Clinics in Orthopedic Surgery最新文献

{"title":"Clinical Impact of Meniscal Scaffold Implantation in Patients with Meniscal Tears: A Systematic Review.","authors":"Joo Hyung Han, Min Jung, Kwangho Chung, Se-Han Jung, Hyunjun Lee, Chong-Hyuk Choi, Sung-Hwan Kim","doi":"10.4055/cios24285","DOIUrl":"10.4055/cios24285","url":null,"abstract":"<p><strong>Background: </strong>Meniscal scaffold implantation has been introduced as a treatment for meniscal injuries, but there is still no clear consensus on its clinical impact, including its chondroprotective effect. This review aimed to assess the chondroprotective effects, clinical outcomes, and survivorship of meniscal scaffold implantation compared to meniscectomy, as well as among different types of scaffolds.</p><p><strong>Methods: </strong>A comprehensive search strategy was performed on the databases of PubMed, Embase, Cochrane Library, and Google Scholar, encompassing articles published until June 1, 2024. Randomized controlled trials (RCT) and comparative studies published in English that reported results using collagen meniscal implant (CMI) and polyurethane meniscal scaffold for meniscal tear were included.</p><p><strong>Results: </strong>A total of 421 studies were initially identified across databases, and a systematic review was conducted on 8 studies involving 596 patients. Among the 5 studies that addressed the chondroprotective effect, none found that meniscal scaffolds had a higher chondroprotective effect compared to meniscectomy. In studies comparing CMI and meniscectomy, the Lysholm score results showed a mean difference (MD) range between -5.90 and -4.40. In the case of visual analog scale score, the MD ranged from -1.0 to 1.0. In studies comparing polyurethane meniscal scaffolds and CMI, the Tegner score results showed an MD range of -2.0 to 0.4.</p><p><strong>Conclusions: </strong>There was no superiority in chondroprotective effects for both CMI and polyurethane meniscal scaffolds compared to meniscectomy. Although meniscal scaffolds may provide improvements in clinical outcomes, no clinically relevant differences were observed in comparison to meniscectomy. There are no discernible differences between the 2 types of scaffolds.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"17 1","pages":"112-122"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11791501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257032","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 and Safety of Topical Tranexamic Acid in Elderly Hip Fractures Undergoing Surgical Treatment: Meta-Analysis of Randomized Controlled Trials.","authors":"Sanzhar Artykbay, Paweena Susantitaphong, Saran Tantavisut","doi":"10.4055/cios24184","DOIUrl":"10.4055/cios24184","url":null,"abstract":"<p><strong>Background: </strong>Hip fractures are a major health concern, especially among older adults. The conventional treatment for this condition involves surgery, but it carries the risk of excessive blood loss and complications. Tranexamic acid (TXA) has emerged as a possible solution for reducing bleeding during surgery. This study aims to evaluate the safety and efficacy of topical TXA compared to systemic TXA and a placebo in adult patients undergoing surgical treatment for hip fractures.</p><p><strong>Methods: </strong>The literature was reviewed using 3 databases (PubMed, Scopus, and Google Scholar) for studies published up to November 2023. All randomized controlled trials (RCTs) assessing the effectiveness of topical TXA in hip fracture surgery were included for analysis. Two reviewers assessed the quality of studies independently using the Cochrane-recommended risk-of-bias tool. Statistical analysis was performed on Comprehensive Meta-Analysis Software (version 2.0).</p><p><strong>Results: </strong>Nine RCTs with 1,024 patients assessed topical TXA in hip fracture surgery. Topical TXA significantly reduced hemoglobin loss (mean difference [MD], 1.004 g/dL; 95% CI, 0.096-1.911; <i>p</i> = 0.03) and transfused blood units (relative risk, 0.640; 95% CI, 0.487-0.841; <i>p</i> = 0.001) versus placebo, but there was no significant difference in hematocrit loss, total blood loss, deep vein thrombosis (DVT) rates, mortality, hospital stays, or surgery duration compared to placebo. Moreover, the meta-analysis revealed no significant differences between local and intravenous TXA administration in blood transfusion rates, total blood loss, incidence of DVT, and surgery duration. The results of the subgroup analysis that compared topical TXA to placebo in the arthroplasty group showed that TXA significantly reduced hemoglobin drop (MD, 1.500 g/dL; 95% CI, 0.324-2.676; <i>p</i> = 0.012) and total blood loss (MD, -322.3 mL; 95% CI, -566.6 to -78.0; <i>p</i> = 0.010).