Int Orthop. 2025 Mar 13. doi: 10.1007/s00264-025-06489-1. Online ahead of print.

ABSTRACT

PURPOSE: Total knee arthroplasty (TKA) is a highly effective treatment for osteoarthritis patients unresponsive to conservative therapies. Chronic postsurgical pain (CPSP) following TKA is understudied, with approximately 20% of patients reporting chronic pain. This cross-sectional study conducted in Jordan aims to (1) determine the prevalence of chronic knee pain after TKA in the Jordanian population and (2) identify associations between demographics and rehabilitation factors with chronic pain.

METHODS: Data were collected from 90 Jordanian patients post-TKA. Demographics (age, gender, BMI, and smoking) and rehabilitation factors (pre-operative sessions, post-operative sessions, and duration) were recorded. Statistical analyses included descriptive statistics and 95% confidence intervals. Independent t-tests and Chi-square analyses were used to determine the differences between those with and without chronic pain. Pearson correlations were used to determine the association between demographic and rehabilitation factors with the prevalence of chronic pain.

RESULTS: Ninety patients were included in the study with an average age of 60.3 ± 10.1 years. The prevalence of chronic post-TKA pain in Jordan was 57.8% (52/90), (95% CI: 46.9-68%). No significant differences were found in demographics and pre-operative rehabilitation. Chronic pain was significantly associated with post-operative rehabilitation sessions and duration (r =.349, p =.001) (r =.342, p =.001, respectively. Patients with chronic pain received fewer post-operative rehabilitation sessions (P <.001) and had shorter rehabilitation durations (P <.001) compared to patients without chronic pain.

CONCLUSION: Chronic pain after TKA is highly prevalent in Jordan (57.8%), with reduced rehabilitation engagement strongly linked to its occurrence. Optimizing post-operative rehabilitation protocols may mitigate CPSP risk among Jordanian TKA patients.

PMID:40080128 | DOI:10.1007/s00264-025-06489-1

EFORT Open Rev. 2025 Feb 3;10(2):95-103. doi: 10.1530/EOR-24-0100. Print 2025 Feb 1.

ABSTRACT

PURPOSE: Total knee arthroplasty (TKA) in patients who underwent previous knee surgeries can be a challenging procedure both technically and for the complication rate. Conversion TKA is affected by a higher risk of infection compared to primary TKA. The aims of this meta-analysis are i) to compare the infectious risk among patients undergoing TKA after a prior hardware implantation, evaluating removal vs maintenance of the hardware, and ii) within the removal group, to compare staged vs concurrent procedure.

METHODS: In accordance with the PRISMA guidelines, a systematic literature review was conducted up to January 2024. The review was registered in the PROSPERO database: CRD42024510444. The inclusion criteria comprised the following: i) patients aged 18 years or older, ii) individuals who had undergone total knee replacement and iii) those with a history of prior nonabsorbable hardware implantation. The pooled incidence of periprosthetic joint infections (PJI) was reported using odds ratios with corresponding 95% confidence intervals (CIs).

RESULTS: The investigation of database and references identified 284 studies. PJI risks differed significantly among groups, with a higher risk in the removal group (z = 3.5630, P = 0.0004). Furthermore, within the removal group, the risk of PJI was lower in cases of staged removal compared to concurrent removal (z = 2.0931, P = 0.0363).

CONCLUSIONS: TKA following a previous knee hardware implantation indicates a higher PJI risk when the hardware is removed compared to leaving it in place. If hardware removal is necessary, staged removal is recommended. The presence of minor hardware is the only scenario where, if removal is necessary, one-stage approach is preferred.

PMID:40071998 | PMC:PMC11825155 | DOI:10.1530/EOR-24-0100

EFORT Open Rev. 2025 Mar 3;10(3):125-140. doi: 10.1530/EOR-2024-0129.

