Int Orthop. 2025 Jul 29. doi: 10.1007/s00264-025-06626-w. Online ahead of print.

NO ABSTRACT

PMID:40728644 | DOI:10.1007/s00264-025-06626-w

Int Orthop. 2025 Jul 29. doi: 10.1007/s00264-025-06625-x. Online ahead of print.

NO ABSTRACT

PMID:40728643 | DOI:10.1007/s00264-025-06625-x

Int Orthop. 2025 Jul 29. doi: 10.1007/s00264-025-06627-9. Online ahead of print.

ABSTRACT

PURPOSE: Shepherd's crook deformity is a characteristic complication of fibrous dysplasia (FD) of the femur, leading to coxa vara and mechanical instability. Two-stage surgical approaches involve initial valgus osteotomy followed by delayed intramedullary femoral stabilization, prolonged treatment, and increasing morbidity. This study evaluates a one-stage surgical correction that employs fibular strut allograft augmentation for both the femoral neck and shaft.

METHODS: A retrospective review was performed on 17 patients with Shepherd's crook deformity who underwent one-stage hip lag screw and side plate fixation with fibular strut allograft augmentation of the femoral neck and shaft between 2002 and 2022. Radiographic and clinical outcomes were assessed, including neck-shaft angle (NSA) restoration, fixation stability, graft incorporation, and functional improvement. The median follow-up of the patients was 96 months.

RESULTS: The mean preoperative NSA was 93° (SD: 13.5°), improving significantly to 130° (SD: 5°) at the latest follow-up (p < 0.001). Stable fixation was achieved in 16 of 17 patients, with one case of fixation failure. Fibular graft resorption was noted in six patients but did not compromise fixation. Clinically, postoperative pain, limping, and activity limitations improved substantially, though seven patients experienced persistent restrictions in outdoor activities. The average limb shortening was 3.5 cm before the operation and 0.9 cm at the end of the follow-up.

CONCLUSION: One-stage correction of Shepherd's crook deformity using lag hip screw fixation and fibular strut allograft augmentation could be a viable alternative to staged procedures, though further studies are needed to confirm its efficacy and generalizability.

PMID:40728642 | DOI:10.1007/s00264-025-06627-9

Int Orthop. 2025 Jul 28. doi: 10.1007/s00264-025-06613-1. Online ahead of print.

NO ABSTRACT

PMID:40719875 | DOI:10.1007/s00264-025-06613-1

Int Orthop. 2025 Jul 26. doi: 10.1007/s00264-025-06618-w. Online ahead of print.

ABSTRACT

PURPOSE: Dislocation after total hip arthroplasty (THA) via the posterior approach remains a serious complication. This cadaveric study compared two soft tissue repair techniques-trans-osseous and direct suturing-regarding their effect on dislocation torque and angle.

METHODS: Ten hips from five fresh-frozen cadavers were used. A Posterior approach identified the short external rotators. Following standard THA, each limb was mounted on a motorized torque wrench. Hips were tested first with no posterior repair (NPR), then with either transosseous or direct repair techniques. Dislocation torque and angle were recorded, with each hip serving as its own control.

RESULTS: Posterior repair significantly increased the force required for dislocation compared to NPR (mean 9.12 Nm vs. 2.73 Nm; p = 0.004). Trans-osseous repair led to a 4.41-fold increase in torque (p = 0.04), and direct repair a 2.47-fold increase (p = 0.03), with a significant difference between the two (p = 0.016). The dislocation angle increased with repair (mean 54.6° vs. 45.1°; p = 0.09), though not significantly. Trans-osseous and direct repairs increased the angle by 1.70× and 1.18×, respectively.

CONCLUSION: Posterior soft tissue repair improves hip stability in THA performed via a posterior approach. Trans-osseous repair provides significantly greater resistance to dislocation torque than direct suturing and may be the preferred technique to reduce postoperative instability.

PMID:40715845 | DOI:10.1007/s00264-025-06618-w

Int Orthop. 2025 Jul 26. doi: 10.1007/s00264-025-06620-2. Online ahead of print.

ABSTRACT

BACKGROUND: Total knee arthroplasty (TKA) is a highly effective procedure for end-stage knee osteoarthritis, but postoperative instability remains a major concern, impacting patient satisfaction and leading to potential revision surgeries. Understanding patient-related risk factors for instability is crucial for optimizing outcomes and minimizing complications.

METHODS: We conducted a retrospective cohort study of patients who underwent revision TKA at our clinic between 1996 and 2021, focusing on those who required revision specifically due to instability. We analyzed a dataset of 39,572 primary TKA patients without documented revisions and 859 revision patients. Data extraction included age, gender, body mass index (BMI), age-adjusted Charlson Comorbidity Index (CCI) score, and comorbidities. Statistical analyses, including binary logistic regression, were performed to identify independent risk factors for instability.

