Orthopaedics & Traumatology-Surgery & Research最新文献

{"title":"Pathologies of the cervical spine in skeletal syndromes and dysplasias.","authors":"Raphaël Vialle","doi":"10.1016/j.otsr.2025.104437","DOIUrl":"10.1016/j.otsr.2025.104437","url":null,"abstract":"<p><p>Skeletal syndromes and dysplasias include more than 150 entities, most often of genetic origin. Some of them cause abnormalities in the cervical spine, with or without instability, distortion or compression of the spinal cord. These abnormalities must be detected and treated if necessary because they can have serious consequences such as quadriplegia. Up to 30% of patients with Down syndrome are affected by occipitocervical or atlantoaxial instability. Dynamic cervical spine radiographs are the most common screening tool. Mucopolysaccharidoses (MPS) are a group of inherited lysosomal storage diseases that result in the accumulation of glycosaminoglycans sometimes responsible for craniocervical instability and cervical spinal canal stenosis. Their monitoring requires an MRI every two years. Neurofibromatosis type 1 and syndromes with connective tissue abnormalities (Marfan syndrome, Loeys-Dietz syndrome, Ehlers-Danlos syndrome) can cause severe and unstable cervical spine deformities that may remain asymptomatic for a long time. Cervical X-rays should therefore be performed if there is the slightest doubt. Some rare chondrodysplasias (punctate chondrodysplasia, Larsen syndrome, Metatropic dysplasia) or segmentation anomalies (Klippel Feil syndrome, Sprengel's disease) have cervical spine abnormalities that should be looked for. In case of progression of a deformity (usually kyphosis) or stenosis of the cervical spine, it is important to consider surgical treatment with correction and stabilization. Sometimes preceded by a period of Halo traction, the instrumentation must have \"wide\" limits and exceed the anatomical limits of the spinal deformity by at least 2-3 levels to prevent the development of an adjacent deformity. The increasing use of surgical navigation techniques allows for greater corrections and more efficient stabilizations, including severe cervical spinal deformities. Vigilance and the detection of these abnormalities remain the key to early and preventive treatment of the complications of these spinal anomalies on often difficult terrain. LEVEL OF EVIDENCE: >V (expert opinion).</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104437"},"PeriodicalIF":2.2,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114807","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":"A composite test 6 months after an Anterior Cruciate Ligament Reconstruction cannot predict graft failure: A prospective analysis of 498 patients with a mean 5-year follow-up from MERIScience cohort.","authors":"Thibault Marty-Diloy, Pierre Laboudie, Clément Cazemajou, Nicolas Graveleau, Nicolas Bouguennec","doi":"10.1016/j.otsr.2025.104434","DOIUrl":"10.1016/j.otsr.2025.104434","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to investigate a correlation between various components of the composite test and graft failure at mid-term follow up after an Anterior Cruciate Ligament (ACL) reconstruction.</p><p><strong>Methods: </strong>This single-center study includes patients who underwent primary ACL reconstruction surgery and received an identical 6-months postoperative composite evaluation at the institution (isokinetic tests, jump tests and ACL - Return to Sport and Injury (RSI) psychological evaluation) between 2017 and 2020. To be eligible, a minimum follow-up period of 3 years was necessary, with evaluations conducted at the longest follow-up interval to assess the rates of graft failure.</p><p><strong>Results: </strong>Overall, 498 patients were analyzed, with a mean follow-up of 4.9 ± 1.23 years. The overall ACL graft failure rate was 5.4% (27 patients). The mean ACL-RSI at 6 months was 64.9 ± 19.4% for patients without graft failure, compared to 60.8 ± 16.3% for patients who experienced graft failure. No statistically significant difference was observed between the two groups (p > 0.05). There was no statistically significant between-group difference for any of the other composite test items (p > 0.05).</p><p><strong>Conclusion: </strong>The composite test performed 6 months after an ACL reconstruction was not predictive of the risk of graft failure. Although it can be used to guide recovery and re-athletization, other predictive factors for the risk of graft failure, or a modification of the test items, should be considered for post-operative follow-up and evaluation after ACL reconstruction. Doctors should strive to readjust patients' expectations of these composite tests, which appear to be useful only for assessing a return to sport.