Journal of orthopaedics最新文献

{"title":"Oral pharmacological management of Bertolotti syndrome presenting as chronic low back pain – A case report and review of literature","authors":"Saarim Bari ,&nbsp;Varun Menon ,&nbsp;Shankar Bhuvanesh","doi":"10.1016/j.jor.2024.10.028","DOIUrl":"10.1016/j.jor.2024.10.028","url":null,"abstract":"<div><h3>Background</h3><div>Bertolotti syndrome (BS) is often a missed cause of chronic lower back pain in young individuals, commonly associated with the presence of anomalous lumbosacral transitional vertebrae.</div></div><div><h3>Case presentation</h3><div>A 19-year-old female with no significant medical or family history presented with persistent lower back pain localized to the gluteal region and posterolateral aspect of the left lower back. The pain worsened over time and limited their movements, including walking. A Ferguson radiograph revealed fusion of the left transverse process of the L5 vertebral segment with the left sacral ala. History, examination findings, and radiological workup confirmed the diagnosis of BS. The patient preferred conservative management, receiving oral pharmacological therapy for six weeks, along with education on preventive measures and routine exercises for postural stability. At a six-month follow-up, the patient remained asymptomatic and managed well.</div></div><div><h3>Conclusions</h3><div>Conservative oral pharmacological treatment presents a unique and viable alternative to traditional methods for managing BS, which often involve surgery or steroids/anesthetics at the pseudo-articulation site. Given that BS is common yet underdiagnosed in young patients with chronic back pain, this report also underscores the importance of including it in differential diagnoses for chronic lower back pain in this demographic.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The efficacy of tranexamic acid in perioperative bleeding following total hip arthroplasty through different surgical approaches: Systematic review and meta-analysis","authors":"Roya Khorram ,&nbsp;Roham Borazjani ,&nbsp;Armin Khavandegar ,&nbsp;Morteza Behjat ,&nbsp;Elham Rahmanipour ,&nbsp;Reza Vafadar ,&nbsp;Mohebat Vali ,&nbsp;Ali Parsa ,&nbsp;Mohammad Ghorbani","doi":"10.1016/j.jor.2024.10.030","DOIUrl":"10.1016/j.jor.2024.10.030","url":null,"abstract":"<div><h3>Introduction</h3><div>Tranexamic acid (TXA) has been documented to reduce perioperative blood loss following orthopedic surgeries, such as total hip arthroplasty (THA). Previous studies focused on the best applicable dose and administration method to minimize blood loss. Although the surgical approach is another factor that may influence perioperative bleeding, no previous research has examined its concurrent impact alongside TXA. This meta-analysis investigated the effect of intravenous TXA on perioperative bleeding in primary THA, focusing on the surgical approach used.</div></div><div><h3>Method</h3><div>The authors searched PubMed, Web of Science, Scopus, Embase, and the Cochrane Library through November 2022. Fourteen studies, comprising 1358 patients, were identified as suitable for inclusion in this meta-analysis. To assess perioperative bleeding, hemoglobin (Hb) decline, transfused blood products, total blood loss (TBL), and intraoperative blood loss (IOBL) were recorded.</div></div><div><h3>Results</h3><div>The study showed that the lateral approach (LA) maintains the postoperative Hb level more effectively (WMD = 1.081, 95 % CI: 0.620–1.541). Significantly less IOBL was observed with the posterolateral approach (PLA; WMD = −70.578, 95 % CI: [-130.389] – [-10.766]). The posterior approach (PA) was associated with a reduction in TBL (WMD = −392, 95 % CI: [-474.439] – [-310.231], P-value &lt;0.0001).</div></div><div><h3>Conclusion</h3><div>The surgical approach plays a significant role in blood management during surgery. Overall, the PLA resulted in the least IOBL, while the LA was associated with the least blood transfusion and a decline in Hb level. Additionally, the PA was linked to the lowest TBL.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of total knee arthroplasty using hospital-based 3D printed patient-specific instrumentation: A radiology research","authors":"Vo Sy Quyen Nang ,&nbsp;Pham Trung Hieu ,&nbsp;Vu Tu Nam ,&nbsp;Tran Trung Dung ,&nbsp;Duong Dinh Toan","doi":"10.1016/j.jor.2024.10.032","DOIUrl":"10.1016/j.jor.2024.10.032","url":null,"abstract":"<div><h3>Background</h3><div>Patient-specific instruments (PSIs) were reported to improve implant position and rotation accuracy in total knee arthroplasty (TKA), among other benefits. Most PSIs used in TKA were commercial products from implant manufacturers, which could be time-consuming and could potentially affect accuracy as they relied on engineer's decision. This study aimed to present the radiological outcomes of PSI produced by the 3D printing facility at our hospital, with direct involvement of the surgeon in its design.