Archives of Orthopaedic and Trauma Surgery最新文献

{"title":"Optimal timing for hemodialysis in relation to hip fracture surgery for patients with end-stage renal disease","authors":"Hanna E. House,&nbsp;Michelle R. Shimizu,&nbsp;Insup Hong MA,&nbsp;Joseph B. Cohen,&nbsp;Hobie D. Summers,&nbsp;Ashley E. Levack","doi":"10.1007/s00402-026-06209-3","DOIUrl":"10.1007/s00402-026-06209-3","url":null,"abstract":"<div><h3>Introduction</h3><p>End-stage renal disease (ESRD) is associated with a significantly increased risk of hip fractures and a higher rate of postoperative complications and mortality, particularly in patients on hemodialysis (HD). The timing of HD relative to surgery may influence outcomes by altering acid–base balance, electrolyte levels, and fluid status. This study aimed to evaluate the effect of perioperative HD timing on postoperative complication rates in ESRD patients undergoing hip fracture surgery.</p><h3>Materials and Methods</h3><p>This retrospective cohort study included patients with ESRD on HD who underwent operative treatment for hip fractures at a single Level I academic trauma center. Patient demographics, comorbidities, and perioperative variables were collected. Timing of HD was calculated as the interval in hours from the start of HD to the start of surgery. Disruptions in patients’ routine HD schedules were also recorded. Univariable logistic regression was used to assess associations between HD timing and 90-day postoperative complications.</p><h3>Results</h3><p>Forty-one patients met inclusion criteria; 25 (61.0%) experienced a postoperative complication. The interval between HD and surgery did not significantly predict postoperative outcomes. Disruption of routine HD schedules, observed in 31 patients, was also not associated with increased risk of complications (OR = 0.94, 95% CI = [0.22, 4.00], p = 0.929).</p><h3>Conclusions</h3><p>Neither the timing of preoperative HD nor disruptions in HD scheduling were significantly associated with 90-day postoperative complications in ESRD patients undergoing hip fracture surgery. As the first study to examine this relationship in this population, these findings contribute to the growing body of evidence guiding perioperative management in dialysis-dependent patients. Further research with larger sample sizes is needed to confirm these results.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06209-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147738446","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":"20 years of blood management and VTE prevention in orthopedic surgery in the Netherlands – a nationwide survey","authors":"Ruben Y. Kok,&nbsp;Joost-Jelle T. M. Gerritsen,&nbsp;Cees C. P. M. Verheyen,&nbsp;Banne Németh,&nbsp;Harmen B. Ettema","doi":"10.1007/s00402-026-06301-8","DOIUrl":"10.1007/s00402-026-06301-8","url":null,"abstract":"<div><h3>Introduction</h3><p>Advances in arthroplasty care have progressively improved patient outcomes, including reduced bleeding and venous thromboembolism rates. Consequently, blood-saving measures applied pre-, peri- and postoperatively as well as thromboprophylaxis regimens have evolved over time. To evaluate these developments, we conducted a 2023 follow-up to the national surveys from 2002, 2007 and 2012, examining current blood-saving strategies and thromboprophylaxis use in The Netherlands.</p><h3>Materials and methods</h3><p>In 2023, a questionnaire designed to match the previous surveys was distributed to all orthopedic departments in the Netherlands. The collected data were summarized and compared with previous findings.</p><h3>Results</h3><p>Responses were received from 61% of the Dutch orthopedic departments. Blood-saving practices have shifted significantly toward the use of tranexamic acid, accompanied by a decline in other measures. In particular, the use of drains, blood transfusions, and erythropoietin supplementation has decreased substantially. Thromboprophylaxis protocols showed fewer changes, although the average duration of prophylaxis has shortened, with low-molecular-weight heparin remaining the most commonly used anticoagulant.