Indian Journal of Orthopaedics最新文献

{"title":"Jumbo Acetabular Cup in the Indian Population: Is It Time to Reconsider Existing Thresholds?","authors":"Akshaya Gadekar, Adarsh Annapareddy, Tarun Jayakumar, Praharsha Mulpur, Raja Bhaskara Rajasekaran, Ravikumar Mukartihal, Sharan S Patil, Vijay C Bose, Shanmuganathan Rajasekaran, A V Gurava Reddy","doi":"10.1007/s43465-026-01790-6","DOIUrl":"https://doi.org/10.1007/s43465-026-01790-6","url":null,"abstract":"<p><strong>Purpose: </strong>The definition of jumbo acetabular cups for revision total hip arthroplasty (THA) is predominantly based on Western populations, with limited applicability to ethnic variations. Indian patients often exhibit distinct anatomical characteristics, necessitating population-specific guidelines to avoid complications such as excessive bone loss or suboptimal component fixation. This study aimed to establish jumbo cup dimensions for Indian patients and compare these findings with global standards.</p><p><strong>Methods: </strong>This retrospective, multicenter observational study analyzed data from 2,372 primary THA patients across four high-volume orthopedic centers in India (2010-2023). Patient demographics, etiology, and acetabular component sizes were extracted from institutional registries. The jumbo cup was defined as 10 mm larger than the mean acetabular component size. Statistical analyses, including one-way ANOVA and linear regression, were conducted to assess the influence of demographic and etiological factors on cup size.</p><p><strong>Results: </strong>The mean acetabular cup size was 49.99 mm (SD: 3.51). Male patients required significantly larger components (mean: 51.23 mm) compared to females (mean: 47.21 mm, <i>p</i> < 0.001). Based on the jumbo cup definition, thresholds were proposed as 62 mm for men and 58 mm for women. These dimensions are 2-4 mm smaller than those recommended for Western populations. Etiology-specific differences were observed, with post-acetabular fractures requiring the largest cups (mean: 2.08 mm increase, <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>This study highlights the need for ethnic-specific jumbo cup definitions in revision THA. The proposed dimensions for Indian patients provide a practical framework for preoperative planning, emphasizing the importance of personalized surgical strategies to enhance outcomes and reduce complications.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"60 9","pages":"2294-2301"},"PeriodicalIF":1.3,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13627498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hip-Spine Evaluation: A Clinical Practice for Total Hip Arthroplasty in Indian Scenario.","authors":"Shreesha Parthaje, Mahesh Kulkarni, Rishi Raj","doi":"10.1007/s43465-026-01815-0","DOIUrl":"https://doi.org/10.1007/s43465-026-01815-0","url":null,"abstract":"<p><strong>Purpose: </strong>Instability following total hip arthroplasty (THA) remains a significant complication. This study aimed to evaluate spinopelvic parameters in Indian patients and the role of functional component positioning in preventing dislocations.</p><p><strong>Methods: </strong>This prospective study included 338 patients undergoing primary THA from January 2023 to June 2024. Spinopelvic alignment and mobility were assessed using standing and sitting radiographs, with classification based on the Simple Hip-Spine classification system. Component positioning was tailored to spinopelvic parameters, including robotic-assisted THA in selected cases.</p><p><strong>Results: </strong>The mean age was 48 years and most common indication of THA was osteonecrosis of head of femur. Spinopelvic abnormalities were observed only in 12% of patients, lower than in Western populations. Functional component positioning successfully prevented dislocations, with no cases reported at 6 months. PI-LL was negative in 58% with hyperlordosis (PI-LL < -10⁰) in 22% and spinopelvic imbalance (PI-LL > 10⁰) was in 9%.</p><p><strong>Conclusion: </strong>Spinopelvic abnormalities are less common in Indian THA patients. Preoperative evaluation and personalized component positioning effectively prevent dislocations.