</div></div><div><h3>Methods</h3><div>This prospective study enrolled 45 patients who underwent mechanically aligned TKA. Preoperative whole-limb 3D-CT scans were obtained to create the sizing plan. The surgeon identified the position of the cut plane and guide pin locations on software, which were then forwarded to engineers for further processing. Subsequently, the PSI was fabricated using in-hospital 3D resin printers. During surgery, after removing all remaining cartilage, the PSI was utilized on the bone surfaces to assist surgeons in drilling pinhole positions for the manufacturer's cutting instruments. Post-surgery, CT scans were acquired and overlaid onto the 3D model of the implant to compare to the plan.</div></div><div><h3>Results</h3><div>On average, it took three days to prepare for the surgery using PSI. 100 % of patients had implant sizes that matched the preconception template. The mean postoperative hip-knee angle was 178.1° ± 1.34°. The mean femoral component rotation angle relative to the surgical transepicondylar axis (sTEA) and the mean rotation mismatch between the femur and tibial component were 0.99° ± 0.84° and 0.91° ± 1.61°, respectively.</div></div><div><h3>Conclusions</h3><div>Preliminary radiological results demonstrated that in-hospital PSI was a useful technique for improving the accuracy of implant positioning in TKA, especially in controlling the rotational alignment.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knee dislocation with concomitant patellofemoral dislocation: A systematic review","authors":"Jonathan McKeeman,&nbsp;Ryan Lee,&nbsp;Tyler Smith","doi":"10.1016/j.jor.2024.10.025","DOIUrl":"10.1016/j.jor.2024.10.025","url":null,"abstract":"<div><h3>Background</h3><div>There is no consensus treatment for knee dislocations with associated patellar dislocation. This systematic review provides an overview of current treatments and the authors preferred treatment algorithm. Knee dislocation with concomitant patellar dislocation is a rare occurrence and there is no standard of care for these injuries. This review seeks to provide a systematic review of literature and a proposed treatment algorithm for this injury pattern.</div></div><div><h3>Methods</h3><div>A systematic review was performed following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines using the PubMed, MEDLINE, and Cochrane databases in July 2024. Studies were assessed for human patients who sustained a knee dislocation with concomitant patellar dislocation.</div></div><div><h3>Results</h3><div>The literature search yielded 288 titles and abstracts to be screened. Of the 288 articles, 281 titles and abstracts were excluded. Ultimately six full text articles were included. There were three case reports/series of acute knee dislocation with associated patellar dislocation and there were three case reports of chronic knee dislocation with associated patellar dislocation. In all studies, patellar instability was addressed surgically regardless of patient risk factors.</div></div><div><h3>Conclusion</h3><div>Knee dislocation with associated patellar dislocation is a rare occurrence, but in general can be treated with the standard of care for a knee dislocation and then an assessment of risk factors for consideration of MPFL repair or reconstruction.</div></div><div><h3>Level of evidence</h3><div>Level 4- systematic review of case reports and case series.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total knee arthroplasty reimbursement is declining overall and at a marginally faster rate amongst female orthopaedic surgeons: A Medicare analysis","authors":"Georgia Sullivan ,&nbsp;Vikram Gill ,&nbsp;Eugenia A. Lin ,&nbsp;Alexandra Cancio-Bello ,&nbsp;Jack Haglin ,&nbsp;Joshua S. Bingham","doi":"10.1016/j.jor.2024.10.029","DOIUrl":"10.1016/j.jor.2024.10.029","url":null,"abstract":"<div><h3>Background</h3><div>While the prevalence of total knee arthroplasty (TKA) is increasing, reimbursement is declining. The purpose of this study was to determine how surgeon gender influences procedure volume, reimbursement, practice style, and patient demographics for TKAs nationally and regionally between 2013 and 2021.