Int Orthop. 2025 Jun 14. doi: 10.1007/s00264-025-06577-2. Online ahead of print.

ABSTRACT

PURPOSE: Unilateral biportal endoscopy (UBE) is a predominantly minimally invasive surgical technique for addressing LDH. Nonetheless, recurrent lumbar disc herniation (rLDH) remains the predominant reason for reoperation following UBE. This retrospective study examined the risk factors and reoperation rates for rLDH following UBE. This study aimed to examine the risk factors associated with rLDH and the reoperation rate after single-level UBE.

METHODS: We retrospectively analyzed 205 patients who underwent UBE for single-level LDH from 2019 to 2023 to determine reoperation causes and related risk variables. Reoperation was characterized as the postoperative radiological evidence of persistent symptomatic disc herniation at the same level, necessitating further surgical intervention. We gathered radiographic and demographic parameters preoperatively and postoperatively. Patients with recurrent LDH had additional evaluation during recurrence and revision operations.

RESULTS: Of the 205 patients, 21 (10.2%) required further rLDH revision surgery. The multivariate analysis indicated that obesity and elevated fasting blood glucose (FBG) levels were independent risk variables with strong predictive value for reoperation after controlling for other potential risk factors. Based on the receiver operating characteristic curve analysis, the cutoff points for UBE were body mass index (BMI) = 25.775 kg/m2 and FBG = 5.155 mmol/L.

CONCLUSION: This study identified obesity (BMI > 25.775 kg/m²) and elevated FBG levels (> 5.155 mmol/L) as independent risk factors for UBE reoperation. Hence, we recommend longer rehabilitation interventions, such as wearing a suitable brace and strengthening the paraspinal muscles, for patients with obesity and high FBG who undergo UBE.

PMID:40515760 | DOI:10.1007/s00264-025-06577-2

Int Orthop. 2025 Jun 14. doi: 10.1007/s00264-025-06572-7. Online ahead of print.

ABSTRACT

OBJECTIVE: This comparative cohort study evaluates the clinical efficacy of 3D-printed patient-specific cutting guides (PSCGs) versus conventional manual techniques in correcting rigid midfoot pes cavus deformities.

METHODS: A retrospective analysis of 40 patients (80 feet) undergoing Cole osteotomy between 2021 and 2023 was conducted. Patients were stratified into two matched cohorts: Group A (manual osteotomy, n = 20) and Group B (PSCG-assisted, n = 20). Radiographic parameters (Meary's angle, TMI, TCA, Djian-Annonier angle, Pitch angle) and functional outcomes (VAS, AOFAS, SF-36) were analyzed preoperatively and at mean 17-month follow-up. Surgical metrics including operative time, fluoroscopy frequency, and complication rates were systematically compared.

RESULTS: Radiographic analysis demonstrated superior angular correction in the PSCG-assisted cohort versus conventional osteotomy, with significantly improved bilateral Meary's angle (Right: 1.94°±0.62 vs. 6.04°±2.20, P < 0.05; Left: 1.62°±0.54 vs. 6.39°±2.04, P < 0.05) and TMI angle (Right: 4.32°±3.14 vs. 8.51°±8.12, P < 0.05; Left: 4.74°±2.44 vs. 8.53°±5.93, P < 0.05). The PSCG technique achieved equivalent correction in TCA, Djian-Annonier, and Pitch angles while demonstrating enhanced consistency (38-66% reduction in standard deviations). Functionally, PSCG-assisted procedures yielded superior AOFAS scores (97.71 ± 0.77 vs. 92.07 ± 2.25, Δ = 5.64 [95%CI 4.54-6.74], P < 0.05) and SF-36 outcomes, particularly in general health (Δ = 16.96, P < 0.05) and mental well-being (Δ = 7.92, P = 0.001). Operative metrics favored PSCG with 36% shorter procedure time (82.9 ± 13.9 vs. 129.0 ± 39.6 min, P < 0.05) and 77% reduced intraoperative fluoroscopy (4.65 ± 1.06 vs. 20.07 ± 2.92 exposures, P < 0.05). No surgical site infections occurred in the PSCG group versus one superficial SSI in controls CONCLUSION: 3D-printed PSCGs provide anatomically precise, efficient correction of complex midfoot deformities while minimizing intraoperative radiation exposure, establishing this technology as a safe and reproducible alternative to conventional techniques.