</p><p><strong>Level of evidence: </strong>IV; Case-control study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104434"},"PeriodicalIF":2.2,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092967","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":"Can anterior midfoot tarsectomy procedure be improved using patient-specific cutting guide? An experimental study.","authors":"Julie Mathieu, Guillaume Lamouroux, Mathilde Gatti, François Canovas, Pierre-Emmanuel Chammas, Louis Dagneaux","doi":"10.1016/j.otsr.2025.104433","DOIUrl":"10.1016/j.otsr.2025.104433","url":null,"abstract":"<p><strong>Background: </strong>Anterior midfoot tarsectomy remains difficult to achieve for the treatment of cavovarus foot. Computer-assisted planning and printed patient-specific cutting guides (PSCG) aim to reduce technical errors. This study investigated the accuracy and safety of PSCG-assisted anterior tarsectomy from a cadaveric analysis.</p><p><strong>Hypothesis: </strong>PSCGs provide an accurate correction and safety, disregarding the experience of the operator.</p><p><strong>Material and methods: </strong>Ten foot and ankle specimen underwent an anterior tarsectomy using PSCG with a dorsal closed-wedge effect of 15°. An initial CT-scan of the foot was performed to create 3D geometrical foot models, then used to virtually plan the closed osteotomy. Outcomes were investigated from preoperative, computer-assisted planed and postoperative 3D reconstructions. Accuracy was defined as differences between planed and postoperative reconstructions, using computational matrix transformation to quantify angular corrections and surface-distance mapping. Differences in accuracy between two differently-skilled operators were evaluated. Finally, the specimens were dissected to verify the absence of iatrogenic lesions.</p><p><strong>Results: </strong>The mean sagittal error was 1.1° ± 1.0° (95% CI: 0.4-1.7°), and the accuracy in the Méary's angle correction was 2.5° ± 1.7° (95% CI: 1.4-3.6°). The maximal error was shown for the setting of pronation-supination. Overall, 92% of the surface distance mapping were < 2 mm. No significant differences in accuracy were found between operators. No iatrogenic neuro-vascular lesions were found after dissection.</p><p><strong>Conclusions: </strong>Our study validated the use of PSCG in performing anterior tarsectomy with a good accuracy, with neuro-vascular safety. Therefore, the use of PSCG can decrease the risk for iatrogenic flatfoot or undercorrection. The operator experience did not influence the risk for angular errors, as shown by other papers dealing with PSCG. Patient-specific cutting guides-assisted anterior tarsectomy showed high accuracy to correct Meary's angle, disregarding the experience of the operator. Further perspectives need to be considered, including correction guides to monitor the pronation-supination.</p><p><strong>Level of evidence: </strong>IV; experimental study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104433"},"PeriodicalIF":2.2,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145093026","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":"Manipulation under anesthesia for stiffness after total knee arthroplasty: A French multicenter study with 5 years' follow-up including 344 cases.","authors":"Claude-Alain Roullet, Stéphane Descamps, Shirin Monadjemi, Aymard De Ladoucette, Cecile Batailler, Bruno Miletic, Matthieu Ehlinger","doi":"10.1016/j.otsr.2025.104432","DOIUrl":"10.1016/j.otsr.2025.104432","url":null,"abstract":"<p><strong>Introduction: </strong>knee stiffness is a common complication following total knee replacement (TKA), causing important morbidity. Although manipulation under anesthesia (MUA) is a safe method for the treatment of stiffness, its benefits over long-term and for large cohorts are not precisely known. The aim of this retrospective study was to assess clinical and functional outcomes and patients satisfaction after MUA over 5 years of follow-up.</p><p><strong>Hypothesis: </strong>Our hypothesis was that range of motion (ROM) improvement would be superior to 30° and would be sustained at 5 years follow-up leading to a patient satisfaction rate exceeding 70%.</p><p><strong>Material and methods: </strong>This was an observational retrospective study organized with 14 French centers implied in the SOFCOT. Three hundred and forty four patients who underwent MUA following TKA were reviewed between January 2023 and June 2024. Among the cohort, patients who underwent a second MUA were analyzed separately. The collected data included patient demographics, Devane activity, ASA score, functional scores, knee amplitudes and satisfaction rates. Statistical analysis was performed with EasyMedStat.</p><p><strong>Results: </strong>The mean time between TKA and MUA was 2.9 ± 6.9 months and the mean follow-up was 5.5 ± 2.5 years. In comparison with the ROM at stiffness diagnosis (66.6°± 21.0°), at 5 years post-MUA, the ROM was improved by 36.0° ± 26.1 (p < 0.001), at a mean of 102.2° ± 22.6°. The subgroup of patients having a second MUA had a ROM gain of 16.8° ± 12.3° at 5-years post-MUA. The global complication rate after MUA was 2.3% (n = 8) including hematoma, wound dehiscence, infection, tibial tubercle fracture and patellar tendon rupture. At last follow-up, OKS was 35.4 ± 9.6. The KOOS for all subscales ranged from 38.5 ± 30.9 to 57.5 ± 33.8 and the mean FJS was 35.0 ± 14.3. A high satisfaction rate was recorded (77.5%).