SICOT J. 2026;12:28. doi: 10.1051/sicotj/2026022. Epub 2026 May 13.

ABSTRACT

INTRODUCTION: As early as 1985, Charles S. Neer II and Peter Welsh emphasized that successful shoulder treatment - whether surgical or non-surgical - relies on structured rehabilitation based on simple exercises performed independently by the patient several times daily. The Sarah Jackins auto-rehabilitation program, developed with Frederick A. Matsen and Douglas T. Harryman in Seattle, further reinforced this concept and was widely implemented in clinical practice and training.

METHODS: This paper describes the application of four key rehabilitation principles in more than 24,000 patients treated for shoulder conditions, including over 8,000 surgical cases.

RESULTS AND DISCUSSION: The protocol is based on (1) simple self-administered exercises performed three to five times daily, (2) supervision by a trained physiotherapist. The paper is well illustrated with examples of all the exercises performed. Type of paper: Descriptive, Level V of evidence, Expert Opinion.

PMID:42127303 | PMC:PMC13171015 | DOI:10.1051/sicotj/2026022

SICOT J. 2026;12:27. doi: 10.1051/sicotj/2026023. Epub 2026 May 12.

ABSTRACT

INTRODUCTION: Rotationplasty is a valid surgical technique in the management of bone sarcomas about the knee in children. This technique is often useful in patients with large extraosseous tumor extension and in the very young patients with anticipated significant limb length discrepancy. The aim of this study is to assess the long-term functional outcome and quality of life in our cohort of patients who have survived into adulthood.

METHODS: We have prospectively analyzed the functional outcome and quality of life in ten rotationplasty survivors. There were five male and five female patients with a mean age at the time of the index procedure of 11.6 ± 2.7 years. The functional outcome was evaluated using the Musculoskeletal Tumor Society Score (MSTS) and the Quality of Life (QoL) was assessed using the core quality of life questionnaire (QLQ-C30) of the EORTC.

RESULTS: Patients were followed up for a mean duration of 13.8 ± 4.4 years. The mean overall MSTS functional score was 82.7%. Nine patients reported either no or only minor functional restrictions. Only one patient used a crutch on walking for long distances, while other patients had unlimited or mild limitation of the distance that they could walk. The mean score of the global health status (QoL) was 85.8% with a mean score for social functioning of 90% and a mean score for role functioning of 88.3%.

CONCLUSIONS: Rotationplasty affords the patients with an active lifestyle with no psychological or psychosocial disadvantages. The long-term assessment confirms that these patients maintain excellent functional results and quality of life through adulthood.

PMID:42127302 | PMC:PMC13171014 | DOI:10.1051/sicotj/2026023

SICOT J. 2026;12:26. doi: 10.1051/sicotj/2026014. Epub 2026 May 12.

ABSTRACT

INTRODUCTION: Chronic rupture of the extensor mechanism is a serious complication that could occur in the context of revision total knee arthroplasty (TKA). Performing combined extensor mechanism allograft reconstruction and revision TKA as a single-stage procedure requires precise surgical technique.

TECHNIQUE: Allograft size and quality were assessed preoperatively. A tibial tubercle osteotomy (TTO) was performed prior to revision TKA. After implantation of the definitive prosthesis, the TTO was fixed to the tibia using screws. The quadriceps tendon was sutured to the allograft using the Pulvertaft weave technique with the knee in full extension. Native patellar retinacula and prepatellar fascia were preserved to optimize graft coverage. Postoperatively, patients were immobilized in full extension for three months before starting progressive mobilization.

RESULTS: From January 2017 to April 2024, 20 patients underwent a single-stage revision TKA with total extensor mechanism allograft and were followed for a minimum of one year. Range of motion was recovered at follow-up. Five patients (25%) had failures attributed to the allograft.

CONCLUSION: Single-stage TKA revision combined with extensor mechanism allograft, in the context of multiply operated knees, requires meticulous stepwise execution, including secure tibial fixation, precise graft tensioning, and preservation of native soft tissue coverage, to optimize outcomes in this high-risk setting.

