Archives of Orthopaedic and Trauma Surgery最新文献

{"title":"The usability of robotic-assisted systems for total knee arthroplasty can be improved without hindering the accuracy of the bone cuts","authors":"Killian Cosendey,&nbsp;Julien Stanovici,&nbsp;Jaad Mahlouly,&nbsp;Patrick Omoumi,&nbsp;Brigitte M. Jolles,&nbsp;Julien Favre","doi":"10.1007/s00402-025-05818-8","DOIUrl":"10.1007/s00402-025-05818-8","url":null,"abstract":"<div><h3>Introduction</h3><p>This study assessed the bone cuts accuracy of a robotic-assisted system for total knee arthroplasty (TKA) that was recently upgraded.</p><h3>Materials and methods</h3><p>Three orthopaedic surgeons planned and executed TKA on 24 sawbones. Bone cut accuracy was assessed using CT scans, comparing the planning and the actual bone cuts in all six degrees-of-freedom.</p><h3>Results</h3><p>The root-mean-square (RMS) values were below 2 mm or 2° for all error types, except for the medio-lateral position (2.4 mm) and internal-external rotation (2.3°) of the left tibias. The maximal amplitude of the 288 errors (6 degrees-of-freedom * 2 bones * 24 knees) was observed in tibial external rotation (3.2°). Most error types reported a bias, with limited variations among knees.</p><h3>Conclusions</h3><p>The errors were in the same range as those of the prior version of the system, suggesting that the improvements brought by the system upgrade were not obtained at the expense of accuracy.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-025-05818-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144140157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Representativeness of participants in the Danish National Health Survey across 422,371 orthopedic surgeries: a study of hip and knee arthroplasty and hip fracture patients","authors":"Simon Storgaard Jensen,&nbsp;Nadia R. Gadgaard,&nbsp;Heidi Amalie Rosendahl Jensen,&nbsp;Lei Wang,&nbsp;Alma Becic Pedersen","doi":"10.1007/s00402-025-05924-7","DOIUrl":"10.1007/s00402-025-05924-7","url":null,"abstract":"<div><h3>Aims</h3><p>Orthopedic registries have provided valuable knowledge about risk for and prognosis after total hip arthroplasties (THA), knee arthroplasties (KA), and hip fractures. However, registries are often limited by the lack of data on health risk behaviors, quality of life, and social background, which are readily available in surveys. We examined if participants in The Danish National Health Survey, based on self-administered questionnaires, are representative of THA, KA, and hip fracture patients.</p><h3>Methods</h3><p>Patients were identified in the Danish orthopedic registries and linked with survey data (from 2010, 2013, and 2017) on an individual level. Data on age, sex, comorbidity, medication, markers of socioeconomic position, and healthcare utilization were assessed from the Danish medical databases. We calculated the proportions of variables before and after surgery, comparing patients who had and had not participated in surveys.</p><h3>Results</h3><p>We included 177,617 THA surgeries (4.5% of patients completed pre-surgery surveys and 7.0% completed post-surgery surveys), 152,154 KA surgeries (7.0% of patients completed pre-surgery surveys and 6.2% completed post-surgery surveys) and 92,600 hip fracture surgeries (3.8% of patients completed pre-surgery surveys and 2.2% completed post-surgery surveys). Survey participants and non-participants had similar age and sex distribution in the three cohorts. Based on comorbidity, medication, and healthcare utilization, participants appeared slightly healthier than non-participants. There was a slight variation in socioeconomic markers for THA and KA patients between participants and non-participants.</p><h3>Conclusion</h3><p>The Danish National Health Survey provides a sample that appears to be largely representative of all THA, KA, and hip fracture patients in Denmark. Survey data could be a valuable data source for further studies of the risks and outcomes associated with patients undergoing THA and KA and those suffering from hip fractures, while carefully considering the identified similarities and differences when designing studies and analyzing the survey data.