Journal of Orthopaedics and Traumatology最新文献

{"title":"Is there a need for exploration in pulseless supracondylar fractures of the humerus? A systematic review and individual patient data meta-analysis.","authors":"Chen Haoyang, Junye George Chen, Haoxing Lai, Andrew Kean Seng Lim, Si Heng Sharon Tan, James Hoi Po Hui","doi":"10.1186/s10195-026-00908-8","DOIUrl":"10.1186/s10195-026-00908-8","url":null,"abstract":"<p><strong>Background: </strong>Different approaches have been proposed to treat patients with pulseless supracondylar humeral fractures (SHF). We aim to analyze the current outcomes of patients who have undergone different treatment options for pulseless SHF, namely watchful waiting versus urgent surgical exploration.</p><p><strong>Methods: </strong>Electronic databases including PubMed, Embase, and Cochrane Library were explored. Our study included patients from all age groups but only included English-language articles. Single case reports and case studies with adequate description of patient population, injury, and outcomes were included. An individual patient data meta-analysis was done to evaluate key outcomes of surgical exploration versus no surgical exploration in pulseless patients with SHF.</p><p><strong>Results: </strong>Overall, the data for 1070 individual patients from a total of 48 studies were included. Patients with pulseless SHF with open fractures have a higher probability of requiring vascular intervention (p < 0.001) as they are more likely to have disrupted arteries (p = 0.050) and more likely to require vascular repairs (p < 0.001) than patients with closed fractures. Similarly, patients with pulseless SHF with pucker sign (p = 0.003) and ecchymosis (p = 0.002) were more likely to undergo surgical exploration. However, the neurological status had no relation to them undergoing surgical exploration (p = 0.382), and also does not affect complication outcomes (p = 0.326) nor the need for vascular intervention (p = 1.00). However, patients with pale pulseless SHFs were more likely to undergo surgical exploration (p < 0.001), were more likely to have disrupted arteries (p < 0.001), required more vascular intervention (p < 0.001), and had a higher likelihood of complications (p < 0.001). Notably, there is no significant difference in overall complications between those who underwent exploration of arteries and those who did not among patients with pink pulseless SHF (p = 0.230).</p><p><strong>Conclusions: </strong>Significant predictors for arterial injury requiring intervention include a pale pulseless limb, open fracture, pucker sign, and ecchymosis; expedient surgical exploration is recommended in these scenarios. However, for patients with pink pulseless SHF, watchful waiting is a viable strategy. Our meta-analysis found no significant difference in overall complication rates between patients with pink pulseless who underwent exploration and those who did not.</p><p><strong>Level of evidence: </strong>Level II.</p><p><strong>Registration: </strong>The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines CRD.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146195809","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":"Increasing complexity and plateauing outcomes in AO type C distal humerus fractures: a 50-year institutional case series.","authors":"Karina Hönck, Peter Wenzelburger, Nicolas Eibinger, Patrick Sadoghi, Paul Puchwein","doi":"10.1186/s10195-026-00905-x","DOIUrl":"10.1186/s10195-026-00905-x","url":null,"abstract":"<p><strong>Background: </strong>Distal humerus fractures in adults are rare but complex injuries, particularly AO type C3 fractures, often involving comminution, instability, and osteoporotic bone. Demographic trends indicate rising incidence, especially among elderly patients, with increasing functional demands challenging modern osteosynthesis. Open reduction and internal fixation (ORIF) with bicolumnar plating remains the preferred reconstructive approach, although complications remain substantial. This study aimed to evaluate trends in fracture complexity, patient demographics, and functional outcomes over five decades, focusing on the most recent cohort (2009-2018, series E) and comparing with historical cohorts (series A-D, 1969-2008).</p><p><strong>Methods: </strong>This retrospective analysis included five consecutive 10-year institutional cohorts (series A: n = 43; B: n = 29; C: n = 47; D: n = 58) of 233 patients with 235 supradiacondylar distal humerus fractures (AO type C1-3) treated with ORIF. Functional outcome parameters (Jupiter and Cassebaum Scores) and demographic data were available for all cohorts; additional parameters (range of motion (ROM), QuickDASH Score) were available for series D and E, Mayo Elbow Performance Score (MEPS), Short Form (SF)-36, and strength were assessed specifically in series E (n = 56; follow-up n = 21). Cross-cohort comparisons of categorical variables used chi-square tests; continuous outcomes were summarized descriptively. Historical cohort means served as a basis for comparison, and analysis of variance (ANOVA) with Tukey Honestly Significant Difference (HSD) was applied for within-series analyses.