PMID:42127301 | PMC:PMC13171016 | DOI:10.1051/sicotj/2026014

SICOT J. 2026;12:25. doi: 10.1051/sicotj/2026018. Epub 2026 May 6.

ABSTRACT

INTRODUCTION: The optimal management of the long head of the biceps tendon (LHBT) during rotator cuff repair remains controversial, particularly when the tendon appears normal. This study aims to compare the clinical outcomes of arthroscopic rotator cuff repair with and without routine LHBT release.

METHODS: A retrospective study including patients aged >50 years with a repairable rotator cuff tear and documented normal LHBT who underwent arthroscopic surgery was conducted. Patients were divided into two groups: LHBT preservation group (n = 113) and LHBT release group (n = 110). Postoperative evaluation included the visual analog scale (VAS) for pain, while functional outcomes were assessed by the Constant-Murley score and the American Shoulder and Elbow Surgeons (ASES) scores. Postoperative pain and functional outcomes were compared between the two study groups at 12 and 24 months.

RESULTS: Groups were comparable in terms of age (p = 0.16), sex (p = 0.30), rotator cuff tear size (p = 0.51), and number of anchors used for the repair (p = 0.44). At 24 months, the LHBT release group demonstrated lower VAS score (p < 0.001), higher Constant-Murley score (medians: 86 vs 81, p < 0.001), and higher ASES score (medians: 90 vs 83, p < 0.001). Regression analysis confirmed that LHBT release is independently associated with improved functional outcomes (coefficient = 4.85, p < 0.001 for Constant-Murley score; coefficient = 6.66, p < 0.001 for ASES score).

DISCUSSION: The findings of this study indicate that routine LHBT release during rotator cuff repair, even in the absence of macroscopic pathology, is associated with less postoperative pain and superior functional scores.

PMID:42090591 | PMC:PMC13148789 | DOI:10.1051/sicotj/2026018

SICOT J. 2026;12:24. doi: 10.1051/sicotj/2026026. Epub 2026 May 5.

ABSTRACT

BACKGROUND: Robotic-assisted systems have been developed to improve the accuracy and reproducibility of total knee arthroplasty (TKA). While outcomes have been widely studied, the effects of these systems on intraoperative workflow and surgical team workload have received less attention. The aim of this study was to compare procedural setup, efficiency, workload, and ergonomics between the VELYS robotic-assisted solution (VRAS) and computer-navigated TKA (NAVI).

METHODS: Twenty patients who underwent primary TKA performed by a single surgeon, using a single implant type, were enrolled in this research (10VRAS, 10NAVI). Procedural efficiency was assessed by reference to an AI-backed process digital twin platform. Workload was evaluated using NASA-TLX questionnaires, objective ergonomic measures (power tool holding times, retractor holding times, and leg holding times), and a tray analysis.

RESULTS: The mean total operating room (OR) time was 69.4 min for the VRAS group and 72.9 min for the NAVI group, with no significant difference. The preparation (22 min) and the breakdown times (12.6 vs.11.7 min) were equivalent. The skin-to-skin times averaged 34.3 min for the VRAS group versus 38.9 min for the NAVI group. NASA-TLX scores revealed significantly lower mental, physical, and temporal demands, reduced effort and frustration, and better perceived performance of the surgeon in the VRAS group (p < 0.05). The instrument burden was similar, 5 trays (21.5 kg) for VRAS and 4 trays (20.9 kg) for NAVI. The objective workload was reduced for the VRAS group, with shorter power tool holding (2.7 vs. 7.7 min, p < 0.001), retractor holding (7.8 vs. 13.0 min, p = 0.01), and leg holding times (3.4 vs. 4.7 min, p = 0.02).

DISCUSSION: Compared with navigated TKA, robotic assistance did not prolong overall OR time and was associated with lower measured NASA-TLX scores. These findings suggest that robotic-assisted TKA may offer workflow and ergonomic advantages, although further studies with larger samples are needed to confirm these preliminary observations.

