Orthopaedic Surgery最新文献

{"title":"The Influence of Fracture Defect Size on Treatment Outcomes in Distal Femur Fractures: A Comparative Study Between Lateral Locking Plate and Double Plate Fixation.","authors":"Meng Li, Taoguang Wu, Zicheng Zhang, Xiaomeng Ren, Mengmeng Hu, Dong Zhang, Wei Zhang","doi":"10.1111/os.70103","DOIUrl":"10.1111/os.70103","url":null,"abstract":"<p><strong>Objective: </strong>Double plate (DP) fixation does not significantly improve outcomes compared to lateral locking plate (LLP-only) fixation for distal femur fractures (DFFs). We hypothesize this is due to the absence of clear indications for the application of these two fixation methods. This study aims to clarify the impact of metaphyseal defect size on the outcomes of these two treatments, in order to optimize surgical efficacy and minimize complications.</p><p><strong>Methods: </strong>We screened patients with distal femoral fractures treated with lateral locking plate or dual plate fixation at our hospital between January 2018 and June 2023 retrospectively. Information such as demographic data, fracture classification, operation details, metaphyseal bone defect size, pre-nd post-operative imaging data, and other medical records were compiled. Additionally, patients' recovery status was follow-up, including evaluation of knee joint function (Lysholm score), range of motion (ROM), and EQ-5D-3L health score. We used diverse statistical methods for further analysis, such as t-test, chi-square test, Pearson correlation coefficients, and binary logistic regression analysis.</p><p><strong>Results: </strong>According to the specified criteria, 55 distal femur fracture cases were ultimately included, with 38 cases in the LLP-only group and 17 cases in the DP fixation group. In terms of surgical and follow-up information, there were no statistical differences in healing status, but there were statistically significant differences in average blood loss (p = 0.013), metaphyseal bone defect size (p < 0.001), Lysholm score (p = 0.003), and EQ-5D score (p = 0.010). Notably, compared to other parameters, the size of the fracture defect exhibited the highest correlation (0.69) with healing outcomes. In logistic regression analysis, the defect size (OR 1.052, 95% CI 1.008-1.098, p = 0.021) was independently associated with the healing outcome. Upon further analysis, non-healing cases in the LLP-only group were predominantly associated with A3, C2, and C3 type fractures, with 83.3% of these patients presenting metaphyseal defects exceeding 15 mm.</p><p><strong>Conclusions: </strong>We carried out a comparative evaluation of LLP-only versus DP fixation in addressing DFFs. Our research outcomes revealed that LLP-only fixation yielded notably suboptimal results compared to DP fixation, especially in intricate fractures accompanied by defects, such as those classified under types A3, C2, and C3. Furthermore, the more significant the defect, the less effective the fixation of LLP-only will be. This observation underscores the pivotal role of the scope of metaphysical damage in determining the most suitable internal fixation techniques for DFFs.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2435-2444"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12318682/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144507334","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":"Correlation of Preoperative Inflammation/Immunity Markers With Postoperative Urinary Tract Infections in Elderly Hip Fracture Patients.","authors":"Xiao-Yang Liu, Si-Qin Guo, Xu-Ming Chen, Wei-Nan Zeng, Zong-Ke Zhou","doi":"10.1111/os.70107","DOIUrl":"10.1111/os.70107","url":null,"abstract":"<p><strong>Objective: </strong>Given the rising incidence of postoperative urinary tract infections (UTIs) in elderly patients with hip fractures and their substantial impact on mortality and functional recovery, identifying accessible predictors for early risk stratification is critical to improving perioperative management. This study aimed to investigate the association between preoperative inflammation/immune markers and the occurrence of postoperative UTIs in the vulnerable population.</p><p><strong>Methods: </strong>This study examined elderly patients who underwent hip surgery for hip fractures at our institution from March 2014 to June 2024. Preoperative inflammation/immune markers such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune inflammation index (SII) were measured. Receiver operating characteristic (ROC) curves were used to identify optimal cutoff values for each marker. To control the potential confounding factors, multivariate logistic regression analysis and propensity score matching analysis were conducted, resulting in adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to assess the strength of the association between each marker and UTIs.