Efort Open Reviews最新文献

{"title":"Arthroscopic subtalar arthrodesis using grafts grants higher union rates and faster time to union: systematic review and meta-analysis.","authors":"Matthieu Lalevee, Camille Rodaix, Floris Van Rooij, Victor Leroux, Marie-Aude Munoz","doi":"10.1530/EOR-2025-0059","DOIUrl":"10.1530/EOR-2025-0059","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the outcomes of open vs arthroscopic subtalar arthrodesis using grafts in terms of union rate and time to union.</p><p><strong>Methods: </strong>The authors conducted a structured electronic literature search using MEDLINE and Embase. This review included prospective and retrospective comparative clinical studies comparing union rates following primary isolated subtalar arthrodesis, using biological adjuvants, which had a follow-up ≥6 months.</p><p><strong>Results: </strong>The systematic search returned 929 records, of which 119 were duplicates, leaving 810 for screening. A total of 781 studies were excluded by examining their titles and/or abstracts, and a further 17 studies were excluded after full-text review. This left 12 eligible studies. The pooled union rate was significantly higher following arthroscopic surgery (100%; CI: 0.98-1.00; I 2: 0%) compared to open surgery (93%; CI: 0.89-0.95; I 2: 0%). The pooled time to union was significantly faster following arthroscopic surgery (12.2 weeks; CI: 12.0-12.5; I 2: 0%) compared to open surgery (13.8 weeks; CI: 13.4-14.2; I 2: 21%). There was no difference between arthroscopic and open arthrodesis for postoperative AOFAS and complications.</p><p><strong>Conclusion: </strong>Compared to open subtalar arthrodesis, arthroscopic treatment resulted in significantly higher union rates (93 vs 100%) and faster time to union (13.5 vs 12.0 weeks), while there were no differences between postoperative AOFAS (75.7 vs 73.8) and complication rates (14 vs 7%).</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 6","pages":"446-455"},"PeriodicalIF":4.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13238978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148144864","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 incidence of detectable bacterial contaminated primary joint arthroplasties and periprosthetic joint infection: a systematic review and meta-analysis.","authors":"Maarten M Bruin, Rob G H H Nelissen, Jan W Schoones, Mark G J de Boer, Ruud L M Deijkers, Bart G C W Pijls","doi":"10.1530/EOR-2025-0074","DOIUrl":"10.1530/EOR-2025-0074","url":null,"abstract":"<p><strong>Purpose: </strong>The association between positive intraoperative cultures during primary joint arthroplasty and periprosthetic joint infections (PJIs) remains controversial. This systematic review and meta-analysis examines the association between intraoperative contamination and complications such as PJIs and revision rates.</p><p><strong>Methods: </strong>We searched PubMed, Web of Science, Cochrane, Emcare (OVID), Embase (OVID), MEDLINE, Academic Search Premier and the references of included studies evaluating the outcome of contaminated and non-contaminated primary joint arthroplasties. This systematic review and meta-analysis was performed according to the PRISMA statement, and the research protocol was uploaded a priori at Open Science Framework. Two researchers independently reviewed all the titles, abstracts and full texts, and extracted the available data. Study eligibility criteria were primary joint arthroplasty with cultures taken during initial procedure and documentation of PJIs and revision rates.</p><p><strong>Results: </strong>The search yielded 26 studies after inclusion and exclusion criteria, involving 4,556 primary joint arthroplasties. The overall incidence of bacterial contamination was 24.7% (95% CI: 19-30%). The incidence of PJIs was 2.0% (95% CI: 1.1-2.8%) in the contaminated group versus 1.0% (95% CI: 0.6-1.4%) in the non-contaminated group, with a pooled adjusted risk ratio (RR) of 2.0 (95% CI: 1.3-3.1). The pooled analysis revealed an increased risk of contaminated joint arthroplasties for revision for any reason, with a pooled RR of 1.86 (95% CI: 1.14-3.03).</p><p><strong>Conclusion: </strong>This systematic review and meta-analysis suggests intraoperative bacterial contamination may increase the risk of PJIs and the risk of revision in primary hip, knee and shoulder arthroplasty. However, over more than 9 out of 10 patients with an intraoperative contaminated joint arthroplasty did not develop a PJI.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 6","pages":"524-535"},"PeriodicalIF":4.