Archives of Orthopaedic and Trauma Surgery最新文献

{"title":"Different sagittal cutting plane orientations do not affect posterior tibial slope in open wedge high tibial osteotomy: a Sawbone model study","authors":"Elvin Gurbanov,&nbsp;Blaise Cochard,&nbsp;David Bauer,&nbsp;Hermes Miozzari,&nbsp;Philippe Tscholl","doi":"10.1007/s00402-026-06292-6","DOIUrl":"10.1007/s00402-026-06292-6","url":null,"abstract":"<div><h3>Purpose</h3><p>Control of the posterior tibial slope (PTS) is crucial in high tibial osteotomy (HTO), since unintended changes can alter the normal knee kinematics and ligament loading. This study investigated the influence of sagittal cutting plane orientations on PTS in bi-planar medial open wedge HTO (MOWHTO) on a Sawbone model.</p><h3>Methods</h3><p>Sixty Sawbone^® left-tibia models (A Pacific Research Company, USA) were used to perform biplanar MOWHTO with three sagittal orientations: (1) parallel to the medial tibial plateau (PO); (2) 10° anterior-inclined osteotomy (AIO); (3) 10° posterior-inclined osteotomy (PIO). The biplanar cut was performed distal to the tibial tuberosity in half the specimens and proximal in the remainder. Customized 3D-printed cutting guides ensured reproducibility. PTS and valgus correction were measured pre- and post-osteotomy using a navigation system. Group- and subgroup-specific ΔPTS were analyzed using a Bayesian multilevel model. Minimal clinically important difference (MCID) was set at 2.5°. Bayesian “power” analysis (assurance) was used to assess the sensitivity of ΔPTS and pairwise differences relative to the MCID.</p><h3>Results</h3><p>Across the three sagittal orientation and their distal/proximal subgroups, ΔPTS and pairwise ΔPTS did not exceed the predefined MCID of 2.5°. Bayesian assurance of equivalence exceeded 86% in every unit and pairwise comparison, indicating a high confidence that the evaluated HTO configurations are clinically equivalent with respect to ΔPTS.</p><h3>Conclusion</h3><p>In this experimental study, different sagittal osteotomy inclinations in MOWHTO showed no clinically relevant changes in posterior tibial slope. No significant differences were observed across sagittal cut orientations or ATT levels.</p><h3>Level of evidence</h3><p>In vitro biomechanical study.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06292-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147642719","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":"Comparative assessment of the reaming characteristics of two different technologies for intramedullary bone graft harvesting","authors":"Simone Guttau,&nbsp;Merle Lange,&nbsp;Ronja Finze,&nbsp;Claudia Beimel,&nbsp;Siamak Saifzadeh,&nbsp;Jonathan Gospos,&nbsp;Marie-Luise Wille,&nbsp;Philipp Kobbe,&nbsp;Markus Laubach","doi":"10.1007/s00402-026-06270-y","DOIUrl":"10.1007/s00402-026-06270-y","url":null,"abstract":"<div><h3>Introduction</h3><p>The study aimed to compare the biomechanical impact and reaming performance of two intramedullary bone graft harvesting techniques: the established Reamer-Irrigator-Aspirator 2 (RIA 2) system and a novel aspirator+reaming-aspiration (ARA) concept.</p><h3>Materials and methods</h3><p>In a preclinical in vivo sheep model, sixteen femora were assigned to either the RIA 2 or ARA group (<i>n</i> = 8 each). Biomechanical testing, computed tomography (CT)-based 3D bone geometry analysis, and fracture line assessment were performed postoperatively. Bending stiffness of the reamer shafts, cortical wall thickness pre- and post-reaming, and torsional stability of reamed femora were evaluated. Statistical analysis included TOST, Mann-Whitney U, and Shapiro-Wilk tests, considering values of <i>p</i> &lt; 0.05 as statistically significant.</p><h3>Results</h3><p>Both reaming systems produced the greatest cortical thinning medially in the midsections of the analyzed region. No statistically significant differences were observed in postoperative cortical wall thickness, bone removal rates, or torsional stability between groups (all <i>p</i> &gt; 0.05). Bending stiffness was significantly higher for the RIA 2 system (<i>p</i> = 0.004). In both groups, fractures predominantly initiated medially or at sites of previous drill holes. The ARA concept demonstrated equivalent biomechanical and reaming performance compared to the RIA 2 system, with a comparable safety profile.