Current Issue : October-December Volume : 2026 Issue Number : 4 Articles : 6 Articles
Introduction The optimal fixation method in total hip arthroplasty (THA) remains under debate. While cemented fixation has been associated with a lower risk of periprosthetic fracture, uncemented fixation predominates in Japan. This study aimed to compare early postoperative complications between cemented and uncemented fixation in elective THA using a nationwide inpatient database. Materials and methods We identified 198,102 patients aged ≥ 65 years who underwent primary THA for osteoarthritis, osteonecrosis, or rheumatoid arthritis between December 2011 and March 2023 from the Japanese Diagnosis Procedure Combination (DPC) database. After 1:1 propensity score matching for age, sex, body mass index (BMI), and Charlson Comorbidity Index, 36,859 patients were included in each fixation cohort. Surgical and medical complications, and in-hospital mortality were compared using multivariate logistic regression. Results Cemented fixation was associated with a significantly lower risk of periprosthetic fracture (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.30–0.53; p < 0.001), blood transfusion (OR, 0.76; 95% CI, 0.74–0.78; p < 0.001), and deep vein thrombosis (OR, 0.79; 95% CI, 0.74–0.84; p < 0.001). There were no statistically significant differences based on the predefined threshold (p < 0.001) in dislocation, infection, pulmonary embolism, cardiac or cerebrovascular events, or inhospital mortality between fixation types, although a trend toward higher in-hospital mortality in the cemented group was observed. Conclusions Cemented THA was associated with reduced rates of periprosthetic fracture, transfusion, and deep vein thrombosis without increasing other perioperative or medical complications. These findings suggest that cemented fixation may be associated with favorable short-term outcomes in selected patients....
Background/Objectives: Extraforaminal lumbar interbody fusion provides indirect decompression without entering the spinal canal, but its uptake has been limited by poor visualization and risk of exiting nerve root injury. We describe a minimally invasive exoscopic extraforaminal lumbar interbody fusion (exELIF) technique and evaluate its clinical and radiological outcomes. This study aims to describe the exELIF technique and report its early clinical and radiological outcomes. Methods: Twenty-six patients with lumbar degenerative diseases underwent exELIF using a 3D exoscope (ORBEYE). The procedure was performed through bilateral 30–40 mm posterior incisions. Clinical outcomes were assessed using the Japanese Orthopedic Association score preoperatively and at 1-year follow-up. Postoperative computed tomography evaluated interbody fusion. Operative time, blood loss, and complications were recorded. Results: Mean operative time was 131 ± 51 min, and mean estimated blood loss was 82 ± 99 mL. The mean JOA score improved from 15.2 ± 2.2 to 24.3 ± 2.6, with a mean recovery rate of 66% at 1 year. Interbody fusion was achieved in 96%. In an exploratory CUSUM analysis of 18 single-level fluoroscopyguided cases, a transition in operative time was observed at approximately the 10th case; operative time and estimated blood loss decreased from 141.5 ± 39.2 min and 89.0 ± 77.8 mL in cases 1–10 to 80.1 ± 6.7 min and 21.2 ± 18.1 mL in cases 11–18 (p < 0.001 and p = 0.035, respectively), indicating a reduction of operative time with accumulated experience rather than a formally established learning curve. Three patients developed transient exiting nerve root symptoms that resolved spontaneously during follow-up. One patient at the L5/S level required revision surgery due to left L5 nerve root palsy caused by posterior migration of the bone graft; this complication led to a modification of the technique, with posterior bone grafting no longer performed at L5/S. Partial screw loosening was observed in 5 patients (19%), all of which were asymptomatic and required no additional intervention. Conclusions: ExELIF provides excellent visualization in deep surgical fields, allowing the use of conventional surgical instruments through minimally invasive incisions. This is an early feasibility report of a single-institution retrospective case series with a heterogeneous cohort and no control group; the present data therefore do not establish superiority over conventional or endoscopic ELIF. Within these limits, exELIF was associated with acceptable early clinical improvement and a high interbody fusion rate, and progressive reduction in operative time with experience suggests that it may be a technically feasible minimally invasive option for selected patients with lumbar degenerative disease and for revision surgery after lumbar decompression....
Purpose: To quantify sagittal and coronal inclination angles following overthe‐ top (OTT) anterior cruciate ligament (ACL) reconstruction using magnetic resonance imaging (MRI), to compare these measurements with the native ACL, and to evaluate graft alignment relative to the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) consensus. Methods: Thirty‐five patients underwent single‐bundle OTT ACL reconstruction combined with lateral plasty and underwent postoperative MRI evaluation at a minimum of 6 months. The reference group consisted of 28 patients with knee pain and an intact ACL on MRI. Sagittal and coronal inclination angles were measured using standardised tibial‐axis–based MRI definitions. Measurements were performed independently by two examiners, and mean values were used for analysis. Group comparisons were conducted using independent‐samples t‐tests. Interexaminer reliability was assessed using intraclass correlation coefficients (ICC). Results: OTT reconstruction demonstrated a mean sagittal inclination angle (SIA) of 53.2° ± 5.1° and a mean coronal inclination angle (CIA) of 71.3° ± 5.9°. Compared with the native ACL cohort, OTT reconstructions showed significantly greater sagittal (mean difference 3.6°, p = 0.007) and coronal (mean difference 8.2°, p < 0.001) inclination angles. Most reconstructions fell within ESSKA consensus sagittal (<60°) and coronal (<75°) MRI thresholds (85.7% and 71.4%, respectively). Interexaminer agreement was excellent for both sagittal and coronal measurements (ICC > 0.90). Conclusion: OTT ACL reconstruction produces graft inclination angles that differ significantly from native ACL orientation but frequently fall within consensus‐recommended MRI thresholds for sagittal alignment. MRIbased inclination assessment provides objective structural characterisation of this technique and complements previously reported long‐term clinical outcomes. However, these imaging findings do not establish full anatomic replication or clinical equivalence. Level of Evidence: Level IV, case series....
