SICOT-J - Société Internationale de Chirurgie Orthopédique et de Traumatologie
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Prevalence and demographic correlates of Methicillin-Resistant
No full textBackground: Methicillin-resistant Staphylococcus aureus (MRSA) remains a significant concern in orthopedic surgery, particularly in total knee replacement (TKR), where infection can lead to severe complications. In procedures like TKR, where implants act as a foreign body and potential surface for biofilm formation, infections can lead to severe complications, including delayed healing, and implant failure, and often need multiple revision surgeries. Screening for MRSA before surgery has become a standard practice in many hospitals to reduce the risk of infection. This study aims to evaluate the prevalence of MRSA in patients undergoing TKR and analyze demographic characteristics. Methods: A retrospective analysis was conducted on patients scheduled for TKR. Demographic data, including age, gender, and other relevant clinical information, were extracted from the patient’s medical records. MRSA screening was performed as part of the preoperative protocol, and the results were recorded. Descriptive statistics were used to summarize the data and calculate the prevalence of MRSA. Results: A total of 938 patients underwent MRSA screening prior to TKR. The mean age was 67.25 years (median: 68; range: 33–87). The majority of patients were female, accounting for 706 (75.0%), while 232 (25.0%) were male. MRSA test results revealed that 938 (99.3%) patients tested negative, whereas 6 (0.7%) tested positive. Among MRSA-positive patients, all were aged 60 years or older, suggesting a potential correlation between advanced age and MRSA positivity. Conclusion: This study found a low MRSA prevalence (0.7%) in TKR patients, with all cases occurring in individuals aged ≥60 years. The findings advocate prioritizing preoperative screening in older patients to optimize resource use in low-prevalence settings and highlight the need to investigate TKR-specific risk factors for tailored infection control strategies
Rotating-platform deep-dish total knee arthroplasty with restricted kinematic alignment: Five-year clinical and functional outcomes
No full textIntroduction: Total knee arthroplasty (TKA) utilizing deep-dish tibial inserts has gained interest due to its high congruency and enhanced stability. However, due to the advent of more personalized alignment philosophies, the combination of a rotating-platform deep-dish TKA design with restricted kinematic alignment (rKA) might improve patient satisfaction. Therefore, this study evaluated the five-year clinical and functional outcomes of rKA with a deep-dish TKA design. Methods: A retrospective analysis was conducted on patients who underwent primary TKA with a rotating-platform deep-dish design and rKA. Of 143 eligible patients, 123 completed five-year follow-up. Clinical and radiographic assessments included the five-year postoperative results: Knee Society Score (KSS), patient satisfaction, range of motion, coronal limb and implant alignment, postoperative complications and implant survivorship. Statistical analyses compared preoperative and postoperative outcomes with paired analyses. Results: Median KSS Knee and Function scores significantly improved from 70 (IQR 5) and 60 (IQR 26) preoperatively to 90 (IQR 20) and 93 (IQR 21) postoperatively (p < 0.001). Postoperative coronal alignment in this study encompassed a hip-knee-ankle angle was 178.1° ± 3.5, a Lateral Distal Femoral Angle of 89.9° ± 2.6, and a Medial Proximal Tibial Angle of 88.6° ± 2.2. At five years, 94% of patients were either satisfied or very satisfied. The revision-free survival rate was 98%. Periprosthetic joint infection and arthrofibrosis were the most common complications (1.6% for both groups separately), followed by aseptic loosening of a cementless femoral component (0.8%) and patellar dislocation (0.8%). Discussion: Rotating-platform deep-dish TKA with restricted kinematic alignment results in excellent functional outcomes, high patient satisfaction, and low complication rates at five-year follow-up. These findings support its viability as a surgical strategy, though long-term studies are warranted to assess implant durability and survivorship beyond 10 years
Radiotherapy after surgery for spinal metastasis is associated with superior neurological improvement as compared to surgery alone
