Journal of orthopaedics最新文献

{"title":"A preclinical model for osteoarticular fracture fragment preservation for delayed re-implantation","authors":"João Bourbon de Albuquerque II ,&nbsp;Gregory J. Della Rocca ,&nbsp;Aaron M. Stoker ,&nbsp;Chantelle C. Bozynski ,&nbsp;Anna Sullentrup ,&nbsp;Tamara Gull ,&nbsp;James L. Cook ,&nbsp;Julia A.V. Nuelle","doi":"10.1016/j.jor.2024.09.019","DOIUrl":"10.1016/j.jor.2024.09.019","url":null,"abstract":"<div><h3>Background</h3><div>Open articular fractures often include contaminated, devascularized osteoarticular fragments that are critical for joint reconstruction. Definitive treatment is often delayed such that decontamination and preservation of critical fragments for joint reconstruction is highly desirable. To validate decontamination and preservation protocols for safe and effective preservation of osteoarticular fragments for re-implantation, a preclinical animal model for inducing type 3 open articular fractures with contaminated, devascularized osteoarticular fragments was developed and validated.</div></div><div><h3>Materials and methods</h3><div>With IACUC approval, purpose-bred hounds (n = 5) were humanely euthanized. Immediately following euthanasia, a penetrating captive bolt pistol with 1.25 grain cartridge centered on the cranial aspect of each distal humerus was discharged to create open fractures in 3 dogs (6 elbows). In 2 dogs, matched osteoarticular tissues from non-injured elbows (controls) were retrieved for comparison. Distal humerus, proximal radius, and proximal ulna osteoarticular fragments (n = 27) were immediately placed in Missouri Osteochondral Preservation System (MOPS) solution and stored at room temperature. Radiographic, chondrocyte viability, and quantitative microbial culture assessments were performed immediately (time-0) and at 7 and 14 days of storage.</div></div><div><h3>Results</h3><div>This preclinical canine model reliably produced type 3 open distal humeral fractures characterized by devascularized and contaminated osteoarticular fracture fragments. All fragments produced extensive microbial growth through 14 days of storage. Without decontamination, viable chondrocyte density in the fragments decreased significantly within 7 days, likely attributable to the profound contamination.</div></div><div><h3>Conclusion</h3><div>These data highlight the importance of developing a reliable method for point-of-care decontamination and preservation of osteoarticular fracture fragments for safe and effective reimplantation of articular fracture fragments for joint reconstruction.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142428353","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":"Global research trends and hotspots in rheumatoid arthritis joint replacement:Bibliometric analysis and visualization study","authors":"Lin Zeng,&nbsp;Yihan Shi,&nbsp;Parhati Subatijang,&nbsp;Lei Zhang,&nbsp;Jian Gao,&nbsp;Rongxin Sun,&nbsp;Kan Jiang","doi":"10.1016/j.jor.2024.09.017","DOIUrl":"10.1016/j.jor.2024.09.017","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to analyze and visualize global research trends and hotspots in rheumatoid arthritis joint replacement over the past two decades using CiteSpace and VOSviewer software.The findings from this bibliometric analysis will inform and guide future research directions in this field.</div></div><div><h3>Methods</h3><div>We searched for relevant literature on rheumatoid arthritis joint replacement from January 2005 to August 2024 in the Web of Science database.Using CiteSpace, VOSviewer,and Bibliometrix software,we analysed keywords, authors,institutions, countries,and journals,and constructed a network cooperation map.</div></div><div><h3>Results</h3><div>A total of 2888 articles written by 11,723 authors from 70 countries and 3194 institutions were analysed and published in 530 journals.The United States, with 855 publications accounting for 29.61%of the world's total,and the United Kingdom, with 332 publications representing 11.50 %,made the greatest contributions.Additionally,the United States maintains strong collaborative relationships with many countries. According to the analysis of the outbreak keyword map, the joint replacement of rheumatoid arthritis has become mature, and the complications, prognosis and functional rehabilitation of joint replacement are the main focus of research in this field.</div></div><div><h3>Conclusion</h3><div>we conducted a comprehensive summary of the literature on rheumatoid arthritis joint replacement published between 2005 and 2024 using bibliometrics and visual analysis.This enabled us to identify the development trends and research hotspots in this field over the past two decades, offering valuable insights for researchers planning future studies in this area.