SICOT J. 2025;11:58. doi: 10.1051/sicotj/2025060. Epub 2025 Dec 5.

ABSTRACT

BACKGROUND: Subtrochanteric femur fractures present complex biomechanical and biological challenges with considerable variability in management approaches. Despite a structured approach to operative fixation using the intramedullary nail being accepted as the gold standard for most subtrochanteric fractures, a number of high-impact clinical dilemmas lack clarity and consensus on management approaches due to limited high-level clinical and published evidence.

METHODOLOGY: We identified 11 key controversies through a comprehensive literature review of the PubMed, Scopus, and Cochrane databases from 2011 to 2024. Expert input through direct conversations with high-volume trauma surgeons further reinforced the selection of these problem statements. A modified Delphi consensus process was used to engage with 64 experienced Indian orthopedic surgeons. A four-phase methodology was employed, beginning with the pre-definition of 11 key controversies through literature review. PubMed/Scopus/Cochrane: 2000-2024 and expert input. Phase I description: Before initiating the consensus process, a steering committee systematically reviewed existing literature to predefine and shortlist 11 high-impact, unresolved clinical dilemmas. This ensured all subsequent phases of evidence synthesis and voting were focused on these predefined domains.

RESULTS: Eleven evidence-supported consensus statements were ratified, addressing implant selection, reduction techniques, technical nuances, and complex scenarios. All statements included clinical rationale, consensus strength (10 Strong, 1 Moderate), and evidence level (I-III). Key outputs of the meeting were the formulation of a standardized treatment algorithm and a decision-making framework for ambiguous clinical situations.

CONCLUSION: This consensus provides practical, expert-endorsed guidance to resolve recurring controversies in subtrochanteric fracture management. By bridging evidence gaps with collective surgical experience, it aims to standardize care, reduce unwarranted variation, and improve patient outcomes.

PMID:41348957 | PMC:PMC12680372 | DOI:10.1051/sicotj/2025060

SICOT J. 2025;11:57. doi: 10.1051/sicotj/2025048. Epub 2025 Oct 31.

ABSTRACT

INTRODUCTION: Osteoporosis is a prevalent and often underdiagnosed condition that significantly increases the risk of fragility fractures. Dual-energy X-ray absorptiometry (DXA) is the standard diagnostic tool; however, many patients remain unscreened. Preoperative computed tomography (CT) scans obtained for robotic-assisted total knee arthroplasty (TKA) planning present an opportunity for opportunistic osteoporosis screening without additional radiation exposure.

METHODS: A retrospective observational study was conducted on 637 patients (307 males, 330 females) who underwent robotic-assisted TKA between January 2023 and December 2024. Preoperative CT scans were analyzed using quantitative computed tomography (QCT) software to determine T-scores, Z-scores, and percentage of bone mineral density (BMD) relative to a young-adult reference. Patients were categorized as normal (T-score ≥ -1.0), osteopenic (-2.5 < T-score < -1.0), or osteoporotic (T-score ≤ -2.5).

RESULTS: Among 597 patients with available T-score data, 41.0% were classified as normal, 32.3% as osteopenic, and 26.6% as osteoporotic. Notably, 37.0% of female patients were osteoporotic compared to 15.3% of male patients. Bone density parameters declined progressively with age, with females over 80 years exhibiting a mean T-score of -2.53 and BMD at 68.25% of the young-adult reference.

DISCUSSION: Opportunistic screening using preoperative CT scans in robotic-assisted TKA patients reveals a high prevalence of undiagnosed low BMD, particularly among elderly women. Integrating QCT analysis into the preoperative workflow may facilitate early identification of at-risk individuals, informing surgical planning and enabling timely interventions to improve bone health.

PMID:41172241 | PMC:PMC12578436 | DOI:10.1051/sicotj/2025048

SICOT J. 2025;11:56. doi: 10.1051/sicotj/2025051. Epub 2025 Sep 30.

ABSTRACT

BACKGROUND: Ankle pain frequently occurs in patients with medial compartment knee osteoarthritis (OA), particularly in those with varus deformity. In these patients, an atypical alignment of the ankle joint line relative to the ground is often observed in the coronal plane. The purpose of this study was to evaluate changes in ankle pain and ankle joint orientation after high tibial osteotomy as a treatment of medial compartment knee OA.