Background: Intraoperative periprosthetic proximal femoral fractures (PPFFs) represent a significant complication during total hip arthroplasty (THA), especially when using cementless stems via a direct anterior approach (DAA). Methods: This retrospective case series evaluated 10 patients with Vancouver A2 PPFFs treated with 2.7 mm lag screws alone or in combination with plates during DAA THA or partial hip arthroplasty between January 2021 and March 2024. Results: All fractures healed. One patient experienced 1 cm of stem subsidence without the need for revision. The mean Harris Hip Score improved from 35.4 preoperatively to 85.6 postoperatively. Functional recovery and radiological stability were comparable between fixation methods, though the screw-only group experienced slightly more postoperative pain. Patients in the screw-and-plate group were significantly older than those in the screw-only group (p = 0.026). No significant differences were found between groups regarding surgical time (p = 0.62) or BMI (p = 0.82). Due to the limited number of subsidence events, the statistical comparison of subsidence rates was inconclusive. Conclusions: In this preliminary retrospective case series, the use of 2.7 mm lag screws and small locking plates appeared feasible and was associated with favorable short-term outcomes in selected Vancouver A2 intraoperative PPFFs during DAA. These findings are hypothesis-generating and require confirmation in larger, prospective comparative studies....
Patients with neurological conditions like cerebellar atrophy and ataxia face many challenges when recovering from fractures. This case report details the management and recovery of a 45-year-old woman with severe, pre-existing cerebellar atrophy and ataxia who sustained a right femoral shaft fracture after a fall. Before her injury, her neurological impairment required her to use a walker to move around. She underwent open reduction and internal fixation (ORIF) and was given a 3-month period during which she could not put weight on her leg. Her rehabilitation involved a team approach focused on specific goals, emphasizing early knee range-of-motion exercises. Given her dual diagnosis, the intensive program focused on various training components, including progressive resistance, coordination drills, and challenging balance exercises. These exercises have been shown to reduce ataxia symptoms and improve motor function significantly. The tailored intervention operated on the idea that the quality and difficulty of rehabilitation are key factors for positive outcomes in patients with degenerative cerebellar ataxias (DCAs). After 3 months, the fracture healed well, and the patient moved to full weight-bearing, showing significant improvements in mobility and independence. This case highlights that a unified, specialized, and evidence-based team approach can lead to successful functional recovery, even in complex neuro-orthopedic situations. It aligns with modern rehabilitation methods that focus on enhancing the quality of life by reducing secondary impairments....
Purpose: To determine if distraction distance changes on an axial traction examination between the time zero capsular repair state and a later follow-up traction examination in patients with staged bilateral hip arthroscopies for femoroacetabular impingement syndrome. Methods: Patients between September 2022 and February 2025 who underwent staged, primary bilateral hip arthroscopies for femoroacetabular impingement syndrome with a closed periportal capsulotomy were included. Patients were excluded if they had prior hip surgery or had acetabular pathology beyond a labral tear. Fluoroscopic images were obtained at 0 and 100 pounds of axial traction force (lbf ) at multiple time points: preinstrumentation, postcapsulotomy, postcapsular repair, and at follow-up during contralateral hip surgery. Linear regression assessed the change in distraction distance over time between time zero repair and the follow-up distraction distance, whereas logistic regression evaluated factors associated with substantial distraction increase, defined by the minimal detectable change. Results: Forty-one patients (41 hips, mean age 25.7 ± 11.4 years, 66% female) were included. Mean lateral center edge angle was 28.5 ± 5.0° and mean alpha angle was 59.7 ± 7.4°. Mean time between surgeries was 248 ± 191 days [range 43-833]. Compared with the native state, a repaired periportal showed greater resistance to axial traction at 100 lbf (8.50 ± 2.35mm vs 6.37 ± 2.67 mm; P = .01). Regression analysis showed a significant relationship between time since surgery and increase in distractibility (β = 0.003, 95% confidence interval [0.001-0.006], P = .01). Logistic regression identified female sex (β = 1.74, 95% confidence interval [1.02-31.9], P = .04) as a predictor of a substantial postoperative increases in distractibility (minimal detectable change ≥1.2 mm). Conclusions: A repaired periportal capsulotomy shows increased resistance to axial traction compared with the native state at time zero; however, this resistance progressively decreases over time and returns to the native state on follow-up testing. Level of Evidence: Level IV, retrospective case series....
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