Clinics in Orthopedic Surgery最新文献

{"title":"The Efficacy of a Double Wiring Technique in Cementless Hemiarthroplasty for Unstable Basicervical Intertrochanteric Fractures: A Propensity Score-Matched Analysis of Femoral Neck Fractures.","authors":"Dae-Kyung Kwak, Ji-Hyo Hwang, Je-Hyun Yoo","doi":"10.4055/cios26025","DOIUrl":"10.4055/cios26025","url":null,"abstract":"<p><strong>Background: </strong>Basicervical intertrochanteric (IT) fractures are a distinct subtype of proximal femoral fractures, characterized by marked rotational instability and a high risk of fixation failure. In elderly patients, primary arthroplasty may serve as a viable option. This study aimed to report the clinical outcomes of cementless hemiarthroplasty using a double wiring technique for unstable basicervical IT fractures in elderly patients and to compare them with those after cementless hemiarthroplasty for displaced femoral neck (FN) fractures.</p><p><strong>Methods: </strong>We retrospectively reviewed 45 patients aged 75 years and older who received cementless bipolar hemiarthroplasty using a double wiring technique for unstable basicervical IT fractures and were followed up for more than 1 year between January 2015 and December 2022. After propensity score matching (2 : 1), the control group comprised 90 patients who underwent cementless hemiarthroplasty for displaced FN fractures. All operations were performed via a short external rotator-preserving posterolateral approach. The perioperative results, postoperative complications, and 1-year mortality of the 2 groups were investigated and compared.</p><p><strong>Results: </strong>The IT group exhibited significantly longer operation times (<i>p</i> = 0.031) and greater total blood transfusion volume (<i>p</i> = 0.027) than the FN group despite no significant differences in blood loss and transfusion rate. No significant differences were observed in postoperative medical and surgical complications. Wire breakage occurred in 7 patients, and of those, 5 showed proximal migration of the greater trochanter fragment. However, there was no subsequent functional impairment in these patients. At 1 year after the index surgery, there were no significant differences in walking ability and mortality rate between the 2 groups.</p><p><strong>Conclusions: </strong>Cementless hemiarthroplasty with a double wiring technique for unstable basicervical IT fractures demonstrated clinical outcomes and 1-year mortality equivalent to those of hemiarthroplasty for displaced FN fractures, suggesting it as a feasible and safe option in osteoporotic elderly patients with these fractures.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 4","pages":"631-639"},"PeriodicalIF":2.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674393","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":"Total and Hidden Blood Loss in Biportal Endoscopic Versus Tubular-Based Minimally Invasive Transforaminal Lumbar Interbody Fusion.","authors":"Tae Hoon Kang, Byungjun Kang, Jung-Man Lee, Minjoon Cho, Jae Hyup Lee","doi":"10.4055/cios25409","DOIUrl":"10.4055/cios25409","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to compare total blood loss (TBL) and hidden blood loss (HBL) between biportal endoscopic transforaminal lumbar interbody fusion (BE-TLIF) and tubular-based minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) using hematocrit-based calculations. The study aimed to compare blood loss outcomes between the 2 techniques during their respective initial adoption phases to ensure a fair comparison of hemostatic control.</p><p><strong>Methods: </strong>This retrospective study included 72 patients who underwent single-level lumbar fusion. Thirty-six consecutive BE-TLIF cases (June 2023-July 2025) were compared with 36 early-period MIS-TLIF cases (2016-2021) to ensure comparable learning curve stages. TBL was calculated using Nadler's and Gross's formulas based on hematocrit changes. HBL was derived by subtracting estimated blood loss and drainage from TBL.</p><p><strong>Results: </strong>The BE-TLIF group underwent more additional adjacent-level decompression procedures and longer operative times than the MIS-TLIF group. However, the BE-TLIF group showed consistently lower TBL at the immediate postoperative time point (0.42 vs. 0.62 L, <i>p</i> = 0.001) and at the time point of maximum calculated loss (0.87 vs. 1.05 L, <i>p</i> = 0.025). HBL was similar between the groups (0.32 vs. 0.43 L, <i>p</i> = 0.262), suggesting that reduced TBL in the BE-TLIF group resulted from decreased intraoperative bleeding rather than postoperative extravasation differences. No patients in either group required blood transfusion.