Orthopaedics & Traumatology-Surgery & Research最新文献

{"title":"Complications of open fractures: Observational study over 4 years, search for risk factors for infection.","authors":"Maxime Palmier, Guillaume Villatte, Magali Vidal, Clément Theis, Stéphane Descamps, Stéphane Boisgard, Roger Erivan","doi":"10.1016/j.otsr.2025.104340","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104340","url":null,"abstract":"<p><strong>Background: </strong>Open fractures account for approximately 2.6% of all fractures but continue to pose a significant clinical challenge due to their associated complications and potential impact on limb function. Among these complications, infection remains particularly prevalent. Although numerous recent studies have addressed this issue, many are limited by restrictive inclusion criteria, especially regarding the anatomical segments of the limbs evaluated HYPOTHESIS: We hypothesized that recent advances in open fracture management may have impacted infection rates across the entire appendicular and pelvic skeleton, and may have altered the associated risk factors compared to historical data.</p><p><strong>Materials and methods: </strong>We conducted a retrospective, single-center, observational study including 368 open fractures treated at our institution between January 2017 and December 2020, with a minimum follow-up of one year. The primary outcome was the incidence of secondary infection. Secondary outcomes included the occurrence of other complications, the need for surgical reinterventions, and the time required for bone and soft tissue healing.</p><p><strong>Results: </strong>A secondary infection occurred in 13.3% of cases. The most frequently isolated pathogens were Staphylococcus spp. and Enterobacter cloacae. Identified risk factors included bone loss, crush injuries, and pelvic trauma. The presence of secondary infection was significantly associated with a higher number of reinterventions, increased complication rates, and prolonged skin healing time (p < 0.05).</p><p><strong>Discussion: </strong>The 13.3% secondary infection rate observed aligns with existing literature but exceeds recent reports limited to tibial fractures. Our broader anatomical scope revealed higher infection risks in ankle and pelvic fractures. Known risk factors (diabetes, high Gustilo grade, crush injuries) were confirmed, while emerging associations (high BMI, bone loss, pelvic/ankle location) warrant prospective validation. A surprising correlation between prolonged prophylaxis and infection likely reflects confounding by indication. The underuse of SFAR-recommended regimens-despite frequent isolation of amoxicillin-clavulanate-resistant Enterobacter-underscores the need to reassess prophylactic strategies. Study limitations include retrospective design and potential selection bias, but robust follow-up and comprehensive data support the clinical relevance of our findings.</p><p><strong>Level of evidence: </strong>IV; retrospective study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104340"},"PeriodicalIF":2.3,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719117","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":"Artificial intelligence and human expertise in hand trauma diagnosis: A collaborative approach.","authors":"Céline Klein, Pierre Fondu, Daniel Aiham Ghazali, Vladimir Rotari, Osama Abou-Arab, Emmanuel David","doi":"10.1016/j.otsr.2025.104338","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104338","url":null,"abstract":"<p><strong>Background: </strong>Hand injuries are a frequent reason for an emergency department visit and require a radiographic analysis. Misdiagnosed or undiagnosed injuries may lead to poor functional outcomes. Artificial intelligence (AI) is providing new tools for the diagnosis of injuries in routine clinical practice. The primary objective of the present study was to assess the diagnostic performance of AI in the diagnosis of hand fractures and dislocations, when compared with reviews by two experienced hand surgeons. The secondary objective was to assess the diagnostic performance of a resident vs. the AI.</p><p><strong>Hypothesis: </strong>On the basis of standard radiographs, the AI system would diagnose metacarpal and phalangeal fractures and dislocations with the same level of diagnostic accuracy (i.e. sensitivity and specificity) as senior hand surgeons.