Orthopaedic Surgery最新文献

{"title":"Trapdoor Procedure for Benign Bone Lesions in the Femoral Head of Skeletally Immature Children.","authors":"Qichao Ma, Fangchun Jin, Taichun Li, Honghong Pei, Yichen Wang, Yi Luo, Ziming Zhang","doi":"10.1111/os.70083","DOIUrl":"https://doi.org/10.1111/os.70083","url":null,"abstract":"<p><strong>Objective: </strong>Benign bone lesions involving the femoral head are common in pediatric populations but pose significant challenges due to anatomical complexity and the need to preserve growth plate integrity. This study aims to evaluate the efficacy of the trapdoor procedure in treating these lesions in skeletally immature patients.</p><p><strong>Methods: </strong>From 2013 to 2023, five pediatric patients with femoral head bone lesions were identified who underwent the trapdoor procedure retrospectively. Preoperative assessments included computed tomography (CT) and magnetic resonance imaging (MRI). Follow-up spanned a mean of 37.8 ± 11.2 months, with attention to pathology, recurrence, and complications. Functional outcomes were assessed using the McKay clinical grading method.</p><p><strong>Results: </strong>Histological examination postoperatively confirmed Langerhans cell histiocytosis (LCH) in two patients and chondroblastoma in two others. One patient's diagnosis remained unclear, indicating only fibrous tissue cell proliferation. No recurrences were observed, but avascular necrosis (AVN) occurred in both LCH patients, necessitating revision surgery.</p><p><strong>Conclusions: </strong>The trapdoor procedure is a safe and effective method for treating benign bone lesions of the femoral head in children, with attention needed for the potential of AVN.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Lateral Ankle Sprain Impairs Function and Strength Without Altering Muscle or Tendon Stiffness: A Controlled Observational Study.","authors":"Pedro Bainy Franz, José Roberto de Souza Júnior, Hortência Cordeiro de Lima, Estevão de Souza Diniz, Rogério de Brito Aguiar, Jeam Marcel Geremia, Henrique Mansur, Rita de Cássia Marqueti, João Luiz Quagliotti Durigan","doi":"10.1111/os.70082","DOIUrl":"https://doi.org/10.1111/os.70082","url":null,"abstract":"<p><strong>Introduction: </strong>Acute lateral ankle sprain (LAS) frequently results in persistent functional limitations. Understanding changes in calf muscle and Achilles tendon (AT) stiffness after LAS may shed light on mechanisms underlying impaired function.</p><p><strong>Objective: </strong>To investigate the effects of acute LAS on the mechanical properties of the calf muscles and the Achilles tendon, ankle function, pain, edema, and strength.</p><p><strong>Methods: </strong>This controlled observational study was conducted from August 2023 to January 2025. Fourteen participants with acute LAS and 14 healthy controls were evaluated twice, 6 weeks apart. Shear wave elastography (SWE) assessed the stiffness of the triceps surae and AT. Ankle function, pain, and edema were evaluated using the Foot and Ankle Outcome Score, Visual Analog Scale, and figure-of-eight method. Plantar flexion strength was measured via isometric dynamometry.</p><p><strong>Results: </strong>No significant differences in stiffness were found between or within groups (soleus: p = 0.932; MG: p = 0.760; LG: p = 0.800; AT: p = 0.070), although a time effect (p = 0.005, η² = 0.269) indicated a general increase in AT stiffness over time (MD = -0.72, p = 0.05, d = 2.86). At baseline, the LAS group exhibited reduced ankle function (MD = 3.43, p < 0.001, d = 2.20), increased pain (MD = 1.88, p < 0.001, d = 1.86), and greater edema (MD = -51.27, p < 0.001, d = -3.58). Over time, improvements were noted in function (MD = -37.04, p < 0.001, d = 2.27), pain (MD = 2.66, p < 0.001, d = -1.31), and edema (MD = 1.07, p = 0.014, d = -0.95), but ankle function remained lower in the LAS group at follow-up (MD = -14.17, p < 0.001, d = -1.79). For plantar flexion strength, no group × time interaction was found (p = 0.745), but a group effect indicated lower peak torque in the LAS group (MD = -32.05, p = 0.012, d = -3.82). A time effect (p < 0.001, η² = 0.622) showed increased torque across both groups (MD = -18.74, p < 0.001, d = 3.07).</p><p><strong>Conclusion: </strong>LAS reduces ankle function and leads to pain and edema but does not induce notable changes in calf muscle or AT stiffness within 6 weeks.