Hasil untuk "Orthopedic surgery"

Yutaka Fujita, Tomoharu Mochizuki, Shigeru Takagi et al.

Abstract Purpose To evaluate and compare clinical and radiological outcomes of surgical strategies for osteochondritis dissecans (OCD) lesions across ICRS grades, and to investigate the impact of recipient hole drilling (RHD) as a biological augmentation to osteochondral grafting. Methods This retrospective study included 60 knees (ICRS grades 1–4) treated surgically from 2001 to 2022. Stable lesions (grade 1) were managed with either retrograde or antegrade drilling with bioabsorbable pin fixation. For unstable lesions (grades 2–3), in situ osteochondral autograft transfer (OATS) or detach-and-fix techniques were performed. Detached lesions (grade 4) underwent either mosaicplasty or fragment fixation. RHD was introduced in select OATS and mosaicplasty cases to stimulate subchondral bone remodeling. Outcomes were assessed using the Lysholm and Tegner scores and MOCART-based MRI evaluations. Statistical comparisons were performed across groups. Results Antegrade drilling resulted in significantly higher Lysholm, Tegner, and MOCART scores than retrograde drilling for ICRS grade 1 lesions. In situ OATS for ICRS 2–3 lesions showed superior clinical and radiological outcomes compared to detach-and-fix, with no reoperations. For ICRS 4 lesions, both mosaicplasty and fragment fixation yielded favorable outcomes, though only Tegner scores showed a significant difference. RHD tended to improve cartilage repair quality in OATS and mosaicplasty but did not reach statistical significance. Conclusions Antegrade drilling and in situ OATS were superior to retrograde drilling and detach-and-fix, respectively. No statistically significant advantage was found between mosaicplasty and fragment fixation. RHD may enhance subchondral integration and healing, supporting its further evaluation. Clinical relevance Optimizing OCD treatment requires surgical strategies that achieve both mechanical stability and biological activation. Integrating these principles may enhance repair quality and long-term joint preservation. Level of evidence Level III, retrospective comparative study.

Sun Hwan Choi MD, Myeong Gu Lee MD, Yoon Je Cho MD et al.

Introduction Prophylactic surgery for symptomatic incomplete atypical femoral fractures (SIAFFs) has demonstrated favorable outcomes. However, concerns remain regarding surgical intervention for a fracture that has not yet completed. This retrospective study aimed to evaluate the efficacy of conservative treatment using teriparatide (TPTD) as a conservative treatment for SIAFF. Methods This retrospective study reviewed 30 cases with SIAFF who underwent conservative treatment between November 2012 and September 2019. The diagnosis of SIAFF was based on the criteria established by the Task Force of the American Society for Bone and Mineral Research(ASBMR). The treatment protocol included (1) discontinuation of bisphosphonates, (2) use of 2 crutches or a four-point walker, (3) daily subcutaneous TPTD injection until pain subsided, and (4) monthly radiographic follow-up. Radiographs and bone scans were used to assess bone union, and follow-up continued for up to 2 years from protocol initiation. Comparisons between the successful and failed treatment groups were performed using the Student’s t-test for continuous variables and Fisher’s exact test for categorical variables. Results The mean age was 72.6 years (range, 55-87) and all patients were female. 13 cases involved the diaphyseal region and 17 involved the subtrochanteric region. The average duration of TPTD treatment was 6.5 months (range, 3-12), and the average follow-up was 45.5 months (range, 19-84) after the final injection. The mean SIAFF severity score was 9.5 (range, 7-11). Symptom-free bone union was achieved in 23 of 30 cases (76.7%). Five cases (4 with worsening pain, 1 with radiographic progression) underwent prophylactic intramedullary nailing, and 2 cases progressed to complete fracture and were treated with intramedullary nailing. Conclusion The result of this study suggests that the conservative treatment with teriparatide injection may be a potentially effective option for patients with SIAFF.

Anatoliy S. Sudnitsyn, Alexander L. Shastov, Nikolay M. Klushin et al.