</p><p><strong>Patients and methods: </strong>This single-centre, retrospective study was conducted on hand radiography datasets collected from consecutive patients over the age of 16 consulting in an emergency department. The radiographic data were reviewed by two senior hand surgeons (constituting the gold standard) and a resident. Based on a contingency table, sensitivity, and specificity, the AI's and resident's respective abilities to detect fracture/dislocation were compared with the gold standard. The resident and the AI were also compared.</p><p><strong>Results: </strong>1915 radiographic datasets (4738 X-rays for 1892 patients) were included in the analysis. The Cohen's kappa of 0.865 indicated almost perfect agreement between the two senior surgeons. The AI's analysis yielded a sensitivity [95% confidence interval] of 97.6% [0.96-0.98] and a specificity of 88.9% [87.2-90.4]. False positives were noted in 162 cases. The AI failed to diagnose 11 injuries (0.6%): two dislocations of the proximal interphalangeal joint, seven fractures of the phalanx (including one third phalanx amputation and two metacarpal fractures). Relative to the AI, the resident's analysis yielded a significantly lower sensitivity (p < 0.0001) and a significantly higher specificity (p = 0.007).</p><p><strong>Conclusion: </strong>An AI may be a valuable tool in emergency settings - especially for less experienced practitioners - but does not surpass the diagnostic performance of senior surgeons. The AI's ability to detect dislocations and amputations must be improved. An AI can complement (but not replace) a thorough clinical examination.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104338"},"PeriodicalIF":2.3,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719115","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":"Comparative study of patients undergoing total hip arthroplasty or hip resurfacing before 30 years of age: Survivorship, Functional and Activity scores at 9-year follow-up.","authors":"Nathan Alloun, Pierre Martinot, Philippe-Alexandre Faure, Henri Migaud, Julien Girard","doi":"10.1016/j.otsr.2025.104339","DOIUrl":"10.1016/j.otsr.2025.104339","url":null,"abstract":"<p><strong>Introduction: </strong>Total hip arthroplasty (THA) remains relatively uncommon procedure in patients under the age of 30. Hip resurfacing (HR) is a potential alternative to THA. To our knowledge, no study has compared these two options in patients under 30 years old. Therefore, we conducted a retrospective comparative study of HR versus THA to: 1) assess implant survival, 2) evaluate functional outcomes.</p><p><strong>Hypothesis: </strong>HR provide better survival and superior functional and activity scores compared to THA.</p><p><strong>Materials and methods: </strong>Between 2006 and 2017, 105 patients under 30 years underwent either HR (62 cases) or THA (43 cases). We compared the number of surgical revisions and their causes to determine survival. Clinical outcomes were assessed using the following scores: Merle d'Aubigné, UCLA, Forgotten Joint Score (FJS), Oxford-12, Harris, and Devane. The Minimum Clinically Important Difference (MCID) and the Patient Acceptable Symptom State (PASS) were also analyzed using the Oxford-12 score.</p><p><strong>Results: </strong>After 8 years of follow-up, implant survival was 89.9% (95%CI: 0.71-0.96) in the THA group versus 98.4% (95%CI: 0.89-0.99) in the HR group. The THA group had three revisions (due to wear, metallosis, and infection), whereas the HR group had one (femoral collapse). Before adjusting for preoperative status, Harris and Devane scores were higher in the THA group: 96.8 (Interquartile Range (IQR): 92-100) vs 91.5 (IQR: 86-97) (p = 0.002) and 4 (IQR: 4-5) vs 4 (IQR: 3-5) (p = 0.003), respectively. After adjustment, THA patients showed significantly greater improvements in activity scores: Devane (0.5 vs. 0 (p = 0.0006)) and UCLA (1.2 vs. 0 (p = 0.0007)). No significant differences were observed between HR and THA regarding MCID or PASS based on Oxford-12.</p><p><strong>Discussion: </strong>HR allows for easier revision surgery and demonstrates excellent clinical outcomes, making it a valuable option in very young patients who are likely to require future surgeries. Our data confirm that HR is a viable long-term option for patients under 30 years old when technically feasible.