No full textIntroduction: Treatment of spinal metastases is multidisciplinary, where radiotherapy (RT) and surgery have a central role. The effect of adjuvant post-operative RT versus surgery alone for metastatic spinal disease has not been previously investigated. Our aim was to analyze whether post-operative RT was associated with better functional outcome or increased incidence of local complications after surgical treatment for spinal metastatic disease. Methods: Information on neurologic outcome of 200 patients surgically treated for spinal metastases was retrieved from the institutional registry. The events of pre-operative and post-operative neurological function, post-operative wound complications as well as death and implant revision were available. Results: Post-operative RT was significantly associated to superior neurological recovery, evaluated both as restoration of the ambulatory capacity and absolute change in the Frankel score. At the same time, use of post-operative RT was not associated to an increased risk of wound complications. The risk for revision surgery when RT was administered was similar to surgery alone in a competing risks analysis with death as the competing event. Discussion: The results indicate that surgery with post-operative RT is associated with superior neurologic recovery than surgery alone. The results also do not indicate any significant risk for wound healing problems with administered post-operative RT
Does the change between the native and the prosthetic posterior tibial slope influence the clinical outcomes after posterior stabilized TKA? A review of 793 knees at a minimum of 5 years follow-up
No full textIntroduction: The understanding of the influence of posterior tibial slope (PTS) on knee kinematics has increased. However, the PTS influence on clinical outcomes remains unclear. The study aimed to evaluate whether a significant change between the native and the prosthetic tibial plateau PTS influences functional results and the risk of complications following total knee arthroplasty (TKA). Methods: This was a retrospective, monocentric comparative study. Clinical and radiological data from 793 knees were collected from a prospective surgical database. Inclusion criteria were patients operated with a posterior-stabilized TKA (PS-TKA) for primary tibiofemoral osteoarthritis, with or without associated patellofemoral osteoarthritis, or osteonecrosis of the femoral condyle or tibial plateau, with a minimum follow-up of 5 years. Range of motion and International Knee Society (IKS) score as well as radiological measurements were collected preoperatively and postoperatively at each follow-up visit. Two groups were composed according to the change in PTS between pre- and post-op (Group 1: ≤10°, n = 703; Group 2: >10°, n = 90). Results: The mean follow-up was 75.5 months ± 9.1. The mean change in PTS from preoperative was 4.96° ± 3.24 in group 1 and 12.7° ± 1.87 in group 2. There was no significant difference in the mean IKS Knee subscore (89.5 ± 10.7 and 89.7 ± 10.2, p = 0.89) and mean IKS Function subscore (88.2 ± 15.7 and 86.3 ± 16.6, p = 0.33) in groups 1 and 2, respectively. Postoperative maximum flexion was very satisfactory in both groups with no clinically relevant difference (120.0 ± 11.9 and 123.0 ± 8.3, p = 0.026). The complication rate was 5.0% (n = 40) (5.5% in group 1; 1.1% in group 2; p = 0.07) while the most common complication requiring further procedure was deep infection (n = 9, 1.1%) and the second most common was stiffness (n = 6, 0.8%). Discussion: PTS did not influence postoperative maximum flexion or clinical scores and was not associated with a higher complication rate at a minimum 5-year follow-up after PS-TKA
Implant survival and risk factors for failure after proximal femoral megaprosthetic reconstruction
No full textBackground: Proximal femoral megaprosthetic reconstruction is a well-established solution for extensive bone loss in the hip region. Despite its utility in limb salvage, it carries notable complication rates, reported between 30% and 40%, along with increased morbidity and mortality. This study evaluated implant and patient survival, failure modes, and associated risk factors. Methods: We retrospectively reviewed 165 patients who underwent proximal femoral megaprosthetic reconstruction between 2003 and 2023. Indications included primary bone tumors (n = 67), metastatic bone disease (n = 60), and non-oncologic conditions (n = 38). A total of 57 METS (Stanmore) and 108 MUTARS (Implantcast) implants were used. Median follow-up was 5 years (range: 0.25–17 years). Results: Mean implant survival