</p><p><strong>Conclusions: </strong>Despite longer operative times and more extensive adjacent-level decompression procedures, BE-TLIF resulted in significantly lower TBL. HBL was comparable between the techniques, indicating that BE-TLIF's hemostatic advantages are achieved through improved intraoperative control. Even during the initial adoption phase, BE-TLIF demonstrated superior hemostatic control.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 4","pages":"679-686"},"PeriodicalIF":2.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674473","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 Clinical Outcomes According to Preoperative Skin Preparation in Hip Arthroplasty for Hip Fracture: A 3-Arm Randomized Controlled Trial.","authors":"Chanhee Park, Seung-Cheol Choi, Seong Gyu Kim, Myung-Rae Cho, Suk-Kyoon Song","doi":"10.4055/cios26054","DOIUrl":"10.4055/cios26054","url":null,"abstract":"<p><strong>Background: </strong>Patients with hip fractures undergoing arthroplasty are typically old and frail, and superficial surgical site infections (SSIs) can delay mobilization and prolong hospitalization. Preoperative skin antisepsis is a low-cost, universally used intervention. However, clinical practice varies, and evidence from elective arthroplasty may not fully generalize to urgent hip fracture surgery. Sequential dual-antiseptic protocols combining povidone-iodine (PVI) and chlorhexidine gluconate (CHG) are increasingly adopted; however, the optimal order for \"scrub\" versus \"paint\" remains unclear. We compared the prophylactic efficacy of 3 skin preparation protocols using different sequences of PVI and CHG.</p><p><strong>Methods: </strong>In this single-center, prospective, randomized controlled trial, 108 patients undergoing hip arthroplasty for hip fracture were randomly allocated to 3 groups based on the antiseptic agents used for the mechanical \"scrub\" and final \"paint\" steps: group 1 (PVI scrub/PVI paint), group 2 (PVI scrub/CHG paint), and group 3 (CHG scrub/PVI paint). The primary outcome was the rate of positive skin culture results immediately before draping and pathogen identification results. The secondary outcome was the incidence of superficial SSI.</p><p><strong>Results: </strong>Post-preparation culture positivity was significantly lower in the CHG-containing groups (group 2 and group 3: 5.6% each) than in the PVI-only group (group 1: 27.8%; <i>p</i> = 0.005). The incidence of superficial SSI differed significantly among the 3 protocols (<i>p</i> = 0.015). The highest superficial SSI rate was observed in group 1 (30.6%), followed by group 2 (13.9%). Group 3 had the lowest superficial SSI rate (5.6%). In multivariable logistic regression adjusted for confounders, group 1 was associated with a significantly higher risk of SSI than group 3 (adjusted odds ratio, 3.89; 95% CI, 1.22-12.37; <i>p</i> = 0.021).</p><p><strong>Conclusions: </strong>The sequence of antiseptic application significantly influenced microbiological outcomes, with CHG-containing protocols demonstrating lower post-preparation culture positivity. A protocol using a CHG scrub followed by PVI paint provided the most effective bacterial suppression. Differences in superficial SSI rates were also observed and may reflect the impact of improved microbiological control. Optimizing the order of antiseptic administration may contribute to improved infection prevention in this high-risk population.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 4","pages":"640-650"},"PeriodicalIF":2.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680612","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":"Efficacy of Intraligamentous Steroid Injection in Pain Reduction and Knee Motion Improvement in Patients with Mucoid Degeneration of the Anterior Cruciate Ligament.","authors":"Sang Yoon Kim, Byung Sun Choi, Du Hyun Ro, Hyuk-Soo Han","doi":"10.4055/cios25280","DOIUrl":"10.4055/cios25280","url":null,"abstract":"<p><strong>Background: </strong>This study assessed the efficacy and safety of fluoroscopy-guided intraligamentous steroid injections in managing mucoid degeneration of the anterior cruciate ligament (MDACL) in patients resistant to oral medication and intra-articular steroid injections.