Int Orthop. 2025 Apr 21. doi: 10.1007/s00264-025-06532-1. Online ahead of print.

ABSTRACT

PURPOSE: Implant wastage in trauma and orthopaedic (T&O) surgery remains an under-reported yet significant issue, contributing to rising healthcare costs and environmental concerns. With increasing surgical demand driven by an ageing population and the growing prevalence of conditions like osteoporosis, this study aimed to quantify implant wastage in T&O procedures at a Level 1 Major Trauma Centre in London, assessing both its frequency and financial impact.

METHODS: A retrospective cohort study was conducted on all weekday T&O procedures performed between 1st December 2023 and 31st January 2024. Two of the authors identified wasted implants using intraoperative implant logbooks, and cross-referencing implant stickers with post-operative radiographs. Data pertaining to patient demographics, procedure types, surgical sites, and implant usage were collected. Cost analysis was performed using procurement data to determine the financial impact of implant wastage.

RESULTS: Among 184 procedures analysed, 131 (71.2%) used implants, with wastage observed in 108 (82.4%) cases. A total of 141 implants were wasted, with screws accounting for 92.9% (n = 131) of wasted implants. Locking screws were the most frequently discarded (n = 65; 46.1%). Across ORIF and intramedullary nailing procedures, an overall screw wastage rate of 20% (17-31%) was observed with 2.4 screws wasted per trauma procedure. The financial cost of implant wastage over the 44-day study period amounted to approximately £335 per day and £136 per case.

CONCLUSION: This study highlights the substantial economic burden associated with implant wastage in T&O surgery, with screws, particularly locking screws, being the primary contributors. Targeted interventions, including improved preoperative planning, precision-based implant selection, and enhanced intraoperative decision-making, are essential to reducing waste and improving cost-efficiency and sustainability in surgical practices. Further research should explore the broader economic and environmental impact of implant wastage, incorporating factors such as operative time and carbon footprint to develop comprehensive waste-reduction strategies.

LEVEL OF EVIDENCE: IV.

PMID:40257588 | DOI:10.1007/s00264-025-06532-1

Int Orthop. 2025 Apr 21. doi: 10.1007/s00264-025-06534-z. Online ahead of print.

ABSTRACT

PURPOSE: There is still a debate regarding the removal of the femoral stem due to the risk of trunnion. To answer this question, we conducted a study to compare long terms outcomes of isolated acetabular to total revision of MoM THA using an institutional arthroplasty registry.

METHODS: From 1996 to 2019, 150 patients (12.5%) of the 1202 revision THAs (rTHA) recorded in Geneva Arthroplasty Registry (GAR) underwent a revision of a MoM THA. After matching the two groups,126 patients were finally included: 63 in each group. The mean age was 64.4 (SD 11.6) years, 48.4% (61/126) were women with a mean BMI of 27.2 (SD 5.5) Kg/m2.

RESULTS: The overall survival rate was 88.1% [79.9-97.2%] at ten years. 10-year survival rate was 93.5% [86.2-100.0%] after isolated acetabular rTHA and 79.5% [61.7-100.0%] after total rTHA (p = 0.16). Regarding Hip Harris score and Merle d'Aubigne score, no difference at last follow-up was observed between the two groups (respectively: p = 0.39; p = 0.33). Regarding the chrome, cobalt, and nickel level reduction, no difference was observed between the two groups (respectively, p = 0.38, 0.81 and 0.97).

CONCLUSION: No difference was observed between isolated acetabular and total revision of MoM THAs regarding survival rate and ions levels at long term. It seems advisable to perform an isolated acetabular revision of a MoM THA when it is indicated.

LEVELS OF EVIDENCE: Level III, case control studies.

PMID:40257587 | DOI:10.1007/s00264-025-06534-z

Int Orthop. 2025 Apr 21. doi: 10.1007/s00264-025-06533-0. Online ahead of print.

ABSTRACT

PURPOSE: There is a paucity of clinical studies examining outcomes following surgical revision in cases of histologically confirmed arthrofibrosis after total hip arthroplasty (THA). Consequently, the aim of this study is to present the clinical outcomes and to identify risk factors for poor clinical and functional outcome following surgical intervention for histologically confirmed arthrofibrosis following THA.