PMID:40515759 | DOI:10.1007/s00264-025-06572-7

Int Orthop. 2025 Jun 14. doi: 10.1007/s00264-025-06573-6. Online ahead of print.

NO ABSTRACT

PMID:40514517 | DOI:10.1007/s00264-025-06573-6

Int Orthop. 2025 Jun 11. doi: 10.1007/s00264-025-06576-3. Online ahead of print.

NO ABSTRACT

PMID:40498111 | DOI:10.1007/s00264-025-06576-3

Int Orthop. 2025 Jun 11. doi: 10.1007/s00264-025-06578-1. Online ahead of print.

ABSTRACT

BACKGROUND: Adequate postoperative analgesia is critical for elderly patients undergoing total hip arthroplasty (THA). The pericapsular nerve group (PENG) block relieves pain while preserving motor function, but its limited duration necessitates adjuncts. This study evaluates the efficacy of perineural dexamethasone in prolonging PENG block analgesia in geriatric THA patients.

METHODS: In this double-blinded, randomized controlled trial, 60 patients (≥ 65 years) undergoing THA under spinal anaesthesia were assigned to the PENG group - PENG block with 20 mL 0.2% ropivacaine and the PENG + DEX group - PENG block with 20 mL 0.2% ropivacaine + 4 mg perineural dexamethasone. The primary outcome was time to first rescue opioid administration. The secondary outcomes included total opioid consumption, pain scores (NRS), quadriceps strength, and adverse effects over 48 h.

RESULTS: Dexamethasone significantly prolonged analgesia (16.0 ± 1.3 vs. 9.0 ± 1.7 h, p < 0.0001) and reduced opioid use (0.9 ± 1.2 vs. 2.1 ± 1.4 mEQ, p = 0.0003). Pain scores were lower at six, 12, and 24 h (p < 0.05). Quadriceps strength remained intact in both groups. No nerve injuries were observed (p > 0.9999). Blood glucose levels at 12, 24, and 48 h showed no significant differences between groups (p > 0.05).

CONCLUSIONS: Perineural dexamethasone effectively prolongs PENG block duration, reduces opioid consumption, and does not compromise motor function, nerve integrity, or glycaemic control. It is a promising strategy for optimizing pain control in elderly THA patients.

PMID:40498110 | DOI:10.1007/s00264-025-06578-1

Int Orthop. 2025 Jun 11. doi: 10.1007/s00264-025-06574-5. Online ahead of print.

ABSTRACT

PURPOSE: Bone deformities, such as cubitus varus, can lead to abnormal joint alignment and impaired function. Corrective osteotomy aims to restore anatomical alignment, and its precision may be enhanced using various guidance methods. Emerging mixed reality systems allow for the placement and manipulation of virtual objects and may offer effective surgical navigation. This study aimed to validate the accuracy and precision of holographic guidance compared with classic visual estimation and a printed triangle gauge in a controlled laboratory setting.

METHODS: Closed-wedge osteotomies at angles of 15° and 30° were performed on fresh-frozen porcine femora. Three techniques were evaluated: Group EB (eyeballing)-visual estimation; Group PW (printed wedge)-using 15° and 30° plastic templates; and Group HW (holographic wedge)-using a mixed reality system (RSQ HOLO, RSQ Technologies, Poznań, Poland, and HoloLens 2, Microsoft). In the HW group, a holographic wedge tool guided the osteotomy. The angle of the excised bone wedge and post-osteotomy alignment in the anteroposterior (AP) and lateral planes were measured physically (goniometer) and digitally (radiographs). Statistical analysis assessed accuracy (closeness to 15°/30°) and precision (standard deviation [SD], mean deviation, coefficient of variation [CV]).

RESULTS: At 15°, the PW and HW techniques demonstrated greater accuracy and lower error compared with EB (T = 3.60; p < 0.01), with HW yielding the lowest systematic error (SE = 0.12). Alignment in the AP plane was similar across groups (T < 2.11; p > 0.05), whereas lateral alignment showed significant differences (T > 2.11; p < 0.05). At 30°, HW achieved the best alignment in both AP (T = 2.48; p = 0.01) and lateral views (T = 2.35; p = 0.02). Lateral alignment was improved by more than 5° with holographic guidance compared to other techniques (p = 0.01). The HW group exhibited the highest precision for both 15° and 30° angles (lowest SD and CV; p < 0.05).