</p><p><strong>Results: </strong>Mean patient age increased to 62.6 (range 19-89, SD ± 18.1) years in series E. The proportion of AO type C3 fractures rose significantly from 11.6% (series A) to 71.4% (series E) (p ≤ 0.05). In series E (n = 56, follow-up n = 21), ORIF with bicolumnar plating was performed in 94.6% of cases and the overall complication rate was 16.4%, with mean hospitalization time of 11.1 (range 1-40, SD ± 10.1) days, mean extension deficit of 23° (range 0-90°, SD ± 26.4°), strength loss of 25.5 N (range 0-64.7 N, SD ± 19.1 N), QuickDASH Score of 23.3 (range 0-61.4, SD ± 21.2), and mean MEPS of 83.2 (range 45-100, SD ± 17.0). Good-to-excellent results were observed in 52.6% (Jupiter) and 73.7% (Cassebaum). Subjective satisfaction remained high.</p><p><strong>Conclusions: </strong>Over five decades, distal humerus fractures increasingly involved older patients and more complex AO type C3 patterns. While ORIF continues to provide satisfactory outcomes, persistent deficits in motion and plateauing functional scores indicate that reconstructive limits may be approached in this evolving patient population.</p><p><strong>Level of evidence: </strong>Level IV; Case series, treatment study.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13079252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146158999","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":"Long-term outcomes of the modified Dunn procedure in moderate and severe slipped capital femoral epiphysis: a prospective case series with 7-year follow-up.","authors":"Mahmoud Fahmy, Ahmed Hazem Abdelazeem, Mostafa Ahmed Shawky","doi":"10.1186/s10195-026-00899-6","DOIUrl":"10.1186/s10195-026-00899-6","url":null,"abstract":"<p><strong>Introduction: </strong>Slipped capital femoral epiphysis (SCFE) is the most common hip disorder in adolescents and may lead to femoroacetabular impingement, early osteoarthritis, and long-term functional disability if inadequately treated. While in situ pinning remains the standard treatment for mild slips, it fails to correct the deformity in moderate and severe cases, potentially predisposing to degenerative changes. The modified Dunn procedure (MDP) was developed to restore proximal femoral anatomy through surgical hip dislocation while preserving vascular supply. The aim of the study is to evaluate the long-term radiological and functional outcomes of the MDP in patients with moderate (14 cases) and severe (10 cases) SCFE, and to assess the incidence of avascular necrosis (AVN), osteoarthritis, and other complications.</p><p><strong>Methods: </strong>A prospective case series was conducted between August 2015 and January 2019 at a single tertiary institution. A total of 24 hips with moderate-to-severe SCFE and open physis were treated using the MDP via surgical hip dislocation. Mild and acute-only slips were excluded. MDP was used as a primary procedure, performed early in severe slips and in selected moderate slips after clinical assessment. Patients were followed clinically and radiologically for a mean duration of 84 ± 2.6 months (range 80-88 months). Functional outcomes were assessed using the Harris Hip Score (HHS) and Merle d'Aubigné and Postel score. Radiographic outcomes and complications, including AVN and secondary arthritis, were documented. Fixation was performed using Schanz screws, cannulated screws, or K-wires according to intraoperative findings.</p><p><strong>Results: </strong>The mean preoperative slip angle (48.3° ± 7.2°) significantly improved postoperatively (11.4° ± 3.1°, p < 0.001). HHS improved from a preoperative mean of 70.4 ± 5.8 to 92.9 ± 4.2 at final follow-up (p < 0.001). The Merle d'Aubigné and Postel score improved from 13.8 ± 1.6 preoperatively to 17.5 ± 0.9 at final follow-up (p < 0.001). AVN developed in 4 out of 24 hips (16.7%). Arthritis developed in 2 out of 24 hips (8.3%, degenerative OA; no septic arthritis or chondrolysis), representing a total of 6 out of 24 hips (25%) with significant complications when combined with AVN. No cases of postoperative instability or wound infection occurred. Functional scores showed sustained improvement in the majority of patients.</p><p><strong>Conclusions: </strong>MDP offers favorable long-term anatomical correction and functional recovery in moderate-to-severe SCFE. However, the risk of AVN and arthritis, particularly in unstable or severe cases, warrants careful patient selection and technical precision. Extended follow-up is essential to detect late complications and evaluate procedural durability.