</div></div><div><h3>Methods</h3><div>The Medicare Physician and Other Practitioners database was queried from 2013 to 2021 for procedure volume, TKA reimbursement, surgeon characteristics, and patient demographics for any surgeon who performed at least ten primary TKAs per year. Statistical tests were conducted to analyze differences based on surgeon gender, geography, and year.</div></div><div><h3>Results</h3><div>Of the 2,415,802 TKAs performed between 2013 and 2021, 1.5 % were billed by female surgeons. The number of TKAs performed annually increased by 29.1 % for female surgeons and decreased by 2.6 % for male surgeons. Between 2013 and 2021, reimbursement for TKAs decreased by 23.9 % for male surgeons and 26.2 % for female surgeons. In 2021, male surgeons were reimbursed $1017 per TKA while female surgeons were reimbursed $964 (p = 0.049). Male surgeons performed more TKAs annually in 2021 (Male: 39.3, Female: 30.9, p &lt; 0.001), more total billable services (Male: 4148.0, Female: 2719.3, p &lt; 0.001), and more unique billable services (Male: 70.7, Female: 55.3, p &lt; 0.001) than female surgeons.</div></div><div><h3>Conclusions</h3><div>Female representation among surgeons who perform TKAs is increasing nationally. However, male surgeons treat more patients, perform more total billable services, and perform more unique billable services than female surgeons. TKA reimbursement is decreasing at a faster rate for female surgeons than male surgeons, although this is likely due to geographical differences.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-specific 3D-Printed PEEK implants for spinal tumor surgery","authors":"Nikita Zaborovskii ,&nbsp;Sergei Masevnin ,&nbsp;Oleg Smekalenkov ,&nbsp;Vladislav Murakhovsky ,&nbsp;Dmitrii Ptashnikov","doi":"10.1016/j.jor.2024.10.024","DOIUrl":"10.1016/j.jor.2024.10.024","url":null,"abstract":"<div><h3>Aims &amp; objectives</h3><div>This study evaluates the feasibility and clinical outcomes of using 3D-printed polyetheretherketone (PEEK) patient-specific implants (PSI) for vertebral body replacement (VBR) in patients with spinal tumors. The research question focuses on postoperative results, implant integration, and complications over a 12-month period.</div></div><div><h3>Methods</h3><div>A single-center, retrospective case series analyzed five patients who underwent spinal reconstruction after tumor resection using PEEK 3D VBR between April 2022 and June 2023. Inclusion criteria were thoracic/lumbar spinal tumors, tumor resection with PEEK 3D VBR reconstruction, and follow-up exceeding 12 months. PEEK implants were created using fused filament fabrication from medical-grade PEEK. Patient data included demographics, medical history, tumor characteristics, and surgical outcomes. Radiological evaluations assessed bony fusion, local angle changes, and segment height stability. Descriptive statistical analyses were performed using R software.</div></div><div><h3>Results</h3><div>The mean follow-up duration was 19.2 months. All patients remained alive, with one experiencing local recurrence. Postoperative imaging showed a decrease in local angle with no significant changes during follow-up. Segment heights remained stable, and no PEEK 3D VBR subsidence or hardware failure was observed. Bony fusion was observed in all patients.</div></div><div><h3>Conclusions</h3><div>The use of PEEK 3D printed PSI for VBR in spinal tumor patients demonstrates promising feasibility and clinical outcomes, with stable implant integration and minimal complications over a 12-month period. Further studies with larger cohorts are recommended to validate these findings.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome of posterior short segment fixation with implanting pedicle screw at the fractured level for treatment of thoracolumbar fracture","authors":"Sameer Lamichhane,&nbsp;Pashupati Chaudhary,&nbsp;Raju Rijal,&nbsp;Rajiv Maharjan,&nbsp;Krishna Kandel","doi":"10.1016/j.jor.2024.10.026","DOIUrl":"10.1016/j.jor.2024.10.026","url":null,"abstract":"<div><h3>Introduction</h3><div>Thoracolumbar fractures make up majority of the spinal fractures. Various techniques including long, short, mono and short segment screw fixation have been used to achieve stability. There are still few studies describing the results of short segment fixation with intermediate screw fixation in fractured vertebrae, despite the fact that all have adequate efficacy and stability.