Accurate alignment correction is closely correlated with functional results after corrective osteotomy for knee joint deformities. Traditionally, osteotomy procedures were performed on the basis of the surgeon's experience and direct visual estimation. However, discrepancies between the planned and achieved corrections usually exist due to pre- and intraoperative errors. Digitized orthopedic surgery is an exciting field that utilizes computer science and medical engineering to facilitate personalized surgical treatment. Its potential in corrective osteotomy for treating knee joint deformity deserves a comprehensive review. This review searched the relevant literature in the Web of Science, Scopus, and PubMed, and focused on three aspects: three-dimensional (3D) printed patient-specific instrumentation, computer navigation system, and surgical robots. The characteristics and research status of digitized corrective osteotomy for treating knee joint deformities are outlined. The first-hand experiences from relevant papers and potential future advances in clinical, educational, and research areas were summarized. Current concerns about the already used approaches were clarified. Technological innovations in corrective osteotomy have steadily evolved with the aim of ensuring surgical precision and alignment accuracy, simplifying operational procedures, and improving patient outcomes. Digitized orthopedic surgery has favorable potential in terms of surgical practice, skill training, and delivery of healthcare information. Surgical navigation systems with synthetic functions of planning, training, and robotic assistance should be developed.
Amputation has a profound impact on an individual's quality of life (QoL) and functional ability. While socket prostheses are the current first-line treatment, they often cause socket-related issues. Bone-anchored prostheses (BAP) have been introduced to address these problems and improve the amputee experience. This systematic review and meta-analysis aim to compare the QoL between bone-anchored and socket prostheses in transfemoral amputees. A systematic review and meta-analysis were conducted from November 2023 to July 2024, following PRISMA guidelines. Databases including PUBMED, EMBASE, Scopus, Cochrane, and Web of Science were searched. Studies of single-arm trial design comparing pre- and post-operative outcomes were selected based on specific inclusion and exclusion criteria. Statistical analysis was performed using inverse variance with a random effect model. The primary outcome was QoL, measured using the Questionnaire for Persons with a Transfemoral Amputation (Q-TFA) and 36-Item Short Form Survey (SF-36), and the secondary outcome was mobility, assessed by the 6-Minute Walk Test (6MWT). Subgroup analyses compared different types of BAP (Press-fit vs. Screw-type) on QoL. Thirteen NRCTs with 398 participants were included. Significant improvements in QoL were observed in all Q-TFA domains and the SF-36 Physical Component Score (PCS), but not in the SF-36 Mental Component Score (MCS). Mobility improved significantly as measured by the six-minute walk test (6MWT). No significant differences in QoL were found between Press-fit and Screw-type BAP implants. Overall, BAP significantly improve both QoL and mobility, but study limitations currently restrict their use to individuals with socket-related complications. As such, it cannot yet be universally recommended as a first-line intervention.
Pain management in elderly patients with hip fractures has received more and more attention, which is crucial for promoting recovery and reducing complications. At present, there are various and controversial analgesic methods for this population. This meta-analysis evaluated the analgesic effects and side effects of intravenous analgesia compared to different nerve block techniques, including femoral nerve block, fascia iliaca block or pericapsular nerve group block, in this patient group. The study was conducted following the PRISMA 2020 guidelines. A search was performed in October 2024 across PubMed, Web of Science, Cochrane Library, and Embase. Pain scores at different time points, supplemental analgesic morphine consumption, and adverse reactions were compared between intravenous analgesia and nerve blocks. Data were collected from 12 studies and 1157 elderly patients using intravenous analgesia and nerve block after hip fracture, with no differences in sample size, mean age, or percentage of females between the two groups at baseline. Compared to intravenous analgesia, nerve blocks showed significant advantages in the pain score of 2 h after block (SMD-0.80; 95% CI: −1.23 to −0.38; I2 = 90%) and the supplemental analgesic morphine consumption (SMD = −0.46; 95% CI: −0.73 to −0.19; I2 = 59%). The incidence of adverse reactions and the pain scores at various time points also demonstrated significant differences between the two groups. The application of nerve blocks in elderly patients with hip fractures demonstrates significant clinical advantages, particularly in postoperative pain management, decreasing opioid use, and reducing postoperative complications.
Background: Osteoporotic vertebral compression fractures (OVCFs) are prevalent among the elderly. Percutaneous vertebroplasty (PVA) is a commonly adopted minimally invasive treatment, yet many patients endure residual back pain (RBP) posttreatment, affecting their recovery and quality of life. Given the inconsistent prevalence of RBP across studies and the multitude of influencing factors, a systematic review and meta-analysis is necessary to determine its prevalence and identify risk factors.
Methods: English (PubMed, Embase, Web of Science, Ovid, Cochrane Library) and Chinese (CNKI, WanFang Data, VIP, CBM) literature databases were systematically searched until December 31, 2023. A random-effects meta-analysis was used to pool prevalence rates from individual studies. The associations between the identified risk factors and RBP were also analyzed. Sensitivity and subgroup analyzes were performed to identify the source of heterogeneity and to compare the prevalence estimates across the groups. The Joanna Briggs Institute's (JBIs) quality assessment checklist was used to evaluate the quality of the included studies. The I2 tests were used to assess heterogeneity among the studies.
Results: A total of 5146 articles were collected. Finally, 26 articles involving 9703 participants were included. Among them, 1245 experienced RBP. The prevalence of RBP in individual studies ranged from 4.56% to 50.00%, with a median of 14.90%. The pooled prevalence was 16.3% (95% CI: 13.5%–19.1%). The prevalence was higher among females [16.1% (95% CI: 13.1%–19.1%)] than males [15.9% (95% CI: 12.5%–19.2%)]. Subgroup analysis based on evaluation time showed that the prevalence was higher at 3 months or more after surgery [total: 17.3% (95% CI: 13.2%–21.4%) vs. 15.7% (95% CI: 12.1%–19.2%), males: 16.5% (95% CI: 12.3%–20.6%) vs. 15.3% (95% CI: 11.0%–19.6%), females: 16.9% (95% CI: 12.6%–21.1%) vs. 15.5% (95% CI: 11.6%–19.5%)]. Regarding the risk factors, several factors demonstrated significant associations with RBP. Patients with low pre-bone mineral density were more likely to experience RBP compared to those with higher density. Moreover, thoracolumbar fascia injury, unsatisfactory cement distribution, multiple vertebral fractures, and postoperative vertebral body height recovery rate were also identified as risk factors increasing the likelihood of RBP.