</p><h3>Conclusions</h3><p>In this preclinical in vivo comparison, the RIA 2 system and the ARA concept with BixCut reamers demonstrated equivalent reaming performance regarding cortical bone removal and femoral shaft geometry. Although the RIA 2 drive shaft exhibited greater bending stiffness, both systems induced comparable medial cortical thinning in the mid-diaphyseal region. Three-dimensional geometric analysis and ex vivo biomechanical testing showed no significant differences in residual cortical thickness or torsional stability. Fracture patterns were similar and correlated with areas of maximal medial thinning. Overall, both systems provided comparable reaming functionality and biomechanical outcomes.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06270-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147637744","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":"Differences in pelvic tilt and spinal alignment according to age in patients with hip dysplasia","authors":"Hiroto Funahashi,&nbsp;Yusuke Osawa,&nbsp;Yasuhiko Takegami,&nbsp;Hiroaki Ido,&nbsp;Takamune Asamoto,&nbsp;Shiro Imagama","doi":"10.1007/s00402-026-06281-9","DOIUrl":"10.1007/s00402-026-06281-9","url":null,"abstract":"<div><h3>Introduction</h3><p>We aimed to establish age-related characteristics of posture-dependent pelvic tilt and standing spinopelvic alignment in patients with symptomatic hip dysplasia (HD) from adolescence to middle age.</p><h3>Materials and methods</h3><p>A total of 101 patients with HD indicated for eccentric rotational acetabular osteotomy (ERAO) between 2016 and 2024 were included. Pelvic tilt in supine and standing positions was quantified using the anterior pelvic plane (APP) angle estimated from computed tomography-based 3D pelvic models matched to supine and standing anteroposterior hip radiographs. The change from supine to standing was calculated as standing minus supine; negative values indicated a posterior change. Three-dimensional acetabular coverage during postural transition was compared across age groups. Standing radiographic hip and spinopelvic parameters were also examined using multivariable regression analysis to identify factors associated with age.</p><h3>Results</h3><p>Age was correlated with the supine-to-standing change in the APP angle (r = 0.47, p &lt; 0.001). The change shifted closer to zero with increasing age, with younger patients showing a larger posterior change compared with older patients. Patients in their teens showed a more pronounced decrease in anterosuperior acetabular coverage at the 2 o’clock position compared with those in their 40 s (p = 0.017) and 50 s (p = 0.040). Furthermore, anterior wall index in standing (β = 0.26, p = 0.007), sagittal vertical axis (β = 0.24, p = 0.015), and sacral slope (β = 0.24, p = 0.014) were identified as independent factors associated with age.</p><h3>Conclusions</h3><p>Younger patients with HD showed a larger posterior change in pelvic tilt during postural transition compared with middle-aged patients. These findings support preoperative assessment of functional acetabular coverage in the standing position, particularly in the anterosuperior region in younger patients, when planning ERAO. Longitudinal studies are needed to determine whether maintaining anterior pelvic tilt during standing contributes to preservation of joint integrity into middle adulthood.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147621764","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":"External fixation versus reverse shoulder arthroplasty for proximal humerus fractures in the elderly: a retrospective comparative study","authors":"Antonio Vadalà,&nbsp;Cristiano Benelli,&nbsp;Francesco Suraci,&nbsp;Benedetto Carta,&nbsp;Giorgio Baldassari,&nbsp;Nicola Maffulli","doi":"10.1007/s00402-026-06286-4","DOIUrl":"10.1007/s00402-026-06286-4","url":null,"abstract":"<div><h3>Background</h3><p>The optimal management of displaced proximal humerus fractures (PHFs) in the elderly remains a subject of ongoing debate. This study aims to compare the clinical and functional outcomes of biologically driven external fixation (EF) versus functional joint replacement via reverse shoulder arthroplasty (RSA) in patients aged 65-80 years.