International Orthopaedics最新文献

{"title":"The effectiveness and safety of tripod-enhanced percutaneous reconstruction combined with local tumour inactivation for periacetabular metastases: a long-term follow-up study.","authors":"Yuan Yan, Guoli Huang, Peng Gu, Xin Wang, Wenhan Huang, Mengyu Yao, Yu Zhang","doi":"10.1007/s00264-026-06970-5","DOIUrl":"10.1007/s00264-026-06970-5","url":null,"abstract":"<p><strong>Objectives: </strong>Periacetabular metastases often cause severe pain and functional impairment, whereas open acetabular reconstruction carries substantial morbidity that may delay systemic cancer treatment. This study evaluated the safety and effectiveness of tripod-enhanced percutaneous reconstruction combined with microwave ablation (MWA) for periacetabular metastases.</p><p><strong>Methods: </strong>We retrospectively reviewed 31 patients (mean age, 59.5 ± 14.4 years; 18 men, 13 women) with acetabular metastases treated with this technique. Clinical outcomes were assessed preoperatively and at three, six and 12 months postoperatively and final follow-up. Endpoints included pain (VAS), functional status (ECOG), weight-bearing ability, perioperative blood loss, complications, and survival.</p><p><strong>Results: </strong>Fourteen of 31 patients died during follow-up, with a median postoperative survival of 35.0 months (95% CI, 17.5-52.5). Mean VAS scores improved significantly from 5.85 ± 1.63 preoperatively to 2.48 ± 1.25, 1.22 ± 0.95, and 1.59 ± 1.10 at three, six and 12 months, respectively (all p < 0.001). ECOG performance status also improved from 2.44 ± 1.00 to 1.60 ± 0.65, 1.48 ± 0.59, and 1.50 ± 0.67 at three, six and 12 months. In patients surviving beyond one year (12-41 months), pain relief and functional improvement were maintained. No implant failure, infection, or treatment delay occurred. At final follow-up, 21 patients (67.7%) achieved independent ambulation, seven (22.6%) required assistive devices, and three (9.7%) received additional radiotherapy. No patient underwent total hip arthroplasty.</p><p><strong>Conclusion: </strong>Tripod-enhanced percutaneous reconstruction combined with MWA is a safe, minimally invasive, and effective option for periacetabular metastases, providing durable pain relief and improved mobility.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"3035-3046"},"PeriodicalIF":2.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148603056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does tibia vara increase medial knee pain following cemented mobile-bearing unicompartmental knee arthroplasty? a prospective comparative study.","authors":"Boonchana Pongcharoen, Chuntit Panumaswiwat, Sitichoke Promkoh, Sakon Donnimitsakul","doi":"10.1007/s00264-026-06977-y","DOIUrl":"10.1007/s00264-026-06977-y","url":null,"abstract":"<p><strong>Purpose: </strong>To determine whether preoperative tibia vara increases medial knee pain (MKP) following cemented mobile-bearing unicompartmental knee arthroplasty (UKA).</p><p><strong>Methods: </strong>This prospective study included 150 knees with anteromedial osteoarthritis undergoing cemented mobile-bearing UKA (Group I: 39 tibia vara; Group II: 111 normal tibia). Primary outcome was VAS for MKP, analysed by generalized estimating equations to account for bilateral cases. Secondary outcomes included Knee Society Score, Oxford Knee Score, Knee injury and Osteoarthritis Outcome Score, Forgotten Joint Score, Kujala Score, and anterior knee pain, assessed at six weeks to 24 months.</p><p><strong>Results: </strong>VAS for MKP was never higher in Group I and did not differ at two years (0.2 ± 0.5 vs. 0.3 ± 0.7; p = 0.25); it was significantly lower in Group I at six months (0.2 ± 0.6 vs. 0.6 ± 1.3; p = 0.01), by margins below the minimal clinically important difference. Postoperative aTFA was lower in Group I (0.0° ± 2.5 vs. 3.4° ± 2.9; p < 0.001). No complications occurred in either group.</p><p><strong>Conclusion: </strong>Tibia vara does not increase MKP or adversely affect short-term clinical outcomes following cemented mobile-bearing UKA.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"2885-2894"},"PeriodicalIF":2.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148684506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A historical journey through total knee arthroplasty: the evolutionary milestones.","authors":"Julien Wegrzyn, Mo Saffarini","doi":"10.1007/s00264-026-06976-z","DOIUrl":"10.1007/s00264-026-06976-z","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to examine historical progressions to demonstrate how current debates in alignment philosophy, implant personalization, robotic surgery, and ligament management serve as direct extensions of past concepts.</p><p><strong>Methods: </strong>The history of TKA was divided into four major evolutionary phases: the era of experimentation between 1860 and 1970, the period of implant design and biomechanical standardization between 1970 and 2000, the rise of personalization and morphologic understanding between 1985 and 2020, and the modern era of perioperative and technological evolution beginning in the early 2000's.