Int Orthop. 2025 Nov 14. doi: 10.1007/s00264-025-06673-3. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to assess the functional and radiological outcome of transpedicular fixation system for managing unstable sacral fractures in adults.

METHODS: This prospective case series study included 21 patients with unstable type C sacral fractures according to AO Spine classification of sacral fractures. The patients were treated by a transpedicular fixation system connecting the lower lumbar spine to the ilium, as a vertical element, which was bilateral in seven cases and unilateral in 14 cases. A transverse element connecting both sides of the posterior pelvic ring was added to augment fixation in the transverse plane. The minimum period of follow-up was 12 months.

RESULTS: Mean Majeed Score was 84,29 ± 9.97; excellent, good and fair classes were present in 14 (66.7%), five (23.8%) and two (9.5%) patients, respectively. There was a significant reduction of the vertical, anterior posterior and rotational displacement postoperatively in comparison to preoperative measures. There was a significant improvement in neurological deficit postoperatively. Eight (38.1%) patients developed complications postoperatively. Wound Infection was the most common complication.

CONCLUSION: The use of transpedicular fixation as a vertical element combined with a transverse element connecting both sides of the posterior pelvic ring, to treat unstable sacral fractures, offers adequate fixation strength that helps to achieve union in a well reduced position, leads to satisfactory functional outcome and improves neurological deficit.

TRIAL REGISTRATION: (ID/NCT06888583) retrospectively registered.

PMID:41233652 | DOI:10.1007/s00264-025-06673-3

Int Orthop. 2025 Nov 13. doi: 10.1007/s00264-025-06698-8. Online ahead of print.

ABSTRACT

AIM: Our primary aim was to describe the microbiology of long-bone non-unions after open fracture. Then, we sought to determine the clinical and biological factors associated with the risk of positive intraoperative tissue cultures and the outcome after non-union surgery.

METHODS: We retrospectively selected patients > 18 years, who had a primary planned surgical treatment of long-bone non-union after diaphyseal open fracture, with no previous history of infection. Infection was confirmed when growth of the same micro-organism was observed from at least two bone/tissue samples obtained at the time of non-union surgery.

RESULTS: From 2005 to 2021, 85 patients (64 males, 21 females) were included, with a mean age of 38.5 ± 15 years (18-75 years) at the time of non-union surgery. Anatomic regions included the tibia (58 cases), femur (21 cases), and humerus (6 cases). Cultures were positive in 29 cases (34%), including nine polymicrobial infections (31%), with coagulase-negative Staphylococcus species (n = 10) and Staphylococcus aureus (n = 9) being the most prevalent bacteria, followed by Cutibacterium acnes (n = 5), and Pseudomonas aeruginosa (n = 2). The risk of infection correlated with diabetes mellitus (p = 0.0017), the presence of a fistula (p = 0.001), and the type of index wound according to Cauchoix-Duparc (p = 0.03). The risk of postoperative complications and the need for additional surgery, notably for persistent non-union, were higher in patients with an infected non-union.

CONCLUSIONS: An underlying low-grade indolent infection was found in a third of cases of presumed aseptic long-bone non-union following an open fracture. The risk of infection was associated with diabetes mellitus, the presence of a fistula, and greater severity of the initial wound. In these cases, the risk of septic failure was almost three times higher as compared to patients with negative cultures.

LEVEL OF EVIDENCE: Retrospective study, Level III.

PMID:41225170 | DOI:10.1007/s00264-025-06698-8

Int Orthop. 2025 Nov 13. doi: 10.1007/s00264-025-06697-9. Online ahead of print.

ABSTRACT

PURPOSE: The goal of surgery for pelvic metastasis is pain-free reconstruction that enables daily activity without complications for the patient's remaining life. The purpose of our study was to assess complications, reoperations, functional outcomes, and survival in patients with pelvic metastasis treated with standard or dual mobility total hip arthroplasty (THA) and antiprotrusio cage.

METHODS: We prospectively analyzed 36 patients with pelvic metastasis who underwent reconstruction with standard (n = 20) or dual mobility (n = 16) bearing THA and antiprotrusio cage between 2015 and 2024 at a single institution. We evaluated complications, reoperations, functional outcomes and survival.