ABSTRACT

This review focuses on the anatomic and radiographic characteristics of the pediatric proximal femur and the advantages and disadvantages of different protocols for the management of pediatric femoral neck fractures (PFNFs) in terms of fracture classification, reduction methods, reduction quality and fixation methods, with the goal of proposing an optimal treatment protocol for PFNFs to reduce the incidence of postoperative complications. The anatomic and radiographic characteristics of the pediatric proximal femur, including the presence of an active growth plate, an immature femoral calcar, greater trabecular density and plasticity and a relatively immature blood supply are very different from those of the adult proximal femur. Treatment protocols for PFNFs must differ from those for adult femoral neck fractures. PFNFs with posterior translation, and those with comminuted medial-posterior columns, are associated with a higher postoperative complication rate. This review suggests that the degree of damage to the nutrient vessels along the posterior femoral neck and the stability of the medial-posterior column of the femoral neck should be well assessed in patients with PFNFs for both classification and treatment purposes. Anatomic reduction through an anterior approach, placement of a small number of implants in the mid-inferior part of the femoral neck and additional external support are effective in reducing postoperative complications in patients with PFNFs.

PMID:40071987 | PMC:PMC11896687 | DOI:10.1530/EOR-2024-0129

EFORT Open Rev. 2025 Feb 3;10(2):82-94. doi: 10.1530/EOR-24-0002. Print 2025 Feb 1.

ABSTRACT

Wounds in orthopaedic surgery differ from wounds in other surgical fields in various ways. Tissues that are highly affected due to the trauma itself, the presence of an orthopaedic implant and the performance of prosthetic surgery in patients with many comorbidities make these wounds need special consideration. Complications of the surgical wound in orthopaedic surgery are not unusual, being the main cause of medical care and readmission in the first 90 days. There is no consensus on the best way to perform closure in orthopaedic surgery. The national 'Adequate Wound Management in Orthopaedic Surgery' survey has shown interindividual variability in wound closure and soft tissue management in orthopaedic surgery at the local level. This consensus document, generated by a group of experts in soft tissue management in orthopaedic surgery, proposes recommendations based on evidence (using the GRADE methodology) to promote best practices in this field. This document considers recommendations for surgical wound closure, dressing management and haemostasis. In addition, some of the 32 questions in the national survey, plus others relevant to the subject, were taken as a starting point for developing the contents.

PMID:40071985 | PMC:PMC11825138 | DOI:10.1530/EOR-24-0002

EFORT Open Rev. 2025 Feb 3;10(2):66-74. doi: 10.1530/EOR-22-0088. Print 2025 Feb 1.

ABSTRACT

PURPOSE: Evolving evidence demonstrates the role of epigenetics in the pathogenesis of osteoarthritis (OA), whereas in terms of mechanism, DNA methylation has received the highest attention thus far. This systematic review summarizes the current knowledge of DNA methylation and its influence on the pathogenesis of OA.

METHODS: A protocol in alignment with the PRISMA guidelines was employed to systematically review eight bibliographic databases between 1 January 2015 and 31 January 2021, to identify associations between DNA methylation and articular chondrocytes in OA.

RESULTS: We identified 23 gene-specific studies and 28 genome-wide methylation analyses. Gene-specific studies focused on pro-inflammatory markers in OA, demonstrating that DNA hypomethylation in the promoter region results in overexpression and hypermethylation is linked to gene silencing. Others reported on the association between OA risk genes and DNA methylation. Genome-wide methylation studies reported on differentially methylated regions (DMRs) comparing OA and non-OA chondrocytes. DMRs were seen in hip OA and knee OA chondrocytes.

CONCLUSION: The current body of literature demonstrates the potential and crucial role of DNA methylation in the pathogenesis and progression of OA. This knowledge contributes to the understanding of the pathomechanisms behind OA at gene-specific and genome-wide levels. The observed differences in DNA methylation between healthy and diseased tissues indicate the occurrence of changes in DNA methylation. Based on this, future research in this field that explores the characteristics of potentially reversible changes in DNA methylation may lead to opportunities for causative treatment options for OA.

PMID:40071982 | PMC:PMC11825139 | DOI:10.1530/EOR-22-0088

EFORT Open Rev. 2025 Mar 3;10(3):151-155. doi: 10.1530/EOR-24-0137. Print 2025 Mar 1.

