International Orthopaedics

Predictive modeling and long-term outcomes in optimizing fusion strategies for congenital scoliosis: a retrospective analysis of posterior hemivertebra resection

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

ABSTRACT

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

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

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

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

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

Efficacy of focused low intensity pulsed ultrasound in reducing lower-extremity swelling and pain after total knee arthroplasty: a randomized study

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

ABSTRACT

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

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

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

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

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

Is surgical resection of the primary site associated with longer survival in patients with metastatic chondrosarcoma at initial diagnosis?

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

ABSTRACT

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

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

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

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

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

Orthopaedic heritage in seventeenth Century Dutch and Flemish genre painting

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

ABSTRACT

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

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

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

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

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

Functional outcomes and complications of classic grammont-style reverse shoulder arthroplasty in patients with os acromiale: a retrospective case-control study

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

ABSTRACT

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

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

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

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

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

Can radiologists and orthopaedic surgeons distinguish between traumatic and degenerative rotator cuff tears on MRI?

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

ABSTRACT

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

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

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

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

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

Vancomycin-soaking of the graft significantly reduces the incidence of septic arthritis following anterior cruciate ligament reconstruction: comparison of cohorts from the Single-Centre database

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

ABSTRACT

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

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

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

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

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

Neurologic and psychiatric disorders as risk factors following hip arthroplasty: results from the German arthroplasty registry

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

ABSTRACT

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

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

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

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

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

Radiographic and functional outcomes of shelf acetabuloplasty versus conservative management in legg-calvé-perthes disease: an age- and gender-matched study including healthy controls for isokinetic hip muscle strength

Int Orthop. 2025 Jun 25. doi: 10.1007/s00264-025-06588-z. Online ahead of print.

ABSTRACT

INTRODUCTION: Shelf acetabuloplasty, one of surgical containment methods, have been employed to preserve hip joint congruity in the management of Legg-Calvé-Perthes disease (LCPD). However, its long-term effect on radiographic and functional outcomes remains unclear due to limited evidence. Moreover, comparative studies against conservative treatment are lacking. This study aimed to (1) compare the mid- to long-term outcomes between children with advanced-stage LCPD treated with shelf acetabuloplasty and those receiving conservative management, and (2) evaluate isokinetic hip muscle strength compared to age- and gender-matched healthy controls.

MATERIALS AND METHODS: This retrospective age- and gender-matched study included 28 children with unilateral LCPD, divided into Shelf (n = 14) and Conservative (n = 14) treatment groups. A healthy control group (n = 14) was also recruited for isokinetic comparisons. Radiographic outcomes were assessed using modified Stulberg classification and several quantitative parameters. Functional outcomes were assessed using the Harris Hip Score (HHS) and isokinetic testing of hip muscle strength.

RESULTS: The Shelf group (median follow-up: 5.5 years, IQR: 4-7) showed significantly better HHS (67.9 ± 15.9) compared to the Conservative group (median follow-up: 6 years, IQR: 5-8) (54.6 ± 13.3; p = 0.024) at the final follow-up. Shelf acetabuloplasty also resulted in significantly improved radiographic parameters, including centre-edge angle (p < 0.001) and femoral head coverage (p = 0.002). Isokinetic testing revealed that the Conservative group had significantly lower hip extension (p = 0.021), abduction (p = 0.018), and adduction (p = 0.027) torque values, as well as greater muscle fatigue (p = 0.014). In contrast, the Shelf and Control groups exhibited comparable performance in most strength and endurance parameters.

CONCLUSIONS: Shelf acetabuloplasty, when applied as a salvage procedure in advanced-stage LCPD, may provide better functional outcomes and improved hip muscle performance compared to conservative treatment, despite comparable long-term femoral head morphology. Following Shelf acetabuloplasty, comparable hip flexor and extensor strength to healthy controls can be expected, although mild abductor and adductor weakness may persist.

PMID:40560220 | DOI:10.1007/s00264-025-06588-z

What is the influence of tibial component posterior slope on clinical and radiographic outcomes following cemented medial unicompartmental fixed-bearing knee arthroplasty? A retrospective study with a minimum follow-up of five years

Int Orthop. 2025 Jun 25. doi: 10.1007/s00264-025-06579-0. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate how changing the native posterior tibial slope (PTS) through implantation of a cemented medial unicompartmental knee arthroplasty (UKA) impacts clinical and radiographic outcomes, specifically whether it correlates with the occurrence of tibial periprosthetic radiolucency or tibial aseptic loosening (AL).

METHODS: This retrospective study analyzed 63 patients with cemented medial UKAs with a minimum follow-up of five years. Patient-reported outcomes (PROMs) included the Oxford Knee Score (OKS). Radiographic parameters assessed were: PTS, mechanical axis, prosthetic joint space height, tibial component obliquity, intraprosthetic divergence, and tibial periprosthetic radiolucency. Partial Pearson correlation and multiple linear regression analyses were used to evaluate the relationship between tibial periprosthetic radiolucency and demographic or radiographic parameters.

