Journal of Orthopaedic Surgery最新文献

BackgroundRestoring native alignment or allowing slight residual varus is often considered optimal in medial unicompartmental knee arthroplasty (UKA). However, it remains unclear whether postoperative alignment remains stable over time and which preoperative factors contribute to varus progression.MethodsWe retrospectively reviewed 126 medial UKAs performed between 2017 and 2022 with a minimum follow-up of 3 years. Standing long-leg radiographs were obtained preoperatively, at 1-3 months postoperatively, and at final follow-up. Hip-knee-ankle (HKA), medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), and tibial plateau tip-to-proximal tibial shaft (TPTPS) angle were measured. Change in alignment (ΔHKA) was defined as the difference between final and immediate postoperative HKA. Correlation and multivariate regression analyses were performed to identify predictors of ΔHKA, and clinical outcomes were analyzed relative to preoperative alignment.ResultsMean HKA increased from 2.7° to 4.2° at final follow-up (p < 0.001). The proportion of outliers (HKA >5°) increased from 17% to 39%. ΔHKA was significantly correlated with preoperative HKA (r = 0.471), MPTA (r = -0.388), and TPTPS (r = 0.355) (all p < 0.001). In multivariate regression analysis, preoperative HKA, LDFA, and MPTA independently predicted ΔHKA (R² = 0.295, p < 0.001). No association was found between ΔHKA and clinical outcomes.ConclusionVarus progression may occur after medial UKA, particularly in patients with preoperative varus alignment and proximal tibial varus. Surgeons should consider these factors when determining intraoperative alignment targets to avoid excessive residual varus.

PurposeThis study aimed to evaluate the clinical and financial outcomes of the My PreHab Program (MPP), a digitally delivered, patient-led prehabilitation initiative for patients undergoing elective hip or knee arthroplasty across two metropolitan hospitals.MethodsAn observational cohort study of MPP participants compared to a standard care group (SCG). MPP participants were invited via text message to complete a Health Assessment Questionnaire (HAQ) and received tailored health information on modifiable risk factors. For analysis, demographic data, length of stay (h = hours), hospital-acquired complications, readmission rates and hospital costings were collected from hospital records and the digital platform's website.ResultsA 24-h reduction in length of stay was observed in MPP participants compared to the SCG (MPP: 107 h vs SCG: 131 h, p = <0.001). The average cost of an admission for MPP participants was $2,251.85 less than SCG. MPP participants rated the program as acceptable (3.6/5), appropriate (3.6/5), and feasible (3.8/5).ConclusionMPP demonstrated promising results, specifically by reducing length of stay and hospital costs. These findings support broader implementation of digitally delivered, self-administered prehabilitation programs as an effective, affordable strategy in elective surgery pathways.

BackgroundDistal clavicle fractures and acromioclavicular joint dislocations frequently require surgical stabilization, and hook plate fixation is widely used but can be complicated by peri-implant fractures. This study aimed to evaluate patient, anatomical, and implant-related factors associated with peri-implant fractures after hook plate fixation for these injuries.MethodsA retrospective cohort study was conducted at a single tertiary center including adults who underwent open reduction and internal fixation with a pre-contoured clavicle hook plate for distal clavicle fractures or acromioclavicular joint dislocations between October 2013 and November 2023. Demographic data, implant characteristics, and radiographic parameters (clavicle diameter, clavicle length, plate diameter, plate length, and their ratios) were collected. Patients with and without peri-implant fracture were compared using univariable statistical tests, and exploratory univariable logistic regression was performed to estimate associations between selected variables and peri-implant fracture.ResultsAmong 282 patients, 9 (3%) developed peri-implant fractures after hook plate fixation. Patients with peri-implant fractures were older, shorter, and had lower body weight than those without fractures. The peri-implant fracture group also showed a smaller clavicle-to-plate diameter ratio, a higher plate-to-clavicle length ratio, and more frequent use of plates with a greater number of holes, indicating relatively thinner clavicles and disproportionately longer plates.ConclusionsPeri-implant fractures after hook plate fixation for distal clavicle fractures and acromioclavicular joint dislocations were uncommon in this cohort but were associated with older age, smaller skeletal build, longer plates, and poor dimensional matching between the clavicle and plate. Careful assessment of clavicle morphology and judicious selection of plate length may help reduce stress concentration at the medial plate end and lower the risk of peri-implant fracture.

