Archives of Orthopaedic and Trauma Surgery最新文献

{"title":"Medial meniscus posterior root tears with advanced osteoarthritis or subchondral insufficiency fracture are good indications for unicompartmental knee arthroplasty at a minimum 2-year follow-up","authors":"Koki Kawada,&nbsp;Yusuke Yokoyama,&nbsp;Yuki Okazaki,&nbsp;Masanori Tamura,&nbsp;Toshifumi Ozaki,&nbsp;Takayuki Furumatsu","doi":"10.1007/s00402-024-05671-1","DOIUrl":"10.1007/s00402-024-05671-1","url":null,"abstract":"<div><h3>Introduction</h3><p>The outcomes of unicompartmental knee arthroplasty (UKA) in the presence and absence of medial meniscus posterior root tears (MMPRTs) have not been compared. This study compared the characteristics and clinical outcomes of patients undergoing UKA with and without MMPRTs.</p><h3>Materials and methods</h3><p>This study analyzed 68 patients. The presence or absence of MMPRTs was evaluated using preoperative magnetic resonance imaging. Patient characteristics, clinical scores before surgery and at the final evaluation, and imaging findings were compared between patients with and without MMPRTs. Multiple regression analysis was conducted on postoperative visual analog scale (VAS)-pain scores.</p><h3>Results</h3><p>MMPRTs were present in 64.7% (44/68) of patients. Patients with MMPRTs were significantly younger (67.8 ± 8.2 vs. 75.0 ± 7.1 years, <i>p</i> &lt; 0.001) and had a shorter duration from the development of symptoms to the time of surgery than those without (6.8 ± 8.4 vs. 36.1 ± 38.9 months, <i>p</i> &lt; 0.001). Component placement or lower-limb alignment did not significantly differ between the groups. Preoperative clinical scores were not significantly different between the groups; however, patients with MMPRTs showed significantly better postoperative VAS-pain scores than those without (10.0 ± 9.0 vs. 28.2 ± 26.0 points, <i>p</i> = 0.026). Multiple regression analysis of postoperative VAS-pain scores revealed the significant effect of duration from the development of symptoms to the time of surgery (<i>p</i> = 0.038).</p><h3>Conclusions</h3><p>Patients undergoing UKA with MMPRTs were younger with less radiographic osteoarthritic changes compared to those without MMPRTs, and their postoperative VAS-pain scores were significantly superior. The duration from the development of symptoms to the time of surgery significantly influenced postoperative pain in patients undergoing UKA.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-024-05671-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142844720","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":"More intraoperative complications but similar revision rate in primary total hip arthroplasties using direct anterior approach in supervised trainees—a retrospective cohort study","authors":"Sebastian Simon,&nbsp;Jennyfer A. Mitterer,&nbsp;Stephanie Huber,&nbsp;Alexander Aichmair,&nbsp;Martin Dominkus,&nbsp;Jochen G. Hofstaetter","doi":"10.1007/s00402-024-05669-9","DOIUrl":"10.1007/s00402-024-05669-9","url":null,"abstract":"<div><h3>Introduction</h3><p>There are conflicting data regarding the safety of the direct anterior approach (DAA) for primary total hip arthroplasty (THA) during the learning process. The aim of this study was to evaluate the intra- and postoperative complication rates of DAA THA performed by supervised trainees compared with senior surgeons.</p><h3>Material and methods</h3><p>A retrospective cohort study was conducted using a prospectively maintained arthroplasty database of patients who underwent primary THA via the DAA between 01/08/2013 and 31/12/2022. We compared all cemented and cementless DAA THR using one implant system operated by senior surgeons (n = 6044) and supervised trainees (n = 385) with regard to operative time, intraoperative complications, and re-operation rate. Data were compared using <i>Mann–Whitney-U</i>-testing or <i>t</i>-tests and Pearson's <i>chi</i>-squared test or Fisher's exact test, as appropriate. The <i>Kaplan–Meier</i> method with 95% confidence intervals (CI) was used to determine septic- and aseptic-free implant survival.