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Patrick Ziegler, Christian Bahrs, Christian Konrads, Philipp Hemmann, and Marc-Daniel Ahrend

  • The present narrative review provides a summary of current concepts for the treatment of ankle fractures in elderly patients.

  • Despite a high complication rate, open reduction and internal fixation is the gold standard for operative care. However, individual patient-based treatment decision considering the soft-tissue status, the fracture pattern, as well as the patient’s mobility and comorbidities is mandatory to achieve sufficient patient outcomes.

  • Due to high complication rates after surgery in the past, techniques such as fibular nails or minimal invasive techniques should be considered.

Richard N de Steiger, Brian R Hallstrom, Anne Lübbeke, Elizabeth W Paxton, Liza N van Steenbergen, and Mark Wilkinson

  • Recent concerns surrounding joint replacements that have a higher than expected rate of revision have led to stricter controls by regulatory authorities with regards to the introduction of new devices into the marketplace.

  • Implant post-market surveillance remains important, and joint replacement registries are ideally placed to perform this role. This review examined if and how joint replacement registries identified outlier prostheses, outlined problems and suggested solutions to improve post-market surveillance.

  • A search was performed of all joint replacement registries that had electronic or published reports detailing the outcomes of joint replacement. These reports were examined for registry identification of outlier prostheses. Five registries publicly identified outlier prostheses in their reports and the methods by which this was performed, and three others had internal reports.

  • Identification of outlier prostheses is one area that may improve overall joint replacement outcomes; however, further research is needed to determine the optimum methods for identification, including the threshold, the comparator and the numbers required for notification of devices.

  • Co-operation of registries at a global level may lead to earlier identification of devices and thereby further improve the results of joint replacement.

A Prkić, N P Vermeulen, B W Kooistra, B The, M P J van den Bekerom, and D Eygendaal

  • Purpose: Total elbow arthroplasty (TEA) is rarely performed compared to other arthroplasties. For many surgical procedures, literature shows better outcomes when they are performed by experienced surgeons and in so-called ‘high-volume’ hospitals. We systematically reviewed the literature on the relationship between surgical volume and outcomes following TEA.

  • Methods: A literature search was performed using the MEDLINE, EMBASE and CINAHL databases. The literature was systematically reviewed for original studies comparing TEA outcomes among hospitals or surgeons with different annual or career volumes. For each study, data were collected on study design, indications for TEA, number of included patients, implant types, cut-off values for volume, number and types of complications, revision rate and functional outcome measures. The methodological quality of the included studies was assessed using the Newcastle–Ottawa Scale.

  • Results: Two studies, which included a combined 2301 TEAs, found that higher surgeon volumes were associated with lower revision rates. The examined complication rates did not differ between high- and low-volume surgeons. In one study, low-hospital volume is associated with an increased risk of revision compared to high-volume hospitals, but for other complication types, no difference was found.

  • Conclusions: Based on the results, the evidence suggests that high-volume centers have a lower revision rate in the long term. No minimum amount of procedures per year can be advised, as the included studies have different cut-off values between groups. As higher surgeon- and center-volume, (therefore presumably experience) appear to yield better outcomes, centralization of total elbow arthroplasty should be encouraged.

Xiang-Dong Wu, Yixin Zhou, Hongyi Shao, Dejin Yang, Sheng-Jie Guo, and Wei Huang

Background

  • During the past decades, robotic-assisted technology has experienced an incredible advancement in the field of total joint arthroplasty (TJA), which demonstrated promise in improving the accuracy and precision of implantation and alignment in both primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, revision TJA remains a technically challenging procedure with issues of large-scale bone defects and damage to nearby anatomical structures. Thus, surgeons are trying to harness the abilities of robotic-assisted technology for revision TJA surgery.

Methods

  • PubMed, Embase, Cochrane Library, and Google Scholar were comprehensively searched to identify relevant publications that reported the application of robotic-assisted technology in revision TJA.

Results

  • Overall, ten studies reported the use of the robotic system in revision TJA, including active (ROBODOC) and semi-active (MAKO and NAVIO) systems. One clinical case reported conversion from hip fusion to THA, and three studies reported revision from primary THA to revision THA. Moreover, four studies reported that robotic-assisted technology is helpful in revising unicompartmental knee arthroplasty (UKA) to TKA, and two case reports converted primary TKA to revision TKA. In this study, we present the latest evolvements, applications, and technical obstacles of robotic-assisted technology in the revision of TJA and the current state-of-the-art.

