Orthopaedic Surgery最新文献

{"title":"Computer-Aided High Tibial Osteotomy-A Comparative Study of Commonly Used 3D Printing Technology and Navigation Application.","authors":"Elvis Chun-Sing Chui, Kyle Ka-Kwan Mak, Randy Hin-Ting Ng, Ericsson Chun-Hai Fung, Mei-Shuen Chan, Kai Yue, Lawrence Chun-Man Lau, Clifford Long-Fung Chan, Edmond Wing-Fung Yau, Wei Zhao, Xiuyun Su, Jin Zhang, Jianglong Xu, Hongxun Sang, Guoxian Pei, Louis Wing-Hoi Cheung, Sheung-Wai Law, Michael Tim-Yun Ong, Patrick Shu-Hang Yung","doi":"10.1111/os.14274","DOIUrl":"https://doi.org/10.1111/os.14274","url":null,"abstract":"<p><strong>Background: </strong>High tibial osteotomy (HTO) is a surgical procedure for treating certain knee conditions. Proper execution of HTO can preserve joint function and delay or avoid the need for total knee replacement. This study compared different 3D printing techniques (fused deposition modeling, selective laser sintering, and direct metal laser sintering) and a navigation system for their suitability in assisting HTO surgeries.</p><p><strong>Methods: </strong>Tibial saw-bones were used as models, and surgical guides and the navigation system were employed during the procedures. Six parameters (planning time, manufacturing time, delivery time, material cost, operation time, and accuracy) were evaluated. One-way analysis of variance (ANOVA) and t-test were used for the analysis.</p><p><strong>Results: </strong>The results showed that the metal surgical guides had the highest accuracy (angle differences mean, 2.4°) and operation time (mean 9.75 min), followed by plastic guides, classic guides, and the navigation system. The differences in accuracy were attributed to factors like rigidity, melting point, and errors during incisions.</p><p><strong>Conclusions: </strong>The study recommended metal surgical guides as the best option for assisting HTO due to their accuracy and operation time. And the results have implications for orthopedic surgeons performing HTO surgeries, as they can use this information to improve postoperative outcomes, such as mechanical axis alignment and quality of life for HTO patients.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142876900","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":"Curve Behavior of Distal Segments After Posterior-Only Hemivertebra Resection for Congenital Cervicothoracic Scoliosis.","authors":"Yang Li, Zezhang Zhu, Wanyou Liu, Saihu Mao, Zhen Liu, Xu Sun, Yong Qiu, Benlong Shi","doi":"10.1111/os.14341","DOIUrl":"https://doi.org/10.1111/os.14341","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective and consecutive study.</p><p><strong>Objective: </strong>To demonstrate the curve evolution of distal non-structural compensatory curves in patients with congenital cervicothoracic hemivertebra (CTH) scoliosis undergoing posterior-only hemivertebra resection and to propose the possible mechanisms of this specific phenomenon.</p><p><strong>Summary of background data: </strong>Though the spinal alignment could be well corrected via posterior hemivertebra resection in CTH patients, the high prevalence of distal curve progression was remarkable. However, the curve behavior of distal non-structural compensatory curves and its possible mechanisms were unclear.</p><p><strong>Methods: </strong>This study retrospectively reviewed a consecutive series of CTH patients undergoing posterior-only hemivertebra resection with a minimum 24 months follow-up. The parameters measured in coronal plane included local scoliosis, clavicle angle, head shift, and the Cobb angle of distal unfused segments. The distal curve was considered as an emerging scoliosis (ES) if with more than 20° progression and the apex of distal curve no less than 2 levels away from the lower instrumented vertebra.</p><p><strong>Results: </strong>A total of 51 CTH patients with a mean age of 8.5 ± 3.8 years at surgery and a mean 38.0 ± 5.3 months follow-up were recruited. The correction of local scoliosis and clavicle angle was statistically significant (p < 0.05 for all). The distal compensatory curve was 11.8 ± 5.3° before surgery and 6.5° ± 4.1° after surgery (p < 0.001), which was slightly increased to 11.6° ± 10.9° (p = 0.002) at the latest follow-up. During follow-up, the increase of distal compensatory curve was significantly correlated with the change in clavicle angle (r = 0.49, p = 0.038). The ES was observed in 10 patients (19.6%) with an average value of 28.0 ± 2.1° at diagnosis, including 7 patients within 6 months and 3 patients after 5 years postoperatively. The mean value of ES was 31.9° ± 3.1° at the latest follow-up, while no patients required revision surgery. The ES was classified into compensatory and idiopathic types according to the typical curve behaviors. The compensatory ES usually presented within 6 months after operation and was responsible for further reconstruction of head and shoulder balance. While the idiopathic ES occurred at adolescent which may be related to the rapid body growth.