Hospital For Special Surgery Research Articles

The effectiveness of cruciate-retaining versus posterior-stabilized designs on extensor mechanism function and knee function in patients after simultaneous bilateral total knee arthroplasty: A two-year retrospective follow-up study

IntroductionThe importance of the posterior-cruciate ligament in knee functionality is known; however, the effect of preserving the posterior-cruciate ligament in total knee arthroplasty (TKA) on extensor mechanism function and knee function is not clear. We aimed to compare extensor mechanism function and knee function between patients operated with the cruciate-retaining and posterior-stabilized designs for simultaneous bilateral TKA. HypothesisPatients operated with the cruciate-retaining design would produce better outcomes than those operated with the posterior-stabilized design. Materials and methodsA total of 104 patients were divided into two groups as the cruciate-retaining (n=52) and posterior-stabilized (n=52) groups. The groups were compared for extensor mechanism function (chair-rise test) and knee function (Hospital for Special Surgery [HSS] knee score). The follow-up points were six weeks, three months, six months, one year and two years. ResultsNo statistically significant effect on chair-rise performance of the group-by-time interaction (χ2 [5, n=104]=5.32, p=.37) or of group (χ2 [1, n=104]=1.69, p=.19). In the HSS knee score, the group-by-time interaction was statistically significant (F [5.510]=6.24, p<.001). A statistically significant difference of 7.4 points in favor of the posterior-stabilized group was found at six weeks (p=.002). No statistically significant differences were found between the groups at the other follow-up points. DiscussionThe cruciate-retaining and posterior-stabilized designs have similar outcomes with regard to extensor mechanism function and knee function in the long-term period in patients who underwent simultaneous bilateral TKA. In the short-term period, the posterior-stabilized design shows better knee function than the cruciate-retaining design. Level of evidenceIII; a retrospective study.

3D printing combined with anteroposterior cannulated screws for the treatment of posterolateral tibial plateau fracture

PurposeThis study aimed to compare the effects of conventional surgery and three-dimension (3D) printing technology-assisted surgery in the treatment of posterolateral tibial plateau fractures (PTPF).MethodsA cohort of 61 patients afflicted with PTPF, spanning from June 2015 to October 2021, was enrolled. They were divided randomly into two groups: 31 cases of 3D printing group, 30 cases of conventional group. The personalized 3D-printed models were used to simulate the surgical procedures in 3D printing group. The demographic characteristics and clinical data were recorded, encompassing operation duration, intraoperative blood loss, intraoperative fluoroscopy shoots and fracture union time. The radiographic outcomes were gauged, encompassing tibiofemoral angle (FTA), tibial plateau angle (TPA), posterolateral slope angle (PSA) and Rasmussen’s anatomical score. The functional outcomes were assessed at the 12-month postoperative juncture, encompassing range of motion, Hospital for Special Surgery (HSS) score and Rasmussen’s functional score. Furthermore, fracture complications were evaluated,, encompassing infections, traumatic osteoarthritis, and delayed union.ResultsThe 3D printing group exhibited the operation time of 95.8 ± 30.2 min, intraoperative blood loss of 101.1 ± 55.3 ml, and intraoperative fluoroscopy shoots of 6.3 ± 2.3 times, while the conventional group recorded respective values of 115.5 ± 34.0 min, 137.0 ± 49.2 ml and 9.13 ± 2.5 times. Noteworthy disparities were evident between the conventional and 3D printing groups (p < 0.05). Furthermore, in comparison to the conventional group, the 3D printing group exhibited commendable radiological and functional outcomes both immediately and 12 months post-surgery, although statistical significance was not attained. Moreover, the 3D printing group experienced a paucity of complications compared to the conventional group, although without achieving statistical significance.ConclusionThis study demonstrated the clinical feasibility of 3D printing combined with anteroposterior cannulated screws for the treatment of posterolateral tibial plateau fracture.