CONCLUSIONS: Augmented reality provides accurate and precise intraoperative guidance, outperforming both visual estimation and printed wedge templates in deformity correction.

PMID:40498109 | DOI:10.1007/s00264-025-06574-5

Int Orthop. 2025 Jun 9. doi: 10.1007/s00264-025-06575-4. Online ahead of print.

NO ABSTRACT

PMID:40484887 | DOI:10.1007/s00264-025-06575-4

Int Orthop. 2025 Jun 7. doi: 10.1007/s00264-025-06567-4. Online ahead of print.

ABSTRACT

PURPOSE: Bone nonunion, a condition where fractures fail to heal within an expected timeframe, presents significant physical, psychological, and socioeconomic challenges. While various risk factors for nonunion have been extensively studied, the role of psychological factors, particularly anxiety, remains underexplored. This study aims to assess anxiety levels in patients with nonunion fractures and examine its associations with demographic factors such as age and gender.

METHODS: This cross-sectional study included 180 adults with a history of repeated surgical interventions due to nonunion diaphyseal fractures of long bones. Participants' anxiety levels were measured using the State-Trait Anxiety Inventory (STAI), a validated psychological assessment tool. Data were retrospectively collected from hospital records, and statistical analyses were conducted to compare anxiety levels across different age groups and between genders.

RESULTS: A substantial proportion of participants with a history of nonunion fractures exhibited moderate to high anxiety levels, with 70.6% reporting moderate to high state anxiety and 85.6% experiencing moderate to high trait anxiety. While state anxiety was not significantly associated with age, trait anxiety levels were notably higher in older adults. No significant gender-based differences in anxiety levels were observed.

CONCLUSION: The findings underscore the psychological burden of nonunion fractures, particularly among older patients, highlighting the need for integrating mental health assessments into orthopaedic care. Given the potential impact of anxiety on fracture healing, future studies should employ prospective designs to evaluate the role of anxiety in long-term orthopaedic outcomes. Addressing psychological factors in nonunion patients may improve overall recovery and quality of life.

PMID:40481834 | DOI:10.1007/s00264-025-06567-4

Int Orthop. 2025 Jun 7. doi: 10.1007/s00264-025-06560-x. Online ahead of print.

ABSTRACT

PURPOSE: Central sensitization (CS) plays a critical role in prolonged pain and poor outcomes after total knee arthroplasty (TKA), but its prevalence and impact in high-altitude populations remain unexplored. This study aims to examine the prevalence of CS, its associated factors, and short-term postoperative outcomes in high-altitude TKA patients.

METHODS: This prospective, single-centre cohort study included high-altitude (above 2,500 m) TKA patients with primary knee osteoarthritis (OA). Central sensitization (CS) was diagnosed using the Central Sensitization Inventory (CSI), with a cutoff score of ≥ 40. Propensity score matching (PSM) was applied to balance baseline characteristics between the CS and non-CS groups. Preoperative factors, postoperative outcomes (pain levels, complications, opioid consumption, hospital stay), and the incidence of chronic pain and dissatisfaction at six months were collected and analyzed using SPSS software.

RESULTS: A total of 230 patients were included, with 36 (15.7%) classified as having CS. Multivariable logistic regression identified female gender (OR: 3.9, 95% CI: 1.0-14.3, P = 0.043), higher body mass index (BMI) (OR: 1.2, 95% CI: 1.1-1.3, P = 0.006), and residence above 4,000 m (OR: 5.1, 95% CI: 1.7-15.1, P = 0.003) as significant factors associated with CS. After PSM, the CS group had significantly worse short-term outcomes, with higher pain scores at 24, 48, and 72 h (P < 0.001), increased incidence of postoperative nausea and vomiting (PONV) (P < 0.001), longer hospital stays (P < 0.001), greater cumulative opioid consumption (P < 0.001), higher rates of chronic postoperative pain (46.9% vs. 21.9%, P = 0.014), and greater patient dissatisfaction (25.0% vs. 6.3%, P = 0.039) compared to the non-CS group.