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"60 9","pages":"2289-2293"},"PeriodicalIF":1.3,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13627531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Occurrence and Determinants of Periprosthetic Fractures of the Femur During Intraoperative and Post-operative Period in Patients Undergoing Hip Arthroplasty: A Prospective Cohort Study.","authors":"Amit Kumar, Vijay Kumar Jain, Abdus Sami","doi":"10.1007/s43465-026-01808-z","DOIUrl":"https://doi.org/10.1007/s43465-026-01808-z","url":null,"abstract":"<p><strong>Background: </strong>Periprosthetic femoral fractures (PPFs) are serious complications of hip arthroplasty, leading to increased morbidity and the need for revision surgery. Data on determinants of PPFs in Indian populations are limited. This study aimed to evaluate the occurrence and risk factors for PPFs during intraoperative and postoperative periods in patients undergoing hemiarthroplasty (HA) or total hip arthroplasty (THA).</p><p><strong>Methods: </strong>A prospective cohort study was conducted at a tertiary care center between January 2021 and December 2022. Patients aged 18-80 years undergoing primary HA or THA were enrolled. Demographic, clinical, biochemical, and radiological data-including bone mineral density (BMD), serum vitamin D₃ levels, comorbidities, and femoral morphology (Dorr classification)-were collected. Surgical details and postoperative outcomes were recorded. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of PPFs.</p><p><strong>Results: </strong>Among 402 patients, 25 (6.2%) sustained PPFs, all intraoperatively. Fractures predominantly involved the greater trochanter (92%). Multivariate analysis identified Dorr type C femoral canal (adjusted OR [aOR] 13.5, 95% CI 3.06-59.3), severe osteoporosis (BMD T ≤ - 2.5; aOR 5.63, 95% CI 1.56-20.3), and absence of preoperative vitamin D₃ supplementation (aOR 0.20, 95% CI 0.08-0.50) as independent predictors of PPFs. Other significant associations were advanced age, diabetes, hypertension, COPD, smoking, bipolar hemiarthroplasty, anterolateral approach, and higher ASA grade.</p><p><strong>Conclusion: </strong>PPFs during hip arthroplasty are multifactorial, with bone quality, femoral canal morphology, and preoperative vitamin D₃ supplementation being key determinants. Preoperative optimization of bone health and careful surgical planning can reduce fracture risk and improve outcomes in high-risk patients.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"60 10","pages":"2849-2858"},"PeriodicalIF":1.3,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Halo-Pelvic Traction in Severe Adult Spinal Deformity: A Systematic Review and Meta-Analysis.","authors":"Igin Ginting, Lukas Widhiyanto, Primadenny Ariesa Airlangga, Aries Rakhmat Hidayat","doi":"10.1007/s43465-026-01692-7","DOIUrl":"https://doi.org/10.1007/s43465-026-01692-7","url":null,"abstract":"<p><strong>Background: </strong>Severe adult spinal deformity remains a challenging condition to treat, particularly in patients with rigid curves and limited physiological reserve. Halo-pelvic traction (HPT), historically regarded as a transformative technique, has declined in use but continues to be applied in selected cases. This updated systematic review and meta-analysis aims to clarify the efficacy and safety of HPT in adults.</p><p><strong>Methods: </strong>A systematic search of PubMed, Cochrane, Scopus, Wiley, and Proquest was conducted. Eligible studies included adult patients with severe spinal deformity managed with HPT, alone or in combination with surgery. Primary outcomes were radiographic correction (Cobb angle, kyphotic angle). Secondary outcomes included functional scores, pain improvement, and perioperative parameters. Risk of bias was assessed with ROBINS-I, and certainty of evidence was evaluated using GRADE.</p><p><strong>Results: </strong>Ten retrospective studies were included. Pooled analysis demonstrated significant radiographic correction, with a mean Cobb angle reduction of 55.46° and a kyphotic angle reduction of 53.49°. Subgroup analyses showed the greatest corrections in postoperative HPT (71.41° for Cobb, 120.00° for kyphosis). Functional outcomes (MD 0.57, <i>p</i> = 0.168) and pain outcomes (MD 0.47, <i>p</i> = 0.331) did not show significant improvements. Complications included pin site infections, cranial nerve irritation, and pelvic discomfort. Heterogeneity was high across outcomes.