Conclusion: RBP is common after PVA, indicating the imperative of intervention strategies to alleviate the suffering and reduce negative ramifications. Moreover, various risk factors should be comprehensively considered to accurately assess patients' conditions and formulate targeted treatment and rehabilitation plans to alleviate patients' RBP symptoms.
Background: Conflicting evidence exists regarding the impact of total hip arthroplasty (THA) on valgus knee deformities in patients with developmental dysplasia of the hip (DDH). The aim of this retrospective study was to identify the factors potentially contributing to the worsening of valgus knee deformities in DDH patients after THA.
Methods: This retrospective case–control study included 51 patients (69 hips) with Crowe type IV DDH who underwent primary THA between January 2018 and January 2020. The anatomic lateral distal femoral angle (aLDFA), mechanical lateral distal femoral angle (mLDFA), anatomic medial proximal tibial angle (MPTA), hip–knee–ankle (HKA) angle, anatomic tibiofemoral angle (TFA), joint line convergence angle (JLCA), tibial joint line angle (TJLA), femoral offset (FO), acetabular offset (AO), global offset (GO), and extent of leg lengthening were measured before and after THA. The case group comprised patients who complained that their valgus knee deformity worsened after THA, and the control group comprised those who did not. Hip-level data were compared using generalized linear mixed effects models for proportions/rates and linear mixed models for means.
Results: The case group has 19 hips, and the control group has 50 hips. Both groups showed improvement in the HKA after THA (p < 0.05), but the case group presented with a smaller HKA (177.4 ± 2.4 vs. 175.2 ± 2.7, p < 0.001) and greater AO (5.8 ± 1.0 vs. 5.0 ± 1.0, p = 0.011) and GO (7.9 ± 0.7 vs. 7.0 ± 1.1, p = 0.003) values before THA. After THA, GO decreased in both groups, and the TJLA increased in the case group (0.6 ± 2.6 to 2.3 ± 3.5, p = 0.011).
Conclusions: THA improved the HKA in DDH patients. However, a decrease in GO could lead to an increase in the TJLA, suggesting pseudoprogression of the valgus knee deformity and therefore lead to complaints of worsening of valgus knee deformities. GO restoration during surgery may reduce the impact on the TJLA.
Objectives: Subtrochanteric fractures have anatomic characteristics distinct from intertrochanteric fractures that may affect the positioning of the spiral blade during surgical treatment. Tip-apex distance (TAD) and calcar-referenced tip-apex distance (Cal-TAD) were measured to determine if these measures are reliable indicators to assist in the accurate placement of intramedullary nails and minimize postoperative complications.
Methods: For patients treated with proximal femoral nail antirotation (PFNA) internal fixation between 2016 and 2020, we analyzed the TAD, Cal-TAD, and postoperative complications. Fracture healing was assessed radiographically at 6-week intervals until union. The incidences of axial cut-off, cephalad cut-off, and non-union were also examined. Analysis of variance and Fisher's exact test were performed to evaluate differences in complications between the TAD and Cal-TAD groups.
Results: Data from 104 patients (58 males, 46 females) with a mean age of 56.9 years were analyzed. Fracture healing was observed in 90 (86.5%) patients at an average time of 14.92 ± 1.81 weeks. The healing rate was significantly higher when the TAD and Cal-TAD were controlled within the 20–25 mm range (p < 0.05). Postoperative complications occurred in 14 (13.5%) cases [cephalad cut-off, n = 5 (4.8%); axial cut-off, n = 4 (3.8%); non-union, n = 5 (4.8%)]. Five (4.8%) complications occurred without internal fixation failure. The fracture healing time and incidence of complications differed among groups defined by TAD and Cal-TAD measurements, and were shortest and lowest, respectively, in the 20 mm < TAD/Cal-TAD < 25 mm group.
Conclusions: In our cohort, use of PFNA internal fixation for treatment of unstable femoral subtrochanteric fractures and placement of the spiral blade in the middle or lower 1/3 of the femoral neck did not increase the incidence of complications. Therefore, we propose that the TAD rule of 20–30 mm should not apply to subtrochanteric fractures, and TAD and Cal-TAD should be controlled within the range of 20–25 mm to reduce the incidence of complications.
Objective: The object of this retrospective study was to compare the clinical, radiological, and spinal stability outcomes of biportal endoscopic Unilateral Laminectomy for Bilateral Decompression (BE-ULBD) and traditional Unilateral Laminectomy for Bilateral Decompression (ULBD) for multi-segmental lumbar spinal stenosis in elderly patients with osteoporosis.
Methods: We retrospectively identified 41 and 47 patients who underwent BE-ULBD and ULBD, respectively, who were diagnosed with multi-level lumbar stenosis and underwent double-segmental surgery in elderly patients. The clinical outcomes were evaluated using visual analogue scale (VAS) score for both back and leg pain, Oswestry Disability Index (ODI) score, and Zurich Claudication Questionnaire score during the two-year follow-up. The radiological changes of cross-sectional dural area (DCSA), facet joint preservation rate (PFJR) and cross-sectional fat infiltration ratio (FI) on the surgical side were evaluated by MRI before and after operation. At 2 years after operation, progressive spondylolisthesis and instability were evaluated in the X-ray of the lumbar spine.
