Int Orthop. 2025 Apr 28. doi: 10.1007/s00264-025-06546-9. Online ahead of print.

ABSTRACT

PURPOSE: To compare the long-term efficacy of anterior lumbar interbody fusion (ALIF) and posterior transforaminal lumbar interbody fusion (TLIF) in treating lumbar degenerative diseases.

METHODS: A retrospective analysis was conducted on 57 patients with lumbar degenerative diseases who underwent either ALIF or TLIF from March 2003 to October 2007. Patients were divided into an ALIF group (n = 27) and a TLIF group (n = 30). Pain was evaluated using the visual analogue scale (VAS), and the Oswestry Disability Index (ODI) was used to assess clinical outcomes. Radiographic adjacent segment degeneration (rASD) was evaluated using the Modified Pfirrmann Scale. Three-dimensional CT was used to assess the fusion rate at the last follow-up.

RESULTS: Follow-up duration ranged from 58 to 120 months, with an average of 90.6 months. No significant difference was observed in VAS and ODI scores between the two groups (P > 0.05). However, significant differences were noted before and after the operation (P < 0.05). The intervertebral disc height (IDH) and lumbar lordosis (LL) increased after the operation and during follow-ups. The IDH and LL in the ALIF group were significantly higher than those in the TLIF group both postoperatively and at follow-ups (P < 0.05). At the last follow-up, the incidence of rASD in the ALIF group was significantly lower than in the TLIF group (P < 0.05).

CONCLUSIONS: Both ALIF and TLIF provide satisfactory long-term outcomes for lumbar degenerative diseases. ALIF more effectively restores and maintains lumbar intervertebral height and lumbar lordosis, potentially reducing the incidence of adjacent segment degeneration.

PMID:40293512 | DOI:10.1007/s00264-025-06546-9

Int Orthop. 2025 Apr 28. doi: 10.1007/s00264-025-06531-2. Online ahead of print.

ABSTRACT

AIM: We aimed to compare the diagnostic performance of physicians in the detection of arthroscopically confirmed meniscus and anterior cruciate ligament (ACL) tears on knee magnetic resonance imaging (MRI), with and without assistance from a deep learning (DL) model.

METHODS: We obtained preoperative MR images from 88 knees of patients who underwent arthroscopic meniscal repair, with or without ACL reconstruction. Ninety-eight MR images of knees without signs of meniscus or ACL tears were obtained from a publicly available database after matching on age and ACL status (normal or torn), resulting in a global dataset of 186 MRI examinations. The Keros® (Incepto, Paris) DL algorithm, previously trained for the detection and characterization of meniscus and ACL tears, was used for MRI assessment. Magnetic resonance images were individually, and blindly annotated by three physicians and the DL algorithm. After three weeks, the three human raters repeated image assessment with model assistance, performed in a different order.

RESULTS: The Keros® algorithm achieved an area under the curve (AUC) of 0.96 (95% CI 0.93, 0.99), 0.91 (95% CI 0.85, 0.96), and 0.99 (95% CI 0.98, 0.997) in the detection of medial meniscus, lateral meniscus and ACL tears, respectively. With model assistance, physicians achieved higher sensitivity (91% vs. 83%, p = 0.04) and similar specificity (91% vs. 87%, p = 0.09) in the detection of medial meniscus tears. Regarding lateral meniscus tears, sensitivity and specificity were similar with/without model assistance. Regarding ACL tears, physicians achieved higher specificity when assisted by the algorithm (70% vs. 51%, p = 0.01) but similar sensitivity with/without model assistance (93% vs. 96%, p = 0.13).

CONCLUSIONS: The current model consistently helped physicians in the detection of medial meniscus and ACL tears, notably when they were combined.

LEVEL OF EVIDENCE: Diagnostic study, Level III.

PMID:40293511 | DOI:10.1007/s00264-025-06531-2

Int Orthop. 2025 Apr 26. doi: 10.1007/s00264-025-06471-x. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to evaluate long-term radiological and functional outcomes in tibia plateau fractures (TPFs) patients treated using minimally invasive percutaneous plate osteosynthesis (MIPPO) and Double Reverse Traction Repositor (DRTR).

