Int Orthop. 2025 Jul 12. doi: 10.1007/s00264-025-06608-y. Online ahead of print.

ABSTRACT

INTRODUCTION: Necrotizing fasciitis (NF) is a rapidly progressive disease associated with significant morbidity and mortality. Few studies have reported the risk factors for adverse outcomes in NF. Our study aims to investigate the risk factors associated with various clinical outcomes of NF - to better guide decision making and patient counselling regarding outcomes during the crucial initial phase of this time sensitive disease process.

METHODS: A retrospective review of patients diagnosed with NF of the upper and lower extremities over a ten-year period from January 2008 to December 2017 in our tertiary institution was performed. Patient demographics, clinical parameters, microbiological data, and clinical outcomes were collected and analyzed using multivariate regression analysis. The primary clinical outcomes analyzed were mortality, major amputation (proximal to the wrist or ankle), prolonged intensive care unit(ICU) stay (> 7 days), and prolonged hospital stay (> 30 days).

RESULTS: 191 patients were included in the study with a mortality rate of 17%, with predictors for mortality being age > 65 years (OR: 3.04, p = 0.024), female gender (OR: 3.04, p = 0.017), peripheral vascular disease (OR: 8.94, p = 0.003), renal impairment (OR: 5.10, p = 0.002), mean arterial pressure (MAP) < 60mmHg (OR: 3.06, p = 0.040), and bacteraemia (OR: 3.11, p = 0.032). 61 patients underwent major amputation, and the risk factors were peripheral vascular disease (OR: 4.45, p = 0.042), lower limb involvement (OR: 5.67, p < 0.001), soft tissue gas on x-ray (OR: 5.78, p = 0.013), and bacteraemia (OR: 5.20, p < 0.001). The predictors for prolonged ICU admission were female gender (OR: 2.55, p = 0.016) and creatinine > 140µmol/L (OR: 3.44, p = 0.002).

CONCLUSION: This study has helped to identify significant risk factors associated with necrotizing fasciitis for mortality and major amputations. Predictors of mortality included elderly age > 65, female gender, peripheral vascular disease, renal impairment, decreased mean arterial pressure and bacteraemia. Predictors of major amputation were peripheral vascular disease, lower limb involvement, presence of soft tissue gas seen on X-ray and bacteraemia. Factors such as these will assist us in identifying patients with higher probabilities of specific outcomes when they present at an early stage of the disease process, to allow for more accurate patient counselling and management of expectations regarding outcomes of patients with NF.

LEVEL OF EVIDENCE: IV.

PMID:40646259 | DOI:10.1007/s00264-025-06608-y

Int Orthop. 2025 Jul 11. doi: 10.1007/s00264-025-06603-3. Online ahead of print.

ABSTRACT

PURPOSE: Aneurysmal bone cysts (ABCs) are bone tumours characterised by blood-filled cystic lesions. Management strategies for ABCs vary widely and lack consensus. This study aims to evaluate outcomes in 258 patients and investigate the factors affecting the recurrence rates.

METHODS: This study is a single-centre retrospective analysis of patients diagnosed with ABC between January 1990 and December 2020. Patients who were histologically diagnosed with ABC, had available pathology, radiology, and surgery records, and were followed up for at least 24 months were included. Secondary ABCs were excluded. Presenting symptoms and location, computerised tomography (CT) and magnetic resonance imaging (MRI), treatment modalities, and recurrence were investigated.

RESULTS: The mean age of the 258 ABC patients was 17.25 ± 12.37 years, 67.44% being under 18 years, and 12.40% under five years. 49.45% were female. The average follow-up duration was 47.80 ± 41.92 months. Pain was the most common presenting symptom, reported by 79.97% of patients. 5.04% were asymptomatic and diagnosed incidentally, whereas 11.63% were diagnosed following a pathological fracture. The median disease-free survival was ten months, with the average time to first recurrence being 24.22 ± 22.14 months. Recurrence was more common in patients under five years of age (34.38% vs. 19.03%, p = 0.046) and in those with pathologic fractures (40.00% vs. 18.42%, p = 0.006). Conversely, recurrence was less common when burr and/or cautery was added to curettage (31.97% vs. 11.03%, p < 0.001). Time to recurrence was significantly shorter in cases with soft tissue oedema (median 5 vs. 12 months, p = 0.010) or fluid-fluid levels (median 6 vs. 12 months, p = 0.038).

