1-year postoperative mortality. Subgroup analysis showed that being underweight was associated with 1-year postoperative mortality only in male patients but not in female patients, whereas hypoproteinemia was associated with 1-year postoperative mortality in both male and female patients. Furthermore, an injury-to-surgery time of less than 2 days improved patient survival, and patients more than 80 years old showed an elevated risk of postoperative mortality.</p><p><strong>Conclusions: </strong>Preoperative health status is a critical predictor of postoperative outcomes in elderly patients with fragile intertrochanteric fractures. Priority care should be given to the patients who are e","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"19 1","pages":"701"},"PeriodicalIF":2.8,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11523668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546044","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":"Effect of hip abductors training on pelvic drop and knee valgus in runners with medial tibial stress syndrome: a randomized controlled trial.","authors":"Shreen Ahmed Lashien, Ahmed Omar Abdelnaeem, Ebtessam Fawzy Gomaa","doi":"10.1186/s13018-024-05139-3","DOIUrl":"10.1186/s13018-024-05139-3","url":null,"abstract":"<p><strong>Background: </strong>Medial tibial stress syndrome (MTSS) is a prevalent running-related injury that could impact athletic performance and quality of life. The purpose of the study was to investigate the effectiveness of functional hip abductor strength training on reducing contralateral pelvic drop angle (hip frontal plane projection angle), and dynamic knee valgus (knee frontal plane projection angle) in runners with medial tibial stress syndrome (MTSS).</p><p><strong>Methods: </strong>Forty male and female recreational runners were diagnosed with MTSS for at least one month. The age ranged from 25 to 35 years old, and the body mass index (BMI) ranged between (18.5 and 25 kg/m²) participated in this study. This was a single-blind, randomized controlled trial. Participants were randomized into two groups: a control group (Group A, n = 20) received a selected physical therapy exercise program, and an experimental group (Group B, n = 20) received the same program plus functional hip abductor strength training. Dynamic knee valgus (frontal plane projection angle) and contralateral pelvic drop angle were measured using 2D video and analyzed by Kinovea software at baseline and after 8 weeks. Mixed-effect multifactor analysis of variance (MANOVA) was conducted to compare within and between groups effects on FPPA and pelvic drop angle.</p><p><strong>Results: </strong>After 8 weeks, Group B exhibited a significantly decreased frontal plane projection and pelvic drop angles compared to Group A (p < 0.05). Group A also demonstrated a reduced pelvic drop angle, but to a lesser extent, and their frontal plane projection angle increased.</p><p><strong>Conclusions: </strong>This study demonstrates that 8 weeks of functional hip abductor strength training, combined with traditional physical therapy, effectively improves lower extremity kinematics in runners with MTSS by reducing dynamic knee valgus and contralateral pelvic drop. This targeted approach likely addresses underlying muscle weakness and movement dysfunction, offering hope for potentially reducing MTSS recurrence.</p><p><strong>Trial registration: </strong>clinicaltrials.gov. NO: NCT05637476. Date: December 1, 2022.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"19 1","pages":"700"},"PeriodicalIF":2.8,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142522174","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":"Combining tibial tubercle osteotomy with medial patellofemoral ligament reconstruction often yields better outcomes in treating patellofemoral instability: a systematic review and meta-analysis of case-control studies.","authors":"Xiangyu Meng, Zhenwei Ji, Peng Wu, Huanming Fang, Peng Zhao, Yong Ding, Zhixue Wang","doi":"10.1186/s13018-024-05113-z","DOIUrl":"10.1186/s13018-024-05113-z","url":null,"abstract":"<p><strong>Purpose: </strong>Tibial tubercle osteotomy (TTO) is often employed for certain patellofemoral instability (PFI) cases, though its indications and effectiveness are not widely accepted. This systematic review gathers recent studies comparing isolated medial patellofemoral ligament reconstruction (iMPFLR) to MPFLR combined with TTO in managing PFI and to offer recommendations for clinicians when selecting TTO. This review proposes that MPFLR combined with TTO is superior to iMPFLR and that the combined procedure does not increase the incidence of postoperative complications.