</p><p><strong>Conclusions: </strong>Distal compensatory curve had a tendency toward slight progression during follow-up in CTH patients with posterior hemivertebra resection surgery. The prevalence of emerging scoliosis was 19.6% and the typical compensatory and idiopathic curve behavior were firstly proposed. Close and longitudinal follow-up was thus highly recommended for CTH patients with posterior HV resection surgery.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142876997","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":"Effectiveness of Total Hip Arthroplasty Combined With Hip Braces for Hip Charcot Arthropathy.","authors":"Long-Teng Chao, Teng-Feng Zhuang, Song-Wei Huan, Si-Min Luo, Chong-Jie Wu, Wen-Rui Wu, Zhen-Gang Zha, Huan-Tian Zhang, Ning Liu","doi":"10.1111/os.14329","DOIUrl":"https://doi.org/10.1111/os.14329","url":null,"abstract":"<p><strong>Objective: </strong>Charcot arthropathy is characterized by varying degrees of sensory loss and rapidly progressive joint destruction. Historically, limited studies indicated that Charcot arthropathy of the hip joint may be a contraindication for total hip arthroplasty (THA). Yet, some recent studies have shown that good clinical results and acceptable survival rate. Hence, this study aimed to investigate clinical outcomes, radiographic outcomes, complication rates and survivorship of primary THA in Charcot arthropathy.</p><p><strong>Methods: </strong>We retrospectively included 11 patients (11 hips) with Charcot arthropathy who underwent THA between 1998 and 2016. All involved patients were diagnosed as syphilis. All patients had classic radiographic findings of Charcot arthropathy. The hip braces were used in all patients for six weeks after surgery. Outcome measures included VAS, Oxford Hip Score, and UCLA score. Statistical analyses involved t-tests, chi-square tests, and Kaplan-Meier survival analysis.</p><p><strong>Results: </strong>The average follow-up period was 81.73 months. The average VAS, Oxford Hip Score, and UCLA score were improved significantly. There was higher complication rate of 45.5% after THA. Reoperation was carried out in two patients due to dislocation and acetabular component loosening. The Kaplan-Meier survivorship with an end point of reoperation for any reason was 81.8%.</p><p><strong>Conclusions: </strong>THA is proved to be reasonable in improving hip joint function, which is suitable for patients with Charcot hip joint. Although the complication rate is high, we consider that THA combined with hip brace may be a valid treatment choice for Charcot arthropathy with detailed preoperative planning and proper precautions.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877010","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":"Utilization of 3D-Printed Customized Uncemented Stem Prostheses for Revision of Aseptic Loosening in the Distal Femoral Cemented Prostheses: Case Series and Literature Review.","authors":"Zi-Wei Hou, Kai Zheng, Ming Xu, Xiu-Chun Yu","doi":"10.1111/os.14331","DOIUrl":"https://doi.org/10.1111/os.14331","url":null,"abstract":"<p><strong>Objective: </strong>Aseptic loosening (AL) is a common mechanical complication following reconstruction of the distal femoral cemented prosthesis (DFCP), often resulting in severe bone loss, which complicates prosthesis revision. 3D-printed personalized implants represent an emerging solution for the reconstruction of complex bone defects. This study aimed to investigate the early therapeutic effects of using a 3D-printed, customized, uncemented stem prosthesis for revising aseptic AL in DFCP.</p><p><strong>Methods: </strong>From June 2021 to December 2022, a retrospective review was conducted on six consecutive patients who underwent revision surgery due to AL of the DFCP with a 3D-printed customized uncemented stem prosthesis. The study included four male and two female patients, with an average age of 58 ± 11 (range: 46-75) years. All six patients had previously undergone limb salvage surgery using a cemented megaprosthesis after tumor resection. Preoperative imaging evaluation was performed for all patients, and the personalized design of the prostheses was achieved through 3D printing based on CT imaging data. Regular clinical and radiographic follow-up was conducted postoperatively, with the main outcome measures being oncological outcomes, prosthesis survival, osseointegration, complications, and lower limb function.