BackgroundThe optimal positioning range for the femoral component in unicompartmental knee arthroplasty (UKA) performed in osteoporotic bone remains undefined. Most existing biomechanical studies have been established using normal bone quality models, whereas limited evidence addresses abnormal bone conditions. Complications involving the operative-side compartment are closely associated with the high revision rates after UKA.MethodsCT and MRI scans of the right knee of a volunteer without pathological changes were used to construct a three-dimensional finite element model. A normal bone quality UKA model (NB group) was created, and an osteoporotic model (OP group) was generated by reducing the elastic modulus of bone tissue proportionally. Femoral component alignment was set at 0°, as well as 3°, 6°, and 9° of varus and valgus. Stress changes within operative-side structures were quantified and compared between the two models.Results(1) In both models, peak stress on the femoral component increased progressively with greater varus alignment, with the OP group consistently demonstrating higher stress values than the NB group. Compared to their respective 0° neutral position, the peak von Mises stress on the femoral component surface increased by 71.8% and 70.8% at 9° of varus in the NB and OP groups, respectively. (2) Peak stresses on the PE insert and on the cortical bone beneath the tibial component increased with both varus and valgus malalignment; the increase was more pronounced under varus. The OP group exhibited higher peak stresses and greater incremental changes than the NB group. Compared to their respective 0° neutral position, the peak von Mises stress on the cortical bone surface beneath the tibial component increased by 50.0% in the NB group and 40.8% in the OP group at 9° varus, and by 14.2% and 27.0%, respectively, at 9° valgus.ConclusionEven small coronal-plane deviations (±3°) in femoral component positioning during medial UKA may substantially elevate stresses within the operative-side compartment. Strict control of coronal alignment is essential to avoid varus or valgus and prevent abnormal stress concentrations around the implant. Additionally, the impact of osteoporosis on postoperative biomechanical stability warrants careful consideration to optimize implant design and surgical technique, thereby reducing the risks of aseptic loosening, periprosthetic fracture, and improving long-term outcomes.

PurposePatients withspinal degenerative diseases are often older and have multiple comorbidities. This study aims to evaluate the impact of epidural patient-controlled analgesia (PCA) on postoperative pain relief in patients undergoing lumbar spine surgeries for spinal degenerative diseases.MethodsThis retrospective case-control study included patients who underwent lumbar spine surgeries for degenerative spinal stenosis, spondylolisthesis, herniated intervertebral discs, or osteoporotic spinal fractures with spinal stenosis. The PCA group consisted of patients who received 72-h epidural PCA for postoperative pain control, while the control group received standard postoperative pain management. All patients were allowed to request intramuscular rescue analgesics for additional pain control. The primary endpoint was defined as the mean visual analogue scale (VAS) score during the effective PCA period (postoperative day [POD] 1-3). Secondary endpoints included individual daily VAS scores, rebound pain, rescue analgesic injections, morphine consumption, drainage duration, drainage volume, length of hospital stay, and complications.ResultsA total of 209 patients (mean age 73.8 years) were included, with 88 patients in the PCA group and 121 in the control group. Mean VAS score across POD 1-3 was significantly lower in the PCA group (Cohen's d = -1.89, 95% CI = -2.22 to -1.56, p < 0.001). During hospitalization, the PCA group required significantly fewer rescue analgesic injections (Cohen's d = -2.47, 95% CI = -2.84 to -2.11) and less total morphine consumption (Cohen's d = -0.39, 95% CI = -0.67 to -0.11) compared to the control group. Although the PCA group experienced greater drainage volume and longer duration of drainage placement, the incidence of infection and the length of hospital stay were comparable between the two groups.ConclusionIn this real-world cohort of elderly patients with multiple comorbidities undergoing lumbar spinal surgery, epidural PCA provided effective pain relief without an observed increase in infection rates in this study population.

