Journal of Orthopaedic Surgery最新文献

{"title":"Comparative outcomes of single condylar replacement and total knee arthroplasty in elderly patients with knee osteoarthritis: A controlled clinical study.","authors":"Xiangbing Zeng, Dongteng He","doi":"10.1177/10225536261440616","DOIUrl":"https://doi.org/10.1177/10225536261440616","url":null,"abstract":"<p><p>IntroductionOsteoarthritis is a frequent degenerative joint disease, affecting older individuals in particular. When non-surgical treatment options are no longer effective or warranted, surgical options include single condylar replacement (SCR) or total knee arthroplasty (TKA). The optimal surgical approach for elderly patients remains a subject of debate, particularly with respect to short-term recovery and functional outcomes.Materials and Methods82 elderly patients with knee osteoarthritis treated between March 2022 and May 2023 were included in this controlled clinical study. Patients were allocated to the SCR group (n = 41) or TKA group (n = 41) based on clinical indication and patient preference in this non-randomized controlled study. Perioperative parameters, early postoperative inflammatory markers (C-reactive protein and interleukin-6), pain severity (visual analogue scale), knee function (Knee Society Score and Hospital for Special Surgery score), knee mobility, and short-term postoperative complications were evaluated.ResultsSCR was associated with shorter operative time and improved short-term functional outcomes compared with TKA. Early postoperative CRP, IL-6, and VAS scores were lower in the SCR group (p < 0.05). At 6 months, knee mobility and functional scores (KSS, HSS, and AIMS2-SF) were higher in the SCR group (p < 0.05). Differences in complication rates were observed, but should be interpreted cautiously given the short follow-up.ConclusionSCR was associated with improved short-term perioperative recovery and functional outcomes in selected elderly patients. Given the non-randomized design and short follow-up, these findings reflect association rather than superiority. Long-term outcomes and implant survival require confirmation in larger studies with extended follow-up.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"34 2","pages":"10225536261440616"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Repair of the medial meniscus posterior root tear using an all-inside meniscal repair device is not necessary during open-wedge high tibial osteotomy.","authors":"Hee-June Kim, Ji-Yeon Shin, Hyun-Joo Lee, Jong Pil Yoon, Dong-Hyun Kim, Joon-Woo Kim, Changhyun Park, Hee-Soo Kyung","doi":"10.1177/10225536261449645","DOIUrl":"https://doi.org/10.1177/10225536261449645","url":null,"abstract":"<p><p>BackgroundThis study aims to evaluate the clinical and arthroscopic results of medial meniscus posterior tear (MMPRT) repair using an all-inside meniscal repair device combined with high tibial osteotomy (HTO), compared with HTO performed without MMPRT repair.MethodsOverall, 38 patients who underwent open-wedge HTO using a locking plate were examined. Preoperative magnetic resonance imaging (MRI) and intraoperative arthroscopic evaluation confirmed MMPRT. During HTO, meniscal repair with an all-inside meniscal repair device was performed in 24 cases, while partial meniscectomy of the movable torn meniscus was conducted in 14 cases with MMPRT. At 2 years postoperatively, arthroscopic meniscus healing, clinical results, and radiologic results were compared.ResultsArthroscopic evaluation showed improvement in the condition of the medial compartment cartilage after HTO in both groups. In the repair group, meniscus root healing was observed in 22 of 24 cases (92%), whereas in the no-repair group, healing was observed in 10 of 14 cases (71%); however, the difference was not statistically significant. Medial joint space increased in both groups (from 2.4 to 3.2 mm and 2.6 to 3.2 mm, respectively), and clinical scores also improved after HTO, with no significant differences between groups. Osteoarthritis progression, as assessed by K-L grade, progressed after HTO in both groups, without significant differences.ConclusionsNo significant differences were observed in arthroscopic, clinical, or radiographic results after HTO, regardless of MMPRT repair with the all-inside meniscal suture device. These findings suggest that MMPRT repair with the all-inside meniscal repair device may not be necessary during HTO.