Orthopaedics & Traumatology-Surgery & Research最新文献

{"title":"Periprosthetic acetabular fractures","authors":"Nicolas Reina","doi":"10.1016/j.otsr.2024.104068","DOIUrl":"10.1016/j.otsr.2024.104068","url":null,"abstract":"<div><div>Periprosthetic acetabular fractures are a major challenge in orthopedics. Proper recognition of these complex cases helps to identify and treat patients with different presentations. These fractures can occur intraoperatively and be treated immediately, or they can occur postoperatively, following trauma or in the context of chronic low bone quality or associated implant loosening. The existing classification systems categorize these fractures as a function of the acetabular cup’s stability and the context surrounding the fracture.</div><div>When a fracture is detected intraoperatively, immediately analyzing its stability is crucial for choosing between a conservative strategy, the need for additional fixation, or the need to change the cup or use of an acetabular reinforcement ring.</div><div>When the patient has symptoms such as persistent pain or instability, secondary diagnosis of a fracture requires diagnostic imaging. Its treatment depends on the cup’s stability, with options ranging from conservative treatment with functional limitations, cup revision potentially combined with stabilization of the fracture site, and also management of potential periprosthetic bone defects.</div><div>Traumatic fractures require a comprehensive assessment to determine whether the acetabular cup is still stable. The treatment may be conservative or surgical (internal fixation or cup revision).</div><div>Chronic pelvic discontinuity is associated with bone loss and implant loosening. Acute pelvic discontinuity requires treatment tailored to each patient, often with acetabular rings or custom triflange cups to restore function.</div><div>This article aims to provide an in-depth review of periprosthetic acetabular fractures, touching on their causes, classification, assessment and treatment, along with specific considerations for fractures diagnosed postoperatively and following acute trauma.</div></div><div><h3>Level of evidence</h3><div>IV; systematic review of level II-IV studies</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104068"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chiba osteotomy (Tibial condylar valgus osteotomy) for a large tibial varus deformity: Technical note","authors":"Matthieu Ollivier ,&nbsp;Youngji Kim ,&nbsp;Kristian Kley ,&nbsp;Muneaki Ishijima ,&nbsp;Shintaro Onishi ,&nbsp;Hiroshi Nakayama ,&nbsp;Raghbir Khakha","doi":"10.1016/j.otsr.2024.103977","DOIUrl":"10.1016/j.otsr.2024.103977","url":null,"abstract":"<div><div>Chiba osteotomy is an effective technique for advanced knee osteoarthritis (KOA). The principle of the osteotomy is to correct both varus deformity and intra-articular joint congruity through an L-shaped osteotomy from the medial tibial condyle to the lateral intercondylar eminence. Previous studies have demonstrated that Chiba osteotomy is an effective method for alignment correction surgery for severe knee osteoarthritis. However, these reports slightly differ from the original concept of Chiba osteotomy. This report describes the pre-operative planning and surgical technique of Chiba osteotomy for patients with large tibial varus deformity, focusing on the management of early knee osteoarthritis following conditions such as post-traumatic Blount disease and “Pagoda” like proximal tibia varus deformities, as originally described.</div></div><div><h3>Level of evidence</h3><div>IV</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 103977"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does the use of topical vancomycin during primary hip or knee arthroplasty protect from infections?","authors":"François Laudet ,&nbsp;Alice Gay ,&nbsp;Hervé Dutronc ,&nbsp;Thierry Fabre ,&nbsp;Pierre Meynard ,&nbsp;Stéphane Costes","doi":"10.1016/j.otsr.2024.103984","DOIUrl":"10.1016/j.otsr.2024.103984","url":null,"abstract":"<div><h3>Background</h3><div>Infection is one of the main complications of hip and knee arthroplasties. Topical application vancomycin to prevent postoperative infections is efficient in spine surgery, and is spreading in prosthetic surgery. However, its clinical relevance and safety are still under debate. Thus, we conducted the present study to (1) assess whether topical vancomycin reduces peri-prosthetic infection rate, and (2) investigate its influence on surgical wound complications.</div></div><div><h3>Hypothesis</h3><div>Our hypothesis was that topical administration of diluted vancomycin during arthroplasty would reduce infection rate within the first postoperative year.