ABSTRACT

Foraminal and extraforaminal lumbar disc herniations are common sources of pain and disability. Classic surgical treatments, such as open approach through Witsel technique, often involve resection of the superior articular process to decompress the foraminal space. Unilateral biportal endoscopy (UBE) has emerged as a minimally invasive alternative, providing enhanced visualization and precision while minimizing soft tissue damage. The extraforaminal approach using UBE offers a more effective solution for extraforaminal herniations, requiring less bone resection, reducing the risk of pars fracture and enhancing visualization. This article presents a comprehensive methodology for the extraforaminal approach, supported by an illustrated guide, surgical tips and highlights of UBE's advantages over traditional techniques.

PMID:40071975 | PMC:PMC11896681 | DOI:10.1530/EOR-24-0137

EFORT Open Rev. 2025 Mar 3;10(3):156-165. doi: 10.1530/EOR-24-0087. Print 2025 Mar 1.

ABSTRACT

Neurogenic bladder (NB) is a group of bladder and/or urethral dysfunctions caused by neurological lesions, commonly seen in patients with lumbar spine diseases, manifesting as urinary storage and voiding dysfunction, significantly affecting patients' quality of life. Degenerative changes or trauma to the lumbar spine can lead to narrowing of the dural sac, compressing the sacral nerve roots, cauda equina or blood vessels, causing bladder dysfunction and leading to NB. Diagnostic methods for NB include history taking, physical examination and noninvasive and invasive tests, such as urodynamic testing and cystoscopy. The treatment goals for NB are to protect upper urinary tract function, restore or partially restore lower urinary tract function, improve urinary control, reduce residual urine volume, prevent urinary tract infections and improve patients' quality of life. Treatment methods include conservative treatment, pharmacological treatment, catheterization, neuromodulation and surgical treatment, which should be sequentially administered based on the patient's specific condition.

PMID:40071973 | PMC:PMC11896685 | DOI:10.1530/EOR-24-0087

EFORT Open Rev. 2025 Mar 3;10(3):166-171. doi: 10.1530/EOR-2024-0074. Print 2025 Mar 1.

ABSTRACT

PURPOSE: The pre-operative management of fracture blisters is an area of uncertainty within trauma and orthopaedic surgeries. Management strategies vary significantly between and within orthopaedic departments across the United Kingdom. The purpose of this systematic review was to comprehensively appraise and synthesize the existing literature pertaining to this topic, highlighting current practices and areas for ongoing research.

METHODS: Extensive electronic literature searches were performed on PubMed/MEDLINE (January 1946-May 2024), Embase (January 1974-May 2024) and Cochrane library (January 1933-May 2024) databases. The search terms were as follows: (fracture blister OR bone blister*) AND (dress* OR drain* OR aspirat* OR deroof* OR manage*). These keywords were searched in the subject headings, in title and in abstract.

RESULTS: The results of the search methodology revealed five articles, which represented the best evidence to the clinical question. These papers reported on rates of wound healing and post-operative infection, time to surgical readiness and treatment costs, following varying treatment modalities in 1162 patients. The authors, publication dates, countries, patient groups, study outcomes and results of these papers are tabulated in Supplementary Table 1.

CONCLUSION: Fracture blisters pose a significant challenge in clinical practice, leading to delays in surgery, suboptimal surgical approaches and complications in wound healing post-operatively. Currently, there is no consensus describing the optimal management of these blisters. This review challenges the conventional belief that fracture blisters are sterile, highlighting that the application of topical agents to the deroofed blister bed may expedite surgical readiness.

PMID:40071972 | PMC:PMC11896682 | DOI:10.1530/EOR-2024-0074

EFORT Open Rev. 2025 Feb 3;10(2):115-124. doi: 10.1530/EOR-2023-0121. Print 2025 Feb 1.

ABSTRACT

PURPOSE: To evaluate the clinical and biomechanical evidence for the addition of acromioclavicular (AC) ligament repair and reconstruction in the surgical management of high-grade AC joint (ACJ) dislocation.