</p><p><strong>Methods: </strong>Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 (PRISMA 2020), extensive searches were performed on August 20, 2024, across PubMed/Medline, Embase, and Cochrane databases to locate relevant studies. Data on research protocols, participant characteristics (including epidemiological and radiographic features), functional scores, and complications were collected and examined. A meta-analysis was conducted to compare the outcomes between the two surgical techniques.</p><p><strong>Results: </strong>This systematic review analyzed 10 studies involving 715 participants, divided into a control group (which underwent iMPFLR) and an experimental group (which underwent MPFLR combined with TTO). In the control group, the incidence of severe trochlear dysplasia before surgery was 68.3% (95% CI [67.3-69.3%]), and the mean preoperative tibial tubercle to trochlear groove distance (TT-TG) was 16.1 mm (95% CI [15.8-16.3]). In the experimental group, both were respectively 79.1% (95% CI [77.5-80.7]) and 20.2 mm (95% CI [20.0-20.4]). Eight studies (80%) reported postoperative Kujala scores, with an average score of 85.1 (95% CI [84.4-85.9]) for the control group and 85.4 (95% CI [84.9-85.9]) for the experimental group (I²=22.7%). Four studies (40%) reported postoperative Lysholm scores, with an average score of 89.4 (95% CI [88.9-89.9]) for the control group and 89.1 (95% CI [89.0-89.3]) for the experimental group (I²=0%). The mean surgical failure rate for the control group was 5.1% (95% CI [4.7-5.6%]), compared to 3.2% (95% CI [3.0-3.4%]) for the experimental group, with an odds ratio (OR) of 2.18 (95% CI [1.05-4.53], I²=0%, p = 0.738). The rate of secondary surgeries in the control group was 1.9% (95% CI [1.6-2.2]), while in the experimental group it was 10.7% (95% CI [9.4-12.1]), with an OR of 0.12 (95% CI [0.03-0.54], I²=63.1%, p = 0.028).</p><p><strong>Conclusion: </strong>The combination of MPFLR and TTO for treating PFI yields knee joint function comparable to that achieved with MPFLR alone. The approach does not elevate the failure rate of the surgery or the incidence of other adverse events. However, the combined approach may prolong the postoperative rehabilitation process and typically requires removal of internal fixation devices, resulting in a higher rate of secondary surgeries.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"19 1","pages":"695"},"PeriodicalIF":2.8,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11514948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502436","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":"MAKO robot-assisted total hip arthroplasty: a comprehensive meta-analysis of efficacy and safety outcomes.","authors":"Rafael Llombart-Blanco, Gonzalo Mariscal, Carlos Barrios, Pablo Vera, Rafael Llombart-Ais","doi":"10.1186/s13018-024-05199-5","DOIUrl":"10.1186/s13018-024-05199-5","url":null,"abstract":"<p><strong>Background: </strong>Introduction: Robotic surgery in total hip arthroplasty (THA) has emerged as a promising approach for improving precision and reducing errors. This meta-analysis aimed to compare the efficacy and safety of robot-assisted MAKO total hip arthroplasty.</p><p><strong>Methods: </strong>Studies were searched using four databases. Meta-analysis was performed using Review Manager 5.4. Efficacy was assessed radiologically, and functional scores and complications were recorded.</p><p><strong>Results: </strong>Twelve studies (1224 hips) were analyzed. The MAKO group achieved greater cup anteversion (MD 1.53, 95%CI 1.04-2.03) and a higher percentage of components within safe inclination and anteversion ranges (p > 0.05). Harris Hip Scores did not differ significantly (MD 0.61, 95%CI -0.22-1.45) but the forgotten joint scores favored MAKO (MD 5.99, 95% CI 4.10-7.88), although not exceeding the minimally clinically significant difference. No differences in intraoperative complications emerged (OR 0.96, 95%CI 0.51-1.79) but preoperative plans significantly mismatched the final cup placement after MAKO (p < 0.05).</p><p><strong>Conclusions: </strong>The use of the MAKO robot in THA improves radiological outcomes by enhancing safe prosthesis placement. However, no significant differences were observed in terms of complications. Longer follow-up studies are required to assess the clinical impact of improved radiological results.</p><p><strong>Level of evidence: </strong>Level IV metaanalysis of nonrandomized clinical trials.</p><p><strong>Registration: </strong>CRD42023433733.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"19 1","pages":"698"},"PeriodicalIF":2.8,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142522175","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":"Association of MRI-based knee osteoarthritis structural phenotypes with short-term structural progression and subsequent total knee replacement.","authors":"Yukang Liu, Zikai Xing, Baoer Wu, Ning Chen, Tianxing Wu, Zhuojian Cai, Donghong Guo, Gaochenzi Tao, Zikun Xie, Chengkai Wu, Peihua Cao, Xiaoshuai Wang, Jia Li","doi":"10.1186/s13018-024-05194-w","DOIUrl":"10.1186/s13018-024-05194-w","url":null,"abstract":"<p><strong>Background: </strong>The failure of disease-modifying osteoarthritis drugs (DMOADs) trials lies mainly in the heterogeneity of the disease, which calls for a more precise population with specific progression and outcomes. This study aimed to determine whether and which MRI-based structural phenotype of knee osteoarthritis (KOA) is associated with short-term structural progression and subsequent total knee replacement (TKR).