Indian Journal of Orthopaedics最新文献

{"title":"Opioid-Free vs Opioid-Containing Regimens for Postoperative Pain Management After Orthopedic Surgery Discharge: A Meta-Analysis.","authors":"Xinyi Guo, Lei Feng, Juan Han, Lili Han","doi":"10.1007/s43465-026-01780-8","DOIUrl":"https://doi.org/10.1007/s43465-026-01780-8","url":null,"abstract":"<p><strong>Background: </strong>Opioid overprescription, especially after orthopedic surgery, contributes significantly to the ongoing opioid crisis. Despite limited benefit, opioids remain common for postoperative pain, increasing risks of addiction and adverse effects. Opioid-free (OF) analgesia offers a promising alternative. This meta-analysis examines the efficacy and safety of OF versus opioid-containing (OC) regimens for post-discharge orthopedic pain management.</p><p><strong>Method: </strong>A systematic search identified randomized controlled trials (RCTs) comparing OF versus OC analgesia after surgical discharge in orthopedic procedures. A random-effects meta-analysis was performed.</p><p><strong>Results: </strong>13 RCTs involving 1,168 patients (588 OF, 580 OC) were included. The surgical procedures comprised arthroscopy (n = 5), hand and small joint surgery (n = 4), spine surgery (n = 2), extremity fracture repair (n = 1), and general ambulatory orthopedics (n = 1). Pain intensity, measured by Visual Analogue Scale (VAS), showed no statistically significant difference between groups on Day 1 (SMD -0.40; 95% CI: -0.85-0.06; P = 0.086) or Day 3 (SMD -0.93; 95% CI: -1.87-0.02; P = 0.055). However, the OF group demonstrated a statistically significant reduction in VAS scores on Days 4-7 (SMD -0.95; 95% CI: -1.88--0.03; P = 0.043). Regarding adverse events, there was no significant difference in overall incidence (RR 0.88; 95% CI: 0.67-1.16; P = 0.377) or nausea/vomiting rates (RR 0.73; 95% CI: 0.47-1.13; P = 0.155). However, the OF regimen significantly reduced the risk of constipation (RR 0.63; 95% CI: 0.43-0.92; P = 0.015).</p><p><strong>Conclusions: </strong>This meta-analysis suggests that, for the examined procedures (predominantly arthroscopy and hand surgery), opioid use at discharge offers no pain control advantage over OF regimens and may increase adverse events. These results support the broader adoption of multimodal OF strategies in these specific contexts, though future research must validate these protocols in major trauma and complex reconstruction surgeries while identifying optimal patient candidates.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at https://doi.org/10.1007/s43465-026-01780-8.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"60 9","pages":"2532-2547"},"PeriodicalIF":1.3,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13627479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109099","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":"Diagnostic Performance of Serum Creatine Kinase and Lactate in Acute Compartment Syndrome of the Extremities: A Systematic Review and Meta-analysis.","authors":"Anil Regmi, Vijay Kumar Jain, Surakshya Baral, Sachin Yashwant Kale, Sanyam Kulshrestha, Karthikeyan P Iyengar","doi":"10.1007/s43465-026-01810-5","DOIUrl":"https://doi.org/10.1007/s43465-026-01810-5","url":null,"abstract":"<p><strong>Background: </strong>Acute compartment syndrome (ACS) is a time-critical surgical emergency requiring prompt diagnosis to prevent irreversible tissue damage. Current diagnostic methods rely on subjective clinical findings and invasive intracompartmental pressure measurement, both with significant limitations. Serum biomarkers may provide non-invasive adjuncts, particularly in patients with unreliable clinical examinations. This study aims to evaluate the diagnostic association of serum creatine kinase (CK) and lactate levels with ACS in patients with extremity trauma.</p><p><strong>Methods: </strong>A systematic literature search was performed in PubMed, Embase, and Scopus as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guideline (PROSPERO Registration: CRD420261351683) from inception through February 2026. Studies evaluating serum CK or lactate in patients with suspected or confirmed ACS with comparison groups were included. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Threshold-based analyses pooled odds ratios (ORs) with 95% confidence intervals (CIs) using fixed-effect models. Continuous biomarker levels were analyzed using standardized mean differences (SMDs) with random-effects models.</p><p><strong>Results: </strong>Four studies comprising 1158 patients (481 ACS cases, 677 controls) were included. For CK, thresholds above 4000 U/L show the strongest associations (OR > 4.0). Continuous CK analysis showed higher levels in ACS patients but did not reach significance (SMD 5.80, 95% CI - 4.55 to 16.16). For lactate, thresholds exceeding 4 mmol/L demonstrate the greatest utility (OR > 4.0). Continuous lactate analysis showed trends toward higher levels (SMD 0.54, 95% CI - 0.00 to 1.08).