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142428410","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":"Wrist fusion with ulnar translocation for aggressive giant cell tumour of distal end radius: Short-term functional and clinico-radiological outcomes","authors":"Zile Singh Kundu ,&nbsp;PankajKumar Sharma ,&nbsp;Lakshmana Das ,&nbsp;Vishal Verma ,&nbsp;Jyoti Sharma","doi":"10.1016/j.jor.2024.09.018","DOIUrl":"10.1016/j.jor.2024.09.018","url":null,"abstract":"<div><h3>Background</h3><div>The distal end radius (DER) is the third most common site of a giant cell tumour (GCT) in bone. GCT is a locally aggressive benign tumour with metastatic potential. The main goals in the management of GCT of DER are the complete removal of the tumours, the prevention of recurrence, and the restoration of the functional wrist.</div></div><div><h3>Purpose</h3><div>This case series reports the clinical and functional outcome of en bloc tumour resection, ulnar translocation and wrist arthrodesis in patients with high-grade GCT of DER.</div></div><div><h3>Methods</h3><div>Sixteen patients with Campanacci grade II &amp; III GCT of distal end radius who underwent the procedure between 2009 and 2018 and had a follow-up of 2 years were included. Patients with distant metastasis, chronic severe systemic illness, operated previously, and follow-up dropouts were excluded from the study. The patient's demographic profile and tumour characteristics were collected at the initial visit. Grip strength, modified MAYO wrist score, and VAS score for wrist pain were collected preoperatively and at 1-year and 2-year follow-ups.</div></div><div><h3>Results</h3><div>The study included predominantly females (13 vs 3). The mean age was 31.5 ± 8 years with a symptom duration of 6.5 ± 3.1 months (range 3–14). The mean resection length was 8.31 ± 1.5 cm (range 6–12). The mean Ulnoradial and ulnocarpal union time was 22.7 ± 8.0 and 17.5 ± 2.3 weeks, respectively. The mean modified Mayo Wrist score was 20.63 ± 9.4, 48.7 ± 5.6 and 60.6 ± 4.0 at preop, 1 year and 2 years follow-up. The mean MSTS score was 22.68 ± 1.8 (range 19–26). Two patients had ulnoradial nonunion.</div></div><div><h3>Conclusion</h3><div>Wrist arthrodesis by ulnar translocation and plate fixation is a viable option in the management of GCT of distal end radius. The short-term clinical and functional outcomes are favourable for restoring adequate wrist function.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142428412","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":"Investigating the use of peri-operative systemic steroid administration in anterior cervical discectomy and fusion (ACDF) - A systematic review","authors":"Cole Veliky ,&nbsp;Hania Shahzad ,&nbsp;Muhammad Talal Ibrahim ,&nbsp;Paul Michael Alvarez ,&nbsp;Frank Epitropoulos ,&nbsp;Varun Singh","doi":"10.1016/j.jor.2024.09.014","DOIUrl":"10.1016/j.jor.2024.09.014","url":null,"abstract":"<div><h3>Objective</h3><div>The study aims to analyze the utility of peri-operative systemic intravenous (IV) steroids in mitigating postoperative complications and improving clinical outcomes following anterior cervical discectomy and fusion (ACDF) surgery.</div></div><div><h3>Methods</h3><div>A systematic review was conducted by searching PubMed, Scopus, Cochrane, Web of Science, and Embase databases for studies assessing the role of IV or systemic steroids in ACDF surgery. Data extraction and risk of bias assessment were conducted independently by two reviewers using Covidence, with a third reviewer finalizing the data and settling any conflicts. The systematic review was conducted per PRISMA guidelines and registered on Prospero under the title, Investigating the Effectiveness of Early “SYSTEMIC” (oral or IV) Steroid Administration, within a 24-hour to one-week timeframe post-operatively, in Anterior Cervical Discectomy and Fusion (ACDF): A Systematic Review. The Risk of Bias 2.0 (RoB 2.0) tool was used for clinical trials, and the Newcastle-Ottawa Scale (NOS) was used for retrospective studies.</div></div><div><h3>Results</h3><div>Six studies were included and showed that IV steroids effectively mitigated dysphagia for up to a month, with higher efficacy compared to topical steroids used intraoperatively. However, IV steroids did not significantly impact the incidence of paravertebral swelling. Reductions in dysphonia, pain scores, and airway compromise were observed, but their long-term effects were insignificant. Systemic steroids were also found to delay fusion in some cases for up to six months, but long-term healing and fusion were not significantly impacted.</div></div><div><h3>Conclusions</h3><div>The use of IV steroids in the perioperative period after ACDF surgery is beneficial in mitigating dysphagia, with multiple doses showing long-term effectiveness compared to the transient effects of local steroids used intraoperatively. Patients may experience perceived benefits in terms of airway compromise, pain, and dysphonia without significant systemic complications or fusion failure. However, there is limited evidence regarding the optimal steroid dosing, frequency, and formulation and thus strong recommendations cannot be made.