</p><p><strong>Results: </strong>All patients successfully underwent surgery and were followed up for a mean duration of 30.33 ± 6.15 (range: 24-38) months. All patients were alive at the last follow-up, with no tumor recurrence or distant metastasis. No complications such as infection, loosening, or fracture of the prosthesis occurred. Osseointegration was satisfactory, with a mean MSTS score of 26 (range: 20-28) points.</p><p><strong>Conclusion: </strong>3D-printed, customized, uncemented stem prosthesis exhibit immediate initial stability and reliable biocompatibility. Early clinical outcomes are satisfactory, making them an effective method for revision AL of DFCP.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877014","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":"Biomechanical Evaluation of Clival Screw Fixation for Occipitocervical Instablity: A Finite Element Analysis.","authors":"Weipeng Lin, Jianying Zheng, Meichao Zhang, Panjie Xu, Hang Xiao, Wei Ji","doi":"10.1111/os.14314","DOIUrl":"https://doi.org/10.1111/os.14314","url":null,"abstract":"<p><strong>Objective: </strong>The clivus is trapezoidal in shape with uneven bone structure, the optimal number and position of screws for clival fixation are not clear. Therefore, this study aims to explore the optimization clival screw fixation method for occipitocervical instability using finite element analysis.</p><p><strong>Methods: </strong>Seven finite element models were developed to evaluate biomechanical properties of clival screw fixation for treating occipitocervical stability, including (i) one clival screw fixation A1 and A2 models; (ii) two clival screws fixation B1 and B2 models; (iii) three clival screws fixation C1 and C2 models; (iv) four clival screws fixation D1 model. Loads of 1.5 Nm were applied to the model fRoM different directions to induce flexion, extension, lateral bending, and axial rotation movements.</p><p><strong>Results: </strong>The regular triangle C1 type three clival screws fixation exhibited great stability, with RoM of 4.20° in flexion, 5.80° in extension, 0.85° in lateral bending, and 1.60° in axial rotation. The peak stress on the internal fixation devices were relatively low, with maximum screw stress of 194 MPa in flexion, 276 MPa in extension, 180 MPa in lateral bending, and 213 MPa in axial rotation; the maximum plate stress were 126, 554, 426, and 378 MPa, respectively. The areas with higher stress were mainly concentrated at the robust neck section of the plate.</p><p><strong>Conclusion: </strong>The triangular configuration of three clival screws fixation represented the optimized anterior occipitocervical fixation method through the clivus, offering superior biomechanical stability, lower stress on the devices and dispersed stress distribution in the occipitocervical region.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142865051","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":"The Influence of Zero-Profile Implant Selection on the Outcomes of Anterior Cervical Discectomy and Fusion.","authors":"Xing-Jin Wang, Jun-Bo He, Ting-Kui Wu, Bei-Yu Wang, Xin Rong, Quan Gong, Hao Liu","doi":"10.1111/os.14322","DOIUrl":"https://doi.org/10.1111/os.14322","url":null,"abstract":"<p><strong>Objectives: </strong>Anterior cervical discectomy and fusion (ACDF) has been widely used in the treatment of cervical degenerative disc disease (CDDD). Previous studies have demonstrated that the size of implants in ACDF determines radiological and clinical outcomes. However, the principles of choosing an appropriate implant size in ACDF remain controversial. The study aimed to elucidate the influence of the cage size of Zero-profile implant system and offer proposals on the selection of implant size during ACDF.</p><p><strong>Methods: </strong>This retrospective study analyzed 109 patients who underwent single-level ACDF from March 2011 to April 2020 with the Zero-profile implant system. The patients were categorized into two groups based on the preoperative mean height of adjacent segments (Hm). Clinical outcomes included the Japanese Orthopaedic Association scores (JOA), Neck Disability Index (NDI) and visual analog scale (VAS). In addition, radiographical analysis encompassed cervical lordosis (CL), functional spinal unit (FSU) angle, range of motion (ROM) of the total cervical spine and the FSU, anterior and posterior FSU height, C1-C7 sagittal vertical axis (SVA), C2-C7 SVA, the center of gravity of the head (CGH)-C7 SVA as well as T1 slope (T1S) measurements. Besides, bone fusion rates, anterior bone loss, subsidence, and adjacent segment degeneration were also recorded.