Journal of Orthopaedic Science最新文献

{"title":"Far cortical locking constructs for fixation of distal femur fractures in an Asian population: A prospective observational study","authors":"Eic Ju Lim ,&nbsp;Jae-Woo Cho ,&nbsp;Oog-Jin Shon ,&nbsp;Jong-Keon Oh ,&nbsp;Kyu Tae Hwang ,&nbsp;Gwang Chul Lee","doi":"10.1016/j.jos.2024.03.007","DOIUrl":"10.1016/j.jos.2024.03.007","url":null,"abstract":"<div><h3>Background</h3><div>The stiffness of locked plates suppresses healing process, prompting the introduction of far cortical locking to address this issue. This study aimed to demonstrate the clinical efficacy of far cortical locking constructs in treating distal femoral fractures in an Asian population.</div></div><div><h3>Methods</h3><div>This multicenter prospective observational study was conducted at four university hospitals between February 2018 and February 2021. Demographic data, the presence of metaphyseal comminution, and surgical fixation details were recorded. Clinical outcomes, including single-leg standing, EQ-5D, and EQ-VAS scores, and radiologic outcomes, including the RUST score of each cortex, were evaluated and compared according to the presence of metaphyseal comminution.</div></div><div><h3>Results</h3><div>There were 37 patients (14 men and 23 women) with a mean age of 67.3 ± 11.8 years. Twenty-two patients had metaphyseal comminution (59%), and 15 presented simple fractures in metaphyseal areas. Four patients (13%) could stand on one leg &gt;10s at 6 weeks, and 24 patients (92%) at 1 year. EQ-5D increased from 0.022 ± 0.388 to 0.692 ± 0.347, and the mean EQ-VAS 51.1 ± 13.1 to 74.1 ± 24.1 between discharge (n = 37) and post-operative 1 year (n = 33), respectively. RUST score presented increment for time, from 6.2 ± 1.8 at 6 week to 11.6 ± 1.1 at 1 year. Radiological healing demonstrated rapid increase from week 6 (16/28, 43%) to month 3 (27/31, 87%), with no obvious increase was observed in 6 months (23/26, 89%) or 12 months (25/28, 89%). Simple metaphyseal fractures presented significantly higher RUST scores at 6 weeks and 3 months, but there was no difference in RUST scores at 6 months or 1 year according to metaphyseal comminution.</div></div><div><h3>Conclusions</h3><div>Plate constructs with far cortical locking screws provided safe and effective fixation for distal femoral fractures, with consistent radiological and clinical results, regardless of metaphyseal comminution.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 2","pages":"Pages 372-378"},"PeriodicalIF":1.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140782285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mo-fi-disc scoring system: Towards understanding the radiological tools to better delineate the disease process and enhancing our solutions for low back pain in artificial intelligence era","authors":"Murat Şakir Ekşi̇ ,&nbsp;Gürkan Berikol ,&nbsp;Emel Ece Özcan-Ekşi̇","doi":"10.1016/j.jos.2024.03.012","DOIUrl":"10.1016/j.jos.2024.03.012","url":null,"abstract":"<div><h3>Background</h3><div><span>‘Mo-fi-disc’ is a new scoring system that quantifies degeneration of the </span>lumbar spine and predicts the intensity of low back pain (LBP). However, its association with LBP-related disability is unknown. In the present study, we aimed to analyze whether ‘Mo-fi-disc’ scoring system could predict LBP-related disability and distinguish patients with LBP from asymptomatic subjects, while the spine medicine marching towards the era of artificial intelligence (AI).</div></div><div><h3>Methods</h3><div><span>This is a cross-sectional analysis of a prospectively collected database. We included age-, gender-, and BMI-matched 132 subjects (patients: 66, asymptomatic subjects: 66). Modic changes (Mo), fatty infiltration in the paraspinal muscles<span> (fi), and intervertebral disc degeneration (disc) were evaluated using ‘Mo-fi-disc’ scoring system on lumbar spine </span></span>magnetic resonance imaging<span><span>. Pain and disability were evaluated with visual analogue scale (VAS) and </span>Oswestry disability index (ODI), respectively.</span></div></div><div><h3>Results</h3><div>A Mo-fi-disc score of 5.5 was the most appropriate cut-off value. Mo-fi-disc scoring system had an OR of 1.79 in distinguishing patients with LBP from asymptomatic subjects. One point increment in VAS and ODI had ORs of 1.82 and 1.13 for predicting higher Mo-fi-disc scores.