RESULTS: Infection occurred in five of 36 patients (14%): three patients required surgical debridement and two were managed with antibiotics. No dislocations were observed in both standard and dual mobility bearing groups. Local disease progression developed in seven of 36 patients (19%), with only one patient requiring acetabular revision at 63 months postoperatively. Survival of implant was 85.8% (95% CI 74.9%-98.2%) at one year after reconstruction. Median MSTS scores were 22.5 and 20.0 in the standard and dual mobility bearing groups, respectively (p = 0.564), with no difference in ambulation status. Patient survival was 77.7% (95% CI 65.2%-92.6%) at one year and 12.8% (95% CI 4.5%-36.1%) at five years.

CONCLUSION: Patients with pelvic metastasis treated with standard or dual mobility bearing THA with antiprotrusio cage may effectively restore painless function. Despite high risk of infection and local disease progression, no dislocation occurred, supporting this reconstruction as an acceptable surgical option for patients with pelvis metastasis who need surgical treatment.

PMID:41225169 | DOI:10.1007/s00264-025-06697-9

Int Orthop. 2025 Nov 13. doi: 10.1007/s00264-025-06682-2. Online ahead of print.

ABSTRACT

PURPOSE: To compare functional and radiological outcomes between two stage ORIF and single stage external fixation for complex pilon fractures.

METHODS: Prospective, single-center randomized controlled trial at a Level I trauma facility (April 2021-April 2023). Sixty skeletally mature patients with AO/OTA 43-C pilon fractures unsuitable for primary ORIF were randomized to two-stage ORIF (control group) or single-stage limited internal fixation with external fixation (LIFEF) (treatment group). Minimum follow-up was 24 months. The primary outcome was the AOFAS score at final follow-up. Secondary outcomes included time to union, time to return to work, ankle range of motion (ROM), fracture-related infection (FRI), bone-healing complications (nonunion, malunion, delayed union), post-traumatic osteoarthritis (PTOA), and need for secondary procedures.

RESULTS: All 60 patients completed follow-up. Compared with LIFEF, two-stage ORIF achieved higher AOFAS scores (85 ± 9 vs. 77 ± 10; P = 0.006), earlier return to work (7 ± 1.5 vs. 10 ± 3 months; P < 0.001), and shorter time to union (17 ± 3.6 vs. 19 ± 3.5 weeks; P = 0.02). Groups did not differ in quality of reduction (P = 0.14), ankle ROM (P = 0.10 and 0.058 for dorsiflexion and plantarflexion), FRI (P = 0.69), PTOA (P = 0.64), or bone-healing complications (nonunion, delayed union, malunion; P = 0.24, 0.39, 0.39).

CONCLUSION: Two-stage ORIF provided superior functional outcomes and faster recovery (earlier union and return to work) compared with LIFEF, with similar reduction quality and complication rates. These findings support two-stage ORIF as the preferred strategy for AO/OTA 43-C pilon fractures with soft-tissue compromise.

REGISTRY: ClinicalTrials.gov , NCT05141227, Registration date: 29 July 2021.

PMID:41225168 | DOI:10.1007/s00264-025-06682-2

Int Orthop. 2025 Nov 10. doi: 10.1007/s00264-025-06693-z. Online ahead of print.

ABSTRACT

This letter provides a critical commentary on the recent article by Hachadorian et al. entitled "Assessing glenoid orientation on the axillary view: a novel technique using the posterolateral acromion-to-coracoid line." The authors introduced the posterolateral acromion-to-coracoid (PLAC) line as a reproducible reference for assessing glenoid version on axillary radiographs, demonstrating excellent reliability and strong correlation with 3D CT measurements. We highlight the clinical significance of this technique as a cost-effective and radiation-sparing alternative for postoperative evaluation of glenoid orientation. Furthermore, we suggest extending validation to postoperative cases, quantifying projection-related errors, and exploring AI-assisted automation for landmark detection. This work represents a valuable step toward standardized radiographic assessment following shoulder arthroplasty.