CONCLUSION: This study found a 15.7% prevalence of CS among high-altitude TKA patients. Female gender, higher BMI, and residence at altitudes above 4,000 m were identified as factors associated with CS. Furthermore, CS was linked to worse short-term postoperative outcomes, including higher pain levels, increased incidence of PONV, greater opioid consumption, longer hospital stays, and a higher prevalence of chronic postoperative pain and dissatisfaction.

PMID:40481833 | DOI:10.1007/s00264-025-06560-x

Int Orthop. 2025 Jun 4. doi: 10.1007/s00264-025-06569-2. Online ahead of print.

ABSTRACT

BACKGROUND: Management of Open tibia shaft fractures utilizing the conventional protocol is usually cumbersome; involves several operative procedures and longer periods of hospitalization. The use of external fixators for the definitive management of open tibia shaft fractures has been promising. The Ilizarov frame and linear rail system (LRS) are the commonly used options since they are comparable in efficacy and adaptable in the management of open tibia shaft fractures. The study objective is to determine and compare for any significant difference in the mean radiological union time, union rate, bone outcomes and functional outcomes noted in the management of patients with open tibia shaft fractures using Ilizarov frame fixator and linear rail system (LRS) in Ibadan, Nigeria.

RESEARCH METHOD: This is a prospective study involving thirty (30) patients of both sexes, divided into two (2) groups; Ilizarov frame fixator group and LRS group. All patients had open tibia shaft fractures of Gustillo-Anderson Class (GA II- IIIB). The radiological union time was derived from the length of time in the fixator during which radiological union was confirmed, while the bone and functional outcomes were assessed using the ASAMI criteria.

RESULT: Union was achieved in 27 participants while three (2 in LRS group and 1 in Ilizarov group) had non-union. The union rate was 86.7% for the LRS group and 93.3% for the Ilizarov group. The mean radiological union time was 6.5 ± 1.8 months in the LRS group and 6.4 ± 2.1 months in the Ilizarov group. The bone outcomes showed that in the LRS group, 66.7% had excellent, 20% had good and 13.3% had poor outcomes while the Ilizarov group had 53.3% excellent, 40% good and 6.7% poor outcomes. The functional outcome showed that in the LRS group 53.3% had excellent, 40% good and 6.7% fair outcomes while in the Ilizarov group, 40% excellent, 46,7% good and 13.3% fair outcomes. There is no significant difference noted in the mean radiological union time, union rate, bone and functional outcomes in the management of these open tibia shaft fractures using the two fixators under review.

CONCLUSION: The study has re-iterated the fact that the Ilizarov frame fixator and the LRS are quite versatile tools in the armamentarium of the orthopaedic surgeon for managing open tibia shaft fractures.

PMID:40464907 | DOI:10.1007/s00264-025-06569-2

Int Orthop. 2025 Jun 4. doi: 10.1007/s00264-025-06566-5. Online ahead of print.

ABSTRACT

PURPOSE: To compare the treatment approaches for foot compartment syndrome (FCS) and evaluate their outcomes.

METHODS: A systematic review was conducted in MEDLINE, EMBASE, Mayo journals via OVID Databases, Web of Science, and Scopus from each database's inception to December 2024. Two reviewers, independently working in duplicate, assessed each manuscript's title, abstract, and full text for eligibility. Study characteristics, quality of evidence, and outcomes were obtained and analyzed.

RESULTS: A total of 45 articles were included in the qualitative analysis, 38 case reports, and seven cohort studies. Among the case reports, only two patients underwent conservative management, while all remaining cases, as well as all cohort studies, reported fasciotomy as the primary treatment. Trauma was the most frequently identified cause of FCS, and the diagnostic criterion commonly used was an intracompartmental pressure exceeding 30 mmHg. There was no consensus on the number or anatomical location of incisions. Due to the heterogeneity of the data, a meta-analysis could not be performed to assess the risk associated with different incision approaches.

CONCLUSION: Fasciotomy remains the standard treatment for FCS. However, there is insufficient evidence to determine the optimal number and location of surgical incisions. While existing data suggest that using two or more incisions may be associated with fewer long-term sequelae, further research is needed to establish specificity of compartment decompression to enhance treatment recommendations.

