Acta Orthopaedica最新文献

{"title":"Letter to the Editor: Regional variation in low-value musculoskeletal surgery: a nationwide study from the Finnish Care Register.","authors":"Christopher W Digiovanni, C Niek Van Dijk, Mark Glazebrook, Helka Koivu, Mikko Hautamäki, Anssi Härkönen, Masato Takao, Manfred Thomas, Marko Mykkänen, James W Stone, Alastair Younger","doi":"10.2340/17453674.2024.42631","DOIUrl":"10.2340/17453674.2024.42631","url":null,"abstract":"","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"95 ","pages":"744-745"},"PeriodicalIF":2.5,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11664432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142875784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Letter: Regional variation in low-value musculoskeletal surgery: a nationwide study from the Finnish Care Register.","authors":"Ville Ponkilainen, Anniina Laurema, Ville M Mattila, Teemu Karjalainen","doi":"10.2340/17453674.2024.42635","DOIUrl":"10.2340/17453674.2024.42635","url":null,"abstract":"","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"95 ","pages":"748-749"},"PeriodicalIF":2.5,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11664433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142875791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Letter: Using KOOS-PS to validate dichotomous global rating of improvement or worsening following total knee arthroplasty.","authors":"Siri B Winther, Anders Sjøstrøm, Sølvi Liabakk-Selli, Olav A Foss, Tina S Wik, Jomar Klaksvik","doi":"10.2340/17453674.2024.42743","DOIUrl":"10.2340/17453674.2024.42743","url":null,"abstract":"","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"95 ","pages":"750-751"},"PeriodicalIF":2.5,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11664431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142875802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Length of hospital stay and readmissions after major lower extremity amputation: a Danish nationwide registry study.","authors":"Anna Trier Heiberg Brix, Katrine Hass Rubin, Tine Nymark, Hagen Schmal, Martin Lindberg-Larsen","doi":"10.2340/17453674.2024.42637","DOIUrl":"10.2340/17453674.2024.42637","url":null,"abstract":"<p><strong>Background and purpose: </strong> Major lower extremity amputation (MLEA) is associated with complications that may prolong length of hospital stay (LOS) and increase the risk of readmission. We primarily aimed to examine the LOS and risk of readmissions after MLEA in Denmark. Secondarily we investigated the time trends.</p><p><strong>Methods: </strong> Using Danish National Patient Registry data, this observational study analyzed 11,205 first-time MLEAs (35% transtibial amputations, 65% transfemoral amputations) performed between January 1, 2010 and December 31, 2021. Total LOS included pre- and postoperative nights. The first readmission within 30 days and 90 days post-discharge was analyzed.</p><p><strong>Results: </strong> The median total LOS after a transtibial amputation was 19 days (interquartile range [IQR] 11-30), and decreased from 28 days (IQR 17-41) in 2010 to 14 days (IQR 9-23) in 2021. The median total LOS after a transfemoral amputation was 13 days (IQR 8-22) and decreased from 16 days (IQR 9-27) in 2010 to 11 days (IQR 7-18) in 2021. Post-discharge readmission risks within 30 days were 27% (95% confidence interval [CI] 24-28) for transtibial amputations and 23% (CI 22-24) for transfemoral amputations, with corresponding 90-day risks of 40% (CI 39-42) and 35% (CI 34-36), respectively. The 30-day risk of readmission increased in both groups.</p><p><strong>Conclusion: </strong> We observed that MLEA patients' hospital admissions lasted 2-3 weeks and decreased over the study period. A readmission risk of 23-27% within 30 days and 35-40 % within 90 days post-discharge was observed. Readmissions risk increased for both initial transtibial and transfemoral amputations over the study period.