METHODS: This study included 51 patients (51 hips) with histologically confirmed arthrofibrosis of the hip based on the synovial-like interface membrane (SLIM) criteria. These were selected from 7983 revision THA cases performed during the study period After exclusion criteria were applied, 42 cases (59.5% women) with an average age of 63.6 years were included. The mean duration of follow up was 70 months (range 30-122 months). Of these, 73.8% underwent index surgery after primary THA implantation. The primary indication for revision surgery was predominantly the clinical suspicion of arthrofibrosis (n = 35). The Harris Hip Score (HHS) and the EQ-5D-3 L scores were calculated for all cases at the time of follow-up. For the risk analysis of a poor clinical outcome, two groups were divided according to the Harris Hip Score. The group with a poor clinical outcome was defined as a HHS < 55.

RESULTS: Open arthrolysis was performed in all cases with a modular component being replaced in 73.8% of cases (n = 31) and only two cases requiring additional revision of the femoral and acetabular components due to aseptic loosening.The mean pre op Harris Hip Score (HHS) was 53.2 before revision surgery. This increased to 65.7 post op (p < 0.001). Only 34.1% of patients achieved the minimum clinical significance difference (MCID) of 18 HHS points after surgical revision. The EQ-5D Visual Analogue Scale (VAS) score and the Time Trade-Off (TTO) score averaged 0.226 (SD 0.245) and 0.221 (SD 0.37). Complications occurred in seven cases (16.7%,), with dislocation in 2 cases and persistent AF symptoms in 3 cases. Six cases required further revision surgery (14.3%). In three cases, a further open arthrolysis was performed due to persistent symptoms. Increased BMI (30.1 vs. 26.7 BMI, p < 0.05) or higher body weight (88.4 kg vs. 78.7 kg, p = 0.086), smoking and a lower preoperative HHS (p = 0.022) were identified as risk factors for a poor clinical outcome, defined as HHS < 55.

CONCLUSION: Results of this study suggest that mid-term clinical results following surgical intervention for arthrofibrosis following THA show a moderate to poor postoperative outcome with an acceptable complication rate. Risk factors for a poor outcome such as increased weight, BMI or smoking should be considered and critically assessed preoperatively.

PMID:40257586 | DOI:10.1007/s00264-025-06533-0

Int Orthop. 2025 Apr 16. doi: 10.1007/s00264-025-06519-y. Online ahead of print.

ABSTRACT

PURPOSE: Unicompartmental Knee Arthroplasty (UKA) has garnered increasing attention in recent years. Robotic-assisted systems have demonstrated enhanced precision, contributing to improved patient survival rates, satisfaction, soft-tissue balancing, alignment, and component sizing. The purpose of this study is to evaluate the early clinical outcomes of Naton robotic-assisted medial UKA by analyzing postoperative radiographic positioning of the unicompartmental prosthesis and comparing preoperative and postoperative functional outcomes in patients.

METHODS: A retrospective analysis was conducted on the clinical data of 32 patients (32 knees) who underwent Naton robotic-assisted medial UKA at Suining Central Hospital of Sichuan Province from November 2023 to January 2024. The cohort included ten males and 22 females, with a mean age of 70.53 ± 8.08 years, ranging from 53 to 88 years. All patients underwent surgery using the Naton robotic system and the Zhengtian Unique fixed-bearing UKA prosthesis. Radiographic (X-ray) findings, knee function, and complications were evaluated during follow-up. Radiographic assessments included prosthesis position, angle deviation, and posterior tibial slope (PTS). Knee function was assessed using a range of motion (ROM), Knee Society Score (KSS), Oxford Knee Score (OKS), and Forgotten Joint Score (FJS).

RESULTS: All patients in the study were followed for a period of eight to ten months, with a mean follow-up of (9.16 ± 0.68) months. No complications such as poor incision healing, periprosthetic infection, periprosthetic fracture, or prosthesis loosening were observed during the follow-up period. The medial unicondylar prostheses were found to be in place in all 32 cases, and no abnormal deviation of the prosthesis implantation angle was observed compared to immediate postoperative radiographs. The posterior tibial slope (PTS) was reduced from 13.00 ± 2.72° preoperatively to 5.08 ± 1.14° postoperatively, with a statistically significant difference (P ≤ 0.05). At the final follow-up, the knee range of motion (ROM) was improved from 107.03 ± 11.69° preoperatively to 128.25 ± 16.52° postoperatively. The KSS was improved from 46.28 ± 7.27 to 82.34 ± 14.72, and the OKS was improved from 36.13 ± 4.71 to 15.78 ± 3.52, all with statistically significant differences compared to preoperative values (P ≤ 0.05). The Forgotten Joint Score (FJS) was recorded as 89.2 ± 2.9.

