Current Issue : July-September Volume : 2026 Issue Number : 3 Articles : 5 Articles
Background/Objectives: The aim of this study is to investigate how the joint, the number and the type of prior revision surgeries influence the diagnostic thresholds for synovial cell count for patients who undergo their first total hip or knee arthroplasty revision compared to re-revisions, as different cutoffs might substantially influence treatment courses. Methods: In this retrospective single-center register analysis, data from 214 revised THAs (total hip arthroplasties) and TKAs (total knee arthroplasties) were collected, of which 103 (48.1%) have so far undergone at least one revision surgery. Diagnosis was based on the EBJIS criteria, and we identified 163 (76.2%) septic and 51 (23.8%) aseptic cases. Data on synovial cell count were collected and analyzed for their diagnostic accuracy and optimal cutoffs. For re-revisions, a covariate-adjusted ROC (receiver operating characteristic) for the joint, type of previous surgery and number of surgeries was created. Results: We found no significant differences in cell counts between patients before first revision compared to those undergoing re-revision for septic (p = 0.40) and aseptic indications (p = 0.84). The overall diagnostic accuracy was high for all re-revision cases, with a sensitivity of 0.86, specificity of 0.91, AUC (area under the curve) of 0.92, at an optimal cutoff value of 2439.50 G/L. As for re-revised hip joints, the optimal cutoffs were higher compared to knee joints (2439.5 G/L vs. 2626.5 G/L, hip AUC = 0.90, knee AUC = 0.93, p = 0.14). Furthermore, the AUCs for cell count differed significantly depending on the type of previous surgery in re-revision (p = 0.03). The covariate-adjusted analysis showed no significant differences compared to the unadjusted analysis. Conclusions: Cell count remains reliable for diagnosing periprosthetic joint infection in patients with prior revisions, with minor threshold variations from the EBJIS (European Bone and Joint Infection Society) criteria. While the type of preceding revision affects accuracy, the diagnostic value remains consistently high overall....
Background: Fragility fractures of the pelvis (FFPs) are increasingly prevalent given ageing populations. Conservative management is often primarily utilised due to its initial minimal displacement and the high risks of surgery in this vulnerable population. However, this can lead to rapid deconditioning, especially with non-weight-bearing protocols. Parathyroid hormone (PTH), as a bone anabolic agent, has the potential to improve clinical and radiological outcomes in FFPs, but the evidence remains limited. Methods: A systematic review and meta-analysis following PRISMA guidelines was undertaken. Database search results were independently screened by two authors, and data were extracted. The primary outcome measure was time to fracture healing as assessed by imaging, with the secondary outcome measure of pain levels (VAS/NRS). Results: There were 1230 articles screened, and 893 unique results identified. Six studies were included in the final analysis. These compared the use of PTH and its analogues with standard care, placebo, or sacroplasty. The findings suggest that PTH may accelerate fracture healing and reduce pain in this patient population, although evidence is limited and at high risk of bias. Conclusions: Treatment with PTH may improve bone healing and visual analogue pain scores, although the evidence is limited. There may be a benefit from adjunctive PTH treatment for patients with FFPs; however, larger methodologically robust studies are required to confirm this....
Osteoporosis develops silently and is strongly influenced by both genetic and environmental factors. This study investigated whether three well-established osteoporosis-related polymorphisms—SOST rs1513670, LRP5 rs3736228, and ESR1 rs6929137—derived from a commercial genetic testing panel (HelloGene™) were primarily associated with osteoporosis prevalence and/or incidence and secondarily with bone-related biochemical markers in a Korean population. A total of 843 adults who completed genetic testing at Seoul St. Mary’s Hospital and subsequently underwent bone mineral density (BMD) assessment were included. Logistic and linear regression models were applied to evaluate associations between genotypes, osteoporosis diagnosis, and serum calcium and 25-hydroxyvitamin D levels. None of the examined SNPs showed significant associations with osteoporosis status. However, the SOST variant demonstrated a statistically significant association with serum vitamin D concentration (β = −4.836, p = 1.7 × 10−6), with TC and CC genotype carriers exhibiting markedly lower vitamin D levels than TT carriers. LRP5 and ESR1 variants showed no significant relationships with either osteoporosis or vitamin D. These findings suggest a hypothesis-generating finding between SOST-mediated WNT signaling and vitamin D metabolism, even in the absence of measurable effects on clinical osteoporosis....
