Journal of Clinical Orthopaedics and Trauma最新文献

{"title":"Association between haemoglobin A1c level and hip fracture risk in type 2 diabetes patients: A systematic review and meta-analysis","authors":"Mohammad Arshad Ikram ,&nbsp;Justin Vijay Gnanou ,&nbsp;Chin Chai Chong ,&nbsp;Nisar Ahmed ,&nbsp;Shobna Sai Letchumenan ,&nbsp;Zairul-Nizam Zainol Fithri","doi":"10.1016/j.jcot.2025.103040","DOIUrl":"10.1016/j.jcot.2025.103040","url":null,"abstract":"<div><h3>Background</h3><div>Hip fractures are prevalent in the elderly. Diabetes complication includes osteoporosis, which raises the possibility of hip fractures in an elderly population with type 2 diabetes mellitus. The purpose of this Meta-analysis is to determine whether long-term glycaemic management, as measured by HbA1c in patients with diabetes mellitus, is associated with a lower incidence of hip fractures.</div></div><div><h3>Methods</h3><div>The study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 (PRISMA) guidelines. We searched PubMed, Ovid, and ScienceDirect, and did a manual search of the reference lists of identified studies for published data on the association between hip fractures and glycaemic control. This systematic review was registered with PROSPERO with a Registration number: CRD42021260328. All eligible articles were included, and a meta-analysis on the comparison between HbA1c values above 6.5 and below 6.5 and between HbA1c values above 6.0 and below 6.0 in patients above 65 years with diabetes mellitus will be done by using a Forest plot. Odds Ratio (OR) and 95 % confidence intervals (CIs) will be calculated as summary statistics for dichotomous outcomes.</div></div><div><h3>Results</h3><div>Thirty-seven relevant articles were identified in the initial search, and four of these studies met the inclusion criteria for this systematic review and meta-analysis.</div></div><div><h3>Conclusion</h3><div>Our study suggests that hip fractures are more common in the elderly diabetic population when haemoglobin A1c levels exceed 6.5 %.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"67 ","pages":"Article 103040"},"PeriodicalIF":0.0,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144084092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of a curved internal fixation device in adult pelvic Fractures: Short-Term clinical outcomes in high and low energy fractures","authors":"Anthony Sleiman ,&nbsp;Christopher Bejcek ,&nbsp;Jeffrey Baker ,&nbsp;Jeffrey D. Voigt ,&nbsp;Kristin Delfino ,&nbsp;Matthew Gardner","doi":"10.1016/j.jcot.2025.103035","DOIUrl":"10.1016/j.jcot.2025.103035","url":null,"abstract":"<div><h3>Background</h3><div>Current methods of percutaneous fixation for pelvic and acetabular fractures are limited due to the curvature of the pelvic anatomy. The goals of fixation are to reduce pain, improve mobility and decrease length of stay. An implant specifically designed for use in the curved osseous fixation pathways of the pelvis may allow for more stable fixation.</div></div><div><h3>Objective</h3><div>The objective of this review was to examine the results of a new method of fixation (CurvaFix<strong>®</strong>) for pelvic and acetabular fractures.</div></div><div><h3>Methods</h3><div>A retrospective chart review of CurvaFix was employed and evaluated for implant fixation, complications, hospital length of stay (LOS), and inpatient mobility and then compared to current standards of care from the literature for percutaneous fixation.</div></div><div><h3>Results</h3><div>A curved intramedullary device was used to treat 31 low energy and 21 high energy fractures over a median 3.4 months. The median LOS was 7 [1 to 27] days for low and 11 [0 to 68] days for high energy fractures. Median time to first inpatient ambulation was 37 h in high energy fractures and 25 h in low energy injuries. Aggregated complications occurred in 21.3 % (10/46) of patients. Peri-implant failure occurred in 2 patients, with no incidences of hardware failure.</div></div><div><h3>Conclusions</h3><div>This case series demonstrates curved internal fixation is a viable option to consider among other treatment modalities for pelvic ring and acetabular fractures and may allow for early inpatient ambulation and a shorter LOS. Comparative studies are needed to confirm this.