</p><p><strong>Results: </strong>One of the earliest total joint replacement concepts was introduced in 1890 by Gluck, who implanted an ivory hinged knee prosthesis fixed with primitive cement materials. Modern hinged knee arthroplasty emerged during the 1950s to address severe arthritis and ligamentous instability, which constrained out-of-plane movement by allowing only flexion-extension. During the 1980s, modularity and mobile-bearing concepts gained widespread popularity. Metal-backed tibial components allowed polyethylene exchange and improved intraoperative flexibility, a concept exemplified by the Insall Burstein Posterior Stabilized II prosthesis. Beginning in the late 1980s and accelerating during the 1990s and early 2000s, researchers increasingly recognized that standardized implant geometries did not accurately reproduce native anatomy in many patients. During the 2000s and 2010s, alignment philosophy underwent a major paradigm shift. The twenty-first century introduced major advances in digital surgery.</p><p><strong>Conclusion: </strong>The future of total knee arthroplasty will be shaped by advances in implant design, surgical methods, digital technologies, and biologic reconstruction. These trends continue the goal of mimicking native knee anatomy, biomechanics, and function. Future implants will likely shift from standard components to more personalized solutions.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"3059-3069"},"PeriodicalIF":2.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148684516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficiency and cost-effectiveness of three surgical strategies for primary osteoarthritis of the elbow: a multicenter propensity score-weighted cohort study.","authors":"Shiyang Yu, Yanmao Wang, Shicheng Zhou, Fanhui Zeng, Jian Ding, Shengdi Lu","doi":"10.1007/s00264-026-07001-z","DOIUrl":"10.1007/s00264-026-07001-z","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Primary osteoarthritis of the elbow causes progressive stiffness and pain, yet no study has directly compared the efficiency and cost-effectiveness of the three principal surgical strategies: total elbow arthroplasty (TEA), open osteocapsular arthroplasty (OCA), and arthroscopic OCA. We hypothesized that joint-preserving OCA would achieve greater motion recovery at lower cost than TEA.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This multicenter retrospective cohort study identified 542 patients with primary elbow OA from three Chinese Tertiary A hospitals (surgery January 2017-December 2023; minimum two year follow-up through December 2025): 142 TEA, 221 open OCA, and 179 arthroscopic OCA. Because propensity-score matching left substantial residual imbalance in age and baseline motion, primary inference was based on generalized overlap weighting, which achieved covariate balance and estimates the average treatment effect in the overlap population, that is, the sub-population in clinical equipoise [25, 40]. Matching with covariate-adjusted mixed models is reported as a supporting analysis. Co-primary outcomes were the percentage of lost motion recovered and the flexion-extension (FE) arc at two years. Because pain relief rather than motion is the principal indication for TEA, cost-effectiveness was additionally assessed on a pain axis. Willingness-to-pay thresholds were not applied, as gross-domestic-product-based thresholds are defined per quality-adjusted life year and are not commensurate with effects expressed in natural units [4, 27].&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Overlap weighting achieved acceptable balance (age standardized mean difference 0.11; baseline arc 0.08) with an effective sample size of 246 of 542 patients (45.4%; TEA 41, open OCA 144, arthroscopic OCA 62). In the overlap population, the percentage of lost motion recovered at 2 years was 15.8% (TEA), 35.9% (open OCA), and 32.2% (arthroscopic OCA), and the 2-year FE arc was 94.0°, 108.0°, and 104.5°. Both OCA procedures exceeded TEA by 16-20 percentage points of lost motion recovered, whereas the difference between the two OCA approaches was below the minimal clinically important difference. On the pain axis, visual analog scale reduction was 1.93, 2.44, and 2.77 points; all between-group differences (0.33-0.84) fell below the 1.4-point minimal clinically important difference, indicating clinically equivalent pain relief. Overlap-weighted total costs were ¥86,728 (TEA), ¥32,503 (open OCA), and ¥24,677 (arthroscopic OCA). TEA therefore cost approximately ¥62,000 more per patient than arthroscopic OCA without a clinically important advantage on either axis. Corrected complication rates in the TEA group were radiographic aseptic loosening 13.6%, loosening requiring revision 8.2%, and revision surgery 9.4%, consistent with published mid-term series.