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142323359","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":"Far cortical locking versus standard locking screw fixation in simulated femoral fractures: A biomechanical meta-analysis","authors":"Robert S. Bullock,&nbsp;John G. Coury,&nbsp;Brendan Liakos,&nbsp;Eric G. Huish","doi":"10.1016/j.jor.2024.09.013","DOIUrl":"10.1016/j.jor.2024.09.013","url":null,"abstract":"<div><h3>Introduction</h3><div>Far cortical locking (FCL) is a concept of locking plate fixation with reduced stiffness and symmetric micromotion to improve callus formation. The goal of our study was to review biomechanical data evaluating FCL plate and screw fixation versus standard locking (SL) plate and screw fixation by analyzing studies of cadaveric and synthetic bone models to draw biomechanical conclusions.</div></div><div><h3>Methods</h3><div>Biomechanical studies that compared FCL and SL plate fixation for simulated femoral fractures were reviewed for construct stiffness, load to failure, axial motion at the near and far cortices, and the difference between near and far cortical axial motion to demonstrate motion symmetry.</div></div><div><h3>Results</h3><div>FCL decreased stiffness by 1.069 kN/mm compared to SL (95 % CI 0.405 to 1.732, p = 0.002). FCL demonstrated greater axial motion than SL in the near cortex by 0.425 mm (95 % CI 0.359 to 0.491, p &lt; 0.001) and in the far cortex by 0.456 mm (95 % CI 0.378 to 0.534, p &lt; 0.001). FCL resulted in symmetric motion with no significant difference between far and near cortices with the far cortex displacing 0.347 mm more than near (95 % CI -0.038 to 0.731, p = 0.78). SL resulted in asymmetric motion favoring the far cortex by 0.270 mm (0.096–0.443, p = 0.002). Construct strength was not significantly different with FCL load to failure 0.367 kN greater than SL (95 % CI -0.762 to 1.496, p = 0.524).</div></div><div><h3>Conclusion</h3><div>FCL screw fixation in femoral fractures achieves the goals of reducing construct stiffness and promoting more symmetric axial motion while maintaining construct strength. These results support the overall biomechanical goals of far cortical locking and should encourage investigation into its effects on clinical and radiographic outcomes.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142319498","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":"Comparison of hypoallergenic knee arthroplasties in patients with metal hypersensitivity versus standard arthroplasties in non-hypersensitivity patients: A scoping review","authors":"Christian Carulli,&nbsp;Filippo Leggieri,&nbsp;Domenico Rodà,&nbsp;Fabrizio Matassi,&nbsp;Roberto Civinini,&nbsp;Matteo Innocenti","doi":"10.1016/j.jor.2024.09.015","DOIUrl":"10.1016/j.jor.2024.09.015","url":null,"abstract":"<div><h3>Background</h3><p>Metal hypersensitivity in Total Knee Arthroplasty (TKA) continues to intrigue surgeons and researchers, with significant limitation of allergy tests due to the absence of clear cut-offs for a definitive diagnosis and their limited diffusion worldwide. We analyzed the literature to compare clinical outcomes in patients with metal hypersensitivity undergoing hypoallergenic knee arthroplasties and subjects without metal allergy undergoing standard knee arthroplasties.</p></div><div><h3>Methods</h3><p>This review adhered to PRISMA guidelines. A comprehensive search of MEDLINE, EMBASE, and Cochrane databases was conducted from inception to October 1st, 2023. Eligibility criteria included studies comparing clinical outcomes of hypoallergenic and standard knee arthroplasties in patients with and without metal hypersensitivity, respectively. Two independent reviewers screened studies, extracted data, and assessed risk of bias using the ROBINS-I tool. The primary outcome measure was the Knee Society Score (KSS). A random-effects model meta-analysis was performed to account for heterogeneity, with results expressed as standardized mean differences (SMD) with 95 % confidence intervals.</p></div><div><h3>Results</h3><p>From an initial 1846 studies identified, six met the inclusion criteria after rigorous screening. The quantitative included 409 knee replacements from three studies, comprising 95 hypersensitive patients who received hypoallergenic TKA and 314 non-allergic patients who underwent standard CoCr implant procedures. Risk of bias assessment revealedmoderate risk or lower across all included studies. Analysis of the KSS yielded an overall effect size (SMD) of −0.18 (95 % CI: −0.54 to 0.18), slightly favoring standard knee arthroplasties. Moderate heterogeneity was observed (I² = 53 %, τ = 0.0526). The qualitative analysis included three studies. Significantly lower improvements were found in KSS, WOMAC, SF-12, and Euro-QoL-5D L-VAS among metal-sensitive patients. The third one reported no significant clinical differences between groups.