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-025-05924-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144140158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive indicators of proximal femur nail antirotation device cut-out in intertrochanteric fractures: introduction of a novel radiographic parameter","authors":"Nihat Yiğit,&nbsp;Ali Said Nazlıgül,&nbsp;Erman Ceyhan","doi":"10.1007/s00402-025-05937-2","DOIUrl":"10.1007/s00402-025-05937-2","url":null,"abstract":"<div><h3>Introduction</h3><p>Cut-out remains the predominant complication after proximal femoral nail antirotation (PFNA) fixation in intertrochanteric fractures, significantly affecting clinical outcomes. Established predictive parameters, such as tip-apex distance (TAD) and calcar-referenced TAD (CalTAD), offer valuable insights but have limitations. This study introduces a novel radiographic parameter—the discrepancy between preoperatively estimated and intraoperatively selected lag screw length—and assesses its predictive value in implant cut-out.</p><h3>Materials and methods</h3><p>In this retrospective cohort study, 276 patients undergoing PFNA fixation for intertrochanteric fractures from January 2019 to June 2023 were analyzed. Patients were classified into cut-out (n = 20, 7.2%) and uneventful healing (n = 256, 92.8%) groups. Demographics, AO/OTA fracture classification, TAD, CalTAD, shaft-neck angle, reduction quality, and the discrepancy between preoperative radiographic estimates of lag screw length (based on contralateral hip measurements) and actual intraoperative lengths were evaluated. Statistical methods included ROC analysis and multivariate logistic regression modeling.</p><h3>Results</h3><p>TAD (median 31.5 vs. 23.0 mm, p &lt; 0.001) and CalTAD (median 40.9 vs. 31.4 mm, p &lt; 0.001) were significantly greater in the cut-out group. The novel screw length discrepancy parameter demonstrated significant predictive accuracy (AUC = 0.818), with a difference exceeding 3 mm (shorter screw) strongly associated with cut-out risk (OR = 63.0, p &lt; 0.001). Multivariate analysis identified CalTAD &gt; 38.55 mm (OR = 14.2, p = 0.004) and screw length discrepancy &gt; 3 mm (shorter than estimated) as independent predictors for cut-out.</p><h3>Conclusions</h3><p>This study introduces a novel predictor of cut-out in PFNA-treated intertrochanteric fractures: discrepancy exceeding 3 mm between preoperatively estimated and intraoperatively selected lag screw length. Incorporating contralateral hip measurements into preoperative planning protocols may improve surgical precision and decrease the risk of implant failure. Prospective validation studies are recommended to further confirm clinical applicability.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144140320","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":"‘Hybrid’ spacers in two-stage total hip arthroplasty revision: surgical technique, clinical and radiographic outcomes","authors":"Marco Minelli,&nbsp;Vincenzo Longobardi,&nbsp;Guido Grappiolo,&nbsp;Marco Rosolani,&nbsp;Alessio D’addona,&nbsp;Federico Della Rocca,&nbsp;Mattia Loppini","doi":"10.1007/s00402-025-05934-5","DOIUrl":"10.1007/s00402-025-05934-5","url":null,"abstract":"<div><h3>Background</h3><p>Acute periprosthetic joint infections may be managed with debridement, antibiotics, and implant retention, while chronic cases require one- or two-stage revision. Functional spacers allow for joint motion, better functionality and easier reimplantation, but could be associated with acetabular bone wear, higher dislocation risk and abrasion-induced cement particles. A new technique utilizing an antibiotics-loaded cement-based femoral hemispacer articulating with a cemented dual mobility acetabular cup was described.</p><h3>Materials and methods</h3><p>This monocentric retrospective study analyzed a consecutive series of patients who underwent two-stage revision total hip arthroplasty with \"hybrid\" spacers for a periprosthetic joint infection in accordance with the 2014 MSIS criteria. Preoperative templating was carried out to achieve intraoperatively hip biomechanics reconstruction. Surgical procedure involved placement of a proximally cemented antibiotics-loaded hemispacer and a cemented dual mobility cup to reproduce native hip center of rotation and combined anteversion with the femoral component. Immediate postoperative toe-touch weightbearing and range of motion was allowed for every patient, except for cases where significant femoral bone loss was present.</p><h3>Results</h3><p>No intraoperative complications were observed during the first-stage. Fourteen out of the 15 patients (93.3%) underwent the second stage. Only one case of posterior dislocation (6.7%) was observed. No cases of cement migration or acetabular wear and bone defect progression were reported. No case of cup loosening was observed. No hemispacer fracture or loosening was observed. One case of perispacer transverse femoral fracture (6.7%) was reported in a patient who did not follow toe-touch weightbearing indication. Second stage hemispacer removal was carried out in all the patients via endofemoral approach: no intraoperative complications were observed. Explanted spacer and cup sonication was negative in all the cases, except for the only patient who did not undergo the second stage that was found positive for Klebsiella pneumoniae.