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Within the sub-population in clinical equipoise, joint-preserving OCA recovere","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"2935-2947"},"PeriodicalIF":2.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bibliometric analysis of enthesis research: a comprehensive review from 1999 to 2024.","authors":"Aleksey Lychagin, Ivan Lychagin, Yulia Goncharuk, Ivan Vyazankin, Vadim Cherepanov, Tagir Kudrachev, Anastasia Kostysheva, Berardo Di Matteo, Elizaveta Kon, Eugene Kalinsky","doi":"10.1007/s00264-026-06900-5","DOIUrl":"10.1007/s00264-026-06900-5","url":null,"abstract":"<p><strong>Purpose: </strong>The present bibliometric analysis of the literature concerning the bone-tendon interface aims at identifying the past and new trends of research in this specific field under both the rheumatic orthopaedic point of view.</p><p><strong>Methods: </strong>The bibliometric analysis of the bone-tendon interface was conducted using the Scopus online platform with a search period of 1999 to 2024. There were three research steps, and 5 773 articles included in the research. The data was analyzed using Bibliometrix online analytics platform and VOS viewer application.</p><p><strong>Results: </strong>A total of 4,747 articles met the inclusion criteria and were amenable to analysis. The number of published articles has been steadily growing for 26 years with two peaks of interest. The United States is the leader in total amount of international and local publications. Among the institutions researching on enthesis, the University of Toronto (Canada, Toronto) has published the largest number of articles. There is a steady trend towards studying the possibility of using new cellular and cell-free technologies in the treatment of pathologies.</p><p><strong>Conclusion: </strong>Over the past 26 years, the number of published articles on the subject of enthesis has steadily increased, reaching a peak in activity in 2022. The present research also highlighted that researchers are currently focusing on the possibility of using regenerative technologies, in particular exosomes, in the treatment of enthesis pathologies.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"2785-2803"},"PeriodicalIF":2.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148387577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between postoperative surgical site infection and oncologic outcomes in soft tissue sarcoma: a propensity score-matched analysis using the bone and soft tissue registry.","authors":"Jun Iwatsu, Koichi Ogura, Takeshi Morii, Kenji Sato, Akira Kawai","doi":"10.1007/s00264-026-06961-6","DOIUrl":"10.1007/s00264-026-06961-6","url":null,"abstract":"<p><strong>Purpose: </strong>Postoperative surgical site infection (SSI) is a prevalent complication. The impact of SSI on oncologic outcomes in soft tissue sarcoma (STS) remains debatable. This study evaluates the correlation between SSI and prognosis following STS resection through analysis of a national registry and propensity score matching (PSM).</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using data from the Japanese Nationwide Bone and Soft Tissue Tumor (BSTT) Registry between 2006 and 2019. The study included patients aged 18 years or older with localized primary STS who underwent surgical resection. PSM at a 1:3 ratio was performed using 11 baseline variables to ensure balance in patient and tumour characteristics between the SSI and non-SSI groups. The overall survival (OS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were analyzed using the Kaplan-Meier method and compared using the log-rank test.</p><p><strong>Results: </strong>A total of 6,303 patients met the inclusion criteria, of whom 226 (3.6%) developed SSI. Prior to matching, the SSI group exhibited significantly poorer OS (5-year rate: 74.0% vs. 80.0%, p = 0.044) and DMFS (5-year rate: 63.1% vs. 72.4%, p = 0.02). Following PSM, 221 matched pairs (n = 884) were analyzed, and no significant differences in OS (p = 0.53) and DMFS (p = 0.19) were observed between the SSI and non-SSI groups.</p><p><strong>Conclusions: </strong>Postoperative SSIs were not significantly associated with oncologic outcomes after adjusting for confounding factors. These findings suggest that SSI may not be an independent prognostic factor in patients with STS.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"3017-3023"},"PeriodicalIF":2.