CONCLUSIONS: The short-term follow-up indicates a favorable prosthesis in situ rate for unicompartmental knee arthroplasty assisted by the Naton robot, with satisfactory knee function and patient-reported outcomes. The short-term clinical outcomes are satisfactory.

PMID:40237792 | DOI:10.1007/s00264-025-06519-y

Int Orthop. 2025 Apr 14. doi: 10.1007/s00264-025-06530-3. Online ahead of print.

NO ABSTRACT

PMID:40227374 | DOI:10.1007/s00264-025-06530-3

Int Orthop. 2025 Apr 14. doi: 10.1007/s00264-025-06529-w. Online ahead of print.

ABSTRACT

PURPOSE: Removal of volar locking plates after healing of a distal radius fracture is becoming increasingly common. However, it is unclear how the fracture healing proceeds and which defects remain. The aim of this study was to assess changes in bone microarchitecture and biomechanical properties in surgically treated radius fracture after volar locking plate removal.

METHODS: Twelve patients were recruited after undergoing plate removal. High Resolution Quantitative Computed Tomography (HR-pQCT) was used to perform scans of the fractured and contralateral distal radius on average one (M1) and 16 months (M2) after plate removal. Parameters measured were cortical- (Dcomp), trabecular- (Dtrab) and total bone density (D100), as well as cortical thickness (Ct.Th). Axial bone stiffness (FE.Kaxial) was determined through linear micro-finite element analysis (µFEA).

RESULTS: At M1, no significant differences between fractured and contralateral side were detected except for Dcomp. At the fractured side, all parameters except for Dtrab increased significantly between M1 and M2. At M2, Ct.Th and FE.Kaxial were significantly higher at the fractured side compared to the contralateral side, but Dcomp remained significantly lower. Qualitatively, closure of the screw holes was observed between M1 and M2, while large trabecular defects remained.

CONCLUSION: Bone (re)modeling at the distal radius is an ongoing process even after plate removal and leads to a partial exaggeration of the bone properties relative to the intact contralateral side. It seems that the bone regains its biomechanical competence by closing screw holes and increasing cortical thickness, which compensates for trabecular defects that cannot be repaired.

LEVEL OF EVIDENCE: III.

PMID:40227373 | DOI:10.1007/s00264-025-06529-w

Int Orthop. 2025 Apr 14. doi: 10.1007/s00264-025-06527-y. Online ahead of print.

ABSTRACT

PURPOSE: To compare the clinical effects of arthroscopic cystectomy and open surgery for the treatment of popliteal cysts, in order to provide clinical basis for the selection of surgical plan for popliteal cyst.

METHODS: A retrospective study was conducted on the clinical data of 153 patients diagnosed with popliteal cysts from January 2020 to December 2022. Among them, 77 patients underwent arthroscopic cystectomy as the observation group, and 76 patients underwent open surgery as the control group. Compared the surgical related indicators, Rauschening and Lindgren grade, Lysholm and VAS scores between two groups. Follow up on postoperative complications and cyst recurrence.

RESULTS: The observation group had a smaller incision length (P < 0.01), less intraoperative bleeding (P < 0.05), and shorter hospitalization time than the control group (P < 0.01), but longer surgical time (P < 0.05). Both groups of patients showed significant improvement in Rauschening and Lindgren grade, Lysholm and VAS scores after surgery, with the observation group superior to the control group(P < 0.05&P < 0.01). Follow up for 13-25 months (16.34 ± 4.25) after surgery showed no complications in the observation group, while there were two cases of nerve injury in the control group, with no statistically significant difference (P > 0.05). There were two cases of postoperative recurrence in the observation group with no symptoms and nine cases of recurrence in the control group with mild symptoms and did not require further treatment, which had statistical difference (P < 0.05).