</p><p><strong>Results: </strong>A total of 1238 patients were included in this study, of whom 287 (23.18%) developed postoperative UTIs. Among elderly hip fracture patients, NLR demonstrated the highest predictive value for postoperative UTIs compared to PLR and SII (area under the curve [AUC] = 0.608, 95% CI: 0.571-0.645). High NLR (OR = 1.57, 95% CI: 1.16-2.13), high PLR (OR = 1.59, 95% CI: 1.16-2.19), and high SII (OR = 1.75, 95% CI: 1.29-2.37) were significantly associated with the incidence of postoperative UTIs using the best cutoff values. Additionally, a dose-effect relationship was observed for this association (p for trend < 0.05). These results remained significant even after propensity score matching.</p><p><strong>Conclusions: </strong>Preoperative inflammatory/immune markers NLR, PLR, and SII exhibited independent associations with the development of postoperative UTIs in elderly hip fracture patients undergoing surgery. Furthermore, a dose-effect relationship was observed for this association.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2350-2361"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12318684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601141","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":"Unilateral Biportal Endoscopic Decompression for Degenerative Lumbar Spinal Stenosis Under Local Anesthesia in Elderly Patients with Medical Comorbidities.","authors":"Haining Tan, Yuquan Liu, Guangpeng Li, Lingjia Yu, Haibo Sun, Bin Zhu, Qi Fei, Yong Yang, Yuan-Shun Lo, Xiang Li","doi":"10.1111/os.70114","DOIUrl":"10.1111/os.70114","url":null,"abstract":"<p><strong>Objective: </strong>Conventional Unilateral Biportal Endoscopic (UBE) surgery usually requires general anesthesia (GA), which introduces additional risks to patients with significant medical comorbidities. This article explores the use of UBE decompression under local anesthesia (LA) in elderly patients with severe medical comorbidities treated at our institution, providing valuable clinical insights for the application of this technique.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on patients clinically diagnosed with lumbar spinal stenosis (LSS) at our center between November 2021 and March 2024, who underwent UBE decompression surgery under local LA. The data collected included demographics, visual analog scale (VAS) scores for leg pain, oswestry disability index (ODI), and modified Macnab grades. The UBE decompression procedure was divided into seven key steps, and intraoperative pain and the effectiveness of LA were assessed using patient self-reported VAS scores at each step. Data comparisons between the preoperative, postoperative, and follow-up time points were conducted using paired sample t-tests.</p><p><strong>Results: </strong>Eighteen patients (5 males and 13 females) with an average age of 77.1 ± 5.0 years were included in the study, with 83.3% (15 patients) having medical comorbidities. The average follow-up period was 14.8 ± 7.9 months. At 3 months postoperative and final follow-up, both VAS scores for leg pain (p < 0.001) and ODI scores (p < 0.001) showed significant improvement. According to the modified Macnab criteria, outcomes were rated as excellent in 13 patients (72.2%), good in one (5.6%), fair in two (11.1%), and poor in one (5.6%), yielding an excellent-good rate of 77.8%. None of the patients voluntarily requested surgery termination because of unbearable intraoperative pain.</p><p><strong>Conclusions: </strong>For elderly patients with medical comorbidities, UBE decompression under LA is a viable and effective treatment option, yielding favorable clinical outcomes.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2362-2370"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12318675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144637689","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":"Anti-Osteoporosis Treatment Alleviates Osteoarthritis Symptoms and Partially Reverses Disease Progression.","authors":"Ziyang Feng, Heyong Yin, Yufei Ding, Xun Sun, Tao Zhang, Ai Guo","doi":"10.1111/os.70115","DOIUrl":"10.1111/os.70115","url":null,"abstract":"<p><strong>Objective: </strong>Osteoarthritis (OA) and osteoporosis (OP) are highly prevalent in postmenopausal women; however, their relationship remains complex and controversial. This study aimed to investigate whether anti-OP treatment alleviates osteoarthritis symptoms and reverses disease progression.