</p><p><strong>Conclusions: </strong>Elevated serum CK and lactate levels are significantly associated with ACS, with higher thresholds demonstrating stronger diagnostic associations. These biomarkers show promise as non-invasive adjuncts to clinical assessment but should not be used as standalone diagnostic tests. Prospective validation studies are needed to define optimal thresholds for clinical decision-making.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at https://doi.org/10.1007/s43465-026-01810-5.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"60 9","pages":"2368-2377"},"PeriodicalIF":1.3,"publicationDate":"2026-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13627535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108919","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":"Biological Reconstruction Following Distal Tibia Tumor Resection: A Comparative Analysis of Fibula Translocation and Extracorporeal Radiotherapy Autograft.","authors":"Abhijit Behera, Love Kapoor, Venkatesan Sampath Kumar, Sameer Bakhshi, Shah Alam Khan","doi":"10.1007/s43465-026-01802-5","DOIUrl":"https://doi.org/10.1007/s43465-026-01802-5","url":null,"abstract":"<p><strong>Background: </strong>Reconstruction following distal tibia tumor resection presents challenges in achieving stable skeletal support and functional restoration. Various biological reconstruction techniques, including fibula translocation and extracorporeal radiotherapy (ECRT) autograft, have been utilized. This study compares the clinical, radiological, and functional outcomes of these techniques to determine the optimal approach.</p><p><strong>Methods: </strong>A retrospective observational study was conducted on 17 patients who underwent distal tibia tumor resection and biological reconstruction between 2007 and 2022, with a mean follow-up of 62.1 ± 38.6 months. Ten patients received fibula translocation with plate fixation, while seven underwent ECRT autograft reconstruction (four with plate fixation and three with hindfoot nail fixation). Radiological union times, weight-bearing progression, functional scores, and complications were analyzed.</p><p><strong>Results: </strong>ECRT autografts demonstrated a trend towards faster radiological union at both proximal (14.14 ± 3.29 vs. 22.10 ± 1.79 months, <i>p</i> < 0.001) and distal junctions (8.43 ± 1.90 vs. 11.60 ± 1.26 months, <i>p</i> = 0.001). Earlier weight-bearing initiation was observed in ECRT patients (10.79 ± 5.82 vs. 36.90 ± 5.17 weeks, <i>p</i> < 0.001). Time to full weight-bearing was shorter in the ECRT group (19.86 ± 10.10 vs. 57.00 ± 9.76 weeks, <i>p</i> < 0.001). Within the ECRT subgroup, a faster full weight-bearing trend was observed with hindfoot nail fixation as compared to plate fixation (9.33 ± 1.04 vs. 27.75 ± 3.10 weeks, <i>p</i> < 0.001). Functional outcomes remained comparable between groups.</p><p><strong>Conclusion: </strong>ECRT reconstruction facilitates earlier union and weight-bearing compared to fibula translocation. Hindfoot nail fixation further accelerates rehabilitation. While both techniques yield similar functional outcomes, ECRT autograft reconstruction may be preferred for its biomechanical and rehabilitative advantages.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"60 9","pages":"2439-2451"},"PeriodicalIF":1.3,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13627629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108967","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":"Posterior Cruciate Ligament Reconstruction in Elite Athletes: A Narrative Review.","authors":"Darby Amelia Elliott, Chinmay Madhukar Gupte","doi":"10.1007/s43465-026-01794-2","DOIUrl":"https://doi.org/10.1007/s43465-026-01794-2","url":null,"abstract":"<p><strong>Background: </strong>Posterior cruciate ligament (PCL) injuries are uncommon in sport but may be career-defining for elite athletes. Controversy remains regarding indications for reconstruction, optimal techniques and the role of braced non-operative care. This narrative review summarises evidence on operative and non-operative management of PCL injuries in elite athletes, focusing on return-to-play (RTP), graft selection, reconstruction strategy and elite-specific considerations.</p><p><strong>Methods: </strong>A narrative review was conducted in PubMed and Embase (inception-April 2025) with reference list screening. Clinical studies reporting return-to-play outcomes after operative or non-operative management of isolated PCL injuries and PCL-based MLKIs in athletic cohorts were prioritised; 51 studies were included, and heterogeneity precluded meta-analysis.