CONCLUSIONS: Arthroscopic cystectomy and oper surgery both have definite clinical efficacy in treating popliteal cyst, which relying on prospective research to determine the optimal solution.

PMID:40227372 | DOI:10.1007/s00264-025-06527-y

Int Orthop. 2025 Apr 11. doi: 10.1007/s00264-025-06508-1. Online ahead of print.

NO ABSTRACT

PMID:40214746 | DOI:10.1007/s00264-025-06508-1

Int Orthop. 2025 Apr 11. doi: 10.1007/s00264-025-06526-z. Online ahead of print.

ABSTRACT

PURPOSE: Revision total hip arthroplasty (rTHA) is an increasingly common procedure due to the growing number of primary total hip arthroplasties (THAs) performed worldwide. This study evaluates the long-term implant survival, functional outcomes, and radiographic performance of cemented femoral stem (Beznoska s.r.o., Kladno, Czechia) in rTHA.

METHODS: A retrospective analysis was conducted on 183 patients who underwent rTHA with cemented stem between March 2012 and December 2023. The mean follow-up duration was 71.26(± 39.31) months. Implant survival was analyzed using Kaplan-Meier survival estimates, and failure modes were assessed. Radiographic changes were classified using the Gruen Zones system. Functional outcomes were evaluated using the Harris Hip Score (HHS). Cox proportional hazard models were applied to identify prognostic factors influencing implant survival.

RESULTS: The five-year implant survival rate was 98.1%, declining to 83.9% at twelve years. The overall failure rate was 3.83%, with periprosthetic infection (4 cases) being the most common cause, followed by aseptic loosening (2 cases). Radiographic changes were observed in 24.03% of cases, predominantly in Gruen Zones 2, 6, and 1. Functional outcomes were favorable, with a mean HHS of 81.28(± 5.74), comparable to outcomes reported for uncemented revision stems. Age, stem diameter, and stem length did not significantly impact implant survival.

CONCLUSION: The cemented stem demonstrated favourable long-term survival, with high implant retention rates. Functional outcomes indicated overall satisfactory performance. Radiographic evaluation revealed localized changes around the implant, predominantly in Gruen Zones 2, 6, and 1. Implant failure was relatively rare, with periprosthetic infection being the most common cause.

PMID:40214745 | DOI:10.1007/s00264-025-06526-z

Int Orthop. 2025 Apr 10. doi: 10.1007/s00264-025-06528-x. Online ahead of print.

NO ABSTRACT

PMID:40208270 | DOI:10.1007/s00264-025-06528-x

Int Orthop. 2025 Apr 10. doi: 10.1007/s00264-025-06517-0. Online ahead of print.

ABSTRACT

PURPOSE: The "weekend effect" suggests that patients operated upon weekends may experience worse outcomes. This study evaluates whether the day of the week impacts outcomes and costs of open reduction and internal fixation (ORIF) surgery for distal radius fractures (DRF) in a large nationwide cohort.

METHODS: A retrospective cohort study was conducted using data from the PearlDiver Mariner M165Ortho dataset, which covers a U.S. population of over 165 million from 2010 to 2022. Patients who underwent ORIF surgery for DRF were categorized into weekday and weekend groups. Demographics, comorbidities, and adverse outcomes within six months and two years post-surgery were analyzed.

RESULTS: Of the 266,378 patients who underwent ORIF for DRF with at least two years of follow-up, 252,866 had surgery on weekdays, while 13,512 had surgery on weekends. The weekend group exhibited higher rates of surgical site infection (SSI) (OR: 2.29[95%CI = 1.51-3.48], P < 0.001), hardware failure (OR: 5.80[95%CI = 1.13-31.25], P = 0.042), and readmissions (OR: 2.48[95%CI = 2.12-2.91], P < 0.001) at six months post-operatively. At two years post-operatively, the weekend group continued to show higher rates of complications including SSI (OR: 1.66[95%CI = 1.16-2.36], P = 0.005), malunion (OR: 1.44[95% CI = 1.06-1.93], P = 0.017), and readmission (OR: 1.55[95%CI = 1.39-1.74], P < 0.001). Mean total surgical costs were 16.4% higher in the weekend group ($2,394.85 vs. $2,057.88, P < 0.001).