METHODS: This prospective work was conducted on 100 patients, aged 40-55 years old, with symptomatic medial compartment knee OA associated with ankle pain, with a good range of motion and intact lateral compartment. All patients treated with high tibial osteotomy fixed by plate. Ankle pain was measured by visual analogue score (VAS) preoperatively and at 3 months, 6 months, 1 year, and 2 years postoperatively. The following parameters were assessed preoperatively and at 3 months postoperatively: the ankle joint line orientation (AJLO), medial proximal tibial angle (MPTA), and the hip-knee-ankle angle (HKA).

RESULTS: The ankle pain significantly improved postoperatively and at last follow-up after HTO; VAS significantly reduced from 5 (4-5) preoperatively to 2 (1-2) at last follow-up (P < 0.001). AJLO was substantially decreased from 9.58 ± 2.74° preoperative to 0.41 ± 1.88° postoperative (P < 0.001). MPTA increased significantly following surgery, from a preoperative value of 85.78 ± 1.84° to a postoperative value of 90.71 ± 1.58° (P < 0.001). Similarly, HKA improved significantly from -7.73 ± 1.50° preoperatively to 2.43 ± 0.88° postoperatively (P < 0.001). A positive correlation was found between ankle pain improvement via VAS and changes in AJLO, MPTA, and HKA (P < 0.05).

CONCLUSION: In patients with medial unicompartmental knee OA associated with ankle pain, both ankle pain and ankle joint orientation improved following high tibial osteotomy.

PMID:41026917 | PMC:PMC12483354 | DOI:10.1051/sicotj/2025051

SICOT J. 2025;11:55. doi: 10.1051/sicotj/2025054. Epub 2025 Sep 30.

ABSTRACT

PURPOSE: This study aimed to assess hindfoot height (HFH) changes 12 months after posterior arthroscopic subtalar arthrodesis without bone grafting. We hypothesized that HFH reduction would be minimal and would not impact fusion or functional results.

METHODS: A retrospective study was conducted on 39 patients who underwent posterior arthroscopic subtalar arthrodesis. HFH was measured on CT scans preoperatively and at 12 months postoperatively. Inter- and intra-observer reliability of the measurement was also assessed as a secondary outcome. Clinical outcomes included pain (numeric analog scale, NAS) and AOFAS Ankle-Hindfoot scores. Subtalar fusion ratios were evaluated via CT.

RESULTS: Mean HFH loss was 0.85 ± 1.1 mm (range, 0-5 mm). The average fusion ratio was 72 ± 30%. Pain and AOFAS scores significantly improved (NAS: -4 ± 2, p < 0.0001; AOFAS: +31 ± 13, p < 0.0001). No correlation was found between HFH loss and fusion ratio or clinical outcomes. HFH loss > 1 mm was more frequent in women and smokers. HFH measurement on CT showed excellent inter- and intra-observer reliability (ICC intra: 0.989; inter: 0.976).

CONCLUSIONS: Posterior arthroscopic subtalar arthrodesis without bone graft results in minimal hindfoot height loss, with no negative impact on subtalar fusion or functional outcomes. This technique reliably preserves hindfoot alignment and provides excellent clinical results. While the assessment of hindfoot height on CT demonstrated excellent inter- and intra-observer reliability, this was a secondary finding and supports the utility of CT-based measurements in the postoperative evaluation of subtalar arthrodesis.

PMID:41026916 | PMC:PMC12483349 | DOI:10.1051/sicotj/2025054

SICOT J. 2025;11:54. doi: 10.1051/sicotj/2025052. Epub 2025 Sep 24.

ABSTRACT

INTRODUCTION: Worldwide, more than 1 million Total Hip Arthroplasties (THAs) are performed annually, with this number predicted to increase by 37.7% by the year 2060. This places a significant financial burden on the healthcare system, with the average cost of a THA being approximately $40,000. Several factors ultimately contribute to patient outcomes and complications, including surgical approach, surgeon's experience, patient age, BMI, and most importantly, the preoperative diagnosis. Our paper aimed was to describe the various aetiologies of hip pathologies in patients presenting for primary elective THA to a tertiary academic sub-Saharan African institution.

