Int Orthop. 2025 Mar 6. doi: 10.1007/s00264-025-06482-8. Online ahead of print.

ABSTRACT

PURPOSE: Hip osteoarthritis is a common chronic condition primarily affecting the elderly, characterised by the presence of pain, joint stiffness, and restricted movement. Ultrasound-guided Pericapsular Nerve Group (PENG) block combined with viscosupplementation may offer symptomatic improvement in patients with hip osteoarthritis unable to undergo total hip arthroplasty. The aim of this study was to evaluate pain and function in patients with hip osteoarthritis following the administration PENG block combined with viscosupplementation.

METHODS: A retrospective study of 17 consecutive patients (12 Female; 5 Male) with hip osteoarthritis who underwent ultrasound-guided PENG block combined with viscosupplementation were included in the study. The primary outcome was pain assessed using the Visual Analogue Scale (VAS), and function measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) before and 12 weeks after the procedure. The secondary outcome was complication rate.

RESULTS: The mean and standard deviation age was 76.5 ± 8.3 years (range 63-93). There was a significant reduction in mean VAS of 3.6 points (p < 0.001) and a reduction in WOMAC score of 29.1 points (p < 0.001). The majority of participants reported being satisfied with the procedure (82.4%). The minor complication rate was 11.8% (ongoing pain requiring analgesia and transient hip flexor weakness). No major complications were observed during the follow-up period.

CONCLUSIONS: The ultrasound-guided PENG block combined with viscosupplementation demonstrated improvement in pain and function without major complications after 12 weeks of follow-up in patients with hip osteoarthritis.

LEVEL OF EVIDENCE: Level IV, case series.

PMID:40047873 | DOI:10.1007/s00264-025-06482-8

Injury. 2025 Feb 19;56(4):112216. doi: 10.1016/j.injury.2025.112216. Online ahead of print.

ABSTRACT

BACKGROUND: The defect of the distal index finger may cause tissue necrosis, osteomyelitis, even dysfunction, disability in hand, and psychological problems. This study aimed to present our experiences using a modified second toe nail-skin flap to repair and reconstruct the distal index finger defect.

METHODS: From February 2018 to April 2022,48 patients with the distal index finger defects received the modified second toe nail-skin flap to reconstruct the defect. Among them, 35 males and 13 females, with a mean age of 39.4 years (ranged, 11∼48 years) and irregular wound, and exposed or damaged tendons, nerves, or bones. The length of the bone defect was 0.3∼1.4 cm and the mean dimension of the soft tissue defect was 0.7 × 2.1 cm (ranged,0.4 × 1.5∼1.0 × 2.5 cm). All the flaps were individually designed according to the defect condition. Combined pedicled first dorsal metatarsal artery flap and cosmetic sutures was used for repair in all donor areas. We regularly followed up all patients and completed the results of some standardized assessment based on hand function and aesthetic scores.

RESULTS: 48 modified second toe nail-skin flaps survived completely. The fingers were available for a mean follow-up of 10.5 months (ranged, 6∼13 months) without serious complications, such as necrosis of distal index finger, deformity, nonunion, muscle spasms of the index finger, paronychia, pain, abnormal temperature and touch sensation. The functional and aesthetic results of all the flaps were satisfactory.

CONCLUSION: The modified second toe nail-skin flap is one of the preferred ways to reconstruct distal index finger defect. This approach provides cosmetic coverage, functional recovery, allows for faster wound healing and reduced tendon adhesion, and lessens damage to the donor area, and does not affect the functions of foot.

PMID:40048806 | DOI:10.1016/j.injury.2025.112216

J Bone Joint Surg Am. 2025 Mar 6. doi: 10.2106/JBJS.23.01478. Online ahead of print.

ABSTRACT

BACKGROUND: When managing aggressive giant cell tumor of bone (GCTB) around the knee joint, surgeons are often caught in a dilemma when determining whether to perform marginal excision or intralesional curettage. The purpose of this study was to report the long-term results of different treatment strategies in our institute.

METHODS: We retrospectively reviewed 64 eligible cases (34 female and 30 male) with a GCTB (37 in the distal femur, 27 in the proximal tibia) treated from 2002 to 2013. Forty patients received intralesional curettage (group A). Twenty-four received marginal excision of the tumor, with 18 of them undergoing reconstruction with unicondylar osteoarticular allograft (UOA) (group B) and 6 receiving arthroplasty reconstruction (group C). The minimum follow-up was 8 years, and the oncological status, clinical outcomes, and cartilage condition were analyzed.