CONCLUSIONS: This nationwide analysis demonstrates a significant "weekend effect" in ORIF surgery for DRF, with weekend surgeries associated with substantially higher complication rates, readmissions, and costs. These findings highlight the need for systemic changes to ensure consistent quality of care throughout the week, including improved weekend staffing, standardized protocols, and resource allocation.

LEVEL OF EVIDENCE: III (Retrospective cohort).

PMID:40208269 | DOI:10.1007/s00264-025-06517-0

Int Orthop. 2025 Apr 9. doi: 10.1007/s00264-025-06516-1. Online ahead of print.

NO ABSTRACT

PMID:40202543 | DOI:10.1007/s00264-025-06516-1

Int Orthop. 2025 Apr 9. doi: 10.1007/s00264-025-06521-4. Online ahead of print.

ABSTRACT

PURPOSE: This research was designed to explore the incidence of anaemia before surgery and the rate of mortality one year after surgery for femoral neck fractures in older adults. It also investigated whether anaemia prior to surgery influences the likelihood of mortality within one year after the procedure.

METHODS: A retrospective cohort analysis was undertaken at Honghui Hospital, a tertiary academic medical institution affiliated with Xi'an Jiaotong University in China. This investigation included elderly individuals who underwent surgery for femoral neck fractures within the year spanning from January to December 2021. The research team gathered data encompassing demographic details, levels of haemoglobin prior to surgery, existing comorbid conditions, and mortality statistics after one year.

RESULTS: In this retrospective study, 994 patients were analyzed, with 84 reported fatalities. The incidence of anaemia in this group was 71.1%, affecting 707 individuals. Of these, 486 (48.8%) had mild anaemia, and 221 (22.2%) exhibited moderate to severe anaemia. Independent factors correlating with heightened one-year mortality risk included operative blood transfusions (odds ratio [OR] = 1.8, p = 0.0327), coronary artery disease presence (OR = 1.85, p = 0.0077), and moderate to severe anaemia (OR = 3.18, p = 0.0006). In contrast, higher body mass index (OR = 0.8, p < 0.0001) and red blood cell count (OR = 0.6, p = 0.0253) were linked to reduced one-year mortality risk. Multivariate logistic regression analyses underscored the independent association of moderate to severe anaemia with increased one-year mortality risk, with varying ORs across models: non-adjusted OR at 3.18 (p = 0.0006), Adjust I model OR at 3.08 (p = 0.0191), and Adjust II model OR at 2.96 (p = 0.0278).

CONCLUSION: At Honghui Hospital, affiliated with Xi'an Jiaotong University in China, anemia has been identified as a common condition among elderly patients undergoing surgery for femoral neck fractures, and it significantly contributes to an elevated risk of mortality within one year post-surgery. It is advisable to implement interventions aimed at managing anaemia before surgery, which should include setting haemoglobin thresholds that are not specific to any gender for its diagnosis.

PMID:40199757 | DOI:10.1007/s00264-025-06521-4

Int Orthop. 2025 Apr 8. doi: 10.1007/s00264-025-06524-1. Online ahead of print.

ABSTRACT

We study Hernigou P's paper "Is synovectomy still of benefit today in total knee arthroplasty with rheumatoid arthritis?" It highlights the need for further research and progress in this field. Future studies should address limitations like small sample sizes, inadequate patient stratification, lack of quantifiable metrics for synovectomy extent, and limited early postoperative analyses to provide stronger evidence for clinical practice.

PMID:40198386 | DOI:10.1007/s00264-025-06524-1

Int Orthop. 2025 Apr 8. doi: 10.1007/s00264-025-06522-3. Online ahead of print.

NO ABSTRACT

PMID:40198385 | DOI:10.1007/s00264-025-06522-3

Int Orthop. 2025 Apr 7. doi: 10.1007/s00264-025-06507-2. Online ahead of print.

ABSTRACT

BACKGROUND: Modular dual mobility (MDM) cups are constituted by a cobalt-chromium (CoCr) liner inserted into a standard acetabular shell, allowing for intra-operative decision and supplementary screw fixation of the acetabular component. MDM could face mechanical issues and biological issues, with the associated risk of elevated blood metal ions levels and adverse local tissue reactions (ALTRs).