</p><h3>Discussion</h3><p>Hybrid spacers allow for immediate weight-bearing and range of motion. Hybrid spacer technique allows for biomechanical reconstruction and lower dislocation risk even in case of significant acetabular defects, while avoiding acetabular wear and cement-on-cement articulating interface abrasion-induced cement particles.</p><h3>Conclusion</h3><p>Hybrid spacer technique is a safe and effective option for two-stage total hip arthroplasty revisions in periprosthetic joint infections.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144140319","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":"Two portals are sufficient for all-inside arthroscopic isolate anterior talofibular ligament repair","authors":"Shi-Ming Feng,&nbsp;Yue Xue,&nbsp;Zi-He Zhang,&nbsp;Chong Xue,&nbsp;Shun-Hong Gao","doi":"10.1007/s00402-025-05927-4","DOIUrl":"10.1007/s00402-025-05927-4","url":null,"abstract":"<div><h3>Purpose</h3><p>All-inside arthroscopic repair of the anterior talofibular ligament (ATFL) using two or three portals is one of the most commonly performed procedures for managing chronic lateral ankle instability (CLAI). However, it remains unclear whether there are differences in functional outcomes between the use of two versus three portals.</p><h3>Methods</h3><p>This retrospective comparative study included 66 patients with CLAI who underwent an all-inside arthroscopic isolated ATFL repair procedure between 2018 and 2021. Patients were divided into two groups according to the number of portals introduced. In the two-portal group (n = 31), the ATFL was repaired using two portals. In the three-portal group (n = 35), the ATFL was repaired using three portals. The American Orthopedic Foot and Ankle Society (AOFAS) scores, Karlsson Ankle Function Score (KAFS), Anterior Talar Translation (ATT), Active Joint Position Sense (AJPS), complications, as well as the time of return to sports were compared between the two groups.</p><h3>Results</h3><p>All patients were followed up for a minimum of 2 years. Improvement in functional outcomes (AOFAS, KAFS, ATT and AJPS) was recorded at the final follow-up. No significant differences were observed between the two groups in terms of operative time, AOFAS, KAFS, ATT, AJPS, or the time of return to sports. However, no nerve complications were observed in the two-portal group.</p><h3>Conclusion</h3><p>In patients with CLAI undergoing all-inside arthroscopic isolate ATFL repair, the use of either two or three portals results in comparable and favorable functional outcomes. The two-portal procedure was also associated with no superficial peroneal nerve injuries.</p><h3>Level of evidence</h3><p>Level III.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-025-05927-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and patient-reported outcomes of a novel robotic system in total knee arthroplasty","authors":"Farouk Khury,&nbsp;Ittai Shichman,&nbsp;Sophia Antonioli,&nbsp;Joshua Rozell,&nbsp;Morteza Meftah,&nbsp;Ran Schwarzkopf","doi":"10.1007/s00402-025-05932-7","DOIUrl":"10.1007/s00402-025-05932-7","url":null,"abstract":"<div><h3>Background</h3><p>Robotic assistance (RA) is increasingly used in total knee arthroplasty (TKA) for more accurate bony resection and balancing. However, the impact of robotic TKA (RATKA) on clinical outcomes and patient-reported measures (PROMs) remains unclear. This study aims to compare RATKA and conventional TKA (CTKA) using a novel robotic system.</p><h3>Methods</h3><p>A retrospective review was conducted on 10,031 patients who underwent TKA from February 2021 to October 2024. 289 RATKAs were performed with a hand-held robotic system. These RATKA cases were 1:1 propensity-score matched to CTKA for patient demographics, surgeon, implant system, and articulation design. Postoperative and clinical outcomes including surgical time, length of stay (LOS), discharge disposition, 90-day emergency department (ED) visits, manipulation under anesthesia (MUA), debridement, reoperations and revisions were collected and analyzed. Patient-reported outcomes measures (PROMs) included Knee Injury and Osteoarthritis Outcome Scores (KOOS, JR) and Patient Reported Outcome Measurement Information System (PROMIS) scores.