RESULTS: Tumor recurrence was most common in group A (10 of 40, 25.0%), followed by group B (1 of 18, 5.6%) and group C (0 of 6). Eleven patients in group A (27.5%) and 6 in group B (33.3%) developed osteoarthritis (Kellgren-Lawrence grade 3 or 4). Five patients in group A (12.5%) and 3 patients in group B (16.7%) received total knee arthroplasty. Risk factors for the development of osteoarthritis in group A included a centrally located tumor, tumor length of >6 cm, a tumor-cartilage distance of ≤3 mm, and >50% subchondral bone involvement. In group B, osteoarthritis mostly resulted from postoperative complications. The mean Musculoskeletal Tumor Society (MSTS) score was 87.9 in group A, 84.8 in group B, and 93.3 in group C.

CONCLUSIONS: Although intralesional curettage preserved cartilage and resulted in better function, it was associated with a higher tumor recurrence rate in our series. For advanced tumors close to the articular cartilage with significant subchondral bone involvement, marginal excision with UOA reconstruction might be a viable alternative. Arthroplasty should be reserved for patients who have bicondylar involvement with severe bone and cartilage loss making cartilage preservation impossible.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:40048502 | DOI:10.2106/JBJS.23.01478

J Bone Joint Surg Am. 2025 Mar 6. doi: 10.2106/JBJS.24.00640. Online ahead of print.

ABSTRACT

BACKGROUND: The risk factors for fracture-related nerve injury in pediatric Monteggia fracture-dislocations are not well understood. As such, this study aimed to determine the incidence of, and preoperative risk factors for, nerve injury in pediatric Monteggia fracture-dislocations.

METHODS: Patients aged ≤18 years with acute Monteggia or Monteggia-equivalent fracture-dislocations that underwent reduction in the operating room, including closed reduction and casting under general anesthesia and internal fixation of the ulnar fracture with or without opening the radiocapitellar joint, from 2011 to 2021 were retrospectively identified. Exclusion criteria included reduction in the emergency department, concomitant ipsilateral upper-extremity fractures, malunions, or patients without preoperative imaging. Nerve function was assessed preoperatively, and nerve injury was defined as persistent motor and/or sensory deficits on postoperative examination. Patients were followed until nerve-related symptoms resolved. Logistic regression controlled for age and fracture pattern to determine preoperative risk factors.

RESULTS: Of 148 patients (mean age, 6.4 ± 2.8 years), 18.2% (27) had preoperative nerve injury. The posterior interosseous nerve (PIN) was injured in 15 patients, the anterior interosseous nerve (AIN) was injured in 7 patients, and other nerves were injured in 6 patients. All the nerve injuries resolved spontaneously, with a mean resolution time of 63.6 days (range, 8 to 150 days). Risk factors for nerve injury included patient age of ≥8 years (odds ratio [OR], 7.7; 95% confidence interval [CI], 2.6 to 22.8; p < 0.001), lateral radial head dislocation (OR, 6.8; 95% CI, 2.0 to 22.4; p = 0.002), an open fracture (OR, 4.5; 95% CI, 1.2 to 16.5; p = 0.025), and a comminuted ulnar fracture (OR, 4.1; 95% CI, 1.4 to 12.2; p = 0.012). PIN injury was associated with lateral radial head dislocation (p < 0.001) and a comminuted ulnar fracture (p < 0.001). AIN injury was associated with an open fracture (p = 0.002) and diaphyseal ulnar fracture (p = 0.004).

CONCLUSIONS: The incidence of preoperative nerve-related injury in pediatric Monteggia fracture-dislocations was 18.2%. Risk factors for preoperative nerve injury included patient age of ≥8 years, lateral radial head dislocation, an open fracture, and a comminuted ulnar fracture. All the nerve injuries resolved within 150 days, suggesting that early operative intervention may be unnecessary.

LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:40048500 | DOI:10.2106/JBJS.24.00640

Int Orthop. 2025 Mar 6. doi: 10.1007/s00264-025-06476-6. Online ahead of print.

