Orthopaedics & Traumatology-Surgery & Research最新文献

{"title":"Long-term safety of total knee arthroplasty in patients with chronic kidney disease in Taiwan: A retrospective cohort study","authors":"","doi":"10.1016/j.otsr.2024.103847","DOIUrl":"10.1016/j.otsr.2024.103847","url":null,"abstract":"<div><h3>Background</h3><div>Chronic kidney disease<span> (CKD) is a prevalent condition in Taiwan, and the incidence of total knee arthroplasty (TKA) is on the rise. This study aimed to evaluate the postoperative results of patients with different degrees of CKD after TKA, using data from the Taiwan National Health Insurance Research Database.</span></div></div><div><h3>Methods</h3><div>The study analyzed 3078 patients who received TKA from 2012 to 2017, equally divided into three groups: none-CKD, mild CKD (without dialysis), and severe CKD (with dialysis). Propensity score matching was used to minimize selection bias.</div></div><div><h3>Results</h3><div><span>After TKA, there was no significant difference in the risk of debridement surgery for infection between the three groups (adjusted HR of mild CKD: 0.71 95% CI</span> <!-->=<!--> <!-->0.36–1.38, <em>p</em> <!-->=<!--> <!-->0.3073; adjusted HR of severe CKD: 1.14, 95% CI<!--> <!-->=<!--> <!-->0.63–2.06, <em>p</em> <!-->=<!--> <!-->0.6616). However, CKD patients requiring dialysis had a significantly higher risk of mortality (adjusted HR: 1.98, 95% CI<!--> <!-->=<!--> <!-->1.57–2.50, <em>p</em> <!-->&lt;<!--> <!-->0.001) and readmission within 90<!--> <!-->days of any causes (adjusted HR: 1.83, 95% CI<!--> <!-->=<!--> <!-->1.48–2.26, <em>p</em> <!-->&lt;<!--> <!-->0.001) than non-CKD and mild CKD patients.</div></div><div><h3>Conclusion</h3><div>Severe CKD patients needing dialysis after TKA have a higher risk of mortality and readmission rates than that of the non-CKD or mild CKD patients. If the patient is in the early stage of CKD, their prognosis after receiving TKA is expected to be as good as non-CKD patients.</div></div><div><h3>Level of evidence</h3><div>IV; well-designed cohort study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139991866","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 inverse kinematic alignment coupled with robot-assisted TKA optimize patellofemoral clinical and radiological results?","authors":"","doi":"10.1016/j.otsr.2024.103880","DOIUrl":"10.1016/j.otsr.2024.103880","url":null,"abstract":"<div><h3>Introduction</h3><div><span>With a satisfaction rate of 80%, total knee arthroplasty (TKA) surgery has seen significant improvements in recent decades. The 20% of poor results may be explained by the alignment technique used for </span>implant placement, which can influence patellofemoral kinematics. The objective of this study was to demonstrate that the use of inverse kinematic alignment makes it possible to obtain satisfactory clinical and radiological patellar scores in robotic TKA.</div></div><div><h3>Hypothesis</h3><div>The inverse kinematic alignment technique coupled with robotic surgery<span> makes it possible to restore the native kinematics of the patella.</span></div></div><div><h3>Materials and methods</h3><div>This prospective study including 100 TKAs with a primary TKA performed using the Stryker Mako™ robotic surgery system, and the inverse kinematic alignment technique. Patients who underwent patella resurfacing were excluded. Clinical and radiological scores were recorded preoperatively and 1 year postoperatively.</div></div><div><h3>Results</h3><div>At one year, the specific patellar clinical scores were excellent with an average Kujala score of 85.69 and an average HSS Patellar score 88.15. The average patellar lateralization index was 0.15 and the average patellar tilt was 5.1°, showing no significant difference compared to preoperation (<em>p</em> <!-->=<!--> <!-->0.45 and <em>p</em> <!-->=<!--> <!-->0.18). The average external rotation of the femoral implant was 0.47<!--> <!-->±<!--> <!-->0.6° [–1.9; 2.1].</div></div><div><h3>Discussion</h3><div>The patellofemoral clinical results were excellent. The use of the robotic arm coupled with this alignment technique makes it possible to obtain a controlled external rotation of the femoral implant as well as an optimized orientation of the tibial component, favoring good restitution of the alignment of the extensor apparatus. This study did not demonstrate any radiological correction of patellar tilt and lateralization.</div></div><div><h3>Conclusion</h3><div>The combined use of robotic surgery with the inverse kinematic alignment technique seems effective on specific clinical results of the patellofemoral joint.</div></div><div><h3>Level of evidence</h3><div>II; prospective cohort.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140867832","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":"Lumbar scoliosis and stenosis: What outcomes for which treatment? Analysis of three surgical techniques in 154 patients with minimum two-year follow-up","authors":"","doi":"10.1016/j.otsr.2023.103632","DOIUrl":"10.1016/j.otsr.2023.103632","url":null,"abstract":"<div><h3>Study design</h3><div>Prospective multicentric study.