</div></div><div><h3>Materials and methods</h3><div>41 patients were studied and evaluated preoperatively, at discharge and at 2, 6, 12, 24 weeks and 1 year follow-up clinically using Greenough and Fraser Low Back Pain Score, the American Spinal Injury Association (ASIA) grading, four-point scale questionnaire for patient's satisfaction, sagittal index (SI) of injured vertebra and Cobb's angle.</div></div><div><h3>Results</h3><div>The patient's mean age was 36.9 ± 11.7 years, majority (90.2 %) with lumbar (L1-L3) segment involvement. All the patients significantly improved neurologically immediately after surgery (p &lt; 0.001) however the improvement was not significant at final follow up (p = 0.3) as compared to the preoperative ASIA grade (Kendall's tau-b test). Low back pain decreased significantly on subsequent follow-up as measured by Visual Analogue Scale (VAS) score (p &lt; 0.001). The Low Back Pain Scale of Greenough and Fraser calculated at immediate post-operation and at 1 year follow up in comparison to pre-operation status showed a statistically significant improvement (p &lt; 0.001). Sagittal index (SI) estimated at 6, 12, 24 weeks and 1 year follow-up in comparison to preoperative SI was higher and statistically significant (p &lt; 0.001). Mean Cobb's angle significantly decreased during follow-up at 6, 12, 24 weeks and 1 year compared to preoperative angle (p &lt; 0.001). Four Point Scale Questionnaire assessed at 1 year follow-up showed majority (82.9 %) were very satisfied with the outcome.</div></div><div><h3>Conclusion</h3><div>Posterior short segment with intermediate screw fixation in fractured vertebra is a feasible and stable treatment method for traumatic single thoracolumbar fracture with respect to the functional outcome, patient satisfaction and preservation of motion segment.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel radiographic finding for estimation of the cortical-cancellous boundary: A magnetic resonance imaging case series of patients with femoroacetabular impingement","authors":"Madeleine G. DeClercq ,&nbsp;Rui W. Soares ,&nbsp;Adam M. Johannsen ,&nbsp;Toufic R. Jildeh ,&nbsp;Lauren A. Pierpoint ,&nbsp;Carly A. Lockard ,&nbsp;Maitland D. Martin ,&nbsp;Marc J. Philippon","doi":"10.1016/j.jor.2024.10.001","DOIUrl":"10.1016/j.jor.2024.10.001","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine if comparing alpha angle measurements of the outer cortical margin (preoperative alpha angle) and the inner cortical margin (theoretical postoperative alpha angle) on magnetic resonance imaging (MRI) can estimate the amount of sclerotic bone that needs to be resected to restore the alpha angle to normative values (&lt;55⁰) in patients with symptomatic femoroacetabular impingement (FAI).</div></div><div><h3>Methods</h3><div>A retrospective review was conducted on patients with FAI undergoing primary hip arthroscopy and CAM osteoplasty from June 2013 to February 2017. Inclusion criteria were radiologist-measured alpha angles &gt;70° on 3T oblique axial MRI, unilateral primary hip arthroscopy, and age ≥18. Exclusions included previous hip surgery, hip trauma, avascular necrosis, advanced osteoarthritis, dysplasia, poor quality images, or missing MRI images. Alpha angles were measured preoperatively using the outer cortical margin and postoperatively using the inner cortical margin of femur. Surgeries were performed by the senior surgeon. Paired t-tests compared preoperative and postoperative alpha angles, and intraclass correlation coefficients (ICC) were used to assess inter-rater and intra-rater reliability.</div></div><div><h3>Results</h3><div>One hundred patients (100 hips) were included with an average age of 40.8 years (range, 18.7–64.9), with 75 % being male (n = 75). The average BMI was 24.7 ± 3.9 (range, 17.1–38.8). The average maximum alpha angle at the outer cortical margin was 77.0 ± 4.2° (range, 70.0–90.8), with an ICC for inter-rater reliability of 0.861, indicating excellent agreement. The average inner cortical alpha angle was 46.4 ± 3.4° (range, 36.5–55.4), significantly less than 55° (p&lt;0.001). The mean difference between the outer and inner cortical alpha angles was −30.6 ± 5.1° (p&lt; 0.001).</div></div><div><h3>Conclusions</h3><div>The difference between outer and inner cortical alpha angles on MRI can accurately estimate the amount of sclerotic bone resection needed to restore the alpha angle to normative values in patients with FAI. This information may be directly applied clinically marker to assess adequacy of CAM resection.