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"34 2","pages":"10225536261449645"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Length-stable fixation reduces femoral neck shortening in unstable femoral neck fractures: A retrospective comparative study of length-stable dynamic hip screw versus femoral neck system fixation.","authors":"Seonghyun Kang, Wonseok Choi, Jeong Seok Choi, Eic Ju Lim, SungJin Ahn, Jong-Keon Oh, William T Kent, Whee Sung Son, Jae-Woo Cho","doi":"10.1177/10225536261415697","DOIUrl":"https://doi.org/10.1177/10225536261415697","url":null,"abstract":"<p><p>BackgroundFemoral neck shortening following internal fixation of unstable femoral neck fractures can compromise functional recovery, particularly in young, active patients. This study aimed to evaluate the efficacy of a length-stable dynamic hip screw (LSD) construct in minimizing postoperative shortening compared to the femoral neck system (FNS).MethodsA retrospective review was conducted on 65 patients with high-grade unstable femoral neck fractures treated between February 2016 and February 2023 at a single institution. Patients underwent either FNS (<i>n</i> = 31) or LSD (<i>n</i> = 34) fixation. Femoral neck shortening was quantified using vector-based analysis derived from contralateral femoral comparison at final follow-up. Functional outcomes were assessed using the Hip Disability and Osteoarthritis Outcome Score (HOOS).ResultsThe LSD group demonstrated significantly less femoral neck shortening compared to the FNS group (5.0 ± 4.6 mm vs 10.4 ± 6.7 mm, <i>p</i> = 0.001). Final HOOS scores were significantly higher in the LSD group in the symptom (88.1 vs 75.8, <i>p</i> = 0.049) and stiffness subdomains. Union was achieved in 31 of 34 patients (91.2%) in the LSD group and 26 of 31 (83.9%) in the FNS group (<i>p</i> = 0.605). Other complications were more frequent in the FNS group but did not reach statistical significance.ConclusionLength-stable fixation using the LSD construct significantly reduced postoperative femoral neck shortening in high-grade unstable fractures, without compromising union rates or functional recovery. Our results support the role of length-stable constructs as a reliable option for maintaining anatomic integrity in unstable femoral neck fractures.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"34 1","pages":"10225536261415697"},"PeriodicalIF":1.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146052545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Morphology of the scapholunate joint, lunate, and capitate in dorsal wrist ganglion: An MRI case-control study.","authors":"Zeynel Mert Asfuroğlu, Ahmet Ülker, İdris Demirtaş, Atilla Arık","doi":"10.1177/10225536261421345","DOIUrl":"https://doi.org/10.1177/10225536261421345","url":null,"abstract":"<p><p>BackgroundDorsal wrist ganglia (DWGs) are common, yet the contribution of carpal morphology to their formation is underexplored. We investigated whether scapholunate joint, lunate, and capitate morphology differ between DWG wrists and controls.MethodsRetrospective MRI case-control study of adults aged 18-60 years, comprising 70 DWG wrists and 70 controls. Categorical variables were lunate type (medial hamatolunate facet present or absent), scapholunate joint morphology (parallel, inverted-Y, point-like parallel), and capitate head shape (flat, round, V-shaped). Quantitative measures included capitate-triquetral distance, mid-joint scapholunate gap, and medial hamatolunate facet length, recorded only when a facet was present.ResultsInterobserver agreement was generally good across both categorical and quantitative measures (categorical κ range: 0.50-0.88; quantitative ICC range: 0.72-0.95). Capitate morphology differed between groups: round heads were more frequent in DWG (71.4%) than in controls (44.3%) (<i>p</i> < 0.05). The scapholunate gap was larger in DWG (mean 1.8 mm) than in controls (1.5 mm) (<i>p</i> < 0.05). No between-group differences were observed for lunate type (Type II: 51.4% vs 38.6%; <i>p</i> = 0.107), scapholunate joint type (<i>p</i> = 0.787), capitate-triquetral distance (<i>p</i> = 0.223), or medial hamatolunate facet length (<i>p</i> = 0.395).ConclusionDWG wrists more often exhibit a round capitate head and a larger scapholunate gap than matched controls, whereas lunate type, scapholunate joint configuration, capitate-triquetral distance, and medial hamatolunate facet length are similar. Capitate head shape may be associated with DWG; however, given the lower agreement for this parameter, this finding should be considered exploratory and requires further validation before any recommendation for routine reporting can be made. The scapholunate gap can be considered supportive context alongside clinical findings. Prospective multicenter studies with multiplanar/loaded MRI or arthroscopic correlation are warranted.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"34 1","pages":"10225536261421345"},"PeriodicalIF":1.