</div></div><div><h3>Conclusion</h3><div>‘Mo-fi-disc’ scoring system is a useful tool depicting intensity of LBP and LBP-related disability. The cut off value of Mo-fi-disc score is 5.5 to distinguish patients with LBP from asymptomatic subjects. This scoring system, with progressive improvement of its faults, could help clinicians to select appropriate patients for conservative and surgical management in the very near future, in AI-based spine medicine.</div></div><div><h3>IRB approval no</h3><div>ATADEK 2019-12/4.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 2","pages":"Pages 267-272"},"PeriodicalIF":1.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140786465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of accelerometry to detect varus thrust of osteoarthritic knees before and one year after high tibial osteotomy","authors":"Makoto Wada ,&nbsp;Yusuke Yamamoto ,&nbsp;Takayuki Hirai ,&nbsp;Arisa Kubota ,&nbsp;Naoto Takeura ,&nbsp;Takahiro Adachi","doi":"10.1016/j.jos.2024.05.001","DOIUrl":"10.1016/j.jos.2024.05.001","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of this study was to determine the effects of high tibial osteotomy<span> (HTO) on varus thrust during gait in patients with medial compartment knee osteoarthritis (KOA), and to identify factors that influence thrust before and one year after surgery.</span></div></div><div><h3>Methods</h3><div>HTO was performed in 60 KOA patients (70 knees, including 56 knees by open wedge and 14 by closed wedge). The control group comprised 28 normal, control subjects. Several parameters were evaluated before surgery and one year thereafter. Varus thrust was defined as acceleration of the thigh relative to the lower leg in the coronal plane. Knee-injury-and-osteoarthritis-outcome scores (KOOSs), knee joint angles, radiography, and mediolateral knee acceleration during free speed gait were measured and analyzed.</div></div><div><h3>Results</h3><div>One-year after HTO, KOOSs, knee extension angles, and range of knee motion were improved (p &lt; 0.001). The hip-knee-ankle angle and joint-line-convergent angle (JLCA) had decreased (p &lt; 0.001), and walking speed had increased (p &lt; 0.001). Preoperatively, patient acceleration was significantly (p &lt; 0.05) higher than that of controls, and it did not change after HTO. However, it was reduced significantly (p &lt; 0.05) after adjusting for walking speed. Walking speed correlated significantly with acceleration preoperatively, postoperatively, and among controls. Surgical methods (open-wedge/closed-wedge HTO) and correction angle did not affect postoperative acceleration. There was a low correlation between acceleration and KOOSs (KOOSa, KOOSp), knee joint angles, or JLCA postoperatively, but no relationship was found between acceleration and these parameters in the preoperative or the control group.</div></div><div><h3>Conclusions</h3><div>Walking speed correlated significantly with acceleration preoperatively, postoperatively, and with those of controls. Mediolateral acceleration of the thigh relative to the lower leg in patients with KOA was significantly higher than that of normal controls before surgery, and it did not change after HTO. However, after surgery it was reduced significantly after adjusting for walking speed.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 2","pages":"Pages 339-345"},"PeriodicalIF":1.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140958054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Four stem fractures in a 12-year follow-up study of 9,135 patients with Exeter hip stems at seven teaching facilities in Japan","authors":"Kan Sasaki ,&nbsp;Hiroshi Fujita ,&nbsp;Toshiki Iwase ,&nbsp;Tatsuro Sakurai ,&nbsp;Hisanori Oura ,&nbsp;Takkan Morishima ,&nbsp;Fumiaki Nishisaka ,&nbsp;Nao Shibanuma ,&nbsp;Naoyuki Katayama ,&nbsp;Masaji Ishii ,&nbsp;Hiromi Otsuka","doi":"10.1016/j.jos.2024.05.005","DOIUrl":"10.1016/j.jos.2024.05.005","url":null,"abstract":"<div><h3>Background</h3><div>Although excellent long-term results have been reported for the Exeter stem, stem fracture is recognized as a rare complication. However, there have been no reports on the incidence and risk factors for stem fractures based on detailed population information. This study aimed to clarify the incidence of Exeter hip stem fracture based on detailed population information from seven Exeter stem teaching centers in Japan and to examine the risk factors for stem fracture.