Int Orthop. 2025 Jun 7. doi: 10.1007/s00264-025-06567-4. Online ahead of print.

ABSTRACT

PURPOSE: Bone nonunion, a condition where fractures fail to heal within an expected timeframe, presents significant physical, psychological, and socioeconomic challenges. While various risk factors for nonunion have been extensively studied, the role of psychological factors, particularly anxiety, remains underexplored. This study aims to assess anxiety levels in patients with nonunion fractures and examine its associations with demographic factors such as age and gender.

METHODS: This cross-sectional study included 180 adults with a history of repeated surgical interventions due to nonunion diaphyseal fractures of long bones. Participants' anxiety levels were measured using the State-Trait Anxiety Inventory (STAI), a validated psychological assessment tool. Data were retrospectively collected from hospital records, and statistical analyses were conducted to compare anxiety levels across different age groups and between genders.

RESULTS: A substantial proportion of participants with a history of nonunion fractures exhibited moderate to high anxiety levels, with 70.6% reporting moderate to high state anxiety and 85.6% experiencing moderate to high trait anxiety. While state anxiety was not significantly associated with age, trait anxiety levels were notably higher in older adults. No significant gender-based differences in anxiety levels were observed.

CONCLUSION: The findings underscore the psychological burden of nonunion fractures, particularly among older patients, highlighting the need for integrating mental health assessments into orthopaedic care. Given the potential impact of anxiety on fracture healing, future studies should employ prospective designs to evaluate the role of anxiety in long-term orthopaedic outcomes. Addressing psychological factors in nonunion patients may improve overall recovery and quality of life.

PMID:40481834 | DOI:10.1007/s00264-025-06567-4

Int Orthop. 2025 Jun 7. doi: 10.1007/s00264-025-06560-x. Online ahead of print.

ABSTRACT

PURPOSE: Central sensitization (CS) plays a critical role in prolonged pain and poor outcomes after total knee arthroplasty (TKA), but its prevalence and impact in high-altitude populations remain unexplored. This study aims to examine the prevalence of CS, its associated factors, and short-term postoperative outcomes in high-altitude TKA patients.

METHODS: This prospective, single-centre cohort study included high-altitude (above 2,500 m) TKA patients with primary knee osteoarthritis (OA). Central sensitization (CS) was diagnosed using the Central Sensitization Inventory (CSI), with a cutoff score of ≥ 40. Propensity score matching (PSM) was applied to balance baseline characteristics between the CS and non-CS groups. Preoperative factors, postoperative outcomes (pain levels, complications, opioid consumption, hospital stay), and the incidence of chronic pain and dissatisfaction at six months were collected and analyzed using SPSS software.

RESULTS: A total of 230 patients were included, with 36 (15.7%) classified as having CS. Multivariable logistic regression identified female gender (OR: 3.9, 95% CI: 1.0-14.3, P = 0.043), higher body mass index (BMI) (OR: 1.2, 95% CI: 1.1-1.3, P = 0.006), and residence above 4,000 m (OR: 5.1, 95% CI: 1.7-15.1, P = 0.003) as significant factors associated with CS. After PSM, the CS group had significantly worse short-term outcomes, with higher pain scores at 24, 48, and 72 h (P < 0.001), increased incidence of postoperative nausea and vomiting (PONV) (P < 0.001), longer hospital stays (P < 0.001), greater cumulative opioid consumption (P < 0.001), higher rates of chronic postoperative pain (46.9% vs. 21.9%, P = 0.014), and greater patient dissatisfaction (25.0% vs. 6.3%, P = 0.039) compared to the non-CS group.

CONCLUSION: This study found a 15.7% prevalence of CS among high-altitude TKA patients. Female gender, higher BMI, and residence at altitudes above 4,000 m were identified as factors associated with CS. Furthermore, CS was linked to worse short-term postoperative outcomes, including higher pain levels, increased incidence of PONV, greater opioid consumption, longer hospital stays, and a higher prevalence of chronic postoperative pain and dissatisfaction.

PMID:40481833 | DOI:10.1007/s00264-025-06560-x

Int Orthop. 2025 Jun 4. doi: 10.1007/s00264-025-06569-2. Online ahead of print.

ABSTRACT

BACKGROUND: Management of Open tibia shaft fractures utilizing the conventional protocol is usually cumbersome; involves several operative procedures and longer periods of hospitalization. The use of external fixators for the definitive management of open tibia shaft fractures has been promising. The Ilizarov frame and linear rail system (LRS) are the commonly used options since they are comparable in efficacy and adaptable in the management of open tibia shaft fractures. The study objective is to determine and compare for any significant difference in the mean radiological union time, union rate, bone outcomes and functional outcomes noted in the management of patients with open tibia shaft fractures using Ilizarov frame fixator and linear rail system (LRS) in Ibadan, Nigeria.

RESEARCH METHOD: This is a prospective study involving thirty (30) patients of both sexes, divided into two (2) groups; Ilizarov frame fixator group and LRS group. All patients had open tibia shaft fractures of Gustillo-Anderson Class (GA II- IIIB). The radiological union time was derived from the length of time in the fixator during which radiological union was confirmed, while the bone and functional outcomes were assessed using the ASAMI criteria.