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"95 ","pages":"737-743"},"PeriodicalIF":2.5,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11664435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142875767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: Using KOOS-PS to validate dichotomous global ratings of improvement or worsening following total knee arthroplasty.","authors":"Daniel L Riddle, Levent Dumenci","doi":"10.2340/17453674.2024.42632","DOIUrl":"10.2340/17453674.2024.42632","url":null,"abstract":"","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"95 ","pages":"746-747"},"PeriodicalIF":2.5,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11664430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142875789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A new tibial insert design with ball-in-socket medial conformity and posterior cruciate ligament retention has low tibial baseplate migration after unrestricted kinematically aligned total knee arthroplasty: a cohort study using radiostereometric analysis.","authors":"Abigail E Niesen, Pranav A Tirumalai, Stephen M Howell, Maury L Hull","doi":"10.2340/17453674.2024.42489","DOIUrl":"10.2340/17453674.2024.42489","url":null,"abstract":"<p><strong>Background and purpose: </strong> In total knee arthroplasty (TKA), an insert with ball-in-socket (BS) medial conformity (MC) and posterior cruciate ligament (PCL) retention restores kinematics closer to native than an insert with intermediate (I) MC. However, high medial conformity might compromise baseplate stability as indicated by maximum total point motion (MTPM). Using the BS MC insert with PCL retention, we aimed to determine whether (i) the baseplate is stable as indicated by mean MTPM < 0.5 mm, (ii) baseplate stability is not strongly correlated to varus baseplate alignment, and (iii) baseplate stability, clinical outcome scores, and flexion are comparable with that of an I MC insert cohort which has demonstrated high stability, clinical outcome scores, and flexion.</p><p><strong>Methods: </strong> Unrestricted kinematic alignment (unKA) TKA was performed on a cohort of 35 patients using a cemented baseplate. Biplanar radiographs acquired at timepoints up to 12 months were processed with model-based radiostereometric analysis (RSA) software to determine MTPM.</p><p><strong>Results: </strong> At 1 year, mean MTPM of 0.35 mm was significantly below 0.5 mm (P < 0.001). MTPM was not strongly correlated to varus baseplate alignment up to 9° (r = 0.12, 95% confidence interval -0.22 to 0.44). Equivalence analyses revealed that MTPM, Forgotten Joint Score, Oxford Knee Score, and maximum flexion for the sBS MC insert were comparable with the I MC insert.</p><p><strong>Conclusion: </strong> Using the new BS MC insert with PCL retention, the tibial baseplate was stable at the group level at 1 year. Baseplate stability was not strongly related to varus baseplate and limb alignment. Comparable patient-reported outcome scores and maximum flexion/extension at 1 year were shown between the 2 insert designs.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"95 ","pages":"758-764"},"PeriodicalIF":2.5,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11664436/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142875721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcome of curettage in atypical cartilaginous tumors of the long bones: a descriptive cohort study.","authors":"Claire H J Scholte, Michiel A J Van de Sande, Robert J P Van der Wal, Demien Broekhuis, Kirsten Van Langevelde, Desirée M J Dorleijn","doi":"10.2340/17453674.2024.42636","DOIUrl":"10.2340/17453674.2024.42636","url":null,"abstract":"<p><strong>Background and purpose: </strong> Despite evolving management strategies for atypical cartilaginous tumors (ACT)-shifting from radical resection to intralesional curettage and \"wait-and-scan\" approaches-there remains no universal consensus on optimal treatment. We primarily aimed to evaluate disease-specific and progression-free survival following intralesional curettage and adjuvant phenol treatment of ACTs. Secondary aims included assessing surgical complications, the need for additional interventions, and an overview of long-term follow-up.</p><p><strong>Methods: </strong> This retrospective cohort study of 388 ACT patients was conducted at a tertiary referral center from 2000 to 2019. Comprehensive data collection included demographics, tumor characteristics, and follow-up outcomes.