An isoelastic monoblock cup versus a modular metal-back cup : a matched-pair analysis of clinical and radiological results using Einzel-Bild-Röntgen-Analyse software

Introduction Bone preservation and long-term survival are the main challenges in cementless total hip arthroplasty (THA). A good bone stock is especially important for adequate anchorage of the cup in revision cases. However, the optimal acetabular cup design for preserving good bone stock is still unclear. We aimed to compare clinical outcome, radiological alterations, migration, and wear at mid-term for two different cup types. Materials and methods This retrospective matched-pair study was performed using the data for 98 THA cases treated with a monoblock cup composed of vitamin E-blended highly cross-linked polyethylene (VEPE; monoblock group) or a modular cup composed of a highly cross-linked polyethylene (HXLPE) without an antioxidant (modular group). Clinical results were evaluated using the Harris Hip Score (HHS). The obtained radiographs were analyzed for radiological alterations, migration, and wear using Einzel-Bild-Röntgen-Analyse (EBRA) software. Results The mean follow-up duration was 73.2 ± 19.2 months (range: 32–108 months) and 60.5 ± 12.2 months (range: 20–84 months) in the monoblock and modular groups, respectively. HHS improved to 95.7 points in the monoblock group and 97.6 points in the modular group, without significant differences (p = 0.425). EBRA measurements were obtained in all cases. Acetabular bone alterations were not detected on radiological assessments. Mean cup migration was 1.67 ± 0.92 mm (range: 0.46–3.94 mm) and 1.24 ± 0.87 mm (range: 0.22–3.62 mm) in the monoblock and modular groups. The mean wear rate was 0.21 ± 0.18 mm (range: 0.00–0.70 mm) and 0.20 ± 0.13 mm (range: 0.00–0.50 mm) in the monoblock and modular groups. Both migration and wear pattern showed no significant differences (p = 0.741 and 0.243). None of the cases required revision surgery, yielding an implant survival rate of 100% in both groups. Conclusion The isoelastic press-fit monoblock VEPE cup and modular metal-back HXLPE cup showed equivalent mid-term wear and cup migration. Long-term studies are required to determine the effects of modularity, isoelasticity, and polyethylene stabilization with vitamin E on cup loosening and survival rates

Misdiagnosis of Thoracolumbar Posterior Ligamentous Complex Injuries and Use of Radiographic Parameter Correlations to Improve Detection Accuracy

Study Design Retrospective study. Purpose To evaluate radiological parameters as indicators for posterior ligamentous complex (PLC) injuries in the case of limited availability of magnetic resonance imaging. Overview of Literature Traumatic thoracolumbar spinal fractures with PLC injuries can be misdiagnosed on X-rays or computed tomography scans. This study aimed to retrospectively assess unrecognized PLC injuries and evaluate radiographic parameters as indicators of PLC injuries requiring surgery. Methods In total, 314 patients with type A and type B2 fractures who underwent surgical treatment between 2001 and 2010 were included. The frequency of misdiagnosis was reassessed, and radiographic parameters were evaluated and correlated. Results The average age of the patients was 51.8 years. There were 225 type A3/A4 and 89 type B2 fractures; 39 of the type B2 fractures (43.8%) had been misdiagnosed as type A fractures. Type B fractures presented with a significantly higher kyphotic wedge angle and Cobb angle and a lower sagittal index (SI) than type A fractures. In addition, the normalized interspinous distance was higher in type B2 fractures. The significant mathematical indicators for PLC injuries were as follows: Cobb angle+kyphotic wedge angle >29°; Cobb angle2 >170°; and vertebral angle/SI >25. Conclusions The results demonstrated that PLC injuries are frequently misdiagnosed. Correlations between certain radiological parameters associated with PLC injuries can be useful indicators of the presence of such injuries requiring surgery

Überproportional angestiegene Inzidenz proximaler Femurfrakturen in einem Level-One-Traumazentrum : epidemiologische Analyse von 2016 bis 2022