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"67 ","pages":"Article 103035"},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144069659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What are the diagnoses attributed to persistent hip pain after hip arthroplasty? A systematic review","authors":"Kael Hulin ,&nbsp;Angie Fearon ,&nbsp;Phil Newman","doi":"10.1016/j.jcot.2025.103036","DOIUrl":"10.1016/j.jcot.2025.103036","url":null,"abstract":"<div><h3>Background</h3><div>Persistent hip pain after total hip arthroplasty has been reported in up to 23 % of cases. Despite routine clinical tests, the source of pain often remains unclear, and diagnosis requires extensive investigation with imaging or surgical exploration.</div></div><div><h3>Aims</h3><div>This systematic review aimed to identify the diagnoses attributable to the painful hip arthroplasty. The second aim was to identify diagnostic techniques used to identify them.</div></div><div><h3>Method</h3><div>Three databases (Medline, Scopus and CINAHL) were searched from 2012 to 2024 using keywords and medical subject headings (MeSH) including ‘persistent pain AND hip arthroplasty AND diagnoses’. Quality assessment was undertaken with the Joanna Briggs Institute checklist for case-series. Data extraction was performed by one author using Covidence software and crosschecked by another for accuracy. Data included age, sex, arthroplasty type, diagnostic method, and confirmed diagnosis. Data was synthesised to provide a quantitative overview of diagnoses and diagnostic methods. PROSPERO number CRD42022340158.</div></div><div><h3>Results</h3><div>The search and reference screening returned 285 papers of which seven high quality and two unclear quality case-series met the inclusion criteria. There was a total of 388 painful hip arthroplasties included. Prostheses loosening or infection was present in 28.6 % of cases. Iliopsoas impingement was present in 21 % of cases. Causes outside the hip accounted for 16.4 % of cases with referred pain from the lumbar spine (14.6 %) most common. Greater trochanteric pain syndrome (GTPS) was present in 13 %. The painful etiology remained unknown in 9.2 % of participants. The most common diagnostic imaging technique was x-ray (100 %) followed by magnetic resonance imaging (22 %).</div></div><div><h3>Conclusion</h3><div>Prosthesis loosening and infection remain a significant cause of pain despite preliminary screening to exclude them. Iliopsoas impingement and causes outside the hip require significant consideration due to high prevalence. Less common differential diagnoses have been identified. X-ray is an important front-line imaging tool while other advanced imaging is used selectively to identify a diagnosis.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"67 ","pages":"Article 103036"},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143947962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"BioFire in osteoarticular Infections: Rapid syndromic testing for early and accurate diagnosis – A narrative review","authors":"Vibhu Krishnan Viswanathan ,&nbsp;Vijay Kumar Jain ,&nbsp;Karthikeyan P. Iyengar ,&nbsp;Raju Vaishya","doi":"10.1016/j.jcot.2025.103038","DOIUrl":"10.1016/j.jcot.2025.103038","url":null,"abstract":"<div><h3>Introduction</h3><div>In the increasing peril due to multidrug-resistant (MDR) pathogens, importance of novel molecular technologies for rapid pathogen identification has been acknowledged. In this context, the role of multiplex molecular technique, BioFire® Arthritis panel (BFAP) in the evaluation of osteoarticular infections (OI) has been recognized. The current review was performed to comprehensively evaluate the status of BFAP in OI.</div></div><div><h3>Methods</h3><div>A literature search was performed in June 2024 using five databases. Clinical studies (prospective and retrospective series) evaluating the role of BFAP in OI were considered. Experimental studies, editorials, and reviews were excluded. A narrative approach was used for the synthesis of results.</div></div><div><h3>Results</h3><div>Ten manuscripts were finally selected for the review. This test uses cartridge methodology, and the panel includes 31 microorganisms and eight resistance markers. The panel consists of nucleic acid extraction, reverse transcription, amplification of nucleic acid, and analysis of results in an automated manner (approximated duration of 1 h/run). It has been acknowledged for providing rapid results with relatively good diagnostic precision (90.9 % sensitivity, 98.5 % specificity). However, when off-panel pathogens (like <em>Staphylococcus epidermidis/Cutibacterium acnes</em>) are considered, sensitivity drops to 56 %. It significantly impacts its accuracy and false negative results.