PurposeThis 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. MethodsNinety 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. ResultsAfter 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. ConclusionConcurrent 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 evidenceII, prospective comparative study.

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.

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

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.

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.