</p><h3>Results</h3><p>After a median follow-up of 3.9 (IQR: 2.4–5.9) years, there was no significantly higher rate of septic- or aseptic-revisions (supervised trainees: 2.6% vs senior surgeons: 1.7%; p = 0.529). There was a significant higher rate of intraoperative complication in the trainee group (supervised trainees: 2.6% vs senior surgeons: 1.3%; p = 0.036). Senior surgeons operated on more complex cases; however, the operative time of the trainees was significantly longer than that of the senior surgeons, 88 (IQR: 78–103) min vs. 61 (IQR: 50–79) min, respectively (p &lt; 0.001). Patient demographics showed no significant differences between the two groups except for BMI, which was significantly higher in the trainee group (p = 0.008).</p><h3>Conclusion</h3><p>Although the operating time and intraoperative complication rates are higher for supervised trainees, there is no significantly higher rate of postoperative septic or aseptic revisions. These findings highlight the importance of structured training programs in ensuring patient safety and surgical competence among trainees.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142844725","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 it time to Reassess The Role of Preoperative HypoalbuminemiaAmong Geriatric Distal Femur Fracture Patients?","authors":"Eric H. Tischler,&nbsp;Jake R. McDermott,&nbsp;Shivasuryan Vummidi,&nbsp;Samer A. Mahmoud,&nbsp;Jonathan M. Gross,&nbsp;Aden N. Malik,&nbsp;Nishant Suneja","doi":"10.1007/s00402-024-05725-4","DOIUrl":"10.1007/s00402-024-05725-4","url":null,"abstract":"<div><h3>Background</h3><p>Hypoalbuminemia, blanketly defined as Albumin &lt; 3.5 g/dL, is often utilized as a threshold associated with postoperative complications and mortality among orthopedic and non-orthopedic surgical procedures. Albumin level is influenced by a myriad of factors including liver function, malnutrition, and inflammation. This study evaluates the role preoperative albumin as an independent risk factor for mortality and increased length of stay (LOS) among distal femur fracture (DFF) patients.</p><h3>Methods</h3><p>Between 2010 and 2019, the National Surgical Quality Improvement Program (NSQIP) identified isolated closed distal femur fractures preoperative albumin levels using International Classification of Diseases 9th and 10th revisions (ICD9/ICD10) codes [S72.4*; 821.2*]. Albumin was categorized as both continuous and categorical variables: marked hypoalbuminemia (&lt; 2.5 g/dL), mild hypoalbuminemia (2.5–3.5 g/dL), normal albuminemia (3.5–4.5 g/dL) or hyperalbuminemia (&gt; 4.5 g/dL). Primary outcomes included in-hospital mortality and LOS.</p><h3>Results</h3><p>The incidence rate of hypoalbuminemia was 54.6% (419/767). Multivariable logistic regression analysis demonstrated that when compared to patients with baseline marked hypoalbuminemia, patients with mild hypoalbuminemia and normal serum albumin reported a respective 82% (OR 0.18, 95% CI [0.04, 0.71], <i>p</i> = 0.014) and 80% (OR: 0.20, 95% CI [0.05, 0.89], <i>p</i> = 0.034) decreased odds of in-hospital mortality. Similarly, a 53.7% (OR 0.46, 95% CI [0.23, 0.94], <i>p</i> = 0.033), 71.1% (OR 0.29, 95% CI [0.14, 0.60], <i>p</i> = 0.001), and 82.8% (OR 0.17, 95% [0.04, 0.75], <i>p</i> = 0.020) decreased odds of exceeding mean LOS was observed among mild hypoalbuminemic, normal, and hyperalbuminemic patients compared to patients with baseline marked hypoalbuminemia.</p><h3>Conclusion</h3><p>Preoperative hypoalbuminemia is an independent risk factor for increased LOS and mortality among DFFs, controlling for confounding factors. Prospective investigation of albumin risk stratification is warranted to differentiate contributable effects of chronic malnutrition and traumatic inflammatory albumin downregulation among geriatric trauma patients.</p><h3>Level of evidence</h3><p>Prognostic Level III.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142845111","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":"Simultaneous patellar tendon and anterior cruciate ligament rupture: a systematic review, meta-analysis and algorithmic approach","authors":"Petros Ismailidis,&nbsp;Georgios Neopoulos,&nbsp;Christian Egloff,&nbsp;Annegret Mündermann,&nbsp;Florian S. Halbeisen,&nbsp;Corina Nüesch,&nbsp;Christian Appenzeller-Herzog,&nbsp;Sebastian A. Müller","doi":"10.1007/s00402-024-05676-w","DOIUrl":"10.1007/s00402-024-05676-w","url":null,"abstract":"<div><h3>Introduction</h3><p>Isolated patellar tendon (PT) or anterior cruciate ligament (ACL) ruptures are common injuries, yet the co-occurrence of both presents a rare challenge for clinicians. The objectives of the study are to document diagnostic and therapeutic approaches, outcomes, and complications of combined PT and ACL injuries and to develop an algorithm to guide clinicians in decision-making.