Evaluation of Patient Expectations for Surgical Treatment of Degenerative Disease of the Lumbosacral Spine

Objective. To determine the main demographic factors that influence preoperative expectations of patients with degenerative diseases of the lumbosacral spine.Material and Methods. A cross-sectional study was performed for 103 patients with degenerative diseases of the lumbosacral spine who were scheduled for surgery in the period from 2019 to 2021. General demographic data, level of patient’s education and the presence of previous surgeries were taken into account. Expectations for surgical treatment outcome were assessed using a translated and adapted Russian version of the Hospital for Special Surgery – Lumbar Spine Surgery Expectations Survey (HSS-LSSES) questionnaire. The quality of life of patients was assessed using the general questionnaires: European Quality of Life-5 Dimensions (EQ-5D-5L) and the 36-item Short-Form Health Survey (SF-36), as well as the disease-specific Oswestry Disability Index (ODI).Results. It was found that, according to HSS-LSSES, patients’ expectations for the upcoming surgical intervention are the higher, the older the patient’s age, the higher the general and emotional state of health, vitality, ODI scores, as well as the severity of pain syndrome, and the lower the mental health score. Patients with a high level of education and prior spinal surgery have lower expectations for subsequent surgery.Conclusion. The expectations of patients for the surgical treatment for degenerative disease of the lumbosacral spine depend on the patient’s age, level of education, anamnesis and severity of decline in the quality of life.

Evaluating Failure Mechanisms for Total Talus Replacement: A Case Series

Category: Ankle Arthritis Introduction/Purpose: Talar collapse can occur from a variety of etiologies and may pose a unique challenge to the foot and ankle surgeon due to the complexity of the deformity and associated adjacent joint degenerative change. Total talus replacement (TTR) has emerged as an attractive option to help patients return to activities sooner than with arthrodesis and improve pain and joint mechanics postoperatively. However, there is limited long-term data on the most recent generation of implants. In this multi- institution case series, we present the severe complications that can occur after TTR, including instability, infection, and adjacent joint osteoarthritis. Methods: We present three cases from Duke University Hospital in Durham, North Carolina, and the Hospital for Special Surgery In New York City, New York. All three patients were treated with a total talus replacement (TTR) during their clinical course and experienced subsequent complications. Clinical data and radiographs were collected from chart review under an IRB-exempt protocol. Results: Case 1 demonstrates the risk of ligamentous insufficiency leading to dislocation following placement of a TTR. This case highlights the posterior instability due to soft tissue mobilization and division. Case 2 highlights the risk for adjacent joint degeneration with TTR. Case 3 presents an instance of non-union following a total ankle and total talus replacement (TATTR) with subtalar arthrodesis. To our knowledge, this represents the first case of nonunion following TTR in the literature. Finally, we discuss our institution’s experience with infection following TTR and possible contributing factors to this specific procedural risk. Conclusion: TTR shows promise in the properly selected patient with end-stage talar collapse. However, heterogeneous surgical techniques, implant composition, indications, and patient demographic variables complicate the interpretation of the literature. Moreover, few studies report mid-to long-term outcomes after this procedure and the occurrence of adjacent joint OA is likely underreported in the literature. Thus, until further, high-quality studies with long-term follow-up validate the positive early outcomes of TTR, we urge extreme caution in patient selection, choice of implants, and surgical techniques.

Analysis of the Influence of Knee Joint Balancing Manipulation on the Rehabilitation of Patients after Total Knee Arthroplasty

This paper aims to explore the clinical effect of knee-balancing manipulation after total knee arthroplasty. A total of 84 patients with total knee arthroplasty in our hospital were selected. The time of admission and treatment was from March 2021 to March 2023. They were divided into the study group (n = 42) and the control group (n = 42) by lottery method with a digital table. The patients in the control group received conventional rehabilitation, and the patients in the study group received balancing manipulation of the knee joint. The Hospital for Special Surgery (HSS) knee function score and gait indicators were compared between the two groups. The HSS score of patients in the study group was higher than that in the control group at 2 weeks after operation (P &lt; 0.05). The gait indexes of patients in the study group were higher than those in the control group at 2 weeks after operation (P &lt; 0.05). Knee-balancing manipulation after total knee arthroplasty can improve knee joint function and restore gait, which has the value of popularization and application.