</div></div><div><h3>Conclusion</h3><div>The benefits of the BioFire® panel include rapid turn-around time, excellent sensitivity and specificity for on-panel pathogens, and ability to identify antimicrobial resistance. The benefits of BFAP are demonstrated in native septic arthritis and OI in pediatric population. In view of exclusion of specific organisms, its sensitivity and accuracy in diagnosing PJI (early acute PJI) and chronic infections are low.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"67 ","pages":"Article 103038"},"PeriodicalIF":0.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144069660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cystic bone Lesions: Diagnostic pitfalls and therapeutic considerations","authors":"Ashwin Prajapati ,&nbsp;Ashish Gulia ,&nbsp;Kaival Gundavda ,&nbsp;Rajesh Botchu ,&nbsp;Amit Janu","doi":"10.1016/j.jcot.2025.103046","DOIUrl":"10.1016/j.jcot.2025.103046","url":null,"abstract":"<div><div>Bone tumors are rare lesions that often pose diagnostic and therapeutic challenges for an orthopedic surgeon. Malignant bone lesions comprise &lt;0.2 % of all cancers and the precise incidence of benign bone lesions is not documented. Many of these lesions appear cystic on imaging with varying number of overlapping features between benign lesions like Unicameral bone cyst, locally aggressive like Aneurysmal bone cyst, infections like hydatid cyst of bone to malignant like telangiectatic osteosarcoma. To aid the diagnosis, cystic bone lesions are classified into primary and secondary bone cysts. Primary bone cysts include simple bone cysts (SBC), aneurysmal bone cysts (ABC), epidermal inclusion cysts, intraosseous ganglion, intraosseous lipoma, and hydatid cysts of bone. Secondary bone cysts arise within a primary bone condition leading to cyst formation and include pathologies like fibrous dysplasia (FD), telangiectatic osteosarcoma, eosinophilic granuloma, Giant cell tumor (GCT) of bone and brown tumors. Each of these has peculiar diagnostic hallmarks, requires different treatment, and carries different prognosis. Due to their rarity and overlapping clinico-radiological features, cystic lesions often pose diagnostic and therapeutic dilemmas for clinicians and radiologists, often leading to errors in diagnosis and inadequate treatment which can endanger a patient's limb or life. Through this article, we aim to describe specific diagnostic hallmarks and treatment plans for these cystic bone lesions which can aid radiologists and treating orthopedic surgeons in diagnosing and manage these lesions optimally.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"67 ","pages":"Article 103046"},"PeriodicalIF":0.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143937723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional and radiological outcomes of percutaneous wiring for two and three part fractures of the proximal humerus","authors":"Sanjay Sanatkumar Desai ,&nbsp;Rachit Vipul Shah ,&nbsp;Vishwesh Devendrasinh Chudasama","doi":"10.1016/j.jcot.2025.103044","DOIUrl":"10.1016/j.jcot.2025.103044","url":null,"abstract":"<div><h3>Background</h3><div>Proximal humerus fractures are common, with minimally displaced types often managed non-surgically. However, displaced fractures present a challenge due to complex patterns and numerous treatment options. While there is a general agreement on managing displaced four-part fractures in the elderly, two- and three-part fractures can be treated using various surgical methods, including open reduction and internal fixation (ORIF) with plate, ORIF with intramedullary nail, external fixation, screw fixation, arthroplasty, and percutaneous wiring. This study aims to evaluate the functional and radiological outcomes of treating two- and three-part proximal humerus fractures using closed percutaneous wire fixation.</div></div><div><h3>Methods</h3><div>39 patients, with a mean age of 67 years, treated with percutaneous wiring for displaced two and three-part proximal humerus fractures were prospectively evaluated. Radiological evaluation comprised of anteroposterior and axillary radiographs to look for union while functional evaluation was done using the Constant-Murley (CM) and American Shoulder and Elbow Society (ASES) scoring systems.</div></div><div><h3>Results</h3><div>Union was seen in all the cases and 92.3 % patients had satisfactory result with a mean CM score of 72.7 and mean ASES score of 74.2, at an average follow up of 14 months (12–32 months). Three patients (7.69 %) had unsatisfactory results. One patient had malunion secondary to infection. Two patients had low functional scores secondary to systemic illnesses. None of the patients underwent revision surgery.