</p><p><strong>Conclusion: </strong>HPT achieves powerful radiological correction in severe adult spinal deformity, particularly when used preoperatively before definitive surgery. However, functional and pain outcomes remain inconsistent, and the technique carries notable burdens and complications. Its role in modern practice should be individualized, and high-quality prospective studies are needed.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"60 10","pages":"2618-2633"},"PeriodicalIF":1.3,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Preoperative Factors Associated with Early Postoperative Neurological Outcome in the Treatment of Metastatic Spinal Tumors.","authors":"Koji Matsumoto, Hirokatsu Sawada, Sosuke Saito, Tomohiro Furuya, Yuya Miyanaga, Kazuyoshi Nakanishi","doi":"10.1007/s43465-026-01754-w","DOIUrl":"https://doi.org/10.1007/s43465-026-01754-w","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the preoperative factors that affect early postoperative neurological outcome of metastatic spinal tumors in order to determine a new basis for surgical indication.</p><p><strong>Methods: </strong>Eighty-seven patients with metastatic spinal tumors were included. Neurological status was assessed using the American Spinal Injury Association (ASIA) grade at 1 month postoperatively, with an additional evaluation at 3 months. Patients with preoperative ASIA grades B or C whose postoperative ASIA grade remained unchanged or worsened, and those with preoperative ASIA grades D or E whose postoperative grade worsened, were classified as having a poor neurological outcome. Patients whose postoperative ASIA grade improved were classified as the improved group. Preoperative clinical and radiological factors, including ASIA grade and spinal cord compression site, were analyzed using univariate and multivariate logistic regression analyses.</p><p><strong>Results: </strong>Multivariate analysis identified preoperative ASIA grade B or C and circumferential spinal cord compression (anterior + posterior) as independent risk factors for poor neurological outcome at 1 month. In contrast, posterior-only spinal cord compression was an independent predictor of neurological improvement. Among patients with preoperative ASIA grades B or C, 11 of 12 patients with anterior + posterior compression experienced poor neurological outcomes, whereas 6 of 7 patients with posterior compression showed neurological improvement.</p><p><strong>Conclusions: </strong>The spinal cord compression site was a neurological prognostic factor for early postoperative neurological outcome. Even in cases with an ASIA grade of B or C, neurological improvement in the early postoperative period was anticipated if the compression site was posterior-only.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"60 10","pages":"2690-2697"},"PeriodicalIF":1.3,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reference Hallucination in AI-Assisted Academic Writing: A Comparative Analysis of ChatGPT, Gemini, and Perplexity in Rotator Cuff Literature.","authors":"İlhan Celil Özbek, Fatih Bağcıer","doi":"10.1007/s43465-026-01807-0","DOIUrl":"10.1007/s43465-026-01807-0","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to compare the reliability of references generated by three different AI-based conversational agents (ChatGPT, Gemini, Perplexity) within the rotator cuff literature.</p><p><strong>Methods: </strong>Designed as a cross-sectional study, 30 subtopics were posed to each bot in two formats (letter to the editor and original article), resulting in a total of 3150 references. Reference reliability was assessed using the Reference Hallucination Score (RHS), which included the following criteria: existence/verifiability, bibliographic accuracy, PMID validity, and topical relevance.</p><p><strong>Results: </strong>When all formats were analyzed together, ChatGPT had the lowest mean RHS (1.81 ± 3.40) and thus emerged as the most reliable model. Gemini scored 4.01 ± 4.89, while Perplexity had the highest score at 6.51 ± 4.89 (<i>p</i> < 0.001). In the letter format, ChatGPT, Gemini, and Perplexity scored 1.81 ± 3.20, 3.81 ± 4.83, and 6.43 ± 4.78, respectively. In the article format, ChatGPT scored 4.02 ± 1.70, Gemini 4.13 ± 1.57, and Perplexity 6.31 ± 1.68. ChatGPT was more reliable than Gemini and significantly superior to Perplexity.