LEVEL OF EVIDENCE: Level 4, retrospective study.

PMID:42085584 | PMC:PMC13143209 | DOI:10.1051/sicotj/2026026

SICOT J. 2026;12:23. doi: 10.1051/sicotj/2026016. Epub 2026 May 5.

ABSTRACT

INTRODUCTION: Range of Motion (ROM) assessment is a critical baseline metric for diagnosis, treatment monitoring, and rehabilitation goal setting. It significantly impacts patient well-being, aligning with Sustainable Development Goal 3 (SDG 3). However, the universal goniometer (UG), presents limitations regarding accuracy and practical efficiency in clinical settings. Therefore, this study aimed to determine the concurrent validity of an electronic goniometer named Goniwear compared to the UG for measuring elbow and knee angles.

METHODS: The validity of Goniwear involved 40 healthy volunteers stratified by age (20-39 and 40-59 years) and sex. Simultaneous active and passive ROM measurements were conducted three times using both UG and on flexion and extension of the elbow and knee joints. Data were analyzed using the intraclass correlation coefficients (ICC), which were calculated using a two-way random-effects model, and the Bland-Altman method was used to determine the limits of agreement (LoA) between the UG and Goniwear.

RESULTS: Reliability between the two instruments ranged from poor to excellent, depending on the joint and movement type. Elbow flexion and extension demonstrated consistently good to excellent reliability in both active and passive conditions (ICC = 0.84-0.91), with minimal bias and relatively narrow LoA. Knee flexion and extension showed poor to moderate reliability (ICC = 0.44-0.55), particularly for extension, accompanied by a wide LoA.

CONCLUSION: Agreement between the UG and Goniwear varies across joints and movement conditions. While the instruments appear interchangeable for elbow movements, caution is warranted when interpreting knee ROM due to greater measurement variability.

DISCUSSION: The Goniwear demonstrates high validity for single-axis joints with fixed pivot points, suggesting strong potential for clinical application in specific contexts.

TRIAL REGISTRATION: The Thai Clinical Trials Registry is TCTR20251120001.

PMID:42085583 | PMC:PMC13143208 | DOI:10.1051/sicotj/2026016

SICOT J. 2026;12:E3. doi: 10.1051/sicotj/2026019. Epub 2026 May 5.

ABSTRACT

Robotic platforms have revolutionized arthroplasty through precision and patient-specific planning, yet introduce cyber-physical vulnerabilities in interconnected surgical ecosystems. Recent incidents, including the 2026 cyber-attack, highlight operational risks despite low direct intraoperative threats. Proactive cybersecurity, via FDA-aligned secure design, institutional audits, and surgeon vigilance, is imperative to safeguard patient safety and trust in precision orthopedics.

PMID:42085582 | PMC:PMC13143206 | DOI:10.1051/sicotj/2026019

SICOT J. 2026;12:22. doi: 10.1051/sicotj/2026017. Epub 2026 Apr 29.

ABSTRACT

INTRODUCTION: This pilot study investigated the effects of ovariectomy-induced estrogen deficiency on the biomechanical properties of intact anterior cruciate ligaments (ACLs) in a porcine model, a biological condition that may influence ligament integrity and injury susceptibility.

METHODS: A bilateral ovariectomy model was used to induce systemic estrogen deficiency. Fourteen two-month-old female pigs were included. Four pigs (8 knees) underwent bilateral ovariectomy (OV group). The left knees of 10 pigs that underwent laparotomy without ovariectomy for a separate study were analyzed as controls (C group). At 12 weeks, knee joints were examined macroscopically, followed by biomechanical testing consisting of cyclic anterior drawer loading and load-to-failure.

RESULTS: All ACLs were intact without arthrofibrosis or cartilage degeneration. During cyclic testing, anterior tibial translation was significantly lower in the OV group compared with controls (0.47 ± 0.14 mm vs. 0.82 ± 0.32 mm, P = 0.017). Failure mode differed between groups: all posterolateral bundles in controls avulsed at their insertions, whereas six of eight in the OV group ruptured in the midsubstance (P = 0.0070). No significant between-group differences were observed in yield load, maximum load, stiffness, or elongation at failure.