</p><h3>Methods</h3><p>The systematic review und metanalysis was conducted according to the PRISMA guidelines. Studies reporting on simultaneous PT and ACL ruptures were included. Meta-analysis was performed to compare different diagnostic modalities and treatment strategies.</p><h3>Results</h3><p>Thirty-six studies reporting on 56 Patients were included. 88% of patients had a concomitant injury (apart from PT and ACL) to the ipsilateral knee. Part of the diagnosis was missed in 23% of the cases. Performance of MRI significantly reduced the risk of missing a part of the injury (5% with MRI vs 69% without MRI, <i>p</i> &lt; 0.001). Surgical treatment was used only for the PT in 21% of the cases and for the PT and ACL in 77% of the cases (48% one-stage, 52% two-stage surgical treatment).</p><h3>Conclusion</h3><p>Combined ACL and PT rupture is rare, and recognizing its full extent is crucial for successful management. Performing an MRI in PT rupture from high-energy trauma and diagnostic arthroscopy/arthrotomy when MRI is not done is essential. PT ruptures should be treated surgically. For ACL rupture, conservative and operative treatment, one- or two-stage surgery are possible based on the patient's profile and concomitant injuries. Based on the limited available literature, this systematic review provides a diagnostic and therapeutic algorithm to assist in clinical decision-making.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-024-05676-w.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142844723","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":"Total knee arthroplasty in patient with poliomyelitis sequelae: maintaining a recurvatum is associated with better mid-term functional results","authors":"Grégoire Rougereau,&nbsp;Bernard Hollier-Larousse,&nbsp;Vincent Carpentier,&nbsp;Thomas Bauer,&nbsp;François Genêt,&nbsp;Marjorie Salga,&nbsp;Fabien Cale","doi":"10.1007/s00402-024-05708-5","DOIUrl":"10.1007/s00402-024-05708-5","url":null,"abstract":"<div><h3>Purpose</h3><p>Total knee arthroplasty (TKA) in patients with sequelae of poliomyelitis is a surgical challenge due to muscle weakness, bone deformities or post-polio syndrome (PPS). Few data exist to determine the factors contributing to poor functional results. This study aimed: (1) to describe a cohort of patients with poliomyelitis sequelae who underwent TKA; (2) to examine risk factors for poor functional outcome.</p><h3>Methods</h3><p>A monocentric retrospective cohort study of all patients with poliomyelitis sequelae who underwent TKA between January 2006 and December 2019. Clinical, functional outcomes, radiographic results and occurrence of complications were collected.</p><h3>Results</h3><p>A total of 22 patients (24 knees) were included in the analysis, with a mean follow-up of 6.6 years (from 2 to 13.7 years). There was an improvement in KSS (28 +/- 23 vs. 81 +/- 6, respectively; <i>p</i> &lt; 0.0001) as well as functional KSS (25 +/- 12 vs. 57.5 +/- 21, respectively; <i>p</i> = 0.0001). There was less occurrence of annual knee giving way episodes after total knee replacement (11.9+/-16.1 vs. 5.1+/-13.7, respectively; <i>p</i> = 0.04). Even though the total knee replacement allowed a slight recurvatum, it was smaller than the preoperative recurvatum (13° vs. 8°, respectively; <i>p</i> = 0.04). Seven complications with reintervention (7/24; 29%) were found. The presence of a residual post operative recurvatum correlated with better KSS (ρ = 0.53, CI95% [0.15; 0.77]; <i>p</i> = 0.008). The number of postoperative annual knee giving way episodes was inversely correlated with persistent postoperative recurvatum (ρ = -0.42, CI95% [-0.69; -0.01]; <i>p</i> = 0.04) but was not correlated with the type of constraint (ρ = -0.26, CI95% [-0.6; 0.15]; <i>p</i> = 0.21) nor with quadricipital muscle strength (ρ = 0.21, CI95% [-0.21; 0.56]; <i>p</i> = 0.33).</p><h3>Conclusion</h3><p>TKA has a good mid-term functional outcome for knee osteoarthritis in patients with sequelae of poliomyelitis. Preserving a residual recurvatum postoperatively gives better clinical results without increasing the risk of ligament instability or early aseptic loosening.