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142578408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sociodemographic characteristics and outcomes of surgically managed central cord syndrome patients","authors":"Shannon Tse ,&nbsp;Marlisa Olea-Gallardo ,&nbsp;Hania Shahzad ,&nbsp;Yashar Javidan ,&nbsp;Rolando Roberto ,&nbsp;Eric Klineberg ,&nbsp;Shaina A. Lipa ,&nbsp;Hai V. Le","doi":"10.1016/j.jor.2024.10.021","DOIUrl":"10.1016/j.jor.2024.10.021","url":null,"abstract":"<div><h3>Introduction</h3><div>Undiagnosed cervical spine stenosis is a risk factor for central cord syndrome (CCS), especially in vulnerable individuals. Social determinants of health (SDOH) are correlated with health outcomes. The aim of this study was to characterize the sociodemographic characteristics and outcomes in surgically-treated central cord syndrome (CCS) patients, and explore potential associations between them.</div></div><div><h3>Methods</h3><div>This is a retrospective cohort study of surgically-treated CCS patients at a Level-1 trauma center between 2015 and 2021. Patient demographics, radiological findings, and clinical outcomes were collected. SDOH were estimated using the Social Deprivation Index (SDI) and Area Deprivation Index (ADI). Descriptive statistics and regression analyses assessed associations between SDI/ADI, demographics and clinical outcomes.</div></div><div><h3>Results</h3><div>Of 56 patients, 75 % were insured by Medicare/Medicaid and 70 % were discharged to care facilities. Mean SDI was 66.4 ± 24.4, and mean ADI was 7.4 ± 2.2. Three patients required reoperation for post-operative complications. Post-operative neurologic outcomes varied, with 60.7 % stable, 30.4 % improved, and 8.9 % declined. While SDI/ADI did not correlate with outcomes, higher ADI quartiles were associated with decreased likelihood of home discharge (p = 0.048). Decline in neurologic function was associated with Medicare/Medicaid or Military insurance (p = 0.011).</div></div><div><h3>Conclusions</h3><div>The results of this study indicated that CCS patients typically come from lower socioeconomic backgrounds, as indicated by high SDI and ADI scores. Despite this, we did not find significant correlations between SDI or ADI with post-operative outcomes, and most patients had stable or improved neurological function post-surgery in our cohort. Future studies with larger sample sizes will provide a more comprehensive understanding of these findings.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complications following total knee arthroplasty in patients with prior extensor mechanism dysfunction: A retrospective review","authors":"Whisper Grayson ,&nbsp;Nathaniel Baek ,&nbsp;William Hopkinson ,&nbsp;Daniel Schmitt ,&nbsp;Nicholas M. Brown","doi":"10.1016/j.jor.2024.10.023","DOIUrl":"10.1016/j.jor.2024.10.023","url":null,"abstract":"<div><h3>Background</h3><div>Extensor mechanism disruption following total knee arthroplasty (TKA) is a rare, yet serious complication. While previous patellar abnormalities are a theoretical risk factor for this complication, there is a scarcity of literature describing the impact of prior extensor mechanism dysfunction (EMD) on this and other complications following TKA. In this study, we describe our institutional experience with complications following TKA after EMD.</div></div><div><h3>Methods</h3><div>Sixty-one knees that underwent total knee arthroplasty between April 2007 and April 2023 in patients with previous EMD were identified. Extensor mechanism dysfunction types included patellar fracture, patellar tendon rupture, patellar realignment surgery, previous patellar dislocation, and a chronic laterally tracking patella impacting extensor mechanism function. Primary outcomes included extensor mechanism failure, infection, dislocation, aseptic loosening, revision surgery, and stiffness requiring manipulation under anesthesia (MUA).</div></div><div><h3>Results</h3><div>A total of 61 knees, comprised of 53-patients, were included. There were complications witnessed in fifteen patients, leading to a 24.6 % overall complication rate. There was one extensor mechanism disruption in the form of a partial quadriceps tendon tear requiring repair. There was one patellar dislocation requiring reoperation. There were five superficial infections successfully treated non-operatively and four deep infections requiring reoperation. A total of nine reoperations were performed, four of which were revisions. Four patients underwent MUA due to severe post-operative stiffness.</div></div><div><h3>Conclusion</h3><div>In this study, we found a high complication rate following TKA in patients with previous extensor mechanism dysfunction. There was one case of partial quadriceps tendon rupture requiring repair.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}