</p><p><strong>Conclusion: </strong>The improvement in ROM was substantial throughout the 5-year follow-up period. MUA was associated with low complication rates and high patient satisfaction, suggesting that it is an effective treatment for knee stiffness.</p><p><strong>Level of evidence: </strong>III; multicenter retrospective cohort study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104432"},"PeriodicalIF":2.2,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145093023","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":"Do Patient-Specific Guides accurately correct lower limb deformities in children? Preliminary outcomes.","authors":"Virginie Nguyen-Khac, Anne-Laure Simon, Brice Ilharreborde, Laurent Gajny, Franck Fitoussi, Alexandra Alves, Raphael Vialle, Elie Saghbini, Manon Bachy","doi":"10.1016/j.otsr.2025.104431","DOIUrl":"10.1016/j.otsr.2025.104431","url":null,"abstract":"<p><strong>Introduction: </strong>Over the past decade, the use of patient-specific instrumentation (PSI) has increased exponentially as a means of improving surgical precision. In pediatric orthopedics, its adoption is more recent and differs from adult applications due to the unique characteristics of pediatric deformities and anatomical constraints, particularly the need to preserve the physis. This study aimed to assess the reliability and accuracy of PSI in performing lower limb long bone osteotomies in children.</p><p><strong>Hypothesis: </strong>Planned corrections are comparable to the achieved corrections.</p><p><strong>Patients and methods: </strong>This bicentric retrospective study included all PSI-assisted lower limb osteotomies performed since 2021. PSI guides were developed using bilateral CT scans. Demographic data, clinical outcomes at the final follow-up, and any complications were recorded. In all cases, postoperative three-dimensional (3D) reconstruction was performed using low-dose biplanar stereo radiography (EOS) and compared to the preoperative CT-based surgical plan. For each osteotomy, 3D measurements of the primary correction in all three planes were analyzed. Postoperative reliability was defined as the difference between the preoperative plan and the achieved correction (Δ angle). A threshold of ±3 ° was used to assess the accuracy of PSI.</p><p><strong>Results: </strong>Eighteen patients (21 osteotomies, mean age 14.6 ± 3.4 years) were included: 52% femoral (n = 11) and 48% tibial (n = 10). At a mean follow-up of 10 ± 5 months, one intraoperative and three postoperative complications were observed. Two patients reported residual pain at the final follow-up. Planned corrections ranged from 9 ° to 85 °, with 62% exceeding 15 °. The mean Δ angle was 11 °, with no significant difference overall (p = 0.06), but a trend toward undercorrection was observed in cases with planned corrections >15 ° (p = 0.03).</p><p><strong>Discussion: </strong>The use of PSI in pediatric lower limb osteotomies tends to result in undercorrection compared to the planification, particularly in case of severe deformity. This may be explained by the greater magnitude of corrections typically required in pediatric patients compared to adults. Although these findings require confirmation through larger cohorts and 3D postoperative analysis, they should be considered when using PSI in pediatric lower limb osteotomies.</p><p><strong>Level of evidence: </strong>III; Retrospective case-control study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104431"},"PeriodicalIF":2.2,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145093062","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":"Lower infection rate in patients with early flap coverage of open tibial fractures: A single-center retrospective study.","authors":"Mathilde Cochonat, Antoine Bertani, Frédéric Rongieras, Paul-Henri Bauwens","doi":"10.1016/j.otsr.2025.104430","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104430","url":null,"abstract":"<p><strong>Background: </strong>Open tibial fractures with soft tissue defect are associated with a high risk of complications, particularly infection and non-union, and may result in limb loss in an otherwise fit and healthy adult. The timing of flap coverage seems to be a critical component of post-operative outcomes. Hypothesis - We hypothesized that early coverage within a week would be associated with a lower rate of postoperative complications, particularly infections.</p><p><strong>Materials and methods: </strong>In this retrospective study, all consecutive adult patients managed at a French level I trauma centre between 2010 and 2023 for an open tibia fracture requiring flap coverage and having at least 1 year follow-up were included. The collected complications were infection, aseptic or septic non-union, flap failure, and amputation. Subgroup analyses were conducted according to time to flap coverage (early coverage ≤7 days and delayed coverage >7 days) and according to the presence or absence of infection.