</p><p><strong>Level of evidence: </strong>III; retrospective case-control study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104339"},"PeriodicalIF":2.2,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719116","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":"Keblish's lateral subvastus approach for total knee arthroplasty: A technical note.","authors":"Grégoire Micicoi, Rayan Fairag, Styliani Stergiadou, Régis Bernard de Dompsure, Nicolas Bronsard, Axel Machado, Matthieu Perras, Jean-François Gonzalez","doi":"10.1016/j.otsr.2025.104337","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104337","url":null,"abstract":"<p><p>Keblish's lateral surgical approach for total knee arthroplasty enables a direct release of the lateral structures in valgus deformities. In recent years, the development of quadriceps-sparing techniques has improved early functional recovery after arthroplasty, which has been well described using a medial approach. The authors present Keblish's lateral subvastus approach for genu valgum deformities, with key surgical considerations and preliminary outcomes. The novelty of this technique lies in its combination of a lateral subvastus approach with Keblish's Z-plasty, aiming to optimize quadriceps recovery while ensuring secure knee closure following valgus deformity correction. The Keblish's lateral subvastus approach provided adequate surgical exposure without any observed complications in this small short follow-up series, allowing for early recovery of active knee extension and satisfactory clinical outcomes. LEVEL OF EVIDENCE: IV.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104337"},"PeriodicalIF":2.3,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676567","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":"Rate and trends of women authorship in a high-impact French orthopaedic journal over 30 years.","authors":"Céline Klein, Alina Badina, Stéphanie Pannier, Patrick Devos, Marie-Christine Plancq, Mathilde Gaumé","doi":"10.1016/j.otsr.2025.104336","DOIUrl":"10.1016/j.otsr.2025.104336","url":null,"abstract":"<p><strong>Background: </strong>Despite a rise in the number of women in orthopedic surgery over recent decades, their representation in academic and leadership roles remains limited. Authorship in research journals serves as a key indicator of academic involvement. We conducted a retrospective study to assess: (1) the rate of publications by women first and senior authors from 1990 to 2024, and (2) indexed publications and citation impact (3) gender differences in authorship by subspecialty and study type.</p><p><strong>Hypothesis: </strong>The authorship gender disparity may no longer persist over the past 30 years in a high-impact French orthopedic journal.</p><p><strong>Methods: </strong>This study analyzed all articles published in Revue de Chirurgie Orthopédique et Réparatrice de l'Appareil Moteur (RCOT) and Orthopaedic and Traumatology Surgery and Research (OTSR) during four periods (1990-1994, 2000-2004, 2010-2014, 2020-2024). The gender of first and senior authors, subspecialties, gender ratios, and their evolution over time were assessed. Indexed publications and citation impact were also reported.</p><p><strong>Results: </strong>A total of 3,256 articles were included. Over the 30 years, the proportion of women first and senior authors increased significantly from 15/402 (3.7%) in 1990-1994, to 35/502 (7%) in 2000-2004, 120/950 (12.6%) in 2010-2014, and 306/1,402 (21.8%) in 2020-2024 (p < 0.0001). Specifically, the rate of female first authorship rose from 10/392 (2.5%) to 114/1,210 (13.7%) and senior authorship from 5/367 (1.2%) to 114/1,233 (8.1%) (p < 0.0001). Citation impact improved, with 24 articles reaching the top 10% most cited in the latest period, including 4 in the top 1%. Subspecialty analysis showed increased female authorship across all fields, particularly in paediatrics (+48.4%), hand (+32.5%), elbow (+29.2%), and tumor/infection (+35%) from 2020-2024. Significant increases were observed in most subspecialties (p < 0.05), except knee, shoulder, comment, elbow, and infection.</p><p><strong>Discussion: </strong>This study shows a growing female presence in orthopedic publications, with notable subspecialty preferences. Sustaining this trend requires leaders of all genders to mentor and support future candidates. By fostering an inclusive environment that values gender diversity, the field can continue to progress, ensuring equal opportunities for all, regardless of gender, and ultimately enriching the discipline.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104336"},"PeriodicalIF":2.3,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676568","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 analysis of tibial tunnel collision in multiligamentous knee reconstructions - Arthroscopic popliteus tendon reconstruction with anteromedial tibial tunnel drilling.","authors":"Steven Heylen, Annemieke Van Haver, Peter Verdonk, Matthias Krause, Jozef Michielsen","doi":"10.1016/j.otsr.2025.104335","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104335","url":null,"abstract":"<p><strong>Background: </strong>Drilling the tibial tunnel in tibiofibular-based posterolateral corner (PLC) reconstructions is usually performed with a starting point from Gerdy's tubercle. Drilling this tunnel from the anteromedial tibial cortex could reduce the risk of popliteal neurovascular injury but increase the risk of tunnel collision.