SICOT-J - Société Internationale de Chirurgie Orthopédique et de Traumatologie
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Cementless versus cemented fixation in image-based robotic total knee arthroplasty guided by functional knee positioning principles
No full textIntroduction: Under functional knee positioning (FKPos) principles, residual varus or valgus alignment of the tibia and femur may be maintained, resulting in loading conditions that differ from those observed with mechanical alignment. Consequently, there is a need for evidence regarding implant fixation (cemented or cementless) in this context. This study aimed to evaluate the impact of implant fixation type (cemented versus cementless) on clinical outcomes, complications, and implant survival in robotic-assisted total knee arthroplasty (TKA) guided by FKPos principles. Methods: A retrospective comparative analysis of 393 patients who underwent robotic-assisted primary TKA was performed. Patients were divided into two groups: cemented (n = 85) and cementless (n =276) fixation. Radiographic alignment, functional outcomes using the Knee Society Score (KSS) and Forgotten Joint Score (FJS), complication rates, and implant survival were assessed at a minimum 2-year follow-up. Subgroup analyses based on femoral and tibial fixation types were also conducted. Results: Both fixation methods achieved comparable functional outcomes (KSS and FJS) and implant survivorship, with no significant differences in revision rates. Hematomas were significantly more frequent in the cementless group (12.32% vs. 8.24%, p = 0.02). Subgroup analyses of femoral and tibial implants showed no significant differences in functional outcomes. Discussion: This study is the first to assess the influence of fixation type on outcomes in robotic-assisted TKA performed under FKPos principles. Both cemented and cementless fixation methods are safe and effective
A novel in vitro experimental design for biomechanical testing of patellofemoral joint kinetics and kinematics
No full textIntroduction: Complications arising from the patellofemoral joint (PFJ) represent the third most common cause for revision in total knee arthroplasty (TKA). Previous in vitro biomechanical studies have altered the native attachments of muscles controlling the PFJ. The purpose of this study was to design an in vitro biomechanical setup that would allow testing of both native and arthroplasty knee joints, specifically the PFJ, without disturbing the native attachments of the quadriceps and hamstrings muscles. Methods: After finalising a prototype, a pelvis-to-toe human cadaver specimen was tested. The simVITRO platform was used to simulate movement and control force trajectories. A motion capture system was used to capture the motion of the bones and to measure knee flexion angle and patellar movement with respect to the femur. The forces applied in the PFJ were measured using a custom patella sensor. Results: Displacement of the reflective cluster attached to the femur was measured during compression loading at different flexion angles, passive flexion and stairs descent trajectory. The femur showed less than 1 mm and 3 mm displacement with respect to the femur clamp in passive flexion and stairs descent. The most translation of 8.37 mm (<2% average femur length) was observed at 90° flexion which occurred at 483 N simulated compression force. Conclusion: This novel design provides a methodology for studying the biomechanics of the PFJ in vitro that preserves the soft tissues influencing the behaviour of the joint. This setup provides a biomechanics model that can be utilised to better understand and study the PFJ in vitro
Reduction of oxidative stress in total knee arthroplasty using tourniquet with a novel pharmaceutical combination
No full textIntroduction: Tourniquet use in total knee arthroplasty (TKA) can cause ischaemia-reperfusion (I-R) injury via oxidative stress. This study evaluated whether combined administration of the antioxidant N-acetylcysteine (NAC) and the iron-chelator Deferiprone can mitigate oxidative damage and improve clinical outcomes. Materials and methods: Twenty TKA patients were randomized into two groups, one group receiving NAC (600 mg, 6 h pre-op) and Deferiprone (1000 mg, 2 h pre-op) (intervention group) and the other group serving as placebo (control). Lipid hydroperoxides (LOOH) and protein malondialdehyde (PrMDA) were measured from quadriceps muscle tissue samples at 5 min (T1) and 40 min (T2) after tourniquet inflation, and 5 min after deflation (T3). Blood markers including serum ferritin, white blood cell (WBC) count, and polymorphonuclear neutrophils (PMNs) were assessed along with tissue PrMDA and LOOH as primary outcome measurements, while pain scores and knee flexion were recorded postoperatively as secondary outcome measurements. Results: LOOH levels were significantly lower in the intervention group at T2 and T3. PrMDA levels showed no significant differences. Ferritin levels rose by 69% in controls vs. 18% in the intervention group. WBC and PMNs normalized faster, with reduced pain and improved range of motion in the intervention group. Conclusion: The attenuation of LOOH elevation, the faster PMN deactivation, the inhibition of ferritin release from the cells along with the improved clinical outcomes suggest that combined NAC and Deferiprone administration may reduce tourniquet-related oxidative stress and inflammation, enhancing early recovery in TKA patients
Direct anterior total hip arthroplasty with dual mobility cup for femoral neck fractures in dementia patients