</p><p><strong>Results: </strong>Overall, 37 patients in Group A had an implant size ≥ Hm while 72 patients in Group B had an implant size < Hm. The preoperative general data and radiological parameters were comparable between the groups. At the last follow-up, both groups had satisfactory clinical outcomes. As for radiological outcomes, the anterior and posterior FSU heights were significantly higher in Group A compared to Group B (p < 0.05) after ACDF. Besides, both groups corrected and maintained the CL and FSU. However, the average C1-C7 SVA and C2-C7 SVA at the last follow-up were significantly higher in the Group B than in the Group A (C1-C7 SVA: 27.42 ± 9.23 mm vs. 31.76 ± 10.68 mm, p = 0.038; C2-C7 SVA: 14.65 ± 7.27 mm vs. 19.64 ± 8.68, p = 0.003). Additionally, the fusion rates were significantly higher in Group A at the first two follow-up visits.</p><p><strong>Conclusion: </strong>Our study showed that an appropriate size of Zero-profile implant system is crucial to achieving favorable clinical and radiological outcomes after performing ACDF. Implants with a larger height but not oversize could maintain the cervical sagittal balance and FSU height and achieve early bone fusion. Therefore, a larger height might be a better choice for achieving a satisfactory long-term prognosis if Zero-profile implants of adjacent size both fit the disc space properly.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142838749","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":"Is Percutaneous Kyphoplasty the Better Choice for Treatment of Stage III Kümmell's Disease Without Neurological Symptoms? A Retrospective Study of Two Invasive Procedures.","authors":"Yijie Liu, Tangyiheng Chen, Haoyun Yu, Xiaohui Zhou, Runjia Hua, Yudong Wang, Qiang Wei, Yong Gu, Genglei Chu","doi":"10.1111/os.14313","DOIUrl":"https://doi.org/10.1111/os.14313","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective analysis.</p><p><strong>Objective: </strong>Kümmell's disease is an uncommon and complicated spinal condition first described in 1891. Treatment of this disease must be individualized according to the stage of disease and the experience and preference of the surgeon. Nevertheless, the surgical option in Stage III Kümmell's disease without neurological deficits remains controversial. The purpose of this study is to determine whether PKP or pedicle subtraction osteotomy (PSO) combined with long-segment fixation (LSF) is more effective in treating Kümmell's disease at Stage III without neurological impairments.</p><p><strong>Methods: </strong>Between January 2017 and June 2020, 89 patients were treated with PKP or PSO + LSF. The outcomes, including operative time, blood loss, Oswestry Disability Indexes (ODIs), heights of fractured vertebrae, visual analog scale (VAS) scores, and kyphosis Cobb angles, were measured at the follow-up time for the PKP group and PSO + LSF group. Fisher's exact test or chi-square test for number and percentage data was employed to compare statistical analyses between two groups.</p><p><strong>Results: </strong>Forty-six patients underwent PKP and 43 patients who treated by PSO + LSF. Postoperative measurements showed substantial improvements in kyphosis Cobb angle and vertebral height in the PKP group compared to preoperative measurements. Operating time, estimated blood loss, and duration of stay were all reduced in the PKP group compared to the PSO + LSF group. The PSO + LSF group had better correction of a kyphotic Cobb angle than the PKP group. Short-term monitoring showed that the PKP group had fewer ODI and VAS scores than the PSO + LSF group. In addition, no significant neurological symptoms were found after operation in both groups. The complication rates of PKP and PSO + LSF groups were 10.87% and 9.30%, respectively.</p><p><strong>Conclusions: </strong>Kümmell's disease in Stage III without neurological symptoms responded to both PKP and PSO + LSF as safe and efficient treatments. Despite limited correction of kyphotic Cobb angle, PKP patients had better early clinical outcomes, increased fractured vertebral height, decreased blood loss, and less surgical trauma compared with the PSO + LSF group.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829489","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":"Distinguishing Characteristics of Benign Versus Malignant Intraosseous Schwannomas: A Comparative Study.","authors":"Jiangchao Zhang, Ge Xiong, Wei Zheng, Jing Sun","doi":"10.1111/os.14321","DOIUrl":"https://doi.org/10.1111/os.14321","url":null,"abstract":"<p><strong>Objectives: </strong>Benign and malignant intraosseous schwannomas are rare, and primarily documented in case reports. This study aims to elucidate the differences in clinical features and imaging manifestations between these tumors. This will help clinicians identify malignant lesions at an early stage, reliable guide treatment decisions, and accurately predict outcomes.