</p><h3>Conclusions</h3><p>Advances in surgical techniques and postoperative care around arthroplasty appear to have reduced concerns about perioperative blood loss to a level where the use of tranexamic acid alone is considered sufficient to control blood loss, rendering many previously popular perioperative blood-saving measures redundant. In contrast, despite a decline in thrombotic complications associated with the introduction of fast-track surgery, thromboprophylaxis protocols have remained largely unchanged. These findings highlight the opportunity to further balance the risks of bleeding and thrombosis following arthroplasty.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06301-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147738542","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 mental health outcomes in major versus minor upper extremity amputations: a retrospective national database study","authors":"Victoria Nedder,&nbsp;Joyce Wang,&nbsp;Kacy Peek","doi":"10.1007/s00402-026-06319-y","DOIUrl":"10.1007/s00402-026-06319-y","url":null,"abstract":"<div><h3>Background</h3><p>Upper extremity amputations are associated with developing psychiatric conditions. The aim of this study is to identify differences in mental health outcomes for patients undergoing major versus minor upper extremity amputations.</p><h3>Methods</h3><p>Data were obtained from the PearlDiver database between 2010 and 2022 using Current Procedural Terminology and International Classification of Diseases codes. Patients aged 10 and above without prior mental health diagnoses or antidepressant prescription records who underwent upper extremity amputations were stratified by major (shoulder disarticulation, arm, forearm, wrist, transmetacarpal) versus minor (single metacarpal, digit, phalanx) amputations. Demographic characteristics and rates of mental health diagnoses, antidepressant prescriptions, and psychotherapy care were assessed for 90 days and one year postoperatively, using Welch’s T-tests and Pearson’s chi-squared tests.</p><h3>Results</h3><p>Patients with major amputations had increased risk of mental health diagnoses at 90 days (OR: 3.29, <i>p</i> &lt; 0.001) and at one year (OR: 2.01, <i>p</i> &lt; 0.001). Both groups had higher rates of mental health diagnoses than the general population. Patients undergoing major amputations had higher odds of starting antidepressants at 90 days (OR 3.82, <i>p</i> &lt; 0.001) and at one year (OR 2.38, <i>p</i> &lt; 0.001). Psychotherapy care was significantly increased after major amputations at 90 days (OR 5.47, <i>p</i> &lt; 0.001) and at one year (OR 4.18, <i>p</i> &lt; 0.001).</p><h3>Conclusions</h3><p>Mental health disorders, antidepressant use, and psychotherapy care are significantly higher for major upper extremity amputations compared to minor amputations. Surgical teams should provide mental health resources to mitigate negative effects from mental health needs after upper extremity amputation.</p><h3>Level of evidence</h3><p>III.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06319-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147738655","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":"The use of communication applications in orthopaedics: a scoping review","authors":"Annali Olivelle,&nbsp;Poojit Borra,&nbsp;Rami Sati,&nbsp;Mayek S Gupta,&nbsp;Krishna Oochit,&nbsp;Akash Patel","doi":"10.1007/s00402-026-06318-z","DOIUrl":"10.1007/s00402-026-06318-z","url":null,"abstract":"<div><h3>Background</h3><p>Effective communication between clinicians is vital in orthopaedic practice, particularly in trauma and emergency care where optimal decision making is necessary. Although communication application use in orthopaedics is common within practice, there is little research to back up its ongoing use. This scoping review aims to synthesise the existing evidence on the use of clinician-to-clinician communication applications in orthopaedic practice, focusing on its prevalence, perceived utility, diagnostic reliability and associated challenges.</p><h3>Materials and methods</h3><p>A scoping review was conducted in accordance with the PRISMA-ScR guidelines. This involved a literature search of MEDLINE, Embase, and the Cochrane Library from inception to September 2025. Studies involving clinician-to-clinician communication applications used within orthopaedic care were included. Data was extracted and synthesised using a methodological approach.