</p><h3>Level of evidence</h3><p>IV.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142844769","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":"Increased risk of adverse events following the treatment of associated versus elementary acetabular fractures: a matched analysis of short-term complications","authors":"Sarah Cole,&nbsp;Sarah Whitaker,&nbsp;Conor O’Neill,&nbsp;James Satalich,&nbsp;Brady Ernst,&nbsp;Le Kang,&nbsp;Rami Hawila,&nbsp;Jibanananda Satpathy,&nbsp;Stephen Kates","doi":"10.1007/s00402-024-05726-3","DOIUrl":"10.1007/s00402-024-05726-3","url":null,"abstract":"<div><h3>Purpose</h3><p>This retrospective cohort study aims to compare short-term complication rates between patients receiving open reduction and internal fixation (ORIF) for associated versus elementary acetabular fractures, with a secondary objective of identifying independent risk factors for adverse outcomes.</p><h3>Methods</h3><p>The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried using current procedural terminology (CPT) codes to identify patients that underwent ORIF for associated acetabular (CPT 27228) or elementary acetabular fractures (CPT 27226, 27227) from 2010 to 2021. Propensity score matching was employed to account for baseline differences and the short-term complication rates were compared between the cohorts.</p><h3>Results</h3><p>We identified 1,330 patients who underwent ORIF for an acetabular fracture between 2010 and 2021, including 868 patients with elementary fractures and 462 with associated fractures. After matching, there were 462 patients in each cohort. The matched associated acetabular fracture group experienced higher rates of any adverse event (AAE, p = 0.029), transfusion (p = 0.010), and reoperation (p = 0.049). Increased age, increased operative time, higher body mass index (BMI), and prolonged hospital length of stay (LOS) augmented the risk of any complication.</p><h3>Conclusion</h3><p>The findings of this study identify areas of greater risk of postoperative complications after ORIF in individuals with associated versus elementary acetabular fractures. Discussion of these heightened risks is critical to appropriate patient care. Understanding these risks plays an important role in the clinical decision-making process and may identify areas to monitor patients postoperatively.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-024-05726-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142844721","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":"Internal brace augmentation in elbow varus posteromedial rotatory instability (VPMRI) allows early rehabilitation and prevents stiffness","authors":"Stefan Greiner,&nbsp;Andreas Voss,&nbsp;Anna Soler,&nbsp;Himanshu Bhayana","doi":"10.1007/s00402-024-05722-7","DOIUrl":"10.1007/s00402-024-05722-7","url":null,"abstract":"<div><h3>Purpose</h3><p>Varus posteromedial rotatory instability (VPMRI) involves anteromedial coronoid fracture (AMCF), lateral ulnar collateral ligament (LUCL), and medial collateral ligament (MCL) injury. There is no general consensus regarding the surgical treatment, but most surgeons recommend internal fixation of the coronoid along with primary ligament repair. This methodology involves postoperative immobilization to allow ligament healing, occasionally associated with stiffness. Augmentation of one/or both collateral ligaments using a non-absorbable suture tape as an internal brace in VPMRI cases was the subject of the presented study. This method allows brace-free initiation of full elbow range of motion while protecting bony and soft tissue healing.</p><h3>Methods</h3><p>17 patients (13 males and four females) with VPMRI were treated in the center from 2017 to 2021 with internal brace augmentation of collateral ligament along with ORIF (Open reduction &amp; internal fixation)/ reconstruction of the coronoid fragment. All patients were actively mobilized early after surgery. Patients who completed a minimum follow up of 24 months were included in the study. Clinical examination findings at follow-up assessment included ROM (range of motion) recording and instability testing, including special instability tests such as moving valgus stress test, lateral pivot shift test, Posterolateral rotatory drawer test, and gravity-assisted varus stress test. Disabilities of arm, shoulder and hand (DASH) score, Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES), Visual Analogue Score (VAS), and SEV (Simple Elbow values) were assessed and noted at follow-up.