</p><p><strong>Methods: </strong>Eighteen patients who underwent surgery and got pathological examinations in our hospital from 2012 to 2023 were retrospectively reviewed. Among them, 14 cases were found benign with 4 malignant. In the benign group, patients underwent curettage followed by bone grafting, whereas the malignant group was treated with extensive resection or amputation. Patients' demographics and radiographic features, including gender, age at diagnosis, symptom duration, tumor location, tumor margin, and the ratio of sclerotic margins were documented and compared between these tumors. All imaging was reviewed by two fellowship-trained musculoskeletal radiologists, who also quantified the sclerotic margin ratio. The intraclass correlation coefficient was used to determine inter-observer agreement. The Mann-Whitney U test was applied for continuous clinical variables, and the chi-square test or Fisher's exact test for categorical variables.</p><p><strong>Results: </strong>In our series, the mean age of these patients was 43.1 ± 14.0 years, six patients were male and 12 were female. Pain was the predominant preoperative symptom. The average duration from symptom onset to initial physician visit was 28.5 ± 25.3 months for benign schwannomas and 8.3 ± 4.3 months for malignant schwannomas (p = 0.012). On plain radiographs, 13 (13/14) of benign schwannomas exhibited well-defined margins of bone destruction, compared to 1 (1/4) of malignant schwannomas (p = 0.019). Furthermore, benign schwannomas had a significantly higher sclerotic margin ratio (75.5%) than malignant ones (16.7%) (p = 0.001). No statistically significant difference was found between the two groups in terms of cortical bone destruction (p = 1.0). On MRI, both tumors demonstrated intermediate to slightly hypointense signal intensity on T1-weighted images and heterogeneous high signal intensities on T2-weighted images.</p><p><strong>Conclusions: </strong>Despite their rarity, benign and malignant intraosseous schwannomas should be considered in the differential diagnosis for patients presenting with painful and radiographically lytic bone lesions, especially in the mandible, sacrum, and vertebrae. The ratio of sclerotic margins, which we proposed for the first time, in combination with symptom duration and the clarity of tumor margins, provide valuable diagnostic clues for distinguishing the malignancy of the tumors.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829488","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":"Efficacy of Different Doses of Intra-Articular Tranexamic Acid for Reducing Blood Loss and Lower Limb Swelling After Total Knee Arthroplasty: A Prospective, Randomized, Controlled Trial.","authors":"Shuwei Ye, Yue Luo, Qianhao Li, Lijun Cai, Pengde Kang","doi":"10.1111/os.14317","DOIUrl":"https://doi.org/10.1111/os.14317","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Both blood loss and lower extremity swelling after total knee arthroplasty (TKA) can affect a patient's postoperative recovery. The aim of this trial was to investigate whether different doses of intra-articular tranexamic acid (TXA) can reduce blood loss and postoperative lower limb swelling.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In a prospective, randomized-controlled trial, a total of 225 patients were randomly assigned to three groups from September 2020 through January 2021: intra-articular injections of 3 g, 1 g of TXA, or placebo (saline solution). The primary outcome indicators were perioperative blood loss and decreased hemoglobin levels. The secondary outcome indicators were lower extremity swelling, functional recovery indicators (hospital for special surgery [HSS] scores, range of motion), visual analog scale [VAS] scores, and transfusion rates and safety outcomes, including thromboembolic events, incidence of wound-related complications, and length of hospital stay. One-way analysis of variance (ANOVA), post hoc Bonferroni correction, Pearson chi-square test and Fisher exact test were used for statistical analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Postoperative blood loss was lower in the 1 and 3 g TXA groups (754.00 ± 409.67 mL and 568.70 ± 408.27 mL, respectively) than in the placebo group (977.32 ± 418.69 mL) (p &lt; 0.001). The maximum postoperative decrease in hemoglobin was lower in the 1 and 3 g TXA groups (2.4 ± 0.9 and 1.8 ± 0.9 g/dL, respectively) than in the placebo