</p></div><div><h3>Conclusion</h3><p>The scoping analysis showed similar clinical outcome after hypoallergenic TKA in patients with metal hypersensitivity compared to standard knee implants in patients without metal allergy.</p></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0972978X24003234/pdfft?md5=1187f2ab2f75e0736b5f248cc30dd5a2&pid=1-s2.0-S0972978X24003234-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142274497","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":"Peri-operative outcomes of IlluminOss fixation for pelvic metastatic bone disease","authors":"Moses I. Markowitz ,&nbsp;Max Baron ,&nbsp;Julien Montreuil ,&nbsp;Dominic Campano ,&nbsp;Erik Geiger ,&nbsp;Francis Hornicek ,&nbsp;H. Thomas Temple ,&nbsp;Brooke Crawford","doi":"10.1016/j.jor.2024.09.016","DOIUrl":"10.1016/j.jor.2024.09.016","url":null,"abstract":"<div><h3>Background</h3><p>Pelvic metastatic bone disease (MBD) leads to significant pain and functional impairment. Managing these lesions through an open approach involves invasive procedures linked to potential morbidity and complications. The IlluminOss system, a UV light-activated polymer implant, has shown efficacy and safety in managing various fractures. This study evaluates the effectiveness of IlluminOss photodynamic bone stabilization system (PBSS) in pelvic MBD.</p></div><div><h3>Methods</h3><p>A retrospective cohort review was conducted, including all patients treated with the PBSS system for MBD of the pelvis and acetabulum.</p></div><div><h3>Results</h3><p>Fifteen patients were included with a mean follow-up of 4.97 months (SD 3.05). In the thirteen patients treated with the IlluminOss without concurrent total hip arthroplasty, the mean operative time was 170.4 min (SD 90.6). The mean estimated blood loss was 52.3 mL (SD 73.7). No patients required transfusions. The mean visual analog scale (VAS) pain score at the latest follow-up was 2.29, significantly lower than the preoperative score of 9.07 (p &lt; 0.001). Thirteen patients (92.9 %) had improved functional status at the latest follow-up.</p></div><div><h3>Conclusion</h3><p>PBSS offers similar operative times, reduced blood loss, and decreased need for transfusions compared to open pelvic fixation methods. It also demonstrates significant pain reduction and improved functional outcomes without increased complications.</p></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142274491","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":"Geographical incidence of testosterone supplementation in total hip and knee arthroplasty","authors":"Gloria Coden,&nbsp;Andrew Grant,&nbsp;Mikhail Kuznetsov,&nbsp;Eric L. Smith","doi":"10.1016/j.jor.2024.09.002","DOIUrl":"10.1016/j.jor.2024.09.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Prescription testosterone usage in the United States declined after 2013 following reports of its association with myocardial infarction and stroke. However, more recently there has been a documented increase in testosterone prescriptions. Recently, testosterone levels have also been hypothesized to increase infection risk in patients undergoing elective shoulder arthroplasty. Furthermore, testosterone may increase the risk of venous thromboembolism. These complications are perioperative concerns for total hip and knee arthroplasties (THA/TKA). Therefore, the purpose of our study is to identify trends in the incidence of testosterone prescriptions in patients who underwent THA/TKA with respect to geographical population data.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 40,711 primary THAs and 50,893 primary TKAs performed in males between 1/1/2016 and 12/31/2021 using a commercial claims database. Records were reviewed for demographics, geographical location, and supplemental testosterone prescriptions within 1 year prior to surgery. Patient Metropolitan Statistical Area (MSA) was assessed with respect to United States Census Population Data.</div></div><div><h3>Results</h3><div>We identified 91,604 males who underwent primary THA (n = 40,711) or TKA (n = 50,893). For THA/TKA, patients who were younger had a higher likelihood of having a supplemental testosterone prescription (OR = 0.99, 95 % CI [0.99–1.00], p &lt; 0.001). TKA patients (2,507, 4.9 %) had a higher rate of testosterone prescriptions than THA patients overall (1,413, 3.4 %), (OR = 1.44 95 % CI [1.35, 1.54], p &lt; 0.001) as well as within each year.</div><div>For THA and TKA patients, patients in the Midwest (OR = 1.61, p &lt; 0.001), South (OR = 3.04, p &lt; 0.001), and West (OR = 2.28, p &lt; 0.001) regions all had higher testosterone prescription rates than the Northeast. Patients living in a city (MSA population ≥200,000) were more likely to be prescribed testosterone (OR = 1.20, p = 0.002).