METHODS: We reviewed 85 patients treated with MIPPO and DRTR at our hospital from January 2015 to December 2017. Radiologic outcomes, including tibial plateau angle (TPA), posterior slope angle (PSA), and Kellgren-Lawrence classification, were assessed, while functional outcomes were evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short Form (SF)-36, and Hospital for Special Surgery Knee Score (HSS score). Data from medium follow-up (4.39 ± 0.58 years) and final follow-up (7.75 ± 0.53 years) were analyzed with the Wilcoxon signed-rank test.

RESULTS: We included 65 patients with three(4.62%), 26(40.00%), eight(12.31%), six(9.23%), 11(16.92%), and 11(16.92%) were Schatzker I- VI, respectively. The mean follow-up time was 7.75 ± 0.53 years, with surgery performed in 5.72 ± 2.37 days post-injury and mean operation time of 96.72 ± 31.15 min. Short-term complications included two superficial infections (3.08%). Significant improvements in functional outcomes were observed at final follow-up: range of motion was 138.38° ± 8.49°, enhancements in WOMAC scores, HSS knee scores, and SF-36 (P < 0.05). No further progression of osteoarthritis was observed (K-L classification) during seven-year follow-up (P = 0.655).

CONCLUSIONS: MIPPO with DRTR is a promising and safe technique for the TPFs, leading to satisfactory outcomes up to seven years postoperatively, especially in reducing the incidence for knee osteoarthritis.

PMID:40285874 | DOI:10.1007/s00264-025-06471-x

Int Orthop. 2025 Apr 25. doi: 10.1007/s00264-025-06547-8. Online ahead of print.

NO ABSTRACT

PMID:40278855 | DOI:10.1007/s00264-025-06547-8

Int Orthop. 2025 Apr 25. doi: 10.1007/s00264-025-06518-z. Online ahead of print.

ABSTRACT

PURPOSE: The risks associated with low body mass index (BMI) in arthroplasty patients are underexplored. While outcomes of patients with elevated BMI are well-documented, low BMI patients may also face unique challenges, including malnutrition, osteopenia, and increased surgical risks and postoperative complications. To evaluate the impact of low BMI on reoperation risk and other complications compared with normal BMI among patients undergoing total hip or knee arthroplasty.

METHODS: This retrospective cohort study analyzed electronic health records of patients with BMI < 25 kg/m² who underwent hip or knee arthroplasty at Sunnybrook Holland Orthopaedic & Arthritic centre, Toronto, Canada between April 2, 2012, and April 6, 2023. Patients were stratified into low BMI (< 20 kg/m²) and normal BMI (20-24.9 kg/m²) groups, with their outcomes followed until November 2024. The main exposure was BMI categorized as low or normal. Other covariates controlled for were relevant demographics and comorbidities. The primary outcome was the risk of reoperation. The secondary outcome was composite complications (persistent pain, wound issues, and radiographic abnormalities). Survival analysis was performed with probabilities visualized with Kaplan-Meier curves. Multivariate Cox proportional hazards models were employed adjusting for potential confounders.

RESULTS: Among 1,162 included patients (mean [standard deviation] age, 68.8 [11.1] years; 70.1% women), 182 (15.7%) had low BMI and 980 (84.3%) had normal BMI. Kaplan-Meier curves demonstrated significantly higher risks of reoperation and composite complications in patients with low BMI compared to those with normal BMI (both p < 0.001). After adjusting for other covariates, low BMI was independently associated with increased risks of reoperation (adjusted Hazard Ratio (aHR), 5.8; 95% confidence interval (CI), 2.8-12.1; p < 0.001) and composite complications (aHR, 7.5; 95% CI, 3.9-14.5; p < 0.001).

CONCLUSIONS: In this large cohort of arthroplasty patients, BMI < 20 kg/m² was associated with elevated risks of reoperation and composite complications. These findings emphasize the importance of tailored preoperative optimization and vigilant postoperative care for this high-risk population.

LEVEL OF EVIDENCE: Level III.

PMID:40278854 | DOI:10.1007/s00264-025-06518-z

Int Orthop. 2025 Apr 25. doi: 10.1007/s00264-025-06544-x. Online ahead of print.

ABSTRACT

PURPOSE: This research investigates the benefits of robot-assisted navigation systems in retrograde intramedullary nailing for distal femoral fractures and contrasts their outcomes with conventional surgical methods. This is a retrospective clinical study designed to compare the outcomes of these two approaches.