CONCLUSIONS: The study found that pathological fractures and age under five years are associated with a higher risk of recurrence in aneurysmal bone cysts. Electrocauterization and/or high-speed burring as local adjuvant therapy is associated with low recurrence rates.

PMID:40640436 | DOI:10.1007/s00264-025-06603-3

Int Orthop. 2025 Jul 11. doi: 10.1007/s00264-025-06607-z. Online ahead of print.

ABSTRACT

PURPOSE: This investigation examined return-to-sport (RTS) outcomes and performance determinants following surgical fixation of acetabular fractures in young athletes. The primary objectives were to quantify RTS rates, evaluate functional outcomes, and identify key predictors of athletic recovery.

METHODS: We conducted a retrospective analysis of 62 patients (mean age: 29.6 years) who underwent acetabular fracture fixation at a tertiary care centre. The investigation encompassed pre- and post-operative athletic participation, patient satisfaction metrics, and psychological readiness assessments. Primary outcome measures included stratified RTS rates, with functional and psychological parameters evaluated using the Copenhagen Hip and Groin Outcome Score (HAGOS) and Hip Return to Sport after Injury (Hip-RSI) scale.

RESULTS: While 82.3% of patients resumed athletic activities, 53.2% returned to their primary sport, with only 19.4% achieving pre-injury performance levels. Multivariate analysis revealed that superior articular reduction quality and elevated psychological readiness scores, as measured by the Hip-RSI, were significant predictors of successful RTS outcomes.

CONCLUSION: Despite encouraging overall RTS rates, restoration of pre-injury athletic performance remains challenging. The study highlights the critical role of both psychological preparedness and anatomical reduction quality in optimizing outcomes.

PMID:40640435 | DOI:10.1007/s00264-025-06607-z

Int Orthop. 2025 Jul 10. doi: 10.1007/s00264-025-06609-x. Online ahead of print.

NO ABSTRACT

PMID:40634775 | DOI:10.1007/s00264-025-06609-x

Int Orthop. 2025 Jul 10. doi: 10.1007/s00264-025-06584-3. Online ahead of print.

NO ABSTRACT

PMID:40634774 | DOI:10.1007/s00264-025-06584-3

Int Orthop. 2025 Jul 10. doi: 10.1007/s00264-025-06605-1. Online ahead of print.

ABSTRACT

PURPOSE: Management of blood transfusion in the peri-operative period of joint arthroplasties is often difficult and although associated risk factors and practice trends help ease this process, for shoulder arthroplasty, these aspects have not been explored as widely as other procedures. The purposes of the current study were to identify the incidence, risk factors and trends of blood transfusion in shoulder arthroplasty patients over a 25-year period in a single, high-volume centre.

METHODS: We retrospectively reviewed all patients undergoing hemi-, total and reverse shoulder arthroplasties, including revision procedures, between 1997 and 2021. Overall rate of blood transfusion, procedure and patient related risk factors, and transfusion trends over time were evaluated.

RESULTS: A total of 3,168 patients were included in the analysis and overall rate of blood transfusion was 1.8%. Multivariate analysis revealed revision procedure (p < 0.001), prior revision (p = 0.035), regional anaesthesia (p = 0.004), history of hypertension (p = 0.043), history of myocardial infarction (p = 0.004), history of renal insufficiency (p = 0.045), and alcohol abuse (p = 0.033) were independent risk factors for transfusion. Although transfusion rates were observed to be increased after 2007, from 0.6 to 0.8 to over 2%, this trend did not demonstrate statistical significance.

CONCLUSION: Revision procedures and regional anaesthesia as well as hypertension, myocardial infarction, renal insufficiency and alcohol abuse can be regarded as independent risk factors for blood transfusion in shoulder arthroplasty. It is imperative to implement advanced blood conservation protocols for patients with these risk factors.

PMID:40634773 | DOI:10.1007/s00264-025-06605-1

Int Orthop. 2025 Jul 10. doi: 10.1007/s00264-025-06606-0. Online ahead of print.