CONCLUSION: Ovariectomy-induced estrogen deficiency altered ACL failure characteristics and reduced translation without affecting ultimate strength. These findings suggest that ovarian hormone deficiency compromises ligament quality, providing a potential mechanism for increased ACL injury risk in young female athletes. These findings should be interpreted as pilot, hypothesis-generating data.

LEVEL OF EVIDENCE: Experimental laboratory study.

PMID:42053188 | PMC:PMC13127120 | DOI:10.1051/sicotj/2026017

SICOT J. 2026;12:21. doi: 10.1051/sicotj/2026015. Epub 2026 Apr 29.

ABSTRACT

BACKGROUND: Patient positioning for proximal femoral nailing (PFN) in unstable intertrochanteric fractures remains controversial and may influence operative efficiency, radiation exposure, and reduction quality. This study compared lateral decubitus PFN without traction versus the conventional supine traction-table technique in geriatric patients.

METHODS: This prospective randomized comparative study enrolled patients aged >60 years with AO/OTA A2 unstable intertrochanteric fractures who were randomized to supine traction-table PFN (Group A) or lateral decubitus PFN on a radiolucent table (Group B). Primary outcomes were setup time, fluoroscopy (radiation) exposure, and operative time. Secondary outcomes included blood loss, need for open reduction, neck-shaft angle (NSA), tip-apex distance (TAD), and modified Baumgartner reduction quality.

RESULTS: Setup time was markedly shorter with lateral positioning (13.73 ± 2.26 vs 43.73 ± 6.19 min; P < 0.001), and radiation exposure was lower (60.53 ± 15.98 vs 68.48 ± 14.65 s; P = 0.023). Blood loss was higher in the lateral group (328.75 ± 84.65 vs 288.75 ± 48.68 mL; P = 0.011), and open reduction was more frequent (57.5% vs 17.5%; P < 0.001). Operative time was comparable (78.53 ± 15.13 vs 74.48 ± 8.56 min; P = 0.145). NSA (135.88 ± 5.94 vs 136.12 ± 6.27°; P = 0.864), TAD (23.58 ± 2.14 vs 23.15 ± 1.73 mm; P = 0.331), and reduction quality (good: 90% in both; P = 1.000) did not differ.

CONCLUSIONS: Lateral decubitus PFN without traction improved setup efficiency and reduced radiation exposure while maintaining comparable radiographic outcomes, at the expense of more frequent open reduction and modestly higher blood loss.

PMID:42053187 | PMC:PMC13127122 | DOI:10.1051/sicotj/2026015

SICOT J. 2026;12:20. doi: 10.1051/sicotj/2026020. Epub 2026 Apr 29.

ABSTRACT

BACKGROUND: Distal femoral megaprosthetic reconstruction is a standard limb-salvage procedure after tumor resection. This study aimed to evaluate implant survival and associated factors, the incidence of mechanical failure, and functional outcomes following reconstruction with cemented custom-made distal femoral megaprostheses.

METHODS: Fifty-seven patients who underwent distal femoral tumor resection followed by reconstruction with a cemented custom-made distal femoral megaprosthesis between 2010 and 2024 were retrospectively analyzed. Implant survival was evaluated using Kaplan-Meier analysis, and associations with outcomes were assessed using Cox proportional hazards and Fine-Gray competing-risk regression models. The analyzed risk factors included age, sex, resection length, stem diameter, fixation length, and functional score. Functional outcomes were assessed using the Musculoskeletal Tumor Society (MSTS) score.

RESULTS: Implant survival remained above 60% at the latest follow-up, with survival rates of 100% at 12 months, 93.5% at 24 months, and 72.9% at 60 months. No clinical or implant-related geometric variables were significantly associated with implant survival. The cumulative incidence of mechanical failure was 7% at 48 months and approximately 15% at the latest follow-up, with no association between mechanical failure and resection length, stem diameter, or fixation length. Functional outcomes were favorable, with a mean MSTS score of 21.6 ± 3.9.