</p><h3>Methods</h3><p>A retrospective comparative study was conducted on patients with displaced Neer two- or three-part PHFs treated between 2015 and 2022. The final analysis included 67 patients: Group A (EF; n=34) and Group B (RSA; n=33). Clinical and functional outcomes were quantified using the Constant-Murley Score (CMS), Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES) score, Disabilities of the Arm, Shoulder and Hand (Quick-DASH) score, and Range of Motion (ROM) assessment. Patient satisfaction was evaluated via a 5-point Likert scale.</p><h3>Results</h3><p>Both cohorts were homogeneous regarding mean age (72.2 ± 3.5 vs. 73.4 ± 3.8 years). Group A demonstrated significantly shorter mean operative times (48.2 ± 10.5 vs. 92.4 ± 15.2 min; p &lt; 0.001) and a lower requirement for blood transfusions (0% vs. 12.1%; p &lt; 0.05). At the final follow-up, both cohorts achieved comparable CMS (58.4 ± 8.2 vs. 55.2 ± 10.1; p = 0.42), SST (7.6 ± 1.5 vs. 7.0 ± 1.4; p = 0.38), and ASES scores (69 ± 7.8 vs. 65 ± 9.4; p = 0.51). Group A exhibited significantly superior external rotation (60.9° ± 9.2° vs. 46.5° ± 10.1°; p &lt; 0.01) and a trend toward better internal rotation (49° ± 16.2° vs. 42° ± 17.1°; p = 0.09). Subjective satisfaction was comparable (Likert score: 3.2 ± 0.8 vs. 2.9 ± 0.9; p = 0.16). The overall complication rate was 20.6% in Group A and 12.1% in Group B (p = 0.51).</p><h3>Conclusions</h3><p>Both EF and RSA are effective for managing PHFs in the elderly, yielding similar functional outcomes. However, EF represents a significantly less invasive, \"bio-friendly\" alternative, offering shorter surgical duration, no transfusion risk, and superior restoration of physiological rotations. The preservation of native anatomy and high patient satisfaction support EF as a viable treatment option in the geriatric population<b>.</b></p><h3>Level of Evidence</h3><p>Level III, Retrospective Comparative Study.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147621409","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":"Biomechanical comparison of palmar plate plus headless compression screw versus radiopalmar double plating in AO/OTA 23-C2.1 distal radius fractures","authors":"Patrick Riegner,&nbsp;Christian Spiegel,&nbsp;Felix Christian Kohler,&nbsp;Heike Kielstein,&nbsp;Ivan Zderic,&nbsp;Boyko Gueorguiev-Rüegg,&nbsp;Mark Lenz,&nbsp;Wolfram Weschenfelder","doi":"10.1007/s00402-026-06279-3","DOIUrl":"10.1007/s00402-026-06279-3","url":null,"abstract":"<div><h3>Introduction</h3><p>This biomechanical study compared the fracture stability of a palmar plate combined with a headless compression screw (HCS) with that of a radiopalmar double-plate construct for AO/OTA 23-C2.1 distal radius fractures with metaphyseal defect zones.</p><h3>Materials and Methods</h3><p>Eleven matched pairs of cryopreserved human radii were prepared with standardized AO/OTA 23-C2.1 fractures. Left radii (n = 11) were fixed with a palmar plate plus HCS, while right radii (n = 11) received a radiopalmar double-plate construct. Construct stiffness and axial displacement were assessed using a universal testing machine. Interfragmentary range of motion (ROM) and rotation (ROT) were quantified using an optical three-dimensional motion-tracking system. Measurements were obtained before and after 5000 cycles of dynamic axial loading at 150 N. Two specimen pairs were excluded due to early failure or incomplete data acquisition.</p><h3>Results</h3><p>Both constructs demonstrated comparable stiffness and axial displacement, with no implant loosening or hardware failure observed. Interfragmentary ROM did not differ significantly between groups. However, the plate–HCS construct showed greater variability in rotational parameters. Initial radial-shaft rotation was significantly greater in the plate–HCS group (1.14° vs. 0.51°, p = 0.02). After cyclic loading, ulnar-shaft rotation increased significantly in the plate–HCS group (0.97° to 1.16°, p = 0.02) but not in the double-plate group.</p><h3>Conclusion</h3><p>In this cadaveric model, fixation with a palmar plate combined with an HCS provided comparable axial stability but demonstrated greater variability and less consistent rotational control compared with radiopalmar double plating. Clinical studies are required to determine whether this less invasive construct achieves equivalent outcomes in vivo.