SICOT-J - Société Internationale de Chirurgie Orthopédique et de Traumatologie
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Clinical efficacy of oxidized regenerated cellulose powder in perioperative blood management in direct anterior total hip arthroplasty
No full textBackground: Perioperative blood loss remains a challenge in total hip arthroplasty (THA). Although tranexamic acid (TXA) is widely used for hemostasis, the efficacy of oxidized regenerated cellulose (ORC) powder as an adjunct in blood management for THA via the direct anterior approach (DAA) remains underexplored. This study aimed to evaluate the effects of ORC powder on perioperative blood loss, hematological parameters, and clinical outcomes in direct anterior THA. Methods: A total of 133 patients who underwent primary THA via the DAA were enrolled in the study. The patients were divided into two groups: the ORC powder group (combination of ORC powder and topical TXA, n = 53) and the control group (topical TXA alone, n = 80). The demographic and clinical information, operative time, intraoperative bleeding volume, estimated total blood loss (eTBL), hidden blood loss (HBL), trends in hemoglobin, hematocrit, postoperative pain scores using a numeric rating scale (NRS), and adverse events were analyzed. Clinical outcomes were assessed using the Japanese Orthopedic Association score. Results: The ORC powder group had significantly lower eTBL (679.1 ± 230.1 mL vs. 875.8 ± 292.9 mL, p < 0.0001) and HBL (424.1 ± 194.5 mL vs. 558.6 ± 264.2 mL, p = 0.002). Postoperative pain scores at postoperative day 7 were lower in the ORC powder group (1.9 ± 1.6 vs. 2.9 ± 2.2, p = 0.009). The clinical outcomes were excellent, and no significant differences were observed in complication rates between the groups. Conclusion: ORC powder effectively reduced perioperative blood loss in THA via the DAA without increasing complication rates. ORC powder has the potential to be a valuable adjunct in optimizing blood management strategies in THA
Cemented dual mobility cup for primary total hip arthroplasty: survival and quality of life. A multicenter study
No full textIntroduction: Dual mobility cups are characterized by having a prosthetic head inside a polyethylene core that later articulates with a metal cup implanted in the acetabulum. These cups can be cemented or uncemented. This study aimed to determine the survival of a cemented dual-mobility cup (CDMC) with a cobalt-chromium head (CoCr) and the quality of life (QOL) of operated patients. Methodology: Multicenter historical cohort study where survival and QOL were estimated. The cohort includes patients who underwent a primary total hip arthroplasty (THA) with a CDMC and CoCr head. The patients were operated on between 2011 and 2013. Results: 40 patients from 6 institutions with a median age of 81 (IQR 22.25) years. The results in the Kaplan-Meier estimation showed a survival of 94.2% (95% CI [86.6% – 100%]) at 5 years and a maximum follow-up of 9.5 years. Three failures occurred (two dislocations and one mechanical loosening), and Oxford Hip Scale (OHS) of 41.5 (IQR 10.50) points was recorded. Conclusions: In terms of survival and the score obtained in the OHS, the CDMC has comparable results with the scientific literature found on uncemented dual mobility cups. This demonstrates adequate results in patients with a maximum follow-up of 9.5 years
Safety and early outcomes of simultaneous bilateral TKA in patients with BMI > 40: A retrospective comparative study
No full textIntroduction: Simultaneous bilateral total knee arthroplasties (SBTKA) are common in Asia, but surgeons may have a body mass index (BMI) threshold for performing these procedures. However, no guidelines regarding patient weight and SBTKA exist in the literature. We hypothesized that SBTKA can be performed safely and efficiently for morbidly obese patients. We aimed to compare 1) the rate of complications within one year after surgery, 2) operative time, blood loss, and length of stay, and 3) clinical outcomes at one year after SBTKA in patients with BMI 40. Methods: In this retrospective comparative matched (age, ASA score) study, we evaluated 113 patients who underwent SBTKA (posterior stabilized cemented TKA), between 2019 and 2022. The patient population was grouped based on their BMI: BMI 40 (37 patients). A complication was defined as an event that could be classified as a grade > 3 according to the Clavien-Dindo classification within one year of surgery. Data on complication rate, operation time, blood loss, and preoperative and post-operative function KSS at one year were compared. Results: No significant difference in the occurrence of early complications between the three groups was observed. One patient was readmitted for periprosthetic fracture in the BMI 40 is safe, with no increased complications, similar surgical time, and blood loss. Significant functional improvement was observed at one year postoperatively. While promising, further multi-center studies are needed to confirm these findings and evaluate long-term outcomes
Cutaneous metallosis following ceramic insert fracture in total hip arthroplasty: a case report and revision with ceramic-on-ceramic bearing couple