ABSTRACT

We discuss the study by Uğur Bezirgan et al., titled "Comparison of Locking Plate and Conservative Treatment in Elderly Patients with Displaced Proximal Humerus Fractures." The authors are commended for their prospective study, which offers valuable insights into the comparison of locking plate fixation and conservative treatment. The study found no significant difference in functional recovery between the two groups; however, the locking plate group exhibited a higher incidence of complications. We express concerns regarding the potential selection bias arising from the non-randomized allocation of treatments and suggest that not all elderly patients may be suitable candidates for the locking plate fixation approach. Furthermore, the study highlights a lack of patient feedback regarding quality of life, and we recommend that future research incorporate subjective evaluations to provide a more comprehensive understanding of the treatment's effectiveness.

PMID:40044986 | DOI:10.1007/s00264-025-06476-6

Int Orthop. 2025 Mar 5. doi: 10.1007/s00264-025-06469-5. Online ahead of print.

ABSTRACT

PURPOSE: Tunnel syndromes around the foot and ankle are underrecognized and frequently misdiagnosed nerve entrapments that can significantly impact patients' quality of life. This review aims to provide a comprehensive overview of the etiology, clinical presentation, diagnostic challenges, and management strategies for these syndromes, focusing on the sural nerve, deep peroneal nerve, tibial nerve, medial plantar nerve, and inferior calcaneal nerve.

METHODS: A thorough literature review was conducted, examining studies and case reports on nerve entrapments in the foot and ankle. The review covers the clinical assessment, differential diagnosis, and treatment options, including conservative and surgical interventions.

RESULTS: Tunnel syndromes of the foot and ankle can arise from various causes, including trauma, anatomical variations, repetitive strain, and systemic conditions. Clinical manifestations often include burning pain, tingling, and motor weakness, depending on the affected nerve. Accurate diagnosis relies on a detailed patient history, physical examination, and adjunctive tests such as electrodiagnostic and imaging. Conservative treatments, such as physical therapy, orthotics, and corticosteroid injections, are often effective, while surgical decompression is reserved for refractory cases.

CONCLUSIONS: Recognizing and diagnosing tunnel syndromes in the foot and ankle is essential for effective management and preventing permanent nerve damage. A systematic approach that integrates clinical evaluation and appropriate imaging can improve patient outcomes. Timely intervention, whether conservative or surgical, is crucial for alleviating symptoms and restoring function.

PMID:40042611 | DOI:10.1007/s00264-025-06469-5

Int Orthop. 2025 Mar 5. doi: 10.1007/s00264-025-06451-1. Online ahead of print.

ABSTRACT

PURPOSE: While robotic-assisted total knee arthroplasty (RA-TKA) has demonstrated improved surgical precision, its impact on early postoperative pain management remains unclear. This study compared early postoperative pain outcomes between RA-TKA and conventional TKA (C-TKA).

METHODS: In this retrospective study, 230 consecutive patients (309 knees) who underwent primary TKA were analyzed: 143 patients (181 knees) in the C-TKA group and 87 patients (128 knees) in the RA-TKA group. Pain scores at rest and during movement were assessed using the Numerical Pain Rating Scale for 72 h postoperatively. Secondary outcomes included opioid consumption and length of hospital stay.

RESULTS: While pain scores at rest showed no significant differences between groups, RA-TKA patients reported significantly lower pain scores during movement at 24 h post-surgery (p = 0.023). The RA-TKA group demonstrated significantly reduced opioid consumption during the first 48 postoperative hours (p = 0.001 for 0-24 h; p = 0.03 for 24-48 h) and shorter length of hospital stay (p = 0.011). Subgroup analysis of unilateral procedures showed similar advantages in the RA-TKA group.

CONCLUSION: RA-TKA was associated with reduced pain during movement, decreased opioid consumption, and shorter hospital stay in the early postoperative period compared to C-TKA.

PMID:40042610 | DOI:10.1007/s00264-025-06451-1

Injury. 2025 Feb 28;56(4):112231. doi: 10.1016/j.injury.2025.112231. Online ahead of print.

ABSTRACT

INTRODUCTION: There have been no published studies evaluating the impact of humeral stem length on humeral shaft periprosthetic fractures. We sought evaluate the differences in fracture patterns between periprosthetic fractures around a short stem and standard stem humeral implants.