</p><h3>Results</h3><p>Seven studies published between 2016 and 2023 were included. The evidence demonstrates widespread adoption of communication applications, particularly WhatsApp, for informal clinical communication, with consistent perceptions that these platforms improve communication efficiency and coordination of care. Four studies evaluating smartphone transmitted radiographic images reported good to excellent intraobserver diagnostic agreement when compared with Picture Archiving and Communication Systems (PACS). Significant limitations were also identified, including reduced image quality, physical usability constraints and inconsistent documentation resulting in substantial patient data governance and confidentiality concerns.</p><h3>Conclusion</h3><p>Communication applications function as informal adjuncts to clinical communication in orthopaedic practice, driven by clinical necessity. While they support rapid consultation and decision making, their use remains limited by governance, data security, and integration challenges. Future efforts should focus on developing clinician centred communication systems that align usability with regulatory compliance, enabling safe and structured integration into orthopaedic care pathways.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06318-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147738543","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":"Double-row wired anchors combined with “8” cross tension bands: an innovative procedure for the treatment of inferior pole fractures of the patella and its finite element and biomechanical evaluation","authors":"Zihao Deng,&nbsp;Wei Zhang,&nbsp;Jian Chen,&nbsp;Zilong Yang,&nbsp;Wentao Gao,&nbsp;Yuxuan Liu,&nbsp;Xiping Zhang,&nbsp;Wei Zeng,&nbsp;Zhiqin Liu","doi":"10.1007/s00402-026-06283-7","DOIUrl":"10.1007/s00402-026-06283-7","url":null,"abstract":"<div><h3>Objective</h3><p>To propose and verify the biomechanical properties of a new double-row suture anchor combined with figure-of-eight cross tension band technology for the treatment of inferior pole fractures of the patella, in order to overcome the shortcomings of traditional fixation methods in achieving stable fixation and reducing implant-related complications.</p><h3>Methods</h3><p>(1) Based on clinical CT data, a three-dimensional finite element model of patellar inferior pole fracture was reconstructed, and the new fixation technology (deep double-row anchors in the proximal bone fragment combined with figure-of-8 sutures) and Kirschner wire tension band wire fixation (TBW) were simulated and analyzed. Mechanical performance in the treatment of inferior pole fracture of the patella; (2) Divide the model into two groups according to surgical methods: suture anchor (SA) fixation group and TBW fixation group; (3) Carry out finite element analysis to compare the two groups at 500 Displacement and stress distribution of the knee joint at 45°and 135°of flexion under N load.</p><h3>Results</h3><p>Finite element analysis and biomechanical test results showed that there was no significant difference in displacement and stress between the two groups at different flexion angles.</p><h3>Conclusion</h3><p>Double-row anchors combined with figure-of-eight suture technology exhibited excellent biomechanical properties, and is a feasible fixation solution for the treatment of inferior pole fractures of the patella.This technology can significantly reduce stress concentration and the risk of implant complications, providing a minimally invasive solution to replace traditional metal implants and helping patients recover early, but its long-term efficacy still requires further clinical verification.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06283-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728334","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":"Long-term outcomes and revision-free survival following robotic-assisted unicompartmental and total knee arthroplasty","authors":"Alexander Fleisher,&nbsp;Mitchell Kennedy,&nbsp;Maxwell Trudeau,&nbsp;Diana Piergrossi,&nbsp;Ivan Madrid,&nbsp;Morteza Meftah","doi":"10.1007/s00402-026-06250-2","DOIUrl":"10.1007/s00402-026-06250-2","url":null,"abstract":"<div><h3>Background</h3><p>While robotic assistance improves precision in unicompartmental (R-UKA) and total knee arthroplasty (R-TKA), long-term comparative data are limited. This study evaluated perioperative outcomes and mid- to long-term survivorship for R-UKA versus R-TKA.