METHODS: This is a systematic review of biomechanical and clinical studies that describe AC reconstructive or reparative techniques. The search ranged from 1946 to 2024 and included OVID, MEDLINE, PubMed, CINAHL, Embase, Google Scholar and the Cochrane Library databases. Clinical and biomechanical outcomes were evaluated.

RESULTS: Thirty-two eligible studies were identified. Of these, four biomechanical studies focused on the ACJ exclusively. Twenty-eight other studies (15 clinical and 13 biomechanical) were identified involving reconstruction of the ACJ in addition to the treatment of the coracoclavicular (CC) ligaments. There was clinical evidence of improved outcomes with ACJ repair and reconstruction, although comparison was difficult. In comparative studies, ACJ-specific Taft and acromioclavicular joint instability scores were improved in patients with ACJ reconstruction. Constant score and subjective shoulder value also increased, although this was observed in studies lacking a control group. The biomechanical studies provide evidence of increased translational and rotational stability with ACJ repair and reconstruction, but the optimal technique has not been identified.

CONCLUSION: ACJ repair and reconstruction, in addition to CC repair, results in improved biomechanical and functional outcomes and should be considered when treating high-grade ACJ injuries. There is insufficient evidence in the literature to be able to recommend a specific technique to treat ACJ injuries.

PMID:40071970 | PMC:PMC11825160 | DOI:10.1530/EOR-2023-0121

EFORT Open Rev. 2025 Feb 3;10(2):104-114. doi: 10.1530/EOR-24-0138. Print 2025 Feb 1.

ABSTRACT

PURPOSE: The proximal femur is a frequent site of cancer dissemination in the extremities. Patients treated surgically for skeletal metastases have poorer overall health compared to other orthopedic patients, with only one-third expected to survive two years post-surgery. Choosing a treatment that minimizes revision risk and ensures the implant outlives the patient is therefore crucial. We conducted a systematic review to assess the revision rate following internal fixation (IF) or endoprosthetic reconstruction (EPR) of the proximal femur for metastatic bone disease (MBD).

METHODS: This study adhered to the PRISMA guidelines. MEDLINE and Embase were searched, identifying 10,299 records. After removing duplicates, 7731 unique records were screened, 334 of which were retrieved for full-text screening. We included 34 studies in the qualitative synthesis. The MINORS instrument was used for quality assessment.

RESULTS: The quality of the included studies was low to moderate, with median scores of 6/16 for non-comparative studies and 10/24 for comparative studies. We therefore refrained from a comparative analysis. Revision rates varied between 0 and 12.4% following EPR (25 studies) and between 0 and 26.7% following IF, while implant removal rates ranged between 0 and 8.3% and 0 and 26.7%, respectively.

CONCLUSIONS: Revision and implant removal rates for various methods of EPR and IF are satisfactory. However, a meta-analysis or comparison between IF and EPR is not feasible due to a lack of prospective studies, randomized trials and high-quality studies.

PMID:40071964 | PMC:PMC11825154 | DOI:10.1530/EOR-24-0138

EFORT Open Rev. 2025 Mar 3;10(3):141-150. doi: 10.1530/EOR-2024-0077. Print 2025 Mar 1.

ABSTRACT

PURPOSE: No literature consensus was found about the best treatment of acute Rockwood type III acromioclavicular joint (ACJ) dislocation. In particular, the advantages and disadvantages between conservative treatment and surgery are not sufficiently quantified in the current literature.

METHODS: A systematic literature search was conducted using PubMed, Web of Science and Embase in March 2024. We selected studies comparing surgical and conservative treatment in acute Rockwood III ACJ dislocations. The two treatment methods were compared in terms of Constant score; Disabilities of the Arm, Shoulder, and Hand (DASH); American Shoulder and Elbow Surgeons (ASES) score; Acromioclavicular Joint Instability Score (ACJIS); subjective shoulder value (SSV); radiographical findings; reported complications; and return to sports activity. The risk of bias and quality of evidence were assessed using Cochrane guidelines.

