Orthopaedic Surgery最新文献

{"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":"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":"762-772"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872373/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of Animal Models of Traumatic Osteonecrosis of the Femoral Head Based on Blood Supply: A Literature Review.","authors":"Linbao Wang, Yunzhuan Luo, Xing Qiu, Liangliang Cheng, Kaiming Ma, Jianchen Guan, Yuchen Liu, Jiawei Ying, Dewei Zhao","doi":"10.1111/os.14352","DOIUrl":"10.1111/os.14352","url":null,"abstract":"<p><p>Traumatic osteonecrosis of the femoral head (TONFH) refers to ischemic osteonecrosis is resulting from an acute mechanical interruption of the blood supply to the femoral head. The early diagnosis and optimal treatment have been central focuses of research and continue to undergo improvement. Reliable animal models are essential for advancing research into the treatment of the disease. This review aims to provide a comprehensive overview of tetrapod models (rats, rabbits, dogs, and sheep) and bipod models (emus, ostriches), as well as various modeling methods (traumatic hip dislocation, dissection of the round ligament and ligature of the femoral neck, femoral neck fracture (FNF), reduction and internal fixation after femoral neck fracture, and highly selective disruption of the anterior-superior retinacular vessels). This review examines the advantages, disadvantages, and applicability of each model. Based on blood flow analysis, it proposes a more reliable direction for TONFH modeling: simulating partial blood flow injury in the context of FNF.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"703-713"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Construction and Development of an Enhanced Recovery After Surgery Program for the Surgical Management of Patients With Spinal Metastasis: A Modified Delphi Study.","authors":"Fanjie Li, Wenlong Yu, Haohan Zhou, Fan Zhang, Zihuan Zhou, Qiang Gao, Xin Gao, Luosheng Zhang, Yinjie Yan, Quan Huang, Xinghai Yang, Peilin Chu, Mengchen Yin","doi":"10.1111/os.14375","DOIUrl":"10.1111/os.14375","url":null,"abstract":"<p><strong>Objective: </strong>As an effective treatment for spinal metastasis (SM), ERAS protocol can significantly reduce the length of hospital stay and complications in patients. Establishing an ERAS program for perioperative care after SM surgery is a clinical problem that needs to be addressed urgently. We aimed to develop an Enhanced Recovery After Surgery (ERAS) program and Surgical Safety Checklist (SSC) that conferred clinical benefit to patients with SM and made it relatively easy to manage the condition. We believe that our findings could help establish and promote the continuous improvement of additional ERAS programs for SM.</p><p><strong>Methods: </strong>This is a modified Delphi study. We used a two-round process using data acquired from a review of relevant literature and involving a multidisciplinary panel of experts from different hospitals in China. The modified Delphi survey was conducted from February 1, 2024 to April 20, 2024. The experts were invited to evaluate each of the current relevant ERAS recommended topics to determine the appropriateness of inclusion in the ERAS program and SSC with the 5-point Likert scale. Used the results to create specific ERAS and SSC (70% consensus) programs. Close to consensus (65%-69% consensus) findings were considered for the follow-up survey.</p><p><strong>Results: </strong>A multicenter, multidisciplinary group of physicians (n = 75), including clinical workers, researchers, anesthesiologists, nursing specialists, psychologists, nutritionists, and caregivers, with experience in managing patients with SM, were asked to participate. Using the modified Delphi process, we arrived at a consensus for the ERAS program. This included 37 consolidated items in the domains in the following order: preoperative, intraoperative, postoperative, and discharge. The SSC included 37 consolidated items in the domains in the following order: before the induction of anesthesia, before skin incision, and before the patient leaves the operating room.</p><p><strong>Conclusion: </strong>This study, based on the modified Delphi process, helped us develop ERAS and SCC consensus-driven best practice recommendations, including suggestions related to perioperative anesthesia, surgery, and nursing for SM. We hope that this study, in which we integrated both traditional Chinese and Western medical treatment protocols, can provide a basis for a rapid rehabilitation program for surgical interventions in SM.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"939-952"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distal Pedicle Subtraction Osteotomy for Ankylosing Spondylitis With the Dual Complications of Andersson Lesions and Idiopathic Spinal Cord Hernia: A Rare Case Report.","authors":"Junyu Li, Zexi Yang, Xinyu Zhang, Zesen Shang, Hongyu Wu, Danfeng Zheng, Zhuoran Sun, Yongqiang Wang, Yan Zeng, Weishi Li, Miao Yu","doi":"10.1111/os.14344","DOIUrl":"10.1111/os.14344","url":null,"abstract":"<p><strong>Background and importance: </strong>Ankylosing spondylitis (AS) is a systemic chronic inflammatory disease. Andersson lesion (AL) is a late complication of advanced AS. Idiopathic spinal cord hernia (ISCH) is a rare disorder of the spinal cord. However, according to our literature review, the simultaneous occurrence of AL together with ISCH in a single AS patient had never been reported.