Conclusion

  • Current available evidence suggests that robotic-assisted technology may help surgeons to reproducibly perform preoperative plans and accurately achieve operative targets during revision TJA. However, concerns remain regarding preoperative metal artifacts, registration techniques, closed software platforms, further bone loss after implant removal, and whether robotic-assisted surgery will improve implant positioning and long-term survivorship.

Anna Wawrzyniak and Przemysław Lubiatowski

Purpose

  • The purpose of this study was to collect and evaluate clinical and radiological evidence on shoulder neuroarthropathy (NA) in syringomyelia (SM) that may support the management and treatment of patients with this condition.

Materials and methods

  • This systematic review is based on the analysis of reports available in PubMed, Embase, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials using the following keywords: syringomyelia, neuroarthropathy, Charcot joint and shoulder degeneration. Thirty-nine publications were found presenting case reports or case series meeting our criteria. Pooled data included a group of 65 patients and 71 shoulders with NA secondary to SM.

Results

  • The most commonly reported symptoms were range of motion (ROM) limitation, weakness, swelling, pain and dissociated sensory loss. NA is usually monolateral and concerns only the shoulder. The average active shoulder ROM was flexion −59.2° (s.d. 37.9), internal rotation −29.8° (s.d. 22.6) and external rotation −21.1° (s.d. 23.6). Most of the patients (75%) presented with complete or nearly complete proximal humerus degeneration, while the degree of glenoid preservation varied. Fifty-two neuroarthropathic shoulders were treated conservatively with physiotherapy, anti-inflammatory medication and splinting. Eighteen patients were treated by surgical intervention.

Conclusion

  • Shoulder NA due to SM is a devastating and progressive condition, and its course is often unpredictable. Patients with unexplained shoulder degeneration should be evaluated for SM, especially if there are additional neurological symptoms. Conservative treatment usually reduces shoulder pain without improving ROM. For select patients, shoulder arthroplasty may be a better option for restoring function.

Maria E Dey Hazra, Rony-Orijit Dey Hazra, Jared A Hanson, Phob Ganokroj, Matthew L Vopat, Joan C Rutledge, Kohei Yamaura, Sunikom Suppauksorn, and Peter J Millett

  • While functional reconstruction of massive irreparable rotator cuff tears remains a challenge, current techniques aimed at recentering and preventing superior migration of the humeral head allow for clinical and biomechanical improvements in shoulder pain and function.

  • Recentering of the glenohumeral joint reduces the moment arm and helps the deltoid to recruit more fibers, which compensates for insufficient rotator cuff function and reduces joint pressure.

  • In the past, the concept of a superior capsular reconstruction with a patch secured by suture anchors has been used.

  • However, several innovative arthroscopic treatment options have also been developed.

  • The purpose of this article is to present an overview of new strategies and surgical techniques and if existing present initial clinical results.

  • Techniques that will be covered include rerouting the long head of the biceps tendon, utilization of the biceps tendon as an autograft to reconstruct the superior capsule, utilization of a semitendinosus tendon allograft to reconstruct the superior capsule, superior capsular reconstruction with dermal allografts, and subacromial spacers.

Leonard Christianto Singjie, Reynaldo Halomoan, Ifran Saleh, Endrotomo Sumargono, and Erica Kholinne

Purpose

  • Patients undergoing major orthopedic surgeries, such as total hip replacement (THR), total knee replacement (TKR), and trauma surgery, are at an elevated risk of venous thromboembolism (VTE), causing significant morbidity and mortality. Previous studies have investigated aspirin as a thromboprophylactic agent for arthroplasty, besides trauma surgery. Therefore, we sought to analyze the efficacy of aspirin compared to that of other anticoagulants for VTE prophylaxis in patients undergoing major orthopedic surgeries.

Methods

  • This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The study protocol was registered with the PROSPERO register. Randomized controlled trials that investigated the use of aspirin for thromboprophylaxis in major orthopedic lower limb surgeries were included and analyzed. Quality analysis of the literature and level of evidence were assessed. The primary clinical outcome was VTE. Secondary clinical outcomes included mortality, bleeding events, and wound complications.