PMID:41212192 | DOI:10.1007/s00264-025-06693-z

Int Orthop. 2025 Nov 10. doi: 10.1007/s00264-025-06692-0. Online ahead of print.

ABSTRACT

PURPOSE: This study quantifies the reproducibility of soft tissue laxity and gap measurements under manual stress, and implant positioning planning using the imageless ROSA® robotic system, by comparing a senior high-volume surgeon with a low-volume resident.

METHODS: In this single-centre prospective study, 17 patients undergoing robotic-assisted total knee arthroplasty were evaluated. Intra- and inter-operator variability was assessed by recording intraoperative measurements and planning outcomes using a standardized protocol for functional alignment (FA).

RESULTS: Both intra and inter-operator analyses demonstrated good to excellent reproducibility (ICC > 0.75-0.9) for soft tissue and gap assessments. Minor variability was observed in planning parameters (ICC < 0.60), specifically stylus height, femoral flexion, and distal femoral resection, likely reflecting subjective adjustments by the high-volume surgeon.

CONCLUSION: High reproducibility in soft tissue measurements and surgical planning across surgeons with different experience levels is shown by the ROSA® robotic system, while flexibility for individualized surgical strategies is retained.

PMID:41212191 | DOI:10.1007/s00264-025-06692-0

Int Orthop. 2025 Nov 10. doi: 10.1007/s00264-025-06691-1. Online ahead of print.

ABSTRACT

INTRODUCTION: Charcot diabetic arthropathy is one of the most serious complications in patients with diabetes mellitus with sensorimotor neuropathy of the lower extremities, accompanied by metabolic disturbances and subsequent destruction of bones and joints. There are many methods of surgical treatment of diabetic charcot's foot described in the literature. A review of the literature found no publications describing the surgical treatment of Charcot arthropathy patients using the method of two-stage replacement of total and subtotal foot bone defects with heterotopic allografts using 3D modelling.

PURPOSE: The aim of the study is to determine the clinical efficacy of surgical treatment of patients with diabetic Charcot foot with destruction of the middle and hindfoot in remission (without active infectious process) and with active purulent infection by two-stage replacement of total and subtotal bone defects of the foot with heterotopic allografts using 3D modeling.

MATERIALS AND METHODS: This study analysed the treatment outcomes of 40 patients with bone defects due to Charcot neuroosteoarthropathy who were treated at the Centre for Foot and Diabetic Foot Surgery, Yudin City Clinical Hospital in 2022 to 2023. The localisation of the pathological process was diagnosed in the bones of the midfoot in seven patients (type 2 to 3, Sanders & Frykberg classification), of the hindfoot in 30 patients (type 4 to 5, Sanders & Frykberg classification) and of the combined midfoot and hindfoot in three patients (type 3 to 4 to 5, Sanders & Frykberg classification). There were 12 men and 23 women. The mean age was 51.1 ± 2.1 M ± σ (24 to 71) years. The average body mass index was 30.0 ± 1.2 M ± σ (18 to 46.9). Type 1 diabetes mellitus was present in 9 patients and type 2 diabetes mellitus was present in 31 patients.

RESULTS: The mean volume of the simulated allografts for the midfoot was 22.7 ± 6.2 cm3 M ± σ, 37.8 ± 2.9 cm3 for the hindfoot and 41.2 ± 7.6 cm3 for combined defects of the hindfoot and midfoot. The duration of follow-up after the end of treatment ranged from 12 to 36 months. Good results were obtained in all patients with midfoot damage and with combined midfoot and hindfoot damage. In isolated hindfoot lesions, a good result was seen in 19 of 30 patients, or 60.7%. In six patients with hindfoot damage (21.4%), crushing of the allograft was observed with the neoarthrosis formation in supporting region with relative limb shortening, which was considered a satisfactory outcome. Non-union or recurrent osteomyelitis was noted in five patients with hindfoot lesions (17.9%), requiring allograft removal and arthrodesis in an external fixation device (EFD) with intraoperative segment shortening. These results were considered unsatisfactory despite the preservation of the limb. Overall, for the entire cohort of patients, 29 of 40 (72.5 per cent) had a good outcome, six (15 per cent) had a satisfactory outcome and five (12.5 per cent) had an unsatisfactory outcome.