Observation on Curative Effect of Minimally Invasive Osteotomy Combined with Ilizarov Technique in the Treatment of Knee Osteoarthritis with Varus Deformity

This paper aims to analyze the clinical efficacy of minimally invasive osteotomy combined with Ilizarov technique in the treatment of knee osteoarthritis with varus deformity. 80 patients with knee osteoarthritis and varus deformity who were treated in our hospital from January 2022 to May 2023 were selected, all of whom were affected by one knee. They were randomly divided into groups, including the study group and the control group, each with 40 patients. Patients in the control group were treated with fibula-tibial osteotomy and internal fixation, and patients in the study group were treated with minimally invasive osteotomy combined with Ilizarov technique. The operation time of the patients in the study group was significantly longer than that of the control group (P &lt; 0.05). The intraoperative blood loss of the patients in the study group was significantly more than that of the control group (P &lt; 0.05). The hospitalization expenses of the patients in the study group were significantly more than those of the control group (P &lt; 0.05). The postoperative femorotibial angle and mechanical axis offset distance in the study group were significantly smaller than those in the control group (P &lt; 0.05). The postoperative New York Hospital for Special Surgery (HSS) scores of the study group were significantly higher than those of the control group (P &lt; 0.05). The postoperative visual analogue scale (VAS) score of the study group was significantly lower than that of the control group (P &lt; 0.05). The range of motion of the knee joint in the study group was significantly greater than that in the control group (P &lt; 0.05). The incidence of tendon injury, infection, and nerve injury in the study group (2.50%) was significantly lower than that in the control group (30.00%) (P &lt; 0.05). Minimally invasive osteotomy combined with Ilizarov technique can be applied in the treatment of knee osteoarthritis with varus deformity, although the operation time is longer, with more intraoperative blood loss and higher treatment cost, but it has no effect on the femorotibial angle and mechanical axis deviation of the patient. It can significantly improve the movement distance, knee joint function, and knee joint range of motion, and significantly reduce the postoperative pain of patients, reduce the incidence of complications, and thus has high clinical application value.

Mapping knowledge landscapes and emerging trends of robotic-assisted knee arthroplasty: A bibliometric analysis.

The robotic-assisted knee arthroplasty has gained increasing attention in the research field. To date, no comprehensive bibliometric analysis has been carried out on this topic. The present study aimed to introduce the research status and hotspots and explore the field of robotic-assisted knee arthroplasty from a bibliometric perspective. The Web of Science Core Collection database was utilized to retrieve articles and reviews on robotic-assisted knee arthroplasty published between 1993 and 2023. CiteSpace, VOSviewer, Scimago Graphica, Pajek, and a bibliometric online analysis platform (http://bibliometric.com/) were employed to analyze the regions, institutions, journals, authors, and keywords, aiming to predict the latest trends in research related to robotic-assisted knee arthroplasty. This study encompasses 697 records. The annual publication count pertaining to robotic-assisted knee arthroplasty demonstrates consistent growth. The United States leads with the highest number of studies (298), trailed by the United Kingdom (110) and France (49). The Hospital for Special Surgery emerges as the most prolific institution, while Professor Mont, Michael A holds significant author influence. The Journal of Arthroplasty reigns supreme in this field, boasting the highest publication and citation figures. Funding sources predominantly include Stryker (34), Smith Nephew (19), and the National Natural Science Foundation of China (17). Noteworthy research themes within robotic-assisted knee arthroplasty encompass patient satisfaction, kinematic alignment, and clinical benefits. The landscape of robotic-assisted knee arthroplasty research is thriving. Anticipated trajectories of research will be geared toward refining the precision of robotic technology and enhancing clinical outcomes within the realm of robotic-assisted knee arthroplasty.

