Clinical Orthopaedics and Related Research®最新文献

{"title":"What Substitution and Prediction Strategies Address the Challenge of an Unmeasurable C2-7 Cobb Angle?","authors":"Zerui Qin, Yu Ran, Zongshuo Sha, Lingmin Wu, Haodong Xiong, Qianzi Zhao, Zhongze Li, Jinsong Chen, Dongran Han, Yixing Liu, Jinyu Li, Jiang Chen","doi":"10.1097/CORR.0000000000003812","DOIUrl":"10.1097/CORR.0000000000003812","url":null,"abstract":"<p><strong>Background: </strong>The C2-7 Cobb angle is an important parameter in evaluating cervical sagittal alignment, which is widely used for preoperative planning, identifying surgical indications, and postoperative assessment. However, this angle becomes unmeasurable in 28% to 49% of clinical radiographs because of poor visualization of the C7 inferior endplate, limiting treatment planning and radiographic follow-up in cervical alignment assessment. The C2-6 Cobb angle has been proposed as a substitute in previous research, but these studies were limited by small symptomatic cohorts from a single center and lacked both subgroup-specific and external validation. Furthermore, there is currently a lack of reference standards for the clinical use of the C2-6 Cobb angle, and no established machine-learning models are available to accurately predict the C2-7 Cobb angle.</p><p><strong>Questions/purposes: </strong>(1) Can the C2-6 Cobb angle serve as a reliable substitute for the C2-7 angle? (2) Can machine-learning models accurately predict the C2-7 Cobb angle?</p><p><strong>Methods: </strong>We conducted a retrospective, multicountry imaging study from January 2020 to January 2025, utilizing standing lateral cervical spine radiographs from a large hospital data set in China and public data sets from Vietnam and India. In China, 11,800 radiographs were initially screened. The inclusion criterion was cervical radiographs of sufficient clarity. The exclusion criterion was cervical radiographs with incomplete visualization of anatomic structures. Following these exclusions, 10,571 radiographs from China were included, comprising 10,000 standard standing lateral radiographs plus 284 implant and 287 flexion-extension radiographs. From the public data sets, 470 radiographs from Vietnam and 62 from India were reviewed, with no radiographs excluded. A total of 11,103 radiographs were available for final analysis. Key variables included demographics (age, sex), symptomatic status, implant status, and radiographic sagittal parameters derived from standing lateral views. Four orthopaedic specialists labeled keypoints on the original radiographs, including the corner points of C2 to C7 and the centroid of C2. An algorithm was employed for precise measurement of the C2-6 and C2-7 Cobb angles. The Pearson correlation coefficient was calculated to assess the strength of the correlation between the C2-6 and C2-7 Cobb angles, and a linear regression analysis was applied to derive a predictive equation for the C2-7 Cobb angle based on the C2-6 Cobb angle. Subsequently, the 10,000 standard Chinese standing lateral radiographs were randomly assigned to the training set (80%) and the testing set (20%). An independent validation set (n = 1103) was established to assess robustness, comprising 284 implant radiographs and 287 flexion-extension radiographs from China, together with 470 from Vietnam and 62 from India.</p><p><strong>Results: </strong>Correlation analysis dem","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"1001-1017"},"PeriodicalIF":4.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146050583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: What Substitution and Prediction Strategies Address the Challenge of an Unmeasurable C2-7 Cobb Angle?","authors":"Panagiotis Korovessis","doi":"10.1097/CORR.0000000000003847","DOIUrl":"10.1097/CORR.0000000000003847","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"1018-1019"},"PeriodicalIF":4.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146164427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Which Imaging Modalities, Parameters, and Diagnostic Thresholds Best Define Hip Instability? Consensus Statements From a Scoping Review and an International Multidisciplinary Delphi Study.","authors":"Vincent Justus Leopold, Kawan Rakhra, Andrea M Spiker, Jeffrey J Nepple, Martin Beck, Motahareh Karimijashni, Stéphane Poitras, Paul E Beaulé, George Grammatopoulos","doi":"10.1097/CORR.0000000000003905","DOIUrl":"10.1097/CORR.0000000000003905","url":null,"abstract":"<p><strong>Background: </strong>The diagnosis of hip instability remains challenging because of its multifactorial etiology and the variability of imaging practices across institutions. Hip instability refers to a clinical condition of insufficient osseous and/or soft tissue constraint with abnormal femoral head motion and symptoms, which may occur along a morphologic spectrum that overlaps with-but is not synonymous with-developmental dysplasia of the hip. Although numerous imaging modalities and imaging parameters have been proposed, there is limited consensus on which are most relevant, how they should be measured, and what diagnostic thresholds best correlate with instability. To address this gap, a Delphi consensus study with an international panel of experts to establish standardized clinical statements for the diagnostic criteria of hip instability was conducted.</p><p><strong>Questions/purposes: </strong>(1) What are the imaging modalities and protocols for investigating hip instability? (2) Which imaging parameters are most strongly associated with clinical hip instability? (3) What are the quantitative imaging thresholds for diagnosing hip instability?</p><p><strong>Methods: </strong>A consensus study using a modified Delphi technique was conducted in accordance with the Accurate Consensus Reporting Document (ACCORD) guideline. Following a scoping review, 27 statements addressing imaging modalities and protocols (question 1), imaging parameters associated with hip instability (question 2), and quantitative imaging thresholds (question 3) were developed. These statements were evaluated by a multidisciplinary international expert panel during a structured consensus meeting, with two rounds of anonymous voting and consensus defined a priori as ≥ 75% agreement. Consensus was achieved for 81% (22 of 27) of statements.