Orthopaedic Diseases and Innovative Intervention Strategies, 2nd Volume

Topic Information

Dear Colleagues,

Innovations in technology and bioengineering are crucial in modern surgery. In particular, the continuous evolution of surgical techniques and assisted navigation systems has profoundly changed approaches to orthopaedic surgery. In addition, minimally invasive surgery, computer-assisted systems, virtual reality, and augmented and mixed reality now represent valuable and effective options for surgeons. The development of bioengineering has led to new coating materials for prostheses, ensuring more long enduring implants. All of these technological innovations are improving operating times as well as patient outcomes. In addition, the development of minimally invasive surgical techniques has resulted in continuous improvements in patient outcomes, including decreasing operating times, hospitalisations, rehabilitation, and post-surgical pain. These advantages have led to an increase in the number of operations, thus reducing hospital waiting lists. The development of new techniques and instruments for minimally invasive surgery is necessary to improve the quality of orthopaedic surgery, significantly in influencing healthcare costs. Therefore, scientific and technological progress in orthopaedics is essential for ensuring the best possible patient care. This topic aims to provide the latest scientific evidence regarding the most innovative intervention strategies currently available in all fields of orthopaedic surgery.

Prof. Dr. Umile Giuseppe Longo
Prof. Vincenzo Denaro
Topic Editors

Keywords

Participating Journals

Journal Name	Impact Factor	CiteScore	Launched Year	First Decision (median)	APC
Journal of Clinical Medicine jcm	3.0	5.7	2012	16 Days	CHF 2600	Submit
Journal of Personalized Medicine jpm	-	4.1	2011	17.4 Days	CHF 2600	Submit
Medicina medicina	2.4	3.3	1920	17.1 Days	CHF 2200	Submit
Osteology osteology	-	-	2021	30.9 Days	CHF 1000	Submit
Surgeries surgeries	-	0.8	2020	21.8 Days	CHF 1200	Submit

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12 pages, 1530 KiB  

Open AccessArticle

Piriformis-Sparing vs. Conventional Posterior Approach in Total Hip Arthroplasty: A Retrospective Analysis of the Functional Outcomes

by Müren Mutlu, Hakan Zora, Gökhan Bayrak and Ömer Faruk Bilgen

Medicina 2025, 61(4), 609; https://doi.org/10.3390/medicina61040609 - 27 Mar 2025

Viewed by 304

Abstract

Background and Objectives: The posterior approach in total hip arthroplasty (THA) is widely used among surgeons. This study compares dislocation rates and functional outcomes between patients using a piriformis tendon-sparing posterior approach (PSPA) and those using a conventional posterior approach (CPA). Materials and [...] Read more.

Background and Objectives: The posterior approach in total hip arthroplasty (THA) is widely used among surgeons. This study compares dislocation rates and functional outcomes between patients using a piriformis tendon-sparing posterior approach (PSPA) and those using a conventional posterior approach (CPA). Materials and Methods: 350 patients who underwent THA between 2016 and 2020 were retrospectively reviewed, with 163 patients receiving a PSPA and 187 receiving a CPA. Dislocation complication and the functional outcomes including the baseline and postoperative sixth-week pain and Oxford Hip Score, sixth-week Ranawat internal rotation test, and sixth-month acetabular inclination and anteversion angle were recorded. Hospital stay and the duration of surgery were also noted. Results: Implant dislocation occurred in three (1.6%) patients only in the CPA group at six weeks postoperatively (p = 0.104). No differences were noted in surgery time, baseline and postoperative pain, or hip function (p < 0.05). The Ranawat internal rotation test was positive in 89.6% of the PSPA group and 40.1% of the CPA group at six weeks (p = 0.001). The inclination angle was better in the PSPA group (p = 0.001), but there was no difference in anteversion angle (p = 0.523) at the sixth month postoperatively. The PSPA group had a shorter hospital stay (mean = 2.14 days) compared to the CPA group (mean = 2.47 days) (p = 0.006). Conclusions: The absence of dislocation cases in the piriformis-sparing approach suggests that the preservation of the piriformis tendon, especially in the early period, may have reduced the risk of prosthesis dislocation by increasing joint stability from a clinical perspective. Further research is needed to evaluate the long-term impact of the piriformis-sparing posterior approach regarding the dislocation rates and functional outcomes. Full article

(This article belongs to the Topic Orthopaedic Diseases and Innovative Intervention Strategies, 2nd Volume)

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17 pages, 3055 KiB  

Open AccessArticle

Lumbar Muscle Fatty Infiltration and Atrophy in Patients with Low Back Pain and Degenerative Spinal Pathologies: A CT Imaging Study

by Tess Mardulyn, Arnaud Delafontaine, Patrice Jissendi and Laurent Fabeck

J. Clin. Med. 2025, 14(6), 2125; https://doi.org/10.3390/jcm14062125 - 20 Mar 2025

Viewed by 780

Abstract

Background/Objectives: Low back pain (LBP) may be related to intramuscular fatty infiltration (FI), the topography of which has been the subject of only a few studies. Our goal is therefore to determine the importance and topography of FI at the lumbar level and [...] Read more.