</p><p><strong>Hypothesis: </strong>The purpose of this study is to assess the risk of tunnel collision in tibiofibular based reconstructions with a tibial tunnel drilled from the anteromedial cortex versus drilled from the anterolateral cortex.</p><p><strong>Methods: </strong>A total of 18 Computed Tomography scans were performed postoperatively in patients with an anterior cruciate ligament (ACL) reconstruction. Imageprocessing software was used to make a 3D model of the tibia and the trajectory and volume of the ACL tunnel was integrated into the model. Virtual posterior cruciate ligament (PCL) and PLC tunnels were added to the model according to the ideal location of the exit points in the current literature. The starting point for the PCL tunnel was inferomedial to the ACL tunnel. Five virtual tunnel locations for PLC reconstruction were added to the model: lateral, inferolateral, inferior, inferomedial and medial. Tunnel collision and distances were calculated.</p><p><strong>Results: </strong>There was no collision with the lateral, inferolateral or inferior PLC tunnels. The inferomedial and medial PLC tunnels collided with the ACL and/or PCL tunnels in 13 patients. One-way ANOVA test did not show a significantly significant difference in mean distance to the ACL or PCL tunnel for the lateral, inferolateral or inferior PLC tunnels (p > 0.05).</p><p><strong>Discussion: </strong>When drilling the PLC reconstruction tunnel from the anteromedial cortex in case of a multiligamentous knee reconstruction, our study shows that drilling should start from the lateral, inferolateral or inferior position relative to the ACL and PCL reconstruction tunnels to avoid tunnel collision.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104335"},"PeriodicalIF":2.3,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144669013","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":"Role of synovial biopsy in diagnosis of chronic periprosthetic infection in total hip and knee arthroplasties.","authors":"Alice Gay, François Laudet, Pierre Meynard, Yohan Legallois, Véronique Dubois, Frédéric-Antoine Dauchy, Thierry Fabre","doi":"10.1016/j.otsr.2025.104334","DOIUrl":"10.1016/j.otsr.2025.104334","url":null,"abstract":"<p><strong>Introduction: </strong>Infection is a significant and challenging complication of total hip and knee arthroplasties. Diagnosing chronic periprosthetic joint infection (PJI) can be difficult, particularly when joint aspiration yields inconclusive results or no intra-articular effusion is available for aspiration. Synovial biopsy represents a potential diagnostic option. This study evaluated the reliability of minimally invasive surgical biopsy for diagnosing chronic PJI.</p><p><strong>Materials and methods: </strong>This retrospective, single-centre, observational study was conducted over a 10-year period. It included consecutive patients who underwent synovial biopsy in the operating room for suspected chronic PJI following failed joint aspiration. All patients subsequently underwent prosthetic revision surgery, and the final diagnosis of infection was determined based on the 2018 International Consensus Meeting criteria.</p><p><strong>Results: </strong>In total, 52 patients were included, with 20 confirmed cases of PJI. Biopsy cultures were positive in 11 patients. The diagnostic accuracy of minimally invasive biopsy was 78.8%, with a sensitivity of 50%, specificity of 96.9%, positive predictive value of 90.9%, and negative predictive value of 75.6%. Bacteriological concordance between biopsy findings and revision-surgery samples was observed in 70% of the cases.</p><p><strong>Conclusion: </strong>Minimally invasive synovial biopsy demonstrated limited diagnostic performance for chronic PJI, and should not be performed routinely.