</p><p><strong>Results: </strong>A total of 35 patients (mean age 45 ± 17.3, range 18-81; 88.6% of males) were included for analysis. Overall, 16 patients (45.7%) had an infection, 8 patients (24.2%) had non-union, 5 patients (14.3%) had flap failure, and 3 patients (8.6%) had amputation. Of the 35 patients, 17 (48.6%) received early flap coverage while 18 (51.4%) had a delayed flap coverage. The proportion of infections was significantly higher in patients who received delayed flap coverage compare to those who underwent early coverage (72.2% vs. 17.6%, p < 0.05). All cases of flap failure and septic non-union occurred in patients with an infection (p < 0.05).</p><p><strong>Discussion: </strong>The present study confirms that early flap coverage within a week is associated with a lower proportion of infection, a key determinant of treatment success. Rapid and coordinated management between orthopaedic and plastic surgeons remains essential to optimize outcomes and limit complications.</p><p><strong>Level of evidence: </strong>IV; single-centre retrospective cohort study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104430"},"PeriodicalIF":2.2,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082403","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 prone uninstrumented intraoperative frontal radiograph influence distal fusion level selection in adolescent idiopathic scoliosis surgery?","authors":"François Luc, Simon Arvati, Nicolas Mainard, Anne-Laure Simon, Mourad Ould-Slimane, Brice Ilharreborde","doi":"10.1016/j.otsr.2025.104429","DOIUrl":"10.1016/j.otsr.2025.104429","url":null,"abstract":"<p><strong>Background: </strong>The selection of the lowest instrumented vertebra (LIV) is crucial in adolescent idiopathic scoliosis (AIS) surgery to optimize functional and radiological outcomes. Despite established guidelines, the selection strategies vary widely among surgeons. This study aimed to assess how often prone uninstrumented intraoperative frontal radiographs influence LIV selection. The main hypothesis is that uninstrumented intraoperative radiographs lead to a more conservative selection of the LIV level during adolescent idiopathic scoliosis surgery.</p><p><strong>Methods: </strong>A total of 139 patients undergoing posterior spinal fusion for AIS were prospectively analyzed. Preoperative fusion levels were determined, by the staff, six months before surgery using 3D EOS low dose stereoradiography (standing and lateral bending) and supine frontal radiographs. The final LIV chosen during surgery was recorded and compared to the planned one. Frontal radiological parameters (preoperative and intraoperative) were compared between the group \"no change\" (NC) and the group \"change\" (C), in which the surgeon changed his decision based on the intraoperative radiograph.</p><p><strong>Results: </strong>The final LIV matched the preoperative plan in 57% of cases, but changes occurred in 43%, particularly for Lenke 1A curves (47.5%). Two radiographic parameters significantly differed between groups: LIV-CSVL (Central Sacral Vertical Line) (p = 0.04) and LIV + 1-CSVL (p = 0.02). Logistic regression indicated Lenke lumbar modifiers A and B significantly increased the likelihood of intraoperative LIV changes (p = 0.008 and p = 0.01, respectively).</p><p><strong>Conclusion: </strong>Prone uninstrumented intraoperative frontal radiographs substantially impact LIV selection in AIS surgery, especially in Lenke 1A and B curves where selective thoracic fusion is considered.</p><p><strong>Level of evidence: </strong>III; retrospective cohort.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104429"},"PeriodicalIF":2.2,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071273","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":"Interobserver concordance analysis for the evaluation of internal rotation with elbow at the side during shoulder clinical examination.","authors":"Chloé Roy, Julien Berhouet, Adrien Jacquot, Jean-David Werthel, Marc Olivier Gauci","doi":"10.1016/j.otsr.2025.104427","DOIUrl":"10.1016/j.otsr.2025.104427","url":null,"abstract":"<p><strong>Introduction: </strong>Internal rotation with the elbow against the body (IR1) is a crucial functional range of motion of the shoulder for daily activities. Its restoration following prosthetic surgery, particularly after reverse shoulder arthroplasty, remains unsatisfactory and unresolved. In clinical practice, its assessment can be challenging and subject to variability depending on the examiner. One method for evaluating IR range of motion is to determine the highest vertebral level reached by the patient. The objective of this study was to analyze interobserver agreement for the assessment of internal rotation using this commonly employed method, which is also utilized in the calculation of the Constant score.