</p><p><strong>Methods: </strong>A retrospective review of 294 knees diagnosed with MDACL via magnetic resonance imaging between October 2014 and June 2023 was conducted. After applying exclusion criteria and excluding patients who were asymptomatic or showed improvement with conservative treatment, 82 knees were included in the final analysis. Intraligamentous steroid injections were performed under C-arm fluoroscopy by a single orthopedic surgeon. Clinical data collected included the duration of the pain-free period, patient-reported outcome measures (PROMs; pain numeric rating scale, the International Knee Documentation Committee subjective score, Lysholm score, and Knee Injury and Osteoarthritis Outcome Score), range of motion, and other radiological measures. Symptom recurrence rates were determined using the Kaplan-Meier survival analysis.</p><p><strong>Results: </strong>The average age at the time of injection was 64.0 years (range, 39-83 years), and the mean follow-up period was 19.5 months (range, 12-90 months). Pain improvement was noted in 78 of 82 knees (95.1%), with an average effect duration of 7.8 months (standard deviation, 9.1). Improvement of limitation of knee motion was observed in 49 of 50 cases (98.0%). Kaplan-Meier analysis indicated symptom recurrence rates of 19.5% at 3 months, 39.0% at 6 months, and 48.8% at 1 year. All PROMs significantly improved after injection for 6 months (<i>p</i> < 0.01) and then slightly declined. No patients reported post-procedure instability.</p><p><strong>Conclusions: </strong>Fluoroscopy-guided intraligamentous steroid injection demonstrated short-term efficacy in relieving pain and improving knee motion in MDACL patients resistant to conventional treatments, although further studies are warranted to confirm these findings.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 4","pages":"658-665"},"PeriodicalIF":2.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680569","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":"Digital Therapeutics for Postoperative Rehabilitation after Arthroscopic Rotator Cuff Repair: A Single-Center, Assessor-Blinded, Randomized Pilot Study.","authors":"So-Youn Chang, Jong-Ho Kim, Youn Kyu Lee, Hyun Tae Shin, Chul Ho Lee, Su Jeong Lee, Hong Kwon Lee, Min Jeon, Eun-Ji Yoon","doi":"10.4055/cios25474","DOIUrl":"10.4055/cios25474","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Home-based rehabilitation after arthroscopic rotator cuff repair (ARCR) often lacks objective monitoring. To address this limitation, we developed the ANAPA digital rehabilitation (DR) system, which includes a patient-facing mobile application for clinical efficacy evaluation (ANAPA ME) and a physician-facing measurement application for technical assessment (ANAPA PS). This study compared the safety and preliminary efficacy of ANAPA ME with conventional YouTube-based rehabilitation (CR), with an additional validation of the automated measurement functions in ANAPA PS.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This single-center, assessor-blinded, randomized pilot study included 18 patients who had undergone ARCR. The participants were allocated to the DR group (n = 9) or CR group (n = 9) and followed identical postoperative rotator cuff exercise protocols. The program was conducted for 24 weeks postoperatively. The shoulder range of motion (ROM), muscle strength, and clinical outcomes (visual analog scale pain score, Constant shoulder score, Shoulder Pain and Disability Index, and EuroQol-5 Dimension-5 Level questionnaire) were evaluated at baseline and at follow-up up to 24 weeks postoperatively. Ultrasonography was performed at 24 weeks to evaluate the integrity of the repaired tendons. Automated ROM and muscle strength measurements of ANAPA PS were validated against digital goniometry and hand-held dynamometry at the 6-month follow-up, and measurement consistency was assessed using intraclass correlation coefficients (ICCs) and coefficients of variation (CV).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Both the DR and CR groups demonstrated significant within-group improvements in ROM and clinical scores (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). The DR group showed significantly greater improvements in specific ROM parameters, including forward flexion at 24 weeks and abduction, abduction-external rotation, and internal rotation at 18 and 24 weeks, compared with the CR group (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). At 18 weeks, the internal rotation muscle strength was also significantly higher in the DR group than in the CR group (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). A significant time-by-group interaction was observed for abduction, side-external rotation, and internal rotation (&lt;i&gt;p&lt;/i&gt; &lt; 0.05), suggesting a more consistent improvement pattern over time in the DR group compared with the CR group. In supplementary validation, ANAPA PS measurements showed high agreement with reference instruments (mean absolute error of 3.14° for ROM and 0.15-0.22 kgf for muscle strength). In consistency analysis, ANAPA PS showed higher repeatability and lower variability than digital goniometry (ICC = 0.99 vs. 0.97; CV = 1.61% vs. 11.7%, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and hand-held dynamometry (ICC = 0.97 vs. 0.39; CV = 2.1% vs. 13.8%, &lt;i&gt;p&lt;/i&gt; &lt; 0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this exploratory pilot study, the ANAPA DR system demonstrated favorable trends compared with CR in patients after ARCR, suggesting t","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 4","pages":"708-721"},"PeriodicalIF":2.