ABSTRACT

PURPOSE: The objective was to assess whether the size of the supraspinatus tendon retraction following a degenerative full-thickness rotator cuff tear influenced the functional outcome after arthroscopic direct repair.

METHODS: A prospective comparative cohort study of 65 patients underwent arthroscopic rotator cuff repair with a follow-up of 24 months. The mean age was 60.0 years (SD, 9.2). According to the supraspinatus tendon retraction, patients were included into the shorter retraction group (≤ 20 mm; n = 32) and longer retraction group (> 20 mm; n = 33). Clinical outcomes were assessed with the Constant-Murley score and visual analogue scale for pain. Radiological evaluation included magnetic resonance imaging (MRI).

RESULTS: Postoperatively, both groups significantly improved functional and pain outcomes, with no significant differences at the final follow-up (p = 0.671). The mean time interval between the onset of patient-reported symptoms and surgery was not significantly correlated with the retraction size (r = 0.12, p = 0.066). The multivariate analysis did not show significant predictors of satisfactory functional outcome, especially the tendon retraction size (OR 1.0; 95% CI 0.9-1.1; p = 0.728).

CONCLUSION: In degenerative tears, the size of the supraspinatus tendon retraction was not correlated with the duration of the symptoms. The tendon retraction of up to 4 cm did not influence the functional outcome at 24 postoperative months, regardless of the arthroscopic repair technique of one or two rows.

PMID:40634772 | DOI:10.1007/s00264-025-06606-0

Int Orthop. 2025 Jul 10. doi: 10.1007/s00264-025-06610-4. Online ahead of print.

NO ABSTRACT

PMID:40634771 | DOI:10.1007/s00264-025-06610-4

Int Orthop. 2025 Jul 7. doi: 10.1007/s00264-025-06602-4. Online ahead of print.

NO ABSTRACT

PMID:40622391 | DOI:10.1007/s00264-025-06602-4

Int Orthop. 2025 Jul 5. doi: 10.1007/s00264-025-06595-0. Online ahead of print.

ABSTRACT

PURPOSE: This study compares short-segment (2-level) versus longer-segment (> 2-level) fusion after posterior hemivertebra resection in congenital scoliosis (CS) and identifies preoperative thresholds to guide fusion strategy selection.

METHODS: Eighty-eight CS patients (mean age: 5.42 years) undergoing hemivertebra resection with fusion (31 short-segment [Fused_2], 57 longer-segment [Fused_GT2]) were retrospectively analyzed. Radiographic parameters, complications, and reoperations were assessed. Logistic regression derived predictive thresholds for fusion length.

RESULTS: Both groups achieved comparable initial (~ 77%) and final (~ 61%) main curve correction. The Fused_2 group had shorter operative time (154 vs. 204 min, p < 0.001) and lower blood loss (249 vs. 356 mL, p = 0.011). Reoperation rates (20.5% overall), crankshaft phenomenon (25.0%), and neurological complications (5.7%) did not differ between groups. Preoperative main curve ≤ 41.8° and thoracic kyphosis ≤ 30.2° predicted suitability for 2-segment fusion.

CONCLUSION: Short-segment fusion reduces invasiveness without compromising correction in select CS patients. Preoperative thresholds (main curve ≤ 41.8°, kyphosis ≤ 30.2°) may guide strategy, though individualized assessment remains essential.

PMID:40616658 | DOI:10.1007/s00264-025-06595-0

Int Orthop. 2025 Jul 5. doi: 10.1007/s00264-025-06601-5. Online ahead of print.

ABSTRACT

PURPOSE: Low-intensity pulsed ultrasound (LIPUS) is a non-invasive physiotherapy that is often utilized to treat swelling and pain caused by musculoskeletal trauma. We aimed to evaluate the efficacy and safety of LIPUS in reducing lower-extremity swelling and pain following total knee arthroplasty (TKA).

METHODS: This randomized, controlled study evaluated 116 patients undergoing primary TKA, randomly assigning them to either an LIPUS group receiving active LIPUS therapy (0.8 MHz, 1.35 W) or a control group receiving sham treatment. The LIPUS intervention was administered to the operated knee for 25-minute sessions, three times daily for three consecutive days, beginning four hours postoperatively. The primary study outcome measured lower extremity swelling during the first 14 postoperative days, while secondary outcomes included knee pain (assessed by visual analogue scale ranging from 0 to 10 points), Hospital for Special Surgery (HSS) score, range of knee motion (ROM), serum levels of C-reactive protein (CRP), interleukin-6 (IL-6), myoglobin, and complications.