</div></div><div><h3>Material and methods</h3><div>In total, 1900 hip and knee arthroplasties were performed between 2014 and 2021 in a single hospital. From July 2018 and December 2021, 910 prostheses were implanted with intra-articular instillation of vancomycin and tranexamic acid. From November 2014 to June 2018, 990 prostheses were set up without vancomycin. During a follow-up of minimum 12 months, we reported periprosthetic infections occurring during the first postoperative year, as well as vancomycin-induced general or cutaneous complications.</div></div><div><h3>Results</h3><div>We observed periprosthetic infections in 9/990 cases (0.91%) of the control group and 10/910 cases (1.1%) of the vancomycin group (p = 0.82). In parallel, we observed wound complications (erythema, seroma, hematoma, dehiscence and delay in wound healing) in 19/990 (1.9%) and 10/910 cases (1.1%) of the control and vancomycin group, respectively (p = 0.19). There were no general complications resulting from the application of vancomycin.</div></div><div><h3>Discussion</h3><div>Topical diluted vancomycin does not reduce periprosthetic infection risk, and has no effect on the occurrence of surgery wound complications. Considering the present findings, the use of vancomycin cannot be recommended in current practice to prevent infections following hip and knee arthroplasties. Finally, its use does not induce any specific complications, whether local (cicatrisation) or general (related to ototoxicity or nephrotoxicity).</div></div><div><h3>Level of evidence</h3><div>III; case control study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 103984"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Change in lower limb length following total knee arthroplasty","authors":"Simon Marmor ,&nbsp;Younes Kerroumi ,&nbsp;Guillaume Rigoulot ,&nbsp;Pierre-Alban Bouché","doi":"10.1016/j.otsr.2024.104005","DOIUrl":"10.1016/j.otsr.2024.104005","url":null,"abstract":"<div><h3>Background</h3><div>Length variations of the lower limbs after total knee arthroplasty (TKA) constitute a poorly evaluated parameter and can be associated with worse functional outcomes. The objectives of this study were to: (1) describe the variations in the lower limb length after TKA according to the digital accuracy of the computerized navigation system used for prosthesis implantation, (2) describe patient sensation of limb length modification at 3 months postoperatively and to identify its risk factors, (3) identify factors affecting lower limb length modification and to analyze the predictive value causing in the patient the sensation of lower limb discrepancy.</div></div><div><h3>Hypothesis</h3><div>We hypothesize that there may be a lower limb length discrepancy after TKA, which may cause some distress to the patient.</div></div><div><h3>Patients and methods</h3><div>This prospective study included 100 TKAs implanted with navigation gap-balanced adjusted mechanical alignment. Were compared the length of the lower limb before and after implantation and the patient’s changes in leg length perception at 3 months postoperatively. A subgroup analysis was performed according to preoperative knee deformities: varus knee was an HKA &lt; 177 °, normal knee was an HKA between 117° and 183 ° and valgus was an HKA &gt;183 °.</div></div><div><h3>Results</h3><div>Ninety-seven out of 100 patients experienced lengthening compared to the preoperative ipsilateral length, and twenty-three experienced lengthening greater than 10 mm. The mean lengthening was 7.3 mm (maximum 24.8 mm). Lengthening was significantly greater in valgus knees 9.9 mm [range, 2.0–24.8] than in varus 7.2 mm [range, 1.46–19.4] and normal knees 4.11 mm [range, 0.4–11.4] (p &lt; 0.05). The correction of frontal and sagittal deformation were risk factors for limb length modification (OR = 0.595; 95% CI [0.544−0.816] [p = 0.001], OR = 0.396; 95% CI [0.351−0.653] [p = 0.001]).</div><div>Twenty-two patients reported a sensation of limb length change: 11 (50%) reported equalization, whereas the remainder reported lengthening with a leg length difference. The preoperative sensation of lower limb length inequality was the unique factor affecting the patient’s perception post-surgery (OR = 37.50; 95% CI [9.730–144.526] [p = 0.0001]). A threshold value of 6.6 mm was identified for the sensation of limb length modification.</div></div><div><h3>Conclusion</h3><div>Navigation is a tool for describing ipsilateral leg length variations after TKA. These variations are significant and perhaps explain some patient dissatisfaction. A partial correction of the frontal deformity according to the knee phenotype could limit the risk of modification of the native length.