</p><p><strong>Results: </strong>There was strong agreement that radiography (AP pelvis, false-profile, Dunn view) and MRI and CT constitute the foundational imaging modalities for the assessment of hip instability, whereas cartilage mapping techniques and dynamic ultrasound were considered adjunctive modalities with a more limited and evolving role. Radiographic measurements such as lateral center-edge angle (LCEA), anterior wall index (AWI), posterior wall index, and Tönnis angle reached consensus as key morphologic indicators. Several quantitative thresholds were endorsed. An LCEA of < 20° was considered diagnostic for hip dysplasia, a condition in which clinical hip instability is highly prevalent, whereas values between 20° and 25° were considered concerning for possible clinical hip instability. Additional thresholds included an AWI of < 0.30, PWI of < 0.8, and acetabular version < 5° or > 30°. In contrast, no consensus was reached for less-established imaging metrics such as the FEAR index, crescent sign, anterior capsule thickness, and dynamic femoral head translation.</p><p><strong>Conclusion: </strong>This internationa","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"899-915"},"PeriodicalIF":4.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147608412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Residency Diary: Hard.","authors":"Lisa G M Friedman","doi":"10.1097/CORR.0000000000003908","DOIUrl":"10.1097/CORR.0000000000003908","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"854-855"},"PeriodicalIF":4.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: Benchmarking THA Implant Combinations Using Data From a US Total Joint Replacement Registry.","authors":"Troy B Amen","doi":"10.1097/CORR.0000000000003888","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003888","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"484 5","pages":"949-951"},"PeriodicalIF":4.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: Frame-based Draping Technique for Standard Table Direct Anterior Approach THA: Efficient and Safe?","authors":"Geert Meermans","doi":"10.1097/CORR.0000000000003853","DOIUrl":"10.1097/CORR.0000000000003853","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"963-965"},"PeriodicalIF":4.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147316576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Are the Clinical Characteristics and Outcomes of Brucellar Spondylitis in a Nonendemic Region of Southern China?","authors":"Zhuoang Lin, Jiajun Tang, Qiuhong Chen, Haojie Mi, Wensheng Zhang, Jie Zhang, Hengbiao Sun, Shiyong Le, Zhongmin Zhang, Liang Wang","doi":"10.1097/CORR.0000000000003968","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003968","url":null,"abstract":"<p><strong>Background: </strong>Brucellosis, historically endemic to northern China, has recently shown a southward spread into previously nonendemic regions. Although brucellar spondylitis represents one of the most disabling complications of the disease, its clinical and epidemiologic characteristics in these emerging southern regions remain poorly defined, warranting further investigation.</p><p><strong>Questions/purposes: </strong>Among patients diagnosed with brucellar spondylitis from nonendemic regions of southern China, we asked: (1) What are the predominant clinical and laboratory findings? (2) For focal lesion aspiration cultures and blood cultures, what proportion of patients had positive cultures and what factors were associated with having positive cultures? (3) What are the characteristic imaging findings? (4) At a minimum 1-year follow-up, what were the proportions of patients with mild sequelae (exertional pain without functional impairment), moderate sequelae (neurologic deficits or work interference), treatment failure, and infection recurrence?</p><p><strong>Methods: </strong>Between January 2015 and April 2025, we treated 47 patients with brucellar spondylitis at a tertiary medical center in a nonendemic region of southern China. Two patients were excluded because of incomplete clinical records, leaving 45 patients for the baseline analyses. An additional seven patients were excluded from the evaluation of clinical outcomes and sequelae: three because follow-up after completion of therapy was shorter than 1 year and four because they were lost to follow-up after completion of therapy before reaching the minimum 1-year follow-up threshold; this left 38 patients for outcome evaluation. The baseline cohort had a mean ± SD age of 55 ± 11 years; 49% (22 of 45) were women, 58% (26 of 45) lived in rural areas, and 38% (16 of 42) had high-risk occupations. Diagnosis required compatible imaging findings on CT or MRI (including vertebral destruction, disc involvement, or localized abscess formation) together with laboratory confirmation (positive blood culture or focal lesion aspiration culture for Brucella or a standard agglutination test titer of at least 1:100). Demographic, epidemiologic, clinical, laboratory, microbiologic, and imaging data were extracted from electronic medical records. CT and MRI were used to assess vertebral destruction, disc involvement, and abscess formation. All 45 patients received doxycycline-based combination antimicrobial therapy; 76% (34 of 45) were treated nonoperatively with antibiotics and external bracing, whereas 24% (11 of 45) underwent surgery. Clinical outcomes assessed at a minimum of 1 year included recovery, treatment failure, recurrence, and sequelae; recovery was defined as no clinical evidence of ongoing infection at final follow-up. Categorical and continuous variables were compared using the Fisher exact test and independent-samples t-test, respectively, with Bonferroni correction for mul","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: Is Arm Dominance Associated With Clinically Meaningful Differences in Outcomes After Shoulder Arthroplasty?","authors":"Kenneth J Accousti","doi":"10.1097/CORR.0000000000003975","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003975","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: Synthesis and Characterization of an Antimicrobial Honey-based Composite Bone Cement.","authors":"Malcolm R DeBaun","doi":"10.1097/CORR.0000000000003970","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003970","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: Program Size and City Characteristics May Be Associated With Gender Diversity in Orthopaedic Surgery Residency Programs.","authors":"Ellen Lutnick","doi":"10.1097/CORR.0000000000003972","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003972","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}