</div></div><div><h3>Objective</h3><div>This study goal was to analyze the clinical and radiographic outcomes of lumbar stenosis and scoliosis (LSS) patients, treated with lumbar decompression (LD), short fusion and decompression (SF) or long fusion with deformity correction (LF).</div></div><div><h3>Hypothesis</h3><div>Procedures without correction lead to poorer long-term outcomes.</div></div><div><h3>Methods</h3><div>Consecutive patients with two-year minimum follow-up, older than 50, with lumbar scoliosis (Cobb angle<!--> <!-->&gt;<!--> <span><span><span>15°), and symptomatic lumbar stenosis were included. Age, gender, Lumbar and Radicular Visual Analog Scale, </span>ODI, </span>SF12 and SRS30 were collected. Main and adjacent curves Cobb angles, C7 coronal tilt (C7CT), spinopelvic parameters, and spino-sacral angle (SSA) were measured preoperatively, at one and two years. Patients were sorted into surgery type groups.</span></div></div><div><h3>Results</h3><div>In total, 154 patients were included, with respectively 18, 58 and 78 patients in LD, SF and LF groups. Mean age was 69, 85% were women. Clinical scores improved in each group at one year, but only LF group exhibited persistent improvement at 2<!--> <!-->years. A significant fractional Cobb angle increase was noted in the SF group at 2<!--> <!-->years (from 12<!--> <!-->±<!--> <!-->11° to 18<!--> <!-->±<!--> <!-->14°). C7CT significantly increased in the LD group at 2<!--> <!-->years (from 2.5<!--> <!-->±<!--> <!-->1.3° to 5.1<!--> <!-->±<!--> <!-->3.5°). LF group presented the highest complication rate (45%, 19% for SF and 0% for LD). The overall revision rate was 14% in SF group and 30% in LF group.</div></div><div><h3>Conclusion</h3><div>LSS is a complex pathology requiring custom-made surgical treatment. LD, SF and LF allow satisfactory clinical outcome, with a better and more sustained clinical improvement for LF despite higher complication and revision rates.</div></div><div><h3>Level of evidence</h3><div>IV.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9604670","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":"Patellar resurfacing might not be mandatory in contralateral second total knee replacement even if performed during replacement of the first knee","authors":"","doi":"10.1016/j.otsr.2024.103857","DOIUrl":"10.1016/j.otsr.2024.103857","url":null,"abstract":"<div><h3>Introduction</h3><div>The appropriateness or necessity of patellar resurfacing in total knee arthroplasty (TKA) is not clearly established. The objective of the present study was to compare the clinical and functional results of patients with bilateral involvement, operated on in one knee by TKA with patellar resurfacing and in the other knee by TKA without resurfacing. The hypothesis was that there was no difference in results between the two sides.</div></div><div><h3>Method</h3><div><span>This was a retrospective cohort of patients operated on by TKA without patellar resurfacing in a second osteoarthritic knee after contralateral TKA with patellar resurfacing. Twenty consecutive patients who underwent second primary TKA constituted their own control group (40 knees). Iwano scores were comparable. Mean age was 75.9</span> <!-->±<!--> <!-->6.2<!--> <!-->years. Mean time between the two procedures was 20.6<!--> <!-->±<!--> <!-->11.9<!--> <!-->months.</div></div><div><h3>Results</h3><div>There were no differences in SF-36, KOOS<span> or Lille patellofemoral scores between the right and left knees. Sixty-five percent of patients were unable to differentiate the performance of their knees in activities of daily living.</span></div></div><div><h3>Conclusion</h3><div>The present study did not differentiate results according to patellar resurfacing, showing the limitations of resurfacing for early functional gain after primary TKA. Resurfacing might thus not be essential, even if it was performed in replacement of the first knee.</div></div><div><h3>Level of evidence</h3><div>IV; retrospective cohort study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140051006","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":"Pregnancy and childbirth after adolescent idiopathic scoliosis surgery: A study of 80 pregnancies","authors":"","doi":"10.1016/j.otsr.2023.103711","DOIUrl":"10.1016/j.otsr.2023.103711","url":null,"abstract":"<div><h3>Background</h3><div>Adolescent idiopathic scoliosis<span> (AIS) is a common spinal disease affecting 2% of adolescents, and women in 90% of the cases. When a surgical treatment is opted for, many questions are frequently asked by families and patients about the course of pregnancy and childbirth<span> after the spinal fusion. This subject remains little studied in the literature, especially with modern instrumentation techniques.</span></span></div></div><div><h3>Hypothesis</h3><div><span>The goal was to describe pregnancy and childbirth after AIS surgery in terms of access to epidural analgesia, need for </span>cesarean section (c-section), and low back pain during and after pregnancy. We thus hypothesized that women undergoing spinal surgery for AIS have subsequently uncomplicated pregnancies and childbirths, and have access to epidural analgesia as women without AIS do.