</p><p><strong>Conclusions: </strong>The available evidence suggests that local TXA can significantly reduce hemoglobin loss and the number of transfused blood units without the risk of DVT compared to a placebo. Furthermore, local TXA demonstrated comparable effectiveness and safety to intravenous TXA following hip fracture surgery. Subgroup analysis revealed that topical TXA significantly decreased the hemoglobin drop and total blood loss in the arthroplasty group, as compared to the placebo.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"17 1","pages":"16-28"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11791490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257061","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":"Patterns of Avulsion and Osteochondral Fractures Associated with Patellar Dislocations: A Descriptive Study Using 3-Dimensional Computed Tomography.","authors":"Ozkan Kose, Fırat Dogruoz, Omer Faruk Egerci, Faruk Aykanat, Koray Kaya Kilic","doi":"10.4055/cios24270","DOIUrl":"10.4055/cios24270","url":null,"abstract":"<p><strong>Background: </strong>This retrospective study aimed to analyze avulsion and osteochondral fractures associated with patellar dislocation using 3-dimensional (3D) computed tomography (CT).</p><p><strong>Methods: </strong>A retrospective analysis was conducted on patients admitted between 2015 and 2023 with acute or recurrent patellar dislocations. A musculoskeletal radiologist and 2 orthopedic surgeons evaluated CT scans of 148 patients (160 knees) to identify and categorize all avulsion and osteochondral fractures. The included fracture patterns were as follows: pattern I: medial patellofemoral ligament (MPFL) avulsion from the upper two-thirds of the patella, pattern II: medial patellotibial ligament (MPTL) and medial patellomeniscal ligament (MPML) avulsion from the lower one-third, pattern III: inferomedial patellar facet osteochondral fracture, pattern IV: lateral femoral condyle osteochondral fracture, and pattern V: MPFL avulsion from the femoral footprint. The dimensions of patellar articular surface osteochondral fractures were measured, and patient age, sex, and side were recorded. Descriptive statistics and chi-squared tests were performed.</p><p><strong>Results: </strong>A total of 148 patients (93 female and 55 male patients) with a mean age of 18.7 ± 6.8 years were included. Of these, 116 patients (72.5%) had 1 or more fractures, with 71 (44.4%) having isolated lesions and 45 (28.1%) having combined lesions. Pattern II was the most prevalent, observed in 66 knees (41.2%), followed by pattern I in 52 knees (32.5%), and pattern III in 45 knees (28.1%). Patterns IV and V were seen in 4 (2.5%) and 1 (0.6%) knee, respectively. The mean articular fragment size in pattern III was 128.4 ± 95.6 mm² (range, 12-412.5 mm²), all involving the inferomedial facet of the patella. Osteochondral fragments were found in the lateral gutter (35.5%), anterior joint space (51.1%), posterior joint space (8.9%), and suprapatellar space (4.5%). No significant sex differences were observed in isolated versus combined lesions (<i>p</i> = 0.542) or fracture patterns (<i>p</i> = 0.274).</p><p><strong>Conclusions: </strong>This study, the first to evaluate fractures after patellar dislocation using 3D CT, identified 5 distinct fracture patterns. The results show that MPTL/MPML injuries are more common than previously thought, challenging traditional views on patellar dislocation injuries and emphasizing the need for a comprehensive diagnostic approach.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"17 1","pages":"100-111"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11791499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257081","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":"Changes in Gene Expression of the Extracellular Matrix in Patients with Full-Thickness Rotator Cuff Tears of Varying Sizes.","authors":"Jian Jiang, Kwi-Hoon Jang, Sung Yong Ahn, Chris Hyunchul Jo","doi":"10.4055/cios24125","DOIUrl":"10.4055/cios24125","url":null,"abstract":"<p><strong>Backgroud: </strong>This study aimed to investigate changes in gene expression related to matrix synthesis in individuals with full-thickness rotator cuff tears (RCTs) and normal tendon tissues. The study also aimed to examine the differences in gene expression according to 4 distinct tear sizes.