</p><p><strong>Results: </strong>Isolated PCL injuries in elite footballers are rare, whereas PCL-based multi-ligament knee injuries (MLKIs) are more common in collision sports. Early dynamic bracing with quadriceps-focused rehabilitation enables > 90% RTP in selected acute isolated grade II-III tears in high-level athletic cohorts (Level III evidence). For chronic instability or MLKIs, anatomic single-bundle reconstruction remains common, with double-bundle and tibial inlay approaches offering biomechanical but limited clinical advantages. Modern elite MLKI cohorts report 80-90% RTP, though full return-to-performance is less frequent.</p><p><strong>Conclusions: </strong>Management of elite PCL injuries requires individualised, sport-specific decision-making that balances biological healing with performance demands. High-quality, sport-specific outcome data remain limited.Level of EvidenceLevel V, narrative review.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"60 9","pages":"2480-2493"},"PeriodicalIF":1.3,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13627502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108888","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":"Decision-Making in the Choice of Orthopedic Surgeons for Surgery from a Patient and Family Perspective-A Scoping Review.","authors":"Sudip Bhattacharya, Vishal Kumar, Richa, Vikash Raj, Sitanshu Barik","doi":"10.1007/s43465-026-01816-z","DOIUrl":"https://doi.org/10.1007/s43465-026-01816-z","url":null,"abstract":"<p><strong>Background: </strong>Choosing an orthopedic surgeon is a pivotal decision shaped by clinical competence and multiple non-clinical influences. While surgical expertise and outcomes are fundamental considerations, patients and their families also weigh communication quality, cultural alignment, institutional reputation, financial constraints, and increasingly, digital information sources. Understanding these determinants is crucial to delivering patient-centered orthopedic care.</p><p><strong>Methods: </strong>A scoping review was conducted following Arksey and O'Malley's framework and reported in accordance with PRISMA-ScR guidelines. PubMed, Scopus, and Embase were systematically searched for English-language studies published between January 2000 and March 2024 that explored personal, social, institutional, financial, cultural, psychological, or digital factors influencing surgeon selection. Eligible designs included qualitative, quantitative, and mixed-methods studies. Two reviewers independently screened records, extracted data using a standardized form, and synthesized findings narratively across thematic domains.</p><p><strong>Results: </strong>Of 1,245 records identified, 26 studies met the inclusion criteria. Six thematic domains emerged: (1) surgeon-specific attributes such as experience, certification, empathy, and gender; (2) referral networks and peer recommendations; (3) institutional reputation and perceived care quality; (4) financial and insurance constraints; (5) digital influences including online reviews and social media; and (6) familial and cultural dynamics. Surgeon experience and interpersonal communication were consistently prioritized, while referral pathways strongly guided decision-making. Financial and geographic barriers limited choice, particularly in low- and middle-income countries. Digital platforms increasingly shaped perceptions, though concerns about reliability persisted. Family members often dominated decision-making in collectivist societies.</p><p><strong>Conclusion: </strong>Patients' and families' choices of orthopedic surgeons are multifactorial, reflecting an interplay of technical expertise, relational trust, financial considerations, cultural context, and digital engagement. Enhancing transparency, fostering culturally sensitive communication, addressing systemic and financial barriers, and improving the reliability of digital resources can better support informed, equitable, and patient-centered surgical decision-making.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at https://doi.org/10.1007/s43465-026-01816-z.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"60 9","pages":"2470-2479"},"PeriodicalIF":1.3,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13627555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108960","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":"Tumor-Induced Osteomalacia: Clinical Presentation, Evaluation, and Surgical Management of a Rare Paraneoplastic Syndrome-A Case Series.","authors":"Ujjwala Raina, Pulak Sharma, Himanshu J Ashtankar, Lyakat Khan, Akash Yadav","doi":"10.1007/s43465-026-01773-7","DOIUrl":"10.1007/s43465-026-01773-7","url":null,"abstract":"<p><strong>Background: </strong>Primary tumor-induced osteomalacia (PTIO), a paraneoplastic syndrome, is caused by typically benign mesenchymal tumors that secrete fi broblast growth factor 23 (FGF23). This hormone disrupts vitamin D synthesis and phosphate metabolism, manifesting as bone pain, muscle weakness, fractures, hypophosphatemia, and low vitamin D due to renal phosphate wasting. Patients often face delayed diagnosis due to vague symptoms mimicking other conditions and challenges in locating small tumors.