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13238974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148145236","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":"What is the risk of dislocation after hip arthroplasty for patients with neuromuscular disease: a systematic review and meta-analysis.","authors":"Peng Wang, Qianqian Dai, Hanlong Xin, Shaohua Fan, Zhen Chen, Huitao Liu","doi":"10.1530/EOR-2025-0035","DOIUrl":"10.1530/EOR-2025-0035","url":null,"abstract":"<p><strong>Purpose: </strong>Recent research has demonstrated excellent functional outcomes for patients with neuromuscular (NM) disease undergoing hip arthroplasty (HA). However, significant concerns persist regarding a potentially elevated risk of postoperative instability and dislocation in this specific cohort. Therefore, our objective was to synthesize the existing evidence through a systematic review and meta-analysis to evaluate the risks of dislocation in NM patients after HA. The purpose of this study was to answer the following question using a systematic review and meta-analysis: for patients undergoing HA (P), does the presence of a NM disease (I) increase the risk of postoperative dislocation (O) compared to patients without a NM disease (C)?</p><p><strong>Methods: </strong>A meta-analysis was conducted from inception to December 2024, utilizing multiple database searches (PubMed, Embase, Web of Science, and Cochrane Library). Two authors independently selected studies, assessed their quality, and extracted relevant data. Disagreements were resolved through discussion with a third author. A fixed-effects meta-analysis model was used to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs). Statistical heterogeneity was assessed using the I 2 statistic.</p><p><strong>Results: </strong>Six studies were included, involving 22,803 patients; 2,643 NM and 20,160 non-NM underwent HA. We found the risk of dislocation in the NM group is higher than that in the non-NM group (OR: 1.59; 95% CI: 1.24-2.03; I 2 = 0%); the NM group of elderly patients with combined femoral neck fractures also increases (OR: 1.63; 95% CI: 1.22-2.17; I 2 = 0%).</p><p><strong>Conclusion: </strong>In conclusion, the findings of this systematic review and meta-analysis provide robust evidence that patients with pre-existing NM disease face a substantially elevated risk of postoperative dislocation following HA. Our meta-analysis indicates that patients with NM diseases are at a heightened risk of dislocation following HA (OR: 1.59; 95% CI: 1.24-2.03, P < 0.001). This finding underscores the need for heightened preoperative counseling, meticulous surgical technique, and potentially the use of enhanced stability constructs in this vulnerable patient group.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 6","pages":"561-569"},"PeriodicalIF":4.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13238973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148145207","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":"Asymmetrical biomechanics in knee osteoarthritis: a review of contralateral risk from primary disease to post-arthroplasty progression.","authors":"Jing Dai, Jianxiong Ma, Bin Lu, Haohao Bai, Xinlong Ma","doi":"10.1530/EOR-2025-0173","DOIUrl":"10.1530/EOR-2025-0173","url":null,"abstract":"<p><p>Knee osteoarthritis (OA) demonstrates asymmetric joint degeneration (contrasting with symmetric inflammatory arthritis), driven by abnormal lower-limb biomechanics. Patients exhibit persistent inter-limb asymmetries in kinematics (reduced knee flexion/range of motion), kinetics (elevated knee adduction moment and increased contralateral loading), plantar pressure distribution, and muscle strength (15-30% quadriceps deficit), even with bilaterally matched disease severity. These asymmetries endure for months to years after total knee arthroplasty (TKA), manifesting as reduced weight-bearing on the operated limb and compensatory overloading of the contralateral limb. The high incidence of contralateral TKA (39% within 10 years) underscores the clinical importance of persistent biomechanical asymmetry as a prominent and modifiable contributor to OA progression in the opposite knee. Targeted rehabilitation strategies promoting inter-limb symmetry may mitigate disease advancement and improve functional outcomes.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 6","pages":"579-590"},"PeriodicalIF":4.