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

SICOT J. 2025;11:47. doi: 10.1051/sicotj/2025042. Epub 2025 Aug 8.

ABSTRACT

INTRODUCTION: Tourniquet use in total knee arthroplasty (TKA) can cause ischaemia-reperfusion (I-R) injury via oxidative stress. This study evaluated whether combined administration of the antioxidant N-acetylcysteine (NAC) and the iron-chelator Deferiprone can mitigate oxidative damage and improve clinical outcomes.

MATERIALS AND METHODS: Twenty TKA patients were randomized into two groups, one group receiving NAC (600 mg, 6 h pre-op) and Deferiprone (1000 mg, 2 h pre-op) (intervention group) and the other group serving as placebo (control). Lipid hydroperoxides (LOOH) and protein malondialdehyde (PrMDA) were measured from quadriceps muscle tissue samples at 5 min (T1) and 40 min (T2) after tourniquet inflation, and 5 min after deflation (T3). Blood markers including serum ferritin, white blood cell (WBC) count, and polymorphonuclear neutrophils (PMNs) were assessed along with tissue PrMDA and LOOH as primary outcome measurements, while pain scores and knee flexion were recorded postoperatively as secondary outcome measurements.

RESULTS: LOOH levels were significantly lower in the intervention group at T2 and T3. PrMDA levels showed no significant differences. Ferritin levels rose by 69% in controls vs. 18% in the intervention group. WBC and PMNs normalized faster, with reduced pain and improved range of motion in the intervention group.

CONCLUSION: The attenuation of LOOH elevation, the faster PMN deactivation, the inhibition of ferritin release from the cells along with the improved clinical outcomes suggest that combined NAC and Deferiprone administration may reduce tourniquet-related oxidative stress and inflammation, enhancing early recovery in TKA patients.

PMID:40779705 | PMC:PMC12334122 | DOI:10.1051/sicotj/2025042

SICOT J. 2025;11:46. doi: 10.1051/sicotj/2025045. Epub 2025 Aug 7.

ABSTRACT

PURPOSE: Intraoperative periprosthetic femoral fracture (IPFF) is a known complication during hemiarthroplasty (HA), which may lead to inferior outcomes. Few studies have assessed the outcomes of IPFF in HA for displaced femoral neck fractures (FNF). This study aims to evaluate the incidence of IPFF in cementless HA for displaced FNF and compare long-term outcomes between patients with and without IPFF.

METHODS: We retrospectively reviewed institutional surgical data of patients who underwent cementless HA for displaced FNF from January 2010 to January 2022. The presence, location, and treatment of IPFF, as well as the effect of IPFF on postoperative weight-bearing, status were assessed. Mortality, readmission, and revision rates were compared between the IPFF and non-IPFF group.

RESULTS: A total of 1,586 patients were included in the study. 104 patients (6.6%) in the IPFF group vs. 1,482 patients (93.4%) in the non-IPFF group. The IPFF location was mostly the calcar (59.6%), followed by the greater trochanter (35.5%) and the femoral shaft (8.6%). Most fractures were treated with fixation (92.3%) and full weight-bearing postoperatively (95.1%). Surgery duration was longer in the IPFF group (p < 0.001). However, there were no significant differences between groups regarding 30-day, 90-day, and 1-year mortality rates, 90-day readmission rates, or revision rates at the latest follow-up. A multivariate binary logistic regression found similar long-term results.

CONCLUSIONS: While IPFF remains a recognized complication of cementless HA for displaced FNF, its occurrence does not adversely affect long-term outcomes when appropriately managed.

PMID:40773666 | PMC:PMC12331202 | DOI:10.1051/sicotj/2025045

SICOT J. 2025;11:45. doi: 10.1051/sicotj/2025041. Epub 2025 Aug 7.

ABSTRACT

INTRODUCTION: The learning curve associated with adopting new surgical systems in total knee arthroplasty (TKA) can significantly impact surgical efficiency and patient outcomes. This study aimed to evaluate the evolution of operative time with the KNEO® (Groupe Lépine, Genay, France) posterior stabilized knee system and to analyze the learning curve for postoperative complications to achieve surgical proficiency.

METHOD: This retrospective, multicentric study analyzed 481 patients who underwent primary TKA with the KNEO® implant in a high-volume university center between 2020 and 2024. The evolution of operative time and postoperative complications requiring reoperation surgery were evaluated, with a follow-up period extending until January 2025, during which complications were monitored. The study included 481 patients with a mean age of 71.7 ± 8.0 years and a mean Body Mass Index of 29.0 ± 4.0 kg/m2. The cohort comprised 308 female (64%) and 173 male (36%) patients.