METHODS: This study included 56 distal femoral fracture patients treated between February 2020 and May 2023. Among them, 28 patients underwent robot-assisted retrograde intramedullary nailing (robot group), while 28 received conventional retrograde intramedullary nailing (traditional group). Surgical duration, intraoperative fluoroscopy frequency, number of guidewire insertions into the femoral medullary cavity, and intraoperative blood loss were recorded. Healing progress and fixation stability status were observed, and postoperative articular function was assessed using Neer's scoring system at a one year follow-up.

RESULTS: Baseline characteristics were comparable between the two groups, showing no statistically significant differences.The robot group demonstrated shorter operative time, fewer guidewire placements, reduced intraoperative hemorrhage and incision size compared to the traditional group (P < 0.05). While the Neer's score for postoperative joint function showed a higher excellent-to-good rate in the robot group, no significant difference was observed between the group (P > 0.05).

CONCLUSION: Compared with traditional surgical methods, robot-assisted retrograde intramedullary fixation for fractures of the distal femur offers advantages of being minimally invasive, more precise, requiring shorter operative times, and resulting in reduced blood loss, fluoroscopy exposure, and guidewire insertion attempts. These benefits may contribute to a reduction in postoperative complications.

PMID:40278853 | DOI:10.1007/s00264-025-06544-x

Int Orthop. 2025 Apr 23. doi: 10.1007/s00264-025-06535-y. Online ahead of print.

NO ABSTRACT

PMID:40266313 | DOI:10.1007/s00264-025-06535-y

Int Orthop. 2025 Apr 23. doi: 10.1007/s00264-025-06525-0. Online ahead of print.

ABSTRACT

PURPOSE: To assess long term survivorship, patient reported (PROMs) and radiological outcomes, and rate of adverse events and hardware removal after lateral closing wedge high tibial osteotomy (CWHTO) for the treatment of medial knee osteoarthritis (OA) and varus malalignment.

METHODS: Retrospective analysis of patients who underwent isolated CWHTO for medial OA in varus knee between 2009 and 2019 at the same institution was performed. Surgical failure was defined as conversion to total knee arthroplasty (TKA) or need for osteotomy revision procedure for varus recurrence, while clinical failure was defined by a Lysholm score under 65 points. Lysholm score, Visual Analogue Scale for pain (VAS), and patients' satisfaction with the treatment were evaluated. Radiographic parameters assessed included OA degree with the Kellgren Lawrence scale (KL), hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), joint line convergence angle (JLCA), and posterior tibial slope (PTS). Adverse events and rate of hardware removal procedures were recorded through follow up visits and clinical records. Survival analysis was conducted through Kaplan-Meier method with surgical and clinical failure as endpoints.

RESULTS: 70 knees (mean age at surgery 43.3 years) were included in the survivorship analysis at a mean follow up of 11.6 ± 3.4 years. A failure rate of 12.85% (9/70) was recorded during the follow up period, with a survivorship of 92% and 75% at ten and 15 years of follow up, respectively. Mean Lysholm score and VAS at follow up were above the PASS threshold reported in literature. The 75.7% of patients were satisfied with the treatment. Radiological follow up indicated a residual mechanical varus of 2.1°, a decrease of 0.7° of intra articular deformity (JLCA), no change in PTS nor in KL index. The adverse events rate recorded was 5.7% (4/70). In nine knees (14.7%) among the patients survived from surgical failure a subsequent hardware removal procedure was performed.

CONCLUSION: CWHTO represents a safe procedure, which resulted in high survivorship (92% and 75% at ten and 15 years follow up, respectively), with satisfactory PROMs and radiological outcomes at long term follow up in patients affected by medial OA and varus malalignment.

LEVEL OF EVIDENCE: 5, Case Series.

PMID:40266312 | DOI:10.1007/s00264-025-06525-0

Int Orthop. 2025 Apr 23. doi: 10.1007/s00264-025-06542-z. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the efficacy of acellular hyaluronic acid matrix scaffold, BMAC, and autologous bone graft in providing biomechanical support and optimal microenvironment for OLTs treatment.