</div></div><div><h3>Methods</h3><div>A total of 8,499 primary total hip arthroplasties (THA) and 636 revision hip arthroplasties (revisions) performed at seven Exeter teaching hospitals between 1999 and 2021 were included and retrospectively investigated based on medical records.</div></div><div><h3>Results</h3><div>Stem fractures were identified in two primary THA (fracture rate: 0.02%) and two revision THA (fracture rate: 0.21%) cases. The stem length was ≤125 mm in three out of these four cases. Revision and 30 stem were the risk factors for stem fractures. Weight and body mass index (BMI) were not significantly associated with the occurrence of stem fractures.</div></div><div><h3>Conclusions</h3><div>In Western countries, the incidence of Exeter stem fractures is reportedly 0.017−0.15% for primary THA and 0.99−1.21% for revision THA. In this study, the incidence of primary THA was 0.02%, which is similar to the lowest reported rate, whereas the incidence of revision THA was 0.21%, which is lower than that reported in previous studies. Revision surgery had the same risk factors as those reported in the West—namely, stem length ≤125 mm (except for the 30 stem) and BMI, which were not risk factors in Japanese patients.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 2","pages":"Pages 346-351"},"PeriodicalIF":1.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141317576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fracture of the patella involving inferior pole is associated with postoperative patella baja - A retrospective multicenter study","authors":"Fuminori Murase ,&nbsp;Yasuhiko Takegami ,&nbsp;Katsuhiro Tokutake ,&nbsp;Hiroki Oyama ,&nbsp;Oki Arakawa ,&nbsp;Tetsuro Takatsu ,&nbsp;Hiroaki Nakashima ,&nbsp;Kenichi Mishima ,&nbsp;Shiro Imagama","doi":"10.1016/j.jos.2024.03.008","DOIUrl":"10.1016/j.jos.2024.03.008","url":null,"abstract":"<div><h3>Background</h3><div><span>The patella fracture involving of inferior pole fractures (IPF) may be associated with patella baja</span><del>,</del> However, the clinical impact of this condition remains unclear. This study aims to clarify 1) the incidence of patella baja following patellar fracture surgery, 2) the associated clinical outcomes with and without the presence of patella baja, and 3) the potential correlation between the detection of IPF on CT and the occurrence of patella baja.</div></div><div><h3>Methods</h3><div>We conducted a retrospective multicenter study involving 251 patients who underwent surgical treatment for patellar fractures. Patients were divided into the patella baja (PB; n = 49) group and patella norma (PN; n = 202) group. Data collected included demographics, radiographic findings, surgical details, and postoperative complications. We compared these items between PB group and PN group. Logistic regression analyses were used to identify risk factors for patella baja.</div></div><div><h3>Results</h3><div>Immediately following surgery, 36 (14.3%) patients presented with patella baja which increased to 49 cases (19.5%) at six months postoperatively. There is no statistically significant difference in the demographics, surgical details, clinical outcomes and complication between PB group and PN group. While, in the radiographical assessment, the prevalence of IPF on CT scan in the patella baja group was significantly higher than that in the patella norma group. By logistic regression analysis, IPFP on CT was identified as an independent risk factor for patella baja. (odds ratio 2.11, 95% confidence interval: 1.03–4.33, p = 0.042).</div></div><div><h3>Conclusion</h3><div>In patients with patellar fractures, the incidence of patella baja increased from 14.3% immediately post-surgery to 19.5% at the six-month check-up. No significant differences were observed in clinical outcomes between the patella baja group and the norma group. The patella fracture involving IPF on CT emerged as a predictive factor for patella baja.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 2","pages":"Pages 379-384"},"PeriodicalIF":1.