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147621806","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":"Post-traumatic Candida infection leading to bilateral wrist rice body tenosynovitis: a case report and literature review","authors":"Shaohua Wang,&nbsp;Hyosim Ro,&nbsp;Hexing Xu,&nbsp;Longyun Fang,&nbsp;Xun Li","doi":"10.1007/s00402-026-06288-2","DOIUrl":"10.1007/s00402-026-06288-2","url":null,"abstract":"<div><h3>Background</h3><p>Rice body tenosynovitis is a rare condition of uncertain etiology characterized by the formation of multiple fibrinous particles within the synovium or synovial fluid. It is frequently associated with chronic inflammation due to infection or rheumatoid arthritis and most commonly affects large joints such as the shoulder and knee. Simultaneous bilateral wrist involvement following trauma is exceptionally uncommon.</p><h3>Case presentation</h3><p>A 59-year-old man presented with persistent bilateral wrist swelling for 10 months after a fall. MRI demonstrated extensive fluid accumulation and synovial thickening within the flexor tendon sheaths of both wrists. Surgical exploration revealed numerous yellow rice-like loose bodies and inflammatory proliferative tissue in the tendon sheaths. Pathology confirmed inflammatory granulation tissue with fibrinous exudate, and fungal culture identified Candida species infection. The left wrist recovered well after the initial surgery, but the right wrist recurred after 6 months and required a second thorough debridement, after which it resolved completely.</p><h3>Conclusions</h3><p>This report describes a rare case of bilateral wrist rice body tenosynovitis secondary to post-traumatic Candida infection with unilateral postoperative recurrence. It emphasizes that incomplete removal of inflammatory tenosynovium remains the primary cause of recurrence, even with targeted itraconazole antifungal therapy. Thorough exploration and radical excision of all inflammatory tissue and rice bodies during surgery are essential to prevent relapse.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147621421","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":"Are new implants for patellar fractures reasonable? A biomechanical comparison of intramedullary locking nails versus tension-band osteosynthesis","authors":"Nina Gercek,&nbsp;Charlotte Arand,&nbsp;Christian Glockner,&nbsp;Michael Nienhaus,&nbsp;Erol Gercek,&nbsp;Johannes Hopf,&nbsp;Pol Maria Rommens,&nbsp;Dominik Gruszka","doi":"10.1007/s00402-026-06277-5","DOIUrl":"10.1007/s00402-026-06277-5","url":null,"abstract":"<div><h3>Background</h3><p>Patellar fractures are predominantly treated surgically by open reduction and internal fixation using classic tension band osteosynthesis. Biomechanical testing was conducted to examine transverse patellar fracture stabilization using locked intramedullary nail systems in comparison to classic tension band osteosynthesis.</p><h3>Methods</h3><p>Twenty-four Sawbones^® with transverse patellar fractures type AO 34-C1.1 were divided equally into three test groups. Three principles for fracture stabilization were used: classical tension band osteosynthesis and newly developed locked intramedullary double nail- and single nail- prototypes. Knee motion (0°/0°/90°) was simulated in a dynamic test set-up using a “single muscle model” by applying tensile forces up to 300 N. The widening and the symmetry of the fracture gap were investigated over 1000 motion cycles using a video-optical system. The significance level was set at α = 0.05 for all statistical evaluations using the Bonferroni–Holm corrected unpaired unilateral t-test and mixed ANOVA with post-hoc Tukey test.</p><h3>Results</h3><p>The fixation principles showed different maximum fragment displacements of M = 2.04 ± 0.67 mm using classical tension band osteosynthesis, M = 1.34 ± 0.74 mm using intramedullary single nail system and M = 0.55 ± 0.31 mm using intramedullary double nail system. There was a statistically significant change in width of the fracture gap in flexed knee position comparing tension band osteosynthesis and double nail system (<i>p</i> = 0.0015) and comparing single nail and double nail system (<i>p</i> = 0.02). Furthermore, the tension-band osteosynthesis showed a significantly greater divergence from symmetry in the fracture gap compared to both intramedullary treatment methods (<i>p</i> &lt; 0.001).