Orthopaedics & Traumatology-Surgery & Research最新文献

{"title":"Neonatal separation of the distal humeral epiphysis can be treated orthopedically without reduction.","authors":"Malek Brichni, Marine De Tienda, Manon Bachy, Gauthier Caillard, Emeline Bourgeois, Clément Jeandel, Stéphanie Pannier, Marion Delpont","doi":"10.1016/j.otsr.2025.104382","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104382","url":null,"abstract":"<p><strong>Background: </strong>Neonatal separation of the distal humeral epiphysis (NSDHE) is a very rare injury. On one hand, anatomical reduction is usually required in pediatric elbow fractures due to limited remodeling potential at the distal humerus. But on the other hand, neonatal fractures often show favorable evolution without reduction, even in cases of severe displacement. NSDHE, often associated with traumatic deliveries, remains underreported, controversial, and its management lacks standardized protocols. Furthermore, its diagnosis can be difficult on X-rays as the distal humeral epiphysis is not ossified at birth. The study questions are: Can non-reduction orthopedic treatment of distal humeral epiphyseal separation yield good clinical and radiological outcomes? Are there risk factors for distal humeral epiphyseal separation? What relevant additional examinations should be performed?</p><p><strong>Hypothesis: </strong>Orthopedic treatment without reduction may yield satisfactory clinical and radiological outcomes in NSDHE.</p><p><strong>Patients and methods: </strong>This multicenter retrospective study included patients with NSDHE with at least two years of follow-up from four university hospitals. Data on delivery, diagnostic methods, and treatment types were collected. At the last follow-up, joint range of motion, clinical outcomes, and elbow radiographs were evaluated.</p><p><strong>Results: </strong>Fifteen patients were included, with a mean age of 8,8 years at the last follow-up (ranging from 2 years to 29 years). All patients underwent an initial elbow radiograph, which was misinterpreted as an elbow dislocation in two cases. Two radiographs were initially deemed normal, necessitating further examinations (ultrasound, arthrography, Magnetic Resonance Imaging). Twelve patients were treated by immobilization without reduction, while two underwent surgical treatment with reduction under general anesthesia and percutaneous pinning. The non-operated patients had complete and symmetrical range of motion without complications, except for one case of resolving cubitus varus. One of the operated patients developed osteitis that required reoperation and also presented with resolving cubitus varus at 4 years old.</p><p><strong>Discussion: </strong>Orthopedic treatment through immobilization without reduction appears to be a viable option for neonatal epiphyseal separation of the distal humeral, which are frequently mistaken for elbow dislocations on initial radiographs. Complementary examinations, such as ultrasound, can be useful to confirm the diagnosis. This series yields promising results, although the sample size remains limited.</p><p><strong>Conclusion: </strong>Neonatal separation of the distal humeral epiphysis may represent an exception among displaced elbow fractures, as conservative management without reduction can lead to good clinical and radiological outcomes.</p><p><strong>Level of evidence: </strong>IV; Retrospective ","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104382"},"PeriodicalIF":2.2,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979233","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":"Effect of remodeling on correction of tibia vara using the circular hexapod external fixator.","authors":"Sherif Galal, Ahmed O Sabry, Al-Munqith Al-Abri, Amr Arafa, Mohamed Tageldeen Mohamed, Ahmed Afifi","doi":"10.1016/j.otsr.2025.104348","DOIUrl":"10.1016/j.otsr.2025.104348","url":null,"abstract":"<p><strong>Background: </strong>We aimed to evaluate if there would be loss of some correction achieved (caused by remodeling) after correcting tibia vara deformity with hexapod circular fixators and if that loss of correction would influence clinical outcomes.</p><p><strong>Hypothesis: </strong>The hypothesis of the study was that remodeling at the osteotomy site would lead to loss of some correction over time.</p><p><strong>Patients and methods: </strong>This retrospective study included 18 patients with tibial varus deformity as a sequela of adolescent tibia vara who underwent proximal tibial deformity correction using the Hexapod External Fixator between August 2020 and August 2023. We assessed clinical outcomes using the Limb Deformity-Scoliosis Research Society (LD-SRS) score and radiographic parameters such as Mechanical Axis Deviation (MAD) and Mechanical Axis Angle (MAA) measured preoperatively, post-correction, and at the final follow-up. Statistical analyses were performed to quantify the statistical significance of limb alignment change at final follow-up and to attempt to define a cut-off angle to be achieved at the end of correction that would result in no deviation in limb alignment in the long run.