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":" ","pages":"5"},"PeriodicalIF":4.5,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12901798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146151157","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":"Magnetic resonance imaging-based fat infiltration grading improves reparability prediction in massive rotator cuff tears.","authors":"Qi Hu, Guoyin Zhang, Danxiu Wang, Tao-Hsin Tung, Jianrong Ding, Xiaobo Zhou","doi":"10.1186/s10195-026-00900-2","DOIUrl":"10.1186/s10195-026-00900-2","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to investigate the extent of fat infiltration (FI) in the rotator cuff (RC) muscles in more medial slices from the Y-shaped view (Y-view) on shoulder magnetic resonance imaging (MRI) and assess whether these slices provide a more accurate prediction of the repairability of massive RC tears (massive RCTs).</p><p><strong>Methods: </strong>The retrospective study included 57 patients with massive RCTs who successfully underwent arthroscopic surgery between 1 January 2023 and 31 December 2023. Patients were categorized into two groups: the irreparable group and the reparable group. All patients underwent shoulder MRI covering the region from the acromion to the medial border of the scapula in oblique coronal and oblique sagittal orientations. The FI stage of the RC was assessed across three different views to determine which view most effectively predicts the repairability of patients with massive RCTs.</p><p><strong>Results: </strong>The FI stage of the infraspinatus (IS) muscle across three distinct views demonstrated a significant correlation with the repairability of massive RCTs. The FI stage was more severe in the irreparable group. Receiver operating characteristic (ROC) analysis revealed that the area under the curve for the 1/2 scapula view (0.737) and the most severe view (0.745) exceeded that of the traditional Y-view (0.644). Paired-sample ROC curve analysis revealed a significant difference between the most severe view and the traditional Y-view. The number of slices from the Y-view to the 1/2 scapula view was 5.89 ± 1.2. The most severe view of the IS was defined as the slice indicating the most severe FI stage, which was observed in at least two slices (84% probability) or exclusively in a single slice (16% probability).</p><p><strong>Conclusions: </strong>This study's conclusions are based on the following findings: (1) Applying the Goutallier classification confirmed that FI in massive RCTs can extend medially to the Y-view, with the most severe FI not confined to a standard anatomical plane; (2) The concept of the \"most severe view\"-a nonstandardized, non-reproducible MR plane-reflects the area of peak FI. In predicting the reparability of massive RCTs, FI assessment of the IS muscle from this view demonstrates certain advantages over the traditional Y-view; however, its predictive value remains moderate. Future research should therefore focus on developing improved imaging strategies and clarifying the precise relationship between FI progression and clinical outcomes.</p><p><strong>Level of evidence: </strong>Level IV; case-control study.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12961034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146114705","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":"Mid-term clinical and functional outcomes after reverse shoulder arthroplasty with latissimus dorsi transfer.","authors":"Antonio G Colombini, Peter Rab, Arno A Macken, Madu N Soares, Michael Kimmeyer, Igor J Shirinskiy, Ion-Andrei Popescu, Laurent Lafosse, Geert Alexander Buijze, Thibault Lafosse","doi":"10.1186/s10195-026-00902-0","DOIUrl":"10.1186/s10195-026-00902-0","url":null,"abstract":"<p><strong>Background: </strong>Although reverse total shoulder arthroplasty (rTSA) with concomitant latissimus dorsi transfer (LDT) has been shown to effectively treat external rotation (ER) deficits, there are limited data regarding its outcomes with modern implants and its impact on activities of daily living (ADLs) requiring ER. The purpose of this study was to assess the mid-term clinical and radiographic outcomes of rTSA with concomitant isolated LDT in patients with an ER lag sign and posterior rotator cuff deficiency.</p><p><strong>Methods: </strong>This retrospective cohort study with prospective follow-up included consecutive patients who underwent rTSA with concomitant isolated LDT between 2010 and 2022 with a minimum follow-up of 2 years. Primary outcomes included the resolution of ER lag sign, active ER, and the Activities of Daily Living and External Rotation (ADLER) score. Secondary outcomes included the Auto-Constant Score (CS), Subjective Shoulder Value (SSV), activities of daily living requiring internal rotation (ADLIR) score, visual analog scale (VAS) for pain, and radiographic analysis of standardized radiographs.