Introduction The most common approach to the treatment of osteomyelitic cavities (Cierny – Mader type III) is a two-stage approach proposed by Masquelet, the main shortcoming of which is the need to perform a second surgical intervention which results in a longer rehabilitation period, increased economic costs and additional emotional distress of the patient. In electronic databases, we found 17 publications devoted to the use of partially bioresorbable materials for filling in uncomplicated bone defects. The experience of treatment of chronic osteomyelitis (Cierny – Mader type III) using such materials has not been described. Purpose Demonstration of the first use of a partially bioresorbable osteosubstituting material in a one‑stage treatment of a patient with a long-term osteomyelitic process after failures of conventional surgical treatment methods. Materials and methods We present a case of a 54-year old patient with a diagnosis of chronic post-traumatic osteomyelitis of the right leg, fistulous form, associated with contracture of the right ankle joint, 2-cm shortening of the right lower limb. A one-stage treatment technique was used using a partially bioresorbable osteosubstituting material for the first time in combination with antibacterial drugs, preselected in accordance with the patient's microbial cultures. Results The study evaluated the use of a partially bioresorbable material impregnated with antibacterial drugs in the treatment of a patient with osteomyelitic cavity Cierny – Mader type III that achieved stable arrest of purulent and inflammatory process. Discussion The mandatory two-stage Masquelet approach increases the surgical aggression, requires collection of an autologous bone graft, thus the risk of possible complications becomes higher. The obvious advantages of bioresorbable materials impregnated with antibacterial drugs to fill in bone defects are: no need to collect an autograft, a reduction in the number of surgical interventions to one, the possibility of gradual natural degradation of the implant from the patient's body due to bioresorption. Conclusion The study demonstrates the potential use of partially bioresorbable materials in a one-stage technology for treating patients with Cierny – Mader type III osteomyelitic cavities.

Pengfei Guan, Lei Fan, Zhaobo Zhu et al.

Abstract Electroconductive hydrogels offer a promising avenue for enhancing the repair efficacy of spinal cord injuries (SCI) by restoring disrupted electrical signals along the spinal cord’s conduction pathway. Nonetheless, the application of hydrogels composed of diverse electroconductive materials has demonstrated limited capacity to mitigate the post-SCI inflammatory response. Recent research has indicated that the transplantation of M2 microglia effectively fosters SCI recovery by attenuating the excessive inflammatory response. Exosomes (Exos), small vesicles discharged by cells carrying similar biological functions to their originating cells, present a compelling alternative to cellular transplantation. This investigation endeavors to exploit M2 microglia-derived exosomes (M2-Exos) successfully isolated and reversibly bonded to electroconductive hydrogels through hydrogen bonding for synergistic promotion of SCI repair to synergistically enhance SCI repair. In vitro experiments substantiated the significant capacity of M2-Exos-laden electroconductive hydrogels to stimulate the growth of neural stem cells and axons in the dorsal root ganglion and modulate microglial M2 polarization. Furthermore, M2-Exos demonstrated a remarkable ability to mitigate the initial inflammatory reaction within the injury site. When combined with the electroconductive hydrogel, M2-Exos worked synergistically to expedite neuronal and axonal regeneration, substantially enhancing the functional recovery of rats afflicted with SCI. These findings underscore the potential of M2-Exos as a valuable reparative factor, amplifying the efficacy of electroconductive hydrogels in their capacity to foster SCI rehabilitation.

Christopher W Digiovanni, C Niek van Dijk, Mark Glazebrook et al.

Nikolai Ramadanov, Mikhail Salzmann, Maximilian Voss et al.

Jonas Sundkvist, Per Hulenvik, Viktor Schmidt et al.

Background and purpose: Limited research has been conducted on basicervical femoral neck fractures (bFNFs). The importance of displacement in clinical outcomes remains unclear. We aimed to characterize patient demographics, degree of displacement, treatment, treatment failures, and reoperations in a cohort of fractures from the Swedish Fracture Register (SFR). Methods: 1,260 fractures in 1,185 individuals ≥ 60 years who had a bFNF registered in the SFR at 6 orthopedic departments from 2011 to 2020 were screened through radiographic review. The final sample included 291 patients with a confirmed bFNF. The medical records of these 291 patients were reviewed. We assessed baseline characteristics, initial fracture dislocation, treatment methods, tip–apex distance, failures, reoperations, and mortality. Results: The mean age was 82 years (range 60–101, 55% women). 98 (34%) were undisplaced and 193 (66%) displaced. All patients underwent operative treatment. In the undisplaced group 95 (97%) patients received internal fixation (IF) and 3 (3%) had primary hip arthroplasty. In the displaced group 149 (77%) received IF and 41 (21%) had primary hip arthroplasty. 33 (11%) suffered treatment failure. When treating an undisplaced bFNF with IF, only 3 (3%) experienced treatment failure, in contrast to the 24 (16%) failure rate for a displaced bFNF. Conclusion: Undisplaced bFNFs have a low failure rate when treated with IF. For displaced bFNF treated with IF the failure rate is considerably higher. There is a need for further investigation of classification, treatment, and outcome of bFNF.