</p><h3>Results</h3><p>At 43 months of mean follow-up, none of the patients had significant postoperative contracture, and none had any clinically apparent signs of instability or suffered subluxation or re-dislocation. Postoperative radiographs showed complete fracture/graft healing with no signs of subluxation in all patients. The mean range of motion of the patients was 6.2⁰ (1.0⁰-11.3⁰) to 139.1⁰ (136.2⁰–142.0⁰), with a mean Oxford elbow score (OES) of 42.0 (39.9–44.7). The mean DASH (Disability of Arm, Shoulder &amp; Hand) score was 11.4 (6.7–16.1), the mean MEPS (Mayo Elbow Performance Score) was 91.2 (86.3–96.0), the mean Visual Analogue Score (VAS) score was 0.6 (0.1–1.2), and the mean Simple Elbow value (SEV) was 85.4% (81.1-89.8%).</p><h3>Conclusion</h3><p>Internal brace augmentation with a non-absorbable suture tape in the setting of VPMRI is a safe and helpful adjunct to coronoid repair/reconstruction and primary ligament repair and allows early mobilization and recovery of elbow stability and range of motion.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142844722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can surface landmarks help us identify the gibson interval during surgical hip dislocation: a study of 617 hips","authors":"Veerle Franken,&nbsp;Stefan Blümel,&nbsp;Joseph M. Schwab,&nbsp;Moritz Tannast","doi":"10.1007/s00402-024-05622-w","DOIUrl":"10.1007/s00402-024-05622-w","url":null,"abstract":"<div><h3>Introduction</h3><p>The Gibson approach, used in hip-preserving surgery, is intermuscular and develops the space anteriorly to the gluteus maximus. Reliable anatomical landmarks for the development of this interval do not exist, but the interval is marked by perforating vessels (PV) of the inferior gluteal artery. The aim of this study was to provide reference values for the relationship between palpable anatomical landmarks on the femur/pelvis and the anterior border of the gluteus maximus using CT scans of the proximal femur.</p><h3>Materials and methods</h3><p>Single center retrospective study of 617 hips who underwent a CT-scan of the pelvis/femur. We defined 5 anatomical markers on the pelvis and proximal femur and measured the distance of the anterior border of the gluteus maximus in relation to the marker, which was either anterior or posterior. The amount PV’s and it’s location relative to the innominate tubercle were measured in the coronal plane. For each landmark we compared these subgroups: male vs female, age &lt; 40 vs ≥ 40, categorical age (&lt; 20; 20–40; 40–60; &gt; 60), and categorical femoral torsion (&lt; 10°; 10°–25°; 25°–35°; &gt; 35°).</p><h3>Results</h3><p>Mean location of the parameters A-E was at − 8.1 cm, 1.1 cm, 1.8 cm, 1.3 cm and 0.4 cm. Parameters B, C, and D were more posterior in the age ≥ 40 group. Parameters A–E were significantly more posterior in the age &gt; 60 group. Parameters A and E were significantly more anterior in females than in males. 50% of the PV are found between 5 and 9 cm proximal to the innominate tubercle. No statistically significant differences were noted in the location of any of the perforating vessels in the different subgroups.</p><h3>Conclusion</h3><p>The Gibson interval is located more anteriorly in female patients and patients under 40 years of age. It is located more posteriorly in patients over 60 years of age. In addition, the interval moves anteriorly with increasing femoral torsion, most notably in patients with very high femoral torsion (&gt; 35°).</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-024-05622-w.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142845036","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":"Analysis of systemic serum vancomycin levels following intraarticular application in primary total joint arthroplasty","authors":"Stauss R,&nbsp;Savov P,&nbsp;Seeber GH,&nbsp;Brand S,&nbsp;Ettinger M,&nbsp;Beheshty JA","doi":"10.1007/s00402-024-05688-6","DOIUrl":"10.1007/s00402-024-05688-6","url":null,"abstract":"<div><h3>Introduction</h3><p>Periprosthetic joint infection (PJI) is a serious complication following primary total joint arthroplasty (TJA). PJI accounts for 15–25% of revision surgeries, therefore it is associated with PJI is associated with substantial patient morbidity and mortality as well as increased healthcare expenditures due to complex treatment strategies.