</p><p><strong>Results: </strong>In total, 32 procedures in 32 patients were identified. Of these, 22 procedures in 22 patients (68% female, 72.9 ± 8.4 years at surgery) were available for follow-up at 4.8 ± 2.2 years postoperatively (response rate 73%). The ER lag sign resolved in 95.5% of patients, the active ER improved significantly from -13° (-20-0°) preoperatively to 10° (0-20°) postoperatively (p = 0.002). The ADLER score increased from 20 (18-21.5) to 30 (28-30, p < 0.001). The CS improved from 32 (25-52) to 71 (67-75, p < 0.001) and the SSV from 30 (28-40) to 80 (65-100, p = 0.002), and low pain levels were reported. Internal rotation (p = 1) and the ADLIR score (p = 0.56) did not improve or decrease. No revisions or complications were observed.</p><p><strong>Conclusions: </strong>rTSA with concomitant isolated LDT resulted in favorable clinical, functional, and radiographic mid-term outcomes, with a high rate of resolved external rotation lag sign and a significant improvement in activities of daily life that require ER. This procedure should be considered a viable treatment option in patients undergoing rTSA with posterior rotator cuff deficiency and an ER lag sign.</p><p><strong>Level of evidence: </strong>IV, retrospective case series.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12932745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146087755","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":"Partial versus full revision in cementless single-stage exchange for hip periprosthetic joint infection: a multicenter comparative study with 10-year survivorship analysis.","authors":"Wenbo Mu, Atthakorn Jarusriwanna, Boyong Xu, Scot A Brown, Xiaogang Zhang, Alexander Dawes, Javad Parvizi, Li Cao","doi":"10.1186/s10195-026-00901-1","DOIUrl":"10.1186/s10195-026-00901-1","url":null,"abstract":"<p><strong>Background: </strong>Periprosthetic joint infection (PJI) is one of the most challenging complications following total hip arthroplasty (THA). Traditional management typically involves full revision to ensure comprehensive infection eradication. However, for patients with well-fixed implants, partial revision in a single-stage cementless approach may provide a viable alternative, potentially preserving bone stock and reducing operative time. The relative efficacy of this approach compared with full revision remains to be fully explored. This multicenter study aims to determine whether partial revision in cementless single-stage exchange surgery offers comparable infection control outcomes to full revision for select patients with well-fixed implants.</p><p><strong>Methods: </strong>We conducted a retrospective, multicenter cohort study involving 226 patients who underwent cementless single-stage exchange hip arthroplasty for PJI between 1 October 2013 and 31 July 2022. Patients were divided into partial revision (n = 61) and full revision (n = 165) groups. The primary outcome was treatment success, defined as the absence of clinical symptoms and signs of infection at a minimum follow-up of 2 years.</p><p><strong>Results: </strong>The success rates were 77.0% for the partial revision group and 80.0% for the full revision group, with no significant difference (p = 0.629). Both groups showed comparable 10-year survival rates for overall success and infection-free status. Patients with partial revision had significantly shorter operative times (137.3 versus 169.1 min, p < 0.001). Age ≥ 65 years (odds ratios (OR): 2.433, p = 0.003), American Society of Anesthesiologists (ASA) score ≥ 3 (OR: 1.778, p = 0.030), and chronic kidney disease (OR: 3.467, p = 0.053) were identified as independent risk factors for reinfection in the partial revision group.</p><p><strong>Conclusions: </strong>Partial cementless single-stage revision may offer comparable infection control to full revision in selected hip PJI cases with well-fixed implants, while reducing operative time. Given the retrospective design, these findings should be interpreted with caution, and future prospective studies are needed to confirm long-term outcomes, assess implant survival, and evaluate functional recovery.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12923685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146087703","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":"Iatrogenic femoral neck fractures or separation of the proximal femoral epiphysis during closed reduction of irreducible femoral head fracture-dislocations in children: a review of 12 cases.","authors":"Yunan Lu, Chentao Xue, Federico Canavese, Sara De Salvo, Hetu Yao, Dianhua Huang, Ran Lin, Juan Zheng, Shunyou Chen","doi":"10.1186/s10195-026-00906-w","DOIUrl":"10.1186/s10195-026-00906-w","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to analyze the radiologic characteristics of irreducible pediatric femoral head fracture-dislocations to prevent potential iatrogenic femoral neck fractures (FNF) or separation of the proximal femoral epiphysis (SPFE).</p><p><strong>Methods: </strong>This is a retrospective review of patients who were skeletally immature and diagnosed with traumatic hip dislocations combined with femoral head fractures. The collected data included patient demographics, fracture classification, fragment ratio, combined injuries, urgent reductions, treatment strategies, complications, and final outcomes.