</p><p><strong>Methods: </strong>This prospective clinical study enrolled 30 postmenopausal women diagnosed with OP and concomitant knee OA who visited our outpatient clinic between January and June 2023. Patients received anti-osteoporotic treatment comprising calcium carbonate, vitamin D₃, and alendronate (ALN). BMD, WOMAC, and VAS scores were assessed at 6 and 12 months. In animal studies, OP was induced in rats by ovariectomy, followed by OA induction via anterior cruciate ligament sectioning and meniscectomy. ALN treatment was administered for 8 weeks, and evaluations of behavior, macroscopic appearance, pathology, and subchondral bone microstructure were performed 8 weeks after OA induction. One-way ANOVA was used for multiple group comparisons, and Spearman's rank correlation was used to assess associations.</p><p><strong>Results: </strong>Clinical outcomes demonstrated that one-year anti-OP therapy achieved dual therapeutic benefits: a 9.3% increase in bone mineral density (BMD) was accompanied by a 36.54% reduction in knee OA symptoms. Statistical analysis revealed a strong positive correlation between BMD improvement and symptomatic relief (r = 0.76, p < 0.05). In the animal model, OP markedly accelerated OA progression, leading to more severe cartilage damage, as confirmed by symptoms, macroscopic cartilage appearance, and histological evaluations. Micro-CT analysis revealed abnormal subchondral bone microarchitecture in OP animals. Notably, ALN treatment partially reversed OA progression, as evidenced by reduced cartilage degeneration, improved subchondral bone microstructure, and enhanced bone remodeling.</p><p><strong>Conclusion: </strong>Anti-OP treatment alleviates knee OA symptoms in OP patients. Postmenopausal OP accelerates OA progression, while anti-OP therapy can partially reverse this effect. These findings highlights the importance of anti-OP treatment in managing both conditions.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2467-2478"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12318694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650043","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":"Biomechanical Advantages of Novel Duet Screws Plus Bilateral Satellite Rods Fixation in the Correction Surgery for Adult Spinal Deformity.","authors":"Zhong He, Yi Chen, Zhen Liu, Bo Yang, Benlong Shi, Yu Wang, Zhenhua Feng, Tianyuan Zhang, Xipu Chen, Yong Qiu, Xiaodong Qin, Zezhang Zhu","doi":"10.1111/os.70121","DOIUrl":"10.1111/os.70121","url":null,"abstract":"<p><strong>Purpose: </strong>Adult spinal deformity (ASD) patients undergoing pedicle subtraction osteotomy (PSO) with long fusion to the pelvis have a high risk of rod failure at the PSO level or adjacent areas. This study aimed to investigate the biomechanical advantages of novel duet screws (multiaxial screws with dual heads) plus satellite rods in ASD correction using finite element models and cadaveric specimens.</p><p><strong>Methods: </strong>A lumbar-pelvis finite element model was constructed, and Von Mises equivalent stress was used to analyze the structural stress under different fixation constructs. Six human cadaveric spine segments (T11-S2) were selected to validate the finite element results. L3 PSO was performed, with posterior fixation from L1 to pelvis using S2-alar-iliac (S2AI) screws, and satellite rods (L2-L4) were connected to the primary rods using duet screws. Three fixation constructs were evaluated: two rods (Group A), three rods (Group B), and four rods (Group C). In Group B, a biomechanical test was performed on two sides: single rod side (Group B-S) and double rods side (Group B-D). In vitro motion tests were performed under pure moments in lateral bending (LB), flexion/extension (FE), and axial rotation (AR) to measure the range of motion. Rod strain was measured at L3 and S2.</p><p><strong>Results: </strong>Finite element analysis revealed stress concentration near the PSO site, the screw bases, and the L5-S1 region. The use of duet screws with satellite rods significantly reduced primary rod stress. Cadaveric tests showed that all fixation constructs significantly reduced motion in LB, FE, and AR compared to the intact condition (p < 0.001). No significant differences in total motion or motion at the upper lumbar segments (L1-L3) were observed among the three groups, but differences were found in the lower lumbar segments (L4 and L5) and the sacrum (p < 0.007). Increasing the number of satellite rods significantly decreased rod strain (p < 0.004). Group B-D showed significantly lower rod strain compared to Group B-S (p < 0.042), indicating that satellite rods combined with duet screws were highly effective in reducing primary rod strain at L3. Satellite rods also reduced primary rod strain at the sacrum.