</p><h3>Results</h3><p>RATKA demonstrated significantly shorter LOS (30.04 vs. 51.91 hours, <i>p</i> &lt; 0.001, respectively) compared to CTKA. There was no difference in surgical time (107.18 vs. 106.22 minutes, <i>p</i> = 0.349). Although there was no statistical difference in 90-day ED visits, the majority of the CTKA revisits were due to surgery-related causes when compared to the RATKAs (1.38% vs. 0.34%, <i>p</i> = 0.239). While RATKAs had higher incidence of MUAs (2.07% vs. 0.34%, <i>p</i> = 0.201), CTKAs had more reoperations (1 vs. 0, <i>p</i> = 0.369) and more revisions than the RATKAs (6 vs. 0, <i>p</i> = 0.117). In terms of PROMs, both RATKAs and CTKAs showed similar improvements in KOOS, JR and PROMIS pain scores following TKA, with no significant differences in the magnitude of improvement at early postoperative timepoints. However, at the one-year follow-up, RATKA demonstrated significantly greater reduction in PROMIS pain intensity (Δ-9.12, <i>p</i> = 0.032) compared to CTKAs.</p><h3>Conclusions</h3><p>This retrospective analysis showed that the novel RATKA resulted in reduced length of stay, fewer reoperations, and greater reduction in one-year PROMIS pain intensity compared to CTKAs, despite having a higher incidence of MUA rates. Further research is needed to clarify these differences clinically and enhance patient outcomes.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144125656","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 accuracy of MRI diagnosis of thumb ulnar collateral ligament injuries over physical examination in clinical decision-making for surgery","authors":"Nicolas Orbenes,&nbsp;Philipp Moog,&nbsp;Klaus Woertler,&nbsp;Jan Neumann,&nbsp;Hans-Guenther Machens,&nbsp;Haydar Kükrek","doi":"10.1007/s00402-025-05923-8","DOIUrl":"10.1007/s00402-025-05923-8","url":null,"abstract":"<div><h3>Purpose</h3><p>This retrospective study assessed whether magnetic resonance imaging (MRI) confers a diagnostic or therapeutic advantage over clinical examination in managing thumb ulnar collateral ligament (UCL) injuries and evaluated its accuracy in lesion characterization.</p><h3>Materials and methods</h3><p>We reviewed 96 patients undergoing surgical repair over a ten-year period, 43 of whom had preoperative MRI and 53 who did not.</p><h3>Results</h3><p>While MRI exhibited high sensitivity (97%) and specificity (80%) for detecting UCL pathology, its accuracy for differentiating lesion subtypes was only moderate (72–84%). No appreciable difference was noted between MRI and non-MRI cohorts in the proportion of indication-appropriate (57% vs. 45%) or surgeries potentially amenable to conservative treatment (43% vs. 55%).</p><h3>Conclusions</h3><p>Thus, MRI did not influence the indication for surgery beyond what was determined by a meticulous physical examination. A thorough clinical assessment remains the mainstay, reserving MRI for diagnostically challenging scenarios or when detailed anatomical visualization is necessary.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-025-05923-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood transfusion risk factors in patients with osteoporotic hip fracture","authors":"Julián Carlos Segura-Nuez,&nbsp;Pilar Herranz-Andrés,&nbsp;Marta Infantes-Morales,&nbsp;Juan Segura-Nuez,&nbsp;Carlos Martín-Hernández,&nbsp;Adrián Roche-Albero","doi":"10.1007/s00402-025-05930-9","DOIUrl":"10.1007/s00402-025-05930-9","url":null,"abstract":"<div><h3>Purpose</h3><p>This study analyzes the perioperative factors influencing the risk of transfusion in patients with osteoporotic hip fractures and their relationship with 30-day mortality.</p><h3>Methods</h3><p>This is a retrospective analytical study that included patients over 65 years old diagnosed with hip fracture admitted to our hospital from March to October, 2023. They were treated according to the hospital’s osteoporotic hip fracture management protocol. Data collected included admission day, age, sex, type of fracture, anticoagulant or antiplatelet treatment, time to surgery, and 30-day mortality.</p><h3>Results</h3><p>A total of 348 patients (77.3% women) with a mean age of 85.3 (SD 7.51) years were included. The mean hemoglobin level at admission was 12.6 (SD 1.66) mg/dl. The mean time to surgery was 2.51 (SD 1.45) days. The proportion of patients transfused was 42%, and the 30-day post-discharge mortality rate was 4.6%. Multivariate analysis showed that age, type of fracture, hemoglobin level at admission, and surgery within the first 48 h were associated with a higher transfusion rate (<i>p</i> &lt; 0.05). No differences were found regarding sex and prior anticoagulant or antiplatelet treatment. The 30-day mortality was higher in the transfused group.</p><h3>Conclusions</h3><p>Age; hemoglobin level at admission; subtrochanteric, pertrochanteric, and basicervical fractures compared to subcapital fractures; and surgery within the first 48 h were associated with a higher transfusion rate. Multidisciplinary perioperative management of patients who cannot be operated on within the first 48 h is crucial to prevent complications and improve survival.