Yukun Ma, Dingyan Zhao, Xing Yu et al.

Jung-Han Kim, Young-Kyoung Min, Dae-Yoo Kim et al.

Abstract Background Capsular contracture is a well-known etiology in the primary stiff shoulder; thus capsular contracture and resultant decreased joint volume could lead to postoperative stiffness, which is a commonly reported morbidity after arthroscopic rotator cuff repair (ARCR). The purpose of this study was (1) to quantify the joint volume (total joint volume and each quadrant compartmental volume) using computed tomography arthrography (CTA) and (2) to demonstrate the relationship between joint volume and postoperative range of motion (ROM) after ARCR. Materials and methods Eighty-three patients (60 ± 5.11 years, men = 26, women = 57) who had undergone ARCR between January 2015 to December 2020 due to small to medium full-thickness tear and followed by CTA 6 months postoperatively were retrospectively reviewed. An image reconstruction program (3D Slicer, version 4.11.2 software) was used to calculate the joint volume (total joint volume and quadrant compartment joint volumes; anteroinferior, anterosuperior, posterosuperior and posteroinferior). For shoulder ROM, data including scaption (Sc), external rotation on side (ERs), external rotation at 90° (ER90), and internal rotation on back (IRb) were collected 6 months postoperatively. An evaluation of the correlation between joint volume and each shoulder motion was performed. Results There were moderate correlations between the total joint volume and each motion (Sc: Pearson coefficient, 0.32, p = 0.0047; ERs: Pearson coefficient, 0.24, p = 0.0296; ER90: Pearson coefficient, 0.33, p = 0.0023; IRb: Pearson coefficient, 0.23, p = 0.0336). Among the quadrant compartments, the anteroinferior (Sc: Pearson coefficient, 0.26, p = 0.0199; ERs: Pearson coefficient, 0.23, p = 0.0336; ER90: Pearson coefficient, 0.25, p = 0.0246; IRb: Pearson coefficient, 0.26, p = 0.0168) and posterosuperior (Sc: Pearson coefficient, 0.24, p = 0.029; ER90: Pearson coefficient, 0.29, p = 0.008; IRb: Pearson coefficient, 0.22, p = 0.0491) and posteroinferior (Sc: Pearson coefficient, 0.30, p = 0.0064; ER90: Pearson coefficient, 0.29, p = 0.0072) showed moderate correlations with each shoulder motion. Conclusion Total joint volume, anteroinferior compartment joint volume, posterosuperior compartment joint volume and posteroinferior compartment joint volume were related to postoperative ROM after ARCR. Perioperative methods to increase the joint volume, especially the anteroinferior, posterosuperior and posteroinferior parts of the capsule may prevent postoperative stiffness after ARCR. Level of Evidence Level III; Retrospective Case-Control Study.

Yang Wang, Liang Zhang, Guosheng Zhao et al.

Tom W. Andrew, Lauren S. Koepke, Yuting Wang et al.

Abstract Sexually dimorphic tissues are formed by cells that are regulated by sex hormones. While a number of systemic hormones and transcription factors are known to regulate proliferation and differentiation of osteoblasts and osteoclasts, the mechanisms that determine sexually dimorphic differences in bone regeneration are unclear. To explore how sex hormones regulate bone regeneration, we compared bone fracture repair between adult male and female mice. We found that skeletal stem cell (SSC) mediated regeneration in female mice is dependent on estrogen signaling but SSCs from male mice do not exhibit similar estrogen responsiveness. Mechanistically, we found that estrogen acts directly on the SSC lineage in mice and humans by up-regulating multiple skeletogenic pathways and is necessary for the stem cell’s ability to self- renew and differentiate. Our results also suggest a clinically applicable strategy to accelerate bone healing using localized estrogen hormone therapy.

Tobias Kastenberger, Peter Kaiser, Anna Spicher et al.