</p><p><strong>Conclusions: </strong>This study supports clinical practice, providing biomechanical evidence for using four-rod constructs with duet screw-based satellite rods in L3 PSO and long fusion. Satellite rods dispersed rod strain, potentially reducing pseudarthrosis and rod breakage at PSO and sacrum without compromising spinal motion.</p><p><strong>Trial registration: </strong>Registered in ClinicalTrials (NCT06144879).</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2454-2466"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12318676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144643100","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":"Comparison of Biportal Endoscopic Technique and Conventional Unilateral Laminectomy for Bilateral Decompression (ULBD) for Multi-Level Degenerative Lumbar Spinal Stenosis in Elderly People.","authors":"Chenhao Dou, Qingsong Yu, Wei Zhang, Lei Ma, Xianzhong Meng","doi":"10.1111/os.70084","DOIUrl":"10.1111/os.70084","url":null,"abstract":"<p><strong>Objective: </strong>The object of this retrospective study was to compare the clinical, radiological, and spinal stability outcomes of biportal endoscopic Unilateral Laminectomy for Bilateral Decompression (BE-ULBD) and traditional Unilateral Laminectomy for Bilateral Decompression (ULBD) for multi-segmental lumbar spinal stenosis in elderly patients with osteoporosis.</p><p><strong>Methods: </strong>We retrospectively identified 41 and 47 patients who underwent BE-ULBD and ULBD, respectively, who were diagnosed with multi-level lumbar stenosis and underwent double-segmental surgery in elderly patients. The clinical outcomes were evaluated using visual analogue scale (VAS) score for both back and leg pain, Oswestry Disability Index (ODI) score, and Zurich Claudication Questionnaire score during the two-year follow-up. The radiological changes of cross-sectional dural area (DCSA), facet joint preservation rate (PFJR) and cross-sectional fat infiltration ratio (FI) on the surgical side were evaluated by MRI before and after operation. At 2 years after operation, progressive spondylolisthesis and instability were evaluated in the X-ray of the lumbar spine.</p><p><strong>Results: </strong>After 24 months of follow-up, the VAS scores for both back and leg pain, ODI, and Zurich Claudication Questionnaire in both groups were recovered compared to pre-operation. The postoperative VAS score for lower back pain in the BE-ULBD group was lower than in the ULBD group (1.00 ± 0.95 vs. 1.91 ± 1.07, p < 0.001), and the postoperative VAS score for lower limbs was similar (0.49 ± 0.51 vs. 0.46 ± 0.72, p < 0.001). The postoperative ODI score was lower than that of the ULBD group (9.05 ± 5.01 vs. 12.09 ± 6.18, p < 0.001), and the postoperative ZCQ score of the BE-ULBD group was lower than that of the ULBD group (10.59 ± 2.18 vs. 8.85 ± 1.59, p < 0.001; 7.00 ± 1.12 vs. 7.87 ± 1.63, p = 0.012; 8.95 ± 2.11 vs. 10.74 ± 2.47, p < 0.001). In terms of radiological evaluation, the DCSA of patients in both groups was effectively improved after surgery. Compared with the ULBD group, the BE-ULBD group had a tiny improvement in DCSA (195.04 ± 34.54 vs. 180.93 ± 31.07, p = 0.048) and a better FI (43.48 ± 10.24 vs. 53.93 ± 7.62, p < 0.001). The PFJR was higher (85.90 ± 4.03 vs. 81.26 ± 4.56, p < 0.001) in the BE-ULBD group. Two years after surgery, fewer patients in the BE-ULBD group had spondylolisthesis than in the ULBD group (1/41 vs. 7/46, p = 0.043). The results of complications were similar between the two groups.</p><p><strong>Conclusion: </strong>BE-ULBD is a safe and effective technique for multilevel decompression surgery in elderly patients, which can better protect spinal stability and has better long-term follow-up than traditional surgery.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2302-2312"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12318692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317556","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":"Modular Femoral Stem for Hartofilakidis Type C Hip Dysplasia: Is It Necessary for 1-mm Increment of Distal Stem Diameter?","authors":"Jiafeng Yi, Hongbin Xie, Yubo Liu, Yijian Huang, Wei Chai, Xiangpeng Kong","doi":"10.1111/os.70092","DOIUrl":"10.1111/os.70092","url":null,"abstract":"<p><strong>Background: </strong>S-ROM prosthesis, one well-used femoral prosthesis in the patients with developmental dysplasia of the hip (DDH), has a skipping size of the distal stem diameter. The purpose of this study was to investigate whether its 2-mm incremental diameter could meet clinical needs for high-riding DDH patients.