MATERIALS AND METHODS: This is a retrospective cohort study. Patients sustaining a humeral shaft periprosthetic fracture around shoulder arthroplasty implants from December 2011 to January 2021 were identified using ICD-9/10 codes. Three upper extremity trained surgeons evaluated all radiographs assessing fracture location and configuration, as well as signs of stem stability before and after the fracture. They classified the fractures based on two classification schemes: Wright & Cofield, and the Unified Classification System (UCS), and they recorded their recommended treatment for each case based on fracture pattens and implant stability.

RESULTS: 76 patients with periprosthetic humeral shaft fractures were identified and divided into two groups: short stem (n=18) and standard stem (n=58). Patients with a short stem were more likely to be classified as having an unstable prosthesis after fracture (67% versus 33%, p=0.01). Additionally, the proposed plan for treatment was different between the two groups (p=0.004): more patients in the standard stem group were recommended open reduction internal fixation (50% vs. 33%) or non-operative treatment (17% vs. 0%), and more patients in the short stem group were recommended revision arthroplasty (50% vs. 29%).

CONCLUSION: Patients sustaining a periprosthetic fracture around a short implant may be more likely to have an unstable prosthesis compared to a standard stem, which may have an impact on treatment options.

LEVEL OF EVIDENCE: Prognosis Study, Level III.

PMID:40043641 | DOI:10.1016/j.injury.2025.112231

J Bone Joint Surg Am. 2025 Mar 5;107(5):e15. doi: 10.2106/JBJS.24.01497. Epub 2025 Mar 5.

NO ABSTRACT

PMID:40042508 | DOI:10.2106/JBJS.24.01497

J Bone Joint Surg Am. 2025 Mar 5;107(5):e14. doi: 10.2106/JBJS.24.01097. Epub 2025 Mar 5.

NO ABSTRACT

PMID:40042507 | DOI:10.2106/JBJS.24.01097

J Bone Joint Surg Am. 2025 Mar 5;107(5):e13. doi: 10.2106/JBJS.24.01157. Epub 2025 Mar 5.

NO ABSTRACT

PMID:40042506 | DOI:10.2106/JBJS.24.01157

Int Orthop. 2025 Mar 4. doi: 10.1007/s00264-025-06464-w. Online ahead of print.

ABSTRACT

PURPOSE: Medializing displacement calcaneal osteotomies are part of conservative surgical treatments and represent a reliable option in valgus flatfoot deformities. Favorable short-term results of this procedure is well-known. However, there are few series with follow-up beyond five years. This study reports the clinical outcomes of calcaneal medialization osteotomy with a minimum follow-up of five years. The primary objective was to compare functional scores and radiographic measurements at the preoperative stage, immediately post operative, and at the final follow-up.

MATERIALS AND METHODS: This was a retrospective, single-centre, multi-operator study of 32 patients, who underwent a medialization calcaneal osteotomy for type II flatfoot. Clinical evaluation of the patients was conducted using the American Orthopaedic Foot and Ankle Surgery (AOFAS) score and the European Foot and Ankle Society (EFAS) score. Radiographic evaluation used the plantar arch angle angle, the talus-first metatarsal axis (T-M1) on lateral weight-bearing radiographs, and calcaneal valgus on Meary's angle in a hindfoot alignment view.

RESULTS: Mean follow-up was seven years. AOFAS score improved from 46 to 87 and EFAS score from 11 to 20 (p < 0.05). Each radiographic parameter was significantly modified between the preoperative and immediate postoperative periods.

CONCLUSION: We observed a significant and lasting improvement in functional scores at a mean follow-up of seven years. The correction of the evaluated radiographic parameters was significant and remained stable over time.

PMID:40035852 | DOI:10.1007/s00264-025-06464-w

SICOT J. 2025;11:12. doi: 10.1051/sicotj/2025005. Epub 2025 Mar 4.

ABSTRACT

INTRODUCTION: Although the surgical techniques and functional outcomes of conventional total knee arthroplasty (TKA) are well-established, there is limited data available on robotic arm-assisted TKA (RATKA) in the context of valgus knee arthroplasty. The purpose of this study is to assess the efficacy of RATKA in the correction of moderate to severe valgus knee deformities using minimally constrained implants and to evaluate the short-term functional outcomes associated with this technique.