</p><p><strong>Conclusion: </strong>AI-based conversational agents may play a supportive role in academic writing; however, they exhibit critical limitations in reference accuracy. While ChatGPT was relatively the most reliable model, Perplexity had the highest hallucination rate. Researchers must refrain from using references generated by these tools without verification, as doing so poses significant concerns for scientific integrity and ethics.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s43465-026-01807-0.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"60 8","pages":"1949-1956"},"PeriodicalIF":1.3,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148678313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterior Osteophytes at L3-L4 as a Primary Predictor of Adjacent Segment Degeneration After Lumbar Instrumented Fusion.","authors":"Murat Şakir Ekşi, Emel Ece Özcan-Ekşi, Arda Topçu, Furkan Karakaş, Çağrı Canbolat, Erhan Çelikoğlu","doi":"10.1007/s43465-026-01788-0","DOIUrl":"https://doi.org/10.1007/s43465-026-01788-0","url":null,"abstract":"<p><strong>Introduction: </strong>Degenerative lumbar spine disorder (DLSD) is a significant public health concern, presenting with low back pain, radicular leg pain, and reduced quality of life. Although conservative management is the first-line treatment, some patients require surgery due to persistent symptoms or progressive neurological deficits. Lumbar instrumented fusion is a commonly performed procedure for DLSD. Adjacent segment degeneration (ASD) is a frequent complication after spinal fusion, occurring at either the cranial or caudal side of the fusion mass. While the role of spinopelvic parameters in ASD is well recognized, radiological predictors for poor outcomes and complications remain less understood. This study aimed to identify preoperative radiological predictors of ASD in patients who underwent short-segment decompression and fusion for DLSD.</p><p><strong>Materials and methods: </strong>We cross-sectionally evaluated radiological data of the patients who underwent short-segment decompression and spinal fusion for DLSD at a tertiary spine clinic between 2013 and 2023.</p><p><strong>Results: </strong>In 209 patients, 31.6% (<i>n</i> = 66) developed radiological signs of ASD. Multivariable analysis revealed that the presence of anterior osteophytes at the L3-L4 level was a significant predictor of ASD (odds ratio [OR] = 3.528) in the overall cohort. When stratified by upper and lower fusion ends, anterior osteophytes at L3-L4 level (OR = 3.912-4.663) and intrafacet vacuum phenomenon at L2-L3 level (OR = 4.269-5.962) were positive predictors, while Modic changes at L4-L5 (OR = 0.284) and fatty infiltration in the multifidus muscle at L2-L3 (OR = 0.462) were negative predictors of ASD.</p><p><strong>Conclusion: </strong>Preoperative anterior osteophytes at L3-L4 level were the strongest predictors of ASD following short-segment lumbar decompression and fusion. According to our results patients with Modic changes at lower levels and less fatty infiltration in the multifidus at upper lumbar levels were better candidates for lumbar decompression and fusion since they were less likely to develop ASD following surgery. These findings may aid clinicians in surgical planning and postoperative follow-up of patients with DLSD.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"60 10","pages":"2647-2662"},"PeriodicalIF":1.3,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decoding melatonin's role in musculoskeletal health: mechanistic foundations and clinical applications.","authors":"Madhan Jeyaraman, Naveen Jeyaraman, Aadithya Siddarth Sridhar, Swaminathan Ramasubramanian, Arulkumar Nallakumarasamy, Sathish Muthu","doi":"10.1007/s43465-026-01795-1","DOIUrl":"https://doi.org/10.1007/s43465-026-01795-1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Melatonin (N‑acetyl‑5‑methoxytryptamine), traditionally viewed as a pineal neurohormone regulating circadian rhythms, is now recognized as a pleiotropic molecule with significant implications for musculoskeletal (MSK) health. Its receptor‑dependent and receptor‑independent actions influence bone, cartilage, muscle, tendon, ligament, and spine biology, positioning melatonin as a potential therapeutic agent across diverse MSK pathologies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Experimental, translational, and clinical studies were