No full textCeramic fractures in total hip arthroplasty (THA) are rare complications that pose significant challenges for revision surgery. This case report describes a 68-year-old male who experienced a spontaneous alumina (ceramic) insert and head fracture four years after the initial THA. The first revision with cobalt-chrome and polyethylene components led to severe metallosis, including subcutaneous tissue discoloration. A second revision utilized a ceramic-on-ceramic (CoC) bearing couple, resulting in excellent functional outcomes and resolution of symptoms. Cutaneous pigmentation post-THA is rare and has not been previously reported following a ceramic fracture. The case underscores the need for careful material selection in revision surgery to minimize complications such as metallosis. The decision to use a ceramic-on-ceramic bearing couple in this case proved effective, ensuring durability and reducing the risk of third-body wear, which can result from inadequate management of ceramic fractures and lead to joint, systemic, or cutaneous complications
Predicting survival outcomes in dedifferentiated chondrosarcoma: a prognostic factor analysis from a National Registry
No full textIntroduction: Dedifferentiated chondrosarcoma (DDCS) is a high-grade subtype of chondrosarcoma with a poor prognosis. Treatment for localized DDCS generally involves wide resection; the effectiveness of adjuvant radiotherapy and chemotherapy is questionable. This research was designed to find prognostic factors for DDCS and evaluate the impact of adjuvant therapies on localized cases. Methods: One hundred thirty-two patients with DDCS diagnosed by pathology in the period 2006 to 2022 were identified in the Japanese National Bone and Soft Tissue Tumor Registry database and were retrospectively analyzed. Results: Patients with distant metastases at diagnosis (n = 34) had significantly poorer survival than those without metastases (n = 98), with a 5-year disease-specific survival (DSS) of 9.7% vs. 37.1% (P < 0.0001). For patients without distant metastasis at diagnosis, uni- and multivariate analysis showed that R1 or R2 surgical margin was an independent risk factor linked with unfavorable local recurrence (hazard ratio [HR] 3.39 [95% CI: 1.35–8.52]; P = 0.010). Adjuvant radiotherapy was not associated with local recurrence (HR 2.41 [95% CI: 0.87–6.64]; P = 0.090). Larger size (HR 1.13 [95% CI: 1.06–1.19]; P < 0.001) and no surgery (HR 3.87 [95% CI: 1.61–9.28]; P = 0.002) were independent risk factors for unfavorable DSS. Previous surgery (HR 0.19 [95% CI: 0.04–0.84]; P = 0.028) and adjuvant chemotherapy (HR 0.36 [95% CI: 0.16–0.77]; P = 0.009) were independent risk factors for favorable DSS. Discussion: Survival may have been improved by chemotherapy, but the effect of adjuvant radiotherapy in controlling the local spread of the tumor appears to have been limited in DDCS cases that were localized
Current concepts in total knee arthroplasty: Rotating hinge prostheses
No full textThis narrative review evaluates the purpose and functionality of rotating hinged total knee arthroplasty (RHTKA). The main indications for an RHTKA are poor bone stock, soft tissue compromise, gross instability, and periprosthetic fractures. Studies have shown that an RHTKA may be used in both the primary and revision scenarios to improve the range of motion and functional outcomes. Radiostereometric analysis has shown that some RHTKA designs are associated with early femoral component micromotion, but this has not translated to increased failure or revision rates. Implant survivorship with a modern RHTKA is comparable to a condylar-constrained TKA at mid-term follow-up. The most common complications associated with RHTKA are aseptic loosening, periprosthetic joint infection, stiffness and periprosthetic fractures
Inferior outcome of stand-alone short versus long tibial stem in revision total knee arthroplasty. A retrospective comparative study with minimum 2 year follow-up
No full textIntroduction: Revision Total Knee Arthroplasty (RTKA) is complex, and induced bone loss might endanger implant fixation and joint stability. Intramedullary stems improve fixation throughout stress redistribution. The current study aims to compare the performance of short tibial stems with long tibial stems, investigating their intermediate-term radiographic and survival outcomes in RTKA. The main hypothesis is that the two types of tibial stems would exhibit similar complication and revision rates in mid-term follow-up. Methods: Patients who underwent RTKA for all causes in a specialized arthroplasty center from 2010 to 2022 with minimum 2-year follow-up were included in this study. Patients receiving mega prosthesis or implants associated with sleeves or cones were excluded. The final groups consisted of 234 knees: 110 patients with short stems (SS) and 124 with long stems (LS). The mean age at surgery was 65.96 ± 8.73 years in SS and 67.07 ± 8.64 years in LS. The mean Body Mass Index (BMI) was 28.95 is SS and 30.88 in LS (p 0.05). Pathological radiolucency was present in 20.91% in SS group and 33.87% in LS group (p < 0.02). Time-to-re-revision was shorter in SS group and occurred at a mean of 3.1 years, while LS failed at a mean of 5.1 years (p < 0.001). Conclusions: The SS and LS may be comparable in terms of complications and re-revision. SS significantly fails almost 2 years earlier than long stem (p < 0.001). Additionally, there is a higher tendency for re-revision due to loosening in patients who present pathological radiolucency in SS group. To obtain the benefits of short stem and improve the longevity of the construct; adjuvant zone II (metaphyseal) fixation might be the clue
