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

ABSTRACT

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

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

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

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

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

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

ABSTRACT

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

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

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

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

LEVEL OF EVIDENCE: IV (Case series).

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

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

ABSTRACT

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

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

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

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

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

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

ABSTRACT

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

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

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

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

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

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

NO ABSTRACT

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

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

ABSTRACT

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

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

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

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

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

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

NO ABSTRACT

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

Int Orthop. 2025 May 14. doi: 10.1007/s00264-025-06556-7. Online ahead of print.

ABSTRACT

PURPOSE: To assess the potential relationship between synchronous and metachronous occurrences of spondylodiscitis and subsequent periprosthetic joint infection (PJI), shedding light on the interplay between these two distinct yet interconnected conditions. The secondary aim was to investigate the time interval between the occurrences of spondylodiscitis and PJI in metachronous infections, and to identify potential similarities or differences in the causative pathogens between synchronous and metachronous infections.

METHODS: A retrospective single-center study was performed. Patients diagnosed with either spondylodiscitis or PJI (based on the 2018 International Consensus Meeting criteria) were included. Demographic, clinical, laboratory and microbiology patient data were retrieved.

RESULTS: The incidence of metachronous infection and synchronous infection were 86.7% and 13.3% respectively. In metachronous infections, time between spondylodiscitis and PJI was 29.1 months (SD 31.1). The most common relation between spondylodiscitis and PJI were between hip PJI and lumbar spondylodiscitis. There was a statistically significant difference in the time between spondylodiscitis and PJI in the patient who had or had not arthroplasty prior to the spondylodiscitis (p = 0.02). The spondylodiscitis and PJI concomitant infection were predominant a monobacterial infection. Staphylococcus aureus was the most frequent species isolated (47.6%). The same organism was isolated in the cultures in metachronous and in the synchronous infections between spondylodiscitis and PJI in 100% of cases.

CONCLUSION: The findings of this study suggest a potential link between spondylodiscitis and PJI; however, further research is required to understand the mechanisms underlying the potential relationship between these events, as well as to develop effective strategies for prevention, diagnosis, and treatment of these infections.

LEVEL OF EVIDENCE: Level IV, Retrospective case series.

PMID:40366414 | DOI:10.1007/s00264-025-06556-7

Int Orthop. 2025 May 10. doi: 10.1007/s00264-025-06551-y. Online ahead of print.

NO ABSTRACT

PMID:40347266 | DOI:10.1007/s00264-025-06551-y

Int Orthop. 2025 May 10. doi: 10.1007/s00264-025-06553-w. Online ahead of print.

ABSTRACT

BACKGROUND: Total knee arthroplasty (TKA) is the gold-standard treatment for end-stage osteoarthritis (OA), offering substantial pain relief and functional improvement. With the rising incidence of sports-related injuries and advancements in anterior cruciate ligament reconstruction (ACLR) techniques, an increasing number of patients undergoing TKA have a history of ACLR. However, the impact of prior ACLR on postoperative complications and functional recovery after TKA remains controversial.

METHODS: This study performed a systematic search across four databases, including case-control and cohort studies reporting on the outcomes of TKA following ACLR. Primary endpoints included infection, reoperation, prosthesis revision, thrombosis, and postoperative stiffness following manual release under general anaesthesia, with results compared to those of a control group of patients receiving TKA for primary OA. Secondary endpoints were operative time and postoperative range of motion in both flexion and extension. This study was registered in PROSPERO under the registration number CRD420250635375.

RESULTS: A total of nine studies were included in this study, involving 4381 participants, with 1112 undergoing TKA with ACLR history and 3269 undergoing TKA for primary OA. This study showed that the operative time of TKA after ACLR was significantly extended (P < 0.01), but there was no significant difference in postoperative infection, reoperation, prosthesis re-revision, thrombus, postoperative stiffness following manual release under general anaesthesia, and range of motion in both flexion and extension.

CONCLUSIONS: Although the operation time of TKA after ACLR was extended, the complication rate and postoperative functional recovery of TKA were not significantly different from those of primary OA patients. This study provided an evidence-based basis for preoperative assessment and patient management.

PMID:40347265 | DOI:10.1007/s00264-025-06553-w

Int Orthop. 2025 May 10. doi: 10.1007/s00264-025-06539-8. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the predictive ability of AI HIP in determining the size and position of prostheses during complex total hip arthroplasty (THA). Additionally, it investigates the factors influencing the accuracy of preoperative planning predictions.

METHODS: From April 2021 to December 2023, patients with complex hip joint diseases were divided into the AI preoperative planning group (n = 29) and the X-ray preoperative planning group (n = 27). Postoperative X-rays were used to measure acetabular anteversion angle, abduction angle, tip-to-sternum distance, intraoperative duration, blood loss, planning time, postoperative Harris Hip Scores (at 2 weeks, 3 months, and 6 months), and visual analogue scale (VAS) pain scores (at 2 weeks and at final follow-up) to analyze clinical outcomes.