METHODS: A retrospective analysis of 81 ankles from 80 patients treated between 2018 and 2021 was conducted. The inclusion criteria included patients who underwent surgery for osteochondral lesions of the talus (OLTs) and received acellular hyaluronic acid matrix scaffold, bone marrow aspirate concentrate (BMAC) fibrin glue, and autologous bone graft. The exclusion criteria included prior ankle surgery, concurrent lateral instability surgery, malignancy, metabolic bone disease, or related medication. Clinical outcomes were assessed with FAOS, VAS, and SF-36 at a minimum of two years postoperatively. MRI findings were evaluated preoperatively, at six months, and 24 months postoperatively via MOCART. Subgroups were formed on the basis of age (< 45 vs. ≥45), BMI, and full weight bearing mobilization (FWBM) timing (4, 5, 6, or > 6 weeks).

RESULTS: Postoperative FAOS and SF-36 scores significantly improved (p = 0.000), whereas VAS scores decreased (p = 0.001). Early FWBM (4th week) was associated with superior FAOS, SF-36, and MOCART scores at 24 months (p = 0.039). Underweight and healthy individuals exhibited lower VAS (p = 0.001) and higher SF-36 scores (p = 0.000) at three months, alongside higher MOCART scores at 24 months compared to overweight patients (p = 0.039).

CONCLUSIONS: This study highlights the importance of a tailored approach to optimize the microenvironment and biomechanical support in OLTs treatment. Further research is required to refine therapeutic strategies.

PMID:40266311 | DOI:10.1007/s00264-025-06542-z

Int Orthop. 2025 Apr 23. doi: 10.1007/s00264-025-06523-2. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to evaluate the early clinical and radiological outcomes of robot assisted total knee arthroplasty, and to determine the efficiency and safety of its bone resection and implant positioning of the novel robot system.

METHODS: 144 patients who underwent primary TKA were enrolled in this prospective, multicenter RCT conducted in three hospitals. five patients were lost to follow-up at six weeks after surgery. Therefore, 139 patients (73 in the RA TKA group and 66 in the CI TKA group) remained in the final analysis. The primary outcome was the rate of patients whose postoperative alignment was less than 3° deviated from the planned evaluated by full-length weight-bearing X-rays of the lower limb at 12 weeks postoperatively. Secondary outcomes included coronal and sagittal alignment of the components, operation times, blood loss, 12-week range of motion(ROM), 12-week postoperative functional outcomes and satisfaction evaluated by the American Knee Society Score (KSS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and adverse events (AEs).

RESULTS: At 12 weeks postoperatively, we found the rate of radiographic inliers was significantly higher in the RA TKA group (90.4% vs. 59.1%; p < 0.05). The difference between planned and postoperative frontal femoral component (FFC) angle, frontal tibia component (FTC) angle and lateral femoral component (LFC) angle are significantly smaller in the RA TKA group (p < 0.05). The operation time was significantly longer in the RA TKA group than in the CI TKA group (133.01 vs. 92.33 min; p < 0.05). There was no significant difference in blood loss, 12-week ROM, 12-week postoperative functional outcomes and satisfaction evaluated by KSS and WOMAC scores. There were no AEs or SAEs that were determined to be "related" to the robotic system.

CONCLUSION: The novel robot assisted TKA is safe and more precise in bone resection and implant positioning as demonstrated in this trial.

PMID:40266310 | DOI:10.1007/s00264-025-06523-2

Int Orthop. 2025 Apr 22. doi: 10.1007/s00264-025-06543-y. Online ahead of print.

NO ABSTRACT

PMID:40261340 | DOI:10.1007/s00264-025-06543-y

Int Orthop. 2025 Apr 22. doi: 10.1007/s00264-025-06538-9. Online ahead of print.

NO ABSTRACT

PMID:40261339 | DOI:10.1007/s00264-025-06538-9

Int Orthop. 2025 Apr 22. doi: 10.1007/s00264-025-06540-1. Online ahead of print.

ABSTRACT

PURPOSE: Spondylodiscitis is a serious infection of the intervertebral discs and vertebrae, with rising incidence. This study provides an updated evaluation by analyzing causative microorganisms in tuberculous (TS), brucellar (BS), and pyogenic spondylodiscitis (PS). Our findings offer contemporary data to enhance understanding and management of spondylodiscitis.

METHODS: This retrospective study included 109 adult patients diagnosed with spondylodiscitis between 2011 and 2021 at a tertiary research center. Patients were categorized into three groups based on the causative pathogen. Demographic data, clinical presentations, laboratory findings, radiological imaging, and microbiological results were analyzed.