</p><h3>Conclusions</h3><p>Prototypes of locked intramedullary nail systems showed comparable fixation results for transverse patellar fractures compared to tension band wiring. They showed more symmetrical fracture gap openings during biomechanical testing and offered significantly higher stability to the fragments.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147621783","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":"In-hospital mortality among orthopedic trauma patients during and outside the COVID-19 pandemic: a nationwide population-based analysis of 2.67 million hospitalizations in Poland","authors":"Mariusz Jojczuk,&nbsp;Katarzyna Naylor,&nbsp;Kamil Filipek,&nbsp;Iwona Dolliver,&nbsp;Katarzyna Toborek,&nbsp;Krzysztof Goniewicz","doi":"10.1007/s00402-026-06275-7","DOIUrl":"10.1007/s00402-026-06275-7","url":null,"abstract":"<div><h3>Introduction</h3><p>Orthopedic trauma is a leading contributor to morbidity and mortality worldwide. The COVID-19 pandemic created unprecedented disruptions to hospital services, but its indirect effects on in-hospital mortality among orthopedic patients remain poorly quantified.</p><h3>Methods</h3><p>We conducted a nationwide retrospective analysis of 2 674 263 orthopedic hospitalizations in Poland between 2019 and 2023. Hospital admissions were classified as occurring during COVID-19 (19 months across five national pandemic waves) or non-COVID periods (41 months). We examined overall, age-stratified, and injury site–specific mortality using descriptive statistics, Z-tests for proportions, and effect size estimates including risk difference, relative risk, odds ratios, and number needed to harm.</p><h3>Results</h3><p>Overall in-hospital mortality was 1.06% (28 441 deaths). Mortality was significantly higher during the COVID-19 period than in non-COVID months (1.35% vs. 1.01%; RR 1.34, 95% CI 1.30–1.38; NNH 290). Age strongly modified outcomes: excess risk was minimal in young adults (18–40 years; NNH ~ 3 700), moderate in middle-aged patients (41–65 years; NNH ~ 621), and greatest among older adults (65 + years; NNH ~ 111). Mortality rose across all injury sites, with the largest absolute excess in head trauma (RD 0.68% points; NNH 148) and the steepest relative increase in chest injuries (RR 1.48, 95% CI 1.27–1.73).</p><h3>Conclusions</h3><p>The COVID-19 pandemic was associated with a marked rise in in-hospital mortality among orthopedic patients in Poland, disproportionately affecting older adults and those with head or chest injuries. These findings underscore the need for resilient trauma and orthopedic care pathways that maintain operative and critical care capacity during future health system disruptions.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06275-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147589533","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":"Extra-long femoral heads as a surrogate marker for revision risk in primary total hip arthroplasty","authors":"Gautier Beckers,&nbsp;Dominic Simon,&nbsp;Alexander Grimberg,&nbsp;Yinan Wu,&nbsp;Arnd Steinbrück,&nbsp;Boris Michael Holzapfel","doi":"10.1007/s00402-026-06273-9","DOIUrl":"10.1007/s00402-026-06273-9","url":null,"abstract":"<div><h3>Aims</h3><p>The effect of femoral head length on implant survival in total hip arthroplasty (THA) has been little studied so far. Longer heads may increase taper corrosion and reflect intraoperative complexity. This study evaluated factors associated with the use of extra-long heads (≥ XL) and their impact on implant survival.</p><h3>Methods</h3><p>We analyzed 562,001 primary THA from the German Arthroplasty Registry. Subgroup analyses were performed by hospital annual primary THA volume (≤ 250, 251–500, ≥ 501), surgical indication (primary osteoarthritis [OA] vs. femoral neck fracture [FNF]), and fixation method (cemented vs. cementless). Logistic regression identified factors associated with ≥ XL head use, and implant survival was compared between head lengths using Kaplan–Meier analysis in both subgroups and the overall cohort.