CONCLUSION: The utilisation of 3D allografts provides a solution to the issue of restoration total bone defects in Charcot osteoarthropathy, not only at the level of individual bones, but also across the entire segments of the foot while enabling the precise replication of the intricate contours of a complex geometry. The proposed method of restoration bone defects in Charcot arthropathy has been demonstrated to be sustainable and enabling the successful filling of extensive bone defects without complications and the staged compression throughout the entire fixation period, while minimising the risk of implant damage.

PMID:41212190 | DOI:10.1007/s00264-025-06691-1

Int Orthop. 2025 Nov 10. doi: 10.1007/s00264-025-06683-1. Online ahead of print.

ABSTRACT

BACKGROUND: It remains unclear whether altered bone density may be a stability issue in stemless reverse shoulder arthroplasty (RSA).

METHODS: This was a retrospective multicentric study. Patients with stemless RSA with two-year postoperative shoulder X-ray and clinical data were included. Measurement of proximal humeral cortical bone thickness (CBT avg) on postoperative radiography was used to assess bone density.

RESULTS: 68 patients (mean age, 67.0 years) were included. CBT avg < 6 mm (osteoporosis) at two years was reported in 22.2% (2/9) of patients with humeral loosening and 35.6% (21/59) without humeral loosening (p = 0.7073). After adjustment for age and body mass index (BMI), CBT avg < 6 mm was not significantly associated with humeral loosening at two years (OR 0.37; 95% CI 0.04-2.21). Factors associated with humeral loosening vs. no humeral loosening at two years were BMI (24.2 vs. 27.9 kg/m2; p = 0.0131), cervico-diaphyseal angle < 140° at two years (66.7% vs. 16.9%; p = 0.0039) and lateralization of polyethylene (100% vs. 59.3%; p = 0.0217).

CONCLUSIONS: These results suggest that radiological evaluation of bone density does not predict early migration of stemless RSA implants. Some clinical factors such as BMI or implant configuration were associated to early implant migration, but never led to implant removal.

PMID:41212189 | DOI:10.1007/s00264-025-06683-1

Int Orthop. 2025 Nov 8. doi: 10.1007/s00264-025-06669-z. Online ahead of print.

ABSTRACT

PURPOSE: To compare, in two groups of patients, the prognosis of unplanned resections of soft tissue sarcomas treated in a specialised centre, in terms of survival, local recurrence and complications.

METHODS: A retrospective investigation was performed between 2006-2016. A total of 191 patients were included. 147 (77%) were included in the control group (planned reactions) and 44 (23%) corresponded to the study group (unplanned resection). The control group, patients underwent primary limb salvage surgery by the orthopaedic oncology team and the study group those who were initially treated at another center and required a second oncologic surgery to achieve free margins. Overall survival, local recurrence, postoperative complications and prognostic factors were analyzed.

RESULTS: Overall survival at five years was 67% (95% CI: 62-76%). Compared to both groups, there was no significant difference (p = 0.22). The risk of LR at five years was 19.1% (95% CI: 18.89-19.30) for the control group and 35.64% (95% CI: 34.56-36.11) for the control group. for the study group (p = 0.047). Postoperative complications were significantly higher in the study group, 45% versus 21% (p < 0.01). We found a greater number of small tumours in the unplanned resection group.

CONCLUSIONS: Unplanned resection of extremity soft tissue sarcomas does not affect the overall survival of patients, but has a higher risk of local recurrence, a higher risk of developing postoperative complications and a lower chance of limb preservation. This study underscores the importance of thorough preoperative evaluation, particularly for small (< 5 cm) soft tissue tumours of the limb, and supports referral to specialised centres for optimal management.

PMID:41204953 | DOI:10.1007/s00264-025-06669-z

Int Orthop. 2025 Nov 5. doi: 10.1007/s00264-025-06688-w. Online ahead of print.

