Concurrent arthroscopic meniscal repair during open-wedge high tibial osteotomy is not clinically beneficial for medial meniscus posterior root tears.

PURPOSE: This prospective study aimed to investigate the clinical benefits of meniscal repair during open-wedge high tibial osteotomies (OWHTOs) in patients with medial meniscus posterior root tears (MMPRTs) and to identify potential risk factors for meniscal healing. METHODS: Ninety patients with degenerative MMPRTs were included in the final cohort and randomized into three groups. The patients in Group A (n = 30) underwent OWHTO and arthroscopic all-inside meniscal repair concurrently, those in Group B (n = 34) underwent OWHTO only, and those in Group C (n = 26) underwent arthroscopic partial meniscectomy. Clinical and radiological outcomes were recorded, and meniscal healing was evaluated during second-look arthroscopy. Logistic regression analysis was performed to identify risk factors for meniscal healing. RESULTS: After a minimum follow-up of 24 months, no significant differences between Groups A and B regarding the final Lysholm (p = 0.689) or Hospital for Special Surgery (HSS) scores (p = 0.256) were observed. There were significant differences among the three groups regarding the hip-knee-ankle angle (HKA), weight-bearing line (WBL) ratio, medial proximal tibial angle (MPTA), and joint line convergence angle (JLCA) (p < 0.001, respectively), but the differences between Groups A and B were not significant. During second-look arthroscopy, the healing rate of the MMPRTs was significantly higher in Group A (63.3%) than in Group B (35.3%). Concurrent meniscal repair and changes in the HKA, and MPTA were risk factors for meniscal healing. CONCLUSION: Concurrent arthroscopic meniscal repair during OWHTO did not lead to significant clinical benefits in the treatment of MMPRTs, except for an increased rate of meniscal healing, which was not associated with clinical outcomes. LEVEL OF EVIDENCE: II, prospective comparative study.

Risk factors for iliopsoas impingement after total hip arthroplasty using a collared femoral prosthesis.

BACKGROUND: The relationship between collar design of a femoral component and iliopsoas impingement (IPI) after total hip arthroplasty (THA) is still underrecognized. The purpose of our study was to determine the possible risk factors for IPI related to the femoral component, when using a collared femoral prosthesis. METHODS: A total of 196 consecutive THA patients (206 hips) using a collared femoral prosthesis were reviewed retrospectively after exclusion of the factors related to acetabular component and femoral head. The patients were divided into +IPI and -IPI group according to the presence of IPI. Radiological evaluations were performed including femoral morphology, stem positioning, and collar protrusion length (CPL). Multivariate regression analysis was performed to assess the risk factors for IPI. RESULTS: At a minimum follow-up of 1 year, IPI was observed in 15 hips (7.3%). Dorr type C proximal femur was found in nine hips (60%) in the +IPI group and in 28 hips in the -IPI group (14.7%, p < 0.001). The mean stem anteversion in the +IPI group was significantly greater than that in the -IPI group (19.1° vs. 15.2°, p < 0.001), as well as the mean CPL (2.6 mm vs. - 0.5 mm, p < 0.001). The increased stem anteversion (OR = 1.745, p = 0.001) and CPL (OR = 13.889, p = 0.001) were potential risk factors for IPI. CONCLUSIONS: The incidence of IPI after THA is higher than expected when using a collared femoral prosthesis. Among the factors related to collared femoral prosthesis, excessively increased stem anteversion and prominent collar protrusion are independent predictors for IPI. In addition, high risk of IPI should be carefully considered in Dorr type C bone, despite that femoral morphology is not a predictive factor. LEVEL OF EVIDENCE: Level IV, clinical cohort study.

The effect of local bone density on mechanical failure after internal fixation of pertrochanteric fractures.