Background: Distal tibial fractures (DTFs) are a major cause of post-traumatic osteoarthritis (PTOA). The risk of conversion to total ankle arthroplasty (TAA) or ankle fusion (AF) after DTFs remains unclear, and the current literature provides heterogeneous and often incomplete data. The aim of this systematic review was to evaluate the incidence of TAA and AF following DTF-related PTOA and to explore potential predictors of conversion, including initial treatment strategy. Methods: A systematic review was conducted according to PRISMA guidelines. The PICO framework was applied during the study design and literature search phase to dene the research question and eligibility criteria. Studies reporting adult patients with a history of DTFs who later developed PTOA and underwent TAA or AF were included. Descriptive statistics were performed. Study-level proportions of conversion to TAA, AF, or both were analyzed using random-eects metaanalysis with logit transformation. Results: Eight studies comprising 190,383 fractures met the inclusion criteria. Overall, 31,269 patients underwent TAA or AF, corresponding to a conversion rate of 16.4%. The pooled conversion incidence from the random-eects model was 5.6%, with considerable heterogeneity (I2 100%). When procedures were analyzed separately, the pooled incidence was 0.25% for TAA and 0.76% for AF. Conclusions: The risk of conversion to TAA or AF after DTFs appears to be relatively low, despite the high prevalence of PTOA. The higher conversion rate observed in surgically treated fractures likely reects the complexity of the initial fracture rather than the failure of surgical management itself. Level IV, systematic review of retrospective studies....
Background and Objectives: Cementless total knee arthroplasty (TKA) with two-pegged Trabecular Metal (TM) tibial components composed of porous tantalum was introduced to improve fixation and reduce aseptic implant failure, particularly in younger, more active patients. Despite these theoretical advantages, mid-term outcomes remain uncertain. This retrospective study compares the survival of consecutive cementless TKAs with TM posterior-stabilized (PS) and cruciate-retaining (CR) modular tibial components with cemented PS and CR components from the same implant system, using revision for aseptic causes as the primary endpoint. Materials and Methods: Institutional review board approval was obtained, and a minimum follow-up of two years was required. Between January 2017 and November 2021, a total of 1202 TKAs of a single implant design were performed at a high-volume academic center by five board-certified orthopedic surgeons, predominantly for primary osteoarthritis. Of these, 826 (68.7%) procedures were cemented, and 376 (31.3%) were cementless. Demographic data and revision outcomes were collected for all patients. Results: There was no statistically significant difference between cohorts in the 7-year survival rate for all causes of revision (97.4%, 95% CI 95.6–99.2 for cementless vs. 97.8%, 95% CI 96.6–99.0 for cemented; p = 0.63). However, the 7-year survival rate for aseptic causes was significantly lower (p < 0.05) in the cementless TKA group (97.9%, 95% CI 96.3–99.5) compared with the cemented group (99.4%, 95% CI 98.8–100). Revisions for aseptic causes occurred in 7 cementless (1.86%) and 4 cemented (0.84%) TKAs (p < 0.05), most commonly due to loosening of the tibial TM component (6 [1.59%] vs. 2 [0.24%], respectively; p < 0.05). During follow-up, 94 patients (8.7%) died of causes unrelated to TKA. Conclusions: Cementless TM PS and CR modular TKAs demonstrated inferior midterm performance compared with their cemented counterparts for aseptic reasons. These findings raise concerns regarding the durability of this cementless design and underscore the need for cautious use and further investigation....
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