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13240635/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148144892","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 need of innovation and of preservation of well-established techniques in the era of MDR for improving outcomes.","authors":"Max Gordon, Olof Wolf, Viktor Mili-Schmidt","doi":"10.1530/EOR-2026-0055","DOIUrl":"10.1530/EOR-2026-0055","url":null,"abstract":"<p><p>The European Union Medical Device Regulation (MDR 2017/745) has introduced stricter requirements for clinical evidence, limited reliance on equivalence and expanded post-market surveillance for orthopaedic implants. While designed to improve patient safety following high-profile device failures, MDR implementation has been associated with longer certification timelines, increased costs and withdrawal of established implants, particularly in lower-volume indications. The central regulatory challenge is proportionality: novel devices require robust prospective evidence, whereas long-established implants with extensive clinical track records may warrant risk-based recertification pathways. Uniform regulatory application risks unintended consequences for intermediate- and lower-volume indications that fall between orphan-device provisions and standard MDR requirements. Orthopaedic societies may play a key role in developing speciality-specific evidence guidance to support regulators and notified bodies, improving clarity while maintaining patient safety and sustainable innovation.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 5","pages":"366-371"},"PeriodicalIF":4.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822414","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":"Imaging-based assessment of fracture stability does not reliably predict outcomes in patients with two-part proximal humeral fractures and may lead to unnecessary surgeries.","authors":"Stig Brorson","doi":"10.1530/EOR-2026-0043","DOIUrl":"10.1530/EOR-2026-0043","url":null,"abstract":"<p><p>Two-part surgical neck fractures are the most common displaced proximal humeral fractures in the elderly. Most fractures can be categorized into varus-impacted or medially translated fracture patterns. The natural healing process often involves secondary displacement and partial resorption of the humeral head, but these changes are poorly correlated with shoulder function and patient satisfaction. Randomized trials have been unable to identify any benefits from surgery but report a high proportion of implant-related complications. In large prospective cohort studies, patients aged 60 or older with two-part surgical neck fractures treated non-operatively report shoulder function and quality of life close to the background population six months post-injury. Evidence-based and eminence-based approaches to interventions for osteoporotic proximal humeral fractures appear to collide.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 5","pages":"437-445"},"PeriodicalIF":4.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150322/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822470","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":"Management and optimisation in the preoperative phase for patients with a fractured hip.","authors":"Geert Meermans, Jeroen C van Egmond","doi":"10.1530/EOR-2026-0044","DOIUrl":"10.1530/EOR-2026-0044","url":null,"abstract":"<p><p>Hip fractures represent a time-critical, systemic condition in older adults, characterised by frailty, multimorbidity, inflammation, immobility, pain, and high risk of medical complications and mortality. While population ageing is expected to drive a continued rise in absolute hip fracture numbers, contemporary evidence demonstrates declining age-standardised incidence in many high-income countries, highlighting the importance of optimising perioperative care pathways to mitigate morbidity and mortality. Contemporary evidence consistently supports early surgical management, typically within 24-48 h, provided reversible medical issues are addressed in parallel rather than through prolonged preoperative workup. Orthogeriatric co-management and structured multidisciplinary pathways reduce time to surgery, delirium incidence, length of stay, and mortality while improving functional recovery. Key optimisation domains include multimodal opioid-sparing analgesia, delirium prevention bundles, targeted cardiovascular stabilisation, pragmatic management of anti-thrombotic therapy, anaemia, infection, and individualised anaesthetic strategies. Evidence supports protocol-driven, multicomponent care bundles over isolated interventions to enable safe early surgery, reduce complications, and improve functional recovery in this vulnerable population.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 5","pages":"390-403"},"PeriodicalIF":4.