</div></div><div><h3>Level of evidence</h3><div>IV; Descriptive therapeutic prospective study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104005"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supramalleolar osteotomy: technical note","authors":"Julie Mathieu ,&nbsp;Mathilde Gatti ,&nbsp;Louis Dagneaux","doi":"10.1016/j.otsr.2024.104071","DOIUrl":"10.1016/j.otsr.2024.104071","url":null,"abstract":"<div><div>Supramalleolar osteotomy (SMO) aims to correct extra-articular deformities of the distal lower leg. There are several indications, the most common being varus osteoarthritis of the ankle. The rationale in this indication is to modify talocrural stress and pressure distribution by reorienting the limb axis. Preoperative planning is essential to optimize functional outcome, limiting the risk of under- or over-correction. Several SMO procedures have been described, and are preferably performed at the deformity site or center of rotation and angulation (CORA). They aim to restore talocrural joint-line anatomy and correct talar tilt while conserving physiological hindfoot valgus. Techniques use K-wires as cut guides. 3D imaging and patient-specific instrumentation now play key roles in this surgery, which is difficult both to plan and to execute. The present study addresses the following questions: What are the indications and contraindications? What are the technical principles? What preoperative work-up is required for planning and execution? What are the technical particularities? And what contribution can new technologies make?</div></div><div><h3>Level of evidence</h3><div>V.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104071"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spacers in two-stage strategy for periprosthetic infection","authors":"Cécile Batailler ,&nbsp;Nicolas Cance ,&nbsp;Sébastien Lustig","doi":"10.1016/j.otsr.2024.104074","DOIUrl":"10.1016/j.otsr.2024.104074","url":null,"abstract":"<div><div>In two-stage revision of infected implants, the first stage involves removing the implant and implanting a joint spacer, and the second stage involves implanting a new prosthesis at least 6 weeks later. Spacers have two main functions: local administration of high-dose antibiotics, and preservation of the joint space by reducing soft tissue retraction and improving patient comfort until reimplantation. The present review aims to detail the necessary characteristics of antibiotics added to cement to achieve good joint diffusion, to describe the steps of two-stage revision, and to present the types of spacer available according to the joint and complications.</div><div>The antibiotic used in the spacer must be heat-resistant, water-soluble and chemically stable in the cement. Gentamicin and vancomycin are generally preferred. We recommend at least 3 months’ systematic antibiotic therapy for periprosthetic joint infection. Reimplantation is performed either at 6 weeks without antibiotic washout or 3 months after 2 weeks’ washout</div><div>Spacers may be static (non-articulating) or dynamic (articulating). Static spacers are mainly used in the knee or hip in cases of severe bone defect or risk of soft-tissue lesions. An articulating spacer enables some joint functions to be preserved in the knee, hip or shoulder.</div><div>The most frequent complications are the dislocation of dynamic spacers and the breakage of static or dynamic spacers. To optimize efficacy and minimize complications, the biomechanical and bacteriological characteristics of spacers must be considered.</div></div><div><h3>Level of evidence</h3><div>Expert opinion.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104074"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of preoperative medial meniscus status on the outcomes of high tibial osteotomy with human umbilical cord-derived mesenchymal stem cells cartilage regeneration.","authors":"Dhong-Won Lee, Sung-Wook Hong, Seung-Ik Cho, Sung-Gyu Moon, Ji-Hee Kang","doi":"10.1016/j.otsr.2025.104179","DOIUrl":"10.1016/j.otsr.2025.104179","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The effect of medial meniscus (MM) status on outcomes following high tibial osteotomy (HTO) combined with cartilage regeneration using human umbilical cord blood-derived mesenchymal stem cells (hUCB-MSCs) remains unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This study aimed to evaluate the effect of preoperative MM status on the outcomes of HTO combined with cartilage regeneration using hUCB-MSCs. Specifically, clinical and radiological outcomes were compared between two groups of patients, which were divided according to their preoperative MM status. We hypothesized that patients with preserved meniscal integrity or those who underwent meniscal root repair would show better clinical and radiological outcomes compared to those with significant meniscal loss or untreated root tears.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective analysis was performed on 47 patients who underwent HTO with hUCB-MSC implantation. Patients were divided into group P (preserved MM integrity or medial meniscal root repair) and group L (loss of MM integrity, defined as a peripheral rim width &lt;3 mm, unable to maintain hoop function). Clinical outcomes were assessed using the International Knee Documentation Committee (IKDC) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores after a minimum follow-up of 2 years. Cartilage regeneration was evaluated with Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 score and International Cartilage Repair Society (ICRS) Cartilage Repair Assessment (CRA) score from second-look arthroscopy. Correlation analyses were conducted to examine the relationship between preoperative MM extrusion and cartilage repair.