Effectiveness of one-stage total knee arthroplasty in treatment of advanced active knee tuberculosis

To investigate the effectiveness of one-stage total knee arthroplasty (TKA) in the treatment of advanced active knee tuberculosis. The clinical data of 38 patients with advanced active knee tuberculosis who received one-stage TKA between January 2011 and December 2020 were retrospectively analyzed. There were 20 males and 18 females. The age ranged from 20 to 84 years, with an average of 52.8 years. The body mass index ranged from 17 to 36 kg/m 2, with an average of 23.05 kg/m 2. The preoperative C reactive protein (CRP) was (23.49±4.72) mg/L, erythrocyte sedimentation rate (ESR) was (45.95±8.82) mm/1 h. The Hospital for Special Surgery (HSS) score was 48.8±9.1. During the operation, the infected lesions of the knee joint were completely removed, and the operative area was repeatedly soaked with 3% hydrogen peroxide solution and 0.5% povidone iodine solution. The intraoperative pathological examination confirmed the tuberculosis of the knee joint, and systemic anti-tuberculosis treatment was performed. The operation time, postoperative hospitalization stay, postoperative anti-tuberculosis chemotherapy time, and complications were recorded. CRP and ESR were recorded and compared before and after operation. Anteroposterior and lateral X-ray films of the knee joint were taken to evaluate whether the prosthesis had signs of loosening and sinking, and to determine whether there was recurrence of tuberculosis. The knee joint function was evaluated by HSS score. With treatment failure due to any reason as the end event, the survival time of prosthesis was analyzed by Kaplan-Meier survival curve. All operations were successfully completed without fracture, vascular and nerve injury, deep vein thrombosis, and other complications. All incisions healed by first intention after operation. The operation time ranged from 80 to 135 minutes, with an average of 102.76 minutes; postoperative hospitalization stay was 5-16 days, with an average of 9.7 days; the duration of postoperative anti-tuberculosis chemotherapy ranged from 1 to 18 months, and the median duration was 12 months. All 38 cases were followed up 3-133 months (mean, 63.7 months). At last follow-up, CRP was (4.88±1.24) mg/L and ESR was (13.00±2.97) mm/1 h, both of which were significantly lower than those before operation ( t=20.647, P<0.001; t=20.886, P<0.001). During the follow-up, 3 patients (7.89%) had tuberculosis recurrence. Two patients had tuberculosis recurrence due to withdrawal of anti-tuberculosis chemotherapy at 1 and 2 months after operation, respectively. One patient was cured after debridement, preservation of prosthesis and anti-tuberculosis chemotherapy for 12 months, and 1 patient was cured after oral administration of anti-tuberculosis drugs for 12 months. Another 1 patient had recurrent tuberculosis and mixed infection ( Corynebacterium gehreni) at 2 months after operation, and the infection was not controlled after debridement, and finally the thigh was amputated. Except for the patients with recurrent infection, no complications such as prosthesis loosening, periprosthetic fracture, and periprosthetic infection were found. At last follow-up, the HSS score of the knee joint was 86.8±4.8, and the knee joint function significantly improved when compared with that before operation ( t=-31.198, P<0.001). Prosthesis survival time was (122.57±5.77) months [95% CI (111.25, 133.88) months], and the 10-year survival rate was 92.1%. One-stage TKA combined with postoperative antituberculous chemotherapy in the treatment of advanced active knee tuberculosis can achieve satisfactory infection control and joint function.

Meta-analysis of the efficacy and safety of arthroscopic surgery associated with platelet-rich plasma infusion when treating knee osteoarthritis.

To assess the efficacy and safety of arthroscopic surgery associated with platelet-rich plasma (PRP) infusion in treating knee osteoarthritis (KOA). PubMed, EMBASE, ScienceDirect, Cochrane Library, China Knowledge Network Database, China VIP Database, Wanfang Database, and China Biomedical Literature Database online database were searched for the case-control trial of arthroscopic surgery associated with PRP infusion in patients with KOA. During the search period of January 2010 through May 2022, two researchers independently extracted the data. With RevMan5.3, we performed a meta-analysis on the collected data. A total of six clinical controlled studies were included, including 333 individuals. Compared with the control group treated only by arthroscopic surgery, the results showed that the visual analogue scores of patients in the arthroscopic surgery and PRP infusion group were significantly lower at 3, 6 and 12 months after operation, and the Western Ontario and McMaster Universities Osteoarthritis Index were significantly lower at 3, 6 and 12 months after operation (p < .05). The meta-analysis of Hospital for Special Surgery (HSS) knee score and Lisum knee score (LKSS) showed that postoperative HSS score, LKSS score at 3, 6, and 12 months after operation, and SF-36 quality of life score at 6 and 12 months after operation were higher (p < .05). Arthroscopic debridement associated with PRP is more successful in relieving knee pain and enhancing knee joint function than arthroscopic debridement in treating KOA. The treatment scheme deserves to be popularized in clinical practice, but further research and longer interventions will be needed to validate it, using high-quality methods.