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146086115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What you see is what you get: High degree of alignment accuracy with hand-held computer-aided technology when comparing intraoperative alignment to postoperative radiographs in direct anterior total hip arthroplasty.","authors":"Thomas Geissler, Jacob Hall, Nicolas Koerber, Michael Decker, William Lutes","doi":"10.1177/10225536261431549","DOIUrl":"10.1177/10225536261431549","url":null,"abstract":"<p><p>IntroductionTotal Hip Arthroplasty (THA) is a widely performed orthopaedic surgery, essential for treating severe pain and mobility issues arising from various conditions. The anticipated rise in Total Hip Arthroplasty (THA) procedures underscores the critical importance of their success, which is heavily dependent on the accurate positioning of prosthetic components. Various approaches like the Direct Anterior Approach with Fluoroscopy (DAA-F THA) and Robotic-assisted THA (RA THA) have their limitations. Computer-Navigated THA (CN THA) has emerged as a promising alternative, offering real-time feedback and potentially enhanced accuracy in component placement. This study evaluates the precision of CN THA in correcting leg length discrepancies and accurately positioning the acetabular component.MethodsThe study involved 122 consecutive patients undergoing direct anterior CN THA by the senior author. Exclusions were based on different surgical approaches, need for revision surgery, and infections. The study focused on the precise placement of acetabular components and leg length restoration. CN THA was used for intra-operative measurements, while post-operative radiographs were analyzed with TraumaCad® for comparison. Statistical analyses included Pearson correlation coefficients and descriptive analyses.ResultsCN THA showed high accuracy in leg length restoration with 85.25% of cases showing less than 5 mm discrepancy. Similarly, acetabular component positioning was precise, with 90.98% of inclination and 74.59% of anteversion measurements within acceptable ranges. The correlation between intra-operative and post-operative measurements was strong, indicating the reliability of CN THA measurements.ConclusionCN THA was shown to be highly accurate in correcting leg length discrepancies and achieving proper acetabular component positioning. The strong correlation between intra- and post-operative measurements underscores the reliability of CN THA. The study, however, is limited by its single-surgeon, single-approach design, and lack of a control group. Despite these limitations, CN THA shows considerable potential in improving THA precision, enhancing surgical outcomes, and customizing patient care.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"34 1","pages":"10225536261431549"},"PeriodicalIF":1.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147355325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of artificial intelligence in orthopaedic research: From preclinical to translational.","authors":"Ludwig Andribert Powantia Pontoh, Ismail Hadisoebroto Dilogo, Jessica Fiolin, Stephanie Gosal, Joshua Alward Herdiman, Abi Aufar Hawali, Erica Kholinne","doi":"10.1177/10225536261424029","DOIUrl":"https://doi.org/10.1177/10225536261424029","url":null,"abstract":"<p><p>Artificial intelligence (AI) has become pervasive in biomedicine and is transforming orthopaedic research from bench to bedside. Beyond its established roles in robotic surgery and diagnostics, AI now supports advances in biomechanics, imaging, tissue engineering, drug discovery, genomics, and prosthetic control. In biomechanics, AI enables faster finite-element simulations, markerless gait analysis, and data augmentation using synthetic signals. Imaging applications include automated segmentation of the spine and hip, opportunistic screening for osteoporosis, bone metastasis detection, and three-dimensional analysis of knee osteoarthritis. In regenerative medicine, AI assists in scaffold optimization, bioprinting, and personalized cell therapies, while integration with genomic and proteomic data enhances precision orthopaedics. Machine learning-based control systems also improve the usability of prosthetics and exoskeletons, reducing cognitive burden for patients. Despite challenges such as data scarcity, validation, and ethical considerations, AI is emerging as a powerful complement to traditional research methods. By accelerating workflows, improving accuracy, and enabling individualized care, AI holds strong potential to bridge laboratory discoveries with clinical applications in orthopaedics. This review highlights the application of AI in orthopaedic research and assesses how it could integrate into clinical practice in the future.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"34 1","pages":"10225536261424029"},"PeriodicalIF":1.