</p><p><strong>Clinical presentation: </strong>A 49-year-old male reported a 30-year history of thoracolumbar pain and limited mobility and was diagnosed with AS with dual complications of AL and ICSH. Before correction surgery, physical examination, x-ray, CT, MRI and Blood HLA-B27 examination were performed and a series of radiological parameters, including the degree of kyphosis and the T1-pelvic angle (TPA), were measured. Several days after surgery (Distal PSO was used), we performed examinations to check the patient's physical condition which showed the patient recovered remarkably. CTA was done, indicating that the patient's aorta moved anteriorly with the osteotomy side undamaged. A series of morphological parameters were measured again, including TPA, LL, and TK. CT and MRI were performed again, reflecting significant bone-to-bone fusion and successful recovery. The patient relieved the symptoms and regained his daily activities.</p><p><strong>Conclusions: </strong>We deepen the understanding of the diagnosis and treatment of AS with rare complications of AL and ISCH. Distal PSO could be an effective option for severe AS patient.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"971-978"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872360/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Finite Element Analysis of Proximal Femoral Bionic Nail (PFBN), Proximal Femoral Nail Antirotation and InterTan for Treatment of Reverse Obliquity Intertrochanteric Fractures.","authors":"Chen Xiong, Lijia Zhang, Yanhua Wang, Xiaomeng Zhang, Xiaofeng Chen, Kai Yu, Yichong Zhang, Huijuan Fu, Zhentao Ding, Dianying Zhang","doi":"10.1111/os.14345","DOIUrl":"10.1111/os.14345","url":null,"abstract":"<p><strong>Objective: </strong>Reverse obliquity intertrochanteric fracture is an unstable type of fracture. Current guidelines recommend intramedullary fixation, but there are still complications such as screw removal, hip varus, nail withdrawal, and nail fracture. The objective of this study was to use finite element analysis to compare the biomechanical properties of the novel proximal femoral bionic nail (PFBN), proximal femoral nail antirotation (PFNA), and combined compression interlocking intramedullary nail (InterTan) in the treatment of reverse obliquity intertrochanteric fractures (AO/OTA 31-A3.1).</p><p><strong>Methods: </strong>The three-dimensional models of PFBN, PFNA, InterTan, and the A3.1 type intertrochanteric fracture model were established by using modeling software such as Mimics and Unigraphics. Different force loads were implemented using ANSYS software to compare finite element biomechanical parameters, such as maximum stress in the implant and maximum stress and displacement at the proximal femur.</p><p><strong>Results: </strong>In this finite element study, we found that the distribution trend of maximum femoral stress and displacement in the femoral models of the three internal fixation groups was similar, but the maximum stress and maximum displacement were the lowest in the PFBN group, and the maximum stress of the internal fixation implant in the PFBN group was lower than that in the PFNA group and the InterTan group. The maximum stress and displacement of the femur in the PFNA group were 403.71 MPa and 14.274 mm, respectively, the maximum stress and displacement in the InterTan group were 362.72 MPa and 10.678 mm, and the maximum stress and displacement in the PFBN group were 186.23 MPa and 9.7068 mm. In the internal fixation implant model, the maximum stress of the PFNA group was 1445 MPa, the maximum stress of the InterTan group was 919.62 MPa, and the maximum stress of the PFBN group was the lowest, at 911.77 MPa.</p><p><strong>Conclusion: </strong>Compared to PFNA and InterTan, PFBN designed by the \"lever - reconstruction - balance\" hypothesis can provide better biomechanical stability. It is a feasible choice for the future treatment of reverse intertrochanteric fracture, and additional clinical studies are required to substantiate its efficacy.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"888-899"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-Assisted Positioning for Percutaneous Endoscopic Interlaminar Discectomy.","authors":"Shuai Jiang, Fei Xu, Zhuofu Li, Chuiguo Sun, Woquan Zhong, Chengxia Wang, Weishi Li","doi":"10.1111/os.14323","DOIUrl":"10.1111/os.14323","url":null,"abstract":"<p><strong>Objective: </strong>During percutaneous endoscopic interlaminar discectomy (PEID), a range of technologies including medical robotics, visual navigation, and spatial registration have been proposed to expand the application scope and success rate of minimally invasive surgery. The use of robotic technology in surgery is conducive to improving accuracy and reducing risk. This study aims to introduce a precise and efficient targeting method tailored for robot-assisted positioning under C-arm fluoroscopy inPEID.