Abstract:[Objective] To investigate the clinical outcomes of lateral biportal arthroscopic calcaneal spur resection and plantar fascia release for heel pain. [Methods] A retrospective study was conducted on 58 patients who received treatment for heel pain in our hospital from January 2017 to October 2022. Based on the doctor-patient discussion before treatment, 29 patients underwent the arthroscopic surgery (the surgical group), while other 29 patients received conservative treatment (the conservative group). The documents regarding to treatment period, follow-up and images were compared between the two groups. [Results] All the 29 patients in the surgical group were successfully operated on without neurovascular injury, incision infection and other complications. On other hand, those in the conservative group had no adverse reactions during the therapeutic period. During the follow-up period lasted for more than 1 year, no adverse phenomenon or symptom recurrence happened in anyone of the surgery group, whereas heel pain recurred in 2 cases in the conservative group at 6 and 12 months later respectively, who got symptoms were relieved after conservative treatment again. The VAS, AOFAS and Maryland scores in both groups improved significantly over time (P＜0.05). There were no significant differences in VAS, AOFAS and Maryland scores between the two groups before treatment (P＞0.05). However, the surgical group proved significantly superior to the conservative group in terms of VAS score [(3.1± 1.1) vs (5.2±1.2), P＜0.001; (1.6±0.8) vs (4.6±1.4), P＜0.001; (0.6±0.6) vs (3.9±1.3), P＜0.001], AOFAS score [(73.9±10.4) vs (52.2±14.1), P＜ 0.001; (86.1±5.6) vs (59.0±13.3), P＜0.001; (93.5±2.9) vs (62.4±13.0), P＜0.001] and Maryland score [(73.9±10.8) vs (53.0±14.0), P＜0.001; (86.1±5.5) vs (59.3±12.5), P＜0.001; (93.3±2.6) vs (63.0±13.4), P＜0.001] 3, 6 and 12 months after treatment. With regard to imaging, the post-operative X-rays showed that calcaneal spur disappeared, and no recurrence of calcaneal spur occurred until the last follow-up in all the 29 patients in the surgical group, whereas the spurs revealed in images remained unchanged in all patients of the conservative group over time. [Conclusion] The lateral biportal arthroscopic calcaneal spur resection and plantar fascia release for heel pain have the advantage of good curative effect with less iatrogenic trauma. It is superior to conservative treatment in preventing recurrence of heel pain.

Abstract:[Objective] To compare the mid-term clinical outcomes of lateral unicompartmental knee arthroplasty (UKA) in the treatment of post-meniscectomy knee osteoarthritis (PMKO) versus primary knee osteoarthritis (PKOA). [Methods] A retrospective analysis was conducted on 327 patients who underwent initial lateral UKA due to osteoarthritis of the lateral compartment from March 2013 to March 2019. Based on whether they had a history of meniscectomy, the patients were divided into two groups. Of them, 38 patients were fall in the PMKO group (meniscectomy group), subsequently, 38 patients were selected to be included in the PKOA group (non-meniscectomy group) by paired 1∶1 according to age, gender, and side affected. The documents were compared between the two groups regarding to general information, perioperative period, clinical follow-up, and imaging data. [Results] The PMKO group was significantly greater than the PKOA group in terms of ratio of trauma history [(yes/no), (36/2) vs (0/38), P＜0.001] and preoperative Q angle [(15.3±3.0)° vs (12.8±3.3)°, P＜0.001], and the severity preoperative lateral compartmental Kellgren-Lawrence (K-L) classification [0/1/2/3/4, (0/0/1/13/24) vs (0/0/3/21/14), P=0.020], while the former proved significantly less than the latter in term of preoperative knee flexion contracture angle [(5.6±3.9)° vs (8.2±4.5)°, P=0.014]. There was no statistically significant difference between the two groups in terms of surgical time, total incision length, intraoperative blood loss, postoperative drainage volume, incision healing, and hospital stay (P＞0.05). The male got significantly longer asymptomatic survival period than the female after meniscectomy in the PMKO group (P＜0.05). All patients in both groups were followed up for (63.2±24.6) months on an average, and no revision surgery happened in anyone of them. There were no statistically significant differences in VAS, OKS score, ROM, femorotibial angle (FTA), medial proximal tibial angle (MPTA), and posterior tibial slope angle (PTSA) between the two groups at the latest follow-up (P＞0.05). [Conclusion] The mid-term clinical consequence of lateral UKA for knee lateral compartmental osteoarthritis is satisfactory. The history of lateral meniscus resection has no significant impact on the postoperative outcome of lateral UKA.