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140336108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Magnetic resonance imaging findings in patients with dropped head syndrome","authors":"Tomoyuki Ueshima ,&nbsp;Kenji Endo ,&nbsp;Hirosuke Nishimura ,&nbsp;Yasunobu Sawaji ,&nbsp;Hidekazu Suzuki ,&nbsp;Takato Aihara ,&nbsp;Kazuma Murata ,&nbsp;Takamitsu Konishi ,&nbsp;Takuya Kusakabe ,&nbsp;Hideya Yamauchi ,&nbsp;Jun Matsubayashi ,&nbsp;Kengo Yamamoto","doi":"10.1016/j.jos.2024.04.005","DOIUrl":"10.1016/j.jos.2024.04.005","url":null,"abstract":"<div><h3>Background</h3><div>Dropped head syndrome (DHS) is difficult to diagnose only by clinical examination. Although characteristic images on X-rays of DHS have been studied, changes in soft tissue of the disease have remained largely unknown. Magnetic resonance imaging (MRI) is useful for evaluating soft tissue, and we therefore performed this study with the purpose of investigating the characteristic signal changes of DHS on MRI by a comparison with those of cervical spondylosis.</div></div><div><h3>Methods</h3><div>The study involved 35 patients diagnosed with DHS within 6 months after the onset and 32 patients with cervical spondylosis<span> as control. The signal changes in cervical extensor muscles, interspinous tissue, anterior longitudinal ligament (ALL) and Modic change on MRI were analyzed.</span></div></div><div><h3>Results</h3><div>Signal changes of cervical extensor muscles were 51.4% in DHS and 6.3% in the control group, those of interspinous tissue were 85.7% and 18.8%, and those of ALL were 80.0% and 21.9%, respectively, suggesting that the frequency of signal changes of cervical extensor muscles, interspinous tissue and ALL was significantly higher in the DHS group (p &lt; 0.05). The presence of Modic change of acute phase (Modic type I) was also significantly higher in the DHS group than in the control group (p &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>MRI findings of DHS within 6 months after the onset presented the characteristic signal changes in cervical extensor muscles, interspinous tissue, ALL and Modic change. Evaluation of MRI signal changes is useful for an objective evaluation of DHS.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 2","pages":"Pages 273-277"},"PeriodicalIF":1.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140864358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infection of surgery for bone and soft tissue sarcoma with biological reconstruction: Data from the Japanese nationwide bone tumor registry","authors":"Takeshi Morii ,&nbsp;Koichi Ogura ,&nbsp;Kenji Sato ,&nbsp;Akira Kawai","doi":"10.1016/j.jos.2024.04.006","DOIUrl":"10.1016/j.jos.2024.04.006","url":null,"abstract":"<div><h3>Background</h3><div><span><span>Although biological reconstruction (such as recycled autograft, vascularized autograft, </span>allograft<span><span>, or bone transport) is possible for bone defects after malignant bone or </span>soft tissue tumor<span> resection, a high incidence of postoperative complications, including infection, poses a problem. The difficulty in accumulating cases has resulted in a lack of reliable etiological information, such as the incidence and risk factors of </span></span></span>postoperative infections.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study on the nationwide registry data. The primary endpoint was the need for additional surgical intervention for infection control. The overall incidence of postoperative infection and the related risk factors were analyzed.</div></div><div><h3>Results</h3><div>We included 707 malignant bone and soft tissue tumors with biological reconstruction, including recycled autograft, vascularized autograft, allograft, bone transport, and combinations of these. The incidence of postoperative infection was 10.8%. Patients reconstructed by pedicled autograft showed a higher incidence of infection, while cases involving the combination of recycled and pedicled autograft or allograft showed a lower incidence. Independent risk factors for infection included age over 17, tumor diameter over 10 cm, the tumor located on the trunk or being high grade, reconstruction by pedicled autograft, and delayed wound healing.