</p><p><strong>Methods: </strong>A longitudinal study was conducted among participants with baseline Kellgren-Lawrence grade (KLG) ≥ 2 from the Osteoarthritis Initiative (OAI). The structural phenotypes at baseline were defined as subchondral bone, meniscus/cartilage and inflammatory phenotypes according to the MRI Osteoarthritis Knee Score (MOAKS). The primary outcome was the progression of structural abnormalities within 24 months and multivariable logistic regressions were applied to evaluate the associations. The secondary outcome was the incidence of TKR during 108 months. Cox regressions and Kaplan-Meier survival curves were used for the analysis.</p><p><strong>Results: </strong>A total of 733 participants with KOA were finally included in our study, with 493 (67.3%) having the three main structural phenotypes. For the primary outcome, the subchondral bone phenotype (OR [95% CI]:1.71 [1.02, 2.83], 1.52 [1.06, 2.18], 1.65 [1.11, 2.42], respectively) and the inflammatory phenotype (OR [95% CI]: 1.69 [1.05, 2.74], 1.82 [1.31, 2.52], 2.15 [1.48, 3.14], respectively) were both associated with the short-term progression of joint space narrowing, osteophytes and sclerosis in 24 months, whereas the meniscus/cartilage phenotype was only associated with the progression of osteophytes and sclerosis. For the secondary outcome, the subchondral bone phenotype (HR [95% CI]: 1.71 [1.06-2.78]) and inflammatory phenotype (HR [95%CI]: 2.00 [1.02-2.67]) were associated with shorter time to subsequent TKR, but not the meniscus/cartilage phenotype. Besides, the cumulative effect when the structural phenotype overlapped was confirmed in both outcomes.</p><p><strong>Conclusions: </strong>The subchondral bone phenotype and inflammatory phenotype were associated with the progression of joint space narrowing, osteophytes and sclerosis in 24 months, along with subsequent TKR in 108 months. Besides, additive effects of overlapped phenotypes were further determined. These phenotypes could serve as valuable screening tools for future clinical trials and provide guidance for risk evaluation.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"19 1","pages":"699"},"PeriodicalIF":2.8,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142522173","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":"The preventive efficacy of lipid emulsion on the occurrence of local anesthetic systemic toxicity in patients receiving local infiltration analgesia for total joint arthroplasty.","authors":"Huan-Tang Lin, Pang-Hsin Hsieh, Jiin-Tarng Liou, Yung-Tai Chung, Yung-Fong Tsai","doi":"10.1186/s13018-024-05189-7","DOIUrl":"10.1186/s13018-024-05189-7","url":null,"abstract":"<p><strong>Background: </strong>Motor-sparing local infiltration analgesia (LIA) enhances recovery after total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, LIA can induce local anesthetic systemic toxicity (LAST), sometimes necessitating rescue lipid emulsion therapy. Our institute initiated a pilot study to pretreat patients with lipid emulsion (SMOFlipid^®) to test its efficacy in mitigating LIA-induced LAST events.</p><p><strong>Methods: </strong>This retrospective study enrolled 1,621 adult patients who received LIA with bupivacaine (2-3 mg/kg, maximum 300 mg) for unilateral primary THA or TKA under general anesthesia between January 2020 and April 2022. A total of 439 patients received lipid pretreatment, while 1,182 did not. Demographics, surgical and anesthesia profiles, along with LAST events affecting the neurological, cardiovascular, and respiratory systems, were compared after propensity score matching for age, sex, body mass index (BMI), and surgery type.</p><p><strong>Results: </strong>The incidence of severe LAST events requiring rescue lipid emulsion slightly decreased after lipid pretreatment (from 2.54 to 2.28 per 1000). Lipid pretreatment significantly reduced the incidence of bradycardia and new-onset arrhythmia (odds ratio: 0.13, adjusted p-value: 0.024) but increased postoperative opioid requirement (odds ratio: 1.71, adjusted p-value: 0.032) after Benjamini-Hochberg correction for multiplicity.