</p><p><strong>Results: </strong>After a mean follow-up duration of 18.7 mo, there was a significant improvement in both functional and radiographic measures. The mean LD-SRS score improved from 3.4 ± 0.5 preoperatively to 4.6 ± 0.4 at the final follow-up. Radiographic parameters showed notable correction, with the mean MAA improving from 25.1º ± 8.7 (varus alignment) preoperatively to 1.7º ± 2.5 (valgus alignment) at the end of correction, and to 2.4º ± 3.3 (varus alignment) at the final follow-up. Similarly, the mean MAD value improved from 87.4 ± 29.5 mm (medial deviation) preoperatively to 7.3 ± 9.6 mm (medial deviation) at the end of correction, and to 6.1 ± 11.5 mm (lateral deviation) at the final follow-up.</p><p><strong>Discussion: </strong>When treating adolescents with tibia vara deformity using hexapod fixators, it is advisable to over correct the MAA by 5° (valgus overcorrection) and the MAD by 7-9 mm to counteract the loss of some correction over time caused by the effect of remodeling.</p><p><strong>Level of evidence: </strong>III; retrospective study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104348"},"PeriodicalIF":2.2,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859937","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":"Return to driving after surgical treatment of proximal humerus fractures.","authors":"Vinh Le Thai, Maxime Antoni, Philippe Clavert","doi":"10.1016/j.otsr.2025.104346","DOIUrl":"10.1016/j.otsr.2025.104346","url":null,"abstract":"<p><strong>Introduction: </strong>There are few data available about how patients resume car driving after proximal humerus fracture. The aim of this study was to evaluate return to car driving after surgical treatment of proximal humerus fracture. Secondary aims were to identify factors associated with return to driving.</p><p><strong>Methods: </strong>This retrospective monocentric study included 155 patients (mean age 64.3 ± 11.7 years), operated on for a traumatic proximal humerus fracture. Among them, 59% were treated by ORIF by nail, 18% by ORIF by plate and 23% by a reverse shoulder arthroplasty. All patients had a driver's license and used to drive a car preoperatively, on a regular basis. Modalities for resuming driving after surgery were collected retrospectively. Primary endpoint was the postoperative time to return to car driving. Secondary endpoints were: return to driving rates at 3, 6, 12, 24 months, the time to be back to driving with a shoulder free of pain. Influence of different potential factors on the primary endpoint was evaluated with multivariate analysis. A p-value of less than 0.05 was considered significant.</p><p><strong>Results: </strong>The 3 groups were comparable with regard to gender, age, medical history, side affected, frequency of pre-operative driving. Postoperative time to return to driving was 15.9 ±11.3 weeks and time to be back to driving with a shoulder free of pain was 31.9 ±13.8 weeks. At 2 years follow-up, 71% of patients had resumed car driving. In multivariate analysis, the following factors were associated with a delayed return to driving: Neer 4 fracture (delayed by 10.2 weeks, p = 0.001); reverse shoulder arthroplasty (delayed by 8.0 weeks, p = 0.02); occurence of a postoperative complication (delayed by 8.9 weeks, p = 0.013). A high SSV score at 3 months was associated with a shortened delay to return to driving (p = 0.035). We did not find any statistical correlation between delay to return to driving and the other potential factors evaluated.</p><p><strong>Conclusion: </strong>After surgical treatment of proximal humerus fracture, 71% of patients were able to resume car driving, at 2 years follow-up. Mean postoperative time to resume car driving was 15.9 weeks.</p><p><strong>Level of evidence: </strong>III; retrospective case-control study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104346"},"PeriodicalIF":2.2,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859938","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":"The impact of a Diagnostic Multidisciplinary Meeting on reducing diagnostic delays in musculoskeletal tumors.","authors":"Emilie Renoud-Grappin, Corentin Bertout, Denis Waast, Najoi Chatt, Louise Galmiche, Mickael Ropars, Christophe Nich, Nicolas Regenet, François Lataste, Vincent Crenn","doi":"10.1016/j.otsr.2025.104349","DOIUrl":"10.1016/j.otsr.2025.104349","url":null,"abstract":"<p><strong>Background/hypothesis: </strong>Sarcomas are rare, complex tumors whose therapeutic management is typically guided by multidisciplinary teams. Many patients with suspected musculoskeletal tumors are referred to expert centers for further evaluation. To optimize initial patient management and reduce diagnostic delays, the implementation of Diagnostic Multidisciplinary Team Meetings (DMDT) has been proposed. We hypothesize that this implementation contributes to optimizing the management of patients and conducted this study to answer the following questions: (1) Does the implementation of DMDT lead to a reduction in diagnostic delays in the management of musculoskeletal tumors at a tertiary referral center? (2) Does the prioritization of biopsy in 2022 allow a faster management of the most suspicious cases?