</div></div><div><h3>Patients and methods</h3><div><span>In this retrospective multicenter study, 198 women who underwent surgery between 1984 and 2014 were reviewed from two university hospitals. Among them, 50 women became pregnant, for a total of 80 pregnancies. Surgical data were collected [approach, uppermost and lowermost instrumented vertebra (UIV, LIV)]. Pregnancy characteristics were evaluated: time between surgery and pregnancy, number of births, mode of analgesia, type of delivery, weight gain. Occurrence of low back pain during pregnancy and at follow-up was recorded using </span>ODI.</div></div><div><h3>Results</h3><div>Of the 50 women, 34 had posterior surgery and 16 had anterior surgery. Deliveries took place from 1988 to 2018. Of the 80 pregnancies, 81% were delivered by vaginal route (<em>n</em> <!-->=<!--> <span>65/80), and an effective epidural anesthesia was performed for 49% of them (</span><em>n</em> <!-->=<!--> <!-->39/80). Epidural analgesia failed in 9% of pregnancies (<em>n</em> <!-->=<!--> <!-->7/80), and was denied in 35% of cases (<em>n</em> <!-->=<!--> <!-->28/80), half of the time by anesthesiologists (<em>n</em> <!-->=<!--> <!-->15/80). Patients refused epidural in 13 pregnancies (16%, <em>n</em> <!-->=<!--> <span>13/80). A general anesthesia was used in six pregnancies (8%, </span><em>n</em> <!-->=<!--> <span>6/80), for c-sections only. Back pain was reported in 48% of the pregnancies (</span><em>n</em> <!-->=<!--> <!-->38/80). The level of fusion was correlated with c-section, and conversely with epidural anesthesia.</div></div><div><h3>Discussion</h3><div>A normal pregnancy with vaginal delivery seems to be the rule for women undergoing spinal fusion for AIS. The c-section rate in AIS women was similar to the general population (19%). Yet, access to epidural anesthesia still seems problematic with only 49% of births in this series, compared with 81% in the French population.</div></div><div><h3>Level of evidence</h3><div>IV, retrospective cohort.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49685051","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":"Retroarticular drilling for osteochondritis dissecans of the talus: A systematic review","authors":"","doi":"10.1016/j.otsr.2024.103834","DOIUrl":"10.1016/j.otsr.2024.103834","url":null,"abstract":"<div><h3>Background</h3><div><span>Opinions differ on the optimal treatment for stable talar osteochondritis dissecans (OCD) with intact cartilage. Some recommend conservative management, while others prefer surgical care, which includes </span>debridement<span><span> and micro-fractures, transarticular drilling through a direct or medial malleolus approach and retroarticular drilling. The rationale behind retroarticular drilling is to induce bone marrow healing without touching the intact cartilage. The goal of this </span>systematic review is to summarize the clinical outcomes of retroarticular drilling as a standalone procedure for stable talar OCD with intact cartilage.</span></div></div><div><h3>Patients and methods</h3><div>A systematic review of the literature prospectively registered in the PROSPERO register was performed along the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Medline, EMBASE and Evidence-Based Medicine databases were searched from inception to December 2021 for retroarticular drilling for stable talar OCD with an intact cartilage. Two independent evaluators screened the search results, selected the articles to be included in the analysis and assessed the methodological quality of all included articles with the Newcastle-Ottawa Scale (NOS).</div></div><div><h3>Results</h3><div>Twelve studies, on 99 patients were included in the final analysis. Methodological quality was poor for all the included studies. High heterogeneity prevented any pooling or meta-analysis, but favorable clinical results were reported according to excellent post-intervention scores on the American Orthopedic<span> Foot and Anke Score (AOFAS), ranging from 88.9 to 100. There was also significant improvement in pain as measured by the Visual Analog Scale (VAS), ranging between 2.3 and 5.9.</span></div></div><div><h3>Discussion</h3><div>Favorable results seem to be achieved with retroarticular drilling without grafting for stable talar OCD with intact cartilage, but more powered comparative studies between surgical options and conservative management are needed to establish the gold standard treatment.</div></div><div><h3>Level of evidence</h3><div>IV.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139716681","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":"MPFL reconstruction with proximal rather than distal femoral tunnel position leads to less favorable short-term results","authors":"","doi":"10.1016/j.otsr.2024.103816","DOIUrl":"10.1016/j.otsr.2024.103816","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to compare the clinical and radiological outcomes of medial patellofemoral ligament (MPFL) reconstruction (MPFLR) between anatomic femoral tunnel positions: proximal (near adductor tubercle [AT]) and distal (near medial epicondyle [ME]).