RESULTS: A total of 1844 articles were evaluated, and ten were included in the study for a total of 397 patients. The results of the meta-analysis showed no significant differences between the two groups in terms of Constant score (P = 0.31), DASH (P = 0.52), ASES (P = 0.66) and SSV (P = 0.21), while it highlighted a statistically significant difference in terms of ACJIS (P = 0.00) and acromioclavicular (P = 0.00) and coracoclavicular distance (P = 0.00).

CONCLUSION: The results showed no significant differences in terms of patient-reported or objective functional outcomes between the two treatment groups. Nonetheless, it highlights a difference in terms of radiographical outcomes and type of complications. While surgical intervention is able to improve joint reduction, it adds the risk for surgical complications.

PMID:40071962 | PMC:PMC11896683 | DOI:10.1530/EOR-2024-0077

EFORT Open Rev. 2025 Feb 3;10(2):75-81. doi: 10.1530/EOR-2023-0112. Print 2025 Feb 1.

ABSTRACT

Alkaptonuria is an extremely rare disorder of tyrosine metabolism caused by an autosomal recessive enzymatic deficiency of homogentisic acid (HGA) oxidase, causing its accumulation in collagenous structures, especially in hyaline cartilage. It is characterized by a triad of homogentisic aciduria, bluish-black discoloration of connective tissues (ochronosis) and arthropathy of the spine and large weight-bearing joints. Several clinical manifestations were described including coronary and valvular calcification, aortic stenosis, limited chest expansion, and renal, urethral and prostate calculi as well as ocular and cutaneous pigmentation. Skeletal affection usually presents as spondylotic changes of the spine. The knee is the most common peripheral joint to be involved. Enthesopathy or tendon ruptures may occur, and reduced bone density is not unusual. A low-protein diet and ascorbic acid may reduce HGA levels. Nitisinone can safely and effectively reduce HGA production and urinary excretion. In severe ochronotic arthropathy, joint arthroplasty can offer reliable pain relief and excellent functional outcomes. Cementless fixation is successful in young patients.

PMID:40071956 | PMC:PMC11825137 | DOI:10.1530/EOR-2023-0112

EFORT Open Rev. 2025 Jan 3;10(1):1-2. doi: 10.1530/EOR-2024-0200. Print 2025 Jan 1.

NO ABSTRACT

PMID:40071949 | PMC:PMC11728856 | DOI:10.1530/EOR-2024-0200

EFORT Open Rev. 2025 Jan 3;10(1):48-56. doi: 10.1530/EOR-24-0048. Print 2025 Jan 1.

ABSTRACT

PURPOSE: Pediatric osteoarticular infections (OAIs) are an orthopedic emergency that can lead to severe sequelae if not treated appropriately. Approximately half of the patients with OAIs in clinical practice fail to obtain microbiological results even after undergoing aspiration or surgery, which presents a significant challenge in clinical practice. The inability to identify pathogens can lead to incorrect antibiotic usage or under-treatment, increasing the risk of adverse outcomes. This study aims to investigate the clinical characteristics and prognosis of culture-negative OAIs compared to culture-positive OAIs through a meta-analysis, providing insights to optimize treatment strategies.

METHODS: A systematic search was conducted to identify cohort studies comparing the clinical characteristics and prognosis of children with culture-negative OAIs to those with culture-positive OAIs. The search encompassed the databases of Wanfang Data, China National Knowledge Infrastructure, China Biology Medicine disc, Excerpta Medica Database, PubMed and the Cochrane Library, with the literature review extending up to March 2024. Data were extracted from eligible articles and assessed using the Newcastle-Ottawa scale, and the articles were selected based on predefined inclusion and exclusion criteria.

RESULTS: Twelve literature reports covering 1630 patients were included in this meta-analysis. Publication bias did not significantly affect the results. The incidence of long-term sequelae, temperature before admission, baseline laboratory indicators and possibility of surgery in the culture-negative group of patients were significantly lower than those in the culture-positive group. In addition, there were no significant differences in gender, age, race, trauma history, patient delay, antibiotic usage before admission or clinical symptoms between the two groups.