RESULTS: The instability group (n = 859) had a mean age of 65.7 years and a significantly lower proportion of males compared to the control group (mean age 67.5 years, p < 0.001; males 30.7% vs. 38.1%, p < 0.001). Notable risk factors included younger age, female gender, stroke, deep vein thrombosis (DVT), and scleroderma. Specifically, scleroderma was associated with a high risk of instability (P < 0.01 OR [odds ratio] 9.27, CI [confidence interval] 2.01 to 42.7), stroke (P = 0.01 OR 1.8, CI: 1.1 to 3.1), and DVT (p < 0.01 OR: 2.0, CI: 1.4 to 2.8).

CONCLUSION: Patient-related factors such as younger age, female gender, stroke, DVT, and scleroderma significantly influence the risk of instability following primary TKA. These findings highlight the multifactorial nature of TKA instability and underscore the importance of tailored preoperative assessment and postoperative care. Addressing these risk factors can improve patient outcomes and reduce the incidence of instability following TKA.

PMID:40715844 | DOI:10.1007/s00264-025-06620-2

Int Orthop. 2025 Jul 21. doi: 10.1007/s00264-025-06619-9. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this study was to define the variability of the scapulohumeral position during preoperative Computed Tomography (CT) acquisition and to evaluate its influence on angular lateralization and distalization measurements. We hypothesized that the preoperative resting arm position, in terms of humeral abduction, flexion and internal rotation, would vary significantly between patients and that this variability would influence the lateralization (LSA) and distalization shoulder angle (DSA).

METHODS: We analyzed a prospectively collected database of preoperative de-identified CT scans from a single Total Shoulder Arthroplasty (TSA) planning system (Equinoxe, Exactech GPS, Blue-Ortho), including all cases with scapular and humeral segmentation. Validated three-dimensional (3D) bone models were used to compute and automatically position scapular and humeral landmarks. These included: the superior glenoid tubercle; the most lateral border of the acromion and the most lateral border of the greater tuberosity. The position of the humerus relative to the scapula was automatically calculated, allowing the angles of abduction, flexion and internal rotation of the scapulohumeral joint to be assessed. Additionally, the potential relationship between the body mass index (BMI) and the resting arm position was assessed. Finally, LSA and DSA were calculated. A multiple linear regression analysis was performed to assess the relationship between the humeral position and the LSA and DSA.

RESULTS: A total of 21,863 patients were included. Preoperative humeral positioning relative to the scapula showed a mean abduction of 10.3°±12.4 (-14.0°; 36.6°), mean flexion of 3.9°±8.9 (-16.0°; 26.1°) and mean internal rotation of 6.5°±18.9 (-41.4°; 48.9°). The preoperative median of LSA and DSA were 87.4°±14.3° and 43°±12.4, respectively. Among the independent variables, abduction showed the strongest negative correlation with LSA (β = -0.2998, p < 0.0001), followed by flexion (β = -0.04342, p < 0.0001). Internal rotation was positively correlated with LSA (β = 0.1229, p < 0.0001). For DSA, abduction had a weak positive influence (β = 0.04321, p < 0.0001), while flexion (β = -0.04302, p < 0.0001) and internal rotation (β = -0.04654, p < 0.0001) were negatively associated. Notably, a 10° variation in abduction, flexion or internal rotation led to a -3°, -0.4° and + 1.2° change in LSA, respectively, whereas DSA was minimally affected, with variations limited to + 0.4°, -0.4° and - 0.5°, respectively.

CONCLUSION: The resting arm position during preoperative CT scans varies significantly, potentially affecting the preoperative planning of TSA. The main findings of this study suggest that there exists a weak correlation between the initial scapulohumeral position and the LSA/DSA measurements.

LEVEL OF EVIDENCE: Level IV. Case series with no comparison group.

PMID:40690017 | DOI:10.1007/s00264-025-06619-9

Int Orthop. 2025 Jul 19. doi: 10.1007/s00264-025-06604-2. Online ahead of print.

ABSTRACT

PURPOSE: The Both Column Screw (BCS) fixation technique is a recently introduced, innovative method for the treatment of acetabular posterior column fractures. This study aims to biomechanically compare the BCS technique with conventional posterior column lag screw fixation methods using finite element analysis.

METHODS: Five different internal fixation models were simulated using five distinct screw fixation techniques: antegrade posterior column screw (APCS), retrograde posterior column screw (RPCS), magic screw (MS), anterior BCS (aBCS), and posterior BCS (pBCS). The modeling process included meshing, assignment of material properties, and definition of boundary conditions. Each model was subjected to three different loading conditions: level walking, stairs up, and stairs down. The biomechanical performance of each fixation technique was evaluated based on five parameters: maximum stress in the screw, maximum stress in the bone, total deformation, gap in fracture surfaces, and sliding distance in the fracture surface.