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146180702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of orthopedic injuries presenting to emergency departments in Gaza amid the 2023-2025 conflict: A cross-sectional analysis.","authors":"Younis Elijla, Fahmy Almedana, Abdalrahman Ajjur, Ayham Abu ElQomboz, Mohammed Al-Ghazi, Eman Rabah, Raghd Alfarra, Heba Abu Shiha, Yara Asi, Mohammed Al-Hasan, Shayan Ali, Barock Tesfaye, Bilal Irfan","doi":"10.1177/10225536261426604","DOIUrl":"https://doi.org/10.1177/10225536261426604","url":null,"abstract":"<p><p>The Israeli military invasion of 2023-2025 has decimated Gaza's health system, constraining trauma capacity and disrupting prehospital and hospital care. We aimed to characterize emergency department (ED) orthopedic injury patterns. We conducted a multicenter, descriptive cross-sectional study across four referral hospitals in different governorates (September 1-16, 2024). A standardized interviewer-administered instrument and chart review captured demographics, mechanism, injury type/site, soft-tissue and neurovascular findings, acute interventions, disposition, perceived care quality, and time metrics (to first care, ED evaluation, surgery). Primary outcomes were admission and emergency surgery. Analyses included descriptive statistics and bivariable/multivariable logistic regression with hospital-clustered standard errors. Among 449 patients, the cohort was predominantly young, male, and displaced. Most presentations followed explosive violence. Fractures predominated, with a large share open; comminuted and segmental patterns were frequent, and neurovascular compromise was common. Many patients reached some form of care rapidly, yet few received first aid before ED arrival, indicating prehospital collapse amid unsafe transit. Median wait-time was short but highly variable between hospitals. Operative demand exceeded theatre capacity, with notable interhospital variation in time to surgery. Orthopedic trauma care in Gaza continues to be affected by widespread damage, though unevenly across the enclave. Immediate priorities include the entry of essential medical supplies and safe protection for hospitals and healthcare workers to operate.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"34 1","pages":"10225536261426604"},"PeriodicalIF":1.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146194509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative duloxetine administration did not significantly modify overall pain trajectories following high tibial osteotomy: An open-label randomized controlled trial.","authors":"Masaya Sengoku, Hiroyasu Ogawa, Yutaka Nakamura, Tetsuya Shimokawa, Kazuichiro Ohnishi, Haruhiko Akiyama","doi":"10.1177/10225536261437327","DOIUrl":"https://doi.org/10.1177/10225536261437327","url":null,"abstract":"<p><p>BackgroundDuloxetine is a potent analgesic that reduces pain associated with knee osteoarthritis. This study aimed to evaluate the analgesic effects of regular postoperative duloxetine after high tibial osteotomy (HTO) and its influence on knee function, pain severity, and daily life.MethodsThis open-label randomised controlled trial was designed as a single-centre, parallel-group study. Patients undergoing HTO were randomly allocated to the control and duloxetine groups. Patients allocated to the duloxetine group were administered oral duloxetine for the first 12 weeks postoperatively and were followed up for 6 months following surgery. The primary outcome was pain assessed by the visual analogue scale (VAS), and secondary outcomes included evaluations using the Brief Pain Inventory, the Knee Society Score, and the 2011 Knee Society Score.ResultsA total of 38 patients in the duloxetine group and 37 patients in the control group were analyzed. The duloxetine group demonstrated significantly lower pain VAS scores at rest 6 months postoperatively compared with the control group (0.5 ± 1.0 vs 1.3 ± 2.0, respectively; <i>p</i> = 0.029). There were no significant differences between the groups in the other scores. However, patients in the duloxetine group showed significantly lower consumption of acetaminophen in the third postoperative week (0.0 ± 0.0 vs 0.3 ± 0.8 tablets/day, respectively).ConclusionsDuloxetine demonstrated a modest analgesic benefit following HTO, with reduced pain at rest at 6 months and decreased rescue medication use during the third postoperative week. Routine use after HTO may therefore not be warranted in unselected patients. Due to the open-label design, performance and detection bias cannot be excluded.Trial registrationThe study protocol was registered in the UMIN clinical trial registration before starting recruitments: UMIN000040026 (registration date: June 1, 2020) https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000045630.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"34 1","pages":"10225536261437327"},"PeriodicalIF":1.