</div></div><div><h3>Conclusion</h3><div>Infection incidence was comparable to those in previous reports. Several conventional and novel risk factors were extracted by administering nationwide registry data. Data from the nationwide registry was informative for analyzing the incidence of postoperative infection in biological reconstruction with malignant bone and soft tissue tumor resection.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 2","pages":"Pages 390-396"},"PeriodicalIF":1.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140958053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting anterior cruciate ligament degeneration using magnetic resonance imaging: Insights from histological evaluation","authors":"Shuji Toyono ,&nbsp;Akemi Suzuki ,&nbsp;Yoshihiro Wanezaki ,&nbsp;Daiichiro Takahara ,&nbsp;Rintaro Ohe ,&nbsp;Shigenobu Fukushima ,&nbsp;Mitsuru Futakuchi ,&nbsp;Michiaki Takagi","doi":"10.1016/j.jos.2024.04.009","DOIUrl":"10.1016/j.jos.2024.04.009","url":null,"abstract":"<div><h3>Background</h3><div>Mucoid degeneration of the anterior cruciate ligament<span><span> is a pathological condition that may impair knee mechanics and contribute to the symptomatology of </span>osteoarthritis<span>. This study aimed to evaluate whether preoperative magnetic resonance imaging can predict anterior cruciate ligament degeneration, specifically mucoid degeneration, and to elucidate the histopathological characteristics of mucoid degeneration in knee osteoarthritis patients.</span></span></div></div><div><h3>Methods</h3><div><span><span>We evaluated a total of 95 knees of osteoarthritis patients (23 males, 72 females; mean age: 72.7 ± 7.5) scheduled for </span>total knee arthroplasty<span>. The relationship between preoperative magnetic resonance imaging findings and the histopathological evidence of anterior cruciate ligament mucoid degeneration was examined. Immunohistochemical analysis was employed for collagen types (COL-I, COL-II), chondrogenesis (SOX9), and </span></span>vascularity (CD31).</div></div><div><h3>Results</h3><div><span>High signal intensity on magnetic resonance imaging showed a positive correlation with Alcian Blue staining areas (rs = 0.59, p &lt; 0.01) and the swelling index (rs = 0.62, p &lt; 0.01), indicating advanced mucoid degeneration. The </span>absence<span><span> of synovial lining around the anterior cruciate ligament was associated with more severe degeneration. In the histological evaluations, advanced degeneration was characterized by an increase in chondroid </span>metaplasia<span> and collagen disorientation. The Alcian Blue<span> and SOX9<span> correlation was positive (rs = 0.69, p &lt; 0.01), but negative with COL-I (rs = −0.38, p = 0.03) and vascularity (CD31) (rs = −0.60, p &lt; 0.01).</span></span></span></span></div></div><div><h3>Conclusions</h3><div>Preoperative magnetic resonance imaging is an effective tool in assessing the severity of anterior cruciate ligament degeneration; it influences surgical decisions. High signal intensity on magnetic resonance images denotes advanced mucoid degeneration. The absence of synovial lining around the anterior cruciate ligament is associated with more severe degeneration and may accelerate degenerative changes. Chondroid metaplasia and collagen disorientation mark advanced degeneration. Magnetic resonance imaging can be used to gauge the degree of anterior cruciate ligament degeneration in osteoarthritis.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 2","pages":"Pages 325-332"},"PeriodicalIF":1.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141074496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Joint-preserving effect and patient-reported outcomes of transtrochanteric curved varus osteotomy for osteonecrosis of the femoral head","authors":"Yusuke Ayabe,&nbsp;Goro Motomura,&nbsp;Satoshi Ikemura,&nbsp;Ryosuke Yamaguchi,&nbsp;Takeshi Utsunomiya,&nbsp;Noriko Yamamoto,&nbsp;Hidenao Tanaka,&nbsp;Satoshi Hamai,&nbsp;Shinya Kawahara,&nbsp;Yasuharu Nakashima","doi":"10.1016/j.jos.2024.03.010","DOIUrl":"10.1016/j.jos.2024.03.010","url":null,"abstract":"<div><h3>Background</h3><div>This study assessed the hip survival rate and patient-reported outcome measures (PROMs) of transtrochanteric curved varus osteotomy<span> (CVO) for osteonecrosis of the femoral head (ONFH) compared with those of conservative management.