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digitized Precision Corrective Osteotomy for Treating Knee Joint Deformities: Current Evidence and Future Perspectives.","authors":"Xiaoyu Wang, Qinglin Kang","doi":"10.1111/os.70085","DOIUrl":"https://doi.org/10.1111/os.70085","url":null,"abstract":"<p><p>Accurate alignment correction is closely correlated with functional results after corrective osteotomy for knee joint deformities. Traditionally, osteotomy procedures were performed on the basis of the surgeon's experience and direct visual estimation. However, discrepancies between the planned and achieved corrections usually exist due to pre- and intraoperative errors. Digitized orthopedic surgery is an exciting field that utilizes computer science and medical engineering to facilitate personalized surgical treatment. Its potential in corrective osteotomy for treating knee joint deformity deserves a comprehensive review. This review searched the relevant literature in the Web of Science, Scopus, and PubMed, and focused on three aspects: three-dimensional (3D) printed patient-specific instrumentation, computer navigation system, and surgical robots. The characteristics and research status of digitized corrective osteotomy for treating knee joint deformities are outlined. The first-hand experiences from relevant papers and potential future advances in clinical, educational, and research areas were summarized. Current concerns about the already used approaches were clarified. Technological innovations in corrective osteotomy have steadily evolved with the aim of ensuring surgical precision and alignment accuracy, simplifying operational procedures, and improving patient outcomes. Digitized orthopedic surgery has favorable potential in terms of surgical practice, skill training, and delivery of healthcare information. Surgical navigation systems with synthetic functions of planning, training, and robotic assistance should be developed.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do Meta-Analyses of Total Hip Arthroplasty Produce Reliable Results? A Systematic Review and Meta-Epidemiological Study of Statistical Methods.","authors":"Nikolai Ramadanov, Maximilian Voss, Radharani Michelle Diallo, Jonathan Lettner, Hassan Tarek Hakam, Robert Prill, Roland Becker, Robert Hable","doi":"10.1111/os.70077","DOIUrl":"https://doi.org/10.1111/os.70077","url":null,"abstract":"<p><strong>Background: </strong>Total hip arthroplasty (THA) is a highly successful orthopedic procedure, with numerous meta-analyses published to optimize its outcomes. However, the reliability of their results and conclusions depends heavily on the use of appropriate statistical methods. Therefore, the aim was to test the reliability of statistical methods in meta-analyses of THA by examining the degree of heterogeneity, the effect of different between-study variance estimators, and the equality of sample size of pooled primary studies.</p><p><strong>Methods: </strong>The literature was systematically searched in PubMed from January 1, 2022, to December 31, 2023, for meta-analyses on THA. The quality of the meta-analyses was assessed using the revised Measurement Tool to Assess Systematic Reviews (AMSTAR 2). All meta-analyses were recalculated using eight different heterogeneity estimators. The following indicators were considered: inequality of patient numbers, proportion of random-effects and fixed-effects models, heterogeneity with I² value, ratio of effect sizes (RES), ratio of confidence interval width (RCIW), and the number of significant results. Mixed linear regression was then used to analyze whether the effect sizes and CIW were significantly different using different heterogeneity estimators. Finally, all examined meta-analyses were recalculated using the eight heterogeneity estimators and the Hartung-Knapp (HK) adjustment.</p><p><strong>Results: </strong>Of the 24 meta-analyses examined, 15 reported an outcome using a mean difference and 20 reported an outcome using an odds ratio. The quality assessment identified 10 meta-analyses of high quality, 7 of moderate quality, 4 of low quality, and 3 of critically low quality. The significance of the examined meta-analyses varied considerably depending on the heterogeneity estimators used. In particular, the DerSimonian and Laird and Hunter-Schmidt heterogeneity estimators tended to produce false-positive results. The meta-analyses examined generally did not use HK adjustment. This effect is amplified when combined with the weak DerSimonian and Laird heterogeneity estimator, which were used in almost all examined meta-analyses.</p><p><strong>Conclusion: </strong>Without HK adjustment, the results depend strongly on the heterogeneity estimator chosen and there is a risk of false positives, especially for the widely used DerSimonian and Laird heterogeneity estimator. For HK adjustment, the choice of heterogeneity estimator seems to play a less important role. We recommend the use of more reliable heterogeneity estimators as well as the HK adjustment as a measure to improve the statistical methodology of meta-analyses. This study highlights the critical need for improved statistical rigor in meta-analyses of THA, ensuring more reliable evidence for clinical decision-making and guideline development.