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674413","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":"Lateral Snapping Elbow Caused by Entrapment of the Degenerative Annular Ligament: A Case Series.","authors":"Hideyuki Kobayashi, Yuichiro Matsui, Hiroyuki Kato, Masanori Hayashi, Makoto Motomiya, Daisuke Momma, Takeshi Endo, Hirofumi Miyaji, Norimasa Iwasaki","doi":"10.4055/cios25490","DOIUrl":"10.4055/cios25490","url":null,"abstract":"<p><strong>Background: </strong>Lateral snapping elbow is a rare condition, and cases attributed to intra-articular lesions of the annular ligament are particularly rare. This study was performed to analyze cases of lateral snapping elbow due to annular ligament entrapment to clarify its pathogenesis and clinical characteristics.</p><p><strong>Methods: </strong>We reviewed 4 patients who underwent surgical treatment for painful lateral snapping elbow caused by annular ligament entrapment at 3 institutions from 2010 through 2018. The patients included 2 men and 2 women with a mean age of 59 years (range, 45-69 years). Preoperative evaluations included physical examination, x-rays, magnetic resonance imaging (MRI), and the Mayo Elbow Performance Score (MEPS).</p><p><strong>Results: </strong>All patients were followed up for an average of 10.5 months (range, 6-12 months). Significant tenderness at the lateral epicondyle of the humerus and snapping were noted preoperatively. MRI consistently demonstrated high signal intensity at the origin of the extensor carpi radialis brevis (ECRB). All 4 patients were diagnosed with snapping elbow associated with lateral epicondylitis, for which surgical intervention was performed because of resistance to conservative treatment. Intraoperatively, the degenerative, entrapped annular ligament within the radiocapitellar joint was observed to reposition during elbow flexion in forearm pronation. Partial resection of the degenerative, entrapped annular ligament was performed, along with ECRB debridement in all patients. The mean MEPS improved from 73.8 preoperatively to 100 postoperatively.</p><p><strong>Conclusions: </strong>Degeneration of the annular ligament can lead to its entrapment in the radiocapitellar joint, resulting in snapping elbow. Surgical partial resection of the annular ligament and debridement of the ECRB effectively resolve symptoms and restore function. Snapping elbow caused by annular ligament entrapment may be distinguished by snapping that occurs during pronation and flexion, indicating ligament relocation.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 4","pages":"722-726"},"PeriodicalIF":2.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674383","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":"Challenging the Role of Routine Thromboprophylaxis in Foot and Ankle Surgery: A Comparative Study of Aspirin, Enoxaparin, and No Prophylaxis.","authors":"Young Uk Park, Jinyoung Jun, Seugyeob Sakong, Myungsub Lee, Young Wook Seo","doi":"10.4055/cios25389","DOIUrl":"10.4055/cios25389","url":null,"abstract":"<p><strong>Background: </strong>Deep vein thrombosis (DVT) is a common postoperative complication in orthopedic surgery and may result in life-threatening events such as pulmonary thromboembolism (PTE). However, evidence on the optimal prophylactic strategy for DVT following foot and ankle surgery remains limited. This study aimed to assess the effect of pharmacologic thromboprophylaxis in patients undergoing foot and ankle surgery with postoperative immobilization.</p><p><strong>Methods: </strong>A retrospective review was conducted of 451 patients who underwent foot and ankle surgery followed by short-leg splint immobilization with restricted ankle motion for more than 2 weeks between April 2022 and February 2024. All patients underwent routine screening duplex ultrasonography at 2 weeks postoperatively, regardless of symptom status. Patients were categorized into 3 groups based on postoperative pharmacologic thromboprophylaxis: no anticoagulation, aspirin (Aspirin Protect, Bayer AG) 100 mg once daily for 14 days, and enoxaparin (a low-molecular-weight heparin; Clexane, Sanofi) 40 mg once daily during hospitalization followed by aspirin after discharge to complete a total of 14 days. The incidence of DVT was compared using the chi-square test, and multivariate logistic regression analysis was performed to adjust for potential confounders.