No full textBackground: Dementia patients with femoral neck fractures (FNFs) are unable to understand their dislocated limb positioning, which may impair rehabilitation and result in poorer functional recovery. Recently, good clinical results have been reported for the direct anterior approach for total hip arthroplasty (DAA-THA) using a dual mobility cup (DMC) for displaced FNFs. This study aimed to investigate differences in the clinical outcome of THA for displaced FNFs in patients with and without dementia. Methods: This study was retrospective and included 151 patients who underwent DAA-THA with DMC for displaced FNFs. Patients diagnosed with dementia prior to injury were classified into a dementia group (43 patients) and a non-dementia control group (control group, 108 patients). The evaluation items were age, sex, body mass index (BMI), preoperative Fracture Mobility Score (FMS), waiting period, preoperative anesthetic assessment, blood loss, operation time, complications, 1-year mortality, and 1-year FMS after surgery. The FMS was scored as: walking alone: 1, walking with a cane: 2, walking with a walker: 3, hand-guided walking: 4, and wheelchair: 5. Results: Significant differences were found in age, weight, BMI, and operation time. Postoperative dislocation was not observed in both groups. FMS was compared before and after injury in three categories: (1) unchanged from before injury, (2) one rank down, and (3) two or more ranks down. No significant differences were found in any of these categories (p = 0.09). Functional outcomes showed no significant difference in mobility recovery. The 1-year mortality rate was 9.35% (16 patients), with no significant difference between the two groups (p = 0.17). Discussion: DAA-THA using DMC for displaced FNFs may have similar functional outcomes and mortality rates in both patients with and without dementia
Venous thromboembolism prophylaxis after anterior cruciate ligament reconstruction: retrospective case-control study
No full textIntroduction: Venous thromboembolism (VTE) is a rare but potentially serious complication following anterior cruciate ligament reconstruction (ACLR). There is no guideline for the routine use of anticoagulants post-ACLR surgery. Methods: This retrospective case-control study reviewed 199 patients who underwent ACLR between February 2020 and November 2024. Two groups were compared: Group A (n = 113) received no pharmacological prophylaxis, while Group B (n = 86) received low-molecular-weight heparin (LMWH) for 2 weeks postoperatively. The incidence of symptomatic VTE, postoperative bleeding, and related complications was evaluated. Results: No symptomatic VTE or bleeding complications were observed in either group. There was no statistically significant difference between the groups in terms of age, BMI, smoking, comorbidities, and postoperative weight bearing. There was a significant difference in surgical duration, graft type, and meniscal procedure. Discussion: Our findings support a risk-stratified approach rather than universal pharmacologic prophylaxis in ACLR patients
Osteoporotic vertebral fractures: an update
No full textIntroduction: Osteoporotic vertebral fractures (OVFs) are the most common type of fragility fractures. They have a significant and usually detrimental impact on the patient’s functional status and mortality rate, constituting a substantial burden for the patients, their families, and the healthcare system. This narrative review aims to summarize the current knowledge of osteoporotic vertebral fractures and secondary fracture prevention. Methods: A comprehensive literature search was conducted across major medical databases, including PubMed, Scopus, and Web of Science. Relevant studies, guidelines, and reviews published were analyzed to provide a broad perspective on the topic. Results: Diagnosis of OVFs is based on history, clinical examination, and plain lateral radiographs of the spine. Their management is mainly non-operative, with surgery being reserved for specific indications. Successful management of osteoporotic vertebral fractures entails alleviating pain, early restoration of mobility, and secondary fracture prevention. Prevention of the next osteoporotic fracture is paramount and should be an integral element of their management. The Fracture Liaison Service (FLS) is the main contemporary service that serves this purpose. Discussion: Diagnosis of OVFs is simple but requires vigilance from the clinicians. Early, accurate diagnosis is essential to initiate appropriate treatment and provide the opportunity for secondary fracture prevention
Intraoperative periprosthetic femoral fracture in cementless hip hemiarthroplasty for femoral neck fracture does not change long-term outcomes
No full textPurpose: Intraoperative periprosthetic femoral fracture (IPFF) is a known complication during hemiarthroplasty (HA), which may lead to inferior outcomes. Few studies have assessed the outcomes of IPFF in HA for displaced femoral neck fractures (FNF). This study aims to evaluate the incidence of IPFF in cementless HA for displaced FNF and compare long-term outcomes between patients with and without IPFF. Methods: We retrospectively reviewed institutional surgical data of patients who underwent cementless HA for displaced FNF from January 2010 to January 2022. The presence, location, and treatment of IPFF, as well as the effect of IPFF on postoperative weight-bearing, status were assessed. Mortality, readmission, and revision rates were compared between the IPFF and non-IPFF group. Results: A total of 1,586 patients were included in the study. 104 patients (6.6%) in the IPFF group vs. 1,482 patients (93.4%) in the non-IPFF group. The IPFF location was mostly the calcar (59.6%), followed by the greater trochanter (35.5%) and the femoral shaft (8.6%). Most fractures were treated with fixation (92.3%) and full weight-bearing postoperatively (95.1%). Surgery duration was longer in the IPFF group (p < 0.001). However, there were no significant differences between groups regarding 30-day, 90-day, and 1-year mortality rates, 90-day readmission rates, or revision rates at the latest follow-up. A multivariate binary logistic regression found similar long-term results. Conclusions: While IPFF remains a recognized complication of cementless HA for displaced FNF, its occurrence does not adversely affect long-term outcomes when appropriately managed