</p><p><strong>Results: </strong>We treated 12 patients with femoral head fractures and dislocations; 11 out of 12 patients underwent urgent closed reduction (91.7%). Six of the patients failed closed reduction and experienced FNF (n = 2, 33.3%) or SPFE (n = 4, 66.7%). Five patients presented with avascular necrosis of the femoral head after open reduction with internal fixation via a surgical hip dislocation approach, and two patients required further surgical treatment. Analysis of radiographs and computed tomography (CT) scans of irreducible femoral head fracture-dislocations revealed that the fractured femoral head was perched on the sharp angle of the posterior wall of the acetabulum, with a fragment ratio of 18-27%. After recognizing the irreducibility, one case with a fragment ratio of 26% underwent immediate open reduction without further attempts at closed reduction. This procedure preserved the natural hip joint, preventing FNF and SPFE.</p><p><strong>Conclusions: </strong>For pediatric patients with irreducible femoral head fracture-dislocation injuries and a fragment ratio greater than 10%, repeated or forceful closed reduction may result in iatrogenic FNF or SPFE. Examining plain radiographs and CT images carefully before attempting reduction may help determine the safest treatment strategy.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":" ","pages":"7"},"PeriodicalIF":4.5,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12909723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146031298","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 presence of a positive blood culture should be regarded a risk factor for DAIR failure in cases of haematogenous total knee arthroplasty infection.","authors":"G Pedemonte-Parramón, E Reynaga, S Molinos, J Díez de Los Ríos, A Vivero, E García-Oltra, V López-Pérez, R Paredes, J A Hernández-Hermoso","doi":"10.1186/s10195-026-00903-z","DOIUrl":"10.1186/s10195-026-00903-z","url":null,"abstract":"<p><strong>Purpose: </strong>Late acute haematogenous total knee arthroplasty (LAH TKA) infections represent approximately 20% of all prosthetic infections. Debridement, antibiotics, and implant retention (DAIR) is a widely accepted treatment; however, it carries a significant risk of failure. The study aims to identify risk factors for DAIR failure in LAH TKA infections, focusing on blood cultures (BC) as a potential contributor.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on 37 cases of LAH TKA infections from 2015 to 2023. Patients were divided into two groups: 20 in the success group (SG) and 17 in the failure group (FG). The study analyzes various factors, including demographics, comorbidities, serum and joint fluid biomarkers, blood and intraoperative cultures, prior infection or antibiotic use, and surgical and post-surgical variables.</p><p><strong>Results: </strong>Positive BC were more frequent in the FG compared with the SG (P = 0.03), and were also more common in patients with a history of prior infection (P = 0.03). Logistic regression identified positive BC as the only significant predictor of DAIR failure (odds ratio (OR) 12, 95% confidence interval (CI) 1.1-18, P = 0.04), even after adjusting for other variables. Positive intraoperative cultures were more frequent in the FG, particularly in those with a prior infection history (P = 0.08), even if they were receiving antibiotics (P = 0.05).</p><p><strong>Conclusions: </strong>Positive BC may be an additional risk factor for DAIR failure in LAH TKA. This highlights the importance of routinely performing BC during diagnosis.</p><p><strong>Level of evidence: </strong>level III.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":" ","pages":"6"},"PeriodicalIF":4.5,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12909695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146020136","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":"Simultaneous versus staged bilateral total hip arthroplasty: a meta-analysis.","authors":"Francisco Soler, Javier Hernández, José María Lamo-Espinosa, María Benlloch, Gonzalo Mariscal","doi":"10.1186/s10195-026-00904-y","DOIUrl":"10.1186/s10195-026-00904-y","url":null,"abstract":"<p><strong>Background: </strong>There is debate regarding the optimal timing of bilateral total hip arthroplasty (THA), with simultaneous or staged approaches considered. Cost-effectiveness is an important factor that influences resource allocation. The main aim of this study was to assess the cost implications of bilateral simultaneous (sim-THA) versus staged (st-THA) total hip arthroplasty. The secondary objective was to evaluate the efficacy and safety of sim-THA compared those with of st-THA.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Studies comparing simultaneous and staged bilateral THA in terms of cost, complications, length of hospital stay, and patient outcomes were eligible. Odds ratios (ORs), mean differences (MD), and standard mean differences (SMD) with 95% confidence intervals (CIs) were calculated. The risk of bias was assessed using the Methodological Index for Non-randomised Studies (MINORS). Meta-analyses were performed using Review Manager version 5.4 (Cochrane, Oxford, United Kingdom).