</p><p><strong>Materials and methods: </strong>We conducted a retrospective comparison of two patient cohorts referred to an expert center for suspected musculoskeletal tumors: one cohort recruited in 2017 (before DMDT implementation) and one another in 2022 (after DMDT implementation). Both cohorts were observed over a 6-month period, focusing specifically on diagnostic delays between referral and biopsy, as well as between referral and diagnosis. In 2022, we also examined the effect of urgency levels (rated from 1 to 3) on biopsy prioritization.</p><p><strong>Results: </strong>Patient volume increased by 80.5% from 2017 (190 patients) to 2022 (343 patients). The implementation of DMDT resulted in a significant reduction in diagnostic delays. The \"Referral-Diagnosis\" delay decreased by 11 days, from 65 ± 51 days in 2017 to 54 ± 43 days in 2022 (p = 0.023). Similarly, the \"Referral-Biopsy\" delay decreased by 11 days, from 50 ± 37 days in 2017 to 39 ± 27 days in 2022 (p < 0.001). Delays were further reduced when biopsies were prioritized according to urgency: the \"DMDT-Biopsy\" delay was 12 days shorter for level 1 urgency (16 ± 18 days) compared to level 3 urgency (28 ± 17 days, p = 0.002).</p><p><strong>Conclusion: </strong>The implementation of DMDT significantly reduced diagnostic delays, even with the increased patient volume at the tertiary referral center. Prioritization of biopsy procedures based on urgency levels was proven effective in expediting the diagnostic process, although further improvements are still required. DMDT demonstrated its value as a major tool for improving access to specialized care and optimizing the efficiency and reliability of the diagnostic pathway for musculoskeletal tumors.</p><p><strong>Level of evidence: </strong>IV; Retrospective study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104349"},"PeriodicalIF":2.2,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859941","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":"Risk factors of flexor tendon tenosynovitis after distal radius fractures treated with volar locking plates: A case-control study.","authors":"Eléonore Canarelli, Clément Berry, Axel Van Vliet, Emmanuel David, Mathilde Léon","doi":"10.1016/j.otsr.2025.104347","DOIUrl":"10.1016/j.otsr.2025.104347","url":null,"abstract":"<p><strong>Introduction: </strong>Flexor tenosynovitis is a well-recognized complication following volar plate fixation of distal radius fractures (DRFs). The aim of our study was to highlight the risk factors of flexor tenosynovitis.</p><p><strong>Material and methods: </strong>We conducted a retrospective case-control study including 200 patients (50 cases and 150 controls) who underwent osteosynthesis with an Aptus™ volar locking plate. We analyzed demographic, surgical, and radiological factors associated with flexor tenosynovitis requiring hardware removal. Univariate and multivariate analyses were performed to identify independent risk factors.</p><p><strong>Results: </strong>The prevalence of hardware removal for flexor tenosynovitis was 3.7% (50 patients). The mean time to symptom onset was 19.4 months ± 22.75 (range: 2-108), with an average delay of 3.8 months ±3.34 (range: 0.2-15) before hardware removal. In univariate analysis, significant risk factors included plate positioning in Soong C (p = 0.018), placement below the watershed line (p < 0.01), and postoperative immobilization with a plaster splint (p < 0.001). In multivariate analysis, only plate position relative to the watershed line (p = 0.038) and postoperative immobilization type (p < 0.001) remained significant. Pronator quadratus repair was more frequent in the control group (p = 0.046) but was not a significant protective factor in multivariate analysis (p = 0.11).</p><p><strong>Conclusion: </strong>Incorrect plate positioning, particularly relative to the Soong zones and watershed line, is a key risk factor for flexor tenosynovitis. Postoperative immobilization type may also play a role. Early plate removal should be considered in high-risk cases.