Two-stage exchange of infected total hip arthroplasty with a dual-mobility cup is associated with a low instability rate
No full textIntroduction: The two-stage management of hip Prosthetic Joint Infection (PJI) is faced with a high rate of dislocation. Dual mobility (DM) cups have proved effective in reducing the risk of dislocation, but few data are available on the two-stage management of hip PJI. The objectives of this retrospective cohort study were to analyze the rate of dislocation, and the rate of recurrent dislocation and to identify risk factors for dislocation. Our hypothesis was that the use of a DM cup during a two-stage replacement had a low instability rate. Methods: Data from 70 two-stage changes with DM cup reimplantation performed in our centre between 2011 and 2020 were retrospectively collated. The mean age was 69 years [18–93], with a mean follow-up of 3.4 years [1.5–9.6]. Dislocation rates and risk factors for prosthetic instability were collected. Univariate and multivariate analyses were performed to identify risk factors favouring prosthetic instability. Results: The rate of dislocation at the last follow-up was 8.6% (6/70), including 4.3% (3/70) in patients with no infection recurrence. The rate of recurrent dislocation was 0% when infection was controlled. The occurrence of spacer dislocation, the presence of immunosuppressive and antiaggregant medication, the local grade of the McPherson score and infection treatment failure were associated with the occurrence of a dislocation. No risk factors were identified in the multivariate analysis. Discussion: Compared with the rates reported in the literature, the use of a DM cup seems indicated in this context in order to lower the risk of recurrent dislocation. Preventing spacer dislocation and infection recurrence seems to be essential to avoid the risk of instability of the future prosthetic hip
Relationship between the location of the popliteal artery and the tibial osteotomy plane in patients with medial and lateral unicompartmental knee arthroplasty: A retrospective analysis of preoperative magnetic resonance imaging and intraoperative findings
No full textPurpose: To clarify the location of the popliteal artery (PA) is relative to the tibial osteotomy plane in patients with medial and lateral unicompartmental knee osteoarthritis (KOA) undergoing UKA. Methods: Preoperative MRI and postoperative radiographs obtained from 50 patients with unicompartmental KOA who underwent fixed-bearing UKA were analyzed. The amount of tibial resection was determined from the surgical records, and a line was drawn parallel to the tibial posterior tilt angle on the sagittal MR image to create a virtual tibial cut line. The tibial resection width measured from the anteroposterior image of the postoperative radiograph was projected onto the transverse plane containing the intersection between the virtual tibial cut line and the posterior tibial cortex, after which a line was drawn parallel to the medial or lateral intercondylar ridge. We then determined whether the PA was within an extension of the osteotomy area. The shortest distance (Distance 1) between the posterior tibial cortex and the PA within the osteotomy area was measured. In addition, the shortest distance between the line extending the osteotomy posteriorly and the PA was measured (Distance 2). Results: The medial UKA (group M) and lateral UKA (group L) group comprised 41 and 9 cases. The percentage of PA located behind the osteotomy plane was significantly higher in group L than in group M [6/9 knees (66.7%) vs. 2/41 knees (4.9%); P < 0.001]. The distance 1 was 12.6 (4.3) mm in group M and 7.9 (3.7) mm in group L (P = 0.004). The distance2 was 11.1 (4.9) mm in group M and 2.6 (3.5) mm in group L (P < 0.001). Conclusion: During lateral UKA, the PA was often located behind the tibial osteotomy plane and close to the posterior tibial cortex. Nearly 5% of medial UKAs, the artery was located behind the osteotomy plane. Level of Evidence: Retrospective comparative LEVEL III study
Proximal femoral replacement with locking plate for massive bone loss: a case report
No full textComplications on the femoral side after performing proximal femoral replacement (PFR), such as stem loosening and periprosthetic fractures, are the major reasons for reoperation. Femoral reconstruction was performed using PFR with a locking plate to minimize the risk of complications. We present the case of an 85-year-old woman with stem loosening and massive proximal femoral bone loss (Paprosky type IV) 10 years after stem revision in bipolar hemiarthroplasty. Femoral reconstruction was performed using the following surgical techniques. After removing the previous implant, a PFR was inserted into the host bone of the distal femur and fixed at the junction with cement. In addition, a locking plate was used for bridging. Full weight-bearing rehabilitation was started the day after surgery. At the 5-year follow-up, the patient could walk steadily without complications. A postoperative radiograph of the femur showed no signs of a radiolucent line, implant-related issues, or bone resorption. This reconstructive technique may reduce the high torsional and compressive stresses on bone cement prostheses, which can cause complications on the femoral side. Even in the case of poor femoral host bone quality, this reconstruction method can achieve robust femoral reconstruction. Femorl reconstruction using PFR with a locking plate is a particularly beneficial reconstruction method for older patients with massive proximal femoral bone loss