Results

  • Eight high-quality studies with level 2 evidence (published within 2006–2021) were included, comprising 6220 patients. The incidence of VTE with aspirin was not found to be more significant than other anticoagulants (risk ratio (RR) = 1.18, 95% CI: 0.89–1.58, P = 0.25). Regarding secondary outcomes, there were no significant differences between aspirin and other anticoagulants (mortality (RR = 1.40, 95% CI: 0.27–7.23, P = 0.69), bleeding events (RR = 0.89, 95% CI: 0.57–1.39, P = 0.61), or wound complications (RR = 0.64, 95% CI: 0.30–1.35, P = 0.24)).

Conclusion

  • The current meta-analysis did not show any difference between aspirin and other anticoagulants as thromboprophylactic agents in preventing VTE in patients who underwent major orthopedic surgeries.

Tianping Zhou, Yihong Xu, Aiai Zhang, Lan Zhou, Qing Zhang, Zhou Ji, and Weidong Xu

Purpose

  • The aim of this study is to comprehensively analyze the publications of anterior cruciate ligament reconstruction (ACLR) research and display the current research status in this field.

Methods

  • Articles regarding ACLR research published before October 7, 2021, were downloaded from the Web of Science Core Collection. Excel 2016 and Bibliometric website were used to analyze the annual article trends and international cooperation network. CiteSpace V and VOSviewer were used to perform co-occurrence and citation analyses for journals, institutions, authors, cocitation authors and keywords. Burst keyword detection was also performed with CiteSpace V.

Results

  • A total of 12 223 ACLR articles were identified. The American Journal of Sports Medicine (1636 publications, 92,310 citations), the Pennsylvania Commonwealth System of Higher Education (624 publications, 25,304 citations) and Freddie H. Fu (321 publications, 15,245 citations) were journals, institutions and authors with the most publications and citations, respectively. Patellar tendon was the keyword with the most occurrences (1618 times) and return to sport was the keyword with the most burst strength (burst strength: 46.99).

Conclusion

  • ACLR-related publications showed a rapid increasing trend since 1990. A large number of articles have been published by authors from different institutions and countries, some of which have gained great academic influence. Based on keyword analysis, patellar tendon is identified as the research hotspot and return to sport is identified as the current research frontier.

Andrew J Harrison, Michael R Redler, David M Taylor, Ansar Mahmood, John T Jones, Yukihiro Arai, and Yoshinobu Watanabe

  • Low-intensity pulsed ultrasound (LIPUS) treatment of fractures has been available to the orthopaedic community for nearly three decades; however, it is still considered an experimental treatment by some clinicians, even though there is a wealth of clinical data.

  • Based on the evaluation of clinical trial data, we have established key criteria which can lead to LIPUS success and avoid failure. These are fracture gap size and stability, accurate transducer placement and minimum treatment number.

  • However, from a clinician’s view, the correct attitude to treatment must be observed, and this has also been discussed.

  • It is hoped, armed with this new evaluation of the clinical data, that clinicians can treat patients with LIPUS more effectively, resulting in fewer failures of treatment.

Emilio Calvo, María Valencia, Antonio Maria Foruria, and Juan Aguilar Gonzalez

  • Latarjet modifies the anatomy of the shoulder, and subsequent revision surgery is challenging.

  • It is mandatory to determine the cause of recurrence in order to select the best treatment option. A CT scan is needed to measure glenoid track and evaluate coracoid graft status: position, degree of consolidation, and osteolysis.

  • Conservative management can be advocated in selected patients in whom the instability level does not interfere with the activities they wish to perform. Surgical treatment is based on the glenoid track measurement and coracoid graft suitability.

  • The coracoid graft is considered suitable if it preserves the conjoint tendon insertion, does not show osteolysis, and is large enough to reconstruct the glenoid surface. Adding a remplissage is recommended for those cases with a coracoid graft insufficient to convert large off-track Hill–Sachs lesions into on-track.

  • If the coracoid graft is suitable to reconstruct bone defects in terms of size and viability but is poorly positioned or avulsed, graft repositioning can be a valid option.

  • In patients with unsuitable coracoid bone graft, free bone graft is the revision technique of choice. The size of the graft should be large enough to restore the glenoid surface and to convert any off-track Hill–Sachs lesion into on-track.

  • There is a small group of patients in whom bone defects were properly addressed but Latarjet failed due to hyperlaxity or poor soft tissue quality. Extraarticular capsular reinforcement is suggested in this population.