RESULTS: Of 63 patients (mean age 68.9 ± 7.9 years, follow-up 62.5 ± 8.8 months), 5 knees (7.9%) demonstrated tibial periprosthetic radiolucency ≥ 2 mm. The mean postoperative PTS change was 3.8 ± 2.6°, mechanical axis change: 2.5 ± 1.8°, prosthetic joint space height: 9.2 ± 3.1 mm, tibial component obliquity: 2.5° ± 3°, and intraprosthetic divergence angle: 5° ± 4°. OKS averaged 43.9 (range 22-48), with a mean knee flexion of 123.4 ± 6.8°. Statistical analysis showed no significant associations between tibial periprosthetic radiolucency and demographics, radiographic parameters, or PROMs. Changes in PTS did not correlate with a range of motion (ROM), PROMs, or radiolucency.

CONCLUSION: In our cohort, the deviation from native PTS following implantation of the cemented tibial component did not show a significant correlation with tibial periprosthetic radiolucency, PROMs, or ROM at mid-term follow-up.

PMID:40560218 | DOI:10.1007/s00264-025-06579-0

The origins of limb lengthening and reconstruction surgery date back to 1521 when the first intervention ever reported in history was performed on St. Ignatius of Loyola

Int Orthop. 2025 Jun 25. doi: 10.1007/s00264-025-06591-4. Online ahead of print.

ABSTRACT

PURPOSE: To explore the historical case of Saint Ignatius of Loyola's leg injury and subsequent surgical interventions as a potential early instance of limb lengthening and reconstruction surgery.

METHODS: A detailed analysis of "A Pilgrim's Journey" (Ignatius of Loyola's autobiography) was conducted, focusing on orthopaedic descriptions of his injury and treatments.

RESULTS: In 1521, Íñigo López de Loyola sustained a severe, comminuted open fracture of the tibia due to a cannonball wound during the siege of Pamplona. Initial attempts at reduction were unsuccessful, leading to a non-union with significant deformity and shortening. He underwent a revision surgery, a procedure described as "carnage" and endured without a single lament. Although the fracture eventually united, residual shortening and a prominent bone deformity persisted. Unwilling to accept this disfigurement for social reasons, Ignatius requested a second, highly painful osteotomy to remove the protruding bone followed by continuous traction for "days and days of martyrdom" for progressive lengthening. Crucially, after these arduous treatments, Ignatius was able to walk and even ride a horse again. The only significant residual symptom was swelling in his leg by evening.

CONCLUSION: St. Ignatius of Loyola's case provides a compelling historical account of complex orthopaedic challenges in the early 16th century. The documented surgeries represent remarkably early attempts at managing non-union, deformity, and potentially achieving limb lengthening, predating modern reconstructive techniques by centuries. This historical narrative offers valuable insights into the nascent stages of orthopaedic surgery and highlights how a physical ordeal can profoundly shape one's life path.

PMID:40560217 | DOI:10.1007/s00264-025-06591-4

Characteristics of acromial morphology in patients with painful shoulders from Indonesia

Int Orthop. 2025 Jun 20. doi: 10.1007/s00264-025-06585-2. Online ahead of print.

ABSTRACT

BACKGROUND: Shoulder pain is a common reason for patients to seek care from general practitioners or orthopaedic specialists. Prior studies suggest a correlation between acromial morphology and shoulder pathologies. This study aimed to determine acromion characteristics in the Indonesian population and evaluate associations between acromion type, radiographic parameters, sex, and shoulder disorders.

METHODS: A cross-sectional study was conducted on 487 patients with shoulder disorders, using consecutive sampling and data from our institution's radiology database (2020-2021). Acromion morphology was classified using the Bigliani system. Diagnoses were based on clinical and radiological records. Radiographic parameters assessed included critical shoulder angle (CSA), acromion index (AI), lateral acromial angle (LAA), acromioclavicular (AC) joint distance, acromiohumeral (AH) joint distance, and acromial tilt.

RESULTS: Among 487 patients, type II acromion was most common (59.5%), followed by type I (33.3%), type IV (4.5%), and type III (2.7%). Mean CSA was 38.36 ± 5.13, AI 0.72 ± 0.09, LAA 72.52 ± 6.01, AC joint distance 3.18 ± 0.89, AH distance 8.61 ± 1.86, and acromial tilt 28.84 ± 4.52. No significant association was found between acromion type and shoulder disorders (p = 0.34), or between sex and acromion type (p = 0.516). Radiographic parameters also showed no significant correlation with shoulder disorders.

CONCLUSION: Type II acromion was the most prevalent in this Indonesian population. No significant associations were observed between acromion type, sex, or radiographic parameters and shoulder pathologies. Acromial morphology may represent normal anatomical variation rather than a pathological finding.

PMID:40540035 | DOI:10.1007/s00264-025-06585-2

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