Results: After 24 months of follow-up, the VAS scores for both back and leg pain, ODI, and Zurich Claudication Questionnaire in both groups were recovered compared to pre-operation. The postoperative VAS score for lower back pain in the BE-ULBD group was lower than in the ULBD group (1.00 ± 0.95 vs. 1.91 ± 1.07, p < 0.001), and the postoperative VAS score for lower limbs was similar (0.49 ± 0.51 vs. 0.46 ± 0.72, p < 0.001). The postoperative ODI score was lower than that of the ULBD group (9.05 ± 5.01 vs. 12.09 ± 6.18, p < 0.001), and the postoperative ZCQ score of the BE-ULBD group was lower than that of the ULBD group (10.59 ± 2.18 vs. 8.85 ± 1.59, p < 0.001; 7.00 ± 1.12 vs. 7.87 ± 1.63, p = 0.012; 8.95 ± 2.11 vs. 10.74 ± 2.47, p < 0.001). In terms of radiological evaluation, the DCSA of patients in both groups was effectively improved after surgery. Compared with the ULBD group, the BE-ULBD group had a tiny improvement in DCSA (195.04 ± 34.54 vs. 180.93 ± 31.07, p = 0.048) and a better FI (43.48 ± 10.24 vs. 53.93 ± 7.62, p < 0.001). The PFJR was higher (85.90 ± 4.03 vs. 81.26 ± 4.56, p < 0.001) in the BE-ULBD group. Two years after surgery, fewer patients in the BE-ULBD group had spondylolisthesis than in the ULBD group (1/41 vs. 7/46, p = 0.043). The results of complications were similar between the two groups.
Conclusion: BE-ULBD is a safe and effective technique for multilevel decompression surgery in elderly patients, which can better protect spinal stability and has better long-term follow-up than traditional surgery.
Background: S-ROM prosthesis, one well-used femoral prosthesis in the patients with developmental dysplasia of the hip (DDH), has a skipping size of the distal stem diameter. The purpose of this study was to investigate whether its 2-mm incremental diameter could meet clinical needs for high-riding DDH patients.
Methods: Between July 2018 and December 2022, the Hartofilakidis type C DDH patients with S-ROM stem (9 or 11 mm) were retrospectively enrolled according to the inclusion criteria and exclusion criteria in our institute. The intraoperative femur fractures, the diameter of the femoral medullary cavity, the canal filling ratio of the S-ROM stem, the closure conditions of the stem slot, and the healing rate of subtrochanteric osteotomy were analyzed to evaluate the effect of stem design on clinical outcomes. Statistical analyses were conducted using independent samples t-tests, chi-square test, and logistic regression analysis with a significance threshold of p < 0.05.
Results: A total of 95 patients (109 hips) were included in this study, including 60 hips with 9 mm S-ROM and 49 hips with 11 mm S-ROM. Compared with the 9 mm S-ROM group, the 11 mm S-ROM group presented nearly 5 times the intraoperative fracture rate (16.3%, 3.3%, p < 0.05). The mean diameter of the femoral medullary cavity in the 9 mm S-ROM group was 0.84 ± 0.20 mm and in the 11 mm S-ROM group was 1.03 ± 0.18 mm. The canal filling ratio in the 9 mm S-ROM group is significantly lower than that of the 11 mm S-ROM group. In the 11 mm S-ROM group, the filling ratio of the femoral medullary cavity of fracture hips was significantly higher than that in non-fracture hips.
Conclusion: The S-ROM design with a distal stem diameter increment of every 2 mm would increase the risk of intraoperative periprosthetic femoral fractures in high-riding DDH patients. It is necessary for a 1-mm increment of distal stem diameter in such patients.
Level of Evidence: Level III, retrospective comparative study.
Objective: The Collum Femoris Preserving (CFP) stem offers biomechanical advantages in total hip arthroplasty (THA). However, aseptic loosening remains the most common cause of failure and other severe complications, with specific risk factors associated with the CFP stem remaining inadequately defined. This study aims to investigate the possible factors associated with aseptic loosening.
Methods: This study retrospectively analyzed patients who underwent primary THA with the CFP stem from January 2004 to December 2009 in our institution. Patients were divided into two groups based on whether there was aseptic loosening. Demographic and imaging parameters were collected from medical records and the hospital's Picture Archiving and Communication System (PACS). Comparative analyses were conducted, and variables with significant differences were subjected to Cox regression to identify independent risk factors of aseptic loosening.
Results: A total of 469 hips were included, with 52 hips (11.1%) of aseptic loosening identified. Seven independent risk (protective) factors were found, including ceramic-on-polyethylene (COP) bearing surfaces (Hazard Ratio = 2.084, 95% Confidence Interval: 1.043–4.166, p = 0.038), history of steroid therapy (HR = 2.393, 95% CI: 1.056–5.425, p = 0.037), neck resorption ratio (NRR) (HR = 1.019, 95% CI: 1.005–1.033, p = 0.008), bone mineral density (BMD) (HR = 0.933, 95% CI: 0.891–0.976, p = 0.003), canal fill ratio (CFR) (HR = 0.951, 95% CI: 0.923–0.980, p = 0.001), cortical index (HR = 0.933, 95% CI: 0.891–0.976, p = 0.003), and varus/valgus angle between 3° and 6° (HR = 4.427, 95% CI: 2.303–8.509, p < 0.001), varus/valgus angles > 6° (HR = 8.854, 95% CI: 3.704–21.165, p < 0.001).
Conclusion: This study identifies key risk factors contributing to aseptic loosening, including COP bearing surfaces, steroid therapy history, excessive femoral neck resorption, and significant varus/valgus malalignment. Conversely, higher BMD, improved cortical index, and favorable CFR were protective against loosening. These findings underscore the need for careful preoperative assessment and precise intraoperative positioning to optimize long-term implant stability.
Objective: Idiopathic glenohumeral adhesive capsulitis, known as idiopathic frozen shoulder (IFS) and characterized by pain and limited motion of the shoulder, is often treated by arthroscopic capsule release surgery, though residual symptoms may remain postoperatively. Due to overlapping symptoms and shared anatomical involvement, it is hard to distinguish the source of shoulder pain between concurrent long head of the biceps tendon (LHBT) inflammation and IFS. The study aimed to verify that LHBT tenotomy, compared with leaving it in situ, could provide better pain reduction and shoulder mobility in early rehabilitation of post-arthroscopic IFS capsule release surgery.
Methods: From January 2020 to January 2022, 73 patients with idiopathic adhesive capsulitis were divided into two groups based on the preoperative LHBT lesions and treatment received for LHBT: tenotomy or left in situ. All patients underwent arthroscopic capsular release, coracohumeral ligament release, and subacromial decompression. Outcomes were measured before surgery and at 1, 3, 6, 12, and 24 months and final follow-up postoperatively, including shoulder functional scores, joint range of motion, visual analog scale (VAS) score for pain, and complications. T-test, Chi-square test, and Fisher's test were performed to analyze the data.