</p><p><strong>Level of evidence: </strong>IV; retrospective study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104334"},"PeriodicalIF":2.3,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144669014","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":"Clinical outcomes of fixed-bearing unicompartmental knee arthroplasty in patients with ACL degeneration and patellofemoral joint degeneration: A retrospective cohort study.","authors":"Xi Zhang, Yishu Liu, Yu Shengyuan, Ming Gao, Chaozhe Han, Bing Xue, Jingsong Liu, Yong Zhou","doi":"10.1016/j.otsr.2025.104333","DOIUrl":"10.1016/j.otsr.2025.104333","url":null,"abstract":"<p><strong>Purpose: </strong>This study re-evaluates the clinical outcomes and prosthesis survival of fixed-bearing UKA in patients with ACL degeneration, PFJ degeneration, or both, compared to standard indications of UKA by examining its clinical outcomes in patients with anterior cruciate ligament-degeneration or deficient (ACLD) and patellofemoral joint degeneration (PFJ). These findings suggest a paradigm shift in patient selection, offering a broader surgical option for knee OA management. The transition from traditional contraindications to potential indications for UKA in selected ACLD and PFJ cases may significantly impact clinical decision-making.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 375 patients with knee osteoarthritis who underwent UKA from January 2014 to January 2019. Patients were divided into ACLD (n = 52), PFJ (n = 101), ACLD + PFJ (n = 16), and other (n = 206) groups. Postoperative complications, including polyethylene wear, infection, and revision procedures, were retrospectively recorded and analyzed across all patient groups. Postoperative outcomes, including the Knee Society Score (KSS), Western Ontario and McMaster University Arthritis Index (WOMAC), and prosthesis survival rates, were compared across groups.</p><p><strong>Results: </strong>Preoperatively, the ACLD + PFJ group had higher Kellgren-Lawrence (KL) grades and poorer knee function (p < 0.05). After a median follow-up of 7 years, all groups demonstrated significant improvements in KSS and WOMAC scores (p < 0.0001), with no significant differences between groups. During the follow-up period, a total of 4 patients required revision surgery, prosthesis survival rates also showed no significant differences (p = 0.16), with an overall survival rate of 98.93% (371/375).</p><p><strong>Conclusions: </strong>Fixed-bearing UKA demonstrated promising clinical outcomes and high prosthesis survival rates in this study, including in patients with ACLD and PFJ degeneration. While ACL degeneration (excluding total deficiency) and medial PFJ osteoarthritis (excluding lateral condyle involvement) may be considered as possible indications for UKA, this approach requires careful patient selection and the surgeon's expertise. These findings highlight the potential for expanding UKA indications and call for further studies to validate its use in more complex knee pathologies.</p><p><strong>Level of evidence: </strong>III; Retrospective Cohort Study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104333"},"PeriodicalIF":2.3,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644063","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":"Medial vs. Anterior Malleolar Osteotomy in Osteochondral Autologous Transplantation for Hepple V Talar Lesions: A Retrospective Study.","authors":"Lu Bai, Sanbiao Liu, Yuxin Yan, Jianjing Lin, Sumeng Chen, Xintao Zhang","doi":"10.1016/j.otsr.2025.104332","DOIUrl":"10.1016/j.otsr.2025.104332","url":null,"abstract":"<p><strong>Aims: </strong>To compare clinical outcomes in patients with talar Osteochondral lesions (OLTs) treated with medial malleolar osteotomy (MMO) or anterior malleolar osteotomy (AMO) combined with Osteochondral autologous transplantation (OAT).</p><p><strong>Methods: </strong>From May 2014 to May 2020, 39 patients with Hepple V OLTs underwent MMO (n = 22) or AMO (n = 19). Functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale (AOFAS) and Visual Analog Scale (VAS) pain scores. Magnetic Response Observation of Cartilage Repair Tissues (MOCART) score was used for radiological evaluation. Second-look arthroscopy and hardware removal were performed 2 years postoperatively. International Cartilage Repair Society (ICRS) scores were used to assess cartilage quality at the graft and osteotomy sites.</p><p><strong>Results: </strong>There was no significant difference in the occurrence of surgical complications (P = 0.581) between groups. AOFAS, VAS and ICRS scores were significantly improved during follow-up in patients who underwent MMO or AMO (P < 0.01). At the 1-year follow-up, the AOFAS score (92.5±3.3 vs. 89.2±4.9, t = 2.53 P = 0.02) and MOCART score (67.0±3.7 vs. 63.0±8.5, t = 2.14, P = 0.048) were significantly higher in patients who underwent MMO vs. AMO (t = 2.53 P = 0.02). There was no significant difference in AOFAS scores at the 2-year follow-up (MMO, 94.0±4.0 vs. AMO, 91.5±5.5, t = 1.63 P = 0.11); however, the VAS pain score (0.3±0.5 vs. 0.8±0.9, t = 2.53 P = 0.02) was significantly lower and MOCART score (69.3±5.0 vs. 64.1±7.5, t = 2.59 P = 0.013) was significantly higher in patients who underwent MMO vs. AMO. Second-look arthroscopy revealed superior cartilage quality at the osteotomy site in patients who underwent MMO vs. AMO (χ² = 22.826 P < 0.05), but no significant difference at the graft site (χ² = 6.049 P = 0.327).