ABSTRACT

Overstuffing can be defined as too much stuff in a limited space. In anatomic shoulder arthroplasty, overstuffing is a principal cause of postoperative pain, stiffness and limited function. This article reviews the concept of overstuffing in shoulder arthroplasty and how it can be avoided.

PMID:41191070 | DOI:10.1007/s00264-025-06688-w

Int Orthop. 2025 Nov 5. doi: 10.1007/s00264-025-06679-x. Online ahead of print.

ABSTRACT

PURPOSE: To compare the clinical and functional outcomes of Ilizarov external fixation versus open reduction and internal fixation in the management of complex tibial plateau fractures.

METHODS: A prospective, randomised comparative clinical study was conducted at two trauma centres including 40 adult patients with Schatzker types IV-VI tibial plateau fractures. Patients were randomly assigned to internal fixation (n = 20) or Ilizarov external fixation (n = 20).

RESULTS: Patients in the external fixation group (Group B) started partial weight-bearing significantly earlier (mean 6.6 weeks) compared to the internal fixation group (Group A; mean 9.6 weeks; p = 0.002). Full weight-bearing was also achieved significantly sooner in Group B (mean 11 weeks) compared to Group A (mean 17.65 weeks; p < 0.001). Healing time, Knee Society Scores, pain, and range of motion were comparable.

CONCLUSION: Ilizarov external fixation facilitates earlier partial and full weight-bearing compared to internal fixation, with similar healing times and functional outcomes, suggesting its efficacy as an alternative to internal fixation for complex tibial plateau fractures.

PMID:41191069 | DOI:10.1007/s00264-025-06679-x

Int Orthop. 2025 Nov 5. doi: 10.1007/s00264-025-06690-2. Online ahead of print.

ABSTRACT

INTRODUCTION: Medical registries are structured tools for collecting, monitoring, and analyzing clinical data for epidemiological purposes, as well as for improving patient care. In the field of orthopaedics, arthroplasty registries help monitor implant performance, identify complications, and standardize surgical practices. In Burkina Faso, despite the increase in the number of joint replacements and epidemiological features such as sickle cell disease, no national registry exists. This work aims to establish a prototype of a registry tailored to local realities.

METHODS: A cross-sectional descriptive study was conducted, combining a literature review to assess the existing situation and a questionnaire survey administered to orthopaedic surgeons in Burkina Faso. The analysis was conducted with Python 3.12.3, integrating descriptive statistics, visualizations, and synthesis of functional expectations.

RESULTS: To date, there is no structured system for monitoring orthopaedic implantable devices at the national level. Orthopedists during the survey expressed the need for a centralized, secure, and accessible system, allowing the traceability of implants, the monitoring of complications, and the production of reports that can guide the choice of prostheses. Priority features include web and smartphone access, prosthesis survival statistics, and implant selection recommendations. The main constraints identified are the lack of a homogeneous IT infrastructure and limited financial resources. Based on the needs collected, a prototype was modeled, including UML diagrams, specifications, and web and smartphone models.

CONCLUSION: The establishment of a national arthroplasty registry is perceived as a strategic lever by practitioners to improve the quality of care and strengthen the surveillance of implantable devices. The prototype is intended to be a contextual, secure, and scalable solution. A pilot phase is recommended, with strong institutional support (Ministry of Health, National Orthopedics society) and participatory governance to ensure user buy-in and the sustainability of the registry.

PMID:41191068 | DOI:10.1007/s00264-025-06690-2

Int Orthop. 2025 Nov 4. doi: 10.1007/s00264-025-06681-3. Online ahead of print.

ABSTRACT

PURPOSE: Pelvic-ring injuries in women often result in urinary dysfunction owing to the proximity of pelvic organs to the urinary tract, significantly affecting quality of life. However, detailed research on urinary sequelae remains limited. This study aimed to assess the incidence of urinary dysfunction in women after pelvic-ring injuries and to identify risk factors influencing urinary function.

METHODS: We conducted a retrospective cohort study of women who underwent osteosynthesis for pelvic-ring injuries between January 2022 and June 2023 with ≥ 12 months of follow-up. Urinary dysfunction was evaluated using the Questionnaire for Urinary Incontinence Diagnosis and Female Urinary Symptom Score at one, three, six and 12 months postoperatively.