CONCLUSION: Cemented custom-made distal femoral megaprostheses demonstrated satisfactory mid- to long-term survival following tumor resection. In this cohort, none of the evaluated variables were significantly associated with implant survival. The incidence of mechanical failure remained relatively low, and geometric implant parameters were not significantly associated with mechanical failure. Functional outcomes were favorable, with most patients achieving good or excellent MSTS scores.

PMID:42053186 | PMC:PMC13127123 | DOI:10.1051/sicotj/2026020

SICOT J. 2026;12:E2. doi: 10.1051/sicotj/2026006. Epub 2026 Apr 29.

ABSTRACT

Volume 11 (2025) of SICOT-J showcases high-quality global orthopaedic research spanning spine, trauma, arthroplasty, sports, and perioperative care. Through impactful original studies, reviews, and editorials, the volume reinforces evidence-based practice, surgical innovation, and multidisciplinary approaches to contemporary musculoskeletal challenges worldwide.

PMID:42053185 | PMC:PMC13127121 | DOI:10.1051/sicotj/2026006

SICOT J. 2026;12:19. doi: 10.1051/sicotj/2026002. Epub 2026 Apr 20.

ABSTRACT

INTRODUCTION: Implant subsidence remains one of the complications following lumbar interbody fusion and total lumbar disc replacement, often attributed to excessive and uneven preparation of the subchondral bone. To address this limitation, we describe a novel surgical approach - en bloc discectomy - designed to enable more controlled disc removal, preserve subchondral endplate integrity, and minimize the risk of implant subsidence.

METHODS: We describe the procedural steps for the en bloc discectomy, including patient positioning, surgical approach, and the specific technique using a Cobb spinal elevator to remove the cartilaginous en bloc. The technique's advantages include controlled disc removal, minimized subsidence, and even subchondral endplate preparation.

RESULTS: En bloc discectomy was successfully performed in our patient. No intraoperative or postoperative complications occurred, and all patients reported immediate and sustained symptomatic improvement.

CONCLUSION: En bloc discectomy provides a safe and reproducible alternative to conventional (standard piecemeal discectomy) disc excision. By reducing endplate damage and implant subsidence, this technique has the potential to improve long-term stability and clinical outcomes in patients undergoing lumbar interbody procedures.

PMID:42007623 | PMC:PMC13094346 | DOI:10.1051/sicotj/2026002

SICOT J. 2026;12:18. doi: 10.1051/sicotj/2026009. Epub 2026 Apr 20.

ABSTRACT

INTRODUCTION: The knee is a biomechanically complex joint supported by multiple anatomical structures, making it vulnerable to multiple injuries. Finite element analysis is a valuable tool for studying joint biomechanics, particularly in pre-operative planning and injury evaluation. However, most models are based on computed tomography, which limits soft tissue visualization. Thus, a magnetic resonance imaging-based finite element model of the knee, incorporating bones, ligaments, tendons, cartilage, and menisci, was developed to improve realism and clinical relevance in biomechanical simulations.

MATERIALS AND METHODS: Magnetic resonance imaging data were obtained from a healthy adult male using a 1.5T scanner and processed using RETOMO and Rhinoceros software for 3D reconstruction and modeling. Meshes were cleaned, optimized, and anatomically validated. All major knee structures were modeled, including the femur, tibia, fibula, patella, cruciate and collateral ligaments, patellofemoral ligaments, quadriceps and patellar tendons, menisci, and articular cartilage.

RESULTS: The resulting model reconstructed both hard and soft tissues of the knee joint with high anatomical fidelity, based on direct MRI segmentation and literature-supported anatomical definitions. The use of magnetic resonance imaging enabled high-resolution identification of soft tissues, while advanced mesh refinement preserved anatomical detail with optimized file management. The inclusion of structures like the anterolateral ligament and patellofemoral ligaments expands the model's clinical relevance in addressing a wider range of knee pathologies.