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-related rather than surgery-related factors predict mortality following femoral stem revision for periprosthetic femoral fracture: a series of three hundred and ninety eight cases.","authors":"Lorene Tallet, Mohammad Alsuwaidi, Vincent Haignere, Olivier Mares, Nicolas Cellier, Philippe Marchand, Remy Coulomb, Pascal Kouyoumdjian","doi":"10.1007/s00264-026-06944-7","DOIUrl":"10.1007/s00264-026-06944-7","url":null,"abstract":"<p><strong>Introduction: </strong>Periprosthetic femoral fractures (PPFs) are an increasing cause of revision total hip arthroplasty (THA) and mainly affect an elderly and frail population. When femoral stem revision is required, surgical management remains associated with substantial morbidity and mortality. However, it remains unclear whether postoperative mortality is primarily driven by patient-related characteristics or by surgery-related factors.</p><p><strong>Purpose: </strong>To identify time-dependent prognostic factors for mortality during the first postoperative year following femoral stem revision for PPF.</p><p><strong>Material and methods: </strong>A retrospective single-centre consecutive series of 398 PPFs treated with femoral stem revision between January 2011 and August 2023 was analysed. Mean age was 81 years (± 11), and 59% of patients had an ASA score ≥ 3. Mortality risk factors were evaluated at 30 days, three months, six months, and one year using multivariate analysis.</p><p><strong>Results: </strong>One-year mortality was 20.4%. Male sex, older age, and a higher ASA class were independent predictors of mortality at all evaluated postoperative time points. Low BMI emerged as an additional independent predictor of year mortality. Although several clinical and surgical variables were associated with mortality in univariate analyses, only patient-related factors remained independently associated with mortality after multivariable adjustment.</p><p><strong>Conclusion: </strong>Mortality following femoral stem revision for PPF remains high in this elderly and vulnerable population. Patient-related factors, particularly older age, higher ASA class, male sex, and low BMI, were the main independent predictors of postoperative mortality, whereas surgical variables were not independently associated with survival after adjustment. These findings highlight the predominant role of baseline patient frailty and may help improve perioperative risk stratification and multidisciplinary management.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"2989-2997"},"PeriodicalIF":2.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148630441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for revisions in patients following total hip arthroplasty and hemiarthroplasty due to femoral neck fractures.","authors":"Itay Ron, Yakov Tkatch, David Shaked Zari, Mosa Shhade, Noam Reshef, Utai Rudich, Alexander Lerner, Jacob Shapira","doi":"10.1007/s00264-026-07051-3","DOIUrl":"https://doi.org/10.1007/s00264-026-07051-3","url":null,"abstract":"<p><strong>Background: </strong>Total hip arthroplasty (THA) and hemiarthroplasty (HA) are established treatments for displaced femoral neck fractures (FNF), yet factors associated with revision following either procedure remain poorly defined. This study evaluated demographic, clinical, and laboratory predictors of revision after THA and HA for FNF.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted at a tertiary trauma centre including 2,522 patients treated with arthroplasty for FNF (885 THA, 1,637 HA). Demographic characteristics, comorbidities, and pre- and postoperative laboratory parameters were compared between patients who underwent revision and those who did not. Variables significant on univariate analysis were entered into multivariable logistic regression. Receiver operating characteristic (ROC) analysis was performed to determine optimal cutoff values for significant continuous predictors.</p><p><strong>Results: </strong>Revision occurred in 93 of 885 THA patients (10.5%) and 43 of 1,637 HA patients (2.6%) (p < 0.001). In the THA cohort, patients requiring revision were younger (65.4 vs. 72.5 years, p < 0.001), had shorter hospital stays (5.4 vs. 7.5 days, p = 0.001), higher postoperative haemoglobin (10.5 vs. 9.6 g/dL, p < 0.001), and lower postoperative C-reactive protein (CRP) levels (10.8 vs. 15.7 mg/dL, p = 0.007). Multivariable analysis identified younger age (OR 0.94 per year, 95% CI 0.91-0.98; p = 0.003), higher postoperative haemoglobin (OR 1.29, 95% CI 1.01-1.66; p = 0.044), and lower postoperative CRP (OR 0.94, 95% CI 0.90-0.99; p = 0.029) as independent predictors of revision. ROC analysis identified age < 60 years (AUC 0.66) and postoperative haemoglobin ≥ 10.55 g/dL (AUC 0.63) as optimal thresholds. In the HA cohort, only postoperative lymphocyte count differed significantly between revision and non-revision groups, precluding multivariable analysis.</p><p><strong>Conclusions: </strong>Revision following arthroplasty for femoral neck fracture was substantially more common after THA than HA. Among THA patients, revision was associated with younger age and markers of better postoperative physiological recovery rather than medical frailty. These findings suggest that revision risk after fracture-related THA may largely reflect the greater activity level and longer survivorship of healthier patients, information that may assist preoperative counseling and individualized procedure selection.