RESULT: Union was achieved in 27 participants while three (2 in LRS group and 1 in Ilizarov group) had non-union. The union rate was 86.7% for the LRS group and 93.3% for the Ilizarov group. The mean radiological union time was 6.5 ± 1.8 months in the LRS group and 6.4 ± 2.1 months in the Ilizarov group. The bone outcomes showed that in the LRS group, 66.7% had excellent, 20% had good and 13.3% had poor outcomes while the Ilizarov group had 53.3% excellent, 40% good and 6.7% poor outcomes. The functional outcome showed that in the LRS group 53.3% had excellent, 40% good and 6.7% fair outcomes while in the Ilizarov group, 40% excellent, 46,7% good and 13.3% fair outcomes. There is no significant difference noted in the mean radiological union time, union rate, bone and functional outcomes in the management of these open tibia shaft fractures using the two fixators under review.

CONCLUSION: The study has re-iterated the fact that the Ilizarov frame fixator and the LRS are quite versatile tools in the armamentarium of the orthopaedic surgeon for managing open tibia shaft fractures.

PMID:40464907 | DOI:10.1007/s00264-025-06569-2

Int Orthop. 2025 Jun 4. doi: 10.1007/s00264-025-06566-5. Online ahead of print.

ABSTRACT

PURPOSE: To compare the treatment approaches for foot compartment syndrome (FCS) and evaluate their outcomes.

METHODS: A systematic review was conducted in MEDLINE, EMBASE, Mayo journals via OVID Databases, Web of Science, and Scopus from each database's inception to December 2024. Two reviewers, independently working in duplicate, assessed each manuscript's title, abstract, and full text for eligibility. Study characteristics, quality of evidence, and outcomes were obtained and analyzed.

RESULTS: A total of 45 articles were included in the qualitative analysis, 38 case reports, and seven cohort studies. Among the case reports, only two patients underwent conservative management, while all remaining cases, as well as all cohort studies, reported fasciotomy as the primary treatment. Trauma was the most frequently identified cause of FCS, and the diagnostic criterion commonly used was an intracompartmental pressure exceeding 30 mmHg. There was no consensus on the number or anatomical location of incisions. Due to the heterogeneity of the data, a meta-analysis could not be performed to assess the risk associated with different incision approaches.

CONCLUSION: Fasciotomy remains the standard treatment for FCS. However, there is insufficient evidence to determine the optimal number and location of surgical incisions. While existing data suggest that using two or more incisions may be associated with fewer long-term sequelae, further research is needed to establish specificity of compartment decompression to enhance treatment recommendations.

PMID:40461896 | DOI:10.1007/s00264-025-06566-5

Int Orthop. 2025 Jun 2. doi: 10.1007/s00264-025-06552-x. Online ahead of print.

ABSTRACT

PURPOSE: This study documented changes in cartilage lesions in the arthritic medial knee compartment after medial opening wedge high tibial osteotomy (MOWHTO), their impact on clinical outcomes and possible factors influencing this improvement.

METHODS: Forty-nine patients indicated for MOWHTO (per ISAKOS criteria) underwent arthroscopy at osteotomy and implant removal (mean interval: 22.2 months). Cartilage lesions (medial femoral condyle [MFC], medial tibial plateau [MTP]) and clinical scores (Lysholm score and KOOS) were documented. No cartilage restoration procedures were performed.

RESULTS: The mean age was 47.5 years and most were females (n = 32). Arthroscopically, cartilage improvement occurred in 32 (65.3%) MFC and 25 (51%) MTP lesions. MOWHTO significantly improved the mechanical tibiofemoral angle (TFA) (7.88 ± 3.66 vs. - 2.71 ± 1.98 (°); P < 0.001). Lysholm knee score (77 ± 16.2 vs. 48.4 ± 16.3, p < 0.001) and KOOS (64.1 ± 13.6 vs. 43.8 ± 12.5, p < 0.001) significantly improved after osteotomy. On the femoral side, cartilage repair was documented in patients who achieved relatively more valgus correction, with a mean final TFA of 3.32 ± 1.7, compared with 1.57 ± 2 in the no improvement group (P = 0.001). For the MTP, no factor of statistical significance could be detected.

CONCLUSIONS: MOWHTO can improve articular cartilage lesions as a standalone procedure. A greater incidence of cartilage repair is expected with more valgus correction of the mechanical axis of the limb. This cartilage infill is associated with slightly better clinical outcomes.

TRIAL REGISTRATION: ClinicalTrials.gov (ID NCT04541342) registered on 9.9.2020, https://clinicaltrials.gov/study/NCT04541342 .

PMID:40455268 | DOI:10.1007/s00264-025-06552-x

Int Orthop. 2025 May 30. doi: 10.1007/s00264-025-06565-6. Online ahead of print.

NO ABSTRACT

PMID:40445355 | DOI:10.1007/s00264-025-06565-6

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