group (3.1 ± 1.2 g/dL) (p &lt; 0.001). On postoperative Days 1, 2, and 3, the TXA group presented significantly reduced thigh, suprapatellar, and calf swelling and significantly reduced pain scores during exercise. Compared with that in the low-dose group, perioperative blood loss was further reduced in the high-dose TXA group (p = 0.006). However, while patients in the TXA group had improved pain scores, Hospital for Special Surgery scores, and joint range of motion at postoperative rest, these differences were not statistically significant. There were no significant differences in thromboembolic events or complication rates among the three groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Topical TXA in total knee arthroplasty was effective in reducing postoperative blood loss by 24%-43% and in reducing postoperative lower extremity swelling and pain during exercise. Higher doses (3 g) of TXA further controlled perioperative blood loss without affecting postoperative lower extremity swelling, and there was no increase in the incidence of related complications during follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Trial registration: &lt;/strong&gt;This study was a single-center, prospective, randomized controlled trial (RCT). The trial was approved by the Clinical Trials and Biomedical Ethics Committee at our institution (number: 2018.676), all participants provided written informed consent, and the trial was prospectively registered in the Chinese Clinical Trial Registry (Chi","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824103","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":"Learning Curve of Uniportal Compared With Biportal Endoscopic Techniques for the Treatment of Lumbar Disc Herniation.","authors":"Yuquan Liu, Xiang Li, Haining Tan, Xinyi Hao, Bin Zhu, Yong Yang, Lingjia Yu","doi":"10.1111/os.14312","DOIUrl":"https://doi.org/10.1111/os.14312","url":null,"abstract":"<p><strong>Objectives: </strong>Currently, unilateral biportal endoscopic (UBE) and uniportal full-endoscopic (UFE) techniques for the treatment of lumbar disc herniation (LDH) are gaining popularity. However, studies investigating the number of surgeries needed for surgeons to achieve proficiency in these procedures are lacking. This study aims to compare the early learning curve for UBE and UFE when treating LDH.</p><p><strong>Methods: </strong>The learning curve for two fellowship-trained surgeons at our institution was retrospectively assessed for 160 consecutive patients (UFE: n = 100, UBE: n = 60) who underwent procedures between September 2020 and May 2023. Surgeon 1 first learned UBE, followed by UFE (S1BF), while Surgeon 2 first learned UFE and then UBE (S2FB). Operation time was evaluated as the primary outcome for determining the learning curve using cumulative sum (CUSUM) analysis. Secondary outcomes assessing endoscopic prowess include surgical outcomes, such as fluoroscopy usage times, postoperative hospital stays, the incidence of complications, and clinical outcomes, including visual analog scale (VAS) scores for back and leg pain, Oswestry disability index (ODI) score and modified MacNab criteria.</p><p><strong>Results: </strong>The learning curve analysis identified the cutoff point in UBE at 14 cases and 11 cases for S1BF and S2FB, respectively, and in UFE at 31 cases and 27 cases, respectively. Without UFE or UBE experience, at the last follow-up, both the VAS back and leg pain in UFE were significantly higher than that in UBE (p < 0.05). Furthermore, the incidence of complications of UFE was also higher than that of UBE (29.0% vs. 7.1%). When surgeons have previous UFE or UBE experience, there was no significant difference in the clinical outcomes between UFE and UBE, and the complication rates were also similar (p > 0.05). After gaining UBE experience, the UFE performed by S1BF showed significantly better outcomes in fluoroscopy usage times (p = 0.024), surgical complications (p = 0.036), last follow-up VAS back pain (p = 0.003), and leg pain (p < 0.001) compared to S2FB. However, after gaining UFE experience, the S2FB only showed significant improvement in operation time (p = 0.041) during the process of learning UBE compared to S1BF.</p><p><strong>Conclusions: </strong>Regardless of whether UBE or UFE is learned first, both techniques can significantly shorten the learning curve for the other technique. We recommend prioritizing the learning of UBE. Compared with UBE, the learning curve for UFE was significantly steeper and longer with higher incidence of complications in the early stage.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824173","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}