MATERIALS AND METHODS: We retrospectively reviewed 1400 consecutive patients presenting for elective primary THA between January 2015 and December 2021. Patients' preoperative clinical notes, radiological records, and intraoperative results were independently assessed by two examiners to diagnose the hip pathology. A comparison of the presenting preoperative aetiologies was made between those seen in developed countries and those seen in more developing countries.

RESULTS: 2176 pathological hips were evaluated. Bilateral pathology was present in 56% of patients, of which 92% had the same pathology. There were 427 (31%) males and 973 (69%) females, with an average patient age of 58 ± 14.13 years and an average BMI of 31.01 ± 15.13 kg/m2. The preoperative aetiologies included primary osteoarthritis (OA) (n = 406 [29%]) and avascular necrosis of the femoral head (AVN) (n = 322 [23%]), of which (n = 162 (58%) had bilateral pathology. The primary cause of AVN was HIV (49%). Patients presenting with AVN were significantly younger (p < 0.0001) and had a lower BMI (p < 0.0001) in comparison to patients presenting for other pathologies.

CONCLUSION: This study underscores the significance of aetiology in THA outcomes and highlights the unique challenges faced in developing countries. By identifying the specific causes of hip pathology in this population, healthcare providers can better allocate resources and develop tailored treatment strategies to improve outcomes in resource-limited settings.

PMID:40990380 | PMC:PMC12459105 | DOI:10.1051/sicotj/2025052

SICOT J. 2025;11:E2. doi: 10.1051/sicotj/2025053. Epub 2025 Sep 24.

ABSTRACT

Physicians often grapple with the delicate balance between providing full disclosure and shielding patients from harsh realities. Honesty, empathy, and patient-centered care are crucial elements influencing patient outcomes and well-being. The revelation process of life-threatening diseases triggers distinct psychological coping stages, emphasizing the need for sensitive communication. Cultural factors further shape communication dynamics, necessitating individualized approaches. As such, this paper discusses the need for truth in the relationships and interactions of doctors and patients, emphasizes adequate information of patients based on honesty and consideration of their expectations, environment, and cultural values, and explores the pivotal role of bioethics education and training in preparing medical professionals to navigate these complex situations. By integrating bioethics education into medical curricula, fostering open and honest communication, and building strong patient-doctor relationships, we can enhance the quality of care and empower patients to embrace their medical journey with dignity and acceptance.

PMID:40990379 | PMC:PMC12459106 | DOI:10.1051/sicotj/2025053

SICOT J. 2025;11:53. doi: 10.1051/sicotj/2025050. Epub 2025 Sep 19.

ABSTRACT

BACKGROUND: Correcting severe scoliosis is challenging due to curve rigidity and risks to cardiopulmonary and neurologic function. Osteotomy techniques offer greater correction but carry higher complication rates, while non-osteotomy methods may be safer but less effective. This systematic review compares outcomes between osteotomy and non-osteotomy approaches in treating severe idiopathic scoliosis.

METHODS: A systematic search was conducted in PubMed, EMBASE, and the Cochrane Library using MeSH terms related to "idiopathic adolescent scoliosis", "AIS", "severe scoliosis", and "surgical outcome". The review followed PRISMA guidelines.

RESULTS: An initial search yielded 565 studies, of which 23 studies (n = 932 patients) met the inclusion criteria. The Vertebral Column Resection (VCR) group achieved the greatest spinal correction, with a mean Cobb angle of 106.7 ± 9.7° and a correction rate of 62.1%, but also had the highest complication rate at 24%. Non-osteotomy methods provided similar correction (107.0 ± 9.1°, 61.5%) with a slightly lower complication rate of 19.6%. The Ponte osteotomy group had the lowest complication rate (4%) with a moderate level of correction (107.4 ± 10.5°, 60.3%). In terms of functional outcomes, the non-osteotomy group reported the highest SRS-22r scores, averaging 4.3.

CONCLUSION: VCR offers the most significant curve correction, but with a higher complication rate. Ponte osteotomy provides a safer alternative with acceptable clinical outcomes. In contrast, non-osteotomy techniques strike a balance between correction and risk, with favorable functional results.