RESULTS: On the acetabular side, the accuracy of AI preoperative planning was higher compared to X-ray preoperative planning (75.9% vs. 44.4%, P = 0.016). On the femoral side, AI preoperative planning also showed higher accuracy compared to X-ray preoperative planning (85.2% vs. 59.3%, P = 0.033). The AI preoperative planning group showed superior outcomes in terms of reducing bilateral leg length discrepancy (LLD), decreasing operative time and intraoperative blood loss, early postoperative recovery, and pain control compared to the X-ray preoperative planning group (P < 0.05). No significant differences were observed between the groups regarding bilateral femoral offset (FO) differences, bilateral combined offset (CO) differences, abduction angle, anteversion angle, or tip-to-sternum distance. Factors such as gender, age, affected side, comorbidities, body mass index (BMI) classification, bone mineral density did not affect the prediction accuracy of AI HIP preoperative planning.

CONCLUSION: Artificial intelligence-based 3D planning can be effectively utilized for preoperative planning in complex THA. Compared to X-ray templating, AI demonstrates superior accuracy in prosthesis measurement and provides significant clinical benefits, particularly in early postoperative recovery.

PMID:40347264 | DOI:10.1007/s00264-025-06539-8

Int Orthop. 2025 May 8. doi: 10.1007/s00264-025-06554-9. Online ahead of print.

NO ABSTRACT

PMID:40338292 | DOI:10.1007/s00264-025-06554-9

Int Orthop. 2025 May 7. doi: 10.1007/s00264-025-06550-z. Online ahead of print.

ABSTRACT

PURPOSE: To identify evidence of surgical practice in Armorica during the Roman period.

METHODS: Various sources were examined to search for potential traces of surgical activity during the Roman era. The objective was to identify archaeological artifacts that could be associated with ancient surgical instruments. Once identified, the objects of interest were examined in different archaeological repositories in Brittany by an independent observer.

RESULTS: Between March 2021 and December 2022, 995 excavation reports were analyzed. Twenty-one documents mentioned a potentially surgical object. One of the analyzed artifacts was referenced in an excavation report containing the keyword "scalpel," originating from the site of Ploufragan (22240, Côtes d'Armor, Brittany, France). Following an in-depth investigation, the artifact was successfully retrieved. The object, measuring 14 cm in length, was made of oxidized bronze. Its tapered handle had an octagonal cross-section. At one end, the handle broadened and flattened into a pointed spatula. The opposite end featured a slit containing an iron component, which was heavily corroded. According to Ralph Jackson, former curator of the British Museum and a specialist in Roman medical instrumentation, this scalpel handle is most likely from the Roman period, dating back to the first to third century CE. The presence of this scalpel suggests that relatively advanced surgical practices were performed by Armorican practitioners in Antiquity. This study provides evidence that operative medicine, as conceptualized in the Greco-Roman tradition, extended to Armorica during Antiquity.

CONCLUSION: While the study of "beautiful objects" and monumental remains gives a biased image of a given society, the analysis of everyday artifacts can yield significant insights into the habits and routines of a population. This principle also applies to the study of surgical practice in Antiquity. The examination of small objects provides crucial information on the dissemination of medical and surgical knowledge during this period. This work shows the extent to which the history of surgery cannot be conceived without interdisciplinarity.

PMID:40332583 | DOI:10.1007/s00264-025-06550-z

Int Orthop. 2025 May 7. doi: 10.1007/s00264-025-06545-w. Online ahead of print.

ABSTRACT

PURPOSE: This study explores how age affects the location, extent, and progression of rotator cuff (RC) lesions in shoulder arthroscopy patients, aiming to identify age-related patterns of injury from localized damage in younger patients to more extensive degeneration in older ones, guiding age-specific diagnostic and treatment strategies.

METHODS: A prospective study of 487 shoulder arthroscopy patients (October 2019-September 2023) categorized cases into < 55 and ≥ 55 years. SLAP lesions, pulley injuries, RC tears (Lafosse and Bateman), and rotator cable damage were systematically documented. All surgeries followed standardized protocols by a single surgeon. Statistical analyses (Pearson correlation, Chi-squared tests) assessed age-related RC pathology associations, with significance set at α = 0.05.