</p><h3>Results</h3><p>The use of ≥ XL femoral heads decreased with increasing hospital volume (5.4% low, 4.5% medium, 3.0% high; <i>p</i> &lt; 0.001). Rates were higher in FNF than OA across all volumes (8.1% vs. 4.7% in low-volume hospitals; 5.0% vs. 2.7% in high-volume hospitals). Cemented fixation was independently associated with higher odds of ≥ XL head use (OR 1.14, 95% CI 1.09–1.18, <i>p</i> &lt; 0.001), with additional predictors including male sex (OR 2.13, 95% CI 2.06–2.19), BMI ≥ 40 (OR 1.94, 95% CI 1.77–2.12), higher Elixhauser comorbidity score (OR 1.09, 95% CI 1.04–1.15), and surgery for FNF (OR 1.92, 95% CI 1.83–2.02), while treatment at high-volume hospitals was associated with lower odds (OR 0.56, 95% CI 0.54–0.58). Kaplan–Meier analysis revealed higher cumulative revision rates with ≥ XL heads (7.2% vs. 4.5% at 9 years), consistent across all subgroups.</p><h3>Conclusion</h3><p>The use of femoral heads ≥ XL was independently associated with lower hospital THA volume, femoral neck fracture, cemented fixation, male sex, higher BMI, and greater comorbidity burden. Their implantation was also linked to higher revision rates, suggesting that ≥ XL heads may serve as a surrogate marker for increased revision risk after primary THA.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13035576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147580402","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":"Lateral unicompartmental knee arthroplasty through a medial parapatellar approach: surgical technique and mid-term results in 108 patients","authors":"Filippo Leggieri,&nbsp;Lorenzo Braconi,&nbsp;Mattia Chirico,&nbsp;Paolo Salari,&nbsp;Andrea Baldini","doi":"10.1007/s00402-026-06274-8","DOIUrl":"10.1007/s00402-026-06274-8","url":null,"abstract":"<div><h3>Introduction</h3><p>Lateral unicompartmental knee arthroplasty (L-UKA) is typically performed through a lateral parapatellar approach. Few studies of L-UKA performed through a medial approach are published. We aimed to present surgical tips, and mid-term clinical results and survivorships of L-UKA performed through a medial approach.</p><h3>Methods</h3><p>We retrospectively reviewed single-centre single-surgeon data from L-UKA using medial parapatellar approach between 2016 and 2023. Patients with follow-up &lt; 12 months were excluded. Primary endpoint was implant survivorship (time from index surgery to revision or last follow-up). Secondary endpoints included the rates of patients achieving Patient Acceptable Symptom State (PASS) thresholds: ≥ 67.5 for Knee Society Score-Knee (KSS-K) and ≥ 70.5 for Knee Society Score-Function (KSS-F). Survival analysis was used for implant survivorship. Logistic regression was performed for factors potentially associated with failure to achieve the PASS thresholds. Significance was set at <i>P</i> &lt; 0.05.</p><h3>Results</h3><p>Among 110 patients initially identified, two died before 12-month follow-up and were excluded from clinical outcome analysis, leaving 108 patients for functional assessment at a mean 47.6 months ± 24.5 of follow-up (range 12–96.7 months). No complications were reported during hospitalization. There were four failures (3.7%) overall: two cases (1.8%) of OA progression, one (0.9%) of aseptic loosening, and one case (0.9%) of periprosthetic fracture of the medial condyle requiring revision surgery. All 110 patients were included in survival analysis, with the 2 patients who died before 12 months included as censored data at time of death. The overall 7-year survivorship was 97.2% (95% CI 94.2–100%), declining to 92.1% at 84 months when the last revision occurred. PASS thresholds were achieved by 99.0% patients for KSS-Knee and by 86.1% for the KSS-F. Patient age was a significant predictor of failure to achieve functional PASS thresholds (OR = 1.3 per year, 95% CI 1.0–1.6, <i>p</i> = 0.036).</p><h3>Conclusions</h3><p>L-UKA performed through a medial parapatellar approach yielded excellent clinical outcomes and survivorship at mid-term follow-up.</p><h3>Level of evidence</h3><p>IV (retrospective case series).</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13035596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147580342","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}