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147512780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does tibial slope modification influence early recovery in mechanically aligned robotic-assisted total knee arthroplasty? A retrospective cohort study.","authors":"Jeremy Tze En Lim, Cheryl Gatot, Mann Hong Tan","doi":"10.1177/10225536261444454","DOIUrl":"https://doi.org/10.1177/10225536261444454","url":null,"abstract":"<p><p>PurposeTibial slope influences posterior cruciate ligament tension, flexion-gap mechanics, and mid-flexion stability in cruciate-retaining total knee arthroplasty (TKA). Robotic assistance enables precise slope adjustment, yet the clinical relevance of intentional slope modification for early postoperative recovery remains unclear. This study evaluated whether tibial slope modification during mechanically aligned robotic-assisted CR-TKA affects early functional outcomes.MethodsA retrospective cohort of 55 consecutive mechanically aligned robotic-assisted CR-TKAs performed using the VELYS™ system with ATTUNE® implants (January-July 2024) was analyzed. Patients were stratified by tibial slope change relative to baseline: Decreased (n = 42), Neutral (±0.5°; n = 5), and Increased (n = 8). Early recovery endpoints included postoperative day-1 (POD1) ambulation, POD1 pain score, length of stay, and postoperative knee range of motion. Inter-group differences were assessed using one-way ANOVA with non-parametric sensitivity testing, and linear regression evaluated slope change (Δ°) as a continuous variable.ResultsNo significant differences were observed between groups in POD1 ambulation (p = 0.78), POD1 pain (p = 0.87), length of stay (p = 0.58), postoperative flexion (p = 0.69), or extension (p = 0.27). Findings were consistent on non-parametric analysis. Regression demonstrated no meaningful association between slope change and early outcomes (all p > 0.05; R² < 0.03), with a near-flat slope-ambulation relationship (β = 0.49, p = 0.28).ConclusionWithin a mechanically aligned robotic CR-TKA workflow, tibial slope modification was not associated with early postoperative recovery. Individualized slope adjustment may have limited impact on short-term functional outcomes. Larger prospective studies incorporating PROMs and long-term follow-up are warranted.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"34 1","pages":"10225536261444454"},"PeriodicalIF":1.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147717112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative triglyceride-glucose index as a metabolic predictor of surgical site infection after posterior lumbar fusion.","authors":"Yu Hua, Shaoxing Li, Yuan Jiang, Jinwang Liu","doi":"10.1177/10225536261421333","DOIUrl":"https://doi.org/10.1177/10225536261421333","url":null,"abstract":"<p><p>PurposeTo assess whether the preoperative triglyceride-glucose (TyG) index is associated with 30-day surgical site infection (SSI) after instrumented posterior lumbar fusion (PLF) and to examine its predictive performance.MethodsWe retrospectively reviewed consecutive adults who underwent elective one- or two-level instrumented PLF between 2017 and 2024 at a tertiary center. Patients with active infection, revision surgery, tumor, trauma, or incomplete 30-day follow-up were excluded. Preoperative fasting triglycerides and glucose were used to calculate the TyG index as ln[(triglycerides × glucose)/2]. The primary outcome was 30-day SSI defined by Centers for Disease Control and Prevention criteria. Multivariable logistic regression evaluated the association between TyG and SSI, and receiver operating characteristic analysis assessed discrimination and identified an optimal cut-off. Incremental predictive value was examined by comparing a clinical model with and without TyG using AUC, likelihood ratio testing, reclassification metrics, calibration, Brier score, and decision curve analysis with bootstrap internal validation.ResultsAmong 438 patients, 29 (6.6%) developed SSI (24 superficial, 2 deep, 3 organ/space). Patients with SSI had higher TyG values than non-SSI patients (9.1 ± 0.5 vs 8.6 ± 0.6; p < 0.001). Each 1-unit increase in TyG was independently associated with higher odds of SSI (adjusted odds ratio 3.65; 95% confidence interval 1.62-8.24; p = 0.002). TyG alone yielded an area under the curve of 0.73, and a cut-off of 8.80 identified a high-risk group with an SSI rate of 11.8% versus 2.5% in the low-TyG group. Beyond standard clinical factors, adding TyG improved model fit (LRT χ² = 10.98; p = 0.001) and improved reclassification.ConclusionA higher preoperative TyG index is independently associated with 30-day SSI after PLF and provides moderate discriminative ability as a simple predictor. Incorporating TyG into preoperative risk assessment may help refine perioperative optimization and infection surveillance strategies in lumbar fusion surgery.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"34 1","pages":"10225536261421333"},"PeriodicalIF":1.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146044305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}