</p><p><strong>Results: </strong>Residual disease was observed in 14% (n = 53) of cases, with continued growth on sequential imaging in one-fourth (n = 13 of 53). Postoperative fractures occurred in 10% (n = 37) after a mean of 7 months, and 16% (n = 61) required a second surgery due to pain or joint movement limitations. There was no malignant progression or mortality observed.</p><p><strong>Conclusion: </strong> We found that curettage for ACT is not associated with mortality or malignant progression but does carry risks of complications and residual disease. This raises important questions regarding the necessity of surgical intervention. Further research is needed to refine the treatment approach for ACT.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"95 ","pages":"752-757"},"PeriodicalIF":2.5,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11664434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142875762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-based differences in risk of revision for infection after hip, knee, shoulder, and ankle arthroplasty in osteoarthritis patients: a multinational registry study of 4,800,000 implants.","authors":"Anne M C Roerink, Rob G H H Nelissen, Carl Holder, Stephen E Graves, Michael Dunbar, Eric Bohm, Alexander W Grimberg, Arnd Steinbrück, Håvard Dale, Anne Marie Fenstad, Ashley W Blom, Erik Lenguerrand, Christopher Frampton, Tine Willems, Jan Victor, Mireia Espallargues, Jorge Arias-de la Torre, Enrico Ciminello, Marina Torre, Bart G Pijls","doi":"10.2340/17453674.2024.42183","DOIUrl":"10.2340/17453674.2024.42183","url":null,"abstract":"<p><strong>Background and purpose: </strong> We aimed to determine sex differences for periprosthetic joint infections after primary arthroplasty of the hip, knee, ankle, and shoulder in osteoarthritis patients in an international perspective.</p><p><strong>Methods: </strong> This is a multinational combined arthroplasty registry study. Each arthroplasty registry performed Cox-regression analysis of their data and reported the crude and adjusted hazard ratios (HR) with an a priori designed data form. A random-effects model was used to pool these HRs to estimate an overall HR with 95% confidence interval (CI). Adjustment was undertaken for patient age, BMI, ASA grade, type of fixation, and type of implant. 9 arthroplasty registries participated. Patients who received primary total joint arthroplasty for primary osteoarthritis were considered: 2,134,313 hip arthroplasties, 2,658,237 knee arthroplasties, 57,889 shoulder arthroplasties, and 8,445 ankle arthroplasties. We calculated hazard ratios (HR) for the overall risk of complete revision due to infection for each implant type and follow-up.</p><p><strong>Results: </strong>The pooled HR for revision due to infection for men compared with women at 1-year follow-up was 1.60 (95% confidence interval [CI] 1.42-1.80) for hip arthroplasties; 2.06 (CI 1.90-2.46) for knee arthroplasties; 4.51 (CI 2.99-6.80) for shoulder arthroplasties; and 0.87 (CI 0.46-1.62) for ankle arthroplasties. These results remained consistent over time and were identified in both unadjusted and adjusted models.</p><p><strong>Conclusion: </strong> Men have a higher risk of revision due to infection than women after primary hip, knee, and shoulder arthroplasty. No evidence of difference was found for ankle arthroplasty. These elevated relative risks persist in the fully adjusted investigations and over the 10-year postoperative period studied.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"95 ","pages":"730-736"},"PeriodicalIF":2.5,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Open versus arthroscopic fusion of the subtalar joint: a randomized controlled trial.","authors":"Mark Stegeman, Nathalie Pruijn, Saskia Susan, Petra J C Heesterbeek, Jan Willem K Louwerens","doi":"10.2340/17453674.2024.42448","DOIUrl":"10.2340/17453674.2024.42448","url":null,"abstract":"<p><strong>Background and purpose: </strong> Our primary aim was to compare the early complication rate (< 6 weeks postoperatively) after open or arthroscopic fusion of the subtalar joint. Secondary outcomes included late complications (> 6 weeks postoperatively), function, pain, and patient satisfaction.