RESULTS: Fifty-eight patients (mean age, 43.2 years) were included, with motor-vehicle collisions being the most common cause for pelvic-ring injuries (74.1%). Most injuries (84.5%) were classified as Type B. Nearly half of the patients reported urinary symptoms one month post-surgery, which significantly improved over 12 months (P < 0.05). In the multivariate analysis, greater injury severity was independently associated with urinary dysfunction at six months (adjusted odds ratio: 1.05, 95% confidence interval 1.00-1.12, p = 0.049), while no other clinical or procedural factors, including age, arterial embolisation, or surgical approach, stayed significant. Functional recovery correlated with reduced symptoms over time.

CONCLUSION: Urinary dysfunction is a frequent but under-recognised complication after pelvic-ring injuries. Although most patients experience gradual improvement over time, greater injury severity is independently associated with early urinary symptoms. Continuous monitoring and timely rehabilitation may help optimise long-term functional recovery.

PMID:41186674 | DOI:10.1007/s00264-025-06681-3

Int Orthop. 2025 Nov 4. doi: 10.1007/s00264-025-06687-x. Online ahead of print.

ABSTRACT

PURPOSE: Aseptic loosening of the acetabular cup component is the primary cause for complex revision surgery following total hip arthroplasty. However, the extent to which the different zones of the prosthetic contribute to successful osseointegration and how reliable this integration can be assessed using conventional radiographs remain unclear. The aim of the study was to evaluate the osseointegration of cementless threaded acetabular cups through a combination of radiological analysis and histological validation.

METHODS: Eight hemipelves of body donors with cementless threaded acetabular cups were included in this study. Conventional radiographs were used to assess the specimens for existing radiolucent lines, periprosthetic osteolysis, or fractures. For histological analysis, thin sections of the acetabular cup were examined for the presence of a periprosthetic membrane, particle debris or inflammatory cells. The areas of visible contact were identified and the bone-to-implant contact (BIC) was calculated.

RESULTS: Radiographic analysis revealed no signs of insufficient osseointegration, osteolytic lesions, or periprosthetic loosening, in any of the specimens. Histological examination showed an average osseointegration rate of 41.84%. Bone-to-implant contact analysis showed no significant differences between different sectors or zones, or between conical and bi-conical acetabular cups.

CONCLUSION: This study highlights successful osseointegration of cementless threaded acetabular cups, with a mean survival of 18.2 years. Radiological imaging aligned closely to histological finding, confirming implant stability and long-term clinical effectiveness.

PMID:41186673 | DOI:10.1007/s00264-025-06687-x

Int Orthop. 2025 Nov 1. doi: 10.1007/s00264-025-06684-0. Online ahead of print.

ABSTRACT

PURPOSE: Preoperative anxiety (Pop-Anx) is highly prevalent among patients undergoing orthopaedic surgery. Pop-Anx can stem from fears related to the procedure, anaesthesia, or the recovery process. It has been linked to poorer postoperative outcomes, including greater pain, reduced function, and a lower quality of life. Despite its clinical significance, Pop-Anx is inconsistently assessed due to a lack of standardized tools and clear guidelines. The objective was to identify instruments used for measuring Pop-Anx in patients undergoing orthopaedic surgeries.

METHODS: A systematic search was conducted across five databases up to September 2024, following PRISMA guidelines. Data on anxiety assessment tools, timing, administration, and related outcomes were extracted. Meta-analyses were conducted on studies with a low risk of bias using random-effects models.

RESULTS: Screening of the literature revealed that 42 studies assessed Pop-Anx, involving a total of 115,380 patients. Ten different tools were used to measure Pop-Anx, with the Hospital Anxiety and Depression Scale (HADS) being the most frequent. Significant variability was observed in assessment timing and methodology. A meta-analysis showed that Pop-Anx was positively correlated with postoperative anxiety (z = 0.60) and pain (z = 0.22) and negatively correlated with joint function (z = -0.25). Females reported higher Pop-Anx (g = 0.38). The timing of outcome assessment did not significantly moderate these relationships.