The life and legacy of John Robert Cobb: the man behind the angle.

In 1934, Dr. John Robert Cobb moved to New York to serve as the Gibney Orthopedic Fellow at the Hospital for the Ruptured and Crippled, now known as the Hospital for Special Surgery. In this role, Cobb was faced with a unique task that would shape not only his personal career but also the fields of scoliosis and spine care: to design the first scoliosis specialty clinic. He critically reviewed the treatment methods for scoliosis outlined by prior pioneers in spine surgery and kept his own meticulous records of diagnoses, treatments, and radiographs. Cobb's work culminated in major contributions to spine surgery that are highly relevant to this day, including the Cobb angle and the Cobb elevator. In this detailed analysis of the career and academic legacy of Dr. John R. Cobb, the authors examine in detail the historical events surrounding Cobb's great contributions to spine surgery and their lasting impact on our specialty, as well as unique aspects of his personal life. This historical vignette constitutes the first comprehensive analysis of the life, career, and academic legacy of Dr. John R. Cobb, the man behind the angle.

Assessment of knee pain and knee range of motion (ROM) in distal third femur shaft fractures managed with retrograde (RG) intramedullary locking nail: A Retrospective study.

Objective: To assess knee pain and ROM in distal third femoral Fracture managed with RG intramedullary nailing technique. Study Design: Retrospective study. Setting: Ghurki Trust Teaching Hospital, Lahore. Period: November 2020 to March 2021. Material &amp; Methods: 38 patients with extra-articular distal femoral Fracture were surgically treated in our center with an RG IM nail. The functional Outcome of the knee for knee pain and knee ROM was assessed using a modified Hospital for Special Surgery (HSS) Knee Score. Results: In this study, a total of 38 patients were diagnosed with distal third femur shaft fractures managed with retrograde (RG) intramedullary locking nail; among these, 31(81.6%) were males, and 7(18.4%) were females. The mean age of patients was 29.76±11.87, ranging from (16-50) years. In more than half of the cases, 30(78.9%) had a history of injury as RTA and 8(21.1%) sustained fall. The right side effected 65.8% of cases compared to the left side. 60.53% of cases had excellent functional Outcomes due to HSS sore between 85-100, 7.89% had good Outcomes because of scores ranging from 70-84, 26.32 had fair, and 5.285 had poor outcomes, respectively. There was no case with extension lag. Conclusion: Based on this study, RG IM nail fixation of distal extra-articular femur fracture can be safely performed, and improved knee function score can be anticipated with meticulous patient selection and adherence to proper postoperative physical therapy protocol.

Long-term Outcomes after Medial Open Wedge High Tibial Osteotomy - A Retrospective Study of 69 Patients.

High tibial osteotomy (HTO) is a widespread option to avoid or delay total knee arthroplasty (TKA). The present study aimed to assess the long-term survival rate and postoperative subjective knee function after isolated medial open wedge HTO in patients with symptomatic medial compartment knee osteoarthritis (OA) and varus malalignment.Sixty-nine patients (48.8±6.7, 35-66 years; preoperative mechanical tibiofemoral angle [mTFA] -5.3±3.4; -14.9-0.0° varus) treated with medial open wedge HTO using a TomoFix plate were included in this retrospective study, with a follow-up of at least 10 years (11.8±1.0 years). The survival rate after HTO was calculated after 5 and 10 years. Subjective knee function was assessed using Hospital for Special Surgery (HSS), Oxford knee, Lequesne, and Lysholm scores.Thirty-three patients underwent conversion to TKA, on average, 7.0±3.4 (1.3-13.7) years after HTO. Five- and ten-year survival rates were 84.1 and 60.9%, respectively. Patients without conversion to TKA showed a Lysholm score of 64.5 (35-92), Lequesne score of 7 (1-13), HSS score of 71 (56-86), and Oxford knee score of 38.5 (25-44) at the last follow-up (more than 10 years). Significantly higher scores were registered at the last follow-up compared to the preoperative state regarding the Lysholm score (preoperative: 43.5 [12-95]; follow-up: 64.5 [35-92]; p<0.001). The HSS score (preoperative: 69.5 [43-93]; follow-up: 71 [56-86]; p=0.6941) showed no statistically significant change during the 10-year follow-up period. The Lequesne score was significantly lower than the preoperative score (preoperative: 11.5 [0.5-22]; follow-up: 7 [1-13]; p<0.001), indicating a lower handicap.The majority of patients with a valgus medial compartmental knee OA treated with HTO with fixation using the TomoFix plate can expect no conversion to TKA for more than 10 years. Furthermore, patients without conversion to TKA after 10 years still had a significantly higher subjective knee function than preoperatively. Further research is needed to identify risk factors for conversion to TKA. This helps to guide surgeons in selecting patients who will benefit most from HTO.