Abstract Background Only few methods treating comminuted radial head fractures have been established providing sufficient joint reconstruction, restoring radial length and enabling early joint mobilization. When an anatomical reconstruction using open reduction and internal fixation is not possible, radial head resection or primary arthroplasty is often conducted. An “Ex situ/on-table” reconstruction is widely disregarded but can be an option. The purpose of this study was to evaluate the functional and radiological outcome of comminuted radial head fractures treated with an “on-table” reconstruction and internal fixation using a low profile plate. Methods Fourteen patients who sustained a radial head fracture (9 Mason-Johnston type III and 5 Mason-Johnston type IV) and were treated with an “on-table” reconstruction between 2010 and 2020 were evaluated retrospectively. The patients mean age was 41.3 years (range 21–69). The clinical evaluation included active range of motion, grip strength, pain level and elbow stability. The functional outcome was assessed using the Disability of Arm, Shoulder and the Hand (DASH) score, Mayo Elbow Performance Index (MEPI), Broberg and Morrey score. The radiological examination included a.p. and lateral views of the injured elbow to evaluate nonunions, loss of reduction, joint alignment, avascular radial head necrosis, heterotopic ossifications and posttraumatic osteoarthritis. Results The inclusion rate was 74% with a mean follow-up of 50 months (range 16–128). The mean elbow flexion of the injured side was 126° (range110–145°) with an average extension loss of 8° (range 0–40°). Pronation was 65° (15–90°) and supination 66° (5–90°). The mean MEPI was 87 points (range 45–100). The mean DASH score was 13 points (range 1–88). According to the Broberg and Morrey functional scoring system, the average score was 92 points (range 88–100). Complete bone union was achieved in 9 cases, partial union in 4 cases and nonunion in one case. There were no signs of avascular necrosis of the radial head. Signs of post-traumatic osteoarthritis were seen in 11 cases. Five patients needed an implant removal due to a radio-ulnar impingement and one patient a revision surgery due to the nonunion and implant breakage. Conclusions An on-table (ex situ) reconstruction of the radial head is a reliable option with a good clinical outcome and low complication rate in the surgical treatment of comminuted radial head fractures. It can restore joint alignment and maintain radial length. The risk for avascular necrosis is neglectable, and the bone healing rate is high.

Clayton Del Prince, John Reza Matthews, Matthew Phillips

We present a 69-year-old male with osteoarthritis of a varus mechanically aligned left knee that developed delayed arterial thrombosis after primary total knee arthroplasty (TKA) requiring stenting and subsequent trans-metatarsal amputation. This case is unique since initial presentation involved neurologic instead of ischemic changes. We also performed a literature review of arterial injuries in primary TKA. This case highlights the importance of maintaining a high clinical suspicion for vascular insult in patients undergoing correction of varus malalignment with initial complaints of neurologic dysfunction.

Janet Le, David R. Perkins, Miguel Sierra-Hoffman et al.

Extrapulmonary Histoplasma capsulatum infections in the immunocompetent population are rare and pose a diagnostic challenge. Upper extremity histoplasmosis without a primary lung infection is uncommon. It is possible to acquire it by inadvertent trauma with direct inoculation.Our case describes an immunocompetent patient with progressive swelling with minimal pain in the wrist associated with a small puncture wound on the left dorsal forearm. The initial workup failed to identify a specific etiology. For the following six weeks, the patient experienced progressive worsening of symptoms, warranting a referral to an orthopedichand surgeon. Left lower extremity magnetic resonance imaging (MRI) findings were non-specific.The surgeon performed a surgical exploration and debridement with the excision of hypertrophic tissue. Initial stains showed a granulomatous tissue but did not reveal an organism; however, a month later, mold was identified on the growth medium. The patient was initiated in isavuconazole empiric therapy. Four weeks later, a matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) confirmed the diagnosis as Histoplasma capsulatum. The patient had clinical remission with isavuconazole used as the United States Food and Drug Administration (FDA) off label use.

Hermes H Miozzari, Christophe Barea, Didier Hannouche et al.

Background and purpose — Prior to primary total knee arthroplasty (pTKA), 6–34% of patients have undergone surgical procedure(s) of their knee. We investigated whether history of previous surgeries influences the risk of revision of pTKA, the risk according to the type of previous surgery, and how previous surgery influences specific causes of revision and the time of revision. Patients and methods — This is a prospective cohort study from the Geneva Arthroplasty Registry. All pTKA between 2000 and 2016 were included and followed until December 31, 2019. Outcomes were risk of revision, evaluated using Kaplan–Meier survival and Cox and competing risks regression, the specific causes, and time of revision. Results — Of 3,945 pTKA included (mean age 71 years, 68% women), 21% had a history of previous surgery, with 8.3% revisions vs. 4.3%, at 3–20 years’ follow-up (mean 8.6). 5- and 10-year cumulative failure by previous surgery (yes vs. no) were 6.6% (95% CI 5.1–8.5) vs. 3.3% (CI 2.7–4.0), and 8.4% (CI 6.6–10.6) vs. 4.5% (CI 3.8–5.4). Baseline differences explained only part of the higher risk (adjusted HR 1.5, CI 1.1–2.1). The risk of failure was higher for all causes of revision considered. Patients in the previous surgery group had a higher risk of an early revision. Interpretation — A history of previous surgery adversely affected the outcome with a 1.5 times higher cumulative risk of all-cause revision over the course of up to 20 years after index surgery. The increased risk was seen for all causes of revision and was highest in the first years.