</p><p><strong>Level of evidence: </strong>III; retrospective case control study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104347"},"PeriodicalIF":2.2,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859939","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":"Robot-assisted knee surgery: A turning point or just another step?","authors":"Pierre-Alban Bouché ,&nbsp;Sébastien Parratte ,&nbsp;Didier Hannouche","doi":"10.1016/j.otsr.2025.104345","DOIUrl":"10.1016/j.otsr.2025.104345","url":null,"abstract":"","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 5","pages":"Article 104345"},"PeriodicalIF":2.2,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859940","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":"Is patient weight a risk factor for breakage of smaller cementless femoral stems in total hip arthroplasty? A prospective monocentric cohort study of 251 femoral stems at risk with a mean follow-up of six years.","authors":"Victor Housset, Pierre-Alban Bouché, Guillaume Auberger, Wilfrid Graff, Antoine Mouton, Younes Kerroumi, Luc Lhotellier, Simon Marmor","doi":"10.1016/j.otsr.2025.104344","DOIUrl":"10.1016/j.otsr.2025.104344","url":null,"abstract":"<p><strong>Background: </strong>In 2014, based on biomechanical test results, the use of cementless Meije Duo™ (Corin, Cirencester, UK) stems (sizes 1 and 2) was contraindicated for patients weighing more than 60 kg to mitigate the risk of fracture. There is no data regarding the in vivo behavior of such components, therefore we did a retrospective study aiming to evaluate the incidence of stem breakage or failure in these patients, considering weight and activity level, with a minimum follow-up of four years.</p><p><strong>Hypothesis: </strong>There is no greater risk of implant breakage for patients not following the ISO 7206-4 standard.</p><p><strong>Methods: </strong>This retrospective, single-center, multi-operator study was conducted at a specialized hip prosthetic surgery center. It included all consecutive patients who received an cementless Meije Duo™ femoral stem (sizes 1 or 2) between 2007 and 2014, with at least four years of postoperative follow-up. Weight changes, complication occurrence, and the need for surgical revision were evaluated, alongside radiographic assessments for stem subsidence or non-integration.</p><p><strong>Results: </strong>A total of 251 stems were analyzed, with a mean follow-up of 88 months (range, 77-109). Primary THA was performed in 241 cases (96%) and 10 (4%) were revision surgeries. The mean age at surgery was 59.3 years (range, 53-66 years), and the average weight was 66.2 kg (range, 40-103 kg). One hundred and fifty-eight THAs (62.9%, 158/251) were over 60 kg at the time of surgery. No stem breakages were observed at the final follow-up. Seven adverse events occurred (3.2%), including two dislocations, one instance of non-osseointegration, one case of femoral stem subsidence at three months without stem revision, and three femoral stem revisions (1.2%) (1 instance of subsidence at one year, 1 mechanical pain at seven years, 1 non-osseointegration following a periprosthetic fracture at 5 months). A significant increase in patient weight was observed (p = 0.02): 60% of THAs (140/233) experienced weight gain, with an average increase of 5 kg (range: 0.5-33 kg). Sixteen patients (6.8%, 16/233) had an inclusion weight <60 kg but > 60 kg at the last follow-up. Finally, the Devane score remained stable or increased in 176 patients (77.2%, 176/228).</p><p><strong>Discussion: </strong>No stem breakage was observed in this cohort of patients considered at risk. A postoperative increase in body weight was noted in several cases, with some patients exceeding the weight limits set by the ISO 7206-4 standard. While these findings do not directly question the validity of the standard, they suggest that weight at the time of implantation may not be the sole parameter to consider when assessing the risk of stem breakage.</p><p><strong>Level of evidence: </strong>IV; retrospective study, therapeutic study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104344"},"PeriodicalIF":2.2,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144735487","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 novel technique for open hip capsular reattachment and plication in hip preservation surgery: Technical note.","authors":"Alexander Antoniadis, Thibaut Royon, Julien Wegrzyn","doi":"10.1016/j.otsr.2025.104341","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104341","url":null,"abstract":"<p><p>This technical note presents a hip capsular reattachment and plication technique using an arthroscopically assisted mini-open direct anterior approach (DAA). By placing a dual-channeled suture anchor at or slightly proximal to the original capsular insertion in the posteroinferior groove of the anterior inferior iliac spine (AIIS), a controlled reattachment is achieved, with the option for a superior shift if required. This method minimizes iatrogenic damage and ensures stable capsular reattachment while allowing for a tailored shift and plication based on the desired degree of imbrication. Furthermore, it preserves anatomical integrity without increasing the risk of postoperative stiffness. LEVEL OF EVIDENCE: V.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104341"},"PeriodicalIF":2.3,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719104","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":"Quantifying the effect of tibial stem extension length for primary TKA in obese patients: A biomechanical study.","authors":"Nolwenn Gelin, Julien Druel, Christophe Jacquet, Matthieu Ollivier, Jean-Noël Argenson, Patrick Chabrand, Flavy Roseren","doi":"10.1016/j.otsr.2025.104343","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104343","url":null,"abstract":"<p><strong>Background: </strong>Obesity can cause higher failure rates and inferior clinical outcomes after Total Knee Arthroplasty (TKA). This study aimed to analyze the biomechanical consequences of a short or long-extension stem on primary TKAs in a BMI-dependent manner.