CONCLUSION: This magnetic resonance imaging-based finite element analysis model provides a detailed and comprehensive, representation of the healthy human knee, including bones, cartilage, menisci, and tendons. While some ligament attachment points were derived from literature rather than MRI data, the model provides a foundation for future biomechanical studies, surgical planning and personalized treatment simulations.

PMID:42007622 | PMC:PMC13094345 | DOI:10.1051/sicotj/2026009

SICOT J. 2026;12:17. doi: 10.1051/sicotj/2026004. Epub 2026 Apr 20.

ABSTRACT

BACKGROUND: Rotator cuff calcific tendinopathy (RCCT) has traditionally been described as a localized enthesopathy. However, calcium deposits sometimes extend beyond the enthesis into adjacent soft tissues or humeral bone, resulting in atypical patterns not considered in existing classification systems. Failure to recognize these patterns can lead to diagnostic errors or the indication of unnecessary invasive diagnostic procedures.

METHODS: In order to describe atypical patterns and to assess their incidence, 100 consecutive shoulder cases with radiographically confirmed RCCT were retrospectively reviewed. Calcific deposits were categorized by tendon involvement, size, and morphology. Based on imaging findings, deposits were also classified according to their anatomic location and extension into: Type I (enthesis-confined), Type II (extension into soft tissue), and Type III (bone involvement). Associations between patient characteristics, calcification size, morphology, and location were analyzed.

RESULTS: According to the proposed classification, 67% of cases were Type I, 14% showed soft tissue extension (Type II), and 19% involved bone (Type III). Type III group showed a significantly higher proportion of females (83%) compared to the entire cohort (54%) (p < 0.001). Larger deposits (>15 mm) were significantly associated with bone involvement (p < 0.01).

CONCLUSION: Extension of calcium deposits beyond the rotator cuff enthesis was a frequent finding in this series. Incorporating an anatomic extension-based classification may enhance diagnostic precision, possibly avoiding invasive differential diagnostic procedures.

LEVEL OF EVIDENCE: IV.

PMID:42007621 | PMC:PMC13094347 | DOI:10.1051/sicotj/2026004

SICOT J. 2026;12:16. doi: 10.1051/sicotj/2026013. Epub 2026 Apr 16.

NO ABSTRACT

PMID:41988652 | PMC:PMC13082743 | DOI:10.1051/sicotj/2026013

SICOT J. 2026;12:15. doi: 10.1051/sicotj/2025065. Epub 2026 Apr 15.

ABSTRACT

BACKGROUND: ITF are extracapsular proximal femoral fractures that occur in both younger and older populations, with a higher prevalence among females. They account for most hip fractures, reaching 44.1%. The Elderly are at risk with an increased first-year mortality risk reaching up to 30%. This research aimed to compare the functional outcomes, effectiveness, and safety profile of long as opposed to short cephalomedullary nails (CMNs) in the management of unstable ITF in elderly individuals aged >60 years.

METHODS: This single-blinded randomized controlled research was carried out on 30 participants aged >60 years old, both sexes, with unstable ITF. Participants were categorized into two groups (GPs): GP A: had a long cephalomedullary nail (LCMN), and GP B: had short cephalomedullary nail.

RESULTS: Mean hospital stay length, period of surgery, operative blood loss, and the incidence of transfusion requirements were higher in GP A, yet no significant difference was observed. Functional outcomes, union and complication rates were comparable between the two GPs.

CONCLUSIONS: Irrespective of the length, CMNs are suitable for the treatment of unstable ITF, aiming to achieve early mobility and satisfactory functional outcome. Further large-sampled RCTs need to be conducted comparing both GPs based on more recent CT-based classification systems with osteoporosis considered.

PMID:41988651 | PMC:PMC13082745 | DOI:10.1051/sicotj/2025065

SICOT J. 2026;12:14. doi: 10.1051/sicotj/2026010. Epub 2026 Apr 15.