BackgroundThe routine use of postoperative drainage after total knee arthroplasty (TKA) remains controversial, particularly in the era of modern blood-saving strategies. While drains have traditionally been used to reduce hematoma formation, their effect on early postoperative pain has not been clearly established. This study aimed to evaluate whether postoperative drainage influences early pain outcomes following primary TKA.MethodsAn assessor-blinded randomized comparative study was conducted including 60 patients undergoing primary hybrid TKA with posterior cruciate ligament preservation. Patients were randomly allocated to a drainage or no-drainage group, with stratification by sex. All patients followed identical anesthetic, surgical, and multimodal analgesic protocols, including routine administration of tranexamic acid. Pain was assessed using the visual analogue scale (VAS) preoperatively and at 48 h postoperatively. The number of postoperative morphine rescue doses was recorded as an objective pain-related outcome. Secondary outcomes included haemoglobin level at discharge and length of hospital stay.ResultsNo significant differences were observed between the drainage and no-drainage groups regarding postoperative VAS pain scores, morphine rescue requirements, haemoglobin levels at discharge, or length of hospital stay (all p > 0.05). In both groups, postoperative pain was significantly lower than preoperative pain (p < 0.05). Higher body mass index was associated with greater preoperative pain but did not influence postoperative pain outcomes.ConclusionWithin contemporary perioperative protocols including tranexamic acid, routine use of postoperative drainage after primary TKA does not improve early postoperative pain control or reduce opioid requirements. These findings support omitting routine drainage without compromising early pain outcomes.

BackgroundOrthopaedic infections are difficult to eradicate because biofilm and poor local vascularity limit antibiotic exposure. Continuous local antibiotic perfusion (CLAP) delivers sustained, titratable antibiotics directly into infected compartments. We used harmonised individual participant data (IPD) to quantify early effectiveness, longer-term control, safety, and patient-level modifiers.MethodsWe performed an IPD review of observational reports using CLAP as primary or adjunctive therapy (January-May 2025). The primary outcome was 30-days early response (C-reactive protein ≤3 mg/L or earliest sustained clinical/wound improvement). Secondary outcomes were durable infection control at ≥6 and ≥12 months using evaluable denominators with best-worst bounds, infection-free days) and safety. One-stage analyses used mixed-effects logistic regression; Restricted Mean Survival Time (RMST) was preferred when proportional hazards were violated. Multiple imputation supported inferences.ResultsEighty-one studies (n = 256) were included; 164 patients had observed time-to-response. Fifty-nine percent achieved a 30-days response; median time-to-response was 26 days. Implant involvement was associated with lower odds of 30-days response; trajectories were slower with implants and higher organism burden (polymicrobial ≥3), while osteomyelitis responded faster than fracture-related infection. RMST (30) showed delays with implants (+4.43 days) and polymicrobial infection (+6.74 days), and faster response for osteomyelitis versus fracture-related infection (-9.06 days). Durable control among evaluable patients was 88.4% at ≥6 months and 90.2% at ≥12 months, with best-worst bounds of 89.2-82.2% and 90.9-83.5%, respectively. Infection-free-day RMST supported substantial time free of recurrent infection within the first year. Adverse events were uncommon; renal events were generally reversible.ConclusionsCLAP achieved encouraging early response and high durability among evaluable patients, with slower trajectories when implants were retained or pathogen burden was high and faster responses in osteomyelitis. Safety appeared acceptable with monitoring. Prospective comparative studies using standardised endpoints, with RMST for non-proportional hazards, are warranted.