was 5.13 years (range: 0.2–17 years), with an overall complication rate of 30.9%. The most common failure modes were type 1 (11.5%) and type 4 (13.3%) per Henderson classification. Five-year implant survival ranged from 60% to 70% across indications. Independent risk factors for type 4 failure included prolonged hospitalization (OR = 1.07, p = 0.020) and longer operative time (OR = 1.01, p = 0.023). Silver-coated implants showed a trend toward reduced infection (OR = 0.18, p = 0.29), though not statistically significant. METS implants were associated with lower type 1 failure risk (OR = 0.09, p = 0.020), with a soft-tissue failure rate of 3.5% versus 15.7% for MUTARS. Conclusion: Proximal femoral megaprostheses remain effective for limb salvage but are linked to a substantial complication burden. Recognition of modifiable and patient-specific risk factors may improve surgical outcomes and reduce failure rates
Tell or hide the truth from patients? The role of bioethics in medicine
No full textPhysicians often grapple with the delicate balance between providing full disclosure and shielding patients from harsh realities. Honesty, empathy, and patient-centered care are crucial elements influencing patient outcomes and well-being. The revelation process of life-threatening diseases triggers distinct psychological coping stages, emphasizing the need for sensitive communication. Cultural factors further shape communication dynamics, necessitating individualized approaches. As such, this paper discusses the need for truth in the relationships and interactions of doctors and patients, emphasizes adequate information of patients based on honesty and consideration of their expectations, environment, and cultural values, and explores the pivotal role of bioethics education and training in preparing medical professionals to navigate these complex situations. By integrating bioethics education into medical curricula, fostering open and honest communication, and building strong patient-doctor relationships, we can enhance the quality of care and empower patients to embrace their medical journey with dignity and acceptance
Impact of screw reinsertion on osteosynthesis stability in Schatzker IV tibial plateau fractures: a biomechanical study
No full textIntroduction: This biomechanical study evaluated the effect of screw reinsertion with a locking plate on fixation strength and the stability of osteosynthesis in medial tibial plateau fractures using porcine bone. Materials and methods: Thirty porcine tibiae were divided into three groups: group A (underwent biomechanical testing after medial tibial fixation with a large fragment T-shaped locking plate), group B (underwent plate fixation, followed by the removal of all screws and plates and refixation with the same screws and plates using the same holes before biomechanical testing), and group C (underwent biomechanical testing once after plate fixation, followed by the removal of all screws and plates, refixation with the same screws and plates using the same holes, and then biomechanical testing). The translation pattern of the constructs in each group was examined using cyclic loading tests. The changes in the joint gap and step-off after 2000 cycles were compared among the three groups. Results: Significant differences in displacement were observed at 10–100 cycles (group A: −0.01 ± 0.04 mm, group B: −0.02 ± 0.04 mm, group C: −0.13 ± 0.15 mm, P = 0.021). However, no significant differences were found in other displacement and translation measurements among the groups. Regarding the gap and step-off among groups, significant differences were observed in anterior and posterior gap changes. Despite the statistical significance, the absolute displacement values were small, suggesting minimal clinical relevance. These findings indicate that reinserting screws and plates into the same hole may not substantially compromise overall fixation strength. Conclusion: Screw reinsertion in the same holes after removal did not significantly compromise the stability of osteosynthesis in this biomechanical model. These findings suggest that reinsertion may be a viable option in revision surgery
Lateral approach in robotic total knee arthroplasty for valgus knees: A step-by-step technique