RESULTS: Among 109 patients, 59 (54.1%) had PS, 33 (32%) BS, and 17 (15.5%) TS. The cohort included 65 males (59.6%) and 44 females (40.4%), with a mean age of 57.6 ± 13.8 years. Back pain was the most common symptom (85.3%). Night sweats were more prevalent in BS (p < 0.001), while weight loss was less frequent in PS (p < 0.05). Diabetes was more common in PS (p < 0.001). PS cases had higher inflammatory markers (p < 0.001). Blood culture positivity was 53.6% in BS and 53.8% in PS. Surgery with tissue sampling was performed in 62 cases (56.9%). S. aureus was the most frequent pathogen, followed by Brucella spp.

CONCLUSION: Spondylodiscitis requires a multidisciplinary diagnostic approach due to its variable clinical presentations. PS is characterized by elevated inflammatory markers and concurrent infectious foci, BS by endemic risk factors and systemic symptoms, and TS by prolonged symptoms and thoracic involvement.

PMID:40261338 | DOI:10.1007/s00264-025-06540-1

Int Orthop. 2025 Apr 22. doi: 10.1007/s00264-025-06541-0. Online ahead of print.

ABSTRACT

Surgical approaches in bone surgery have undergone a long evolution over more than 130 years. While a number of publications have been devoted to the history of internal fixation, surgical approaches have remained neglected from this perspective. The development of approaches in musculoskeletal surgery is inextricably linked to four personalities. Theodor Kocher, in 1892, pointed out that descriptions of surgical approaches must be an essential part of surgical textbooks of operative techniques; James Edwin Thompson, in 1918, formulated the basic requirements for the surgical approaches to the skeleton of limbs; Arnold Kirkpatrick Henry published the first textbook of surgical approaches in 1927 and presented the concept of internervous planes in 1945; in the same year, Toufick Nicola created the first comprehensive atlas of surgical approaches to bones and joints of limbs, the pelvis and spine.

PMID:40261337 | DOI:10.1007/s00264-025-06541-0

Int Orthop. 2025 Apr 21. doi: 10.1007/s00264-025-06532-1. Online ahead of print.

ABSTRACT

PURPOSE: Implant wastage in trauma and orthopaedic (T&O) surgery remains an under-reported yet significant issue, contributing to rising healthcare costs and environmental concerns. With increasing surgical demand driven by an ageing population and the growing prevalence of conditions like osteoporosis, this study aimed to quantify implant wastage in T&O procedures at a Level 1 Major Trauma Centre in London, assessing both its frequency and financial impact.

METHODS: A retrospective cohort study was conducted on all weekday T&O procedures performed between 1st December 2023 and 31st January 2024. Two of the authors identified wasted implants using intraoperative implant logbooks, and cross-referencing implant stickers with post-operative radiographs. Data pertaining to patient demographics, procedure types, surgical sites, and implant usage were collected. Cost analysis was performed using procurement data to determine the financial impact of implant wastage.

RESULTS: Among 184 procedures analysed, 131 (71.2%) used implants, with wastage observed in 108 (82.4%) cases. A total of 141 implants were wasted, with screws accounting for 92.9% (n = 131) of wasted implants. Locking screws were the most frequently discarded (n = 65; 46.1%). Across ORIF and intramedullary nailing procedures, an overall screw wastage rate of 20% (17-31%) was observed with 2.4 screws wasted per trauma procedure. The financial cost of implant wastage over the 44-day study period amounted to approximately £335 per day and £136 per case.

CONCLUSION: This study highlights the substantial economic burden associated with implant wastage in T&O surgery, with screws, particularly locking screws, being the primary contributors. Targeted interventions, including improved preoperative planning, precision-based implant selection, and enhanced intraoperative decision-making, are essential to reducing waste and improving cost-efficiency and sustainability in surgical practices. Further research should explore the broader economic and environmental impact of implant wastage, incorporating factors such as operative time and carbon footprint to develop comprehensive waste-reduction strategies.

LEVEL OF EVIDENCE: IV.

PMID:40257588 | DOI:10.1007/s00264-025-06532-1

Int Orthop. 2025 Apr 21. doi: 10.1007/s00264-025-06534-z. Online ahead of print.

ABSTRACT

PURPOSE: There is still a debate regarding the removal of the femoral stem due to the risk of trunnion. To answer this question, we conducted a study to compare long terms outcomes of isolated acetabular to total revision of MoM THA using an institutional arthroplasty registry.