RESULTS: Finite element analysis demonstrated biomechanical differences among the five fixation techniques. The APCS model consistently showed the highest stress values and deformation across all loading conditions, whereas the MS, aBCS, and pBCS models exhibited lower deformation and stress parameters. Among these, pBCS generally displayed the most favorable performance in terms of stress reduction and fracture stability. Overall, the BCS configurations (aBCS and pBCS) showed improved biomechanical behavior compared to conventional fixation methods.

CONCLUSION: The BCS fixation technique, due to its superior biomechanical properties, may serve as a valuable addition to current methods for acetabular posterior column fractures. It broadens surgical options and may support clinical decision-making for orthopaedic surgeons.

PMID:40682622 | DOI:10.1007/s00264-025-06604-2

Int Orthop. 2025 Jul 18. doi: 10.1007/s00264-025-06615-z. Online ahead of print.

ABSTRACT

PURPOSE: A proper balance of soft tissues is essential in total knee arthroplasty (TKA) for varus knees, but assessing soft tissue tension preoperatively is challenging. This study aimed to determine whether lower limb alignment angles can predict the necessary degree of soft tissue release.

METHODS: A retrospective cohort study was conducted on 953 patients with varus knees (> 10°) who underwent primary TKA from 2018 to 2020. The patients' data, release stage data, and three-joint alignment radiograph parameters were extracted from the Joint Reconstruction Research Center Knee registry, focusing on variables such as age, sex, body mass index (BMI), femoral mechanical‒anatomical angle (FMAA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), joint line congruent angle (JLCA), and varus angle (VA). Data analysis was performed via SPSS 26.0.

RESULTS: The mean age of the patients was 65.4 (43-86) years, with a predominance of females (57.9%). Findings revealed significant associations between soft tissue release and FMAA, LDFA, MPTA, JLCA, MPTA/VA, and JLCA/VA. ROC curve analysis indicated that the JLCA/VA ratio had the highest predictive accuracy (0.997). A cutoff value of 0.49 for JLCA/VA was used to predict the soft tissue release grade, with a sensitivity of 98.8% and specificity of 99.9%.

CONCLUSION: Angular parameters from three-joint alignment radiographs can effectively predict soft tissue release needed for TKA in varus knees, with the JLCA/VA being the most reliable parameter.

PMID:40679593 | DOI:10.1007/s00264-025-06615-z

Int Orthop. 2025 Jul 17. doi: 10.1007/s00264-025-06614-0. Online ahead of print.

ABSTRACT

PURPOSE: Medial open-wedge high tibial osteotomy (MOWHTO) is an effective treatment for medial compartment knee osteoarthritis. However, there is no consensus regarding the optimal management of the pes anserinus during the procedure. This study aimed to investigate the effects of pes anserinus release on radiological healing, alignment correction, and functional outcomes after MOWHTO.

MATERIALS AND METHODS: This retrospective cohort study included 73 patients who underwent MOWHTO with locking plate fixation. Patients were divided into two groups based on surgical preference: pes anserinus release (n = 35) and non-release (n = 38). Functional outcomes were assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS) at baseline, six months, and 12 months. Radiographic parameters included the hip-knee-ankle (HKA) angle, medial proximal tibial angle (mMPTA), tibial slope, and time to bone union. Complications were also documented.

RESULTS: Both groups were comparable in demographic characteristics and preoperative alignment. The non-release group achieved bone union significantly earlier (median 4.0 vs. 5.0 months, p = 0.019). There were no significant differences in HKA angle, mMPTA or tibial slope between the groups. At six months, KOOS scores were significantly higher in the non-release group (p < 0.001); however, by 12 months, both groups demonstrated similar functional outcomes. No major complications or nonunions were observed in either group.

CONCLUSIONS: Preserving the pes anserinus during MOWHTO does not compromise alignment correction and may enhance early bone healing and functional recovery. Routine release of the pes anserinus may be unnecessary, and its preservation could offer clinical benefits during the early postoperative period. Further prospective, randomized studies are needed to validate these findings.

PMID:40676248 | DOI:10.1007/s00264-025-06614-0

Int Orthop. 2025 Jul 15. doi: 10.1007/s00264-025-06612-2. Online ahead of print.

ABSTRACT

BACKGROUND: Managing large to massive rotator cuff tears accompanied by pseudoparalysis poses a considerable challenge in shoulder surgery. Superior capsular reconstruction (SCR) is increasingly considered a viable surgical option, yet optimal graft choices and outcomes in pseudoparalysis patients remain under investigation. This study assesses the clinical effectiveness of arthroscopic SCR using the long head of the biceps tendon (LHBT) in patients with large-to-massive RCT, comparing outcomes between those with and without pseudoparalysis.