CONCLUSION: Although Pop-Anx is associated with worse postoperative outcomes, it is assessed using heterogeneous and sometimes inadequate tools. Standardized, context-specific assessment methods are needed. Despite its clinical relevance, Pop-Anx remains underassessed in some common orthopaedic procedures.

PMID:41174327 | DOI:10.1007/s00264-025-06684-0

Int Orthop. 2025 Nov 1. doi: 10.1007/s00264-025-06689-9. Online ahead of print.

ABSTRACT

PURPOSE: Fractures in persons with haemophilia (PWH) exhibit similarities and distinctions compared to typical fractures. However, complications confer an added increase in the risk of fractures. This study aimed to summarize the treatment experience of fractures in PWH based on a classification.

METHODS: A retrospective cohort study was conducted on PWH between 2001 and 2023. The classification was developed into three types according to PWH's clinical presentations and imaging findings. Subsequently, the distribution and distinctions among subtypes were analyzed, followed by an exploration of risk factors for fracture-related complications.

RESULTS: A total of 61 fractures in PWH met the inclusion and exclusion criteria. The median follow-up duration was 6.87 years. Type II and III fractures in PWH exhibited a longer time of fracture healing and hospital stay, along with increased fracture-related complication rates. In further analysis, the operative time and intraoperative blood loss also increased significantly. Furthermore, compared to non-surgical approaches, the surgical treatment appeared to reduce the incidence of fracture-related complications. Next, the femur was identified as the most frequently fractured site. Plate fixation was the predominant surgical approach for types II (20/29) and III (8/13).

CONCLUSION: This study reviews treatment experience for fractures in PWH according to a classification and stresses the importance of surgery. The classification may provide a potential strategy for post-operative care. However, further classification is required.

PMID:41174326 | DOI:10.1007/s00264-025-06689-9

Int Orthop. 2025 Oct 31. doi: 10.1007/s00264-025-06685-z. Online ahead of print.

ABSTRACT

INTRODUCTION: Two-stage revision of total hip arthroplasty (THA) remains the gold standard for periprosthetic joint infection (PJI). Trabecular Metal (TM) offers a valuable option for acetabular reconstruction, but evidence in septic revision THA (rTHA) is scarce. This study evaluated outcomes of TM implants in two-stage rTHA for infection, hypothesizing results comparable to existing literature, especially in cases with major bone loss.

MATERIALS AND METHOD: We retrospectively analyzed 32 two-stage rTHA (32 patients) performed between January 2010 and July 2021, with a minimum two years follow-up. All patients received TM acetabular implants. Bone loss was classified according to Paprosky: 3 IIA, 8 IIB, 3 IIC, 12 IIIA, and 6 IIIB, with pelvic discontinuity in 13 cases.

RESULTS: At mean follow-up of 30.2 ± 10.9 months (range, 24 to 69), infection eradication was achieved in 87,5%. Staphylococcus species accounted for 84,4% of cases. Seven complications occurred, including six reoperations: five revisions (two for recurrent infection, 3 for mechanical failure). The overall failure rate was 21,9%. At 24 months, the healing rate, including all causes of failure, was 78,1% and revision-free rate 84,4%.

CONCLUSION: TM implants in two-stage rTHA for septic failure achieved satisfactory mid-term results, even in advanced acetabular bone loss (44% Paprosky II, 56% Paprosky III). To our knowledge, this is the first study exclusively evaluating TM in this context, supporting its role in complex acetabular reconstruction during septic revisions.

LEVEL OF EVIDENCE: IV.

PMID:41168498 | DOI:10.1007/s00264-025-06685-z

Int Orthop. 2025 Oct 29. doi: 10.1007/s00264-025-06677-z. Online ahead of print.

ABSTRACT

OBJECTIVE: Debridement, antibiotics, and implant retention (DAIR) is a widely used surgical approach for managing acute prosthetic joint infection (PJI) following knee arthroplasty (KA). However, limited studies have explored its application across different KA types. This study aims to compare the clinical outcomes of DAIR in acute PJI following unicompartmental knee arthroplasty (UKA) versus total knee arthroplasty (TKA), with a focus on microbial profiles, treatment characteristics, and patient outcomes.