</p><h3>Methods</h3><p>A retrospective review was performed of 163 patients who underwent primary, elective, R-UKA (<i>n</i> = 84) or R-TKA (<i>n</i> = 79) between 2011 and 2020 at a single, tertiary academic medical center, with a minimum follow-up of five years. Demographics, perioperative characteristics, and postoperative outcomes were compared between cohorts. Revision-free implant survivorship was evaluated using Kaplan–Meier analysis.</p><h3>Results</h3><p>R-TKA procedures had longer operative times than R-UKA (131 vs. 112.5 min; <i>P</i> &lt; 0.001) and both were performed primarily for primary osteoarthritis. Cohorts had similar 90-day ED visit rates (3.8 vs. 4.8%; <i>P</i> = 1), for both surgical (2.5 vs. 3.6%) and medical causes (1.3 vs. 1.2%), while readmission rates were also similar (2.5 vs. 3.6%, <i>P</i> = 1). Median follow-up (9.55 vs. 6.07 years) and time since surgery (12.33 vs. 7.48 years) were significantly longer for R-UKA (both <i>P</i> &lt; 0.001). At final follow-up, revision occurred in 3.8% of R-TKA and 4.8% of R-UKA cases (<i>P</i> = 1). Time to revision was shorter for R-TKA (1.36 vs. 5.22 years; <i>P</i> = 0.114). Kaplan–Meier analysis demonstrated 5-year revision-free survivorship of 96.2% for R-TKA and 97.6% for R-UKA, with the overall log-rank test showing no significant survivorship difference between groups (<i>P</i> = 0.866).</p><h3>Conclusions</h3><p>In this cohort, R-UKA and R-TKA demonstrated favorable long-term survivorship with no statistically significant differences in ED visits, readmissions, or revision rates. These findings show comparable safety profiles and low revision rates at long-term follow-up for both procedures, suggesting that for patients meeting specific indications for either procedure, robotic-assisted knee arthroplasty provides durable outcomes for appropriately selected patients.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13090181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147715768","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":"Modified rotational wedge distal metatarsal osteotomy versus chevron osteotomy for hallux valgus: long-term radiographic and clinical outcomes","authors":"Ahmet Aybar,&nbsp;Kemal Gokkus,&nbsp;Erdem Özden,&nbsp;Mehmet Hamdi Çetin,&nbsp;Mehmet Ümit Çetin","doi":"10.1007/s00402-026-06315-2","DOIUrl":"10.1007/s00402-026-06315-2","url":null,"abstract":"<div><h3>Background</h3><p>Distal Chevron osteotomy is commonly used for mild-to-moderate hallux valgus, but long-term loss of correction and radiographic recurrence remain concerns, particularly when distal articular alignment and sesamoid position are not adequately restored. We compared long-term radiographic and clinical outcomes of a modified rotational wedge distal metatarsal osteotomy versus standard distal Chevron osteotomy in adults with mild-to-moderate symptomatic hallux valgus.</p><h3>Methods</h3><p>In this single-center retrospective cohort study, 100 feet (100 patients) treated between 2010 and 2019 were analyzed (Modified, <i>n</i> = 46; Chevron, <i>n</i> = 54) at a mean follow-up of 101.2 ± 11.5 months. Soft-tissue balancing was standardized, with an intra-articular lateral release performed in both groups. Outcomes included radiographic measures (hallux valgus angle [HVA], intermetatarsal angle [IMA], distal metatarsal articular angle [DMAA], and medial sesamoid position), clinical scores (AOFAS, VAS), recurrence, and complications. Radiographic recurrence was defined as final HVA &gt; 15°.</p><h3>Results</h3><p>Final AOFAS scores were similar between groups (<i>p</i> = 0.621), and the between-group difference in final VAS pain scores did not remain significant after Benjamini-Hochberg false discovery rate (BH-FDR) adjustment (q = 0.057). Compared with the Chevron group, the Modified group demonstrated superior final radiographic alignment, with lower HVA and IMA (both <i>p</i> &lt; 0.001) and lower DMAA (<i>p</i> = 0.002). Despite worse baseline sesamoid subluxation, the Modified group achieved a more central final sesamoid position (<i>p</i> = 0.010). Radiographic recurrence was less frequent in the Modified group (4.3% vs. 27.8%), representing a relative risk of 0.16 (95% CI 0.04–0.65; <i>p</i> = 0.003); this association persisted after inverse probability of treatment weighting (adjusted odds ratio [aOR] 0.09, 95% CI 0.01–0.60; <i>p</i> = 0.013). Complication rates were low and comparable.