PMID:40971604 | PMC:PMC12448635 | DOI:10.1051/sicotj/2025050

SICOT J. 2025;11:52. doi: 10.1051/sicotj/2025040. Epub 2025 Sep 4.

ABSTRACT

Patellofemoral arthroplasty (PFA) is useful and effective option for treating patients with isolated patellofemoral osteoarthritis. The concept of functional positioning (FP) in PFA focuses on resurfacing the trochlea and restoring normal patellar tracking, while keeping the joint anatomy and kinematics. Even though the patellar liner cannot yet be placed with robotic assistance, robotic tools still help surgeons manage and optimize patellar tracking during surgery. This surgical technique highlights how the image-based robotic system assists the surgeon in improving patellar positioning and patellar tracking during a PFA. This technique could contribute to reduce complications, although its actual benefits remain to be validated. It may help prevent patellar instability through direct tracking assessment and reduce fracture risk by preserving more patellar bone. Accurate placement of the patellar button and evaluation of anterior offset might alleviate anterior knee pain. A tailored resection could also help protect the patellar vascular supply. Image-based planning may assist in avoiding malpositioning, potentially leading to fewer revisions.

PMID:40906908 | PMC:PMC12410931 | DOI:10.1051/sicotj/2025040

SICOT J. 2025;11:51. doi: 10.1051/sicotj/2025047. Epub 2025 Sep 1.

ABSTRACT

BACKGROUND: The lateral approach in total knee arthroplasty (TKA) is indicated primarily for patients with valgus knee deformity, as it allows direct access to the lateral anatomy and systematic correction of associated pathologies.

SURGICAL TECHNIQUE: This technique involves strategic lateral soft tissue releases, which improve exposure to the posterolateral corner, enhance tibial rotation, and support patellar alignment without compromising medial vascularity or requiring a tibial tubercle osteotomy for joint exposure. Critical steps in the lateral TKA approach include maintaining a capsular-synovial overlap and preserving the Hoffa fat pad for optimal joint closure, releasing the lateral soft-tissue structures, and using a contralateral tibial cutting guide for enhanced access and protection of the patellar tendon.

DISCUSSION: These techniques collectively allow for a balanced, stable joint with effective alignment and soft tissue management. Outcomes of the lateral approach in valgus TKA are comparable to those of the medial approach, with similar functional outcomes, range of motion, and surgical time. Some studies even report superior patellar tracking and function scores with the lateral approach. Complication rates are low, though attention is required to avoid peroneal nerve injury in severe deformities. Future research involving large, randomized controlled trials is recommended to substantiate these favorable outcomes and guide long-term treatment strategies for valgus TKA.

PMID:40889350 | PMC:PMC12401512 | DOI:10.1051/sicotj/2025047

SICOT J. 2025;11:50. doi: 10.1051/sicotj/2025031. Epub 2025 Aug 26.

ABSTRACT

BACKGROUND: Proximal femoral megaprosthetic reconstruction is a well-established solution for extensive bone loss in the hip region. Despite its utility in limb salvage, it carries notable complication rates, reported between 30% and 40%, along with increased morbidity and mortality. This study evaluated implant and patient survival, failure modes, and associated risk factors.

METHODS: We retrospectively reviewed 165 patients who underwent proximal femoral megaprosthetic reconstruction between 2003 and 2023. Indications included primary bone tumors (n = 67), metastatic bone disease (n = 60), and non-oncologic conditions (n = 38). A total of 57 METS (Stanmore) and 108 MUTARS (Implantcast) implants were used. Median follow-up was 5 years (range: 0.25-17 years).

RESULTS: Mean implant survival was 5.13 years (range: 0.2-17 years), with an overall complication rate of 30.9%. The most common failure modes were type 1 (11.5%) and type 4 (13.3%) per Henderson classification. Five-year implant survival ranged from 60% to 70% across indications. Independent risk factors for type 4 failure included prolonged hospitalization (OR = 1.07, p = 0.020) and longer operative time (OR = 1.01, p = 0.023). Silver-coated implants showed a trend toward reduced infection (OR = 0.18, p = 0.29), though not statistically significant. METS implants were associated with lower type 1 failure risk (OR = 0.09, p = 0.020), with a soft-tissue failure rate of 3.5% versus 15.7% for MUTARS.