</div></div><div><h3>Hypothesis</h3><div>MPFLR with the proximal femoral tunnel position has worse clinical and radiological outcomes than those with the distal femoral tunnel position.</div></div><div><h3>Patients and methods</h3><div>Fifty-five patients who underwent isolated MPFLR with proximal or distal femoral tunnels with at least 2 years of follow-up were retrospectively analyzed. Based on postoperative CT images, 28 patients were classified as group AT and the remaining 27 patients were classified as group ME. The International Knee Documentation Committee, Lysholm, Tegner, Kujala scores, and complications were evaluated. Radiologically, the Caton-Deschamps Index (CDI), patellar tilt angle, patellofemoral osteoarthritis (PFOA), patellofemoral cartilage status by the International Cartilage Repair Society (ICRS) grade, bone contusion, and MPFL graft signal intensity were evaluated.</div></div><div><h3>Results</h3><div>All clinical scores significantly improved in both groups (<em>p</em> <!-->&lt;<!--> <span>0.01). No statistically significant difference was noted between the two groups in regards to their preoperative demographic data, postoperative clinical scores, complications, or radiological findings<span> (CDI, patellar tilt angle, PFOA, bone contusion, and graft signal intensity). The group AT had worse cartilage status on the medial facet of the patella (</span></span><em>p</em> <!-->=<!--> <!-->0.02). The ICRS grade for the medial facet of the patella statistically progressed in group AT compared to group ME (<em>p</em> <!-->=<!--> <!-->0.04) as well.</div></div><div><h3>Discussion</h3><div>Both groups showed significantly improved clinical outcomes. However, for the medial facet of the patella, MPFLR with the proximal femoral tunnel position had worse cartilage status and ICRS grade progression than those with the distal femoral tunnel position.</div></div><div><h3>Level of evidence</h3><div>III; retrospective comparative study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139508046","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":"Revision total knee arthroplasty with periprosthetic distal femoral fracture","authors":"","doi":"10.1016/j.otsr.2024.103856","DOIUrl":"10.1016/j.otsr.2024.103856","url":null,"abstract":"<div><div><span>Treatment strategies for periprosthetic distal femoral fracture<span> depend on the type of fracture, level with respect to the prosthesis, and prosthesis fixation. The usual treatment is internal fixation by nail or locking plate. This can be more difficult when the fracture is close to the joint, is destabilizing the prosthesis or is associated with reduced bone stock, and implant exchange should be considered, depending on the patient's health status. The aim is to obtain the fastest possible recovery while limiting complications and minimizing surgery time for often frail and elderly patients. The present study details the implant revision technique in periprosthetic distal femoral fracture, which requires experience in </span></span>traumatology and prosthetic revision and material adapted to the situation.</div></div><div><h3>Level of evidence</h3><div>V, expert opinion.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140029615","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":"Minimally invasive surgery of femoral periprosthetic fractures increases the rate of consolidation and decreases time to bone healing without a higher rate of complications","authors":"","doi":"10.1016/j.otsr.2024.103866","DOIUrl":"10.1016/j.otsr.2024.103866","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Knee periprosthetic femoral fractures (KPPFF) are becoming more frequent due to the increasing number of arthroplasties and the aging population, for whom maintaining autonomy and function remains a challenge. The use of locking plates has improved functional results and promoted the development of “minimally invasive” surgical (MIS) approaches. Despite the availability of literature comparing between different types of osteosynthesis for KPPFF, there is a paucity of information available on the complications of osteosynthesis using locking plates, depending on the approach. We therefore carried out a retrospective multicenter study (nine centers: Dijon, Grenoble, Lille, Marseille, Nice, Paris, Saint-Étienne, Strasbourg, Colmar) as part of a Symposium of the French Society of Orthopedic Surgery and Traumatology (SOFCOT). Following osteosynthesis of KPPFF by locking plates carried out by a standard approach or by a minimally invasive approach (MIS), the objectives were: (1) to compare the complications, (2) to evaluate whether the radiological and clinical results (rate and time of consolidation, resumption of weight bearing, lack of reduction, postoperative autonomy) were comparable in the two groups.