RESULTS: The LIPUS (n = 55) and control (n = 56) groups showed similar baseline characteristics. LIPUS treatment significantly improved clinical outcomes compared to sham treatment, reducing calf swelling by 2.37-2.74%, thigh swelling by 2.76-4.81%, and patellar swelling by 2.30-3.28% (all p < 0.001). Patients receiving LIPUS also reported less walking pain (1.16-2.48 point reduction, p < 0.001) and showed lower inflammatory markers (CRP reduction of 2.53-13.85 mg/L, p = 0.047; IL-6 reduction of 3.64-17.27 pg/mL, p = 0.041). However, the treatment did not significantly affect resting pain, HSS scores, ROM, serum myoglobin levels, or complication rates.

CONCLUSION: This study found that short-term LIPUS use markedly decreased lower-extremity swelling and walking pain post-TKA, with no major safety concerns. However, future studies are needed to determine the optimal protocol and long-term safety of LIPUS in TKA patients.

PMID:40616657 | DOI:10.1007/s00264-025-06601-5

Int Orthop. 2025 Jul 4. doi: 10.1007/s00264-025-06598-x. Online ahead of print.

NO ABSTRACT

PMID:40613903 | DOI:10.1007/s00264-025-06598-x

Int Orthop. 2025 Jul 4. doi: 10.1007/s00264-025-06600-6. Online ahead of print.

ABSTRACT

PURPOSE: Patients with metastatic chondrosarcoma at presentation have a poor prognosis. Owing to the lack of sensitivity to chemotherapy and radiotherapy, surgical resection is the mainstay of treatment of localized chondrosarcoma. The aim of this study was to investigate whether surgical resection of the primary site was associated with improved survival in patients with metastatic chondrosarcoma at presentation.

METHODS: Sixty-two patients with distant metastases at initial diagnosis who were pathologically diagnosed with grade 2 or 3 conventional chondrosarcoma, dedifferentiated chondrosarcoma, or mesenchymal chondrosarcoma between 2001 and 2022 and registered in the Japanese National Bone and Soft Tissue Tumour Registry database were analysed retrospectively. Propensity score matching was performed to correct for differences in background characteristics, including the number of organs affected by metastases, performance of metastasectomy, and performance of chemotherapy, between patients who underwent surgical resection of the primary site (N = 31) and those who did not (N = 31).

RESULTS: The median disease-specific survival was six months for the whole cohort, 12 months for the patients who underwent surgical resection of the primary site, and two months for the patients who did not. Overall, 37 patients (59.7%) died of the disease. Univariate analysis showed a better disease-specific survival for patients who underwent surgical resection of the primary site compared with patients who did not (2-year disease-specific survival 51.0% [95% CI: 32.3-69.4] vs. 19.3% [95% CI: 6.9-43.7]; P = 0.005).

CONCLUSION: Surgical resection of the primary site may increase the survival of patients with metastatic chondrosarcoma at presentation.

PMID:40613902 | DOI:10.1007/s00264-025-06600-6

Int Orthop. 2025 Jul 2. doi: 10.1007/s00264-025-06597-y. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study is to explore the representation of professionals engaged in medico-surgical practices within seventeenth-century Dutch and Flemish genre painting. The research focuses on how these works of art mirror the rich diversity of healthcare practitioners, the techniques employed, the spaces of care depicted, and the societal perception of medical knowledge.

MATERIALS AND METHODS: An extensive review has been conducted of the foremost museums and painting databases devoted to seventeenth-century Dutch and Flemish art related to the treatment of illness. Over one hundred and fifty works, created by some sixty painters active during this period, have been subjected to a meticulous formal and iconographic analysis.

RESULTS: The study unveils the coexistence of a multifaceted array of medical figures - from physicians and barber-surgeons to empirics and charlatans - and illustrates how paintings of the time portrayed urban, rural, and mercantile settings of medical practice. These visual narratives document surgical techniques, orthopaedic interventions, and the complex social dynamics between patients and healthcare providers. Furthermore, the works frequently incorporate satirical and allegorical elements that critique the pretensions of the medical elite, highlight surgical ineptitude, or expose the cunning of itinerant healers.