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The early diagnostic value of emergency laboratory indicators in patients with acute compartment syndrome after tibiofibular fractures.","authors":"Tao Wang, Shuo Yang, Yubin Long, Zhiyong Hou","doi":"10.1007/s00264-026-07061-1","DOIUrl":"https://doi.org/10.1007/s00264-026-07061-1","url":null,"abstract":"<p><strong>Purpose: </strong>Acute compartment syndrome (ACS) is a serious complication after tibiofibular fractures, which may cause muscle necrosis or even amputation due to challenges in making a prompt diagnosis. Therefore, this study tries to investigate its potential biomarkers from emergency blood tests.</p><p><strong>Methods: </strong>Data on patients with tibiofibular fractures from January 2016 to January 2026 were gathered from three Level I trauma centres and categorized into ACS and non-ACS groups. Propensity score matching (PSM) analysis was used to reduce the impact of potential confounding variables. Then, univariate, logistic regression, and ROC curve analyses, as well as a nomogram prediction model, were performed to examine predictors of ACS.</p><p><strong>Results: </strong>After PSM analysis, 260 patients were assigned to each group. Even though univariate analysis identified several indicators related to ACS, logistic regression analysis demonstrated that creatine kinase [CK, p < 0.001, OR = 1.003, 95% CI (1.002, 1.004)], creatine kinase myocardial band [CK-MB, p < 0.001, OR = 1.171, 95% CI (1.125, 1.219)], and C-reactive protein [CRP, p < 0.001, OR = 1.259, 95% CI (1.150, 1.377)] are predictors. Furthermore, ROC curve analysis identified 1219.5 U/L, 34.5 U/L, and 13.5 mg/L as the optimal cut-off values to diagnose ACS in patients with tibiofibular fractures. Our model predicts with an AUC of 0.8519 [95% CI (0.8184, 0.8813)], showing consistent calibration and effective clinical application as evidenced by decision curve analysis.</p><p><strong>Conclusions: </strong>The levels of CK, CK-MB, and CRP were found to be potential biomarkers for ACS, with their optimal cut-off values identified. Our nomogram prediction model can accurately predict ACS in patients with tibiofibular fractures. We still need large sample data to validate these results.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Limb salvage for long-bone sarcomas: a comparative of clinical outcomes and cost-effectiveness analysis of biological versus endoprosthetic reconstruction.","authors":"Jixiang Shi, Zehao Guo, Yiying Bian, Hao Yao, Yongqian Wang, Changye Zou, Gang Huang, Junqiang Yin, Jingnan Shen, Xianbiao Xie","doi":"10.1007/s00264-026-07033-5","DOIUrl":"https://doi.org/10.1007/s00264-026-07033-5","url":null,"abstract":"<p><strong>Purpose: </strong>Endoprosthetic reconstruction (EPR) and biological reconstruction (BR) are the two primary methods for limb-salvage surgery in long-bone sarcomas. Comparative data on clinical outcomes and cost-effectiveness are lacking. This study aimed to compare EPR versus BR for long‑bone sarcomas in terms of these outcomes.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of 1657 patients who underwent limb-salvage surgery for long‑bone sarcomas (2008-2023) at a single center. After propensity score matching, 70 BR patients were matched to 157 EPR patients. We compared perioperative outcomes, complications, MSTS-93 functional scores, and survival endpoints. A lifetime cost-effectiveness analysis from a Chinese healthcare perspective was performed using a Markov model.</p><p><strong>Results: </strong>BR was associated with greater blood loss (797 vs. 443 mL) and longer operative time (7.0 vs. 4.2 h; both P < 0.001). The cumulative complication rate within the first three postoperative years was higher in the BR group (28.6% vs. 15.3%; P = 0.019); however, the total complication rates were similar between the two groups (31.4% vs. 27.4%; P = 0.498) at final follow-up. The MSTS scores were higher in the EPR group at six months (22.2 vs. 17.7; P < 0.001), but higher in the BR group at final follow-up (24.9 vs. 22.6; P < 0.001). No significant differences were observed in overall survival (OS), disease-free survival (DFS), revision-free survival (RFS), and implant survival (IS). BR had lower implant costs (¥53,269 vs. ¥89,960; P < 0.001) and total hospitalization costs (¥94,224 vs. ¥122,586; P < 0.001), and was associated with lifetime cost savings of ¥82,690, an additional 2.44 QALYs, and an ICER of -¥33,964 per QALY.</p><p><strong>Conclusion: </strong>Both EPR and BR effectively address long-bone defects post-tumour resection. Compared with EPR, BR had longer operative time and more early complications, but fewer intermediate-term complications and better functional outcomes. BR also had lower costs and favourable cost‑effectiveness.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}