</p><p><strong>Methods: </strong>Several finite element models (FEM) were developed to assess the biomechanical effects of adding stem extension in primary TKA on stress distribution, resistance to sinking, motion, and shear forces at the bone/implant interface as a function of different BMIs.</p><p><strong>Results: </strong>Adding an extension stem improves stress distribution and resistance to sinking. It also reduces deformations and displacements at the bone/implant interface, avoiding implant tilting.</p><p><strong>Conclusion: </strong>The FEM showed that a long extension would give better results if maximum unloading and stabilization of the implant were sought. However, a greater risk of stress shielding must be taken into account. This is why a short extension seems to be the most suitable since it homogenizes the mechanical loading and reduces the effects of implant tilting compared to the case without extensions. The addition of an extension stem could be beneficial in the case of patients with high BMIs.</p><p><strong>Level of evidence: </strong>IV; biomechanical computational study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104343"},"PeriodicalIF":2.3,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719118","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":"Degenerative spondylolisthesis: A significant risk factor for adverse spinopelvic mobility and impingement in patients undergoing total hip arthroplasty.","authors":"Thomas Aubert, Guillaume Rigoulot, Philippe Gerard, Guillaume Riouallon","doi":"10.1016/j.otsr.2025.104342","DOIUrl":"10.1016/j.otsr.2025.104342","url":null,"abstract":"<p><strong>Background: </strong>Analysing the hip‒spine relationship allows the identification of risk factors for adverse spinopelvic mobility or impingement, including degenerative lumbar pathologies. Spondylolisthesis prevalence appears to increase with age, but the association of spondylolisthesis with pelvic mobility has not been studied.</p><p><strong>Hypothesis: </strong>Our hypothesis was that the presence of a degenerative spondylolisthesis on the preoperative lateral spine radiograph analysis before total hip arthroplasty was associated with a higher rate of adverse spinopelvic mobility, and that this exposed patients to a greater risk of prosthetic impingement when using a systematic implant positioning strategy.</p><p><strong>Methods: </strong>The clinical data of 605 consecutive patients who underwent total hip arthroplasty were retrospectively analysed. We evaluated the presence of degenerative spondylolisthesis on lateral lumbar spine radiographs, its potential associations with adverse spinopelvic mobility (Δspinopelvic tilt (SPT) ≥20 °), and the risk factors associated with a ΔSPT ≥20 ° in the overall population. Secondarily, we analysed the in-silico risk of impingement with the standard orientation of the cup at 40/20 ° and the safe zone without impingement.</p><p><strong>Results: </strong>The ΔSPT ≥20 ° rates were 40% and 15% in patients with and without spondylolisthesis, respectively (odds ratio (OR) = 3.76; confidence interval (CI) [2.13; 6.64]; p < 0.001). In the multivariable analysis, the following independent predictors of ΔSPT ≥20 ° were identified: SPT ≤-15 ° (OR = 3.9, [1.58; 9.65], p = 0.003), PI-LL ≥20 ° (OR = 3.14, [1.34; 7,34], p = 0.008), low PI/low lordosis and distal apex of lumbar lordosis (OR = 2.08, [1.24; 3.48], p = 0.005) and spondylolisthesis OR = 4.16, [2.31; 7.51], p < 0.001). The impingement rates with an orientation of the cup at 40 ° and 20 ° were 49,3% and 24.35%, respectively, in patients with and without spondylolisthesis (OR = 3.2; [1.91; 5.37]; p < 0.001). The median anteversion safe zone was 17.0 (interquartile range (IQR) = 25.0) in patients with spondylolisthesis and 27.0 (IQR = 17.0) in patients without spondylolisthesis (median Δ = -10.0; p < 0.001). A total of 23.88% patients with a spondylolisthesis had no anteversion safe zone, compared with 9.12% of patients without spondylolisthesis (OR = 3.12; [1.66; 5.89]; p = 0.001).</p><p><strong>Conclusion: </strong>Degenerative spondylolisthesis, a common degenerative condition, is a risk factor for adverse spinopelvic mobility and prosthetic impingement in patients undergoing total hip arthroplasty. The identification of spondylolisthesis on lateral spine radiographs should prompt adjustments in implant orientation.</p><p><strong>Level of evidence: </strong>IV; retrospective study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104342"},"PeriodicalIF":2.2,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719119","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}