</p><p><strong>Results: </strong>Of the 451 patients, 73 patients (16.2%) developed DVT. The incidence of DVT was comparable among the 3 groups, with no statistically significant differences observed (no-anticoagulation group: 24 of 147 [16.3%]; aspirin group: 25 of 145 [17.2%]; enoxaparin group: 24 of 159 [15.1%]; <i>p</i> = 0.34). Most DVTs were asymptomatic (66 / 73, 90.4%) and confined to the distal calf veins (70 / 73, 95.9%), while proximal DVT was rare (3 / 73, 4.1%), occurring in 1 patient in each group. Multivariate logistic regression analysis demonstrated no significant association between pharmacologic thromboprophylaxis and postoperative DVT after adjustment for confounding variables.</p><p><strong>Conclusions: </strong>In this retrospective cohort, pharmacologic thromboprophylaxis with enoxaparin or aspirin was not associated with a reduced incidence of postoperative DVT following foot and ankle surgery with immobilization. These findings should be interpreted cautiously given the observational design and short duration of prophylaxis. A uniform anticoagulation strategy may not be appropriate for all patients.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 4","pages":"746-752"},"PeriodicalIF":2.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437156/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680478","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 an Extended Offset Stem Improve Hip Stability and Function in Elderly Patients with a Femoral Neck Fracture?","authors":"Min Seok Kim, Suc Hyun Kweon, Han Seok Ko, Jong Seok Baik","doi":"10.4055/cios25266","DOIUrl":"10.4055/cios25266","url":null,"abstract":"<p><strong>Background: </strong>Hip fractures in elderly patients remain a major clinical challenge, with optimal surgical strategies still debated. Evidence regarding abductor strength recovery and functional outcomes after total hip replacement (THR) using an extended offset cemented stem in elderly patients with femoral neck fracture (FNF) remains limited. We evaluated functional outcomes and abductor muscle strength of THR for FNF in elderly patients, comparing an extended medial offset (MO) stem and a standard MO stem.</p><p><strong>Methods: </strong>We retrospectively reviewed 120 patients undergoing THR with an extended MO Exeter 44-mm stem (group A) and 100 patients undergoing THR with a standard MO Exeter 37.5-mm stem (group B) for FNF. We enrolled patients with a Koval grade of 3 or higher, an American Society of Anesthesiologists (ASA) grade of 3 or lower, and a Mini-Mental State Examination score of 24 or higher. Postoperative MO of the affected hip was compared with the native hip. Abductor muscle strength was measured using a muscle dynamometer (KINVENT technologies). Complications including dislocation, thigh pain, and greater trochanteric pain (GTP) were investigated.</p><p><strong>Results: </strong>No significant differences in ASA, body mass index, bone mineral density, or implant position were observed between the 2 groups. The mean MO of the affected hip was 42.6 mm in group A and 36.2 mm in group B, approximately 5 mm greater than the native hip in group A (37.8 mm) and 6 mm greater in group B (30.4 mm). Abductor muscle power of the affected hip recovered to approximately 86% of the native hip in group A and 81% in group B. No dislocations or thigh pain occurred. In group A, 5 patients had mild GTP treated with physical therapy. Group A demonstrated smaller differences between the affected and native hips in mean MO, mean vertical offset, and abductor muscle strength compared with group B (<i>p</i> < 0.05).</p><p><strong>Conclusions: </strong>For healthy elderly patients with FNF undergoing THR, the extended MO stem had a positive effect on the recovery of abductor muscle strength, potentially contributing to improved joint stability.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 4","pages":"624-630"},"PeriodicalIF":2.