</p><p><strong>Conclusions: </strong>The efficacy of lipid pretreatment (SMOFlipid^® 1.5 ml/kg, maximum 100 ml) in mitigating LIA-induced LAST remains controversial. While lipid pretreatment reduced the incidence of new-onset arrhythmia, it showed no clear benefits for neurologic and respiratory outcomes. Additionally, lipid pretreatment might hinder postoperative recovery by increasing the need for rescue opioid analgesia. Further prospective pharmacokinetic studies are required to assess plasma bupivacaine concentrations following LIA and lipid pretreatment, examine their relationship to LAST events, and establish the efficacy and safety of lipid pretreatment.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"19 1","pages":"697"},"PeriodicalIF":2.8,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11514964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142522176","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":"Effects of platelet-rich plasma combined with exercise therapy for one year on knee osteoarthritis: retrospective cohort study.","authors":"Tsuneo Kawahara, Shuhei Iida, Kazuma Isoda, Sungdo Kim","doi":"10.1186/s13018-024-05186-w","DOIUrl":"10.1186/s13018-024-05186-w","url":null,"abstract":"<p><strong>Background: </strong>Platelet-rich plasma (PRP) is a promising treatment for knee osteoarthritis (OA). However, exercise therapy and activities of daily living (ADL) guidance are recommended as core treatments in the Osteoarthritis Research Society International (OARSI) guidelines. However, the effects of PRP combined with exercise therapy are not fully understood. This study aimed to clarify the effectiveness of this treatment.</p><p><strong>Methods: </strong>We assigned patients diagnosed with knee OA and treated between January 2021 and December 2022 to groups who underwent PRP + exercise (PE), PRP (P), or exercise (E) therapy. Outcomes were evaluated using Knee Injury and Osteoarthritis Outcome Scores (KOOS) before, and 1, 3, and 12 months after treatment. Within-group comparisons according to the time of each score were statistically assessed using a one-way analysis of variance, then differences were analyzed using Bonferroni multiple comparisons p < 0.05). Treatment responses were determined using Outcome Measures in Rheumatology (OMERACT)-OARSI Responder criteria.</p><p><strong>Results: </strong>Pre-treatment KOOS did not significantly differ among the groups. Pain in the PE group improved within 1 month, symptoms, ADL, and quality of life (QOL) improved after 3, months and continued for 12 months. Pain and symptoms improved in the P group within 1 month, but ADLs and the QOL did not significantly change. Pain improved after 3 months in the E group and ADL, and QOL improved by 12 months. The response among the groups was the highest for the PE, with 50.0% at 1 and 3 months, and 65.0% at 12 months.</p><p><strong>Conclusions: </strong>Therapy with PRP immediately relieved pain, whereas exercise conferred late, but enduring effects. Combining PRP with exercise conferred synergistic advantages that persisted for up to 12 months.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"19 1","pages":"696"},"PeriodicalIF":2.8,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11514950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502452","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":"A study on the effect of platelet-rich plasma (PRP) to promote bone fusion in lateral interbody fusion of the lumbar spine using artificial bone.","authors":"Hiroshi Noguchi, Toru Funayama, Kosuke Sato, Masao Koda, Hiroshi Takahashi, Kousei Miura, Hiroshi Kumagai, Masashi Yamazaki","doi":"10.1186/s13018-024-05184-y","DOIUrl":"10.1186/s13018-024-05184-y","url":null,"abstract":"<p><strong>Background: </strong>Lateral lumbar interbody fusion (LLIF) via a retroperitoneum approach has gained popularity due to minimal invasiveness, which avoids resection of the spinous process and laminae. However, as challenges in grafting autogenous bone persist, artificial bone has been tested in Japan to fill the spinal cage. Platelet-rich plasma (PRP) contains growth factors and anti-inflammatory cytokines to promote cellular proliferation and repair damaged tissues. While the effects of PRP on tendon and ligament repair are widely known, any effects on bone healing are scarcely reported. However, PRP-loaded artificial bone carries potential to improve intervertebral bone fusion.</p><p><strong>Objective: </strong>This study assessed whether PRP enhances intervertebral bone fusion in LLIF surgery using β-tricalcium phosphate artificial bone.</p><p><strong>Methods: </strong>The current study was a prospective, randomized, controlled trial. We evaluated 13 consecutive patients undergoing LLIF surgery in our hospital. Patients received artificial bone impregnated with PRP or without PRP within the same fusion cage. The primary outcome was the intervertebral bone fusion rate at 6 and 12 months postoperatively, evaluated using CT imaging. The intervertebral bone fusion rates with and without PRP loading and with and without contact part between the endplate and the artificial bone were compared. Secondary outcomes included clinical evaluations using visual analog scale scores for low back pain, buttock-leg pain, and leg numbness from the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOA-BPEQ) and the Oswestry Disability Index (ODI), plus adverse events information.