</p><p><strong>Methods: </strong>A total of 12 patients with full-thickness RCTs were included in the study, all of whom underwent arthroscopic rotator cuff repair. The RCTs were stratified by size into small, medium, large, and massive. Tendon samples were harvested from the midpoint between the lateral end of the torn tendon and the musculotendinous junction. Subsequent analysis of the tissue samples revealed the mRNA expression levels of 11 collagen types, 6 proteoglycans, and 8 glycoproteins through real-time polymerase chain reaction techniques. For control purposes, supraspinatus tendon tissue was sourced from 3 patients who had proximal humerus fractures but did not present with RCTs.</p><p><strong>Results: </strong>Among the 11 collagens and 14 non-collagenous protein (NCP) genes examined in this study, <i>COL3A1</i> and <i>COL10A1</i> showed a significant increase, whereas <i>COL4A1</i> and <i>COL14A1</i> showed a tendency to decrease compared to those in the normal group. <i>ACAN</i> significantly increased by 8.92-fold (<i>p</i> < 0.001) compared to that in the normal group, whereas <i>DCN</i> and <i>LUM</i> showed a tendency to decrease. <i>FN1</i> and <i>TNC</i> increased significantly by 3.47-fold (<i>p</i> = 0.003) and 5.38-fold (<i>p</i> = 0.005), respectively, and the genes <i>ELN</i>, <i>LAMA2</i>, and <i>THBS1</i> were all significantly reduced compared to those in the normal group. In the NCPs, almost all the genes with increased expression levels had the highest level in small size RCTs, and gene expression decreased as the size increased. The 3 proteoglycans (<i>ACAN</i>, <i>BGN</i>, and <i>FMOD</i>) showed the highest levels of expression in small size RCTs compared to those in the normal group, and 5 glycoproteins (<i>COMP</i>, <i>FBN1</i>, <i>FN1</i>, <i>HAPLN1</i>, and <i>TNC</i>) also showed the highest expression in small size RCTs.</p><p><strong>Conclusions: </strong>We confirmed that most of the detected extracellular matrix gene expression changes were related to the size of the full-thickness RCTs. In NCPs, gene expression was increased in small-size tears, and gene expression levels were significantly reduced when the size increased.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"17 1","pages":"138-147"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11791492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257031","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":"Satisfactory Clinical Outcomes of Revision Anterior Cruciate Ligament Reconstruction Using Quadriceps Tendon-Patellar Bone Allograft.","authors":"Do Weon Lee, Sanguk Lee, Du Hyun Ro, Hyuk-Soo Han","doi":"10.4055/cios23409","DOIUrl":"10.4055/cios23409","url":null,"abstract":"<p><strong>Backgroud: </strong>Allografts are preferred in certain cases of revision anterior cruciate ligament reconstructions to avoid additional graft harvesting and to fill in enlarged tunnels. The clinical outcomes of quadriceps tendon-patellar bone allograft in revision anterior cruciate ligament reconstruction are not well-known. This study was performed to evaluate the clinical outcomes of revision anterior cruciate ligament reconstructions using quadriceps tendon-patellar bone allografts.</p><p><strong>Methods: </strong>Patients who underwent revision anterior cruciate ligament reconstructions with quadriceps tendon-patellar bone allografts with a minimum follow-up of 2 years were retrospectively reviewed. Their mean follow-up length was 33.5 ± 19.5 months. Outcomes including clinical scores (Lysholm, International Knee Documentation Committee [IKDC], Tegner scale, and Knee injury and Osteoarthritis Outcome Score [KOOS]), knee stability (physical examinations and knee arthrometer), return to sports, and any associated complications were assessed. Degrees of graft synovialization were also evaluated using arthroscopy.</p><p><strong>Results: </strong>A total of 38 patients were reviewed and their age at the time of surgery and follow-up length were 37.2 ± 12.5 years (range, 17-66 years) and 2.8 ± 1.6 years, respectively. All clinical scores including KOOS, IKDC, Lysholm, and Tegner scale significantly improved at 2 years after surgery and 92.1% of the patients returned to sports. The mean preoperative side-to-side difference in knee arthrometer decreased from 4.5 ± 2.3 mm before surgery to 2.6 ± 1.5 mm after surgery (<i>p</i> < 0.001). Graft synovialization was observed in 13 of 16 patients (81.3%) who underwent second-look arthroscopy. Complication rate was 10.5% (n = 4). All complications were graft re-rupture and occurred at an average of 18 months after revision surgery.