surveyed to evaluate melatonin's role in MSK medicine. The literature was analyzed for insights into molecular mechanisms, therapeutic targets, and clinical applications, with particular emphasis on receptor signaling pathways, antioxidant and mitochondrial effects, and epigenetic regulation. Evidence spanning bone, cartilage, muscle, tendon, ligament, spine, and autoimmune MSK conditions was incorporated to provide a comprehensive synthesis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Melatonin exerts its effects through MT1/MT2 receptor signaling, stabilization of Wnt/β‑catenin pathways, modulation of circadian clock genes, andreceptor‑independent mechanisms such as antioxidant activity, mitochondrial protection, and regulation via non‑coding RNAs. In bone biology, it enhances osteoblastogenesis, suppresses osteoclastogenesis, and modulates RANKL/OPG and NLRP3 inflammasome pathways, thereby mitigating osteoporosis and accelerating fracture healing through angiogenesis and callus formation, although dosing requires careful optimization to balance remodeling. In cartilage, melatonin resynchronizes disrupted circadian clocks, inhibits NF‑κB‑mediated inflammation, and preserves extracellular matrix integrity, with novel delivery systems currently under investigation. Skeletal muscle studies highlight its role in Pax7 regulation and Wnt signaling, contributing to the prevention of sarcopenia and cachexia. Evidence also supports its benefits in tendon and ligament repair, while in spinal pathologies melatonin demonstrates protective effects against intervertebral disc degeneration, spinal cord injury, and chronic back pain. Beyond structural tissues, melatonin exhibits cytoprotective roles in musculoskeletal oncology and shows therapeutic promise in systemic autoimmune conditions such as rheumatoid arthritis, lupus, gout, and fibromyalgia. Clinical trials further reveal analgesic, sedative, and sleep‑modulating effects, though translation gaps remain regarding optimal dosing strategies and bioavailability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Melatonin is a multifaceted agent bridging molecular cytoprotection with translational musculoskeletal medicine. Its diverse actions across bone, cartilage, muscle, tendon, ligament, and spine highlight therapeutic promise. However, clinical translation requires precision‑based dosing strategies, improved bioavailability, and rigorous validation in large‑scale trials to full","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"60 9","pages":"2520-2531"},"PeriodicalIF":1.3,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13627577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complications After Internal Fixation of Acetabular Fractures in the Elderly: A Retrospective Review of Incidence and Risk Factors.","authors":"Ashok S Gavaskar, Rodrigo Pesantez Hoyos, Ramesh Kumar Sen","doi":"10.1007/s43465-026-01791-5","DOIUrl":"https://doi.org/10.1007/s43465-026-01791-5","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the incidence and risk factors for complications after open reduction and internal fixation (ORIF) of acetabular fractures in the elderly.</p><p><strong>Methods: </strong>Patients over 60 years undergoing ORIF from 2015 to 2023 were reviewed. The primary outcome measure was incidence of medical and surgical complications, including the 1-year mortality rate. Age, gender, fracture pattern, surgical approach and medical comorbidities (using the American Society of Anesthesiologists, ASA grade) were examined for association with fracture reduction, arthritis, hospital stay and patient-reported outcome measures (Hip Disability and Osteoarthritis Outcome Score, HOOS-12).</p><p><strong>Results: </strong>The study cohort included 28 males and 24 females (52 patients). 12 patients (23%) experienced a medical complication that needed active treatment and 6 patients (12%) died within the first year. 31 patients (60%) experienced one or more surgery-related complication of which 17 patients (33%) needed revision procedures. Higher age and associated fracture patterns were strongly associated with non-anatomical reduction and post-traumatic arthritis. Surgery needing more than one approach, higher age and ASA grades were associated with prolonged hospital stay. Higher age was the only factor which influenced the HOOS-12 scores negatively.