</div></div><div><h3>Conclusion</h3><div>Percutaneous wiring for displaced two- and three-part fractures of proximal humerus is a reliable, minimally invasive method of fixation. The procedure has predictable outcomes with low complication rate and can be performed under regional block.</div></div><div><h3>Level of Evidence</h3><div>Level IV; Case series; Treatment Study.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"67 ","pages":"Article 103044"},"PeriodicalIF":0.0,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143947963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The additional value of radiology reports in the follow-up of extremity fractures: a retrospective study in an academic hospital","authors":"Mare M.H. Walraven ,&nbsp;Pieta Krijnen ,&nbsp;David A. Vuijk ,&nbsp;Monique Reijnierse ,&nbsp;Inger B. Schipper ,&nbsp;Marco F. Termaat","doi":"10.1016/j.jcot.2025.103043","DOIUrl":"10.1016/j.jcot.2025.103043","url":null,"abstract":"<div><h3>Background</h3><div>Radiology reports on radiographic findings during follow-up (FU) after extremity fractures are generally not yet available when the patient is seen by the treating orthopedic trauma surgeon and may therefore be redundant. The aim of this study was to explore the inter-observer agreement on the reported findings of the FU radiograph between orthopedic trauma surgeons and radiologists.</div></div><div><h3>Method</h3><div>This retrospective cohort study included all FU radiographs of adult patients with an extremity fracture, treated in a Dutch university hospital between January 2022 and July 2023. The radiologist's and orthopedic trauma surgeon's assessments of unacceptable alignment, delayed/non-union and abnormalities associated with osteosynthesis material (OSM) on the FU radiographs were collected from the medical files. Fracture healing was considered normal in the absence of these findings. The interobserver agreement of the radiographic parameters between surgeon and radiologist was determined using Cohens' Kappa (κ). Additionally, incidental findings and their clinical relevance were explored.</div></div><div><h3>Results</h3><div>953 FU radiographs of 569 patients were included. The interobserver agreement was close to perfect for normal fracture healing (κ = 0.82, 95 % CI 0.77–0.88) and delayed/non-union (κ = 0.94, 95 % CI 0.89–0.99). The inter-observer agreement was substantial for unacceptable alignment of the fracture (κ = 0.80, 95 % CI 0.72–0.88) and abnormalities associated with the OSM (κ = 0.77, 95 % CI 0.65–0.89). Twenty-one incidental findings were diagnosed in the FU by the radiologist of which two were also independently described by the surgeon. Three of the findings that were missed or not described by the surgeon could have clinical significance, however the missing of these findings did not lead complications or additional hospital visits. These included two missed rib fractures and one osteochondral defect, which led to prolonged immobilization due to pain.</div></div><div><h3>Conclusion</h3><div>Radiographic reports in the FU of extremity fractures have limited additional value for clinical care and probably lacks cost-effectiveness or efficiency.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"67 ","pages":"Article 103043"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143916096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-incision anatomic technique yields good outcomes in acute and chronic distal biceps avulsions alike","authors":"D. Bodansky ,&nbsp;V. Gandbhir ,&nbsp;N. Modi ,&nbsp;J. Brookes ,&nbsp;M. Rathinam ,&nbsp;M. Pullagura","doi":"10.1016/j.jcot.2025.103042","DOIUrl":"10.1016/j.jcot.2025.103042","url":null,"abstract":"<div><h3>Background</h3><div>Distal biceps tendon ruptures can be treated with a single incision intervention, fixed with a combination of devices. Shorter time to surgery is expected to yield better results. Our hypothesis was that the timing of surgery whether within 4 weeks or beyond does not affect return to full work, post-operative range of motion or outcome scores.</div></div><div><h3>Methods</h3><div>The retrospective cohort consisted of consecutive adult patients referred to a U.K. hospital from 2012 to 2019 and received single incision anatomic repair for distal biceps rupture. Patients were stratified into two groups: an acute group, that received operation within 4 weeks and chronic group, beyond 4 weeks.</div></div><div><h3>Results</h3><div>52 patients were included, with 37 acute and 15 chronic. All participants were male, with a mean age of 43.5 (±8.01 SD). Patients underwent surgery at median of 6 days (Range 0–26) in acute group compared to median of 47 days (Range 29–147) in chronic group (p &lt; 0.00001). No significant differences were found as regards post-operative range of motion, QuickDASH scores and return to full work.