Hintergrund Proximale Femurfrakturen stellen mit mehr als 20 % die häufigste Frakturentität in Deutschland dar. Gleichzeitig müssen proximale Femurfrakturen aufgrund eines Beschlusses des Gemeinsamen Bundesausschusses (G-BA) von 2019 innerhalb von 24 h operiert werden. Um einen subjektiv wahrgenommen Anstieg des Arbeitspensums in der Unfallchirurgie an einem überregionalen Traumazentrum (ÜTZ) zu quantifizieren, wurde die Anzahl der proximalen Femurfrakturen von 2016 bis 2022 analysiert. Proximale Femurfrakturen wurden hierfür aufgrund ihrer Häufigkeit und der Homogenität in der Behandlung ausgewählt. Methode Anhand der ICD-10-Diagnosen wurden alle operierten proximalen Femurfrakturen der Jahre 2016–2022 mitsamt der Postleitzahl an einem ÜTZ ausgewertet. Ergebnis Die Anzahl der operativ versorgten proximalen Femurfrakturen ist von 2016 bis 2022 um 100 % gestiegen. Der größte Anstieg wurde mit 60 % von 2020 bis 2022 verzeichnet. Gleichzeitig kam es zu einer deutlichen Vergrößerung des Einzugsradius der versorgten Patienten. Schlussfolgerung Am untersuchten ÜTZ kam es im (inter-)nationalen Vergleich zu einem überproportionalen Anstieg der versorgten proximalen Femurfrakturen. Der Anstieg des Einzugsradius und die Zunahme der versorgten Patienten im Stadtgebiet zeigen, dass immer weniger Krankenhäuser an der Notfallversorgung teilnehmen. Mögliche Erklärungen sind ein Ressourcenmangel, verstärkt durch die COVID-19-Pandemie und den Fachkräftemangel, Schnittstellenproblematiken an Bundesländergrenzen oder strenge Vorgaben des G‑BA in der Versorgung der proximalen Femurfrakturen. Es ist bei gleich gebliebener Infrastruktur im untersuchten ÜTZ von einem deutlich erhöhten Arbeitsaufkommen für alle beteiligten Professionen auszugehen

Pleiotropic Long-Term Effects of Atorvastatin on Posttraumatic Joint Contracture in a Rat Model

The antifibrotic effect of atorvastatin has already been demonstrated in several organ systems. In the present study, a rat model was used to investigate the effect of atorvastatin on posttraumatic joint contracture. Forty-eight Sprague Dawley rats were equally randomized into an atorvastatin group and a control group. After initial joint trauma, knee joints were immobilized for intervals of 2 weeks (n = 16) or 4 weeks (n = 16) or immobilized for 4 weeks with subsequent remobilization for another 4 weeks (n = 16). Starting from the day of surgery, animals received either atorvastatin or placebo daily. After euthanasia at week 2, 4 or 8, joint contracture was determined, histological examinations were performed, and gene expression was assessed. The results suggest that the joint contracture was primarily arthrogenic. Atorvastatin failed to significantly affect contracture formation and showed a reduction in myofibroblast numbers to 98 ± 58 (control: 319 ± 113, p < 0.01) and a reduction in joint capsule collagen to 60 ± 8% (control: 73 ± 9%, p < 0.05) at week 2. Gene expression of α-smooth muscle actin (α-SMA), collagen type I, transforming growth factor β1 (TGF-β1) and interleukin-6 (IL-6) was not significantly affected by atorvastatin. Atorvastatin decreases myofibroblast number and collagen deposition but does not result in an improvement in joint mobility

The effect of losartan on the development of post-traumatic joint stiffness in a rat model

Post-traumatic joint stiffness (PTJS) is accompanied by a multidimensional disturbance of joint architecture. Pharmacological approaches represent promising alternatives as the traumatic nature of current therapeutic standards may lead to PTJS’ progression. Losartan is an auspicious candidate, as it has demonstrated an antifibrotic effect in other organs. Forty-eight Sprague Dawley rats were randomized into equally sized losartan or control groups. After a standardized knee trauma, the joint was immobilized for either 2 weeks (n = 16), 4 weeks (n = 16) or 4 weeks with re-mobilization for an additional 4 weeks (n = 16). Pharmacotherapy with losartan or placebo (30 mg/kg/day) was initiated on the day of trauma and continued for the entire course. Joint contracture was measured alongside histological and molecular biological assessments. There were no significant biomechanical changes in joint contracture over time, comparing short-term (2 weeks) with long-term losartan therapy (4 weeks). However, comparing the formation of PTJS with that of the control, there was a trend toward improvement of joint mobility of 10.5° (p 0.09) under the influence of losartan. During the re-mobilization phase, no significant effect of losartan on range of motion (ROM) was demonstrated. At a cellular level, losartan significantly reduced myofibroblast counts by up to 72 % (4 weeks, p ≤ 0.001) without effecting the capsular configuration. Differences in expression levels of profibrotic factors (TGF-β, CTGF, Il-6) were most pronounced at week 4. The antifibrotic properties of losartan are not prominent enough to completely prevent the development of PTJS after severe joint injury