Background/Objectives: Low back pain (LBP) may be related to intramuscular fatty infiltration (FI), the topography of which has been the subject of only a few studies. Our goal is therefore to determine the importance and topography of FI at the lumbar level and evaluate its correlation with LBP. Methods: We conducted a retrospective study and compared 254 LBP patients who underwent a lumbosacral CT scan with a sample of 115 healthy subjects, all classified into three age groups (≤35, 36–55, and >55 years old). In CT scan images from L2 to S1, muscle density (Hounsfield unit values ranging from −29 to +150), reflecting intramuscular FI, was measured. LBP was further divided into five subgroups of pathologies. Results: There was a significant difference in muscle density between the small and large circles at the L4/L5 and L5/S1 levels in LBP patients, which was not observed in the healthy subjects. In both LBP patients and healthy subjects, a decreasing density gradient was observed from L2 to S1, with a significant difference in density across age groups. LBP patients exhibit lower muscle densities compared to healthy subjects. Conclusions: In LBP patients, fatty infiltration (FI) of the paraspinal muscles is most pronounced in the lower lumbar region and appears to be localized at the level of muscle insertion. This localized muscle deficit differs from the age-related process of FI and may contribute to the development of LBP and discopathies. Full article

(This article belongs to the Topic Orthopaedic Diseases and Innovative Intervention Strategies, 2nd Volume)

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19 pages, 657 KiB  

Open AccessReview

Surgical Techniques of Gastrocnemius Recession and Achilles Tendon Lengthening (Descriptive Review Article)

by Robin Olaonipekun, Bouchra Ghania Merabia, Anthony Lisyansky, Emmanuel Olaonipekun, Karim Gaber and Waleed Kishta

Osteology 2024, 4(3), 132-150; https://doi.org/10.3390/osteology4030011 - 14 Aug 2024

Cited by 1 | Viewed by 7573

Abstract

This paper aims to review the various surgical techniques for gastrocnemius–soleus recession and Achilles tendon lengthening, with a special focus on the treatment of clubfoot and cerebral palsy (CP) equinus contracture. This descriptive review article comprehensively explores different techniques for gastrocnemius recession, including [...] Read more.

This paper aims to review the various surgical techniques for gastrocnemius–soleus recession and Achilles tendon lengthening, with a special focus on the treatment of clubfoot and cerebral palsy (CP) equinus contracture. This descriptive review article comprehensively explores different techniques for gastrocnemius recession, including the Hoke percutaneous triple hemisection, Baker’s method (Tongue-in-Groove Gastrocnemius–Soleus Recession), the Vulpius method, the Baumann procedure, and the Strayer procedure (Gastrocnemius Recession). The objective is to present a detailed analysis of these methods, covering their indications, procedural nuances, relevance in clinical practice, and outcomes. Full article

(This article belongs to the Topic Orthopaedic Diseases and Innovative Intervention Strategies, 2nd Volume)

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32 pages, 474 KiB  

Open AccessReview

Loss of Independence after Index Hospitalization Following Proximal Femur Fracture

by Hannan A Maqsood, Adam Pearl, Awni Shahait, Basmah Shahid, Santosh Parajuli, Harendra Kumar and Khaled J. Saleh

Surgeries 2024, 5(3), 577-608; https://doi.org/10.3390/surgeries5030047 - 31 Jul 2024

Viewed by 1842

Abstract

Purpose: Proximal femur fractures (PFFs) in elderly patients lead to decreased productivity. Skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs) are non-home destinations for post-discharge disposition. This study aims to evaluate the loss of independence (LOI) following PFFs and examine the economic [...] Read more.