CONCLUSION: Seventeenth-century genre painting serves as a vivid visual testament to the popular perception of medicine and provides invaluable insight into the tensions between academic medicine and empirical practice. These works offer a critical and nuanced lens through which to apprehend the medical culture and epistemologies of the period.

PMID:40600997 | DOI:10.1007/s00264-025-06597-y

Int Orthop. 2025 Jul 2. doi: 10.1007/s00264-025-06596-z. Online ahead of print.

ABSTRACT

PURPOSE: To determine the functional impact and complications associated with os acromiale after the implantation of a reverse total shoulder arthroplasty (RTSA) with medialization of the centre of rotation.

METHODS: A retrospective case-control study with cross-sectional evaluation was conducted. Between 2004 and 2021, patients who underwent RTSA for cuff arthropathy, GH osteoarthritis or massive irreparable rotator cuff tears with os acromiale (OA) and more thantwo years of follow-up, were identified. A control cohort (2:1) without acromial compromise (NOOA) was also identified. Functional (Constant, ASES, Quick-DASH, VAS, ROM) and radiological assessment (os acromiale type, acromiohumeral distance, acromion tilt) were performed.

RESULTS: RTSA was implanted in 432 cases during the study period, 221 with rotator cuff arthropathy, irreparable tears, or osteoarthritis, of these, 12 had an os acromiale (OA) (5.4%) and were compared to 24 patients without os acromiale (NOOA). Epidemiologic data OA/NOOA were: female 10/20, mean follow-up 47.2 ± 25/56.1 ± 30 months, mean age 73.5 ± 4.7/75.4 ± 4.1 years. Regarding the difference in preoperative and final follow-up functional outcomes (OA/NOOA): Constant 20.2/30.9 (p =.012), ASES 28/54 (p =.017), Quick-DASH - 19.6/-27.2 (p =.220), VAS - 5/-7 (p =.007), difference in pre-surgery/last follow-up ROM: elevation 50º/60º (p =.138), abduction 60º/60º (p =.775). The os acromiale group presented two prosthetic dislocations (16.7%).

CONCLUSION: Patients with os acromiale improve their preoperative condition after RTSA implantation; however, although there are no differences in joint balance, this improvement is significantly lower in the Constant and ASES scores, primarily due to a decrease in strength and pain relief experienced by patients with os acromiale.

PMID:40600996 | DOI:10.1007/s00264-025-06596-z

Int Orthop. 2025 Jul 2. doi: 10.1007/s00264-025-06592-3. Online ahead of print.

NO ABSTRACT

PMID:40600995 | DOI:10.1007/s00264-025-06592-3

Int Orthop. 2025 Jul 2. doi: 10.1007/s00264-025-06570-9. Online ahead of print.

ABSTRACT

PURPOSE: MRI plays an important role in the evaluation of rotator cuff tears. Our study aimed to determine if specific MRI criteria can be used to distinguish between acute traumatic and pre-existing degenerative lesions.

MATERIALS AND METHODS: The study included 40 MRIs or MR-arthrograms with rotator cuff tears. Twenty tears were traumatic and 20 were non-traumatic. Two radiologists specialized in musculoskeletal imaging, an experienced shoulder surgeon and a registrar trained in shoulder surgery assessed on each MRI the presence or absence of the following 11 parameters: tendon oedema, oedema in the muscles of the rotator cuff and the deltoid, edema and cysts in the greater tuberosity, tendon stump at the insertion site, tangent sign, tendon kinking, cobra sign, superior and posterior decentering of the humeral head. All investigators were blinded to the age and sex of the patients, the cause of the tendon lesion, the duration of the symptoms and the proportions of traumatic and non-traumatic tears. They were also asked for their assessment regarding the cause of each patient's tear, traumatic or degenerative.

RESULTS: All features could be observed with varying percentages in both groups. It was therefore impossible to assign a specific MRI to one group or the other, even with a combination of two or three features. One observer categorized 25 of 40 cases correctly (62.5%), two observers assigned 22 cases (55%), and one observer 19 cases (47.5%) correctly.