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144160742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive Impact of Multiplanar Malalignment on Prosthetic Mechanics Under Gait Loading After Total Knee Arthroplasty-A Finite Element Analysis.","authors":"Yichao Luan, Min Zhang, Xiang Dong, Hongping Duan, Zhiwei Wang, Zhichang Li, Cheng-Kung Cheng","doi":"10.1111/os.70068","DOIUrl":"https://doi.org/10.1111/os.70068","url":null,"abstract":"<p><strong>Background: </strong>Component alignment is a key factor influencing clinical outcomes after total knee arthroplasty (TKA). Previous studies have shown that single-plane alignment can significantly affect knee joint kinematics and biomechanics. However, the comprehensive impact of multiplanar malalignment has been rarely investigated.</p><p><strong>Objective: </strong>This study aimed to investigate the influence of the multiplanar malalignment combination on the polyethylene tibial liners under gait loading, a primary activity of daily life, as well as the degree of the influence of the alignments on the different planes.</p><p><strong>Method: </strong>A validated finite element model of a cruciate-retaining knee prosthesis under gait loading was used in this study. Five alignment parameters (-5°, -3°, 0°, 3°, 5°) on each plane (coronal, sagittal, and transverse) were selected to simulate clinical alignment errors, resulting in 125 models combining various alignment errors across the three planes. Boundary and loading conditions were set according to ISO 14243-3:2014. The maximum von Mises stress and contact stress during a gait cycle were recorded for statistical analysis. A polynomial model was used for regression analysis, with the degree of influence of each alignment error on von Mises and contact stress determined by examining the quadratic coefficients.</p><p><strong>Results: </strong>The highest Mises and contact stress values occurred with alignment errors of 5° varus, 5° flexion, and 5° internal rotation on the coronal, sagittal, and transverse planes, respectively. The lowest stress values were observed with a combination of 3° valgus, 5° flexion, and 0° internal rotation. The regression analysis yielded an R² value of 0.69 between alignment errors and Mises stress, with quadratic coefficients of 0.096, 0.013, and 0.064 for the coronal, sagittal, and transverse alignments, respectively. For contact stress, the R² was 0.697, with quadratic coefficients of 0.083, 0.002, and 0.026 for the coronal, sagittal, and transverse alignments, respectively.</p><p><strong>Conclusion: </strong>The coronal alignment of the lower limb has the most significant impact on both Mises stress and contact stress of the tibial liner, followed by the rotational alignment of the tibial component. In contrast, the sagittal alignment of the femoral component has the least influence.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144160740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One-Year Functional Outcomes Following Geriatric Hip Fracture: A Prospective Cohort Analysis.","authors":"Wei Zheng, Qianying Cai, Changqing Zhang, Shengbao Chen, Kai Fu","doi":"10.1111/os.70081","DOIUrl":"https://doi.org/10.1111/os.70081","url":null,"abstract":"<p><strong>Objective: </strong>With the characteristics of population change, geriatric hip fracture is increasing, accompanied by high morbidity and mortality rates. However, limited research has thoroughly investigated the postsurgery functional outcomes of hip fractures in the elderly population.</p><p><strong>Methods: </strong>This study included 993 patients who underwent hip fracture surgery, drawn from a prospective cohort in China. Demographic and clinical data were collected for all participants. The cohort was randomly divided into training and validation sets (8:2). Least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression analyses were employed to identify predictive factors for hip function at 12 months postoperatively. A nomogram was developed using R software and evaluated using concordance index (C-indexes), area under the curve (AUC), decision curve analysis (DCA), and calibration curves.</p><p><strong>Results: </strong>Patients were divided into training (n = 794) and validation set (n = 199). Eight independent predictive variables for the poor functional outcome (Harris Hip Score < 80) after hip fracture include age (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.04-1.12), hypertension history (OR, 2.53; 95% CI, 1.50-4.23), fracture type (OR, 0.28; 95% CI, 0.17-0.48), blood transfusion (OR, 2.30; 95% CI, 1.35-3.94), baseline PARKER score (OR, 0.85; 95% CI, 0.75-0.97), adverse events occurred within 12 months postoperatively (OR, 5.49; 95% CI, 2.30-13.08), transfer to the rehabilitation institution (OR, 3.22; 95% CI, 1.51-6.88), and time from surgery to weight-bearing (OR, 1.02; 95% CI, 1.01-1.03). The nomogram demonstrated excellent predictive ability in the training set (AUC = 0.853, [95% CI: 0.816-0.890]). Furthermore, according to the calibration curve, the model's prediction and actual observation were in good consistency, and the DCA curve demonstrated good clinical usefulness.