RESULTS: The mean operative time significantly decreased from 83.5 min in the initial case to 63.0 min after 481 cases (p < 0.001). The learning curve showed an initial learning phase with high variability, followed by stabilization around 150 procedures and subsequent optimization. Postoperative complication rates showed a 31.9% reduction per group of 100 patients (β = -0.3848, p = 0.0075), indicating improved surgical proficiency and patient safety over time.

CONCLUSION: The findings suggest that the KNEO® system follows a measurable learning curve, with operative efficiency and complication rates improving as case volume increases. These results emphasize the importance of structured training and experience accumulation in optimizing patient outcomes when implementing new implant technologies.

PMID:40773665 | PMC:PMC12331203 | DOI:10.1051/sicotj/2025041

SICOT J. 2025;11:44. doi: 10.1051/sicotj/2025044. Epub 2025 Aug 4.

ABSTRACT

BACKGROUND: To evaluate whether the use of patient-specific instrumentation (PSI) or conventional instrumentation (CI) is associated with superior implant positioning and knee alignment in total knee arthroplasty (TKA).

METHODS: Clinical data, pre- and post-operative knee X-rays of 95 patients, who underwent TKA with use of either patient-specific instrumentation (group PSI) or conventional intra-/extramedullary cutting guides (group CI) were retrospectively collected. Preoperative measurements of knee alignment were done by assessing the femorotibial axis, the lateral femoral distal angle, and the medial tibial proximal angle. Postoperative measurements of the mechanical TKA alignment were performed by assessing the relative position of components to the femur and tibia and the femorotibial axis angle. Only when all three parameters were within generally accepted limits was the postoperative radiological outcome considered optimal.

RESULTS: Preoperative measurements and demographics were similar among the two groups. No statistically significant differences were found between postoperative radiographic findings in patients operated on with PSI or CI. A restoration of the femorotibial axis was achieved in 87.8% and 87.0% of patients treated with PSI and CI, respectively (p = 0.583). Coronal alignment of the femoral component was within acceptable limits in 97.6% and 94.4% (p = 0.631) of patients of the PSI and CI groups, respectively. The respective percentages for the tibial component were 85.3% and 83.3% (p = 0.510) of patients. An accurate coronal plane radiological outcome was achieved in 82.9% and 77.8% of patients treated with PSI and CI, respectively (p = 0.611) Conclusions: The use of PSI does not increase the accuracy of component positioning and leg axis restoration compared to CI in TKA in patients with mild deformity.

PMID:40758900 | PMC:PMC12321163 | DOI:10.1051/sicotj/2025044

SICOT J. 2025;11:43. doi: 10.1051/sicotj/2025046. Epub 2025 Aug 4.

ABSTRACT

INTRODUCTION: Knee dislocations, particularly high-grade injuries such as Schenck class KDIV, are complex injuries often resulting from high-energy trauma. While magnetic resonance imaging (MRI) is widely used preoperatively to assess ligamentous damage, its diagnostic accuracy remains uncertain.

METHODS: A retrospective review was conducted on 92 patients who underwent surgery for a knee dislocation at a Level I trauma center over 10 years. Patients who had a preoperative MRI report and intraoperative confirmation of a KDIV injury without a tibial plateau fracture were included, which left 31 patients. MRI sensitivity was determined by comparing radiology reports to operative findings with fluoroscopic examination under anesthesia (EUA) for injuries to the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), lateral collateral ligament (LCL), and posterolateral corner (PLC). Postoperative follow-up documents were reviewed for functional outcomes. A one-way analysis of variance (ANOVA) was performed to evaluate differences in sensitivity across ligament types, followed by a Tukey post hoc test for pairwise comparisons. Mean flexion ROM at final follow-up (≥6 months) was compared between the accurate and inaccurate MRI cohorts using an independent t-test.

RESULTS: Only 35.5% of MRI reports fully matched operative findings. MRI sensitivity was 71.0% for the ACL (22/31), 61.3% for the PCL (19/31), 93.5% for the MCL (29/31), 64.5% for the LCL (20/31), and 51.6% for the PLC (16/31). ANOVA revealed that MCL sensitivity was significantly higher than that of the PLC, PCL, and LCL. The difference in mean flexion ROM at final follow-up between accurate and inaccurate MRI cohorts was not statistically significant (p = 0.56).