</p><h3>Conclusions</h3><p>At long-term follow-up, the modified rotational wedge distal osteotomy yielded superior radiographic alignment and a lower recurrence rate than distal Chevron osteotomy, without higher complication rates, while functional outcomes were similar.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13090300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147715773","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":"Periacetabular osteotomy of the hip: an 8-year follow-up of 96 consecutive cases","authors":"Anders Enocson,&nbsp;Richard Wallensten,&nbsp;Henrik Lundblad","doi":"10.1007/s00402-026-06298-0","DOIUrl":"10.1007/s00402-026-06298-0","url":null,"abstract":"<div><h3>Introduction</h3><p>A periacetabular osteotomy (PAO) is a joint-preserving surgical option for treatment of acetabular dysplasia. The procedure aims to prevent, or at least delay, the development of osteoarthritis, and subsequent need for total hip arthroplasty (THA). The conversion rate to THA differs widely in the literature, but most of the studies have few patients, and the follow-up time is often short for THA as an endpoint. The aim of this study was to evaluate the long-term outcome after PAO surgery with the rate of conversion to THA as the primary outcome.</p><h3>Materials and methods</h3><p>Patients ≥18 years that underwent a PAO operation at the Karolinska University Hospital in Stockholm, Sweden from 2006 to 2022 were included. Radiological signs of hip osteoarthritis, and the lateral center-edge angle (LCEA) was calculated on pre- and postoperative radiographs or CT-scans. The national Swedish Arthroplasty Register was used to find cases who had a secondary operation with THA.</p><h3>Results</h3><p>The number of cases included was 96. Median age was 30 (18–46) years, and 84% (<i>n</i> = 81) were females. Median follow-up time was 99 (17–227) months (8 years). A total of 21 (22%) cases had a secondary THA. Cox regression analyses identified that age ≥ 30 years and smoking was associated with THA reoperation in both uni- (HR 2.8, CI 1.1–7.3, HR 3.7, CI 1.0–13) and multivariable (HR 4.0, CI 1.1–15, HR 7.8, CI 1.7–37) analyses. Preoperative osteoarthritis (Tönnis grade 2) was weakly associated with THA in multivariable (HR 31, CI 2.6–384) analysis. A total of 10 (10%) cases had an unexpected reoperation due to other reasons than a secondary THA, and the most common reason was nonunion (<i>n</i> = 6, 6.3%). Forty-four (43%) patients had an adverse event. The most common was a transient nerve injury.</p><h3>Conclusions</h3><p>The PAO procedure is a suitable option in young patients with symptomatic dysplasia of the hip in order to avoid, or at least delay, hip arthroplasty.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13090176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147715796","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":"Functional and quality-of-life outcomes after metal-on-polyethylene articulating spacer implantation for periprosthetic knee infection: a retrospective evaluation of a prospectively collected cohort","authors":"Giovanni Balato,&nbsp;Enrico Festa,&nbsp;Tiziana Ascione,&nbsp;Domenico De Mauro,&nbsp;Donato Di Gennaro,&nbsp;Massimo Mariconda","doi":"10.1007/s00402-026-06260-0","DOIUrl":"10.1007/s00402-026-06260-0","url":null,"abstract":"<div><h3>Introduction</h3><p>This study aims to evaluate functional and quality-of-life (QoL) outcomes in patients with periprosthetic joint infection (PJI) undergoing implantation of a metal-on-polyethylene articulating knee spacer as part of a planned two-stage revision, and to explore preoperative predictors of meaningful postoperative improvement.