</p><p><strong>Conclusions: </strong>Quadriceps tendon-patellar bone allograft showed satisfactory clinical outcomes in revision anterior cruciate ligament reconstruction and thus could be a good alternative when autograft harvesting is not optimal.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"17 1","pages":"91-99"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11791487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256549","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":"Patient-Specific 3-Dimensional-Printed Orthopedic Implants and Surgical Devices Are Potential Alternatives to Conventional Technology But Require Additional Characterization.","authors":"Aidan P McAnena, Taylor McClennen, Hua Zheng","doi":"10.4055/cios23294","DOIUrl":"10.4055/cios23294","url":null,"abstract":"<p><strong>Background: </strong>Three-dimensional (3D) printing allows anatomical models, guides, and implants to be easily customized to individual patients. Three-dimensional-printed devices can be used for a number of purposes in the medical field, yet there is a lack of data on the implementation of 3D-printed patient-specific implants and surgical guides in orthopedics. The objective of this review of the literature was to summarize the implementation of 3D printing in orthopedic surgery and identify areas that require more investigation.</p><p><strong>Methods: </strong>PubMed and Scopus were used to perform a literature search. Articles that described 3D-printed patient-specific orthopedic implants or intraoperative guides were reviewed. Relevant articles were compiled and summarized to determine the role of personalized 3D-printed implants in orthopedic surgery.</p><p><strong>Results: </strong>A total of 58 papers were selected. Overall, 3D-printed implants and surgical guides were shown to be effective in the selected cases. Patients with bone tumors benefitted from custom 3D-printed implants, which allow aggressive resection while preserving the function and mechanical stability of the limb. Eighty-one percent of devices were made using titanium, and 48% of articles reported the use of 3D printing in oncology. Some reported adverse events including wound dehiscence, periprosthetic infection, dislocation, and sequelae of malignancy. Regulations surrounding the use of 3D-printed surgical devices are ambiguous.</p><p><strong>Conclusions: </strong>Three-dimensional-printed orthopedic implants and guides present an alternative to commercial devices, as they allow for customizability that is useful in cases of anatomic complexity. A variety of materials were surveyed across multiple subspecialties. Large controlled studies are necessary to compare patient-specific implants with the standard of care and evaluate their safety profiles over time.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"17 1","pages":"1-15"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11791502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257079","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":"Midterm Results of Total Hip Arthroplasty Using a Delta Ceramic Liner with a Titanium Taper Locking Band.","authors":"Vahit Emre Ozden, Goksel Dikmen, Kayahan Karaytug, İsmail Remzi Tozun","doi":"10.4055/cios24093","DOIUrl":"10.4055/cios24093","url":null,"abstract":"<p><strong>Backgroud: </strong>This retrospective midterm study aimed to analyze seating properties, fracture types, noisy hips, and survivorship of a delta ceramic liner with a titanium taper locking band.</p><p><strong>Methods: </strong>A total of 451 patients (538 hips) underwent cementless total hip arthroplasty using the same design delta ceramic liner. Patients' clinical functions were evaluated using Harris Hip score, and the radiological migration or loosening of cementless cups was recorded. Component survival was evaluated by Kaplan-Meier survivorship analysis, with failure defined as revision of any component or ceramic bearing for any reason. The worst-case survival scenario for noisy hip revision recommendations was estimated.