MATERIALS AND METHODS: A systematic review of the literature on minimum five years outcomes of modular dual mobility in primary total hip arthroplasty (THA) was performed on PubMed, Cochrane, and Google Scholar databases, in adherence with PRISMA guidelines. Risk of bias in each study was assessed through the JBI checklist for case series.

RESULTS: A total of 381 primary THAs with MDM acetabular cup were performed. At minimum five years follow-up, mean revision rate was 2.3% and implant survivorship was 98.2%. No MDM acetabular construct was revised specifically due to liner mechanical failure, neck-rim impingement, or ALTRs. No intraprosthetic dislocation or iliopsoas tendinitis was observed. No cases of THA dislocation were reported. Mean serum metal ion levels were observed to be within laboratory reference ranges. Greater-than-normal values of serum Co were observed in 9.4% of cases, while greater-than-normal values of serum Cr were observed in 1.6% of patients.

CONCLUSIONS: The main finding of this systematic review is that modular dual mobility acetabular construct appears to be a safe and effective option for primary THA at minimum five years follow-up. Longer follow-up time is needed in order to investigate modular dual mobility long-term survivorship, revision and complication rates, clinical and radiological outcomes.

PMID:40192789 | DOI:10.1007/s00264-025-06507-2

Int Orthop. 2025 Apr 7. doi: 10.1007/s00264-025-06470-y. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to investigate the incidence and associated risk factors of ischaemic muscle sequelae in patients with traumatic femoropopliteal artery injuries following revascularization, as well as to develop a nomogram to predict the risk of ischaemic muscle sequelae.

METHODS: Data from patients with acute traumatic femoropopliteal artery injuries between January 2008 and December 2022 were collected. All patients with successful limb salvage were divided into two groups based on the occurrence of ischaemic muscle sequelae: the ischemic muscle sequelae group (IG) and the non-ischaemic muscle sequelae group (NG). Univariate and multivariate logistic regression analyses were used to identify potential predictive factors associated with ischaemic muscle sequelae. A predictive nomogram was constructed and internally validated.

RESULTS: Among the 102 patients, 30 cases (29.41%) developed ischaemic muscle sequelae. Independent predictors of ischaemic muscle sequelae were identified as crush injury, HCT, and CKMB. A nomogram was constructed based on these three parameters. The area under the receiver operating characteristic (ROC) curve of the predictive model was 0.894, indicating excellent discrimination. The calibration curve demonstrated a high degree of consistency between the predicted probabilities and the observed outcomes. Additionally, the decision curve analysis (DCA) showed that the nomogram model had good predictive capability.

CONCLUSIONS: Our study demonstrated that crush injury, HCT, and CKMB were independent predictors of ischaemic muscle sequelae in patients with acute traumatic femoropopliteal artery injuries following revascularization. The nomogram integrating clinical factors and blood markers can assist physicians in conveniently predicting the risk of ischaemic muscle sequelae in patients.

PMID:40192788 | DOI:10.1007/s00264-025-06470-y

Int Orthop. 2025 Apr 7. doi: 10.1007/s00264-025-06510-7. Online ahead of print.

ABSTRACT

PURPOSE: There is a lack of data evaluating the impact of tourniquet versus no tourniquet surgery in patients with sickle cell disease (SCD).

METHODS: The records of 233 sickle cell patients who underwent orthopaedic surgery with a tourniquet between 1978 and 2018 were retrospectively reviewed. This study group (233 patients) was compared to a control group of 574 SCD patients followed by the same surgical team in the same hospital undergoing the same procedures in the same period between 1978 and 2018 but without a tourniquet. Outcomes assessed skin complications, thrombophlebitis, bone necrosis, muscle necrosis or abnormal muscle function, peripheral nerve impairment, elevated blood pressure, post-operative sickle cell crises, and blood loss under a tourniquet.