Results: This study found that while functional scores and joint range of motion of both groups improved significantly in the final follow-up, the LHBT tenotomy group showed lower VAS scores for pain at 1 (2.2 ± 0.8) and 3 months (2.1 ± 0.6) postoperatively (p < 0.001). Additionally, there was better shoulder mobility in external rotation compared to the LHBT left in situ group at 1–12 months postoperatively (p < 0.001). There was no significant difference in postoperative complications between the two groups.
Conclusion: In idiopathic adhesive capsulitis patients undergoing arthroscopic release, LHBT tenotomy led to significant improvements in joint mobility and pain reduction in early rehabilitation stages compared with leaving LHBT in situ, despite two groups showing no significant difference at the final follow-up postoperatively.
Objective: Intramedullary nailing is a treatment method for metastatic humerus fractures that stabilizes a large area while minimizing damage to the surrounding soft tissues. However, the results of this treatment may vary depending on certain factors. This study aimed to investigate the factors influencing functional outcomes and survival in patients with pathological humeral fractures treated using humeral nails.
Methods: This retrospective study included 41 patients who underwent humeral nailing for metastatic pathological humerus fractures between 2009 and 2024. Functional outcomes were compared based on factors such as gender, age, cancer type, another pathological fracture surgery, visceral metastases, cancer diagnosis prior to fracture, fracture type and location, and cement use, using VAS improvement, MSTS, KPS scores, and ROM measurement. Survival analysis was performed considering these same factors. Statistical analyses included the Mann–Whitney U test, Kruskal-Wallis test, Chi-square test, and Kaplan–Meier survival curves. Cox regression analyses were used to identify factors associated with mortality.
Results: In younger patients, better VAS improvement(p = 0.001), MSTS(p = 0.038), KPS(p = 0.028), and ROM(p = 0.045) were observed compared to those 65 and older. Cancer type and visceral metastases negatively impacted MSTS(p = 0.007, p = 0.049) and KPS(p = 0.002, p = 0.022). Actual fractures showed greater VAS improvement than impending fractures(p = 0.002), and shaft fractures had greater VAS improvement than proximal fractures(p = 0.037). Unknown cancer diagnosis prior to fracture led to better VAS improvement(p = 0.008), MSTS(p = 0.018), KPS(p = 0.023), and ROM(p = 0.006). Rapid growth tumor(p < 0.001) and visceral metastasis(p = 0.007) were independently associated with poor survival. No significant effects were seen for gender or cement use on functional outcomes and mortality.
Conclusion: Although intramedullary nails are feasible implants for humeral pathological fractures, there are significant factors that affect their functional outcomes and survival. Actual fractures and shaft fractures showed better pain relief. Patients with a known cancer diagnosis prior to fracture and older patients had poor functional outcomes. Rapid cancer type and visceral metastasis negatively affect both functional outcomes and survival. Although cement use carries a risk of thrombosis, no significant changes in mortality and functional outcomes were observed with cement use.
Level of Evidence: IV.
Objective: Given the rising incidence of postoperative urinary tract infections (UTIs) in elderly patients with hip fractures and their substantial impact on mortality and functional recovery, identifying accessible predictors for early risk stratification is critical to improving perioperative management. This study aimed to investigate the association between preoperative inflammation/immune markers and the occurrence of postoperative UTIs in the vulnerable population.
Methods: This study examined elderly patients who underwent hip surgery for hip fractures at our institution from March 2014 to June 2024. Preoperative inflammation/immune markers such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune inflammation index (SII) were measured. Receiver operating characteristic (ROC) curves were used to identify optimal cutoff values for each marker. To control the potential confounding factors, multivariate logistic regression analysis and propensity score matching analysis were conducted, resulting in adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to assess the strength of the association between each marker and UTIs.
Results: A total of 1238 patients were included in this study, of whom 287 (23.18%) developed postoperative UTIs. Among elderly hip fracture patients, NLR demonstrated the highest predictive value for postoperative UTIs compared to PLR and SII (area under the curve [AUC] = 0.608, 95% CI: 0.571–0.645). High NLR (OR = 1.57, 95% CI: 1.16–2.13), high PLR (OR = 1.59, 95% CI: 1.16–2.19), and high SII (OR = 1.75, 95% CI: 1.29–2.37) were significantly associated with the incidence of postoperative UTIs using the best cutoff values. Additionally, a dose–effect relationship was observed for this association (p for trend < 0.05). These results remained significant even after propensity score matching.
Conclusions: Preoperative inflammatory/immune markers NLR, PLR, and SII exhibited independent associations with the development of postoperative UTIs in elderly hip fracture patients undergoing surgery. Furthermore, a dose–effect relationship was observed for this association.
Objective: Conventional Unilateral Biportal Endoscopic (UBE) surgery usually requires general anesthesia (GA), which introduces additional risks to patients with significant medical comorbidities. This article explores the use of UBE decompression under local anesthesia (LA) in elderly patients with severe medical comorbidities treated at our institution, providing valuable clinical insights for the application of this technique.
Methods: A retrospective analysis was conducted on patients clinically diagnosed with lumbar spinal stenosis (LSS) at our center between November 2021 and March 2024, who underwent UBE decompression surgery under local LA. The data collected included demographics, visual analog scale (VAS) scores for leg pain, oswestry disability index (ODI), and modified Macnab grades. The UBE decompression procedure was divided into seven key steps, and intraoperative pain and the effectiveness of LA were assessed using patient self-reported VAS scores at each step. Data comparisons between the preoperative, postoperative, and follow-up time points were conducted using paired sample t-tests.
Results: Eighteen patients (5 males and 13 females) with an average age of 77.1 ± 5.0 years were included in the study, with 83.3% (15 patients) having medical comorbidities. The average follow-up period was 14.8 ± 7.9 months. At 3 months postoperative and final follow-up, both VAS scores for leg pain (p < 0.001) and ODI scores (p < 0.001) showed significant improvement. According to the modified Macnab criteria, outcomes were rated as excellent in 13 patients (72.2%), good in one (5.6%), fair in two (11.1%), and poor in one (5.6%), yielding an excellent-good rate of 77.8%. None of the patients voluntarily requested surgery termination because of unbearable intraoperative pain.