RESULTS: Among 487 shoulder arthroscopies (mean age: 57.38 years), younger patients (< 55 years) had higher rates of medial (95.2%) and lateral (95.9%) pulley lesions, while older patients (≥ 55 years) exhibited significantly more advanced pathology, including lateral pulley lesions (100%), high-grade subscapularis tears (p < 0.0001), Bateman III-IV cuff tears (p < 0.0001), and combined cable tears (p < 0.0001). Medial pulley lesions correlated strongly with SLAP tears (r = 0.609), and age was positively associated with advanced injuries (r = 0.509) and negatively with partial subscapularis tears (r = - 0.143), indicating an age-related progression in rotator cuff degeneration.

CONCLUSION: The study suggests that lesions of the shoulder possibly arise from the biceps pulleys and extend more posteriorly. Distinct age-based patterns of RC pathology highlight the progression from localized injuries in younger patients to extensive degenerative damage in older individuals. These findings underscore the need for age-specific diagnostic and treatment strategies.

PMID:40332582 | DOI:10.1007/s00264-025-06545-w

Int Orthop. 2025 May 7. doi: 10.1007/s00264-025-06555-8. Online ahead of print.

ABSTRACT

PURPOSE: One ongoing debate in orthopaedic surgery concerns using tourniquets in sickle cell trait (SCT) patients. SCT, a heterozygous carrier state of sickle cell disease (SCD), affects an estimated 300 million individuals globally with various genetic ancestries.

METHODS: A retrospective cohort study was conducted on 940 SCT patients and 1263 matched non-SCT controls who underwent limb surgeries using tourniquets between 1978 and 2018. Patient data were gathered from hospital records, blood bank information, and postoperative haemoglobin electrophoresis. Outcomes assessed included the incidence of venous thromboembolism (VTE), pulmonary embolism (PE), phlebitis, peripheral nerve impairment, and superficial infection. Covariates included age, sex, ethnicity, and diabetes status.

RESULTS: Among SCT patients, 75% were unaware of their carrier status at surgery. VTE incidence was significantly higher in SCT patients (10%) than non-SCT controls (2%), especially after prolonged tourniquet use and in upper limb procedures without anticoagulation. PE occurred in 3% of SCT patients, versus 1% in controls. Diabetes, more prevalent in SCT individuals (9% vs. 6%), further increased the complication risk. Tourniquet inflation time did not differ significantly between groups; however, neurologic complications and phlebitis were more common in SCT patients, particularly those with Mediterranean ancestry. Notably, SCT carriers of African and Mediterranean descent experienced higher complication rates than non-carriers, though complications were not confined to any single ancestry.

CONCLUSION: SCT is associated with an increased risk of thrombotic and neurologic complications during tourniquet, particularly in patients with undiagnosed SCT or diabetes and in procedures with extended ischaemia time. These results confirm the perception of SCT as a benign condition, but call for further clinical guidelines regarding tourniquet use in SCT carriers.

PMID:40332581 | DOI:10.1007/s00264-025-06555-8

Int Orthop. 2025 May 7. doi: 10.1007/s00264-025-06460-0. Online ahead of print.

ABSTRACT

PURPOSE: In this study we aimed to identify the impact of the weekend effect on complications in patients undergoing total joint arthroplasty (TJA) including total knee arthroplasty (TKA) and total hip arthroplasty (THA) in the United States.

METHODS: This study is a retrospective cohort study including patients who underwent total joint arthroplasty (i.e. TKA and THA) from 2010 to 2022 across the United States. Patient records were queried from PearlDiver. The 90-days surgical outcomes were compared between patients who had the surgery on weekends and those who underwent the operation on a weekdays.

RESULTS: The study consisted of 2,208,713 patients who underwent TJA; 1,374,018 and 834,695 with TKA and THA, respectively. Ninety-days' incidences of peri-prosthetic joint infection, implant loosening, pneumonia, sepsis, and readmission were higher after TKA surgeries performed on weekends compared to weekdays (OR (95%CI): 4.20 (3.25, 5.44), 2.62 (1.06, 6.45), 1.65 (1.11, 2.43), 3.65 (2.51, 5.29), and 3.14 (2.74, 3.61), respectively). As for THA surgeries, 90 days' incidence of per-prosthetic joint infection, peri-prosthetic fracture, acute renal failure, respiratory failure, sepsis, systemic complications, and readmission were higher among surgeries performed on weekends (OR (95%CI): 4.61 (3.63, 5.85), 2.00 (1.41, 2.83), 1.60 (1.21, 2.11), 1.73 (1.15, 2.60), 2.61 (1.86, 3.67), 1.21 (1.06, 1.39), and 4.12 (3.61, 4.71), respectively).

CONCLUSIONS: TJAs performed on weekends carry higher risk of post-operative complications and poor surgical outcomes. Also, patients undergoing TJA on weekends have a higher prevalence of pre-existing risk factors and poorer baseline health conditions. Findings from this study suggest that access to adequate physical therapy and a rehabilitation centre staffed with skilled nurses on a seven day basis could mitigate complications in patients undergoing TJA during the weekends. Furthermore, high-risk patients should undergo their procedures when hospitals are most well-prepared.