INTRODUCTION: The aim of this prospective study was to investigate the effect of local hip bone density on mechanical failure after fixation of pertrochanteric fractures and to establish possible risk factors for the failures. MATERIALS AND METHODS: A total of 136 consecutive patients presenting a closed unilateral pertrochanteric fracture were enrolled. The patients were treated with a sliding hip screw or an intramedullary nail. Dual energy X-ray absorptiometry measurements for bone density of the contralateral hip were made within 4 weeks postoperatively. Follow-up evaluations on the standard radiographs were documented for any mechanical failure including loss of reduction, screw or blade cut-out, lateral migration of the screw or blade, and implant breakage. Secondary outcomes were also recorded including patient characteristics and fixation construct variables as possible predictors for mechanical failure. RESULTS: At a minimum of 2 years of follow-up, 38 patients were reported with mechanical failure at an estimated risk of 27.9 %. The local bone density measurements for the study population showed no difference between patients with (0.710 g/cm(2)) and without (0.726 g/cm(2)) mechanical failure (P = 0.180). We also observed no significant correlation between local bone density and failure in patients with good fracture reduction (P = 0.862). The multivariate regression analysis identified fracture type (P < 0.001) and quality of fracture reduction (P < 0.001) as being independent predictors for mechanical failure, whereas local bone density was not (P = 0.658). CONCLUSIONS: Local hip bone density does not appear to have a significant influence on mechanical failure after internal fixation of pertrochanteric fractures. Stable fractures and fractures with good reduction are expected to obtain satisfactory outcomes.

Bilateral stenting methods for hilar biliary obstructions.

OBJECTIVE: There is no consensus regarding the most appropriate methods (i.e., the side-by-side versus the stent-in-stent technique) for placing bilateral stents for malignant hilar biliary obstructions. We aimed to perform a quantitative review of the published data regarding the clinical efficacy of the side-by-side and stent-in-stent bilateral drainage techniques for hilar biliary obstructions. METHODS: A comprehensive search of several databases was conducted and a fixed-effects or random-effects model was used to pool the data from all of the study end-points. RESULTS: Four clinical trials were identified. A comparison of the side-by-side and stent-in-stent groups revealed no significant differences with respect to the rates of successful placement, successful drainage, early complications, late complications and stent occlusions. There were also no significant inter-group differences in stent patency and patient survival and no publication bias was observed. CONCLUSIONS: The performance of the side-by-side technique appears to be similar to that of the stent-in-stent technique for bilateral drainage in patients with malignant hilar biliary obstructions.

Multiple radiographic projections in detecting intra-articular screw penetration during fixation of femoral neck fractures.

The authors performed a cadaveric study to evaluate the efficacy of multiple fluoroscopic projections in detecting intra-articular penetration of the screws during femoral neck fracture fixation and also to determine the most suitable radiographic projection. Models of intra-articular penetration in 8 normal proximal femur specimens were created by placing the pins in different quadrants of the femoral head and extending 1 mm beyond the femoral head surface. The tip-to-surface distance was measured on anteroposterior (AP) and lateral views, with the femur positioned at varying degrees of rotation, flexion, adduction, and abduction. After correcting for differences in magnification, associations between the tip-to-surface distance and femur position were noted. In certain femur positions and K-wire placements, conventional AP and lateral views did not show that the wire extended beyond the surface of the femoral head. The tip-to-surface distance on an AP radiograph with the femur in the neutral position was not comparable to that on the lateral view with the femur positioned at 20° of adduction (P=.821). However, the tip-to-surface distance on an AP radiograph with the femur in the neutral position varied significantly (P<.001) from all other tip-to-surface distances on either the AP or lateral projection. A linear association was found between the tip-to-surface distance and femur rotation angles on AP views and between femur adduction and abduction angles on lateral views. In conclusion, fluoroscopy in varied projections at different angles can detect unrecognized intra-articular screw penetration during internal fixation of femoral neck fracture. Additional special projection methods are suggested to identify and prevent intra-articular screw penetration.