Arthritis Foundation/HSS Workshop on Hip Osteoarthritis, Part 2: Detecting Hips at Risk: Early Biomechanical and Structural Mechanisms.

Far more publications are available for osteoarthritis of the knee than of the hip. Recognizing this research gap, the Arthritis Foundation (AF), in partnership with the Hospital for Special Surgery (HSS), convened an in-person meeting of thought leaders to review the state of the science of and clinical approaches to hip osteoarthritis. This article summarizes the recommendations gleaned from 5 presentations given in the "early hip osteoarthritis" session of the 2023 Hip Osteoarthritis Clinical Studies Conference, which took place on February 17 and 18, 2023, in New York City. It also summarizes the workgroup recommendations from a small-group discussion on clinical research gaps.

Patella scores are similar both with gap balancing and measured resection after total knee arthroplasty: a randomized single-centre study.

The purpose of this prospective study was to compare femoral component rotation (FCR) values when adjusted with 'gap balancing' (GB) and 'measured resection' (MR) techniques following total knee arthroplasty (TKA). The study hypothesis was that the GB technique would be better on FCR than MR in TKA. From a total of 93 unilateral TKAs performed between August 2019 and November 2020, the FCR values were adjusted by GB in 46 cases and MR in 47. Post-TKA magnetic resonance imaging (MRI) was applied for FCR assessment. Orthoroentgenograms and lateral knee radiographs were taken to determine the mechanical axis and posterior condylar offset (PCO) ratio, respectively. Both groups were compared radiologically. The Western Ontario and Mcmaster Universities Osteoarthritis Index (WOMAC), Knee Society Score (KSS), and Hospital for Special Surgery (HSS) patella scores were calculated and compared between the groups preoperatively and at the end of 6months, and 1 and 2years postoperatively. There was no difference between the groups in respect of the demographic data. The mean HSS patella score was 86.4 ± 4.1 in the GB group and 84.6 ± 3.8 in the MR group in the 2nd year (p = 0.047). A higher degree of external rotation in the FC was determined in the GB group [2.2° (1.7°-4.3°)] compared to the MR group [1.7° (0.8°-3.0°)] (p = 0.009). The postoperative increase in PCO ratio was higher in the GB group (p = 0.005). All other variables were similar in both groups. The results of this study showed that at the end of the 2nd year, the HSS patella scores were better, FCs were more externally rotated and PCO ratios were higher in TKAs using the GB technique. However, taking into account that the difference between the 2nd year HSS patella scores was too small to be considered clinically significant, it was shown that both the GB and MR techniques can be used for FCR in clinical practice without any hesitation.

Arthritis Foundation/HSS Workshop on Hip Osteoarthritis, Part 4: Nonoperative Options, Machine Learning in Predicting Total Hip Arthroplasty, Robotics, and Phenotyping to Guide Precision Rehabilitation.