CONCLUSION: In individual cases, a partial or full-thickness lesion of the supraspinatus tendon or a postero-superior rotator cuff tear without advanced fatty infiltration cannot be correctly assigned to an acute traumatic or a preexisting lesion based on MRI.

PMID:40600994 | DOI:10.1007/s00264-025-06570-9

Int Orthop. 2025 Jun 30. doi: 10.1007/s00264-025-06587-0. Online ahead of print.

NO ABSTRACT

PMID:40586928 | DOI:10.1007/s00264-025-06587-0

Int Orthop. 2025 Jun 30. doi: 10.1007/s00264-025-06594-1. Online ahead of print.

ABSTRACT

PURPOSE: Presoaking of hamstrings autograft in vancomycin solution has been associated with significant reduction of post-operative septic arthritis rate after anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to evaluate this effect by comparison of cohorts from the single-centre database.

METHODS: In a period between January 2018 and November 2023, 1329 patients underwent ACL reconstruction surgery at our institution, with a newly introduced technique of soaking the hamstrings autografts in a 5-mg/ml vancomycin solution. Data was retrospectively analysed to identify post-operative knee septic arthritis rate amongst this group. Results were compared with the results from our previous study, which included 1891 patients from January 2007 to December 2017, when ACL reconstruction surgery was made at our institution without soaking the autografts in vancomycin solution.

RESULTS: Results showed that one (0,07%) out of 1329 patients who underwent ACL reconstruction with vancomycin-soaking of the graft developed knee joint infection after the surgery, while using the old method the infection rate was 1,4%. Statistical analysis showed that there is a significant difference in the infection rate between two groups (OR, 0,05 [95% CI, 0.0073-0.3982]; p < 0.01).

CONCLUSION: Presoaking of the hamstrings graft for ACL reconstruction in 5 mg/ml vancomycin solution as an addition to standard pre-operative intravenous antibiotic prophylaxis is associated with significant reduction of post-operative infection rate.

PMID:40586927 | DOI:10.1007/s00264-025-06594-1

Int Orthop. 2025 Jun 26. doi: 10.1007/s00264-025-06593-2. Online ahead of print.

ABSTRACT

PURPOSE: We investigated whether neurologic and psychiatric disorders (ICD-10 F00-F99, G00-G99) increase postoperative complications and mortality after hip arthroplasty and identified subgroups with distinct complication patterns, including dislocations, loosening, fractures, and elevated mortality.

METHODS: We analyzed 190,340 primary cementless hip arthroplasties from the German Arthroplasty Registry (2012-2024). Patients with relevant diagnoses were compared to matched controls (1:1 Mahalanobis distance) across subgroups F00-F99 and G00-G99, adjusting for age, sex, BMI, Elixhauser Index, and arthroplasty type. Primary endpoints were implant survival (time to revision) and all-cause mortality over up to eight years. Revision causes including periprosthetic fracture, infection, dislocation, loosening, and others were systematically recorded.

RESULTS: Most subgroups showed significantly higher revision rates (p < 0.0001 for F00-F09, F10-F19, F30-F39, G20-G26, G40-G47, G60-G64). Mortality was also significantly higher (p < 0.0001 for F00-F09, F10-F19, F30-F39). Schizophrenia (F20-F29) increased revision (p < 0.0001) and mortality (p < 0.0001). Organic mental disorders (F00-F09) showed markedly elevated revision and mortality rates, with more frequent dislocations and fractures (p < 0.0001). Extrapyramidal disorders (G20-G26) mainly increased dislocation risk (p = 0.00032), while degenerative diseases (G30-G32) raised mortality (p < 0.0001). Episodic/paroxysmal disorders (G40-G47) increased loosening (p = 0.0041) and revision (p < 0.0001). Polyneuropathies (G60-G64) were linked to joint instability and dislocations (p = 0.0008).

CONCLUSION: Neurologic and psychiatric disorders significantly elevate revision and mortality risks following hip arthroplasty. Subgroup-specific vulnerabilities, dislocations/fractures (F00-F09), high complication and mortality (F10-F19), and joint instability (G60-G64), highlight the need for individualized perioperative strategies and close postoperative monitoring to improve outcomes.

PMID:40569372 | DOI:10.1007/s00264-025-06593-2