DISCUSSION: Preoperative MRI radiology reports demonstrated substantial limitations in accurately identifying ligamentous injuries in KDIV knee dislocations, particularly involving the PLC, PCL, and LCL. These findings highlight a gap between radiologic interpretation and surgical findings. Surgeons should interpret MRI reports with caution and incorporate fluoroscopic EUA at the time of surgery to ensure a comprehensive assessment of ligamentous damage.

PMID:40758899 | PMC:PMC12321162 | DOI:10.1051/sicotj/2025046

SICOT J. 2025;11:42. doi: 10.1051/sicotj/2025038. Epub 2025 Jul 23.

ABSTRACT

PURPOSE: Severe varus knee osteoarthritis (OA) alters weight-bearing mechanics, leading to progressive stress concentration on the posteromedial tibial plateau. In select cases, this results in the development of a Posteromedial Varus Fatigue Fragment (PVFF), a chronic stress-related fracture that remains ununited and influences knee stability, surgical planning, and implant selection. This study aims to evaluate the incidence, radiographic detectability, and intraoperative significance of PVFF in patients undergoing total knee arthroplasty (TKA).

METHODS: A retrospective analysis was conducted of 856 consecutive TKA cases performed by a single surgeon. Preoperative radiographs, intraoperative findings, and surgical modifications were assessed to determine the incidence and implications of PVFF. Correlation with varus severity and absence of ACL was done.

RESULTS: PVFF was detected intraoperatively in 17 of 856 cases (1.99%), but only 9 (53%) were visible on pre-op imaging." All PVFF cases exhibited varus alignment exceeding 15° and complete ACL deficiency. Intraoperatively, fragment removal resulted in an increased medial flexion gap, impacting gap balancing and necessitating adjustments in implant selection, including the use of tibial stems or augments in select cases.

CONCLUSION: PVFF is an underrecognized structural lesion for precision in severe varus knee OA, affecting tibial fixation, load distribution, and medial knee stability. Its presence requires careful intraoperative assessment, as fragment removal can alter gap balancing. Improved preoperative recognition and surgical planning are essential to optimize TKA outcomes in patients. Further prospective studies and biomechanical analyses are needed to better understand PVFF's long-term clinical implications and refine surgical strategies.

PMID:40700623 | PMC:PMC12286574 | DOI:10.1051/sicotj/2025038

SICOT J. 2025;11:41. doi: 10.1051/sicotj/2025039. Epub 2025 Jul 21.

ABSTRACT

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) remains a significant concern in orthopedic surgery, particularly in total knee replacement (TKR), where infection can lead to severe complications. In procedures like TKR, where implants act as a foreign body and potential surface for biofilm formation, infections can lead to severe complications, including delayed healing, and implant failure, and often need multiple revision surgeries. Screening for MRSA before surgery has become a standard practice in many hospitals to reduce the risk of infection. This study aims to evaluate the prevalence of MRSA in patients undergoing TKR and analyze demographic characteristics.

METHODS: A retrospective analysis was conducted on patients scheduled for TKR. Demographic data, including age, gender, and other relevant clinical information, were extracted from the patient's medical records. MRSA screening was performed as part of the preoperative protocol, and the results were recorded. Descriptive statistics were used to summarize the data and calculate the prevalence of MRSA.

RESULTS: A total of 938 patients underwent MRSA screening prior to TKR. The mean age was 67.25 years (median: 68; range: 33-87). The majority of patients were female, accounting for 706 (75.0%), while 232 (25.0%) were male. MRSA test results revealed that 938 (99.3%) patients tested negative, whereas 6 (0.7%) tested positive. Among MRSA-positive patients, all were aged 60 years or older, suggesting a potential correlation between advanced age and MRSA positivity.

CONCLUSION: This study found a low MRSA prevalence (0.7%) in TKR patients, with all cases occurring in individuals aged ≥60 years. The findings advocate prioritizing preoperative screening in older patients to optimize resource use in low-prevalence settings and highlight the need to investigate TKR-specific risk factors for tailored infection control strategies.

PMID:40689503 | PMC:PMC12278734 | DOI:10.1051/sicotj/2025039

SICOT J. 2025;11:40. doi: 10.1051/sicotj/2025035. Epub 2025 Jul 16.