</p><p><strong>Conclusions: </strong>A high incidence of medical and surgical complications was observed in elderly patients undergoing ORIF for acetabular fractures. Higher age was consistently associated with complications and poor hip function. More complex fracture patterns, associated medical comorbidities and need for a more extensive surgery were also associated with higher incidence of complications.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"60 5","pages":"1096-1101"},"PeriodicalIF":1.1,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13219670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148137847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Neutrophil-to-Lymphocyte Ratio is Associated with Early Postoperative Pain and Opioid Consumption after Total Knee Arthroplasty: A Retrospective Study.","authors":"Yonghong Ding, Sufen Lu, Huili Kan, Zongwang Zhang","doi":"10.1007/s43465-026-01792-4","DOIUrl":"https://doi.org/10.1007/s43465-026-01792-4","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;As the number of total knee arthroplasties (TKA) continues to rise worldwide, effective postoperative pain management remains a major clinical priority. Poor early pain control can delay recovery, impede mobilization, and increase the risk of persistent pain. Identification of simple preoperative predictors of postoperative pain and opioid requirements may facilitate individualized analgesic management. This study, therefore, investigated whether the preoperative neutrophil-to-lymphocyte ratio (NLR), a marker of systemic inflammation, was associated with pain intensity and opioid consumption during the first three postoperative days after TKA.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective study was performed by reviewing perioperative records of patients undergoing TKA. Adult patients (≥ 18 years) undergoing primary unilateral TKA under general anesthesia with American Society of Anesthesiologists (ASA) physical status I-III were included. Exclusion criteria were revision or bilateral TKA, inflammatory or autoimmune disease, ongoing infection, preoperative chronic opioid use or immunosuppressive therapy, and incomplete clinical records. Patients were divided into two groups based on their preoperative NLR (NLR ≤ 2 vs NLR &gt; 2), according to previously published literature. Postoperative pain was assessed using the 0-10 numerical rating scale (NRS) on postoperative days 1-3, where 0 indicates no pain and 10 the worst imaginable pain; scores of 1-3 were defined as mild, 4-6 as moderate and 7-10 as severe pain. We analyzed differences in analgesic dosages, NRS scores and other relevant parameters between the two groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 427 patients were analyzed. Preoperative NLR showed a significant positive correlation with postoperative NRS scores and sufentanil consumption (both &lt;i&gt;P&lt;/i&gt; &lt; 0.001). Group 2 (NLR &gt; 2) exhibited significantly higher median (Q1-Q3) sufentanil consumption compared to Group 1 (NLR ≤ 2): 102.2 µg (89.0-118.7) vs 72.8 µg (58.7-85.7), &lt;i&gt;P&lt;/i&gt; &lt; 0.001. Higher NLR values were also associated with significantly greater median NRS scores for pain at rest and during movement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Preoperative NLR may serve as a simple and cost-effective biomarker associated with increased postoperative pain and opioid consumption after TKA. Preoperative assessment of NLR may help identify patients at risk for greater pain and higher analgesic requirements, thereby facilitating individualized analgesic management. However, because these findings were derived from a retrospective single-center study, prospective multicenter studies are needed to validate the clinical utility of NLR, determine optimal cutoff values, and develop formal prediction models in accordance with TRIPOD guidelines.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Graphical abstract: &lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Supplementary information: &lt;/strong&gt;The online version contains supplementary material available at https://do","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"60 9","pages":"2313-2321"},"PeriodicalIF":1.3,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13627514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}