PMID:40461896 | DOI:10.1007/s00264-025-06566-5

Int Orthop. 2025 Jun 2. doi: 10.1007/s00264-025-06552-x. Online ahead of print.

ABSTRACT

PURPOSE: This study documented changes in cartilage lesions in the arthritic medial knee compartment after medial opening wedge high tibial osteotomy (MOWHTO), their impact on clinical outcomes and possible factors influencing this improvement.

METHODS: Forty-nine patients indicated for MOWHTO (per ISAKOS criteria) underwent arthroscopy at osteotomy and implant removal (mean interval: 22.2 months). Cartilage lesions (medial femoral condyle [MFC], medial tibial plateau [MTP]) and clinical scores (Lysholm score and KOOS) were documented. No cartilage restoration procedures were performed.

RESULTS: The mean age was 47.5 years and most were females (n = 32). Arthroscopically, cartilage improvement occurred in 32 (65.3%) MFC and 25 (51%) MTP lesions. MOWHTO significantly improved the mechanical tibiofemoral angle (TFA) (7.88 ± 3.66 vs. - 2.71 ± 1.98 (°); P < 0.001). Lysholm knee score (77 ± 16.2 vs. 48.4 ± 16.3, p < 0.001) and KOOS (64.1 ± 13.6 vs. 43.8 ± 12.5, p < 0.001) significantly improved after osteotomy. On the femoral side, cartilage repair was documented in patients who achieved relatively more valgus correction, with a mean final TFA of 3.32 ± 1.7, compared with 1.57 ± 2 in the no improvement group (P = 0.001). For the MTP, no factor of statistical significance could be detected.

CONCLUSIONS: MOWHTO can improve articular cartilage lesions as a standalone procedure. A greater incidence of cartilage repair is expected with more valgus correction of the mechanical axis of the limb. This cartilage infill is associated with slightly better clinical outcomes.

TRIAL REGISTRATION: ClinicalTrials.gov (ID NCT04541342) registered on 9.9.2020, https://clinicaltrials.gov/study/NCT04541342 .

PMID:40455268 | DOI:10.1007/s00264-025-06552-x

Int Orthop. 2025 May 30. doi: 10.1007/s00264-025-06565-6. Online ahead of print.

NO ABSTRACT

PMID:40445355 | DOI:10.1007/s00264-025-06565-6

Int Orthop. 2025 May 26. doi: 10.1007/s00264-025-06564-7. Online ahead of print.

ABSTRACT

INTRODUCTION: Since the introduction of videogames and augmented reality technology, injuries associated with e sports have garnered increased attention from researchers and healthcare professionals. This review articles examines the spectrum of injuries associated with videogames and augmented reality and describes the nuances of the diagnoses associated with gaming injuries.

MATERIALS AND METHODS: An online-based questionnaire of 25 items was distributed to all the members of the Italian Society of Orthopedic Surgery and Traumatology (SIOT) regarding their indications, usual practices, and complications encountered with hardware removal in upper and lower limbs. The survey was open from July 2024 to October 2024. Exclusion and inclusion criteria were applied.

RESULTS: Five hundred answers were received. While implant removal is primarily achieved in symptomatic patients, in the case of asymptomatic patients, it is not routinely performed, with a slightly higher tendency of removal in those aged 16-40 years old. These tendencies were registered both for the upper and lower limbs, with more reticence in hardware removal in the upper limbs. 96% of respondents declared the lack of hospital guidelines regarding this kind of surgery. The most feared intraoperative complications during the removal concerned screw stripping and implant breakage, with only 0.6% of respondents reporting no intraoperative difficulties. While patient discomfort and avoidance of future complications were the main indications for removal, postoperative complications occurred as wound scarring concerns, persistence of symptoms and bleeding. Despite not being considered a "procedure for the resident", when residents were specifically questioned, in 76% of cases they felt self-confident ≥ 7 on a scale from 1 to 10. Lastly, according to 62% of the respondents, titanium implants are more difficult to remove than stainless steel ones.

CONCLUSION: This survey describes a general tendency to not routinely remove implants, even in younger patients in the lower and especially upper limbs, unless in case of symptoms. Hardware removal could evolve from a simple procedure into a more complex surgery due to intraoperative technical difficulties. A lack of universal policy and guidelines exists throughout the Italian territory.