ABSTRACT

INTRODUCTION: Medial patellofemoral ligament (MPFL) reconstruction is a well-established treatment for recurrent lateral patellar dislocations, yielding satisfactory clinical outcomes. Although synthetic materials are not widely used due to limited long-term data, they offer the potential to eliminate donor-site complications and may provide promising results. This study evaluated the five-year clinical and functional outcomes of MPFL reconstruction using suture tape, hypothesising that it is a safe alternative to traditional grafts.

METHODS: Thirty patients aged 20 - 45 years with recurrent lateral patellar dislocations were treated between 2017 and 2020. Exclusion criteria included patellofemoral joint pathology, high-grade trochlear dysplasia, patella alta, neuromuscular disorders, or significant lower limb malalignment requiring correction. All patients underwent MPFL reconstruction using suture tape, placed in the superomedial half of the patella and fixed to the femoral footprint using a knotless anchor. The vastus medialis obliquus insertion was advanced laterally and distally. Preoperative assessments included clinical examinations, knee radiographs, alignment views, TT-TG measurements via CT scans, and MRIs. Patients were evaluated using the Kujala scale, International Knee Documentation Committee (IKDC) score, Crosby and Insall grading system, and Lysholm score.

RESULTS: At the 5-year follow-up, all patients had resumed their daily activities without recurrence of dislocation. The mean Kujala score improved from 65.23 to 93.60 (P < 0.001), with significant increases also observed in IKDC and Lysholm scores (P < 0.001). According to the Crosby/Insall grading system, 24 patients were rated as "excellent", and six patients were rated as 'good'. The mean knee extension was -5°, and flexion was 140° at the final follow-up.

CONCLUSION: MPFL reconstruction using suture tape with knotless anchors, combined with careful patient selection, appears to be a safe and effective option, demonstrating satisfactory five-year clinical outcomes and no recurrence of instability. However, this study was limited by its relatively small sample size and retrospective design.

PMID:41988650 | PMC:PMC13082744 | DOI:10.1051/sicotj/2026010

SICOT J. 2026;12:13. doi: 10.1051/sicotj/2026008. Epub 2026 Apr 8.

ABSTRACT

BACKGROUND: Osteonecrosis is a disabling complication of sickle cell disease (SCD), with a disproportionate burden in Africa, where healthcare resources are limited. Despite this, the region remains underrepresented in the literature on SCD-related osteonecrosis. This scoping review synthesises current evidence on the epidemiology, management practices, and outcomes of SCD-related osteonecrosis in African healthcare settings.

METHODS: Following PRISMA-ScR guidelines, we systematically searched MEDLINE, Embase, Web of Science, Google Scholar, and African Journals Online through February 2025. Eligible studies reported clinical features, management, or outcomes of osteonecrosis in SCD patients in Africa. Data on demographics, staging, imaging, treatment modalities, and outcomes were narratively synthesised.

RESULTS: Thirty-two studies involving 779 patients met the inclusion criteria. Most were small, descriptive case series. Patients typically presented late: 85% at Ficat stage III-IV, with delays exceeding 20 years in some cases. The femoral head was affected in 98% of cases. Diagnosis relied almost exclusively on radiographs, with MRI reported in only 6% of studies. Conservative management, mainly traction and immobilisation, showed benefit in paediatric early-stage cases but was largely ineffective in adults. Joint-preserving surgeries were rarely reported but included core decompression and vascularised grafting with variable success. Arthroplasty predominated, yielding functional improvement but was technically demanding and prone to complications, particularly in SS genotype patients.

CONCLUSION: Late presentation, diagnostic limitations, and reliance on salvage arthroplasty mark SCD-related osteonecrosis in Africa. Strengthening early detection, expanding capacity for joint-preserving interventions, and generating robust regionally relevant evidence are critical to improving outcomes in this high-burden, resource-constrained setting.