ABSTRACT

INTRODUCTION: Osteoporotic vertebral fractures (OVFs) are the most common type of fragility fractures. They have a significant and usually detrimental impact on the patient's functional status and mortality rate, constituting a substantial burden for the patients, their families, and the healthcare system. This narrative review aims to summarize the current knowledge of osteoporotic vertebral fractures and secondary fracture prevention.

METHODS: A comprehensive literature search was conducted across major medical databases, including PubMed, Scopus, and Web of Science. Relevant studies, guidelines, and reviews published were analyzed to provide a broad perspective on the topic.

RESULTS: Diagnosis of OVFs is based on history, clinical examination, and plain lateral radiographs of the spine. Their management is mainly non-operative, with surgery being reserved for specific indications. Successful management of osteoporotic vertebral fractures entails alleviating pain, early restoration of mobility, and secondary fracture prevention. Prevention of the next osteoporotic fracture is paramount and should be an integral element of their management. The Fracture Liaison Service (FLS) is the main contemporary service that serves this purpose.

DISCUSSION: Diagnosis of OVFs is simple but requires vigilance from the clinicians. Early, accurate diagnosis is essential to initiate appropriate treatment and provide the opportunity for secondary fracture prevention.

PMID:40668980 | PMC:PMC12266666 | DOI:10.1051/sicotj/2025035

SICOT J. 2025;11:39. doi: 10.1051/sicotj/2025034. Epub 2025 Jul 16.

ABSTRACT

BACKGROUND: Dementia patients with femoral neck fractures (FNFs) are unable to understand their dislocated limb positioning, which may impair rehabilitation and result in poorer functional recovery. Recently, good clinical results have been reported for the direct anterior approach for total hip arthroplasty (DAA-THA) using a dual mobility cup (DMC) for displaced FNFs. This study aimed to investigate differences in the clinical outcome of THA for displaced FNFs in patients with and without dementia.

METHODS: This study was retrospective and included 151 patients who underwent DAA-THA with DMC for displaced FNFs. Patients diagnosed with dementia prior to injury were classified into a dementia group (43 patients) and a non-dementia control group (control group, 108 patients). The evaluation items were age, sex, body mass index (BMI), preoperative Fracture Mobility Score (FMS), waiting period, preoperative anesthetic assessment, blood loss, operation time, complications, 1-year mortality, and 1-year FMS after surgery. The FMS was scored as: walking alone: 1, walking with a cane: 2, walking with a walker: 3, hand-guided walking: 4, and wheelchair: 5.

RESULTS: Significant differences were found in age, weight, BMI, and operation time. Postoperative dislocation was not observed in both groups. FMS was compared before and after injury in three categories: (1) unchanged from before injury, (2) one rank down, and (3) two or more ranks down. No significant differences were found in any of these categories (p = 0.09). Functional outcomes showed no significant difference in mobility recovery. The 1-year mortality rate was 9.35% (16 patients), with no significant difference between the two groups (p = 0.17).

DISCUSSION: DAA-THA using DMC for displaced FNFs may have similar functional outcomes and mortality rates in both patients with and without dementia.

PMID:40668979 | PMC:PMC12266661 | DOI:10.1051/sicotj/2025034

SICOT J. 2025;11:38. doi: 10.1051/sicotj/2025032. Epub 2025 Jul 16.

ABSTRACT

INTRODUCTION: Venous thromboembolism (VTE) is a rare but potentially serious complication following anterior cruciate ligament reconstruction (ACLR). There is no guideline for the routine use of anticoagulants post-ACLR surgery.

METHODS: This retrospective case-control study reviewed 199 patients who underwent ACLR between February 2020 and November 2024. Two groups were compared: Group A (n = 113) received no pharmacological prophylaxis, while Group B (n = 86) received low-molecular-weight heparin (LMWH) for 2 weeks postoperatively. The incidence of symptomatic VTE, postoperative bleeding, and related complications was evaluated.

RESULTS: No symptomatic VTE or bleeding complications were observed in either group. There was no statistically significant difference between the groups in terms of age, BMI, smoking, comorbidities, and postoperative weight bearing. There was a significant difference in surgical duration, graft type, and meniscal procedure.

DISCUSSION: Our findings support a risk-stratified approach rather than universal pharmacologic prophylaxis in ACLR patients.

PMID:40668978 | PMC:PMC12266665 | DOI:10.1051/sicotj/2025032