</p><p><strong>Conclusions: </strong>This study developed a personalized, predictive nomogram with eight risk factors for predicting 1-year functional outcomes in geriatric patients with hip fractures. Our model facilitates the early identification of high-risk patients and enables surgeons to implement timely preventive interventions.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterior Cervical V-Shaped Osteotomy and Fusion (ACVF) for Retro-Corporeal Decompression Bypassing Anterior Corpus Vertebra: A Technical Note.","authors":"Minghe Yao, Yaling Li, Beiyu Wang, Tingkui Wu, Kangkang Huang, Shihao Chen, Xiaoqiang Zhao, Yi Deng, Hao Liu","doi":"10.1111/os.70076","DOIUrl":"https://doi.org/10.1111/os.70076","url":null,"abstract":"<p><strong>Objective: </strong>Anterior cervical discectomy and fusion (ACDF) is a trans-intervertebral space procedure with limited ability to treat compression at the back of the vertebral body. Anterior cervical corpectomy and fusion (ACCF) can be applied in this case, but the higher complication rates restrict its usage. This study aims to describe an ACDF-based procedure named anterior cervical V-shaped osteotomy and fusion (ACVF) with a long axial decompression range while preserving the intact anterior half of the vertebral body.</p><p><strong>Method: </strong>Four patients with contiguous two-level degenerative cervical myelopathy who underwent ACVF with 12-month follow-up were retrospectively reviewed. Intraoperatively, an electrode penetration test was conducted to verify complete decompression. Clinical outcomes were evaluated using the modified Japanese Orthopedic Association (mJOA) score and the Visual Analog Scale (VAS) score. Radiological examinations, including computed tomography (CT) and magnetic resonance imaging (MRI), were used to assess spinal cord decompression and intervertebral fusion.</p><p><strong>Results: </strong>All surgeries were successfully completed with an average operative time of 182 min. Both the mJOA score and the VAS score improved at the follow-ups postoperatively. Postoperative imaging showed thorough decompression of the spinal cord, unimpaired fusion process, and acceptable vertebral body height loss.</p><p><strong>Conclusions: </strong>ACVF may be safe and effective for spinal cord direct decompression in the case of retro-corporeal compression, with the potential to serve as a substitute for ACCF and avoid the complications associated with long-strut grafts.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential Influence of Sagittal Parameters in the Pathogenesis of Patients With the Thoracic Ossification of the Ligamentum Flavum.","authors":"Zixuan Xu, Lei Yuan, Siyu Zhou, Xinhu Guo, Shuai Jiang, Longjie Wang, Guanghui Chen, Yuanyu Hu, Junbo Qi, Zhaoqing Guo, Qiang Qi, Weishi Li, Chuiguo Sun","doi":"10.1111/os.70061","DOIUrl":"https://doi.org/10.1111/os.70061","url":null,"abstract":"<p><strong>Purpose: </strong>There are many causes of thoracic ossification of the ligamentum flavum (TOLF), of which mechanical stress factors have gained increasing attention. This study aimed to explore the potential pathogenesis of TOLF by comparing spinal sagittal alignment parameters between patients with TOLF and an asymptomatic population.</p><p><strong>Methods: </strong>We retrospectively included patients who underwent surgical treatment for thoracic myelopathy caused by OLF at Peking University Third Hospital from 2012 to 2022. Sagittal alignment parameters measured by picture archiving and communication system were compared between the TOLF group and a control group with independent t-test, Wilcoxon rank-sum test, and Chi-Squared test. Patients with caudal insertion of OLF above the T10 level were categorized into Group 1, while those with caudal insertion below the T10 level were categorized into Group 2. Sagittal alignment parameters were then compared among these two groups and the control group.</p><p><strong>Results: </strong>Compared with the control group, the OLF group exhibited less lumbar lordosis (44.46° ± 11.41° vs. 52.55° ± 9.70°, p < 0.001), greater thoracolumbar curvature, greater PI-LL mismatch, and greater SVA imbalance. In patients with caudal insertion of the OLF above the T10 level, PI, PT, and LL were smaller compared to the control group. Patients with caudal insertion below the T10 level had smaller LL, greater thoracolumbar kyphosis, more severe SVA imbalance, and more severe PI-LL mismatch.</p><p><strong>Conclusion: </strong>Patients with TOLF have a straighter spine. Mechanical stress plays a more significant role in the development of TOLF in patients with caudal lesions below the T10 level. In patients with TOLF not involving the thoracolumbar segment, factors other than mechanical stress, such as endocrine factors, may play a more crucial role in the development of TOLF.