Conclusions: For elderly patients with medical comorbidities, UBE decompression under LA is a viable and effective treatment option, yielding favorable clinical outcomes.
Objective: To investigate the effects of warmed irrigation fluid during shoulder arthroscopy on patient temperature regulation, recovery outcomes, and cognitive function.
Methods: A randomized single-blind prospective study (Level II) and a total of 85 patients who underwent shoulder arthroscopy at our hospital from February 2022 to April 2023 were selected, all of whom signed informed consent, which was randomly divided into two groups (warmed irrigation fluid group and room temperature fluid group). Among them, there were 29 males (34.1%) and 56 females (65.9%) (male:female ratio = 1:2), with an average age of 60.80 ± 11.70 years (ranging from 19 to 79 years). There were 50 patients (58.8%) aged over 60 and 35 patients (41.2%) aged under 60. All patients were diagnosed with rotator cuff injuries. We recorded primary patient data, anesthesia duration, anesthesia method, surgery duration, intraoperative temperature protection measures, irrigation volume, intraoperative nasopharyngeal and rectal temperatures, and preoperative and postoperative Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores. Statistical analysis was performed to evaluate the impact of warmed irrigation fluid on patient temperature, recovery, and cognitive status.
Results: Analysis of the data from the 85 shoulder arthroscopy patients indicated that warming the irrigation fluid effectively prevented a decrease in core body temperature (nasopharyngeal and rectal temperatures), with significant differences observed at 120 min (nasopharyngeal temperature) and 105 min (rectal temperature). Patients with warmed irrigation fluid had a shorter average anesthesia recovery time than those without warming, although this difference was not statistically significant. Analysis of MMSE and MOCA scores revealed that the areas of cognitive decline post-surgery mainly involved cumulative memory and attention, while orientation was not affected. Education level was identified as a factor influencing cognitive decline.
Conclusion: The administration of warmed irrigation fluid during shoulder arthroscopy has effectively preserved patients' core body temperature. This practice may contribute to a reduction in recovery time and complications associated with the procedure. Furthermore, minimally invasive techniques such as arthroscopy have been associated with a decreased incidence of postoperative cognitive impairment.
Background: The global increase in total hip arthroplasty (THA) has led to widespread use of cementless femoral stems. The Collum Femoris Preserving (CFP) stem, initially designed as an epiphyseal-stabilized prosthesis, aims to preserve proximal bone and reduce stress shielding. However, long-term observations have revealed unexpected proximal bone resorption and distal sclerosis, challenging this classification. This study aims to reassess the fixation pattern and long-term complications of CFP stems to inform clinical decision-making.
Methods: Between 2006 and 2012, 497 patients (705 hips) were included. The primary outcomes included prosthesis survival, periprosthetic bone remodeling, and clinical outcomes, assessed using the Harris Hip Score (HHS). Kaplan–Meier survival analysis was performed, with endpoints of prosthesis loosening and reoperation. Radiographic data were analyzed to evaluate periprosthetic bone remodeling.
Results: A total of 497 patients (705 hips) with a mean follow-up of 10.4 years were included. The long-term survival rate of the CFP stem was 95.32%, with a 97.2% survival rate for aseptic loosening and 95.5% for reoperation. Complications included 2.84% aseptic loosening, 0.99% infection, 0.99% periprosthetic fractures, 0.57% dislocation, and 1.42% heterotopic ossification. The CFP stem, which has not shown signs of aseptic loosening, exhibits radiographic features characteristic of a distal-stabilized prosthesis.
Conclusion: The long-term survival rate of the CFP prosthesis was 95.32%. Radiographic findings indicate that the CFP prosthesis should be considered a distal-stabilized prosthesis rather than the traditionally regarded epiphyseal-stabilized prosthesis.
Objective: Total hip arthroplasty (THA) in Crowe IV hip was a challenge for surgeons, along with some complications. Currently, most evaluations focused on the surgical techniques and radiographs, which were indirectly measured parameters and easily affected by the operators. Objective factors were not considered. This study aimed to investigate objective factors to predict the complications.
Methods: We retrospectively reviewed a series of Crowe IV patients who received THA between July 2010 and December 2019 in our hospital. Demographics and surgical parameters were collected: gender, age, height, weight, sides of preoperative knee valgus, limb length discrepancy, hip surgical history, osteotomy length, acetabular prosthesis position, acetabular prosthesis sizes, femoral prosthesis, femoral head sizes, femoral prosthesis distal sizes, and acetabular liner. The complications periprosthetic fractures, periprosthetic infection, polyethylene lining wear, postoperative dislocation, limited flexion, limp, knee valgus, knee pain, thigh pain (distal femoral prosthesis), and hip abnormal noise were recorded. Univariable and multivariable logistic regression analyses were used to identify the predictors of complications.
Results: A total of 136 Crowe IV patients (176 hips) were included in this study. The mean follow-up time was 8.87 ± 2.60 (5–14) years. The mean limb length discrepancy was 2.73 ± 2.05 cm. Thirty-two hips had a surgical history. One hundred and three hips underwent intraoperative osteotomy, and the mean osteotomy length was 3.42 ± 1.22 (1–7) cm. Complications occurred in 45% (79/176) Crowe IV hips. The height (odds ratio [OR]: 0.00; 95% confidence interval [CI]: 0.00–0.26), and preoperative left knee valgus (OR: 0.37; 95% CI: 0.16–0.88) were identified as independent significant factors for complications in Crowe IV hips. A residual limp was observed in 34.09%, knee valgus was 23.3%, hip abnormal noise was 7.39%, knee pain was 1.7%, thigh pain (distal femoral prosthesis) was 1.14%, and limited flexion was 0.57%. The incidence of polyethylene lining wear was 6.3%, periprosthetic fractures was 1.7%, postoperative dislocation was 1.14%, and periprosthetic infection was 0.57%.
Conclusion: Our model provided a framework to guide decision-making in Crowe IV hips for surgeons. A tall Crowe IV patient with preoperative left knee valgus was found to have a lower rate of complications.