CONCLUSIONS: Children diagnosed with culture-negative OAIs generally demonstrated less severe systemic inflammatory responses, required shorter treatment durations, exhibited a reduced likelihood of requiring surgical intervention and were less prone to experience long-term functional impairments compared to children with culture-positive OAIs. However, no differences in patient characteristics and clinical symptoms were found between the two groups. Further large-scale studies are still required to validate these findings.

TYPE OF STUDY: Meta-analysis.

LEVEL OF EVIDENCE: Level III.

PMID:40071945 | PMC:PMC11728918 | DOI:10.1530/EOR-24-0048

EFORT Open Rev. 2025 Jan 3;10(1):14-27. doi: 10.1530/EOR-2024-0036. Print 2025 Jan 1.

ABSTRACT

PURPOSE: Investigate intra- and post-operative complications and revisions following distal femoral and/or high tibial derotational osteotomies to correct rotational malalignments of the lower limb in patients with anterior knee pain (AKP) and/or patellofemoral instability (PFI).

METHODS: A literature search was conducted on PubMed, EMBASE and Web of Science (until 30 September 2023), including studies reporting complications, reinterventions and revisions following knee derotational osteotomies. Incidence rates were collected for each level of derotational osteotomy (distal femur, high tibia or double-level). A meta-analysis using the Freeman-Tukey double arcsine transformation was conducted to estimate the pooled proportions with their 95% confidence intervals (CIs).

RESULTS: Twenty-one studies involving 564 osteotomies (n = 484) were included, with a mean follow-up of 45.6 ± 15.7 months. The overall complication proportion was 7.5% (95% CI: 3.9-11.8%). Postoperative residual AKP was seen in a pooled proportion of 7.6% (95% CI: 0.7-18.8%), and persistent PFI was not common (0.1%; 95% CI: 0.0-1.7%). Intraoperative complications occurred in a pooled proportion of 3.8% (95% CI: 2.4-6.0%), with peroneal nerve injury being the most common (1.3%) after derotational high tibial osteotomy. Reintervention was needed in a pooled proportion of 13.0% (95% CI: 2.9-27.2%), primarily for hardware removal (n = 158; 28.3%). There was a pooled proportion of knees requiring revision procedures of 12.3% (95% CI: 2.6-26.1%).

CONCLUSIONS: Distal femur and high tibial derotational osteotomies exhibit a considerable incidence of intra- and post-operative complications. Peroneal nerve injury, although infrequent, is a significant complication, underscoring the importance of implementing intraoperative preventive measures during derotational high tibial osteotomy.

PMID:40071944 | PMC:PMC11728914 | DOI:10.1530/EOR-2024-0036

EFORT Open Rev. 2025 Jan 3;10(1):3-13. doi: 10.1530/EOR-2024-0014. Print 2025 Jan 1.

ABSTRACT

PURPOSE: To compare anesthesia techniques (WALANT (wide-awake anesthesia no tourniquet), locoregional anesthesia, local anesthesia with tourniquet or sedation) for carpal tunnel release (CTR).

METHODS: A comprehensive literature search was conducted on PubMed, MEDLINE, Embase and the Cochrane Library up to May 2023. Two independent reviewers selected the studies and extracted the data. The primary outcomes included the pain experienced at the moment of anesthesia and during the surgery and the mean morphine equivalents (MME) administered following the surgery and overall patient satisfaction. Our secondary outcomes consisted of the mean room occupancy time and the mean duration of the procedure, followed by the complication rate. The review process was conducted according to PRISMA guidelines.