BackgroundTotal hip arthroplasty (THA) is an effective treatment for hip osteoarthritis (OA), improving pain, function, and quality of life (QOL). The Hip disability and Osteoarthritis Outcome Score (HOOS) is widely used to assess treatment outcomes; however, the minimal clinically important difference (MCID) in the short-term remains unclear. This study aimed to determine MCID values for HOOS at 3 and 6 months post-THA using the anchor method.MethodsThis multicenter prospective cohort study included patients with hip OA undergoing primary unilateral THA. HOOS subscales (symptoms, pain, activities of daily living [ADL], sport and recreation [SR], and QOL) were assessed preoperatively and at 3 and 6 months postoperatively. MCID was determined using receiver operating characteristic analyses with the Global Rating of Change scale as the anchor.ResultsA total of 127 patients were included in the analysis, with 107 patients assessed at 3 months and 102 at 6 months post-THA. At 3 months after THA, the MCID values for the HOOS subscales were 7.50 for symptoms, 8.75 for pain, 4.41 for ADL, 9.38 for SR, and 9.38 for QOL. At 6 months after THA, the corresponding MCID values were 12.50, 11.25, 23.53, 10.00, and 15.63, respectively.ConclusionShort-term MCID values for HOOS subscales post-THA were established, aiding early assessment of treatment effectiveness and guiding postoperative care.

BackgroundGamification has emerged as a novel approach in rehabilitation. This systematic review and meta-analysis aimed to evaluate the effectiveness of gamification-based exercises on foot posture in children and adolescents with flatfoot.MethodsA systematic review and meta-analysis were conducted in accordance with PRISMA guidelines, utilizing the PubMed, Scopus, Web of Science, and Google Scholar databases to search for original and peer-reviewed articles with selected keywords from inception to July 2025. The quality of the included studies was assessed using the Joanna Briggs Institute checklist. Statistical analysis was conducted with Comprehensive Meta-Analysis software version 3. To evaluate data heterogeneity, the Q-test and I² statistic were applied. Egger's test was used to assess publication bias.ResultsAfter searching the mentioned databases, 2160 articles were found. Finally, seven articles were included in the current review. It was shown that gamification-based exercise had a significant effect, leading to a reduction in navicular drop (95% CI = -1.796 to -0.516, p = 0.000) and an increase in balance scores (95% CI = -1.647 to -0.462, p = 0.000), compared to the passive control groups that did not receive any intervention. However, no significant differences were seen in the Staheli index (95% CI = -3.298 to 0.023, p = 0.053). High heterogeneity was noted in the navicular drop test (95% CI = -2.412 to -0.603, p = 0.001). Egger's test indicated no statistically significant publication bias for either navicular drop (p = 0.080) or Staheli index (p = 0.210).ConclusionThe results showed that exercise with gamification may be effective in improving foot alignment in children and adolescents. Specifically, positive effects were evident when using the navicular drop test, whereas no significant changes were detected with the Staheli index. However, interpretation should be made cautiously due to the limited number of studies and lack of age or gender stratification.

Study designA retrospective study.ObjectivesThis study aimed to evaluate the clinical and radiological outcomes of pedicle subtraction osteotomy (PSO) at L2 and L3 levels in ankylosing spondylitis (AS) patients with similar kyphotic deformities. The primary focus was to compare these levels in terms of spinal alignment, sagittal balance, and functional improvements.MethodsA retrospective analysis was conducted on 28 AS patients who underwent L2 or L3 level PSO between 2010 and 2021. Patients were divided into two groups based on osteotomy levels (14 in each group) and matched for similar kyphosis angles and deformity patterns. Radiological parameters, including pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), global kyphosis (GK), spinosacral angle (SSA), sagittal vertical axis (SVA), osteotomized vertebral angle (OVA) were measured preoperatively, immediately postoperatively, and at final follow-up using SURGIMAP. Functional outcomes were assessed using VAS, ODI, and BASFI scores.ResultsBoth groups showed significant improvements in sagittal alignment parameters such as PT, LL, and SVA postoperatively (p < 0.01). The L3 group demonstrated better sagittal balance, achieving the recommended SVA value (<47 mm) at follow-up, while the L2 group did not. There was no significant difference in radiological parameters between the groups (p > 0.05). Functional outcomes, including VAS, ODI, and BASFI scores, improved significantly in both groups (p < 0.001), with no significant differences between them.ConclusionsL2 and L3 PSO levels yielded comparable radiological and functional outcomes in AS patients with similar curve patterns. Both levels can be effectively utilized for correcting rigid kyphotic deformities, with L3 providing slightly better sagittal balance.