</p><p><strong>Methods: </strong>This study conducted a retrospective analysis of 107 patients with lumbar disc herniation (LDH) who underwent surgical treatment at our hospital from February 2023 to February 2024 (average age: 43.3 ± 13.3 years; 61 males and 43 females). The method entails constructing a specialized end-effector capable of simultaneous fluoroscopy calibration and robot-to-image-space registration. The average time of the surgical procedure and the average number of fluoroscopy exposures were collected. Preoperative and postoperative follow-up data were collected, including assessment scores from the Japanese Orthopedic Association (JOA) and Visual Analog Scale (VAS). Paired t-tests were employed to compare differences in each clinical outcome between the preoperative and follow-up time.</p><p><strong>Results: </strong>These techniques effectively reduce both radiation exposure and operation time. Clinical data reveals that the average time for robot-assisted positioning stands at 2.5 ± 0.7 min, with anteroposterior and lateral radiographs demonstrating accuracies of 2.4 ± 2.8 mm and 3.1 ± 3.7 mm, respectively, during robot-assisted positioning. Postoperative VAS scores for back pain and leg pain were significantly lower than preoperative scores (1.2 ± 1.8 vs. 4.1 ± 2.3, 0.9 ± 2.0 vs. 5.9 ± 1.8; p < 0.05, p < 0.05, respectively). Postoperative JOA scores were significantly higher than preoperative scores (26.1 ± 3.5 vs. 14.5 ± 4.9; p < 0.05).</p><p><strong>Conclusions: </strong>Through the evaluation of the system in robot-assisted positioning during PEID, this study substantiates the accuracy and reliability of the proposed method in clinical applications.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"773-780"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Research Hotspots and Trends in Advances of the Ilizarov Technique: A Bibliometric Mapping.","authors":"Xinxin Wang, Fei Lu, Wenxia Wang, Xiaoyan Zhi","doi":"10.1111/os.14325","DOIUrl":"10.1111/os.14325","url":null,"abstract":"<p><strong>Objective: </strong>An updated bibliometric analysis is needed to address the lack of comprehensive understanding of Ilizarov technique's research trends and hotspots, fostering collaboration and technology adoption. CiteSpace was utilized to perform co-citation analyzes on authors, countries, institutions, journals and cited journals, authors and cited literature, along with keywords. This approach aimed to identify leaders, collaborating institutions, and research hotspots associated with the Ilizarov technique, while also predicting future development trends.</p><p><strong>Methods: </strong>Data relevant to Ilizarov technologies from 1994 to 2023 were extracted from Science Net's core collection. Excel was utilized to develop an exponential function for forecasting annual publication numbers. CiteSpace V5.5 was used to conduct co-citation analyzes, which included authors, countries (regions), institutions, journals, citation journals, authors, citations, and keywords. Burst detection algorithms were applied to analyze countries (regions), institutions, and keywords, with keyword clustering achieved using the logarithmic likelihood ratio.</p><p><strong>Results: </strong>A total of 2030 studies were collected, with annual publications on the Ilizarov technique fitting an exponential model Y = 3E-37e^0.0439x (R ² = 0.7979). Morasiewicz Piotr from the University of Opole in Poland emerged as the most prolific author. The leading countries included the USA and China, and notable institutions included the Egyptian Knowledge Bank and the Ilizarov National Scientific Center for Restorative Traumatology and Orthopaedic. Research outputs appeared primarily in orthopedics and surgery, with a focus on keywords such as management, the Ilizarov technique, external fixation, distraction osteogenesis, reconstruction, and the Ilizarov method.</p><p><strong>Conclusions: </strong>Based on current global trends, the number of publications in the Ilizarov field will continue to increase. Future studies will likely place more emphasis on advancing application concepts and device development.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"663-676"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Robotic-Assisted Total Knee Arthroplasty Improve Outcomes of Adult Osteoarthritis Patients-A Systematic Review and Trial Sequential Meta-Analysis.","authors":"Han-Yang Yue, Guo-Qiang Ding, Hua-Xin Li, Jun Zeng, Xiao-Dan Jiang, Zong-Dong Zhu, Hua Jiang","doi":"10.1111/os.70007","DOIUrl":"https://doi.org/10.1111/os.70007","url":null,"abstract":"<p><strong>Background and objectives: </strong>Total knee arthroplasty (TKA) is a standard treatment for end-stage knee osteoarthritis (KOA). While conventional TKA (cTKA) is widely used, robotic-assisted TKA (rTKA) has gained attention for its potential precision and improved outcomes. However, the comparative efficacy and safety of rTKA versus cTKA remain unclear due to inconsistent findings in existing studies. This study aims to systematically review and compare the efficacy and safety of rTKA and cTKA in patients with KOA.