</p><p><strong>Methods: </strong> In this prospective randomized controlled trial, patients listed for subtalar joint fusion were included and randomized for open or arthroscopic fusion. Complications were assessed at scheduled visits at 2 and 6 weeks, 3, 6, and 12 months postoperatively. Functional scores, pain scores, and patient satisfaction were assessed at 3, 6, and 12 months postoperatively, and PROMS at baseline (preoperatively), 3, 6, and 12 months postoperatively. The scores were compared over time between the groups using Fisher's exact test and linear mixed models.</p><p><strong>Results: </strong> 51 patients were included between 2013 and 2020, of whom 25 were allocated to open and 26 to arthroscopic fusion. 3 early complications (2 sural nerve lesions, 1 infection) occurred in the open fusion group (12%; 95% confidence interval [CI] 3-32) and 3 (2 wound healing problems, 1 screw exchange) in the arthroscopic group (12%; CI 3-31). Late complications included screw removal (n = 5) in the open fusion group versus screw removal (n = 5), non-union (n = 2), bony prominence/calcification removal (n = 1), sural nerve lesion (n = 1), lesion of the calcaneal branch of the tibial nerve (n = 1), complex regional pain syndrome type II (n = 1), and secondary plantar fasciitis (n = 1) in the arthroscopic fusion group. No superiority of arthroscopic over open fusion was found regarding early (P = 1.0) and late complications (P = 0.2), function and pain scores, and patient satisfaction over 12 months Conclusion: Arthroscopic fusion did not result in fewer early complications compared with open fusion. Secondary outcomes did not differ significantly between the approaches.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"95 ","pages":"723-729"},"PeriodicalIF":2.5,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of antibiotic-loaded calcium sulphate beads in debridement, antibiotics, and implant retention (DAIR) for periprosthetic infections: a retrospective comparative cohort on outcome.","authors":"Irene Katharina Sigmund, Antony J R Palmer, Andrew J Hotchen, Martin A McNally, Bernadette C Young, Abtin Alvand, Adrian Taylor, Benjamin John Lee Kendrick","doi":"10.2340/17453674.2024.42360","DOIUrl":"10.2340/17453674.2024.42360","url":null,"abstract":"<p><strong>Background and purpose: </strong> We aimed to compare the effect of calcium sulphate (CS) beads loaded with antibiotics on infection eradication in debridement, antibiotics, and implant retention (DAIR) of periprosthetic joint infection relative to DAIR without local antibiotics delivery.</p><p><strong>Methods: </strong> 176 patients with hip or knee arthroplasty undergoing DAIR were retrospectively identified and divided into a bead group (n = 102) and a control group (n = 74). Infections were classified as early postoperative, acute hematogenous, and chronic. Logistic regression analyses were performed on the use of CS beads. Revision-free and infection-free survival was estimated using Kaplan-Meier analysis.</p><p><strong>Results: </strong> Reinfection occurred in 36% of the bead group, and 39% of the control group (odds ratio [OR] 0.9, 95% confidence interval [CI] 0.5- 1.6); reoperation rates were 34% and 43% (OR 0.7, CI 0.4-1.3). Kaplan-Meier analysis showed no statistically significant difference between the 2 groups regarding infection-free (HR 1.1, CI 0.7-1.8) and revision-free (HR 1.1, CI 0.7-1.9) survival rates. In acute hematogenous PJIs, reinfection (29% vs 56%, OR 0.3, CI 0.1-1.1) and reoperation rates (25% vs 61%, OR 0.2, CI 0.1-0.8) were reduced when CS beads were used; Kaplan-Meier analysis revealed higher infection-free (HR 0.5, CI 0.2-1.4) and revision-free (HR 0.5, CI 0.2-1.3) survival rates in the bead group but not of statistical significance. Wound drainage was not increased by CS beads use (OR 1.0, CI 0.99-1.01), but hypercalcemia was seen in 9% in the bead group.</p><p><strong>Conclusion: </strong> DAIR with antibiotic-loaded CS beads did not improve outcome in early postoperative and chronic PJIs, but reduced the reoperation rate in acute haematogenous infections with similar results compared with early postoperative PJIs.</p>","PeriodicalId":6916,"journal":{"name":"Acta Orthopaedica","volume":"95 ","pages":"707-714"},"PeriodicalIF":2.5,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11605582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142749569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}