Martina Ricci, Daniele Tradati, Alessio Maione et al.

Abstract Purpose The treatment of osteochondral lesions is challenging and no consensus has been established about the best option for restoring both cartilage and subchondral bone. Multilayer collagen‐hydroxyapatite scaffolds have shown promising clinical results, but the outcome at a follow‐up longer than 5 years still has to be proved. The aim was to evaluate the clinical outcome of patients with a knee isolated osteochondral lesion treated with a biomimetic three‐layered scaffold at a minimum 5 years of follow‐up. Methods Twenty‐nine patients (23 males and 6 females, mean age 31.5 ± 11.4 years) were evaluated retrospectively before surgery, at 1 and 2 years and at last follow‐up (FU). Visual Analog Scale (VAS) for pain, International Knee Documentation Committee (IKDC) Subjective Score, Tegner‐Lysholm Knee Scoring Scale and Tegner Activity Level Scale were collected. Mean FU was 7.8 ± 2.0 years (min 5.1 ‐ max 11.3). The etiology of the defect was Osteochondritis Dissecans or osteonecrosis (17 vs 12 cases). Results At 12 months FU the IKDC score improved from 51.1 ± 21.7 to 80.1 ± 17.9 (p < 0.01), Tegner Lysholm Score from 59.9 ± 17.3 to 92.5 ± 9.0 (p < 0.01), VAS from 6.1 ± 2.1 to 1.7 ± 2.3 (p < 0.01) and Tegner Activity Level Scale from 1.6 ± 0.5 to 4.9 ± 1.7 (p < 0.01). The results remained stable at 24 months, while at last FU a statistically significant decrease in IKDC, Tegner Lysholm and Tegner Activity Scale was recorded, though not clinically relevant. Patients under 35 achieved statistically better outcomes. Conclusions The use of a cell‐free collagen‐hydroxyapatite osteochondral scaffold provides substantial clinical benefits in the treatment of knee osteochondral lesions at a minimum follow‐up of 5 years, especially in patients younger than 35 years. Level of evidence Level IV.

Jantine Brauns, MD, Hans Feyen, MD

We present a case of a 59-year-old woman with a history of a right-sided patellectomy. She presented with right-sided anteromedial osteoarthritis. A unicondylar knee arthroplasty was performed. In the literature, we found only a few similar cases, with varying results. The woman in this case showed excellent postoperative clinical results. We concluded that a patellectomy may not be a contraindication for unicondylar knee arthroplasty in patients with isolated medial compartment osteoarthritis. Keywords: Unicondylar, Knee, Arthroplasty, Oxford, Patellectomy, Patella

Jasmine Saleh, Mouhanad M. El-Othmani, Khaled J. Saleh

Raju Vaishya

A. A. Korytkin, A. A. Zykin, D. V. Zakharova et al.

Treatment of avascular necrosis of the femoral head is an issue of current interest while it affects young and employable people. So far there is no well-defined strategy of management which would help to postpone hip arthroplasty and further revision procedure. Hip sparing surgical treatment of avascular necrosis of the femoral head by bone grafting prior to head collapse proved to be a viable option not only during early stages of disease but also at advanced stages. Platelet-rich plasma (PRP) addition to treatment plan potentially helps improving bone regeneration in situ.In this article the authors present a case of a 37 years old patient with avascular necrosis of the femoral head at a fragmentation stage (type 4B by ARCO). The authors centrifuged 15 ml of autologous whole blood (1500 RPM) obtained by a special double-contoured syringe. During the surgical stage of treatment PRP and morselized bone graft were mixed to introduce and impact into the debrided zone of avascular necrosis. The authors also introduced 0.3–0.4 ml of PRP into the debrided zone of avascular necrosis after bone grafting. At 6 months follow-up CT images of the studied patient demonstrated signs of bone reorganization and no loss of femoral head sphericity. Preoperative Visual Analogue Scale (VAS), Harris Hip Score (HHS) and Hip disability and Osteoarthritis Outcome Score (HOOS) prior to treatment were 60, 45 and 33 points respectively. Postoperative VAS, HHS and HOOS scores were 10, 78 and 78 respectively. In the authors’ opinion, impaction bone grafting enhanced by PRP helps obtaining good and excellent outcomes not only at early but also at advanced stages of avascular necrosis.