Far more publications are available for osteoarthritis of the knee than of the hip. Recognizing this research gap, the Arthritis Foundation (AF), in partnership with the Hospital for Special Surgery (HSS), convened an in-person meeting of thought leaders to review the state of the science of and clinical approaches to hip osteoarthritis. This article summarizes the recommendations gleaned from presentations given in the "late-stage osteoarthritis" session of the 2023 Hip Osteoarthritis Clinical Studies Conference, which took place on February 17 and 18, 2023, in New York City. It covers conservative treatment, decision-making in end-stage hip osteoarthritis, advancements in robotics, and the role of phenotyping in precision rehabilitation post-total hip arthroplasty (THA).

Rim plate in the treatment of hyperextension tibial plateau fracture: surgical technique and a series of cases

BackgroundThe existence of a “bare area” at the anterior plateau has been observed in cases where anteromedial and/or anterolateral proximal tibial locking plates are used for fixation in the treatment of hyperextension tibial plateau fractures (HTPF). The objective of this study is to introduce the rim plate fixation technique and evaluate its clinical efficacy.MethodsA retrospective analysis was conducted on HTPF patients who underwent treatment with a combination of rim plate and proximal tibial locking plate at our hospital between April 2015 and December 2019. All patients were followed up for a minimum of one year. Open reduction and internal fixation were performed using anteromedial/posteromedial and/or anterolateral approaches for all cases. The surgical strategies employed for rim plate fixation were introduced, and both radiographic and clinical outcomes were assessed.ResultsThirteen patients were enrolled in the study, with an average follow-up time of 4.3 years. Satisfactory reduction was achieved and radiographically maintained in all cases. Additionally, all patients exhibited satisfactory clinical functions, as evidenced by a mean hospital for special surgery (HSS) knee score of 96.2 ± 2.0 (range: 90–98). Furthermore, no wound complications or implant breakage were observed in this series.ConclusionThe combination of the rim plate and proximal tibial plate proved to be an effective fixation configuration, resulting in satisfactory clinical outcomes.

Arthritis Foundation/HSS Workshop on Hip Osteoarthritis, Part 1: Epidemiology, Early Development, and Cohorts From Around the World.

Far more publications are available for osteoarthritis of the knee than of the hip. Recognizing this research gap, the Arthritis Foundation, in partnership with the Hospital for Special Surgery, convened an in-person meeting of thought leaders to review the state of the science of and clinical approaches to hip osteoarthritis. This article summarizes the recommendations and clinical research gaps gleaned from 5 presentations given in the "how hip osteoarthritis begins" session of the 2023 Hip Osteoarthritis Clinical Studies Conference, which took place on February 17 and 18, 2023, in New York City.

Incidence and risk factors of isolated calf muscular venous thrombosis after tibial plateau fractures surgery

BackgroundThe risks associated with deep vein thrombosis (DVT) have gained significant recognition over time. A prevalent form of distal DVT is isolated calf muscular venous thrombosis (ICMVT). Despite its common clinical occurrence, data on ICMVT subsequent to tibial plateau fracture (TPF) surgery are scarce. This study aimed to examine the epidemiological characteristics and associated risk factors (RFs) of ICMVT following TPF surgery.MethodsFor this retrospective analysis, we included patients from our hospital, who underwent TPF surgery between March 2017 and March 2021. Patients’ electronic medical records were reviewed, including admission details, fracture classification, surgical procedures, and laboratory biomarkers. The HSS (The American Hospital for Special Surgery) and Rasmussen scores were employed to evaluate the clinical effect. A Color Duplex Flow Imager (CDFI) was regularly used to detect pre- and postoperative venous thrombosis in the lower limbs. Finally, uni- and multivariate logistic regression analyses were used to identify independent RFs associated with ICMVT.ResultsOverall, 481 participants were recruited for analysis. Postoperative ICMVT occurred in 47 patients. All ICMVTs occurred on the affected side. Four of the 47 ICMVT patients exhibited sudden postoperative swelling in the affected limb. The HSS and Rasmussen scores in the non-ICMVT cohort (87.6 ± 8.2, 16.0 ± 1.7) were markedly different from the ICMVT cohort (84.8 ± 8.2, 15.5 ± 1.6) (p = 0.014, p = 0.031). This study finally identified five postoperative ICMVT-related RFs, which were age (> 55 years old) (OR 3.06; 95% CI 1.47–6.37; p = 0.003), gender (female) (OR 2.67; 95% CI 1.37–5.22; p = 0.004), surgical duration (> 114 min) (OR 3.14; 95% CI 1.44–6.85; p = 0.004), elevated white blood cell content (OR 2.85; 95% CI 1.47–5.51; p = 0.002), and hyponatremia (OR 2.31; 95% CI 1.04–5.12; p = 0.040).ConclusionThe epidemiological findings of this study may help predict ICMVT risk after surgery thus facilitating the development of individualized clinical assessments and targeted prevention programs.