</p><p><strong>Results: </strong>A total of 475 patients (514 hips) were evaluated with an average follow-up of 9.5 years (range, 5-13.9 years). One hip (0.19%) had intraoperative asymmetric seating. No hips had loosening, osteolysis, wear, or delta ceramic liner or head fracture. Three patients (0.58%) reported reproducible squeaking. Two cups were revised due to recurrent dislocation, 2 femoral stems were revised for periprosthetic fractures, and 1 hip was treated for deep periprosthetic joint infection. Kaplan-Meier survivorship analysis showed a 10-year cup survival rate of 97.8% (95% CI, 95.2%-99.9%), with any revision as the endpoint. The worst-case scenario showed a 10-year survival rate of 96.4% (95% CI, 94.2%-99.2%).</p><p><strong>Conclusions: </strong>The Delta ceramic liner with a titanium locking band on the mutlibearing cementless cup offered secure intraoperative seating properties with fewer ceramic-related complications at the midterm follow-up.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"17 1","pages":"53-61"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11791495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257078","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":"Validation of the Korean Version of the 24-Item Early-Onset Scoliosis Questionnaire: A Multicenter Study from the Korean Research Society of Spinal Deformity.","authors":"Chang Ju Hwang, Sam Yeol Chang, Kun-Bo Park, Dong-Ho Lee, Jae Hwan Cho, Hiroko Matsumoto, Sehan Park","doi":"10.4055/cios24210","DOIUrl":"10.4055/cios24210","url":null,"abstract":"<p><strong>Background: </strong>A 24-item early-onset scoliosis questionnaire (EOSQ-24) has been developed as a valid tool for assessing the physical and emotional function of patients with early-onset scoliosis (EOS). Previous studies that conducted transcultural adaptation of the original EOSQ-24 into other languages have demonstrated the high reliability of the questionnaire. However, a Korean version of the EOSQ-24 is not available, limiting optimal patient assessment in this nation. Therefore, this study was conducted to develop and validate a Korean version of EOSQ-24.</p><p><strong>Methods: </strong>The original English version of the EOSQ-24 was cross-culturally adapted following standard guidelines. The final version of the Korean EOSQ-24 was prospectively applied to a group of patients who were native Korean speakers. Internal consistency was evaluated using the Cronbach α coefficient and item-total correlations. The mean, standard deviation, floor effect, and ceiling effect of each item were also assessed.</p><p><strong>Results: </strong>A total of 102 caregivers of patients with EOS (45 males and 57 females) completed the Korean EOSQ-24. The patients' average age was 6.39 ± 2.16 years. The Cronbach α coefficient for the 24-item scale was 0.942, indicating excellent reliability. The corrected item-total correlation coefficients ranged between 0.449 and 0.788. The mean value of the EOSQ-24 questionnaire was 3.19. Floor and ceiling effects for all questionnaires were below 30%, which could be considered acceptable.</p><p><strong>Conclusions: </strong>Our study successfully developed and validated the Korean version of the EOSQ-24, providing a reliable instrument for assessing the physical and emotional well-being of patients with EOS and their caregivers in the Korean context. The widespread adoption of the Korean EOSQ-24 in clinical practice and research settings can enhance the quality of care and improve outcomes for individuals affected by EOS in Korea.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"17 1","pages":"123-129"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11791488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256753","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":"Comparing Stability, Gait, and Functional Score after 40-mm Dual-Mobility Hip Arthroplasty to 36-mm Head Hip Arthroplasty in Elderly Hip Fracture Patients.","authors":"Yonghan Cha, Sang-Yeob Lee, Ji-Ho Bae, Yang Jae Kang, Ji-Hoon Baek, Joon Soon Kang, Chan Ho Park, Shinjune Kim, Jun-Il Yoo","doi":"10.4055/cios24148","DOIUrl":"10.4055/cios24148","url":null,"abstract":"<p><strong>Backgroud: </strong>This study aimed to compare the intraoperative stability and early clinical outcomes of 40-mm diameter dual mobility (DM)-total hip arthroplasty (THA) with 36-mm ceramic head (large head) THA in active elderly patients with hip fractures.