METHODS: This prospective study was conducted on patients with moderate to severe grade valgus knee deformity who underwent RATKA from August 1, 2020 to May 31, 2022. Of 873 primary RATKA cases, 48 cases had valgus knee deformities. Among these, 27 had grade 2-3 valgus with intact medial collateral ligament (MCL), two had grade 3 valgus with incompetent MCL, 14 had grade 1 valgus, and five had post-traumatic valgus deformities. Over a two-year follow-up period, functional outcomes were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee Society Score (KSS), and complications were documented; however, radiological outcomes were not analyzed.

RESULTS: Among 27 patients with Grade 2-3 valgus, the final cohort included 21 patients (24 knees). The mean age was 58.33 ± 9.63 years and 70.8% were female. Ten (41.7%) patients had rheumatoid arthritis and 14 (58.3%) had degenerative osteoarthritis (OA). The median surgical time was 68.00 (13.00) minutes, and the median blood loss was 478.45 (176.25) mL. The valgus grade was reduced from a baseline value of 22.43 ± 7.05 degrees to 5.26 ± 1.53 degrees at 6 weeks. The WOMAC scores improved from 67.58 ± 7.27 at baseline to 1.38 ± 0.57 in the second year post-operatively. Similarly, the KSS scores improved from 26.67 ± 10.34 at baseline to 181.96 ± 7.20 in the second year. One patient sustained a Type II supracondylar femur fracture after a fall, managed with distal femur arthroplasty, while another had delayed tibia pin tract healing, treated with antibiotics and dressings.

CONCLUSION: RATKA facilitates precise correction of moderate to severe valgus deformity through enhanced surgical planning and execution, achieving adequate functional outcomes with minimal complications through the application of functional alignment philosophy.

PMID:40035462 | PMC:PMC11878094 | DOI:10.1051/sicotj/2025005

Injury. 2025 Feb 20;56(4):112225. doi: 10.1016/j.injury.2025.112225. Online ahead of print.

ABSTRACT

Lacerations rank as the most common paediatric injury that requires a physician evaluation. Glass is a frequent cause of such lacerations, however there is currently little to no information on this. Hence, this paper aims to describe the burden and characteristics of such injuries in Singapore. This study is a retrospective review of glass-related trauma presented to paediatric hospital KKH Emergency Department between 1st January 2017 and 4th July 2023. Data on patient and injury characteristics, as well as treatment plans were collected. 680 patients up to 18 years old (average 6.93) were included in the study. 420 (62 %) were male. The number of glass-related injuries were stable at about 100 per year from 2017 to 2023. 649 (95 %) cases were unintentional. 528 (78 %) injuries occurred indoors.159 (23 %) children had adult supervision at time of injury. A majority of 458 (67 %) injuries occurred during the weekday. Primary blunt injuries were the highest at 414 (61 %), followed by 230 (34 %) penetrating injuries. 317 (37 %) injuries occurred at the lower limb, 305 (36 %) at the upper limb, and 105 (12 %) at the face. 596 (87.6 %) patients had "None to mild" injuries, 31 (4.6 %) with "Moderate" injuries, and 53 (7.8 %) with "Severe" injuries. Glass doors led to 315 (46 %) cases, with glass shards and glass panels causing 85 (12.5 %) and 84 (12.5 %) cases respectively. 555 (82 %) of patients received definitive treatment in the Emergency Department and 74 (11 %) required surgery. The average duration of hospitalization of all patients is 0.36 days. 430 patients averaged 3.66 weeks of follow-up, while 247 were discharged immediately. 85 (13 %) patients required inpatient care. Only 1 patient required fluid resuscitation in the Emergency Department. Most glass injuries are unintentional, caused by glass doors, occur indoors and are, fortunately, mild cases.

PMID:40037263 | DOI:10.1016/j.injury.2025.112225

Int Orthop. 2025 Mar 3. doi: 10.1007/s00264-025-06461-z. Online ahead of print.

ABSTRACT

PURPOSE: Groin pain in athletes, particularly inguinal-related groin pain, remains a diagnostic and therapeutic challenge despite recent consensus on terminology. This study aims to explore nerve disorders as a key contributor to groin pain in athletes, focusing on the anatomy, aetiology, diagnosis, and management options.