</div></div><div><h3>Conclusion</h3><div>The timing of surgery whether within 4 weeks or beyond does not affect return to full work, functional outcome or post-operative range of motion.</div></div><div><h3>Level of evidence</h3><div>Level II.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"67 ","pages":"Article 103042"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143924619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of open femur fractures with massive bone loss using two-stage vascularized fibula grafting and synthetic calcium sulfate: A report of two cases","authors":"Ajayakumar Thankappan,&nbsp;Nizaj Nasimudeen,&nbsp;Aadithya Rangarajan","doi":"10.1016/j.jcot.2025.103037","DOIUrl":"10.1016/j.jcot.2025.103037","url":null,"abstract":"<div><div>Type III Gustilo-Anderson fractures with massive bone loss present significant treatment challenges due to the extensive bony and soft tissue damage they entail. Poor management can lead to complications such as osteomyelitis, non-union, limb length discrepancies, or even amputation. We present two cases of 52- and 56-year-old adults who had complex intra-articular distal femur open fractures with massive bone loss of 21 cm and 18 cm, respectively, successfully managed using synthetic calcium sulfate beads and vascularized fibula grafting.</div><div>The use of calcium sulfate offers several advantages over polymethylmethacrylate (PMMA) beads, including more effective antibiotic delivery, greater osteogenicity, and reduced systemic toxicity of antibiotics. We recommend the use of calcium sulfate over PMMA in managing complex cases with bone defects.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"67 ","pages":"Article 103037"},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143937724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing early functional outcomes between the midvastus and medial parapatellar approach for total knee arthroplasty: A prospective cohort study in an Asian population","authors":"Emrick Sen Hui Quah ,&nbsp;Brian Rui Kye Chee ,&nbsp;Lynn Thwin,&nbsp;Michael Gui Jie Yam","doi":"10.1016/j.jcot.2025.103033","DOIUrl":"10.1016/j.jcot.2025.103033","url":null,"abstract":"<div><h3>Background</h3><div>The medial parapatellar approach is the most prevalent approach for total knee arthroplasty. However, recent studies have suggested that the midvastus approach may confer benefits of better functional outcomes in the early post-operative period. This study aims to explore the differences in early functional outcomes between the two approaches.</div></div><div><h3>Methods</h3><div>This is a prospective cohort study of 72 total knee arthroplasties performed in a single tertiary institution. Baseline demographics and functional status were collected. Patients were followed up at the following time points - post-operative day 0, 1, 2, day of discharge and at first follow up 4–6 weeks post-surgery. The primary outcomes were range of motion, ambulatory distance, use of mobility aids, ability to straight leg raise and quadriceps strength – adjuncts to approximate functional recovery. Secondary outcomes include pain scores, operative time, length of stay, presence of any peri-operative complications, and patient discharge destination.</div></div><div><h3>Results</h3><div>Patients in the midvastus group achieved a greater ambulatory distance on post-operative day 1 compared to those in the medial parapatellar group (median ambulation distance 30m versus 18m, p &lt; 0.001). The time to straight leg raise was also shorter in the midvastus group (median duration 0 days vs 1 day, p = 0.016). There was no significant difference in length of stay, operative time or incidence of peri-operative complications.</div></div><div><h3>Conclusion</h3><div>The midvastus approach showed non inferior outcomes when compared to the classic medial parapatellar approach and may confer additional functional benefits in the form of shorter time to straight leg raise and longer ambulatory distances on post-operative day 1. Clinicians need to balance the purported benefits of the midvastus approach with the intraoperative technicalities of the midvastus approach, before deciding if it is suitable to be a standard approach to the knee in total knee arthroplasties.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"67 ","pages":"Article 103033"},"PeriodicalIF":0.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143924620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}