Abstract:[Objective] To compare the clinical outcomes of non-cemented total knee arthroplasty (TKA) with cemented TKA through a large-scale retrospective analysis. [Methods] A retrospective analysis was conducted on the data of a major U.S. medical records database PearlDiver, covering 103,231 cases of knee osteoarthritis patients who underwent TKA between October 2015 and October 2020. Among them, 17,299 cases received non-cemented TKA, while the remaining 85,932 cases underwent cemented TKA. The medical complications within 90 days after surgery and surgical complications within 2 years after surgery were compared between the two groups. [Results] The non-cemented cohort proved significantly higher than the cemented counterpart in terms of blood transfusion rate within 90 days after TKA [cases (%), 403 (2.3) vs 1 631 (1.9), P＜0.001] and readmission rate [case (%), 1 440 (8.3) vs 6 542 (7.6), P＜0.001], whereas the former had significantly lower incidence of deep vein thrombosis than the latter [cases (%), 495 (2.9) vs 2 725 (3.2), P=0.032]. There was no significant difference in the incidence of other medical complications such as pneumonia and pulmonary embolism (P＞0.05). However, the non-cemented cohort had significantly lower incidence of aseptic prosthesis loosening within 2 years after surgery than the cemented cohort [cases (%), 318 (1.8) vs 1 811 (2.1), P=0.031]. There were no significant differences in the incidence of wound complications, periprosthetic joint infection, joint stiffness, periprosthetic fracture and revision TKA between the two groups (P＞0.05). [Conclusion] In term of primary arthroplasty, the non-cemented TKA has significantly higher risk of perioperative blood loss compared with the cemented counterpart, however, the former has relative lower chance of postoperative aseptic loosening of the prosthesis than the latter. There was no significant difference in the risk of periprosthetic joint infection, revision surgery, or other complications between the two types of TKA.

Abstract:[Objective] To compare the clinical efficacy of open reduction and internal fixation for tibiofibular fractures with or without fixation of the fibular fracture. [Methods] A retrospective analysis was conducted on 54 patients who received surgical treatment for tibiofib- ular fractures in the Department of Traumatic Orthopedic, Ruikang Hospital, Guangxi University of Traditional Chinese Medicine from January 2018 to January 2020. Based on preoperative communication between doctors and patients, 29 patients had tibial fracture fixed, combined with fibular fracture fixed simultaneously (the fixed group), while other 25 patients had the tibial fracture fixed only, without fixation of the fibular fracture (the non-fixed group). The perioperative, follow-up, and imaging data were compared between two groups. [Results] All the patients in both cohorts had the surgical procedures successfully completed without any related complications during the operation. Although the fixed group had significantly longer surgical time [(112.4±13.3) min vs (81.0 ±11.2) min, P＜0.001] and total incision length [(7.0± 1.3) cm vs (4.9±1.2) cm, P＜0.001] than the non-fixed group, the former had significantly fewer intraoperative fluoroscopy times [(3.0±0.9) times vs (5.1±1.4) times, P＜0.001] and resumed postoperative walking significantly earlier than the latter [(8.4±1.4) days vs (24.9±3.0) days, P＜0.001]. All patients in both cohorts were followed up for a period of 12~18 months, and the fixed cohort resumed full weight-bearing activity significantly earlier than the unfixed group [(22.1±1.3) weeks vs (23.4±1.0) weeks, P＜0.001]. Compared with those 3 months after surgery, both groups showed significant improvements in VAS, HSS, AOFAS scores, and ankle dorsal flexion-plantar flexion range of motion (ROM) (P＜0.05) at the last follow-up. The fixed cohort proved significantly superior to the non-fixed counterpart in terms of VAS [(0.2±0.3) vs (1.3± 0.8), P＜0.001], HSS [(88.8 ± 0.7) vs (87.3 ± 2.1), P＜0.001], AOFAS [(91.3 ± 6.6) vs (79.7 ± 14.0), P＜0.001], knee extension-flexion ROM [(134.9±5.5)° vs (126.2±6.1)°, P＜0.001], and ankle ROM [(58.1±8.4)° vs (44.2±10.4)°, P＜0.001] at the latest interview. Regarding imaging,the fixed group also was significantly better than the non-fixed group in excellent rate of fracture reduction and the imaging fracture healing time (P＜0.05). [Conclusion] In open reduction and internal fixation of tibiofibular double fractures, fixing the fibular fracture yields better clinical outcomes, and is a feasible method.