Surgical outcomes and complication rates in severe scoliosis: a systematic review
No full textBackground: Correcting severe scoliosis is challenging due to curve rigidity and risks to cardiopulmonary and neurologic function. Osteotomy techniques offer greater correction but carry higher complication rates, while non-osteotomy methods may be safer but less effective. This systematic review compares outcomes between osteotomy and non-osteotomy approaches in treating severe idiopathic scoliosis. Methods: A systematic search was conducted in PubMed, EMBASE, and the Cochrane Library using MeSH terms related to “idiopathic adolescent scoliosis”, “AIS”, “severe scoliosis”, and “surgical outcome”. The review followed PRISMA guidelines. Results: An initial search yielded 565 studies, of which 23 studies (n = 932 patients) met the inclusion criteria. The Vertebral Column Resection (VCR) group achieved the greatest spinal correction, with a mean Cobb angle of 106.7 ± 9.7° and a correction rate of 62.1%, but also had the highest complication rate at 24%. Non-osteotomy methods provided similar correction (107.0 ± 9.1°, 61.5%) with a slightly lower complication rate of 19.6%. The Ponte osteotomy group had the lowest complication rate (4%) with a moderate level of correction (107.4 ± 10.5°, 60.3%). In terms of functional outcomes, the non-osteotomy group reported the highest SRS-22r scores, averaging 4.3. Conclusion: VCR offers the most significant curve correction, but with a higher complication rate. Ponte osteotomy provides a safer alternative with acceptable clinical outcomes. In contrast, non-osteotomy techniques strike a balance between correction and risk, with favorable functional results
Retrospective study of complications following two-stage bilateral total hip arthroplasty: does inter-stage interval matter?
No full textIntroduction: This study analyzed complication rates in two-stage bilateral Total Hip Arthroplasty (THA) across three distinct inter-stage intervals to determine the optimal timing for minimizing risk. Methods: This was a retrospective, multicentre, analytic study. The three intervals evaluated were 12 weeks (Group C). The primary outcomes were blood transfusions, thromboembolic events (TVE), and coronary events, and the secondary outcomes were hospital stay, respiratory complications, reintervention, and mortality. The associations between demographic characteristics and complications and the risk hazard of complications were determined. Results: A total of 331 patients were included: 86 in Group A, 47 in Group B, and 198 in Group C. Blood transfusions after the second THA were performed in 29.1%, 14.9%, and 7.6% of the time interval groups respectively (p = 0.000). One TVE (1.1%) was recorded in group A and 4 (2%) in group C (p = 0.613). Conclusions: Two-stage bilateral THA with a time interval between both surgeries of <2 weeks presented a significantly higher rate of blood transfusions than longer time intervals between surgeries, with an HR of 2.4 (CI: 95% 1.7–3.3, p = 0.000). The incidences of thromboembolic and coronary events were similar between the different timeintervals, demonstrating that two-stage bilateral THA is safe when performed with an interval of at least 2 weeks between both surgeries
The learning curve of novel implant total knee arthroplasty system in high-volume university center
No full textIntroduction: The learning curve associated with adopting new surgical systems in total knee arthroplasty (TKA) can significantly impact surgical efficiency and patient outcomes. This study aimed to evaluate the evolution of operative time with the KNEO® (Groupe Lépine, Genay, France) posterior stabilized knee system and to analyze the learning curve for postoperative complications to achieve surgical proficiency. Method: This retrospective, multicentric study analyzed 481 patients who underwent primary TKA with the KNEO® implant in a high-volume university center between 2020 and 2024. The evolution of operative time and postoperative complications requiring reoperation surgery were evaluated, with a follow-up period extending until January 2025, during which complications were monitored. The study included 481 patients with a mean age of 71.7 ± 8.0 years and a mean Body Mass Index of 29.0 ± 4.0 kg/m2. The cohort comprised 308 female (64%) and 173 male (36%) patients. Results: The mean operative time significantly decreased from 83.5 min in the initial case to 63.0 min after 481 cases (p < 0.001). The learning curve showed an initial learning phase with high variability, followed by stabilization around 150 procedures and subsequent optimization. Postoperative complication rates showed a 31.9% reduction per group of 100 patients (β = −0.3848, p = 0.0075), indicating improved surgical proficiency and patient safety over time. Conclusion: The findings suggest that the KNEO® system follows a measurable learning curve, with operative efficiency and complication rates improving as case volume increases. These results emphasize the importance of structured training and experience accumulation in optimizing patient outcomes when implementing new implant technologies