PMID:40415005 | DOI:10.1007/s00264-025-06564-7

Int Orthop. 2025 May 23. doi: 10.1007/s00264-025-06561-w. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to evaluate the early outcomes and safety of allograft medial patellofemoral complex reconstruction (MPFC-R) in children and adolescents with patellofemoral instability (PFI).

METHODS: A retrospective analysis of prospectively collected data was conducted, including patients aged ≤ 18 years who underwent MPFC-R with allograft from January 2018 to December 2021. Preoperative assessment included evaluating patellar tracking and radiographic features, such as trochlear dysplasia, patellar height, and tibial tubercle-trochlear groove distance. Data on patient demographics, PFI type, complications, and patient-reported outcomes (Pedi-IKDC, Kujala Anterior Knee Pain Scale, Lysholm Knee Scoring Scale) were collected. Failure was defined by postoperative patellar dislocation or surgical revision for recurrent patellar instability.

RESULTS: A total of 24 allograft MPFC-R (21 patients) were analyzed with a mean follow-up of 28.8 months (range, 12-60 months). The mean age at surgery was 13.4 years (range, 3-18 years), and 71% were female. The mean Pedi-IKDC, Kujala, and Lysholm scores were 91.2 (± 7.2), 92.8 (± 7.5), and 94.3 (± 6.3) points, respectively. Two patients (8.3%) experienced a single episode of patellofemoral instability without needing surgical revision. No other complications were reported.

CONCLUSION: Allograft MPFC reconstruction appears to be a safe and effective surgical option for managing recurrent patellar instability in children and adolescents at a mean follow-up of two years. Further research is needed to confirm its long-term efficacy and safety.

LEVEL OF EVIDENCE: IV (Case series).

PMID:40407901 | DOI:10.1007/s00264-025-06561-w

Int Orthop. 2025 May 22. doi: 10.1007/s00264-025-06563-8. Online ahead of print.

ABSTRACT

PURPOSE: Managing knee arthritis with an associated extra-articular deformity (EAD) by total knee arthroplasty (TKA) is technically demanding. Intra-articular correction of EAD often requires extensive soft tissue release, which can be challenging. This study evaluates whether imageless robotic assisted TKA facilitates intra-articular correction using functional alignment and desired under-correction of severe EAD. Additionally, we assess the short-term functional and radiological outcomes in these patients.

PATIENTS AND METHODS: We prospectively reviewed 14 consecutive patients with knee osteoarthritis and angular EAD of the femur or tibia due to malunited fractures who underwent robotic-assisted TKA between November 2022 and April 2024. Ten patients had tibial EAD, and four had femoral EAD. Twelve had varus deformity and rest two had valgus deformity. Functional outcomes were assessed using the Oxford Knee Score (OKS), Knee Society Score (KSS), and Knee Society Functional Score (KSS-F). Radiological parameters included the Hip-Knee-Ankle (HKA) axis, mechanical axis deviation (MAD), the centre of rotation of angulation (CORA), medial proximal tibial angle (MPTA), and lateral distal femoral angle (LDFA).

RESULTS: The mean follow-up period was 16 months (range: 8 to 25 months). The mean EAD measured 13.8° (range: 5.1°-21.1°) in the coronal plane and 8.2° (range: 1.2°-22.8°) in the sagittal plane. The mean HKA angle improved from 163.9° ± 7.8° preoperatively to 176.4° ± 1.4° postoperatively (p < 0.05) for varus knees and from 189.5 ± 9.2° to 183.8 ± 2.6° for valgus knees (p = 0.002). No patients required grade IV soft tissue release or constrained prosthesis. The mean arc of motion improved from 94.6° ± 19.3° to 109.6° ± 9.8° (p = 0.001). The KSS, KSS-F, and OKS significantly improved from 25.1 ± 10.8, 36.4 ± 14.5, and 17.2 ± 5.7 preoperatively to 86.8 ± 4.4, 88.6 ± 5.3, and 41.4 ± 4.8 postoperatively (p < 0.001). No radiolucent lines were observed at the bone-cement interface during follow-up. Additionally, no complications such as infection, aseptic loosening, or ligament instability occurred.

CONCLUSION: Robotic-assisted TKA allows for effective intra-articular correction of severe EAD while minimizing the need for extensive soft tissue release. Robotic-assisted TKA helps in executing functional alignment, desired under-correction of the deformity and optimal soft tissue balance, resulting in satisfactory functional and radiological outcomes.