CONCLUSION: Proximal femoral megaprostheses remain effective for limb salvage but are linked to a substantial complication burden. Recognition of modifiable and patient-specific risk factors may improve surgical outcomes and reduce failure rates.

PMID:40857599 | PMC:PMC12380411 | DOI:10.1051/sicotj/2025031

SICOT J. 2025;11:49. doi: 10.1051/sicotj/2025043. Epub 2025 Aug 26.

ABSTRACT

INTRODUCTION: Complications arising from the patellofemoral joint (PFJ) represent the third most common cause for revision in total knee arthroplasty (TKA). Previous in vitro biomechanical studies have altered the native attachments of muscles controlling the PFJ. The purpose of this study was to design an in vitro biomechanical setup that would allow testing of both native and arthroplasty knee joints, specifically the PFJ, without disturbing the native attachments of the quadriceps and hamstrings muscles.

METHODS: After finalising a prototype, a pelvis-to-toe human cadaver specimen was tested. The simVITRO platform was used to simulate movement and control force trajectories. A motion capture system was used to capture the motion of the bones and to measure knee flexion angle and patellar movement with respect to the femur. The forces applied in the PFJ were measured using a custom patella sensor.

RESULTS: Displacement of the reflective cluster attached to the femur was measured during compression loading at different flexion angles, passive flexion and stairs descent trajectory. The femur showed less than 1 mm and 3 mm displacement with respect to the femur clamp in passive flexion and stairs descent. The most translation of 8.37 mm (<2% average femur length) was observed at 90° flexion which occurred at 483 N simulated compression force.

CONCLUSION: This novel design provides a methodology for studying the biomechanics of the PFJ in vitro that preserves the soft tissues influencing the behaviour of the joint. This setup provides a biomechanics model that can be utilised to better understand and study the PFJ in vitro.

PMID:40857598 | PMC:PMC12380413 | DOI:10.1051/sicotj/2025043

SICOT J. 2025;11:48. doi: 10.1051/sicotj/2025049. Epub 2025 Aug 26.

ABSTRACT

BACKGROUND: Acetabular reconstruction during revision total hip arthroplasty (THA) with major bone loss is a complex surgical challenge. The combination of custom-made (CM) acetabular components with cemented dual mobility (DM) cups may improve postoperative outcomes in this context. This study aims to assess the clinical, functional, and radiological results of this surgical approach.

METHODS: We conducted a retrospective, single-center observational study including 16 patients (mean age 70 years) who underwent revision THA between May 2016 and December 2024 using a cemented DM cup in a CM acetabular component. All patients presented with Paprosky 3A or 3B defects, and 38% had a history of periprosthetic joint infection (PJI). Functional outcomes were measured using the Oxford Hip Score (OHS) and modified Harris Hip Score (mHHS) pre- and postoperatively. Radiographic assessment included measurement of the center of rotation (COR) deviation in both axes, as well as acetabular inclination and anteversion on postoperative CT scans. Implant survival was analyzed using Kaplan-Meier methodology.

RESULTS: At a mean follow-up of 16.2 months, overall implant survival was 75%, increasing to 93.8% when excluding isolated DM cup revisions. No postoperative infections were observed. OHS improved from 14.1 to 27.6 and mHHS from 27.4 to 52.7 (p < 0.001 for both). A significant negative correlation was observed between vertical (y-axis) COR deviation and functional scores (p < 0.01), highlighting the importance of restoring vertical COR. Mean inclination and anteversion were 41.2° and 29°, respectively, generally within target alignment zones.

DISCUSSION: The combination of cemented DM cups with CM acetabular components appears to be an effective technique in complex revision THA. Functional recovery and implant survivorship are consistent with the existing literature, and the absence of infection despite prior PJI history suggests benefit from a multidisciplinary approach. Restoration of vertical COR is a predictor of functional outcomes.

PMID:40857597 | PMC:PMC12380412 | DOI:10.1051/sicotj/2025049