METHODS: From 1996 to 2019, 150 patients (12.5%) of the 1202 revision THAs (rTHA) recorded in Geneva Arthroplasty Registry (GAR) underwent a revision of a MoM THA. After matching the two groups,126 patients were finally included: 63 in each group. The mean age was 64.4 (SD 11.6) years, 48.4% (61/126) were women with a mean BMI of 27.2 (SD 5.5) Kg/m2.

RESULTS: The overall survival rate was 88.1% [79.9-97.2%] at ten years. 10-year survival rate was 93.5% [86.2-100.0%] after isolated acetabular rTHA and 79.5% [61.7-100.0%] after total rTHA (p = 0.16). Regarding Hip Harris score and Merle d'Aubigne score, no difference at last follow-up was observed between the two groups (respectively: p = 0.39; p = 0.33). Regarding the chrome, cobalt, and nickel level reduction, no difference was observed between the two groups (respectively, p = 0.38, 0.81 and 0.97).

CONCLUSION: No difference was observed between isolated acetabular and total revision of MoM THAs regarding survival rate and ions levels at long term. It seems advisable to perform an isolated acetabular revision of a MoM THA when it is indicated.

LEVELS OF EVIDENCE: Level III, case control studies.

PMID:40257587 | DOI:10.1007/s00264-025-06534-z

Int Orthop. 2025 Apr 21. doi: 10.1007/s00264-025-06533-0. Online ahead of print.

ABSTRACT

PURPOSE: There is a paucity of clinical studies examining outcomes following surgical revision in cases of histologically confirmed arthrofibrosis after total hip arthroplasty (THA). Consequently, the aim of this study is to present the clinical outcomes and to identify risk factors for poor clinical and functional outcome following surgical intervention for histologically confirmed arthrofibrosis following THA.

METHODS: This study included 51 patients (51 hips) with histologically confirmed arthrofibrosis of the hip based on the synovial-like interface membrane (SLIM) criteria. These were selected from 7983 revision THA cases performed during the study period After exclusion criteria were applied, 42 cases (59.5% women) with an average age of 63.6 years were included. The mean duration of follow up was 70 months (range 30-122 months). Of these, 73.8% underwent index surgery after primary THA implantation. The primary indication for revision surgery was predominantly the clinical suspicion of arthrofibrosis (n = 35). The Harris Hip Score (HHS) and the EQ-5D-3 L scores were calculated for all cases at the time of follow-up. For the risk analysis of a poor clinical outcome, two groups were divided according to the Harris Hip Score. The group with a poor clinical outcome was defined as a HHS < 55.

RESULTS: Open arthrolysis was performed in all cases with a modular component being replaced in 73.8% of cases (n = 31) and only two cases requiring additional revision of the femoral and acetabular components due to aseptic loosening.The mean pre op Harris Hip Score (HHS) was 53.2 before revision surgery. This increased to 65.7 post op (p < 0.001). Only 34.1% of patients achieved the minimum clinical significance difference (MCID) of 18 HHS points after surgical revision. The EQ-5D Visual Analogue Scale (VAS) score and the Time Trade-Off (TTO) score averaged 0.226 (SD 0.245) and 0.221 (SD 0.37). Complications occurred in seven cases (16.7%,), with dislocation in 2 cases and persistent AF symptoms in 3 cases. Six cases required further revision surgery (14.3%). In three cases, a further open arthrolysis was performed due to persistent symptoms. Increased BMI (30.1 vs. 26.7 BMI, p < 0.05) or higher body weight (88.4 kg vs. 78.7 kg, p = 0.086), smoking and a lower preoperative HHS (p = 0.022) were identified as risk factors for a poor clinical outcome, defined as HHS < 55.

CONCLUSION: Results of this study suggest that mid-term clinical results following surgical intervention for arthrofibrosis following THA show a moderate to poor postoperative outcome with an acceptable complication rate. Risk factors for a poor outcome such as increased weight, BMI or smoking should be considered and critically assessed preoperatively.

PMID:40257586 | DOI:10.1007/s00264-025-06533-0

Int Orthop. 2025 Apr 16. doi: 10.1007/s00264-025-06519-y. Online ahead of print.

ABSTRACT

PURPOSE: Unicompartmental Knee Arthroplasty (UKA) has garnered increasing attention in recent years. Robotic-assisted systems have demonstrated enhanced precision, contributing to improved patient survival rates, satisfaction, soft-tissue balancing, alignment, and component sizing. The purpose of this study is to evaluate the early clinical outcomes of Naton robotic-assisted medial UKA by analyzing postoperative radiographic positioning of the unicompartmental prosthesis and comparing preoperative and postoperative functional outcomes in patients.