RESULTS: The pneumatic tourniquet was primarily applied proximally in both lower and upper limbs. The median tourniquet duration was 65 minutes, with most procedures lasting between 30 and 90 minutes . Postoperative medical complications occurred in both groups, with no significant difference in hospital stay (6.7 vs. 7.1 days). Painful sickling crises affected 86 patients, with a lower prevalence in transfused patients (p = 0.04). Blood loss was significantly lower in the tourniquet group during knee surgeries (438 ml vs. 731 ml, p = 0.031), resulting in fewer transfusions. Skin complications did not affect wound healing. The 90-day incidence of venous thromboembolism (VTE) was 0.4%, with no significant difference between groups. Muscle biopsies showed no necrosis immediately post-surgery, but some necrosis appeared after 12 weeks in the tourniquet group. New bone osteonecrosis cases and infection rates were similar between groups.

CONCLUSION: this study provides valuable insights into the use of tourniquets in sickle cell disease.

PMID:40192787 | DOI:10.1007/s00264-025-06510-7

Int Orthop. 2025 Apr 4. doi: 10.1007/s00264-025-06513-4. Online ahead of print.

ABSTRACT

PURPOSE: This study investigated the relationship between BMI and microorganism profiles, with a particular focus on gut microorganisms in patients with PJI following total hip arthroplasty (THA). It also explored comorbidities, that may contribute to these variations.

METHODS: This study included all patients treated at our institution for a PJI of a THA between 1996 and 2021. Patients were categorized into four distinct BMI groups: <30; 30-34.9; 35-39.9; ≥ 40. Bivariate and logistic regression analysis were conducted, with presentation of odds ratio (OR) and 95% confidence interval (CI).

RESULTS: A total of 3645 hip PJI cases were recruited for the final analysis. Patients with a BMI ≥ 40 had approximately a ten fold higher risk for Streptococcus dysgalactiae (p < 0.001; OR = 9.92; 95% CI 3.87-25.44) and a seven fold higher risk for Proteus mirabilis (p < 0.001; OR = 7.43; 95% CI 3.13-17.67) and Klebsiella pneumoniae (p < 0.001; OR = 6.9; 95% CI 2.47-19.31). Furthermore, polymicrobial infections (p < 0.001; OR = 2.17; 95% CI 1.50-3.15) were found to be significantly more prevalent in patients with a BMI ≥ 40.

CONCLUSION: Obese patients (BMI ≥ 30) displayed a distinct microorganism profile in hip PJIs, mainly dominated by Firmicutes and Proteobacteria. Comorbidities such as diabetes, hypertension, and hyperlipidaemia may contribute to a leaky gut syndrome, increasing PJI risk caused by gut microorganisms. Optimizing comorbidities may help reduce the risk of hip PJI. Further research is needed to clarify the relationship between obesity, gut microbiome alterations and hip PJI development.

PMID:40183945 | DOI:10.1007/s00264-025-06513-4

Int Orthop. 2025 Apr 3. doi: 10.1007/s00264-025-06430-6. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: Standard recommendations for fast-track hip arthroplasty suggest using 8-10 mg of dexamethasone to reduce opioid consumption, with potential benefits of higher doses but scarce data on glycaemic control and complications. This study compares the effects of higher doses versus the standard doses on postoperative opioid consumption, and secondarily, numerical pain scale, glycaemic control, hospital length of stay and postoperative complications.

METHODS: Retrospective cohort study of patients scheduled for FAST-TRACK primary hip arthroplasty between 2016 and 2021. Propensity score-matched analyses compared the standard dose group (4-8 mg) versus the high-dose group (16-24 mg).

RESULTS: 168 patients were included (56 with 4-8 mg, 112 with 16-24 mg). After one-to-one propensity score matching, 52 patients were included in the standard group and 52 in the high-dose group. After matching, the median [IQR] opioid consumption in the low-dose group was 10 [0-12] and in the high-dose group was 0 [0-10], with a 95% CI of -1 to 0 (p = 0.016). In the matched group, there was a median difference of 8 mg/dL (95% CI, -2 to 7, P < 0.05) in the immediate postoperative glycaemia, of 17 mg/dl (95% CI, -2 to 14, P < 0.05) in glycaemia at 24 h and of -1 day (95% CI, -1 to 0, P < 0.05) in hospital stay. No differences in the numerical pain scale and postoperative complications were found.

CONCLUSION: High-dose dexamethasone slightly increased perioperative glycaemia while reducing opioid consumption and shortening hospital length of stay.

PMID:40178624 | DOI:10.1007/s00264-025-06430-6