PMID:40402236 | DOI:10.1007/s00264-025-06563-8

Int Orthop. 2025 May 21. doi: 10.1007/s00264-025-06562-9. Online ahead of print.

ABSTRACT

OBJECTIVE: Previous studies have analyzed Tibiotalocalcaneal (TTC) nail placement and proximity to neurovascular structures. However, there is a paucity of literature regarding the bony/articular involvement following nail placement. The objective of this study is to analyze calcaneus, talus, and tibia bone structures and articular involvement of the tibiotalar and subtalar joints following TTC nail placement.

MATERIALS/METHODS: Ten fresh-frozen cadaver legs were utilized without previous injuries or surgeries. Prior to nail placement, the tibiotalar and subtalar joints were arthroscopically evaluated for any pre-existing defects or bony abnormalities. The starting point for a TTC nail was established using fluoroscopic guidance with anteroposterior, lateral, and calcaneal views. Following nail placement, each specimen was dissected to analyze for any compromise of the plantar neurovascular bundles and surrounding bone structures. Measurements of nail involvement of the tibiotalar and subtalar joints were recorded.

RESULTS: An arthroscopic evaluation of the specimen before nail insertion confirmed no cartilage abnormalities in any specimen. After nail insertion, four of ten (40%) of the specimens had a partial breach of the medial wall of the calcaneus with no associated fracture. There was no damage to the neurovascular bundles. On average, the subtalar joint had 4.7% of the total cross-sectional area involved in the posterior subtalar facet. In the tibiotalar joint, there was no additional involvement of the articular surface on the talar dome or tibial plafond outside the nail diameter. There was no breach of the walls of the talar dome or tibial plafond.

CONCLUSION: There was no significant damage to the surrounding neurovascular structures or soft tissues. The posterior subtalar facet had minimal involvement after a TTC nail placement. A more lateral and anterior entry point may avoid a medial wall breach and avoid the posterior subtalar facet.

PMID:40397189 | DOI:10.1007/s00264-025-06562-9

Int Orthop. 2025 May 17. doi: 10.1007/s00264-025-06557-6. Online ahead of print.

NO ABSTRACT

PMID:40379871 | DOI:10.1007/s00264-025-06557-6

Int Orthop. 2025 May 16. doi: 10.1007/s00264-025-06558-5. Online ahead of print.

ABSTRACT

PURPOSE: As an alternative to total hip arthroplasty (THA), hip resurfacing arthroplasty (HRA) has numerous advantages including low risk of dislocation, preservation of femoral bone stock, and no restrictions on high-impact sports. This study was designed to evaluate the results of HRA performed in patients under 30 years old with a long-term follow-up.

METHODS: All HRA performed in patients younger than 30 years at the time of surgery were reviewed with a minimum follow up of two years. The analysis was based on clinical data, patient-recorded outcomes measures, biological and radiological evaluation.

RESULTS: One-hundred three HRA procedures in 93 patients (77 males and 16 females) were included. Mean age at surgery was 27.7 years (18 to 29.9). The two most frequent indications were osteoarthritis in 52% (54 HRA) and developmental dysplasia of the hip in 19% (20 HRA). There were two revisions: one for femoral aseptic loosening and one for infection. No dislocation or adverse wear-related failures were found. At a mean follow-up of 10.4 years (2-17.4), the mean UCLA activity and Oxford Hip score improved from 5.4 (1 to 7) and 39.9 (25-55) preoperatively to 7.9 (3 to 10) and 15.8 (12-34) postoperatively (p < 0.001), respectively. Kaplan-Meier survival analysis, with revision for any reason as the endpoint, showed a 10.8-year survival rate of 98%.

CONCLUSION: This cohort of HRA in patients under 30 years old is the longest follow-up ever reported. Despite HRA being done in a challenging cohort of patients, it shows excellent survivorship with a low complication rate.

PMID:40377662 | DOI:10.1007/s00264-025-06558-5

Int Orthop. 2025 May 15. doi: 10.1007/s00264-025-06559-4. Online ahead of print.

NO ABSTRACT

PMID:40369326 | DOI:10.1007/s00264-025-06559-4