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Hypothesis&lt;/h3&gt;&lt;div&gt;The hypothesis was that performing an MIS approach in these indications does not confer more complications than a standard approach, and rather, the MIS approach offers better functional and radiological results.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Material and method&lt;/h3&gt;&lt;div&gt;Five hundred and seventy-three patients presented with KPPFF over the periods studied (retrospective series from January 2012 to December 2016, then prospective series from January to December 2019). After applying the inclusion criteria (KPPFF by locking plate) and exclusion criteria (tumor context, infectious, intraoperative fractures, fractures on loose prostheses, other osteosynthesis methods, treatment by prosthetic revision, patients under the age of 18, follow-up less than 1-year, incomplete files), a global series of 306 patients was retained. Two groups were created according to the approach performed: a standard approach group (S, &lt;em&gt;n&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;228) and a minimally invasive approach group (MIS, &lt;em&gt;n&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;78). The demographic data of the population were recorded, as was the criteria for autonomy (Parker score, place of living). Postoperative complications were sought (infection, mechanical complication, surgical revision). Finally, the radiological and clinical results were evaluated (rate of, and time to consolidation, resumption of weight bearing, lack of reduction, postoperative autonomy).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The comparison of the two subgroups, S and MIS, found complication rates are comparable in the two groups in terms of infections [S group: &lt;em&gt;n&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;18 (7.9%), MIS group: &lt;em&gt;n&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;2 (2.6%)], mechanical complications [S: &lt;em","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140068897","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":"Prediction of postoperative gait speed change after bilateral primary total knee arthroplasty in female patients using a machine learning algorithm","authors":"","doi":"10.1016/j.otsr.2024.103842","DOIUrl":"10.1016/j.otsr.2024.103842","url":null,"abstract":"<div><h3>Background</h3><div>An important aim of total knee arthroplasty is to achieve functional recovery, which includes post-operative increase in walking speed. Therefore, predicting whether a patient will walk faster or slower after surgery is important in TKA, which has not been studied in previous literatures. Who walks faster and who walks slower after TKA? Can we predict these kinds of patients before surgery?</div></div><div><h3>Hypothesis</h3><div>Whether or not a patient walk faster after total knee arthroplasty can be predicted with preoperative characteristics.</div></div><div><h3>Patients and methods</h3><div><span>In this retrospective cohort study, 128 </span>female patients<span><span> who underwent staged bilateral total knee arthroplasty were analyzed with gait analysis preoperatively and at postoperative two years. These patients were divided into three different groups according to the percentage of gait speed change after total knee arthroplasty: 1) V(+), more than 10% gait speed increase; 2) V(−), more than 10% gait speed decrease; and 3) V(0), those in-between. Gait parameters, mechanical axis angles, </span>WOMAC<span> pain score and Knee Society scores of the two groups (V(+) and V(−)) were compared. Furthermore, a classification model predicting whether a patient walks faster after total knee arthroplasty was designed using a machine learning algorithm.</span></span></div></div><div><h3>Results</h3><div>After total knee arthroplasty, average gait speed increased by 0.07<!--> <!-->m/s from 0.87<!--> <!-->m/s to 0.94<!--> <!-->m/s (<em>p<!--> </em>&lt;<!--> <!-->0.001) and gait speed increased in 43.8% of the patients (<em>n</em> <!-->=<!--> <!-->56). However, gait speed decreased in a significant number of patients (<em>n</em> <!-->=<!--> <!-->17, 13.3%). When V(+) and V(−) groups were compared, gait speed, cadence, sagittal/coronal knee range of motion, and Knee Society Function score were lower in the V(+) group before surgery, but became higher after surgery. Gait speed change could be predicted using three variables (preoperative gait speed, age, and the magnitude of mechanical axis angle). The area under the receiver operating characteristic curve of the machine learning model was 0.86.</div></div><div><h3>Discussion</h3><div>After total knee arthroplasty, gait speed was maintained or increased in most patients. However, gait speed decreased in a significant number of patients. The machine learning classification model showed a good predictive performance, which could aid in the decision-making and the timing of total knee arthroplasty.</div></div><div><h3>Level of evidence</h3><div>III; retrospective cohort study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139922350","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}