</p><p>Recently, intraoperative local application of vancomycin powder is increasingly being used in primary total hip and knee arthroplasty (THA, TKA) as an additive strategy for PJI prevention. Whereas local vancomycin concentrations have already been investigated in prior studies, evidence on systemic vancomycin levels and potential adverse drug reactions (ADR) is limited. Purpose of this study was to investigate systemic vancomycin levels following intraarticular application in primary TJA.</p><h3>Materials and methods</h3><p>This pilot study is a prospective analysis of patients undergoing primary THA and TKA between April and July 2023. One gram of vancomycin powder was applied to the prosthesis prior to wound closure. Serum vancomycin levels were measured at two standardised time points, 24 and 48 h postoperatively.</p><h3>Results</h3><p>In total, 103 patients were included, and the patient collective was further stratified by surgical procedure into a THA subgroup (n = 52) and a TKA subgroup (n = 51). Mean serum vancomycin levels showed a significant group difference at both time points (24 h: p &lt; 0.001; 48 h: p = 0.044) with higher serum vancomycin concentrations in the THA cohort. Mean serum vancomycin levels in THA patients were 1.25 μg/ml (range 0.00–7.00 μg/ml) after 24 h and 0.34 μg/ml (range 0.00–4.80 μg/ml) 48 h postoperatively. In TKA, no systemic vancomycin levels were detected. Vancomycin concentrations did not reach therapeutic levels in any patient. No ADR was detected in the whole study collective.</p><h3>Conclusion</h3><p>Following intraarticular administration of vancomycin powder, no systemic vancomycin levels within the therapeutic range were detected, thus it may serve as a safe and cost-effective adjunct to strategies for prevention of PJI.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-024-05688-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142844724","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":"Similar efficacy of intra-articular hyaluronic acid injections and other biologically active injections in patients with early stages knee osteoarthritis: a level I meta-analysis","authors":"Filippo Migliorini,&nbsp;Luise Schäfer,&nbsp;Marco Pilone,&nbsp;Andreas Bell,&nbsp;Francesco Simeone,&nbsp;Nicola Maffulli","doi":"10.1007/s00402-024-05614-w","DOIUrl":"10.1007/s00402-024-05614-w","url":null,"abstract":"<div><h3>Introduction</h3><p>The present meta-analysis compared the efficacy of intra-articular hyaluronic acid (HA) injections in patients with early to mild knee osteoarthritis (OA) (Kellgren Lawrence I–II) versus other commonly injected biologically active compounds using patient-reported outcome measures (PROMs). The outcomes of interest were the visual analogue scale (VAS) and the Western Ontario McMaster Osteo-Arthritis Index (WOMAC) scores.</p><h3>Methods</h3><p>This study was conducted according to the 2020 PRISMA statement. In April 2024, PubMed, Web of Science, Google Scholar, and Embase were accessed without time constraints. All the randomised controlled trials (RCTs) investigating the efficacy of intra-articular HA injections in the early stages of knee OA were accessed. Data concerning the VAS, WOMAC, and related subscales were collected at baseline and the last follow-up. Only studies clearly stated the degrees of advancement of OA using the Kellgren-Lawrence scoring system were used.</p><h3>Results</h3><p>The literature search resulted in four RCTs (390 patients). The mean length of the last follow-up was 7.5 ± 3.0 months. 72.3% (282 of 390) of the patients were women. The mean age of the patients was 58.1 ± 3.2 years, and the mean BMI was 27.3 ± 3.2 kg/m². At the last follow-up, no difference was found between HA and the control group in VAS, WOMAC, and related subscales.</p><h3>Conclusion</h3><p>In patients with early to mild knee osteoarthritis, the current level of evidence suggests that intra-articular injections using HA performed similarly to other biologically active compounds commonly injected in the knee joint for a minimum of three months.</p><h3>Level of evidence</h3><p>Level I, meta-analysis.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142844987","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}