Objective: Increased marrow fat fraction (MFF) of vertebrae was detected in patients with osteoporosis. However, MFF of the fractured vertebrae decreased significantly following the fracture. The aim of this study was to assess the predictive value of fractured vertebrae MFF quantified on T2-weighted Dixon sequences for the prediction of nonunion risk of acute OVCF.
Materials and Methods: Medical records of 39 patients with OVCF, including a total of 60 fractured vertebrae, were reviewed retrospectively. Fractured vertebrae in the acute phase were grouped into the nonunion group (20 vertebrae) and the union group (40 vertebrae), based on the OVCF prognosis confirmed by computer tomography (CT). MFF of the fractured vertebrae was quantitatively assessed with the software Matlab on T2-weighted Dixon sequences. Interclass correlation coefficients (ICC) were analyzed to assess the repeatability of MFF measurement. Binary logistic regression analysis was performed to determine the relative contribution of the MFF for predicting the prognosis of OVCF. Receiver operating characteristic (ROC) curve analysis was performed to determine the diagnostic performance of MFF.
Results: The ICC indicated that the repeatability of MFF measurement was excellent (all p < 0.001). The MFF (42.25% ± 26.61%) decreased significantly compared to the value before OVCF (79.84% ± 9.65%) (p < 0.001). The MFF of the fractured vertebrae was lower in the nonunion group (16.40% ± 15.65%) than in the union group (55.18% ± 20.93%) (p < 0.001). Binary logistic regression analysis indicated that MFF of fractured vertebrae could independently predict the prognosis of acute OVCF (p < 0.001). ROC analysis indicated the area under the curve was 0.928 (95% CI, 0.831–0.979, p < 0.0001).
Conclusions: The MFF quantified on T2-weighted Dixon sequences was a useful marker for assessing the nonunion risk of acute OVCF. The fractured vertebra with low MFF should be carefully monitored for nonunion.
Objective: Acute compartment syndrome is a major orthopedic emergency due to elevated pressure in the closed muscle compartment, and prompt evaluation and fasciotomy are always needed. However, the gold standard indicator of fasciotomy is still under debate. To date, few studies have investigated the variations in compartmental pressure at different locations in people of different ages. The aim of the research was to compare compartmental pressure among different age groups and measurement locations.
Methods: A total of 154 healthy individuals including 106 males and 48 females over 18 years (46.8 ± 14.0 years) were enrolled between January 2020 and December 2021, and classified into five age groups: Group I = 18–30 years; Group II = 31–40 years; Group III = 41–50 years; Group IV = 51–60 years; and Group V ≥ 61 years. Six measurement locations (lower, middle, and upper points, 6 points) were selected to assess pressure variations in the anterior compartment and posterior superficial compartment with the iCare device, which calculates biomechanical properties based on the tissue's inherent response. Differences in pressure among the five age groups and six measurement locations (three for anterior compartment, three for posterior superficial compartment) were examined. One-way ANOVA and LST tests were used to conduct comparisons among five independent age groups.
Results: In the same measurement location, the compartmental pressure in Group V at the upper anterior (anterior fascial compartment) measurement location was increased compared with that in Groups I, III, and IV. However, the compartmental pressures at the middle anterior and posterior measurement locations were almost comparable among the five different age groups. In the same age group, the compartmental pressure was more inclined to be lower at the upper anterior measurement location in Groups I–IV. However, no significant differences were observed for other measurement locations.
Conclusions: The measurement results demonstrated comparable compartmental pressure in the fascial compartment at most measurement locations. The fascia, which forms the limb compartment, may play a role in pressure release or redistribution after injury or fracture due to its function and unique or interconnected structure.
Objective: Residual cam deformity is the main cause of revision hip arthroscopy, and the precise correction of cam lesions is a crucial clinical problem. This study aimed to propose a novel quantitative evaluation and preoperative planning method based on 3D-CT profile analysis applied in primary hip arthroscopy for the treatment of cam-type femoroacetabular impingement syndrome (FAIS) and to evaluate the effect of this method.
Methods: Consecutive patients who underwent primary hip arthroscopy for cam-type FAIS between April 2018 and August 2022 were enrolled in this study. According to the method assisting cam resection, the included patients were divided into the planning group and the control group. Patients' demographic characteristics, preoperative radiographic measurements, and intraoperative procedures were collected. Preoperative and postoperative anterior α angle (Aα) and lateral α angle (Lα) were measured on 3D-CT profiles, and the residual rates of anterior cam lesion (Ac) and lateral cam lesion (Lc) were calculated. Moreover, the 2-year postoperative clinical outcomes, including clinical scores and achieving rates of clinically significant outcomes, were compared between groups.
Results: Eventually, the planning group included 68 patients and the control group included 57 cases. There were no significant differences in demographic characteristics, preoperative radiographic measurements, and intraoperative procedures between groups (p > 0.05). Postoperatively, the mean postoperative Lα in the planning group was significantly smaller than that in the control group (43.4° ± 9.5° vs. 60.8° ± 20.8°, p < 0.001). Correspondingly, patients in the planning group had a significantly lower rate of residual Lc (9.4% vs. 62.5%, p < 0.001) and overall residual cam lesion (14.7% vs. 54.4%, p < 0.001) compared to cases in the control group. At 2-year follow-up postoperatively, patients in the planning group reported significantly superior scores of mHHS (91.0 ± 6.0 vs. 86.3 ± 8.5, p = 0.001), iHOT-12 (89.9 ± 7.2 vs. 82.7 ± 11.1, p < 0.001), and VAS for pain (1.2 ± 0.8 vs. 1.6 ± 1.1, p = 0.018) compared to patients in the control group. Moreover, the percentage of cases achieving patient acceptable symptom state (PASS) for mHHS in the planning group was significantly higher than that in the control group (97.1% vs. 84.2%, p = 0.012).
Conclusions: Quantitative analysis using 3D-CT profiles is a reliable method for the evaluation of femoral morphology in patients with cam-type FAIS. Additionally, preoperative planning based on 3D-CT profiles can reduce the residual rate of cam lesions and improve short-term clinical outcomes in these patients who underwent primary hip arthroscopy.