</p><p><strong>Methods: </strong>This case series reports four PTIO cases managed at a single Indian institute. Diagnosis involved biochemical tests (elevated FGF23, low TmP/GFR), functional imaging (68Ga-DOTANOC PET-CT, FDG PET), and anatomical imaging(MRI, CT). Tumors were resected with wide margins; histopathology confirmed phosphaturic mesenchymal tumors.</p><p><strong>Results: </strong>Tumor locations included anteroinferior iliac spine, proximal humerus, pectineus muscle, and proximal tibia. All patients achieved 100% functional recovery at 1-year follow-up, with normalization of phosphate levels and independence from supplementation (except one initial recurrence in case 4, successfully revised). Mean diagnostic delay was 4 years; post-resection complications were minimal.</p><p><strong>Conclusions: </strong>This case series demonstrates excellent long-term outcomes of surgical resection in PTIO, and emphasizes on high index of suspicion, multimodality imaging, and wide margin excision. This series bridges gaps in Indian data on rare PTIO, advocating early detection to reduce morbidity.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"60 7","pages":"1711-1721"},"PeriodicalIF":1.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13385330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148548772","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":"Total Knee Replacement: Road Travelled and Lessons Learnt.","authors":"Ashok Rajgopal, Kalpana Aggarwal","doi":"10.1007/s43465-026-01789-z","DOIUrl":"https://doi.org/10.1007/s43465-026-01789-z","url":null,"abstract":"","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"60 6","pages":"1295-1297"},"PeriodicalIF":1.1,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13242310/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148204599","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":"Prevalence of Iron-Deficiency Anaemia in Orthopaedic Oncology Patients Planned for Surgery.","authors":"Liong Jia Yang, Vivek Ajit Singh, Carolyn Yim Chue Wai, Nor Faissal Yasin","doi":"10.1007/s43465-026-01786-2","DOIUrl":"10.1007/s43465-026-01786-2","url":null,"abstract":"<p><strong>Background: </strong>Preoperative anaemia is common, seen in about one-third of patients undergoing elective surgery. The most typical cause of anaemia globally is iron deficiency. Anaemia is linked to an increased risk of mortality, acute kidney injury, and postoperative infection. Intraoperative blood loss worsens pre-existing anaemia and increases the risk of allogeneic blood transfusion. This study aims to determine the following: (1) the prevalence of iron-deficiency anaemia (IDA) and non-anaemic iron deficiency (ID) among orthopaedic oncology patients planned for surgery in our centre and (2) the rate of red cell transfusion among these patients.</p><p><strong>Methods: </strong>Patients aged 18 years and above admitted to the Orthopaedic Oncology Unit who had preoperative full blood count and iron studies were recruited into the study. The study recruitment period was from October 2019 until October 2020. One hundred forty patients were included in this study.</p><p><strong>Results: </strong>From this study, the prevalence of IDA among orthopaedic oncology patients planned for surgery was 10.7% and 36.6% of all anaemias. The prevalence of non-anaemic ID among all patients was 24.3%. 17.1% of all patients received blood transfusions, with an average of 1.9 units of red cells transfused per patient. Among anaemic patients, 39.0% received a blood transfusion, and 12.2% of those transfused had IDA. 8.1% of non-anaemic patients received blood transfusions.</p><p><strong>Conclusions: </strong>Orthopaedic oncology patients with iron deficiency may benefit from preoperative optimisation of iron stores and Hb levels to reduce perioperative red cell transfusion and its associated risks and complications.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"60 7","pages":"1636-1640"},"PeriodicalIF":1.3,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13385322/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148548757","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":"Surgical Outcomes in Fibromatosis: A Single-Centre Outcomes.","authors":"Ling Xiu Wen, Vivek Ajit Singh, Brendan Ong Zong Xian, Roshan Banjara, Nor Faissal Yasin","doi":"10.1007/s43465-026-01787-1","DOIUrl":"10.1007/s43465-026-01787-1","url":null,"abstract":"<p><strong>Background: </strong>Fibromatosis is a rare, benign, yet locally aggressive monoclonal fibroblastic proliferation. While current management paradigms increasingly favour non-operative strategies to avoid surgical morbidity and high recurrence rates, the role of surgery remains debated.