</p><p><strong>Conclusion: </strong>Both MMO and AMO combined with OAT can achieve good clinical outcomes for Hepple V OLTs; however, better pain relief and cartilage repair at the osteotomy site at 2-years of follow-up indicate that MMO may be the best choice.</p><p><strong>Level of evidence: </strong>III; Retrospective Comparative Study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104332"},"PeriodicalIF":2.3,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621229","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":"Hip arthroplasty for acute femoral neck fracture: Hemiarthroplasty, dual mobility, or conventional total hip arthroplasty? A comparative analysis of 37,169 hip arthroplasties from the Swiss National Joint Registry.","authors":"Nathan Lacheux, Christian Brand, Martin Beck, Maja Kägi, Alexander Antoniadis, Julien Wegrzyn","doi":"10.1016/j.otsr.2025.104331","DOIUrl":"10.1016/j.otsr.2025.104331","url":null,"abstract":"<p><strong>Background: </strong>The optimal choice of the type of hip arthroplasty for managing acute femoral neck fractures (FNF) remains controversial, particularly when deciding between total hip arthroplasty (THA) and hemiarthroplasty (HA). Dual mobility cups (DM) have demonstrated efficacy in preventing instability, which is a potential concern with conventional THA. This study aimed to compare the outcomes of HA, DM, and conventional THA for managing FNF using data from a nationwide cohort collected through the Swiss National Joint Registry (SIRIS).</p><p><strong>Hypothesis: </strong>Hemiarthroplasty has lower revision rates in older patients, while THA demonstrates lower revision rates in younger patients.</p><p><strong>Patients and methods: </strong>Between 2012 and 2022, 37,169 patients who underwent hip arthroplasty for FNF in Switzerland were prospectively and systematically included in the SIRIS national registry. This cohort included 22,053 HA, 3,263 DM THA, and 11,853 conventional THA procedures. The study compared revision rates and implant survivorship for both septic and aseptic failures among these groups. Hazard ratios (HR) for revisions were calculated to compare HA, DM, and conventional THA, with subgroup analyses performed after adjusting for age, gender, BMI, and ASA scores.</p><p><strong>Results: </strong>At the 10-year follow-up, the cumulative revision rates were 7.8% [6.4-9.4] for HA, 8.1% [7.6-10] for DM THA and 8.7% [7.7-9.9] for conventional THA. HA showed a trend toward a lower revision risk compared to DM and conventional THA (HR = 0.86 [95% CI: 0.72-1.02]), though this did not reach statistical significance. However, in patients <65 years, HA had a high 10-year revision rate of 20.7% [13.5-31.1], with 56.1% of these revisions involving conversion to THA. In addition, HA with cementless femoral stems had a significantly higher revision rate due to femoral periprosthetic fractures compared to cemented stems (HR = 1.81 [95% CI: 1.39-2.38]). Moreover, HA performed through a posterior approach had significantly higher revision rates due to dislocations compared to anterior approaches (HR = 1.64 [95% CI: 1.27-2.11]).</p><p><strong>Discussion: </strong>When managing acute FNF with hip arthroplasty, there was no significant difference in revision rates or survivorship between HA, DM THA, and conventional THA at 10 years. However, for patients under 65 years, HA demonstrated a 20% revision rate over 10 years, with over half of these revisions involving conversion to THA. Based on these results, THA is recommended for younger patients, especially when life expectancy exceeds 10 years. For older patients, HA remains a viable option, provided certain technical considerations are followed i.e. the use of cemented femoral stems to reduce the risk of femoral periprosthetic fractures and the anterior approaches to minimize the risk of dislocation. These findings underlined the importance of tailoring arthroplasty choices to indiv","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104331"},"PeriodicalIF":2.3,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621228","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}