Objective: Double plate (DP) fixation does not significantly improve outcomes compared to lateral locking plate (LLP-only) fixation for distal femur fractures (DFFs). We hypothesize this is due to the absence of clear indications for the application of these two fixation methods. This study aims to clarify the impact of metaphyseal defect size on the outcomes of these two treatments, in order to optimize surgical efficacy and minimize complications.
Methods: We screened patients with distal femoral fractures treated with lateral locking plate or dual plate fixation at our hospital between January 2018 and June 2023 retrospectively. Information such as demographic data, fracture classification, operation details, metaphyseal bone defect size, pre-nd post-operative imaging data, and other medical records were compiled. Additionally, patients' recovery status was follow-up, including evaluation of knee joint function (Lysholm score), range of motion (ROM), and EQ-5D-3L health score. We used diverse statistical methods for further analysis, such as t-test, chi-square test, Pearson correlation coefficients, and binary logistic regression analysis.
Results: According to the specified criteria, 55 distal femur fracture cases were ultimately included, with 38 cases in the LLP-only group and 17 cases in the DP fixation group. In terms of surgical and follow-up information, there were no statistical differences in healing status, but there were statistically significant differences in average blood loss (p = 0.013), metaphyseal bone defect size (p < 0.001), Lysholm score (p = 0.003), and EQ-5D score (p = 0.010). Notably, compared to other parameters, the size of the fracture defect exhibited the highest correlation (0.69) with healing outcomes. In logistic regression analysis, the defect size (OR 1.052, 95% CI 1.008–1.098, p = 0.021) was independently associated with the healing outcome. Upon further analysis, non-healing cases in the LLP-only group were predominantly associated with A3, C2, and C3 type fractures, with 83.3% of these patients presenting metaphyseal defects exceeding 15 mm.
Conclusions: We carried out a comparative evaluation of LLP-only versus DP fixation in addressing DFFs. Our research outcomes revealed that LLP-only fixation yielded notably suboptimal results compared to DP fixation, especially in intricate fractures accompanied by defects, such as those classified under types A3, C2, and C3. Furthermore, the more significant the defect, the less effective the fixation of LLP-only will be. This observation underscores the pivotal role of the scope of metaphysical damage in determining the most suitable internal fixation techniques for DFFs.
Objective: In total hip arthroplasty (THA), intraoperative periprosthetic femoral fracture (IOPFF) is a significant concern, often occurring during femoral canal instrumentation and stem implantation due to proximal femur strain. However, the impact of different stem designs on this strain remains unclear. This study conducted a biomechanical analysis comparing strain patterns on the proximal femur during the implantation of three stem types: single taper, double taper, and collared stems. This study aims to explore if there is a difference in strain patterns placed on the proximal femur during the implantation of three different stem types: single taper, double taper, and collared stems?
Methods: There were 24 cadaveric femurs randomly assigned to three groups based on implant geometry: Smith and Nephew anthology (single taper), synergy (double taper), and polar (collared) stems. Strain gauges were placed on the proximal femur to measure strain during implantation in both horizontal and vertical directions. Peak strain, the difference between maximum strain at final impaction and baseline, was recorded. The Kruskal–Wallis test compared peak strain between stem designs.
Results: At the medial proximal femur, collared stems produced compressive strain (−276) in the horizontal vector, differing significantly from the tensile strain generated by single (41, p = 0.009) and double taper stems (218.5, p = 0.003). No significant strain difference existed between single and double taper stems at the medial proximal femur. At the lateral proximal femur, double taper stem impaction resulted in compressive strain (−69), significantly differing from the tensile strain produced by single taper (221, p = 0.024) and collared stem impaction (462, p = 0.009). No strain differences were observed in other tested areas.
Conclusion: This study highlights distinct strain patterns at the medial and lateral proximal femur depending on the stem type. Collared stems induce compressive strain at the medial proximal femur, while double taper stems result in compressive strain at the lateral proximal femur. Understanding these differences may help reduce IOPFF risk in THA procedures. Based on these findings, the use of collard stems would be preferable over single or double taper stems in elderly patients with suboptimal bone quality, as it reduces strain on the medial cortex and improves immediate stability.
Purpose: Adult spinal deformity (ASD) patients undergoing pedicle subtraction osteotomy (PSO) with long fusion to the pelvis have a high risk of rod failure at the PSO level or adjacent areas. This study aimed to investigate the biomechanical advantages of novel duet screws (multiaxial screws with dual heads) plus satellite rods in ASD correction using finite element models and cadaveric specimens.
Methods: A lumbar-pelvis finite element model was constructed, and Von Mises equivalent stress was used to analyze the structural stress under different fixation constructs. Six human cadaveric spine segments (T11-S2) were selected to validate the finite element results. L3 PSO was performed, with posterior fixation from L1 to pelvis using S2-alar-iliac (S2AI) screws, and satellite rods (L2-L4) were connected to the primary rods using duet screws. Three fixation constructs were evaluated: two rods (Group A), three rods (Group B), and four rods (Group C). In Group B, a biomechanical test was performed on two sides: single rod side (Group B-S) and double rods side (Group B-D). In vitro motion tests were performed under pure moments in lateral bending (LB), flexion/extension (FE), and axial rotation (AR) to measure the range of motion. Rod strain was measured at L3 and S2.
Results: Finite element analysis revealed stress concentration near the PSO site, the screw bases, and the L5-S1 region. The use of duet screws with satellite rods significantly reduced primary rod stress. Cadaveric tests showed that all fixation constructs significantly reduced motion in LB, FE, and AR compared to the intact condition (p < 0.001). No significant differences in total motion or motion at the upper lumbar segments (L1-L3) were observed among the three groups, but differences were found in the lower lumbar segments (L4 and L5) and the sacrum (p < 0.007). Increasing the number of satellite rods significantly decreased rod strain (p < 0.004). Group B-D showed significantly lower rod strain compared to Group B-S (p < 0.042), indicating that satellite rods combined with duet screws were highly effective in reducing primary rod strain at L3. Satellite rods also reduced primary rod strain at the sacrum.
Conclusions: This study supports clinical practice, providing biomechanical evidence for using four-rod constructs with duet screw-based satellite rods in L3 PSO and long fusion. Satellite rods dispersed rod strain, potentially reducing pseudarthrosis and rod breakage at PSO and sacrum without compromising spinal motion.