</p><p><strong>Methods: </strong>A total of seven databases were searched. Only randomized controlled trials (RCTs) were included in this systematic review. Subgroup analysis, sensitivity analysis, and trial sequential analysis (TSA) were used to evaluate the stability of the results.</p><p><strong>Results: </strong>Twenty-five RCTs involving 3156 patients with KOA were included. The only statistically significant clinical difference between patients who received rTKA and cTKA was that the rTKA group was associated with a longer operative duration (MD = 22.38 mins; 95% confidence interval [CI] [12.86, 31.91]; p < 0.00001; I² = 98%). As for functional parameters, the two groups had similar results in postoperative Knee Society Score (KSS), the Western Ontario and McMaster Universities (WOMAC), and Hospital for Special Surgery Score (HSS). Regarding the tibiofemoral angle and the coronal femoral component angle, no significant difference was observed between the two groups. Patients in the rTKA group had a higher hip-knee-ankle angle (HKA) (MD = 0.63; 95% CI [0.23, 1.03]; p = 0.002; I² = 52%), lower HKA deviation (MD = -0.99; 95% CI [-1.24, -0.74]; p < 0.00001; I² = 0%), and a higher coronal tibial component angle (MD = 0.46; 95% CI [0.07, 0.85]; p = 0.02; I² = 81%) after the surgery.</p><p><strong>Conclusions: </strong>While rTKA appears to be a feasible and safe alternative to cTKA, the mixed evidence from our study highlights the need for further research to fully understand its clinical implications and long-term outcomes.</p><p><strong>Trial registration: </strong>PROEPERO: CRD42024541052.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531736","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":"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":"801-813"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872351/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal Trends in the Incidence of Hyperactive Delirium and Its Causes of Change After Surgery for Degenerative Lumbar Disease: A Population-Based Study of 7250 Surgical Patients Over 11 Years.","authors":"Bang-Lin Xie, Li-Zhong Nie, Biao Zhong, Jun Xiong, Miao Nie, Qiu-Xiao Ai, Dong Yang","doi":"10.1111/os.14301","DOIUrl":"10.1111/os.14301","url":null,"abstract":"<p><strong>Objectives: </strong>Delirium is one of the common complications in elderly patients after spinal surgery. Severe delirium can lead to a series of adverse consequences such as drainage tube removal, wound rupture, patient falls, and severe adverse effects. The current research on POD is mostly small sample studies. This study aimed to investigate longitudinal changes in the incidence of hyper-postoperative delirium in patients with lumbar degenerative disease at our institution over the past 11 years and to identify the potential causes of these changes.</p><p><strong>Methods: </strong>This is a retrospective cohort study included 7250 patients who underwent surgical treatment for lumbar degenerative diseases at a single center from 2011 to 2021. These patients were diagnosed with delirium through the Confusion Assessment Method and then diagnosed with high activity delirium through the Richmond Agitation-Sedation Scale, totaling 130 cases. According to the incidence rate of hyper-postoperative delirium within 11 years, the trend test is divided into three groups: S1 upward trend (2011-2014), S2 downward trend (2015-2016) and S3 upward trend (2016-2021). The study collected variables from patients before, during, and after surgery, including gender, age, laboratory tests, anesthesia risk score, New York Heart Association cardiac function grading, number of surgical segments, surgical time, estimated intraoperative blood loss, anesthesia medication, and supplementary analgesic medication in the ward within 3 days after surgery. Kruskal Wallis one-way ANOVA test, Kruskal-Wallis H test, or chi-square test are used to evaluate inter group differences. p < 0.05 is considered statistically significant.</p><p><strong>Results: </strong>The pooled incidence of hyper-postoperative delirium over the past 11 years was 1.79% (130/7250). The average age of 7250 patients was 54.5 ± 13 years, with a male/female ratio close to 1:1. We statistically analyzed the relevant influencing factors before, during, and after surgery of S1 and S3 in the incidence rate increase group and found no statistical difference between the two groups. Our research results show that the incidence of high activity delirium is correlated with age, number of surgical segments, surgical duration, use of dexmedetomidine, remifentanil, and benzodiazepines, with p < 0.05.</p><p><strong>Conclusions: </strong>The reduced use of dexmedetomidine, increased use of benzodiazepines, and prolonged surgical time are the reasons for the increased incidence of hyper-postoperative delirium. The joint management of orthopedic surgeons and anesthesiologists during the perioperative period is of great significance in reducing the incidence of hyper-postoperative delirium in patients undergoing lumbar spine surgery.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"714-723"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142795078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}