METHODS: A prospective analysis was carried out involving 28 patients (14 with pseudoparalysis and 14 without) who underwent SCR using LHBT between January 2022 and December 2023. Clinical outcomes were assessed before surgery and subsequently at three, six and 12 months following the procedure, utilizing the Visual Analog Scale (VAS), University of California Los Angeles (UCLA) shoulder score, American Shoulder and Elbow Surgeons (ASES) score, and shoulder range of motion metrics.

RESULTS: Each group demonstrated substantial gains in reducing pain, enhancing functional outcomes, and increasing shoulder mobility. VAS scores decreased markedly, and ASES and UCLA scores improved substantially in both groups. Forward elevation and external rotation improved significantly, with a slightly greater range observed in the non-pseudoparalysis group. Pseudoparalysis was successfully reversed in 92.85% of affected patients. No major complications were reported.

CONCLUSION: Arthroscopic SCR using LHBT provides significant functional restoration and pain reduction in patients with massive RCT, effectively reversing pseudoparalysis in most cases. This technique offers a reliable and anatomically favorable graft option, supporting its use in both pseudoparalytic and non-pseudoparalytic patients.

PMID:40664842 | DOI:10.1007/s00264-025-06612-2

Int Orthop. 2025 Jul 15. doi: 10.1007/s00264-025-06599-w. Online ahead of print.

ABSTRACT

AIM: Although a severe limb deformity is rare, its management continues to be quite challenging. Various options have been described for correction. However, most of them are expensive, extensive and result in complications. Correction of severe deformities of the extremities has been suggested using the yester biological procedures with successful long term outcome.

MATERIALS AND METHODS: During the last five decades, 50 patients of challenging limb deformities were surgically managed by yester procedures which included corrective osteotomy, arthrodesis and Girdlestone arthroplasty. Eleven patients had upper limb deformity and 39 had lower limb deformity. Sixteen patients had congenital anomaly and 34 acquired. Twelve patients were non-walkers with multiple joint involvement. No metallic implant had been used in any case. No patient had repeat surgery. The age of the patients ranged from five-27 years.

RESULTS: Depending on the procedure adopted in a particular patient, all patients were examined periodically and regularly. The treatment time in a patient with multiple deformities ranged from six-12 months. Out of the twelve non-walkers, eleven could ambulate after the management. Superficial infection was recorded in 27 patients. No deep infection was observed. A long follow-up of 35 years has been available.

CONCLUSION: A rare series of 50 patients with challenging deformities of the extremities has been reported. The patients had been managed with procedures like corrective osteotomy, arthrodesis and Girdlestone arthroplasty with acceptable outcome. After the management 11 out of 12 non-walkers could ambulate themselves. The described procedures are simple, biological, dependable, patient friendly and available at no cost.

PMID:40663166 | DOI:10.1007/s00264-025-06599-w

Int Orthop. 2025 Jul 14. doi: 10.1007/s00264-025-06611-3. Online ahead of print.

ABSTRACT

PURPOSE: There is growing evidence that after moderate and severe slipped capital femoral epiphysis (SCFE), in-situ fixation can result in femoroacetabular impingement (FAI). Several different realignment procedures have been described but their use remains controversial due to high complication rates and technical complexity. Our study aims to evaluate the radiological outcomes and complications of patients who underwent open reduction with subcapital shortening osteotomy for moderate or severe SCFE.

METHODS: Radiographic and clinical data of patients with SCFE treated with subcapital shortening osteotomy performed by a single surgeon between October 2018 and July 2023 were retrospectively analysed. We collected patient demographics, pre- and post-operative radiographic measurements (Southwick slip angle, alpha angle and articulo-trochanteric distance (ADT), and post-operative complications. Patient outcomes were assessed using descriptive statistics.

RESULTS: Eighteen children and adolescents were reviewed, four were excluded due to inadequate follow-up. At the last follow-up, the lateral Southwick slip angle was corrected to a mean of 11 ° (1-31°). The mean alpha angle, measured at the final follow-up, was 59 ° (42-88°). One patient showed signs of radiological coxa breva. There were two patients with severe radiological cam deformities and one case of avascular necrosis (AVN).

CONCLUSION: Our findings suggest that the subcapital shortening osteotomy is an effective method for restoring head-neck anatomy in patients with moderate to severe SCFE, with good radiological outcomes. Our low incidence of avascular necrosis further supports the safety of this procedure.

PMID:40658155 | DOI:10.1007/s00264-025-06611-3

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