</p><h3>Methods</h3><p>This was a retrospective observational study including 108 consecutive patients with chronic PJI treated with a metal-on-polyethylene articulating spacer between 2016 and 2020 and followed prospectively for clinical outcomes. QoL and joint-specific function were assessed preoperatively and before planned reimplantation using EQ-5D-5 L, Western Ontario and McMaster University (WOMAC), and Knee Society Score (KSS). Minimum clinically important difference (MCID) thresholds were derived using a distribution-based method. Receiver operating characteristic (ROC) analysis identified baseline predictors of achieving MCID.</p><h3>Results</h3><p>All outcome measures improved significantly after spacer implantation (<i>p</i> &lt; 0.001), exceeding MCID thresholds for pain and function. The largest EQ-5D-5 L domain gain was for pain/discomfort. Predictive thresholds for achieving MCID were an EQ-5D-5 L index ≤ 0.44 and WOMAC index ≥ 42.5. Female sex was associated with better preoperative and postoperative WOMAC and KSS scores.</p><h3>Conclusion</h3><p>Metal-on-polyethylene articulating spacers are associated with short-term improvements in pain, mobility, and QoL during the interval between stages of revision for PJI. Patients with poor baseline status may experience the greatest benefit, thereby supporting consideration of avoiding definitive reimplantation (1.5 stage). While these interim results may inform patient selection for leaving the spacer indefinitely, long-term follow-up is required to determine durability.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13090179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147715816","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":"Does the preoperative CPAK classification influence clinical outcomes after medial and lateral unicompartmental knee arthroplasty? Short-term outcomes and phenotype distribution in a retrospective series of consecutive cases","authors":"Stefano Campi,&nbsp;Carlo Esposito,&nbsp;Antongiulio Manfreda,&nbsp;Edoardo Franceschetti,&nbsp;Giacomo Rizzello,&nbsp;Gianluca Vadalà,&nbsp;Umile Giuseppe Longo,&nbsp;Rocco Papalia","doi":"10.1007/s00402-026-06235-1","DOIUrl":"10.1007/s00402-026-06235-1","url":null,"abstract":"<div><h3>Introduction</h3><p>Recent evidence suggest that mechanically aligned TKAs may yield heterogeneous outcomes across CPAK categories, but whether this applies to unicompartmental knee arthroplasty (UKA) remains unclear. This retrospective study evaluated the influence of preoperative CPAK category on postoperative clinical outcomes after UKA, with additional analyses assessing CPAK distribution, residual varus alignment, and their relationship with patient-reported outcomes.</p><h3>Materials and methods</h3><p>A total of 312 consecutive UKAs (280 patients) with ≥ 1-year follow-up were analyzed. Preoperative HKA and JLO were measured on weight bearing long-leg radiographs, and patients were classified according to the CPAK system. Outcomes were compared across the six most represented CPAK groups (I – VI) in 253 patients with complete PROM data.</p><h3>Results</h3><p>Mean postoperative OKS was 40.5 ± 5.3, with a mean ΔOKS of 21.3 ± 8.7 and 97% patients’ satisfaction. No significant differences were observed among CPAK categories for OKS (<i>p</i> = 0.80), ΔOKS (<i>p</i> = 0.90), or satisfaction (<i>p</i> = 0.70), and alignment-based grouping (varus, neutral, valgus) showed similarly homogeneous outcomes. Residual varus ≥ 5° did not adversely affect results (<i>p</i> &gt; 0.10), and no meaningful correlation was found between aHKA and postoperative OKS (<i>r</i> = − 0.003, <i>p</i> = 0.96). CPAK distribution differed significantly by sex (<i>p</i> &lt; 0.001). Five patients were revised (2 for persistent pain, 1 for PCL instability, 2 for infection).</p><h3>Conclusions</h3><p>Preoperative CPAK phenotype did not influence short-term clinical outcomes after UKA, and no heterogeneity in PROMs was detected across phenotypes. These findings support UKA as a reliable and alignment-tolerant procedure across a wide range of coronal morphotypes. Prospective studies with postoperative long-leg radiographs and longer follow-up are warranted to determine whether CPAK preservation influences long-term survivorship.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13090233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147715743","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}