Purpose: Proximal femur fractures (PFFs) in elderly patients lead to decreased productivity. Skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs) are non-home destinations for post-discharge disposition. This study aims to evaluate the loss of independence (LOI) following PFFs and examine the economic impact it entails. Method: The literature from various databases was collected and analyzed retrospectively. The inclusion criteria included patients age > 18 years and articles published after 1990. All studies were screened, a PRISMA chart was used to demonstrate the search process, and 24 studies were finally used for review. Results: LOI following PFFs significantly increases with age. Fractures in geriatrics avail a significant amount of post-care resources and had longer lengths of stay. Furthermore, six pre-operative risk factors were identified for non-home disposition, including age > 75, female, non-Caucasian race, Medicare status, prior depression, and Charlson Comorbidity Index. Patients discharged directly to home have lower total costs compared to those discharged to rehabilitation units. Loss of independence increases with advancing age. Conclusions: PFFs can lead to a serious loss of independence among elderly patients. Female gender, advancing age, white population, co-existing morbidities, lack of proper care, post-operative infections, limitation in mobility following surgery, and impaired cognitive function following surgery are the factors that contribute to the decline in the rate of appropriate recovery following surgery. Therefore, these factors could necessitate permanent residence in a nursing facility (IRFs and SNFs), with a direct impact on economic, social, psychological aspects and the healthcare system. Full article

(This article belongs to the Topic Orthopaedic Diseases and Innovative Intervention Strategies, 2nd Volume)

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15 pages, 2873 KiB  

Open AccessArticle

Mobile App for Enhanced Anterior Cruciate Ligament (ACL) Assessment in Conscious Subjects: “Pivot-Shift Meter”

by Edmundo Berumen-Nafarrate, Ivan Rene Ramos-Moctezuma, Luis Raúl Sigala-González, Fatima Norely Quintana-Trejo, Jesus Javier Tonche-Ramos, Nadia Karina Portillo-Ortiz, Carlos Eduardo Cañedo-Figueroa and Arturo Aguirre-Madrid

J. Pers. Med. 2024, 14(6), 651; https://doi.org/10.3390/jpm14060651 - 18 Jun 2024

Cited by 1 | Viewed by 1075

Abstract

Anterior cruciate ligament (ACL) instability poses a considerable challenge in traumatology and orthopedic medicine, demanding precise diagnostics for optimal treatment. The pivot-shift test, a pivotal assessment tool, relies on subjective interpretation, emphasizing the need for supplementary imaging. This study addresses this limitation by [...] Read more.

Anterior cruciate ligament (ACL) instability poses a considerable challenge in traumatology and orthopedic medicine, demanding precise diagnostics for optimal treatment. The pivot-shift test, a pivotal assessment tool, relies on subjective interpretation, emphasizing the need for supplementary imaging. This study addresses this limitation by introducing a machine learning classification algorithm integrated into a mobile application, leveraging smartphones’ built-in inertial sensors for dynamic rotational stability assessment during knee examinations. Orthopedic specialists conducted knee evaluations on a cohort of 52 subjects, yielding valuable insights. Quantitative analyses, employing the Intraclass Correlation Coefficient (ICC), demonstrated robust agreement in both intraobserver and interobserver assessments. Specifically, ICC values of 0.94 reflected strong concordance in the timing between maneuvers, while signal amplitude exhibited consistency, with the ICC ranging from 0.71 to 0.66. The introduced machine learning algorithms proved effective, accurately classifying 90% of cases exhibiting joint hypermobility. These quantifiable results underscore the algorithm’s reliability in assessing knee stability. This study emphasizes the practicality and effectiveness of implementing machine learning algorithms within a mobile application, showcasing its potential as a valuable tool for categorizing signals captured by smartphone inertial sensors during the pivot-shift test. Full article

(This article belongs to the Topic Orthopaedic Diseases and Innovative Intervention Strategies, 2nd Volume)

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10 pages, 222 KiB  

Open AccessArticle

Perioperative Blood Transfusion and Delirium after Total Knee or Hip Arthroplasty: Retrospective Analysis

by Saeyeon Kim, Tak-Kyu Oh and In-Ae Song

J. Pers. Med. 2024, 14(6), 576; https://doi.org/10.3390/jpm14060576 - 28 May 2024

Cited by 1 | Viewed by 1249

Abstract

We investigated the type of blood component transfusion associated with increased postoperative delirium. Adult patients who underwent total knee arthroplasty (TKA) or total hip arthroplasty (THA) between 2017 and 2022 were included. Delirium was evaluated and treated within two days after surgery. A [...] Read more.