RESULTS: A total of 3166 studies were identified, which included 23 studies comparing various anesthesia types and 28,748 CTR surgeries. The WALANT group experienced significantly lower pain levels during anesthesia (-2.67 (95% CIs: 0.12-4.99)) and surgery (-2.04 (95% CIs: 0.08-4.07)) compared to the local anesthesia group. There was no difference in the use of MME for pain relief among different anesthesia techniques. Satisfaction rates were comparable, but WALANT exhibited the highest probability for utmost satisfaction. The mean room occupancy time was lower in patients receiving local anesthesia compared with when sedation was added, with a mean difference of -27.16 (95% CIs: -52.03 to -1.85).

CONCLUSIONS: The WALANT technique for CTR reported better outcomes for pain (during anesthesia and surgery), higher satisfaction and low probability to expand the operating room occupancy time.

LEVEL OF EVIDENCE: Level II of evidence.

PMID:40071930 | PMC:PMC11728873 | DOI:10.1530/EOR-2024-0014

EFORT Open Rev. 2025 Jan 3;10(1):57-63. doi: 10.1530/EOR-24-0110. Print 2025 Jan 1.

ABSTRACT

Esophageal perforation is a rare but serious complication that can occur post-cervical spine surgery. This case report presents the clinical course, diagnostic challenges and management strategies of a patient who had a late-diagnosis esophageal perforation after anterior cervical spine surgery (ACSS). A woman in her 50s underwent ACSS for cervical spondylosis. Three months postoperatively, she experienced persistent right neck and shoulder pain. Despite multiple consultations, an esophageal perforation was only diagnosed 10 years later when a neck mass ruptured, discharging food debris. Surgical management included removing the anterior cervical plate and reconstruction with a sternocleidomastoid muscle flap. Postoperatively, she faced wound complications, and the perforation failed to heal despite multiple debridement and stent placements. Ultimately, complete excision of the diverticulum, repair of the perforation and muscle flap reconstruction led to her recovery, with no recurrence over an 8-year follow-up. We reviewed the literature on cases with esophageal perforation occurring more than 10 years after anterior cervical surgery and summarized the treatment experiences. This case underscores the diagnostic challenges and delayed presentation of esophageal perforation post-ACSS. Early recognition and multidisciplinary management are essential. In cases of late perforation, hardware removal, diverticulum excision and a muscle flap are critical to achieving successful closure of the esophageal lesion, preventing recurrence and ensuring comprehensive repair. Addressing esophageal diverticula during perforation treatment is crucial to prevent recurrence and ensure thorough repair. This highlights the need for high clinical suspicion and a coordinated surgical approach to improve patient outcomes.

PMID:40071924 | PMC:PMC11728875 | DOI:10.1530/EOR-24-0110

EFORT Open Rev. 2025 Jan 3;10(1):28-36. doi: 10.1530/EOR-2024-0070. Print 2025 Jan 1.

ABSTRACT

PURPOSE: A staged bilateral total knee arthroplasty (BTKA) procedure is considered when a patient is not deemed suitable for simultaneous BTKA due to concerns about the risk of mortality and complications. However, no network meta-analysis has been conducted to compare simultaneous vs staged BTKA procedures with different intervals in terms of postoperative mortality and overall complication rates.

METHODS: Four databases - Medline, Embase, Cochrane Library and Web of Science - were searched from inception to December 19, 2023, for studies comparing patients who underwent staged BTKA with different intervals and simultaneous BTKA. The primary outcome domains were 1-year mortality and 90-day overall complications. Secondary outcomes included neurological, cardiovascular, pulmonary, infectious and venous thromboembolic complications within 90 days.

RESULTS: Fifteen observational studies were included. Staged BTKA with intervals between 6 weeks and 3 months (odds ratio (OR): 0.69, 95% CI: 0.53-0.91), between 3 and 6 months (OR: 0.67, 95% CI: 0.53-0.84) and longer than 6 months (OR: 0.67, 95% CI: 0.55-0.83) exhibited a lower mortality risk compared to simultaneous BTKA. Staged BTKA with an interval shorter than 6 weeks and longer than 6 months exhibited a higher risk of pulmonary (OR: 1.24, 95% CI: 1.03-1.49; OR: 1.64, 95% CI: 1.10-2.44) and infectious complications (OR: 1.50, 95% CI: 1.15-1.96; OR: 1.52, 95% CI: 1.14-2.02) compared to simultaneous BTKA. An interval between 3 and 6 months ranked best in outcomes of 1-year mortality (P score = 0.7849) and 90-day complications (P score = 0.7077).