</p><p><strong>Methods: </strong>A prospective randomized controlled trial was conducted from May 2022 to December 2022. Inclusion criteria were as follows: age ≥ 60 years, displaced femoral neck fracture, Koval grade 1 or 2, planned 54-mm acetabular component, and over 1-year follow-up. Intraoperative stability tests were performed on all patients (internal rotation at 45°, 60°, and 90° of hip fracture). Functional outcomes (Harris Hip Score and University of California, Los Angeles [UCLA] Score) were evaluated at 6 weeks and 3 months postoperatively. Gait analysis using artificial intelligence (AI) techniques was conducted at 3 months postoperatively.</p><p><strong>Results: </strong>The study included 36 DM-THA patients (mean age, 69.6 ± 2.2 years; 44% women) and 37 large head THA patients (mean age, 69.6 ± 1.2 years; 64% women). No statistically significant differences were observed in functional outcomes and hip range of motion between the 2 groups. However, there was a significant difference in the gait speed and stance-swing phase of the large head THA group and the DM-THA group: the DM-THA group demonstrated superior gait speed (2.85 ± 0.83 kph vs. 2.04 ± 1.04 kph, <i>p</i> = 0.003) and higher stance phase ratios (operated side: 63.57% ± 3.82% vs. 48.19% ± 5.50%, <i>p</i> < 0.001; opposite side: 62.77% ± 2.27% vs. 49.93% ± 6.94%, <i>p</i> < 0.001). In the stability test at 90° of hip flexion, the DM-THA group had a measurement of 48.40° ± 5.17°, while the large head THA group had a measurement of 30.94° ± 2.98° (<i>p</i> = 0.012). Despite the lack of statistical significance, the intraoperative stability test showed the dislocation angle was notably different between the groups in the hip flexion position of 60° (51.60° ± 6.09° in the DM-THA group and 40.00° ± 2.80° in the large head THA group, <i>p</i> = 0.072).</p><p><strong>Conclusions: </strong>Superior results were observed in the intraoperative stability test and early recovery of gait after DM-THA compared to large head THA. We believe that DM-THA can be a useful surgical option for THA in elderly patients with hip fractures.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"17 1","pages":"62-70"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11791493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256980","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":"Early Single-Stage Curettage and Autogenous Bone Grafting for Enchondroma in the Hand with Minimally Displaced Pathologic Fracture.","authors":"Cheungsoo Ha, Chi-Hoon Oh, Segi Kim, Ju-Sung Lee, Soo-Hong Han","doi":"10.4055/cios24188","DOIUrl":"10.4055/cios24188","url":null,"abstract":"<p><strong>Backgroud: </strong>Enchondroma is a common benign bone tumor in the hand, often leading to delayed diagnosis due to its asymptomatic nature. The surgical treatment strategy for enchondroma, particularly in pathologic fractures, remains unclear. This study aimed to evaluate the outcomes of treatment for non- or minimally displaced pathologic fractures in enchondroma using autogenous bone grafts alone, without metal fixation.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 34 patients who underwent surgery for enchondroma and pathologic fractures. Clinical and radiographic outcomes were assessed, including pain scores, range of motion (ROM), Disabilities of the Arm, Shoulder, and Hand (DASH) score, grip strength, fracture union time, and complications.</p><p><strong>Results: </strong>All patients reported pain at the fracture site preoperatively. The preoperative pain visual analog scale (VAS) score was 4.5. Postoperatively, the pain VAS score improved significantly to 2.3. The postoperative average total ROM was 253.8°. The average DASH score was 5.1, and grip strength was 97.8% compared to the unaffected side. Bony union was achieved in all cases with an average union time of 10.9 weeks. No complications were observed except for 1 suspected recurrence.</p><p><strong>Conclusions: </strong>Early single-stage surgical treatment with curettage and autogenous bone grafts without fixation yielded satisfactory results for non- or minimally displaced pathologic fractures in enchondroma. This non-fixative technique offers a viable option with reduced treatment duration and implant-related complications.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"17 1","pages":"174-180"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11791483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256989","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}