METHODS: We retrospectively reviewed clinical data from 67 consecutive patients diagnosed with acute PJI, as defined by the Musculoskeletal Infection Society (MSIS) criteria, who underwent DAIR at our institution between January 2016 and April 2023. Patients were categorized into two groups based on the type of primary arthroplasty: 51 in the TKA-DAIR group and 16 in the UKA-DAIR group. Comparative analyses included pre- and postoperative serological inflammatory markers, microbiological findings, knee functional outcomes, and infection recurrence rates.

RESULTS: Coagulase-negative staphylococci were the most frequently isolated organisms in both the TKA-DAIR (37.3%) and UKA-DAIR (43.8%) groups. On postoperative day one, ESR and CRP levels showed no significant differences between groups. However, by postoperative day three, the UKA-DAIR group exhibited significantly lower ESR (P = 0.005) and CRP (P = 0.007) levels, a trend that persisted through day five (ESR, P = 0.014; CRP, P = 0.015). At two year follow-up, there were no significant differences between groups in HSS knee scores (P = 0.107), VAS pain scores (P = 0.531), or range of motion (ROM; P = 0.128). Notably, Kaplan-Meier survival analysis demonstrated a significantly lower infection recurrence rate in the UKA-DAIR group over the two year follow-up period (P = 0.041).

CONCLUSION: In cases of acute PJI following UKA, where MRI confirms that the contralateral compartment remains uninvolved and the causative pathogen is clearly identified, DAIR yields superior clinical outcomes compared to TKA. This may be attributed to the reduced prosthetic surface area in UKA and the retention of native cartilage, which may serve as an effective barrier against infection. Based on these findings, we recommend DAIR as the preferred treatment strategy for acute UKA PJI under these conditions.

PMID:41152479 | DOI:10.1007/s00264-025-06677-z

Int Orthop. 2025 Oct 28. doi: 10.1007/s00264-025-06678-y. Online ahead of print.

NO ABSTRACT

PMID:41148295 | DOI:10.1007/s00264-025-06678-y

Int Orthop. 2025 Oct 28. doi: 10.1007/s00264-025-06686-y. Online ahead of print.

ABSTRACT

PURPOSE: Hemiarthroplasty with concentric glenoid reaming (ream-and-run [RnR] arthroplasty) may be considered in patients with glenohumeral arthritis who want to avoid activity restrictions of prosthetic glenoid components. However, there are concerns of glenoid wear and medialization following RnR. While the factors responsible for glenoid medialization are unclear, the presence of bacteria may lead to weakening and osteolysis of the glenoid bone. This study sought to correlate the presence and amount of Cutibacterium cultured from RnR arthroplasties that were revised with the amount of radiographic glenoid medialization.

MATERIALS AND METHODS: Patients who underwent open revision surgery after primary RnR with a minimum of six months between primary and open revision surgery were included. Semi-quantitative Cutibacterium load from cultures at the time of revision was calculated. Glenoid medialization was measured from radiographs taken post-primary RnR and before revision surgery. Glenoid medialization amount and rate were assessed against Cutibacterium presence and load.

RESULTS: Radiographs of 39 shoulders with average follow-up of 2.6 ± 2.4 years were analyzed. Twenty-five (64.1%) were culture-positive (≥ 2 positive deep cultures with Cutibacterium). Patients in the culture-positive and negative cohorts had similar glenoid wear rates of 1.4 and 1.3 mm per year, respectively (p = 0.892). There was no significant association between the amount of glenoid medialization and the presence or load of Cutibacterium.

CONCLUSIONS: We found no association between glenoid medialization after RnR arthroplasty and the presence or load of Cutibacterium at subsequent revision surgery. Longer follow-up studies are needed to better assess Cutibacterium's role in glenoid medialization after RnR arthroplasty.

LEVEL OF EVIDENCE: Level IV; Case Series.

PMID:41148294 | DOI:10.1007/s00264-025-06686-y