METHODS: A comprehensive review of the literature was conducted, focusing on the anatomical variability of the ilioinguinal, iliohypogastric, and genital branch of the genitofemoral nerves, clinical presentations, diagnostic methods, and conservative and surgical treatments for nerve-related inguinal pain. Key studies on nerve entrapment, neuropathic and nociceptive pain mechanisms, and surgical outcomes were analyzed.

RESULTS: Variability in nerve pathways and sensory overlap complicate diagnosis and management. Neuropathic pain often presents with burning or electric sensations due to nerve compression or entrapment, while nociceptive pain manifests as dull or stabbing pain. Conservative treatment, including exercise-based rehabilitation and nerve blocks, offers relief in many cases. For refractory cases, surgical treatment can provide significant pain resolution, with nerve identification and potential neurectomy improving outcomes.

CONCLUSION: Nerve disorders play a critical role in inguinal-related groin pain in athletes. Accurate diagnosis relies on detailed clinical examination and targeted imaging. Conservative treatments are first line, but surgical interventions addressing nerve entrapment or compression are effective for persistent cases. Future research should focus on the role of collagen deficiencies, nerve histopathology, and long-term outcomes of different treatment modalities.

PMID:40032740 | DOI:10.1007/s00264-025-06461-z

Injury. 2025 Feb 22;56(4):112227. doi: 10.1016/j.injury.2025.112227. Online ahead of print.

ABSTRACT

Interlocking screw backout is a significant complication of femoral nailing that may lead to pain, fixation failure, and need for reoperation. The risk for this is increased in osteoporotic bone or in cases of so-called "extreme nailing" when the articular segment is short, and fixation is limited. A newly developed retrograde femoral nailing system (DePuy Synthes RFN-Advanced™ Retrograde Femoral Nailing System (DePuy Synthes, Monument, CO)) was designed specifically to prevent this known failure mode and was recently approved for use within the United States. A preassembled polymer inlay at the distal portion of the nail (through which the distal interlocking screws are placed) is marketed as eliminating interfragmentary motion and screw toggle which can ultimately lead to screw backout. Despite this purposeful design, multiple surgeons at our Level I trauma center in the southeastern US have noted a relatively high occurrence of distal interlocking screw backout when compared to other nail designs used in the same time. We present a single institution retrospective review of placed retrograde femoral nails and their complications, particular loss of interlock bolt fixation and revision surgery in the DePuy Synthes RFN-A group (21.43 %), compared to other implant designs (5.41 %) during the initial implementation period at our institution.

PMID:40031117 | DOI:10.1016/j.injury.2025.112227

J Bone Joint Surg Am. 2025 Mar 3. doi: 10.2106/JBJS.24.01454. Online ahead of print.

NO ABSTRACT

PMID:40029939 | DOI:10.2106/JBJS.24.01454

Injury. 2025 Feb 21;56(4):112226. doi: 10.1016/j.injury.2025.112226. Online ahead of print.

ABSTRACT

Diabetes mellitus is a chronic condition which disrupts bone homeostasis leading to impaired healing and profound complications in ankle fractures. Hyperglycaemia and chronic inflammation cause increased generation of advanced glycation end products and reactive oxygen species which ultimately drive osteoclastogenesis and increase bone resorption. Together with a lack of insulin signalling, these mechanisms compromise bone metabolism and increase the risk of complications in fracture healing. Diabetes is associated with comorbidities such as vasculopathy and neuropathy which further contribute to the risk of complications. The complications identified in diabetic patients with ankle fractures include non-union, malunion, infection, amputation, and mortality. Thus, careful consideration is needed when deciding between surgical and conservative treatment. This narrative review provides a synthesis of the literature covering the impact of diabetes on ankle fractures, considering their high prevalence in the UK.

PMID:40023923 | DOI:10.1016/j.injury.2025.112226

Int Orthop. 2025 Mar 1. doi: 10.1007/s00264-025-06458-8. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to evaluate the outcomes of scaphocapitate arthrodesis with lunate excision in patients with stage IIIB and IIIC Kienböck's disease.

METHOD: Between September 2013 and April 2024, 106 consecutive patients were screened, with 64 consenting to participate. Final analysis included 56 patients (32 stage IIIB and 24 stage IIIC) who underwent scaphocapitate arthrodesis with lunate excision, utilizing distal radius bone grafting stabilized by Herbert compression screws. Preoperative and postoperative assessments (6, 18, 36, and 84 months) included VAS score for pain, ROM, grip strength, MMWS, PRWE scores, and radiographic evaluations including RS angle, CHR, CUDR, and ulnar variance.