Trial Registration: Registered in ClinicalTrials (NCT06144879)
Objective: Osteoarthritis (OA) and osteoporosis (OP) are highly prevalent in postmenopausal women; however, their relationship remains complex and controversial. This study aimed to investigate whether anti-OP treatment alleviates osteoarthritis symptoms and reverses disease progression.
Methods: This prospective clinical study enrolled 30 postmenopausal women diagnosed with OP and concomitant knee OA who visited our outpatient clinic between January and June 2023. Patients received anti-osteoporotic treatment comprising calcium carbonate, vitamin D3, and alendronate (ALN). BMD, WOMAC, and VAS scores were assessed at 6 and 12 months. In animal studies, OP was induced in rats by ovariectomy, followed by OA induction via anterior cruciate ligament sectioning and meniscectomy. ALN treatment was administered for 8 weeks, and evaluations of behavior, macroscopic appearance, pathology, and subchondral bone microstructure were performed 8 weeks after OA induction. One-way ANOVA was used for multiple group comparisons, and Spearman's rank correlation was used to assess associations.
Results: Clinical outcomes demonstrated that one-year anti-OP therapy achieved dual therapeutic benefits: a 9.3% increase in bone mineral density (BMD) was accompanied by a 36.54% reduction in knee OA symptoms. Statistical analysis revealed a strong positive correlation between BMD improvement and symptomatic relief (r = 0.76, p < 0.05). In the animal model, OP markedly accelerated OA progression, leading to more severe cartilage damage, as confirmed by symptoms, macroscopic cartilage appearance, and histological evaluations. Micro-CT analysis revealed abnormal subchondral bone microarchitecture in OP animals. Notably, ALN treatment partially reversed OA progression, as evidenced by reduced cartilage degeneration, improved subchondral bone microstructure, and enhanced bone remodeling.
Conclusion: Anti-OP treatment alleviates knee OA symptoms in OP patients. Postmenopausal OP accelerates OA progression, while anti-OP therapy can partially reverse this effect. These findings highlights the importance of anti-OP treatment in managing both conditions.
Objective: Anterior controllable antedisplacement and fusion (ACAF) is an effective strategy in treating cervical ossification of the posterior longitudinal ligament (C-OPLL). The controllable antedisplacement of the vertebrae-OPLL complex (VOC) through screws is both the most critical and technically challenging procedure, especially in osteoporosis (OP) condition. This study aims to introduce a modified method to significantly improve the procedure of VOC antedisplacement in ACAF.
Methods: The modified ACAF was used to treat 22 patients both with C-OPLL and OP from January 2020 to January 2023. The cohort comprised 17 females and 5 males, with an age of 60.68 ± 1.2 years (50–71 years). During this modified ACAF, bone cement was injected into the VOC, and the corresponding steps of grooving were improved. Japanese Orthopedic Association (JOA) score, complications, and fusion conditions were documented. A paired t-test was used to compare the changes before and after surgery.
Results: Twenty-two C-OPLL patients were successfully treated by the modified ACAF. The operation time was 270.5 ± 14.8 min, and the intraoperative blood loss volume was 303.6 ± 13.0 mL. All patients were followed up for 26.55 months on average. The JOA score with 12.18 ± 1.68 at the last follow-up was significantly improved (vs. 8.59 ± 1.89 of presurgery, p < 0.05). No cement leakage was found during the augmentation, and 0.4 mL of bone cement was injected in each VOC, which obviously enhanced screws anchorage. All VOCs were successfully hoisted after the augmentation without screw loosening. Twenty-two C-OPLL patients achieved satisfactory fusion at the last visit.
Conclusions: Bone cement augmentation with modified steps of grooving can effectively assist the VOC antedisplacement in ACAF for OP group and has potential instantaneous revision ability for the intraoperative screw loosening for no-OP group.
Objective: The use of intramedullary implants for the treatment of pertrochanteric fractures is well-established. Nail entry pathway error is a common intraoperative challenge, particularly in pertrochanteric fractures with unstable greater trochanter fragment. This study introduces our innovative virtual lateral wall technique, which allows “lateral wall fracture” simplification from unstable to stable and effectively guides the reamer to create an accurate entry pathway for nail insertion in the treatment of pertrochanteric fractures.
Methods: A retrospective study was conducted on 12 consecutive cases of pertrochanteric fractures in our department between September 2022 and January 2024. The study population included three men and nine women, aged 68–90 years. Fractures were classified according to the AO/OTA system: one case of AO/OTA 1.3, one case of AO/OTA 2.2, and 10 cases of AO/OTA 2.3. All patients underwent surgical treatment with the proximal femoral nail anti-rotation (PFNA) implant. The surgical technique involved creating a “virtual lateral wall” using two 2.5-mm K-wires inserted into the greater trochanter from anterolateral to posteromedial to stabilize the unstable greater trochanter fragment and guide the nail entry. Intraoperative fluoroscopy was used to confirm the correct nail entry point and pathway. Surgical outcomes, including operative time, fluoroscopic exposure time, tip-to-apex distance (TAD), femoral neck-shaft angle, lag screw placement, and reduction quality based on the modified Baumgaertner criteria, were analyzed to evaluate the feasibility and efficacy of the technique. Complications were also recorded.
Results: The mean operative time was 33.3 ± 10.1 min, with an average blood loss of 58.3 ± 20.8 mL. Intraoperative fluoroscopy was used 13.8 ± 5.4 times, and the surgical incision length was 6.2 ± 0.7 cm. Postoperative radiographic evaluation revealed a femoral neck-shaft angle of 129.4° ± 5.5° and a tip-to-apex distance of 23.3 ± 4.4 mm. The lag screw was consistently positioned inferiorly within the femoral head. All cases achieved good reduction quality according to the modified Baumgaertner criteria. No severe complications, such as neurological or vascular damage, were observed during or after surgery.
Conclusions: The virtual lateral wall technique has demonstrated remarkable efficacy in preventing nail insertion complications in patients undergoing proximal femoral nail treatment for pertrochanteric fractures, particularly those characterized by an unstable lateral wall. This technique provides a reliable method for achieving accurate nail position, making it a valuable addition to the surgical management of complex pertrochanteric fractures with unstable greater trochanter fragment.