</p><p><strong>Hypothesis: </strong>It was hypothesized that IR1 measurement based on the highest vertebral level reached would demonstrate a high degree of interobserver agreement.</p><p><strong>Materials and methods: </strong>A total of 285 photographs of healthy volunteers performing a IR1 movement, as instructed prior to image acquisition, were independently and blindly assessed by four experienced shoulder surgeons. The range of motion was classified into six levels: thigh, buttocks, lumbosacral junction, waist (L3), T12 vertebra, and interscapular region (T7). Interobserver agreement was assessed using Fleiss' kappa, while pairwise agreement between raters was calculated using Cohen's kappa.</p><p><strong>Results: </strong>Overall interobserver agreement was strong (K = 0.7, p-value < 0.04). In the paired analysis using Cohen's kappa, interobserver agreement was almost perfect between certain raters, with values reaching up to 0.89. Detailed kappa analysis showed almost perfect agreement for the IR1 levels corresponding to the thigh and the interscapular region (K = 0.91 and 0.85, respectively). Agreement was strong for the buttocks level (K = 0.66) and moderate for the intermediate levels (T12, L3, and the lumbosacral junction) with K values of 0.57, 0.47, and 0.53, respectively.</p><p><strong>Discussion: </strong>The interobserver correlation for this method of assessing IR1 range of motion is strong, suggesting that evaluating IR1 based on the highest vertebral level reached is a reproducible method for clinical shoulder examination.</p><p><strong>Level of evidence: </strong>III; prospective study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104427"},"PeriodicalIF":2.2,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071207","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":"Instability after total hip arthroplasty: Analysis of combined anteversion and patient-related clinical parameters.","authors":"Joseph Attas, Régis Bernard de Dompsure, Lolita Micicoi, Lillia Gharbi, Michael Lopez, Nicolas Bronsard, Jean-François Gonzalez, Grégoire Micicoi","doi":"10.1016/j.otsr.2025.104428","DOIUrl":"10.1016/j.otsr.2025.104428","url":null,"abstract":"<p><strong>Introduction: </strong>While outcomes after total hip arthroplasty (THA) are generally excellent, prosthetic dislocation remains a multifactorial complication. This study hypothesized that differences in combined anteversion (CA) exist between patients with and without dislocation. The objectives were to (1) compare postoperative alignment parameters between dislocated and stable hips, (2) assess differences of alignement according to surgical approach, and (3) evaluate patient-related risk factors for dislocation.</p><p><strong>Materials and methods: </strong>In this retrospective case-control study, 37 dislocated hips were matched to 74 stable hips by sex, age, body mass index, and surgical approach. Postoperative CT scans measured acetabular anteversion, femoral anteversion, CA, and cup inclination. Alignment was assessed relative to Lewinnek's safe zone (acetabular anteversion 15 ° ± 10 °, inclination 40 ° ± 10 °) and Jolles' target zone for CA (50 ° ± 10 °).</p><p><strong>Results: </strong>Mean CA did not differ between dislocated and stable hips (45.9 ° vs 48.5 °, Δ = 2.6 °, p = 0.35). Target CA was achieved in 51% of dislocated and 54% of stable hips (p = 0.80). Cup inclination, acetabular anteversion, and femoral anteversion also showed no significant differences. Achievement of Lewinnek's safe zone was similar between groups, except for acetabular inclination (67.6% in dislocated vs 83.8% in stable hips, p = 0.04). Surgical approach (direct anterior vs posterior) was not associated with alignment differences. In multivariate analysis, ASA (American Society of Anesthesiologists) score ≥3 (OR = 2.5, p = 0.04) and degenerative lumbar spine symptoms (OR = 3.2, p < 0.01) were independently associated with dislocation risk.</p><p><strong>Conclusion: </strong>CA did not differ between dislocated and stable hips, suggesting that implant orientation alone does not explain instability. Instead, acetabular inclination, high ASA score, and lumbar spine pathology emerged as significant risk factors, underscoring the multifactorial nature of dislocation after THA.</p><p><strong>Level of evidence: </strong>III; case-control study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104428"},"PeriodicalIF":2.2,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071209","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":"Response to letter from Dazhi Li.","authors":"Alexandre Caubère, Olivier Barbier","doi":"10.1016/j.otsr.2025.104421","DOIUrl":"10.1016/j.otsr.2025.104421","url":null,"abstract":"","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104421"},"PeriodicalIF":2.2,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058832","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}