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