Abstract:[Objective] To explore the clinical outcomes of lumbar, abdominal and hip muscle group orientated training on postoperative kinesiophobia, hip function, and quality of life in the elderly who underwent total hip arthroplasty (THA). [Methods] A total of 77 elderly patients who were undergoing THA for femoral neck fractures from February 2022 to December 2022 were included in this study, and divided into two groups according to the doctor-patient communication. Of them, 38 patients received the lumbar, abdominal and hip muscle group orientated training (the training group), while 39 patients received routine rehabilitation training (the conventional group). The differences in TSK-17 score, Harris score for hip joint function, NRS score for pain, and SF-12 score for quality of life were searched between the two groups. [Results] There was no significant difference in the abovementioned scores between the two groups before surgery (P＞0.05). The training group proved significantly less TSK-17 score [(32.2±7.0) vs (37.2±6.5), P=0.002], whereas significantly greater SF-12 score [(63.1±9.2) vs (56.6± 9.1), P=0.003] than the conventional group, despite of the fact that there was no statistically significant difference in Harris and NRS scores between the two groups 3 days postoperatively (P＞0.05). In addition, the training group was marked significantly lower TSK-17 score [(25.3± 4.3) vs (30.7±5.5), P＜0.001] and NRS score [(1.1±0.6) vs (2.4±1.0), P＜0.001], while significantly higher Harris score [(75.3±4.5) vs (70.6± 6.8), P＜0.001] and SF-12 score [(70.9±7.4) vs (65.8 ± 9.0), P=0.008] than the conventional group a week postoperatively. Furthermore, the training group also proved significantly lower TSK-17 score [(4.8±4.6) vs (7.3±5.7), P=0.033] and NRS score [(0.6±0.5) vs (1.1 ± 0.8), P= 0.005], while significantly higher Harris score [(81.8±5.4) vs (79.6±4.6), P=0.045] and SF-12 score [(77.8±8.3) vs (73.9±7.2), P=0.030] than the conventional group at the latest follow-up. [Conclusion] The lumbar, abdominal and hip muscles orientated training after THA in elderly does effectively reduce the incidence of postoperative kinesiophobia, enhance hip functional activity, and improve quality of life.

Abstract:[Objective] To analyze the relationship between L₅S₁ lumbar disc herniation (LDH) and posterior facetjoint (FJ) development. [Methods] A retrospective analysis was conducted on the clinical data of lateral LDH patients who admitted to our department from 2017 to 2020, additionally, 107 cases of lumbar spine MRI without LDH were collected as the normal group. The FJ angle of L₅S₁ and adjacent L_4/5 were measured on MRI to calculate the difference in FJ between the left and right sides. A difference greater than 10° is defined as bilateral FJ asymmetry. Univariate comparison and multiple factor logistic regression were used to analyze the relevant influencing factors of L₅S₁ LDH. [Results] A total of 102 cases were included in the LDH group, while 107 cases were in the normal group. As results of univariate comparison, there were not significant differences in terms of age, gender, BMI, L_4/5 (∠C), L₅S₁ (∠C), and L_4/5 (∣∠α-∠β∣) and the differences in L_4/5 asymmetry between the two groups (P＞0.05), however, the LDH group proved significantly greater than the normal group regarding to L₅S₁ (∣∠α-∠β∣) [(10.2±5.4)° vs (4.9±7.6)°, P＜0.001], incidence of L₅S₁ asymmetry [cases (%), 59 (57.8) vs 14 (13.0), P＜0.001], absolute difference of ∠C between L_4/5 and L₅S₁ [(18.0 ± 13.6)° vs (14.1±9.3)°, P=0.016], absolute difference of ∠α between L_4/5 and L₅S₁ [(12.0±8.2)° vs (8.7±5.9)°, P＜0.001], absolute difference of ∠β between L_4/5 and L₅S₁ [(9.4±7.8)° vs (7.4 ± 5.0)°, P=0.026]. Multivariate logistic regression analysis showed that the L₅S₁ (∣∠α-∠β∣) (OR=1.245, P＜0.001) and the absolute difference between L_4/5 and L₅S₁ ∠C (OR=1.049, P＜0.001) were the independent risk factors for L₅S₁ lateral LDH. [Conclusion] The L₅S₁ lateral LDH is associated with L₅S₁ (∣∠α-∠β∣) and the absolute difference between L_4/5 and L₅S₁∠C.