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Late-Onset Spinal Cord Dysfunction in Rigid Posttraumatic Thoracolumbar Kyphosis: Radiographic Analysis of Neurological Compromise.","authors":"Jiaqi Zhang, Yinhao Liu, Yan Zeng, Weishi Li","doi":"10.1111/os.70075","DOIUrl":"https://doi.org/10.1111/os.70075","url":null,"abstract":"<p><strong>Objective: </strong>Late-onset neurological deficit is a severe complication usually attributed to the medullary compression at the apex as the kyphotic deformity develops gradually. However, little is known about another rare cause of proximal adjacent segment degeneration (ASD) above the kyphosis. This study aimed to report the surgical outcome of rigid posttraumatic thoracolumbar kyphosis combined with neurological deficits and to illustrate the different causes of late-onset spinal cord dysfunction and their relationship to spinopelvic alignment.</p><p><strong>Methods: </strong>In this retrospective cohort study, 39 patients with rigid posttraumatic thoracolumbar kyphosis who underwent surgical correction were enrolled. All patients had late-onset spinal cord dysfunction, and the causes were classified according to the location of the lesion. Patients were divided into Group A (patients without proximal ASD) and Group B (patients with proximal ASD). Neurologic status was graded using the American Spinal Injury Association (ASIA) Impairment Scale. The visual analog scale (VAS) and Japanese Orthopedic Association scores-29 (JOA-29) were utilized for clinical assessment. Radiographic parameters of X-ray and MRI were compared between the two groups.</p><p><strong>Results: </strong>Twenty-three patients (59.0%) had neurological deficits only resulting from the kyphosis itself, and 10 patients (25.6%) had developed neurological dysfunction related to thoracic stenosis above the kyphosis. The remaining six patients (15.4%) had coexisting compression both at and above the kyphotic apex. All the ASD occurred in the lower thoracic spine, and the level of T10/11 was the most involved site. Patients who developed proximal ASD had significantly smaller adjacent thoracic kyphosis (ATK) (1.2 ± 9.6 vs. 14.4 ± 11.6, p < 0.001). These patients had significantly worse preoperative ASIA grades and lower JOA-29 at final follow-up.</p><p><strong>Conclusions: </strong>Proximal ASD above kyphosis could cause late-onset neurological deterioration. Compensatory lordosis in the lower thoracic spine might be associated with degenerative spinal stenosis. The dominant compensatory mechanism might be a decisive factor in developing proximal ASD.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multilevel Meta-Analysis of Treatment Options for Patients With Iliopsoas Impingement Syndrome After Total Hip Arthroplasty.","authors":"Nikolai Ramadanov, Maximilian Voss, Robert Hable, Robert Prill, Dobromir Dimitrov, Marco Ezechieli, Ingo J Banke, Roland Becker","doi":"10.1111/os.70021","DOIUrl":"https://doi.org/10.1111/os.70021","url":null,"abstract":"<p><strong>Objective: </strong>Iliopsoas impingement (IPI) syndrome is a significant complication following total hip arthroplasty (THA), often leading to pain and reduced hip function. Despite its clinical relevance, the optimal treatment strategy remains unclear, with varying success rates reported across different interventions. This study aims to compare four treatment options (endoscopic, acetabular cup revision, open tenotomy and conservative management) for patients with IPI syndrome after THA by comparing outcomes in terms of function, pain, complications, and reoperations through a multilevel meta-analysis.</p><p><strong>Methods: </strong>A literature search was conducted in the following databases until 30 November 2024: PubMed, CENTRAL, Epistemonikos, and Embase. A frequentist multilevel meta-analysis was performed using a random effects model with an inverse variance and restricted maximum likelihood heterogeneity estimator with Hartung-Knapp adjustment. Means with 95% confidence intervals (CIs) were calculated separately in the four treatment groups. Then, a test for subgroup differences in multilevel meta-analysis was performed to determine whether there is a statistically significant difference between the means of the four groups.</p><p><strong>Results: </strong>The systematic review included 15 studies with 425 patients. The test for subgroup differences showed no statistically significant difference between the four treatment subgroups in Harris Hip Score (HHS) post-intervention (F = 2.0; df = 3, 7; p = 0.20), in HHS difference (F = 2.0; df = 3, 6; p = 0.22), and in functional minimal clinically important differences (MCID) post-intervention (F = 1.0; df = 3, 2; p = 0.42). The conservative management group exhibited the lowest mean HHS (70.3 points).</p><p><strong>Conclusions: </strong>Surgical interventions, including endoscopic tenotomy, acetabular cup revision, and open tenotomy, are effective in achieving meaningful functional improvements in IPI patients. While conservative management was the least effective of all treatment groups, the differences did not reach statistical significance.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}