No full textTotal knee arthroplasty (TKA) in valgus knee deformities presents unique challenges, including alignment, soft tissue balance, and implant positioning. The lateral approach offers advantages over the traditional medial approach by improving direct access, patellar tracking, and soft tissue preservation. Robotic-assisted TKA enhances precision, ligament balancing, and patient-specific alignment strategies, such as functional knee positioning (FKP). This study describes a surgical technique integrating the lateral approach with robotic-assisted TKA using FKP principles. The technique is based on an image-based robotic system, ensuring accurate preoperative planning, intraoperative adjustments, and optimized prosthetic placement. Key intraoperative steps, including bone resection strategies, soft tissue balancing, and trial component evaluations, are detailed. The lateral robotic approach with FKP was found to be effective and reproducible, allowing for precise implant alignment and optimized soft tissue balance in valgus knees. This method minimizes the need for extensive lateral releases, preserves vascularity, and ensures postoperative stability. The combination of the lateral approach, robotic-assisted TKA, and FKP represents a promising strategy for valgus knee deformities. Further long-term studies are needed to validate the durability and functional benefits of this technique
Retrograde femoral nailing for deformity correction and fracture treatment in osteogenesis imperfecta: clinical and radiological assessment of a novel technique
No full textIntroduction: Intramedullary anterograde femoral nailing is a standard treatment for femoral deformity and fracture in osteogenesis imperfecta (OI). This study evaluates the clinical and radiological outcomes of a novel retrograde femoral nailing technique. Methods: A retrospective analysis was performed on 31 patients with OI who underwent retrograde femoral nailing using Dubow–Bailey nails from 2004 to 2019. A total of 54 femurs were treated for femoral deformity or fracture by three senior surgeons, with a mean follow-up of 2.7 years. Clinical outcomes, including knee range of motion and pain, were assessed. Radiological outcomes included deformity angle (DA), neck shaft angle (NSA), mechanical lateral distal femoral angle (mLDFA), and nail positioning on AP and lateral X-rays. Potential complications, including hip osteonecrosis, distal femoral growth arrest, and infections, were also evaluated. Results: The procedure showed favorable outcomes, with no postoperative knee motion limitations or persistent pain. The mean pre-operative DA on AP and lateral views was 29° and 40°, respectively, with no residual deformity after surgery. The mean NSA and mLDFA were 132° and 101° before surgery, compared to 143° and 89° post-operatively. Nail alignment was optimal in 81% of the femurs, with proper positioning in both the distal epiphysis and femoral neck. No cases of hip osteonecrosis, distal femoral growth arrest, or infection were reported. Hardware migration occurred in seven cases. Conclusion: Retrograde femoral nailing is a safe and effective technique for managing femoral deformities and fractures in OI
Posterior arthroscopic subtalar arthrodesis without bone graft preserves hindfoot height and function
No full textPurpose: This study aimed to assess hindfoot height (HFH) changes 12 months after posterior arthroscopic subtalar arthrodesis without bone grafting. We hypothesized that HFH reduction would be minimal and would not impact fusion or functional results. Methods: A retrospective study was conducted on 39 patients who underwent posterior arthroscopic subtalar arthrodesis. HFH was measured on CT scans preoperatively and at 12 months postoperatively. Inter- and intra-observer reliability of the measurement was also assessed as a secondary outcome. Clinical outcomes included pain (numeric analog scale, NAS) and AOFAS Ankle-Hindfoot scores. Subtalar fusion ratios were evaluated via CT. Results: Mean HFH loss was 0.85 ± 1.1 mm (range, 0–5 mm). The average fusion ratio was 72 ± 30%. Pain and AOFAS scores significantly improved (NAS: −4 ± 2, p 1 mm was more frequent in women and smokers. HFH measurement on CT showed excellent inter- and intra-observer reliability (ICC intra: 0.989; inter: 0.976). Conclusions: Posterior arthroscopic subtalar arthrodesis without bone graft results in minimal hindfoot height loss, with no negative impact on subtalar fusion or functional outcomes. This technique reliably preserves hindfoot alignment and provides excellent clinical results. While the assessment of hindfoot height on CT demonstrated excellent inter- and intra-observer reliability, this was a secondary finding and supports the utility of CT-based measurements in the postoperative evaluation of subtalar arthrodesis