</p><p><strong>Objective: </strong>This study aimed to evaluate the clinical presentation, management strategies, and oncological outcomes of fibromatosis at a single tertiary care centre.</p><p><strong>Methods: </strong>We conducted a retrospective, observational study of patients with histologically confirmed fibromatosis treated between January 2006 and September 2021. Data on patient demographics, tumour characteristics, treatment modalities, and disease status at last follow-up were analysed.</p><p><strong>Results: </strong>Of 57 identified patients, 33 had complete records and were included. The cohort was predominantly female (81.82%) with a median age at diagnosis of 25 years. The most common site was the lower limb (mid-leg). The majority (93.94%) of tumours were deep to the fascia. Surgery was the primary treatment in 75.76% of patients, with wide, marginal, and intralesional resections performed in 72%, 24%, and 4% of cases, respectively. At a mean follow-up of 80 months, the progression-free rate for patients treated with primary surgery was 72% (18/25), compared to 87.5% (7/8) for those managed primarily with non-operative strategies (active surveillance or systemic therapy). Overall, 75.76% of patients were disease-free. Statistical analysis revealed no significant correlation between disease-free status and the type of surgical procedure (<i>p</i> = 0.45), surgical margin status (<i>p</i> = 0.72), or tumour location (<i>p</i> = 0.61).</p><p><strong>Conclusion: </strong>In our cohort, both surgery and initial non-operative management resulted in favourable medium-term disease control. Although not statistically significant in this small cohort, a trend towards higher recurrence was observed with marginal (50%) compared to wide (22%) margins. Our data suggest that in selected patients, less radical resection may be a viable option to reduce morbidity, but wider margins may be preferable when feasible without functional compromise. These findings contribute to the ongoing reevaluation of management strategies for fibromatosis.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"60 7","pages":"1619-1626"},"PeriodicalIF":1.3,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13385282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148548732","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":"Radiographic Calibration Markers in Digital Preoperative Planning for Total Hip Arthroplasty: A Systematic Review of Accuracy and Positioning.","authors":"David Ferreira, Ana Rita Martins, José Rodrigues, Joana Azevedo, Pedro Varanda, Guilherme Correia","doi":"10.1007/s43465-026-01781-7","DOIUrl":"https://doi.org/10.1007/s43465-026-01781-7","url":null,"abstract":"<p><strong>Purpose: </strong>Accurate preoperative planning is essential for successful total hip arthroplasty (THA). To minimize radiographic measurement errors, external calibration markers (ECMs) are commonly employed. This systematic review aims to identify the most effective ECM types and their optimal placement for digital preoperative planning in THA.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted in accordance with PRISMA guidelines and registered on PROSPERO. Five databases-PubMed, Scopus, Web of Science, ScienceDirect, and TRIP-were queried for studies reporting quantitative data on ECM performance in calibrating supine anteroposterior pelvic radiographs. Study quality was assessed using the JBI Critical Appraisal Tool.</p><p><strong>Results: </strong>17 studies met the inclusion criteria, encompassing five ECM types: metallic spheres, coins, disks, dual-scale single markers, and the KingMark™ system. The 25 mm metallic sphere was the most frequently used marker, commonly positioned either between the patient's thighs or lateral to the greater trochanter. Reported mean magnification across studies was 115.5%, with an average implant size prediction accuracy of 75.5%. While the overall methodological quality was acceptable, significant heterogeneity in study design and outcome reporting was observed.</p><p><strong>Conclusion: </strong>Spherical markers consistently outperformed coins and disks in calibration accuracy. Dual-marker systems such as KingMark™ demonstrated good reproducibility and appear particularly suitable for clinical environments where standardization is crucial. Placement of ECMs lateral to the greater trochanter, and between the thighs, tended to yield more reliable results, despite occasional practical limitations. Further high-quality, standardized studies are needed to define best practices for radiographic calibration in THA planning.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"60 9","pages":"2177-2191"},"PeriodicalIF":1.3,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13627504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108931","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}