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144125634","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":"Early revision of Monteggia-variant fractures","authors":"Valentin Rausch,&nbsp;Thomas Rosteius,&nbsp;Matthias Königshausen,&nbsp;Thomas A. Schildhauer,&nbsp;Dominik Seybold,&nbsp;Jan Geßmann","doi":"10.1007/s00402-025-05895-9","DOIUrl":"10.1007/s00402-025-05895-9","url":null,"abstract":"<div><h3>Purpose</h3><p>Monteggia-variant fractures involve a fracture of the proximal ulna combined with a radiocapitellar dislocation and/or additional injuries to the radial head. These injuries are associated with severe outcomes, high complication rates, and frequent need for revision surgery. This study aimed to investigate strategies for early revision following failed operative treatment of these injuries.</p><h3>Methods</h3><p>We retrospectively included all patients over 18 years of age who underwent revision surgery within the first 3 months after failed initial treatment of a Monteggia-variant fracture due to persistent instability or mechanical failure between October 2013 and December 2018 at our institution. We reviewed the reasons for revision, the operative strategies used, and the clinical and radiological outcomes of these patients.</p><h3>Results</h3><p>Twenty-seven patients, with a mean age of 57.9 ± 17 years (range: 21–94 years), were included in the study. Nineteen patients (70.4%) underwent revision due to instability, and 10 patients (37%) underwent revision due to failed osteosynthesis. For the revisions, the collateral ligaments were reconstructed in 63% (<i>n</i> = 17), a radial head prosthesis was implanted in 51.9% (<i>n</i> = 14), and re-osteosynthesis of the ulna and additional osteosynthesis were performed in 40.7% (<i>n</i> = 11) and 29.6% (<i>n</i> = 8), respectively. The coronoid was reconstructed in 22.2% (<i>n</i> = 6), and a radial head resection was performed in 14.8% (<i>n</i> = 4). In three cases, total elbow arthroplasty was performed, and in six cases, an additional external fixator was applied. All reconstructive procedures successfully stabilized the elbow. The mean functional arc for extension-flexion at final follow-up was 79 ± 29° (range: 20–115°).</p><h3>Conclusions</h3><p>Common reasons for revision surgery in Monteggia-variant fractures include ulnohumeral or radiohumeral instability, often due to missed coronoid fractures, collateral ligament injuries, or absence of the radial head.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144125657","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":"No difference in reoperation rates or aseptic loosening following cemented total knee arthroplasty with or without a tourniquet","authors":"Aaron Gazendam,&nbsp;Hassaan Abdel Khalik,&nbsp;Mansi Patel,&nbsp;Seper Ekhtiari,&nbsp;Isabelle Tate,&nbsp;Thomas J Wood","doi":"10.1007/s00402-025-05933-6","DOIUrl":"10.1007/s00402-025-05933-6","url":null,"abstract":"<div><h3>Introduction</h3><p>The objective of the current study was to evaluate the reoperation rate among patients undergoing cemented total knee arthroplasty (TKA) with or without an intraoperative tourniquet.</p><h3>Materials and methods</h3><p>A retrospective cohort study of consecutive patients who received a primary, cemented TKA at a high volume academic orthopaedic center. Eligible patients underwent primary, cemented TKA either with or without the use of a tourniquet throughout the entirety of the care. The causes and timing of reoperations were recorded. Survivorship analysis was conducted using Kaplan-Meier curves. Cox proportional hazards models were utilized to evaluate independent predictors of reoperation.</p><h3>Results</h3><p>There were 2276 (58%) cases in which a tourniquet was used and 1663 (42%) cases with no tourniquet use. Mean time from the primary TKA was 14.7 years. The cumulative survival at final follow-up for the no tourniquet group and tourniquet group were 92.2% and 96.5%, respectively. Only younger age was an independent predictor of both all cause revision and aseptic loosening.</p><h3>Conclusions</h3><p>Adjusting for confounders, the presence of a tourniquet did not affect the rates of long-term all-cause revision rates or aseptic loosening. Younger patients have a higher risk of all-cause reoperation and reoperation due to aseptic loosening.</p><h3>Level of evidence</h3><p>Level III.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144125655","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}