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674425","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":"Outcomes of Surgical Strategies for Prosthetic Joint Infection Following Unicompartmental Knee Arthroplasty: A 2-Year Follow-up.","authors":"Baijian Wu, Zhishuo Zhang, Ruan Chen, Zhenggui Yu, Ye Yang, Wenbo Li, Wenming Zhang, Xinyu Fang, Zida Huang","doi":"10.4055/cios25110","DOIUrl":"10.4055/cios25110","url":null,"abstract":"<p><strong>Background: </strong>There are limited guidelines on the standard surgical management of unicompartmental prosthetic joint infection (uPJI). The purpose of this study was to review the infection control and functional recovery of a standardized institutional treatment protocol, which included debridement, antibiotics, and implant retention (DAIR) and revision, to provide insights into the proper management of uPJI.</p><p><strong>Methods: </strong>Twenty-seven patients (28 knees) diagnosed with uPJI according to the Musculoskeletal Infection Society (MSIS) criteria from 2017 to 2023 were analyzed. Patients with acute or hematogenous uPJI underwent DAIR, whereas chronic infections were managed with revision strategies according to an institutional protocol; these cohorts represent different infection chronicity categories and were not intended for direct comparative effectiveness analysis. The follow-up ranged from 24 to 102 months. Demographic information, infection types, clinical outcomes, functional assessments, and culture results were recorded.</p><p><strong>Results: </strong>Infection control, defined according to MSIS outcome reporting criteria within 1 year after the index surgery, was achieved in 89.3% of cases (25 / 28): 80% after DAIR (12 / 15) and 100% after revision (13 / 13). Chronic uPJI cases received 2-stage revision with a unicompartmental spacer (n = 10), 2-stage revision with a bicompartmental spacer (n = 1), or 1-stage total knee arthroplasty (TKA) (n = 2). Three failures required reoperation (2 DAIR and 1 two-stage revision with a unicompartmental spacer). Unicompartmental spacers were retained in 4 two-stage cases. At 2-year follow-up, range of motion, Hospital for Special Surgery scores, visual analog scale, and 12-item Short Form Health Survey all improved significantly in both the DAIR and the revision patients.</p><p><strong>Conclusions: </strong>DAIR is suitable for acute or hematogenous uPJI, whereas revision is suitable for chronic uPJI. One-stage revision to TKA and 2-stage revision with unicompartmental spacers may be appropriate in carefully selected patients.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 4","pages":"666-678"},"PeriodicalIF":2.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680563","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":"Optimizing Drill Guide Positioning for Foveal Targeting in Arthroscopic One-Bone Tunnel Triangular Fibrocartilage Complex Repair: A Radiographic and Magnetic Resonance Imaging-Based Study.","authors":"Jae Jun Nam, In Cheul Choi, Yeongyoon Koh, Jong Woong Park","doi":"10.4055/cios25372","DOIUrl":"10.4055/cios25372","url":null,"abstract":"<p><strong>Background: </strong>To determine optimal drill guide positioning over the articular disc of the triangular fibrocartilage complex (TFCC) for accurately targeting the foveal insertion of the TFCC during arthroscopic one-bone tunnel transosseous repair using radiographic and magnetic resonance imaging (MRI)-based analysis.</p><p><strong>Methods: </strong>A retrospective review was conducted on 60 patients who underwent arthroscopic one-bone tunnel TFCC repair for Palmer type 1B foveal tears. Postoperative radiographs were analyzed to measure the bone tunnel's starting point, angle relative to the ulnar shaft, and tunnel length. These parameters were then used to set the expected position of the drill guide tip over the articular disc of the TFCC on preoperative MRI scans.</p><p><strong>Results: </strong>The mean starting point of the bone tunnel was 12.0 mm proximal to the ulnar styloid tip, with an average tunnel angle of 37.0° and length of 10.0 mm. MRI analysis localized the drill guide tip approximately 4.0 mm radial to the medial aspect of the ulnar styloid over the articular disc of the TFCC. This location corresponded to the lateral one-third of a line connecting the center of the sigmoid notch to the center of the ulnar styloid process under the radiocarpal arthroscopic view.</p><p><strong>Conclusions: </strong>These radiologic and anatomic parameters provide a guide for positioning the TFCC drill guide during arthroscopic one-bone tunnel repair. Targeting the lateral one-third of a line between the center of the sigmoid notch and ulnar styloid under the radiocarpal arthroscopic view offers a practical landmark to optimize bone tunnel placement for targeting the foveal insertion of the TFCC.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 4","pages":"738-745"},"PeriodicalIF":2.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674381","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}