METHODS: A retrospective analysis was conducted on the clinical data of 32 patients (32 knees) who underwent Naton robotic-assisted medial UKA at Suining Central Hospital of Sichuan Province from November 2023 to January 2024. The cohort included ten males and 22 females, with a mean age of 70.53 ± 8.08 years, ranging from 53 to 88 years. All patients underwent surgery using the Naton robotic system and the Zhengtian Unique fixed-bearing UKA prosthesis. Radiographic (X-ray) findings, knee function, and complications were evaluated during follow-up. Radiographic assessments included prosthesis position, angle deviation, and posterior tibial slope (PTS). Knee function was assessed using a range of motion (ROM), Knee Society Score (KSS), Oxford Knee Score (OKS), and Forgotten Joint Score (FJS).

RESULTS: All patients in the study were followed for a period of eight to ten months, with a mean follow-up of (9.16 ± 0.68) months. No complications such as poor incision healing, periprosthetic infection, periprosthetic fracture, or prosthesis loosening were observed during the follow-up period. The medial unicondylar prostheses were found to be in place in all 32 cases, and no abnormal deviation of the prosthesis implantation angle was observed compared to immediate postoperative radiographs. The posterior tibial slope (PTS) was reduced from 13.00 ± 2.72° preoperatively to 5.08 ± 1.14° postoperatively, with a statistically significant difference (P ≤ 0.05). At the final follow-up, the knee range of motion (ROM) was improved from 107.03 ± 11.69° preoperatively to 128.25 ± 16.52° postoperatively. The KSS was improved from 46.28 ± 7.27 to 82.34 ± 14.72, and the OKS was improved from 36.13 ± 4.71 to 15.78 ± 3.52, all with statistically significant differences compared to preoperative values (P ≤ 0.05). The Forgotten Joint Score (FJS) was recorded as 89.2 ± 2.9.

CONCLUSIONS: The short-term follow-up indicates a favorable prosthesis in situ rate for unicompartmental knee arthroplasty assisted by the Naton robot, with satisfactory knee function and patient-reported outcomes. The short-term clinical outcomes are satisfactory.

PMID:40237792 | DOI:10.1007/s00264-025-06519-y

Int Orthop. 2025 Apr 14. doi: 10.1007/s00264-025-06530-3. Online ahead of print.

NO ABSTRACT

PMID:40227374 | DOI:10.1007/s00264-025-06530-3

Int Orthop. 2025 Apr 14. doi: 10.1007/s00264-025-06529-w. Online ahead of print.

ABSTRACT

PURPOSE: Removal of volar locking plates after healing of a distal radius fracture is becoming increasingly common. However, it is unclear how the fracture healing proceeds and which defects remain. The aim of this study was to assess changes in bone microarchitecture and biomechanical properties in surgically treated radius fracture after volar locking plate removal.

METHODS: Twelve patients were recruited after undergoing plate removal. High Resolution Quantitative Computed Tomography (HR-pQCT) was used to perform scans of the fractured and contralateral distal radius on average one (M1) and 16 months (M2) after plate removal. Parameters measured were cortical- (Dcomp), trabecular- (Dtrab) and total bone density (D100), as well as cortical thickness (Ct.Th). Axial bone stiffness (FE.Kaxial) was determined through linear micro-finite element analysis (µFEA).

RESULTS: At M1, no significant differences between fractured and contralateral side were detected except for Dcomp. At the fractured side, all parameters except for Dtrab increased significantly between M1 and M2. At M2, Ct.Th and FE.Kaxial were significantly higher at the fractured side compared to the contralateral side, but Dcomp remained significantly lower. Qualitatively, closure of the screw holes was observed between M1 and M2, while large trabecular defects remained.

CONCLUSION: Bone (re)modeling at the distal radius is an ongoing process even after plate removal and leads to a partial exaggeration of the bone properties relative to the intact contralateral side. It seems that the bone regains its biomechanical competence by closing screw holes and increasing cortical thickness, which compensates for trabecular defects that cannot be repaired.

LEVEL OF EVIDENCE: III.

PMID:40227373 | DOI:10.1007/s00264-025-06529-w