CONCLUSIONS: Staged BKTA with an interval of more than 6 weeks but less than 6 months is associated with a lower risk of postoperative mortality and complications. However, these results should be interpreted with caution due to potential biases inherent in the inclusion of nonrandomized studies.

LEVEL OF EVIDENCE: II.

PMID:40071914 | PMC:PMC11728876 | DOI:10.1530/EOR-2024-0070

EFORT Open Rev. 2025 Jan 3;10(1):37-47. doi: 10.1530/EOR-2023-0209. Print 2025 Jan 1.

ABSTRACT

Knee osteoarthritis (OA) is a common chronic condition that leads to joint pain and disability among older adults. An interprofessional collaborative approach has nowadays been widely advocated in knee OA management although little is known about the characteristics of care, roles and responsibilities of healthcare providers and how they collaborate as a team to optimise treatment outcomes. The Donabedian structure-process-outcome framework was used in the review. Six databases were searched from February 2013 to March 2023. A total of 26 articles that met our inclusion criteria were reported. All studies (n = 26) identified the physiotherapist as a critical member of the interprofessional team. Several studies (n = 5) have offered training to healthcare providers in the management of knee OA. The intervention components in most studies included disease-based education (n = 21) and exercise therapy (n = 16). A comprehensive understanding of the existing interprofessional knee OA care in this review could potentially assist the government and healthcare organisations in developing interprofessional practice guidelines and designing intervention programmes that maximise their benefits.

PMID:40071912 | PMC:PMC11728870 | DOI:10.1530/EOR-2023-0209

Injury. 2025 Mar 8;56(4):112236. doi: 10.1016/j.injury.2025.112236. Online ahead of print.

ABSTRACT

INTRODUCTION: Serotonergic antidepressants, including both selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) have been linked to adverse outcomes following orthopedic procedures. This study aims to evaluate the impact of SSRIs/SNRIs on outcomes in patients following operative fixation of the femur. We hypothesized that perioperative use of SSRIs would be associated with worse outcomes post-surgery.

METHODS: A retrospective cohort analysis was conducted using the TriNetX global federated research network. Adult patients (>18 years) with femur fractures treated surgically were identified using Current Procedural Terminology (CPT) and International Classification of Disease (ICD-10) codes. Propensity score matching was performed to create two cohorts: patients using SSRIs/SNRIs and non-users, each consisting of 5,477 matched patients. Outcomes assessed included postoperative bleeding complications, intensive care unit (ICU) requirement, and wound dehiscence.

RESULTS: On the day of surgery, there were no differences in rates of acute post-hemorrhagic anemia (12 % vs 12 %, p = 0.86), hemoglobin <7g/dL (6 % vs 6 %, p = 0.97) or transfusion (4.9 % vs 4.4 %, p = 0.24). From postoperative day 1-7, rates of acute post-hemorrhagic anemia (18 % vs 16 %, p < 0.01), hemoglobin < 7 g/dL (29 % vs 24 %, p < 0.01) and transfusion (9.5 % vs 8.0 %, p < 0.01) were significantly higher in the SSRI/SNRI cohort. From postoperative day 7-30, there were no observed differences in rates for acute post-hemorrhagic anemia, hemoglobin <7g/dL, transfusion and hematoma incision and drainage.

CONCLUSIONS: Perioperative use of SSRIs/SNRIs in patients with femur fractures is associated with increased risk of acute bleeding complications (Day 1-7); however, the increased risk of bleeding complications is not observed beyond one week postoperatively. Balancing surgical risk with mental health needs is crucial. These findings underscore the importance of careful management of patients with SSRIs/SNRIs undergoing orthopedic procedures, particularly in terms of postoperative blood loss anemia and the need for transfusion.

PMID:40073712 | DOI:10.1016/j.injury.2025.112236