RESULTS: The mean operative time was 75 ± 11 min, and the average follow-up was 86 ± 2.5 months. The union rate was 91% with a mean time to union of 10 ± 2 weeks. Preoperative mean VAS scores (63 ± 4 mm) significantly decreased to 25 ± 9 mm at 6 months and 12 ± 4 mm at 36 months (p = 0.001), with a slight increase to 22 ± 5 mm at 84 months. ROM improved from 46% ± 9% of the healthy side preoperatively to 59% ± 3.2% at 36 months (p = 0.001) but slightly decreased to 58% ± 3% at 84 months. Grip strength improved from 48% ± 8% preoperatively to 89% ± 6.4% at 36 months (p = 0.001) and remained stable at 88% ± 4% at 84 months. The mean MMWS increased from 46 ± 7 to 75 ± 5 (p = 0.001), while PRWE scores decreased from 68 ± 8 to 23 ± 6 (p = 0.001). The mean RS angle decreased from 59° ± 8° preoperatively to 50° ± 3° at 36 months (p = 0.001). There was no significant change in CHR (0.44 ± 0.04 to 0.46 ± 0.03, p = 0.251), while CUDR decreased from 31 ± 3 mm to 25 ± 2 mm (p = 0.021). Ulnar variance remained stable (p = 0.325). Degenerative changes were noted in 13 patients (23%) at the RS joint, with six showing Grade I, 5 Grade II, and 1 Grade III degeneration. Additionally, 5 patients (9%) exhibited changes at the STT joint, comprising three with Grade I and 2 with Grade II degeneration.

CONCLUSION: Scaphocapitate arthrodesis with lunate excision can improves pain, ROM, grip strength, and functional scores in patients with stage IIIB and IIIC Kienböck's disease. Over time, improvements in VAS scores and functional metrics were notable, though there was a slight decline in pain relief and ROM at 84 months. These changes are critical to understanding the potential degenerative complications, particularly at the RS joint, where some patients developed osteoarthritis.

LEVEL OF EVIDENCE: Level II.

PMID:40024945 | DOI:10.1007/s00264-025-06458-8

Int Orthop. 2025 Mar 1. doi: 10.1007/s00264-025-06454-y. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the impact of implant-associated and radiographic factors on survival rates and revisions of total shoulder arthroplasty (TSA) in patients with primary osteoarthritis (OA).

METHODS: This retrospective study included 68 patients who underwent TSA for primary OA at a single institution between 2008 and 2015, with a minimum follow-up of 60 months. Patients with prior shoulder surgeries, perioperative infections, or revisions within 12 months postoperatively were excluded. Patients were divided into Group A (Survivors) and Group B (Revisions) based on implant survival. Radiographic parameters analyzed included critical shoulder angle (CSA), acromiohumeral distance (AHD), lateral offset (LO), humeral head-stem index (HSI), centre of rotation (COR), and glenoid erosion, categorized using Sirveaux, Lévigne, Franceschi, and Walch classifications. Demographic data were also assessed.

RESULTS: Of 68 patients, 57 were in Group A (mean age: 58.5 ± 10.1 years; follow-up: 115.8 months) and 11 in Group B (mean age: 61.4 ± 8.3 years; follow-up: 113.9 months). Implant survival was 84% after 115.8 ± 34.5 months. Baseline demographics were comparable (e.g., smoking: p = 0.75), as was osteolysis prevalence (Group A: 47%; Group B: 45%; p = 0.91). HSI was significantly higher in Group B (0.5 ± 0.1 vs. 0.4 ± 0.1; p = 0.03). No other radiographic differences were significant.

CONCLUSION: Patients undergoing anatomic total shoulder arthroplasty can expect favourable mid- to long-term outcomes, with implant survival rates of 84% and relatively low complication rates. Although osteolysis is common, it rarely necessitates revision surgery. The role of the humeral head-stem index (HSI) warrants further investigation.

STUDY DESIGN: Level IV; retrospective case study.

PMID:40024944 | DOI:10.1007/s00264-025-06454-y