</p><p><strong>Results: </strong>Of the 13 patients (29 vertebral segments) included, bone fusion was observed in 43.4% of the PRP group and 26.1% of the non-PRP group at 6 months (p = 0.216). At 12 months, fusion rates were 60.9% with PRP and 34.8% without PRP (p = 0.074). The fusion rate was significantly higher in cases with good contact between the vertebral endplate and the artificial bone (p = 0.0004). Clinical scores improved postoperatively. Adverse events were in accordance with expectations from LLIF surgery and no PRP-specific events occurred.</p><p><strong>Conclusion: </strong>PRP did not significantly improve intervertebral bone fusion rates in LLIF surgeries, particularly in cases with poor contact between the vertebral endplate and artificial bone. While PRP may have a limited role in enhancing bone fusion, maintaining good contact between the vertebral endplate and artificial bone is crucial for successful outcomes. Further research is needed to explore optimal uses of PRP in spinal fusion surgeries.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"19 1","pages":"691"},"PeriodicalIF":2.8,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11515241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502434","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":"Optimal sliding distance in femoral neck system for displaced femoral neck fractures: a retrospective cohort study.","authors":"Shengjian Weng, Dongze Lin, Jikai Zeng, Jiajie Liu, Ke Zheng, Peisheng Chen, Chaohui Lin, Fengfei Lin","doi":"10.1186/s13018-024-05190-0","DOIUrl":"10.1186/s13018-024-05190-0","url":null,"abstract":"<p><strong>Background: </strong>Displaced femoral neck fractures frequently result in considerable patient morbidity, with complications such as postoperative femoral neck shortening occurring in up to 39.1% of cases. This shortening is associated with reduced hip function and mobility. The Femoral Neck System (FNS), which allows for controlled sliding to facilitate fracture reduction and healing, may mitigate these issues. However, the ideal sliding distance to balance fracture healing and minimize complications is not well defined.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of 179 patients who underwent FNS fixation for displaced femoral neck fractures at our institution from September 2019 to September 2023. Patients were categorized into three groups based on the intraoperative sliding distance allowed by the FNS: the Minimal Slide group (≤ 5 mm), the Moderate Slide group (> 5 to ≤ 10 mm), and the Extensive Slide group (> 10 to 20 mm). Primary outcomes included postoperative femoral neck shortening, the incidence of moderate to severe shortening, time to fracture union, and hip joint function as assessed by the Harris Hip Score (HHS) and the Parker Mobility Score. Secondary outcomes included complication rates such as implant cut-out, nonunion, avascular necrosis of the femoral head, and the need for secondary surgery.</p><p><strong>Results: </strong>The Extensive Slide group of moderate to severe shortening at 32.31%, which was 1.59-fold and 8.88-fold that of the Moderate Slide (20.34%) and Minimal Slide group's (3.64%), respectively (P < 0.01). The sliding predominantly occurred within the first three months postoperatively and had substantially ceased by six months. At one year postoperatively, the median shortening was 2.7 mm (IQR, 0.7 to 3.5 mm) for the Minimal Slide group, a value that was notably lower compared to the 3.2 mm (IQR, 2.4 to 4.6 mm) for the Moderate Slide group and the 3.5 mm (IQR, 1.3 to 8.1 mm) for the Extensive Slide group. The average time to achieve union was similar across all groups, with no significant differences. Functional outcomes, as assessed by the Harris Hip Score (HHS) and the Parker Mobility Score, the Harris Hip Score (HHS) demonstrated statistical significance, the Parker Mobility Score did not reach statistical significance.</p><p><strong>Conclusions: </strong>Restricting FNS slide to ≤ 5 mm in surgery may reduce shortening, improve hip function, and not hinder fracture healing or implant stability. Considering the key 3-month sliding timeline postoperatively is advisable in clinical practice. Further research with a broader patient cohort is vital to confirm these findings and to anchor them in evidence-based practice.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"19 1","pages":"690"},"PeriodicalIF":2.8,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11515223/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502463","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}