</span></div></div><div><h3>Methods</h3><div>The CVO group comprised 32 consecutive patients (39 hips) who underwent CVO for ONFH between 2000 and 2011. The conservative group consisted of 36 consecutive patients (37 hips) who were managed conservatively for at least 1 year after collapse and who had ONFH classified by the Japanese Investigation Committee of Health and Welfare as type B or C1, for which CVO is indicated. Kaplan–Meier analysis of hip survival used any ONFH-related therapeutic surgery as the endpoint. PROMs were evaluated for all patients with surviving hips and radiographs available at the latest follow-up.</div></div><div><h3>Result</h3><div>The 10-year hip survival rate in the CVO group was 86.7%, which was significantly higher than the 51.0% 5-year survival rate in the conservative group (p &lt; 0.0001). The Oxford Hip Score and UCLA Activity Score were significantly better in the CVO group without joint space narrowing than in the conservative group, with no significant differences between the CVO group with joint space narrowing and the conservative group.</div></div><div><h3>Conclusion</h3><div>CVO could preserve hip joints more effectively than conservative follow-up after collapse, although the presence of joint space narrowing could reduce satisfaction levels even in patients with long-term hip survival.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 2","pages":"Pages 313-319"},"PeriodicalIF":1.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140787994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Action protocol of medical staff for airway obstruction after anterior cervical spine surgery: A systematic review of case reports","authors":"Kentaro Yamada ,&nbsp;Toshitaka Yoshii ,&nbsp;Takashi Hirai ,&nbsp;Atsushi Kudo ,&nbsp;Nobuyuki Nosaka ,&nbsp;Satoru Egawa ,&nbsp;Yu Matsukura ,&nbsp;Hiroyuki Inose ,&nbsp;Atsushi Okawa","doi":"10.1016/j.jos.2024.03.011","DOIUrl":"10.1016/j.jos.2024.03.011","url":null,"abstract":"<div><h3>Background</h3><div><span>Postoperative airway obstruction after anterior cervical spine surgery (ACSS) can be a fatal complication. Occasionally, it rapidly progresses to complete obstruction. There are no established standardized protocols on how medical staff should assess for signs and symptoms, seek help, or facilitate airway management after ACSS to prevent unfavorable events. This study aimed to primarily describe a systematic approach by assessing the signs and treatment outcomes of airway compromise in patients who underwent ACSS. Further, it recommended an action protocol after </span>extubation for medical staff according to patients’ symptoms to prevent unfavorable outcomes.</div></div><div><h3>Methods</h3><div><span>An extensive literature search was performed on PubMed, Web of Science, and the Cochrane Library to identify case reports, case series, and cohort studies restricted to English and published between January 1990 and March 2023. We included cases that described the signs, symptoms, and treatment of airway obstruction after ACSS. Meanwhile, cases involving complications of other known causes, cases of trauma or occipital-cervical fixation, or those using </span>bone morphogenetic protein were excluded.</div></div><div><h3>Results</h3><div>Twenty cases from 17 studies were obtained, and their study quality was acceptable. Four patients died, and two presented with hypoxic ischemic encephalopathy. Further, five of six patients had fatal complications that initially developed within 7 h after surgery. Then, 9 (69%) of 13 patients with evidence of hematoma (69%) showed initial symptoms within 12 h after surgery. Finally, 9 of 11 patients with early-stage symptoms had favorable outcomes, and patients who developed late-stage symptoms commonly had unfavorable outcomes.</div></div><div><h3>Conclusion</h3><div>The early identification of signs and symptoms and immediate treatment are important, particularly within 12 h postoperatively. We suggest a novel action protocol for medical staff according to symptom urgency, which includes the measurement of neck circumference using a string for evaluating neck swelling.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 2","pages":"Pages 259-266"},"PeriodicalIF":1.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140789674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}