</p><p><strong>Results: </strong>A total of 20 observational studies including 13,984 patients were included. Sim-THA was associated with significantly lower total costs (SMD -0.54, 95% CI -0.92 to -0.16; p = 0.005) and shorter hospital stay (MD -2.90, 95% CI -4.38 to -1.42; p = 0.0001) than those in the st-THA group. Revisions were less frequent in the sim-THA group (OR 0.44, 95% CI 0.36-0.53; p < 0.00001). No differences were observed in mortality (OR 1.01, 95% CI 0.31-3.28; p = 0.98) or readmission rates (OR 0.58, 95% CI 0.23-1.44; p = 0.24). The number of transfusions (OR 4.42, 95% CI 2.18-8.99; p < 0.0001) was lower in st-THA. Functionality (SMD 0.37, 95% CI 0.20-0.53; p < 0.0001) and pain scores (SMD 0.19, 95% CI 0.04-0.33; p = 0.01) favored sim-THA.</p><p><strong>Conclusions: </strong>A meta-analysis of 20 studies demonstrated that sim-THA offers economical and clinical advantages, including reduced hospital expenses and improved patient quality of life, despite a higher number of transfusions, with comparable surgical blood loss to standard THA.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":" ","pages":"4"},"PeriodicalIF":4.5,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12894550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145999421","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 relevance of patient-reported outcome measures in the surgical management of focal chondral defects of the knee: a systematic review.","authors":"Filippo Migliorini, Nicola Maffulli, Michael Kurt Memminger, Ulf Krister Hofmann","doi":"10.1186/s10195-025-00897-0","DOIUrl":"10.1186/s10195-025-00897-0","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;To evaluate clinical outcome following surgical management of focal chondral defects in the knee, patient-reported outcome measures (PROMs) are used. To give these measures meaning, parameters such as the minimal clinically important difference (MCID), patient-acceptable symptom state (PASS), minimally detectable change (MDC), clinically important difference (CID) and substantial clinical benefit (SCB) have been introduced. This systematic review investigated the MCID, SCB, CID, PASS and MDC of the most commonly used PROMs for assessing patients following surgical repair of focal chondral defects of the knee.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This systematic review was conducted in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. All clinical studies investigating tools to assess the clinical relevance of PROMs in the surgical repair of focal chondral defects of the knee were reviewed. In April 2025, the following databases were accessed: PubMed, Web of Science and Embase. The PROMs of interest included: the International Knee Documentation Committee (IKDC) questionnaire, the Knee Injury and Osteoarthritis Outcome Score (KOOS) and its related subscales activities of daily living (ADL), pain, quality of life (QoL), sports and recreational activities, and symptoms, the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score, the Tegner Lysholm knee scoring scale, the Short Form-12 (SF-12) and its related mental and physical component subscales, the Short Form-36 (SF-36) and the Cincinnati Knee Rating System (CKRS). The Risk of Bias in Nonrandomised Studies of Interventions (ROBINS-I) indicated a low to moderate risk of bias.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The systematic literature search yielded 524 articles. Only data from four studies (involving 421 patients) were included. All of these were non-randomised controlled trials (RCTs) employing a retrospective study design. Most reported thresholds for a significant change across the questionnaires ranged from 20 to 30 points on a 100-point scale, whereas PASS values ranged from 62 points in the IKDC to 87 points in the KOOS ADL.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Despite a comprehensive search strategy, only four studies met the inclusion criteria, underscoring that the parameters analysed remain overlooked in the scientific literature. Reported results for MCID, CID and MDC following cartilage repair are relatively consistent in magnitude, ranging from 10 to 20. Differences reported in the literature that fall below this range should be regarded as no improvement. For SCB and PASS, values were even higher, spanning from 20 to 30 and from 62 to 87 points in IKDC and KOOS ADL, respectively. Given the high standard of modern medical care, further development and validation of condition-specific PROMs sh","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":" ","pages":"3"},"PeriodicalIF":4.5,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12847531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145991348","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}