</p><p><strong>Methods: </strong>Between July 2018 and December 2022, the Hartofilakidis type C DDH patients with S-ROM stem (9 or 11 mm) were retrospectively enrolled according to the inclusion criteria and exclusion criteria in our institute. The intraoperative femur fractures, the diameter of the femoral medullary cavity, the canal filling ratio of the S-ROM stem, the closure conditions of the stem slot, and the healing rate of subtrochanteric osteotomy were analyzed to evaluate the effect of stem design on clinical outcomes. Statistical analyses were conducted using independent samples t-tests, chi-square test, and logistic regression analysis with a significance threshold of p < 0.05.</p><p><strong>Results: </strong>A total of 95 patients (109 hips) were included in this study, including 60 hips with 9 mm S-ROM and 49 hips with 11 mm S-ROM. Compared with the 9 mm S-ROM group, the 11 mm S-ROM group presented nearly 5 times the intraoperative fracture rate (16.3%, 3.3%, p < 0.05). The mean diameter of the femoral medullary cavity in the 9 mm S-ROM group was 0.84 ± 0.20 mm and in the 11 mm S-ROM group was 1.03 ± 0.18 mm. The canal filling ratio in the 9 mm S-ROM group is significantly lower than that of the 11 mm S-ROM group. In the 11 mm S-ROM group, the filling ratio of the femoral medullary cavity of fracture hips was significantly higher than that in non-fracture hips.</p><p><strong>Conclusion: </strong>The S-ROM design with a distal stem diameter increment of every 2 mm would increase the risk of intraoperative periprosthetic femoral fractures in high-riding DDH patients. It is necessary for a 1-mm increment of distal stem diameter in such patients.</p><p><strong>Level of evidence: </strong>Level III, retrospective comparative study.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2313-2320"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12318668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317559","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":"Decrease in Global Offset Leads to Complaints of Worsening of Valgus Knee Deformity After Total Hip Arthroplasty in Patients With Crowe Type IV Developmental Dysplasia of the Hip.","authors":"Minzhi Yang, Xiangpeng Kong, Ping Song, Zheng Cao, Wei Chai","doi":"10.1111/os.70091","DOIUrl":"10.1111/os.70091","url":null,"abstract":"<p><strong>Background: </strong>Conflicting evidence exists regarding the impact of total hip arthroplasty (THA) on valgus knee deformities in patients with developmental dysplasia of the hip (DDH). The aim of this retrospective study was to identify the factors potentially contributing to the worsening of valgus knee deformities in DDH patients after THA.</p><p><strong>Methods: </strong>This retrospective case-control study included 51 patients (69 hips) with Crowe type IV DDH who underwent primary THA between January 2018 and January 2020. The anatomic lateral distal femoral angle (aLDFA), mechanical lateral distal femoral angle (mLDFA), anatomic medial proximal tibial angle (MPTA), hip-knee-ankle (HKA) angle, anatomic tibiofemoral angle (TFA), joint line convergence angle (JLCA), tibial joint line angle (TJLA), femoral offset (FO), acetabular offset (AO), global offset (GO), and extent of leg lengthening were measured before and after THA. The case group comprised patients who complained that their valgus knee deformity worsened after THA, and the control group comprised those who did not. Hip-level data were compared using generalized linear mixed effects models for proportions/rates and linear mixed models for means.</p><p><strong>Results: </strong>The case group has 19 hips, and the control group has 50 hips. Both groups showed improvement in the HKA after THA (p < 0.05), but the case group presented with a smaller HKA (177.4 ± 2.4 vs. 175.2 ± 2.7, p < 0.001) and greater AO (5.8 ± 1.0 vs. 5.0 ± 1.0, p = 0.011) and GO (7.9 ± 0.7 vs. 7.0 ± 1.1, p = 0.003) values before THA. After THA, GO decreased in both groups, and the TJLA increased in the case group (0.6 ± 2.6 to 2.3 ± 3.5, p = 0.011).</p><p><strong>Conclusions: </strong>THA improved the HKA in DDH patients. However, a decrease in GO could lead to an increase in the TJLA, suggesting pseudoprogression of the valgus knee deformity and therefore lead to complaints of worsening of valgus knee deformities. GO restoration during surgery may reduce the impact on the TJLA.