</div></div><div><h3>Conclusion</h3><div>Surgeons conducting TKA/THA should be aware that younger patients, those in higher population areas, and those in the Midwest, South, and West regions are more likely to be prescribed testosterone than those in the Northeast.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142319499","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":"Exploring predictors of medial collateral ligament tears in lateral approach total knee replacement: A retrospective study","authors":"Michael S. Messieh ,&nbsp;Steve V. Nguyen","doi":"10.1016/j.jor.2024.09.001","DOIUrl":"10.1016/j.jor.2024.09.001","url":null,"abstract":"<div><h3>Background</h3><p>Medial collateral ligament (MCL) tears are uncommon in total knee replacement (TKR), but they pose significant surgical challenges, affecting recovery and outcomes. This study analyzed 18 (1.3 %) MCL tear cases from 1429 TKR procedures using a lateral subvastus approach. Logistic regression with Lasso regularization was used to assess factors like gender, BMI, and knee alignment. Midsubstance disruptions were the most common. MCL tears were more frequent in females, those with higher BMI, and valgus alignment. The Lasso model achieved an AUC of 0.83 and an F1 score of 0.76.</p></div><div><h3>Methods</h3><p>A retrospective analysis on 1429 TKR cases performed by three experienced surgeons using the Optimotion Implant system and specialized MCL retractors was conducted. The lateral subvastus approach without parapatellar arthrotomy. A hinged knee brace was applied postoperatively and a posterior stabilized insert was used for MCL tears. Demographic data were collected, and a Lasso regression model with data balancing, was employed to identify MCL tear predictors.</p></div><div><h3>Results</h3><p>Among the 1429 TKR cases, 18 cases (1.3 %) involved MCL tears. The average age of these patients was 67.3 years (not statistically significant). The average BMI for patients with MCL tears was 36.7, significantly higher than the overall group average of 31.5, suggesting a link between higher BMI and MCL tears. Females were notably more affected, making up 88.9 % of the MCL tear cases compared to 11.1 % of males. Regarding knee alignment, 38.9 % had valgus alignment (p &lt; 0.05), No significant differences were observed in knee flexion or Knee Society Scores (KSS) following MCL tears.</p></div><div><h3>Conclusions</h3><p>Gender, BMI, and knee alignment are significant factors influencing the incidence of MCL tears in TKR procedures. The Lasso model effectively identified individuals at higher risk. Preventive measures, including surgeon training and the use of specialized MCL retractors, were implemented. Functional outcomes such as knee flexion and KSS scores did not show significant differences post-MCL tear.</p></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142274375","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 after cosmetic limb lengthening, a specialized center experience","authors":"Akram Al Ramlawi,&nbsp;Daniel J. Over,&nbsp;Michael Assayag,&nbsp;Philip McClure","doi":"10.1016/j.jor.2024.09.011","DOIUrl":"10.1016/j.jor.2024.09.011","url":null,"abstract":"<div><h3>Background</h3><p>Cosmetic limb lengthening has been rapidly growing ever since the advent of the external fixators magnetic lengthening nails. Similar to all surgical procedures, cosmetic limb lengthening is not risk free. This paper presents a series of complications encountered and treated at a specialized limb lengthening and deformity correction center, along with an analysis of potential risk factors.</p></div><div><h3>Methods</h3><p>A series of referred patients for complications after limb lengthening using IM nails were identified. Collected variables included demographics, place of index surgery, complication, and treatment of choice and outcome of treatment.</p></div><div><h3>Results</h3><p>22 limb lengthening procedures were identified. Most of these cases were done outside of the U.S. Hardware failure occurred in 23 % of index surgeries, primarily affecting femurs. Mal/nonunion rates were high (45 %), with femurs most affected. Iatrogenic deformities, primarily tibial, and soft tissue complications including contractures and nerve entrapment were observed. Treatment strategies included hardware exchange, bone grafting, and soft tissue release. All patients were successfully treated without any patients suffering from serious long term irreversible outcomes.</p></div><div><h3>Conclusion</h3><p>This study examines the surgical management of complications arising from cosmetic limb lengthening procedures at a single institution. We provide insights into effective treatment strategies and highlight the risks associated with medical tourism for these procedures. Our findings demonstrate a rising incidence of complications linked to international limb lengthening centers.</p></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142274492","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}