We investigated the type of blood component transfusion associated with increased postoperative delirium. Adult patients who underwent total knee arthroplasty (TKA) or total hip arthroplasty (THA) between 2017 and 2022 were included. Delirium was evaluated and treated within two days after surgery. A total of 6737 patients (4112 TKA/2625 THA) were retrospectively studied; 2.48% of patients in the TKA (n = 102) and THA (n = 65) groups had postoperative delirium. The blood transfusion (BT) and non-BT groups had similar percentages of patients who experienced postoperative delirium (3.34 vs. 2.35%, p = 0.080). In the multivariable logistic regression model, BT was not associated with postoperative delirium—adjusted odds ratio (aOR): 1.03, confidence interval (CI): 0.62, 1.71; p = 0.917. Moreover, transfusion of packed red blood cells (p = 0.651), platelets (p = 0.998), and cryoprecipitate (p = 0.999) were not associated with delirium. However, transfusion of fresh frozen plasma was associated with a 5.96-fold higher incidence of delirium—aOR: 5.96, 95% CI: 2.72, 13.04; p < 0.001. In conclusion, perioperative BT was not associated with postoperative delirium in patients who underwent TKA or THA. However, FFP transfusion was associated with an increased incidence of postoperative delirium. Full article

(This article belongs to the Topic Orthopaedic Diseases and Innovative Intervention Strategies, 2nd Volume)

8 pages, 2053 KiB  

Open AccessCase Report

McCleery Syndrome Caused by Pectoralis Minor Hypertrophy Treated with Multimodal Physical Therapy—A Case Report

by Neven Starčević, Tadija Petrović, Tomislav Pavlović, Danijela Klarić and Dragan Primorac

J. Clin. Med. 2024, 13(10), 2894; https://doi.org/10.3390/jcm13102894 - 14 May 2024

Viewed by 1481

Abstract

We present a case of a healthy young male professional water polo player who presented with swelling and pain in the upper arm and elbow after vigorous exercise. Diagnostic workup included an MRI and dynamic duplex ultrasound, which revealed compression of the axillary [...] Read more.

We present a case of a healthy young male professional water polo player who presented with swelling and pain in the upper arm and elbow after vigorous exercise. Diagnostic workup included an MRI and dynamic duplex ultrasound, which revealed compression of the axillary vein by a hypertrophic pectoralis minor muscle without thrombosis, constituting McCleery syndrome. This is a rare entity within the multiple thoracic outlet syndrome aetiologies. Taking a detailed history and physical examination complemented with diagnostic imaging are vital to the diagnosis. Afterward, the patient was treated with multimodal physical therapy and fully recovered and even exceeded his previous training and play level. Full article

(This article belongs to the Topic Orthopaedic Diseases and Innovative Intervention Strategies, 2nd Volume)

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12 pages, 2178 KiB  

Open AccessSystematic Review

How Effective Is Phage Therapy for Prosthetic Joint Infections? A Preliminary Systematic Review and Proportional Meta-Analysis of Early Outcomes

by Jason Young, Nicita Mehta, Sang Won Lee and Edward Kenneth Rodriguez

Medicina 2024, 60(5), 790; https://doi.org/10.3390/medicina60050790 - 9 May 2024

Cited by 2 | Viewed by 3039

Abstract

Background and Objectives: Despite the promise of phage therapy (PT), its efficacy in prosthetic joint infection (PJI) management is unknown. Much of the current literature is largely limited to case reports and series. Materials and Methods: In order to help inform power calculations [...] Read more.

Background and Objectives: Despite the promise of phage therapy (PT), its efficacy in prosthetic joint infection (PJI) management is unknown. Much of the current literature is largely limited to case reports and series. Materials and Methods: In order to help inform power calculations for future clinical trials and comparative analyses, we performed a systematic review and proportional meta-analysis of early PT outcomes to provide a preliminary assessment of early phage therapy treatment outcomes for cases of PJI. Results: In a search of available literature across MEDLINE (Ovid, Wolters Kluwer, Alphen aan den Rijn, The Netherlands), Embase (Elsevier, Amsterdam, The Netherlands), the Web of Science Core Collection (Clarivate, London, UK), and Cochrane Central (Wiley, Hoboken, NJ, USA) up to 23 September 2023, we identified 37 patients with PJIs receiving adjunctive PT. Patients most frequently reported Staphylococcal species infection (95%) and intraarticular phage delivery (73%). Phage cocktail (65%) and antibiotic co-administration (97%) were common. A random-effects proportional meta-analysis suggested infection remission in 78% of patients (95% CI: 39%, 95%) (I² = 55%, p = 0.08) and 83% with a minimum 12-month follow-up (95% CI: 53%, 95%) (I² = 26%, p = 0.26). Conclusions: Our study provides a preliminary estimate of PT’s efficacy in PJIs and informs future comparative studies. Full article