Effects of sports rehabilitation plus platelet-rich plasma treatment on knee cartilage injuries and the expression of inflammatory factors in synovial fluid: A cartilage injury model

This research examined the efficacy of sports rehabilitation training plus platelet-rich plasma (PRP) for cartilage injuries of the knee (CIK) in athletes and its influence on the expression of inflammatory factors (IFs) in synovial fluid in a cartilage injury model. One hundred and four athletes with CIK were selected as the study population, and the selection time was between October 2019 and October 2022. The research (n = 53) and control (n = 51) groups underwent sports and traditional rehabilitation training interventions, respectively. Concurrently, PRP was injected into the affected knee joints of all patients in the research group. The curative effect, knee function (Hospital for Special Surgery [HSS] Knee Scoring System), and motor function (Tegner Activity Scale) in both groups were observed and compared. Furthermore, a rabbit CIK model was established. Hematoxylin and eosin staining and enzyme-linked immunosorbent assay were performed to identify pathological conditions and synovial fluid IFs (tumor necrosis factor [TNF]-α and interleukin [IL]-1β), respectively. The analysis revealed a remarkably higher total effective rate of treatment and notably elevated post interventional HSS and Tegner scores in the research group than in the controls. After modeling, the model group exhibited significant pathological conditions of CIK with overexpressed IFs (IL-1β and TNF-α) in synovial fluid. Conversely, pathologic conditions were obviously ameliorated and IFs were markedly suppressed after undergoing sports rehabilitation training, with better outcomes than traditional rehabilitation training. Therefore, sports rehabilitation training plus PRP can significantly improve CIK in athletes and consequently, knee and motor functions, while considerably mitigating and inhibiting the pathological effects of IFs in synovial fluid in the cartilage injury model.

Reverse traction with Kirschner wires and bilateral external fixation device combined with minimally invasive plate oseoynthesis technique for tibial plateau fractures of type Schatzker V and VI.

Complex bicondylar tibial plateau fracture (TPF) has always been a tricky problem for surgeons. We created a novel external device used intraoperatively consisting of Kirschner wires, and combined with minimally invasive plate oseoynthesis (MIPO) technique to treat complex bicondylar TPFs, and the clinical effect and feasibility were further evaluated. From March 2016 to February 2021, 49 cases (29 males and 20 females) were identified as bicondylar TPF, the mean age 47.2 (27-69). All patients adopted the device and MIPO technique. A series of score, complications, and radiographs in the follow-up period, from threemonths, sixmonths, oneyear, and twoyears and the last follow-up, were recorded, from visual analogue score (VAS), hospital for special surgery (HSS), and Short-Form 36 (SF-36), containing physical (PCS) and mental (MCS), and Rasmussen score. Forty-seven patients showed good functional recovery. No patients were lost, mean follow-up time was 28.17 ± 2.81 (24.2-35.4) months. Operation time was 89.80 ± 13.46 (58-110) min. At the last follow-up, VAS was 1.3 ± 0.92 (0-4), HHS was 93.10 ± 2.63 (89-99), PCS was 49.20 ± 7.40 (38-65), and MCS was 50.08 ± 4.77 (43-62). Complications were as follows: cutaneous necrosis (3, 6%), asymptomatic arthritis (3, 6%), symptomatic arthritis (1, 2%), and deep venous thrombosis (1, 2%). Mean fracture healing time was 11.82 ± 1.5 (10-15.4) weeks. All patients got recovery without extra surgery and removed the implants at 12.85 ± 0.76 (11.2-15.4) months. Temporary traction device of bilateral external fixator combined with MIPO technique was simple and convenient, with a smaller soft-tissue damage, an easier operational approach, and its worth being promoted.