PMID:40329015 | DOI:10.1007/s00264-025-06460-0

Int Orthop. 2025 May 3. doi: 10.1007/s00264-025-06548-7. Online ahead of print.

ABSTRACT

PURPOSE: This study was performed to analyse the clinical factors associated with failure of nano-hydroxyapatite/polyamide 66 (nHA/PA66) bracing rods combined with allogeneic bone in the treatment of early-stage osteonecrosis of the femoral head (ONFH).

METHODS: In total, 96 patients were treated with nHA/PA66 bracing rods combined with allogeneic bone for ONFH between October 2016 and September 2020. The patients were classified according to aetiology, Association Research Circulation Osseous (ARCO) type, Japanese Investigation Committee (JIC) type, age, and body mass index(BMI). The outcome measures were the Hip Harris Score (HHS), imaging changes, and the need for total hip arthroplasty (THA) (performed in cases of clinical failure, at which point follow-up was discontinued).

RESULTS: All patients were included in the study, with a mean follow-up duration of 50.76 ± 17.94 months. The preoperative HHS was 79.00 ± 13.61 and that at the final follow-up was 81.73 ± 17.67(P = 0.149). The excellent and good rate improved from 43.88% preoperatively to 65.47% at the final follow-up(P = 0.000). The radiographic progression rate was 36.70% and the incidence of THA was 23.02%. Univariate analysis identified ARCO type (P = 0.000), JIC type (P = 0.000), and age (P = 0.003) as independent risk factors for postoperative failure. Postoperative multivariate analysis also confirmed ARCO type, JIC classification, and age as risk factors.

CONCLUSION: This technique is not recommended for patients older than 44 years or those with ARCO type 3 or JIC type C ONFH.

PMID:40317313 | DOI:10.1007/s00264-025-06548-7

Int Orthop. 2025 Apr 29. doi: 10.1007/s00264-025-06536-x. Online ahead of print.

NO ABSTRACT

PMID:40298955 | DOI:10.1007/s00264-025-06536-x

Int Orthop. 2025 Apr 29. doi: 10.1007/s00264-025-06537-w. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to evaluate changes in the coagulation profile of patients with knee periprosthetic infections (PJI) and determine its diagnostic value in this complication.

METHODS: A prospective study was conducted with 112 patients who underwent revision surgery for total knee arthroplasty in a single tertiary hospital between January 2021 and December 2022.

RESULTS: 51 patients were diagnosed with PJI. D-dimer (p = 0.001), fibrinogen (p = 0.0007), platelets (0.01), and international normalized ratio (p = 0.01) were significantly higher in patients with PJI.

CONCLUSIONS: Patients with PJI display altered coagulation profile. The evaluation of coagulation-related markers has limited value for diagnosing PJI. Further studies are needed to understand the impact of such alterations on patients' outcomes.

PMID:40298954 | DOI:10.1007/s00264-025-06537-w

Int Orthop. 2025 Apr 29. doi: 10.1007/s00264-025-06549-6. Online ahead of print.

ABSTRACT

PURPOSE: Osteoarthritis (OA) of the knee significantly impairs mobility and quality of life. Knee arthroplasties have dramatically improved patient outcomes, allowing individuals to regain independence. Unicompartmental knee arthroplasty (UKA) is a surgical option for patients with isolated single-compartment disease, offering the benefits of reduced surgical time and minimized surgical risks. However, the appropriateness of UKA is often underestimated. Therefore, this study aims to determine the proportion of patients with varus knee OA who are suitable candidates for UKA.

METHODS: A prospective cross-sectional study was conducted on 207 knees undergoing knee arthroplasty surgery for varus knee OA. Pre-operative radiographs were graded using both the Kellgren-Lawrence (KL) and modified Keyes classifications. Intra-operatively, the knees were inspected, and photographs of the tibial cut were reviewed by a neutral observer. The appropriateness of UKA was determined based on these evaluations.

RESULTS: The lateral compartment was not involved in 169 (81.6%) knees. Only six (2.9%) knees had a KL grade 4 involvement of the lateral compartment. After excluding patients with isolated medial compartment OA, no radiographic evidence of lateral and patellofemoral involvement, and a grade 1 on the modified Keyes classification, we found that 79 (38.2%) patients were suitable candidates for a medial UKA. Intraoperatively, 84 (40.6%) patients had a functional ACL with no observable wear in the lateral and patellofemoral joint (PFJ) compartments.

CONCLUSION: In patients with varus knee OA, a significant proportion have wear patterns suitable for management with a UKA. Identifying these patients requires targeted examinations and specific radiographic views.

PMID:40298953 | DOI:10.1007/s00264-025-06549-6