(This article belongs to the Topic Orthopaedic Diseases and Innovative Intervention Strategies, 2nd Volume)

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9 pages, 205 KiB  

Open AccessArticle

Comparison of Closed and Open Surgical Technique for Second to Fifth Metacarpal Shaft Fractures: A Multicenter, Retrospective Study in a Dutch City Population

by Marcel Libertus Johannes Quax, Maarten Kielman, Sven Albert Meylaerts and Alexander Pieter Antony Greeven

Surgeries 2024, 5(2), 264-272; https://doi.org/10.3390/surgeries5020024 - 18 Apr 2024

Viewed by 1386

Abstract

The aim of this study was to assess surgical treatment in metacarpal shaft fractures of the second to fifth ray to determine the functional outcomes and complications in open reduction and internal fixation (ORIF) versus closed reduction and internal fixation (CRIF). This was [...] Read more.

The aim of this study was to assess surgical treatment in metacarpal shaft fractures of the second to fifth ray to determine the functional outcomes and complications in open reduction and internal fixation (ORIF) versus closed reduction and internal fixation (CRIF). This was a retrospective study that included patients with metacarpal shaft fractures of the second to fifth rays who were treated surgically between 1 January 2007 and 31 December 2019. Functional outcomes were scored using the QuickDASH and Eq5D score. A total of 231 treated patients were included. Single fractures were seen in 180 patients, and multiple fractures in 51 patients. ORIF was applied in 141 patients and CRIF in 90 patients. The functional outcomes were not significantly different between the groups. Complications were found in 41 (29%) of the ORIF patients and 15 (17%) of the CRIF patients. The functional outcomes after single or multiple metacarpal shaft fractures were similar in the ORIF and CRIF patients. ORIF showed significantly more complications, such as functional impairment and infections and a higher reoperation rate. In conclusion, CRIF is as safe as ORIF for the surgical treatment of metacarpal shaft fractures in terms of its functional outcome and slightly preferable due to its lower complication rate. Full article

(This article belongs to the Topic Orthopaedic Diseases and Innovative Intervention Strategies, 2nd Volume)

10 pages, 514 KiB  

Open AccessReview

Dual-Mobility Cups in Patients Undergoing Primary Total Hip Arthroplasty with Prior Lumbar Spine Fusion: A Systematic Review

by Tariq Ziad Issa, Adam Pearl, Emelia Moore, Hannan Ahmad Maqsood and Khaled J. Saleh

Surgeries 2024, 5(2), 125-134; https://doi.org/10.3390/surgeries5020014 - 25 Mar 2024

Cited by 1 | Viewed by 1445

Abstract

Spine and hip abnormalities frequently occur together in most of the orthopedic population; therefore, both of these abnormalities impact the outcomes of the modalities that are being used. Few studies have reported reduced dislocation and revision rates with the use of dual-mobility cups [...] Read more.

Spine and hip abnormalities frequently occur together in most of the orthopedic population; therefore, both of these abnormalities impact the outcomes of the modalities that are being used. Few studies have reported reduced dislocation and revision rates with the use of dual-mobility cups (DMCs) in high-risk lumbar spine fusion (LSF) patients undergoing primary total hip arthroplasty (THA). This study aims to clarify the relationship between pre-existing lumbar spinal fusion and the outcomes of THA with dual-mobility constructs. We systematically reviewed the current literature through several online databases following PRISMA protocol and the Cochrane Handbook for Systematic Reviews of Interventions. We used the methodological index for non-randomized studies (MINORS) to evaluate the methodological quality of the included trials. Four studies examined the feasibility and effectiveness of dual-mobility cups in patients undergoing primary THA with prior LSF. Two studies were conducted in the United States, while the other two originated in Finland and France, respectively. The included studies enrolled 284 patients. Most of these patients had instrumented fusions. Seventy-eight percent of patients received one- or two-level fusions. The average age across the studies was 68.22 and the mean body mass index was 28. No cases of postoperative DMC implant dislocations were identified. The incidence of postoperative complications was 6% (10/173), including deep venous thrombosis, periprosthetic loosening, infection, and fracture, greater trochanteric fracture, and superficial wound infections. Most included studies had some methodological limitations, with an average MINORS score of 10.5 ± 5.8. The use of dual-mobility cups in these high-risk patients undergoing total hip arthroplasty may lead to reduced dislocation rates and postoperative complications. Further long-term follow-up studies are warranted to support these findings. Full article

(This article belongs to the Topic Orthopaedic Diseases and Innovative Intervention Strategies, 2nd Volume)

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