PMID:41949177 | PMC:PMC13059667 | DOI:10.1051/sicotj/2026008

SICOT J. 2026;12:12. doi: 10.1051/sicotj/2025070. Epub 2026 Mar 10.

ABSTRACT

INTRODUCTION: This study aims to assess the functional and radiological outcomes of combining minimally invasive medial displacing calcaneal osteotomy (MDCO) with subtalar arthroereisis (STA) for the treatment of symptomatic planovalgus feet in young adults.

METHODS: A single-centre, prospective cohort study was conducted between November 2015 and February 2022. The study included a total of 32 patients with flexible flatfoot who were treated with subtalar arthroereisis combined with medialising calcaneal osteotomy with at least three years of follow-up. Radiographic evaluation included talar coverage angle, AP talo-first metatarsal (T1MT), AP talo-calcaneal, lateral talo-first metatarsal, and calcaneal pitch angles. Function was assessed by the AOFAS score.

RESULTS: Angles and scores were compared preoperatively and at the third-year follow-up. The mean talo-navicular coverage angle TNCA reduced from 32.72° (±8.33) preoperatively to 8.84° (±5.70) at the last follow-up. The mean AP T1MT improved from 21.59° (±8.47) preoperatively to 7.78° (±4.03) at three years postoperatively. Meary's angle decreased from 20.84° (±7.14) preoperatively to 4.78° (±3.20) following the correction. The mean preoperative AOFAS score was 62.69 (±9.26), and significantly improved to 94.19 (±3.80) at the last follow-up. Four feet experienced sinus tarsi pain (12.5%), and three patients (9.3%) needed removal of the arthroereisis implant.

CONCLUSIONS: The combination of MDCO and STA holds significant promise for treating flexible flatfeet in adolescents and young adults, particularly in cases of moderate to severe deformity. This combination demonstrates a synergistic interaction, with the STA implant providing internal bracing to support MDCO and reducing stresses over the medial arch by preventing hyper-pronation. Simultaneously, the MDCO reinforces the reconstruction, achieving the necessary increased correction in moderate to severe flatfoot cases, while also reducing stresses over the STA implant.

PMID:41805662 | PMC:PMC12975123 | DOI:10.1051/sicotj/2025070

SICOT J. 2026;12:11. doi: 10.1051/sicotj/2025033. Epub 2026 Mar 3.

ABSTRACT

INTRODUCTION: A major complication of hip arthroplasty is dislocation. In revision, the rate of dislocation is even higher, especially among patients with hip prosthetic joint infection treated with two-stage surgery. The utility of a dual-mobility cup (DMC) in revision was already demonstrated but with a relatively low level of confidence due to the lack of direct comparison with other surgical techniques. We hypothesized that the dislocation rate for patients undergoing cementless DMC total hip arthroplasty (THA) would be similar between single and two-stage revisions.

METHODS: We conducted a single-center, retrospective, and case-control study from January 2011 through December 2020. During this period, 220 patients underwent a revision of their total hip arthroplasty. Among these, 40 patients experienced THA two-stage revision. This group constituted the cases in this case-control study. Each of the 40 cases was matched with 2 controls, single-stage surgery, on age, sex, and Paprosky grade, and we defined the groups according to primary endpoint: dislocation rate.

RESULTS: There was no significant difference in dislocation rate between two-stage and single-stage revisions (7.5% vs 3.8%, p = 0.40). In univariate analysis, auto-inflammatory disease and immunosuppressive agent use were risk factors for dislocation. There was no significant difference in dislocation-free survival (log-rank test, p = 0.40) or re-revision (log-rank test, p = 0.92) between single-stage and two-stage revision THA. At the end of follow-up, the mortality rate did not differ between the two groups. No chronic instability was noted at the last follow-up (80.4 ± 38.5 months) in both groups.

CONCLUSION: The dislocation rate was similar between single and two-stage revision THA using DMC. Further studies are warranted to highlight the potential benefits of DMC in preventing dislocation in two-stage revision THA.

PMID:41789833 | PMC:PMC12965059 | DOI:10.1051/sicotj/2025033