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2281-2290"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12318677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144294202","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":"The Long Head of Biceps Tendon Tenotomy in Idiopathic Glenohumeral Adhesive Capsulitis Surgery Improves Early Rehabilitation Outcomes.","authors":"Jia-Long Luo, Ye-Bin Huang, Xing-Hao Deng, Jing-Song Wang, Yu-Heng Li, Wei-Ping Li, Chuan Jiang, Zheng-Zheng Zhang, Zhong Chen","doi":"10.1111/os.70104","DOIUrl":"10.1111/os.70104","url":null,"abstract":"<p><strong>Objective: </strong>Idiopathic glenohumeral adhesive capsulitis, known as idiopathic frozen shoulder (IFS) and characterized by pain and limited motion of the shoulder, is often treated by arthroscopic capsule release surgery, though residual symptoms may remain postoperatively. Due to overlapping symptoms and shared anatomical involvement, it is hard to distinguish the source of shoulder pain between concurrent long head of the biceps tendon (LHBT) inflammation and IFS. The study aimed to verify that LHBT tenotomy, compared with leaving it in situ, could provide better pain reduction and shoulder mobility in early rehabilitation of post-arthroscopic IFS capsule release surgery.</p><p><strong>Methods: </strong>From January 2020 to January 2022, 73 patients with idiopathic adhesive capsulitis were divided into two groups based on the preoperative LHBT lesions and treatment received for LHBT: tenotomy or left in situ. All patients underwent arthroscopic capsular release, coracohumeral ligament release, and subacromial decompression. Outcomes were measured before surgery and at 1, 3, 6, 12, and 24 months and final follow-up postoperatively, including shoulder functional scores, joint range of motion, visual analog scale (VAS) score for pain, and complications. T-test, Chi-square test, and Fisher's test were performed to analyze the data.</p><p><strong>Results: </strong>This study found that while functional scores and joint range of motion of both groups improved significantly in the final follow-up, the LHBT tenotomy group showed lower VAS scores for pain at 1 (2.2 ± 0.8) and 3 months (2.1 ± 0.6) postoperatively (p < 0.001). Additionally, there was better shoulder mobility in external rotation compared to the LHBT left in situ group at 1-12 months postoperatively (p < 0.001). There was no significant difference in postoperative complications between the two groups.</p><p><strong>Conclusion: </strong>In idiopathic adhesive capsulitis patients undergoing arthroscopic release, LHBT tenotomy led to significant improvements in joint mobility and pain reduction in early rehabilitation stages compared with leaving LHBT in situ, despite two groups showing no significant difference at the final follow-up postoperatively.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2331-2341"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12318667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529119","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":"The Efficacy of Intravenous Analgesia and Various Nerve Blocks for Pain Management in Elderly Patients With Hip Fractures: A Meta-Analysis.","authors":"Yuping Liu, Li Zhou, Xin Wang","doi":"10.1111/os.70090","DOIUrl":"10.1111/os.70090","url":null,"abstract":"<p><p>Pain management in elderly patients with hip fractures has received more and more attention, which is crucial for promoting recovery and reducing complications. At present, there are various and controversial analgesic methods for this population. This meta-analysis evaluated the analgesic effects and side effects of intravenous analgesia compared to different nerve block techniques, including femoral nerve block, fascia iliaca block or pericapsular nerve group block, in this patient group. The study was conducted following the PRISMA 2020 guidelines. A search was performed in October 2024 across PubMed, Web of Science, Cochrane Library, and Embase. Pain scores at different time points, supplemental analgesic morphine consumption, and adverse reactions were compared between intravenous analgesia and nerve blocks. Data were collected from 12 studies and 1157 elderly patients using intravenous analgesia and nerve block after hip fracture, with no differences in sample size, mean age, or percentage of females between the two groups at baseline. Compared to intravenous analgesia, nerve blocks showed significant advantages in the pain score of 2 h after block (SMD-0.80; 95% CI: -1.23 to -0.38; I² = 90%) and the supplemental analgesic morphine consumption (SMD = -0.46; 95% CI: -0.73 to -0.19; I² = 59%). The incidence of adverse reactions and the pain scores at various time points also demonstrated significant differences between the two groups. The application of nerve blocks in elderly patients with hip fractures demonstrates significant clinical advantages, particularly in postoperative pain management, decreasing opioid use, and reducing postoperative complications.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2255-2265"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12318691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258655","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}