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Both groups demonstrated significant improvements in IKDC and WOMAC scores (p &lt; 0.01). No significant differences were observed between groups in IKDC and WOMAC scores at final follow-up (p = 0.21, p = 0.42, respectively). MOCART 2.0 and ICRS CRA scores showed no significant differences between groups (p = 0.35, p = 0.08, respectively). Group P showed higher proportions of favorable outcomes compared to group L, including no major subchondral changes or only minor marrow edema (56% vs. 31.8%) and ICRS CRA grades I or II (84% vs. 72.7%). While these findings suggest potential differences in outcomes, neither comparison reached statistical significance (p = 0.09 and p = 0.48, respectively). Preoperative MM extrusion negatively correlated with MOCART 2.0 and subchondral bone changes (r = -0.24, p = 0.03; r = -0.29, p = 0.02, respectively).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;HTO with hUCB-MSC implantation provided significant clinical improvements and effective cartilage regeneration regardless of preoperative MM status. However, preoperative MM extrusion may influence subchondral bone changes, emphasizing the need to consider MM status for long-term outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Level of evidence: &lt;/strong&gt;III; retrospective compar","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104179"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143124018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Techniques for surgical stabilization of the patella in children","authors":"Hassan Al Khoury Salem ,&nbsp;Elie Haddad ,&nbsp;Bruno Dohin ,&nbsp;Franck Accadbled","doi":"10.1016/j.otsr.2024.104062","DOIUrl":"10.1016/j.otsr.2024.104062","url":null,"abstract":"<div><div>Patellar instability can be defined as dislocation or subluxation of the patella relative to the femoral trochlea. It is a common reason for consulting a pediatric orthopedic surgeon. Its etiology is multifactorial. Because of the work of Hughston, Merchant, Ficat, Insall and Dejour, the overall care of this pathology has changed greatly. Surgical stabilization of the patella in children is being performed more often due to better understanding of the pathology and widespread adoption of reconstruction techniques for the medial patellofemoral ligament. However, some surgical techniques should not be used in children. Determining the type of instability is the first step to selecting the appropriate technique and to avoiding the biggest pitfall — recurrence.</div></div><div><h3>Level of evidence</h3><div>Expert opinion.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104062"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142712002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Many thanks to our reviewers","authors":"","doi":"10.1016/j.otsr.2024.104099","DOIUrl":"10.1016/j.otsr.2024.104099","url":null,"abstract":"","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104099"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143139825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of combat-related extremity injuries in modern armed conflicts","authors":"Laurent Mathieu ,&nbsp;Camille Choufani ,&nbsp;Christophe Andro ,&nbsp;Nicolas de l’Escalopier","doi":"10.1016/j.otsr.2024.104055","DOIUrl":"10.1016/j.otsr.2024.104055","url":null,"abstract":"<div><div>While the first conflicts of the 21st century involved asymmetric warfare in the fight against terrorism, recent geopolitical events require us to prepare for the possibility of high-intensity conflicts. Modern wounding agents mainly consist of explosive devices and high-velocity bullets. Every trauma surgeon must be familiar with the mechanisms of injury specific to armed conflicts. The initial care of these injuries is based on applying damage control surgery to save the patient’s life, save their limb if possible and preserve their function. Blast injuries are the most common in modern armed conflicts; the resulting combination of severe injuries can be challenging to treat. Limb reconstruction involves a sequential strategy based on simple, reliable and reproducible techniques which can be used by non-specialized surgeons working in sometimes austere situations.</div></div><div><h3>Level of evidence</h3><div>Expert opinion.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104055"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142696252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}