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822468","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":"'THA for DDH: replacement principles and techniques - femoral side'.","authors":"Konstantinos Konstantinidis, Dimitrios Grammatikopoulos, Eustathios Kenanidis, Alexander Maslaris, Pedro Dantas, Eleftherios Tsiridis","doi":"10.1530/EOR-2026-0069","DOIUrl":"10.1530/EOR-2026-0069","url":null,"abstract":"<p><p>Developmental dysplasia of the hip (DDH) remains a leading cause of early hip osteoarthritis and poses considerable technical challenges during total hip arthroplasty. Existing classification systems focus on the abnormal relationship between the femoral head and the acetabulum without emphasising the femoral morphological variations, which are equally significant in surgical planning. Dysplastic femora often demonstrate excessive neck anteversion, variable neck-shaft angles, reduced offset, and metaphyseal-diaphyseal mismatch with narrow intramedullary canals. These anatomical variations often compromise the abductor mechanism and alter hip biomechanics. Thorough preoperative planning is crucial and should include the evaluation of leg-length discrepancy, reconstruction of the hip centre of rotation, assessment of femoral version and canal morphology, implant selection, and consideration of femoral shortening osteotomy. Computed tomography-based planning can enhance preoperative planning in complex cases. Both cemented and cementless stems align with positive findings in DDH patients. Cemented stems enable reliable version control, decrease intraoperative fracture risk, and may be beneficial for patients with poor bone quality. In mild cases, most uncemented stems are suitable. More severe deformities necessitate specialised implant designs with conical fluted stems, which provide strong fixation and excellent long-term survivorship. Modular and custom-made options also achieve favourable outcomes in high-grade deformities. Femoral shortening osteotomies are often needed to restore biomechanics, correct abnormal version, and prevent nerve injury during reduction. The subtrochanteric osteotomy has been linked with excellent results in treating severe DDH. High-quality research is essential to deepen our understanding of proximal femur morphological abnormalities and to enhance surgical results.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 5","pages":"404-414"},"PeriodicalIF":4.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822511","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":"Indications and techniques of proximal femoral osteotomies in 2026.","authors":"Samuel Friedrich Schaible, Paulo Rego, Simon Damian Steppacher, Sjard Simons, Moritz Tannast","doi":"10.1530/EOR-2026-0076","DOIUrl":"10.1530/EOR-2026-0076","url":null,"abstract":"<p><p>Proximal femoral osteotomy remains an important joint-preserving option for adolescents and young adults with symptomatic proximal femoral deformity, preserved cartilage, and deformity amenable to correction. Surgical hip dislocation provides circumferential access to the femoral head, neck, and acetabulum while preserving the retinacular blood supply, and it allows direct dynamic assessment of impingement together with concomitant treatment of intra-articular pathology. The extended retinacular flap has expanded the indications for intra-articular correction at the femoral neck and head level, enabling larger corrections closer to the deformity with less secondary displacement when compared to extra-articular osteotomies. Preoperative planning must combine standardized radiographs, CT- or MRI-based torsion analysis, and MRI-based cartilage assessment; outcomes depend mainly on cartilage status, patient age, timing of correction, and technical precision.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 5","pages":"415-425"},"PeriodicalIF":4.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822445","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":"Clinical application of mesenchymal stem cells in orthopaedics and traumatology in daily practice.","authors":"Ismail Hadisoebroto Dilogo, Stephanie Gosal, Joshua Alward Herdiman, Alifaturrasyid Syafaatullah Ridwan","doi":"10.1530/EOR-2026-0056","DOIUrl":"10.1530/EOR-2026-0056","url":null,"abstract":"<p><p>Mesenchymal stem cells (MSCs) have been used in clinical practice in orthopaedics and traumatology in accordance with government health regulations. Despite MSCs' promising effects, their application should be guided by the pathophysiology of the target disease. The application of MSCs should follow the regulatory frameworks of each country to ensure their safe and effective use in daily clinical practice. It is suggested that further research be conducted on the current guidelines in broader patient populations.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 5","pages":"372-380"},"PeriodicalIF":4.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822504","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}