Journal of Orthopaedic Surgery最新文献

{"title":"Impact of diabetic nephropathy on outcomes following total knee arthroplasty: A propensity score-matched analysis.","authors":"Yongzhe Cui, Yuanwei Wu, Linjia Li, Qinfeng Yang, Mingying Li, Jinghua Yang","doi":"10.1177/10225536261488192","DOIUrl":"https://doi.org/10.1177/10225536261488192","url":null,"abstract":"<p><p>PurposeWhile diabetic nephropathy (DN) is a known risk factor for poor outcomes in major surgery, its specific impact on perioperative complications following primary total knee arthroplasty (TKA) has not been well-quantified in large-scale studies. This study aimed to determine the correlation of pre-existing DN on perioperative complications, mortality, and healthcare resource utilization in patients undergoing primary TKA.MethodsA retrospective cohort study utilized the US National Inpatient Sample (2016-2019). Patients undergoing primary TKA were stratified into DN and non-DN cohorts using ICD-10 codes, excluding end-stage renal disease or revision cases. A 1:1 propensity score-matched analysis was performed to balance demographics, hospital characteristics, and 30 comorbidities between cohorts. Outcomes included surgical/medical complications, mortality, length of stay (LOS), and hospitalization costs. Multivariable logistic regression analyzed associations pre- and post-PSM.ResultsDN prevalence increased significantly from 1.2% (2016) to 3.4% (2019). After PSM, DN patients had significantly higher adjusted risks of multiple complications. Surgical complications included increased transfusion (aOR=1.64), intubation/mechanical ventilation (aOR=1.52), periprosthetic infection (aOR=1.38). Medical complications included pulmonary edema (aOR=3.40), acute myocardial infarction (aOR=2.13), stroke (aOR=1.43), atrial fibrillation/flutter (aOR=1.09), postoperative delirium (aOR=1.66), urinary retention (aOR=1.26), and urinary tract infection (aOR=1.25). Resource utilization significantly increased, with higher odds of extended LOS (aOR=1.44) and elevated hospitalization costs (aOR=1.19).ConclusionThese findings underscore that DN is significantly associated with a distinct pattern of TKA complications, advocating for targeted perioperative strategies to mitigate risks in this growing population.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"34 3","pages":"10225536261488192"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912564","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":"Outcomes of antegrade straight interlocking intramedullary nail combined with autogenous iliac crest bone graft in the treatment of nonunions of humeral surgical neck fractures at a minimum 2 years' follow-up.","authors":"Hang Chen, Xiaochuan Hu, Huihui Wang","doi":"10.1177/10225536261496398","DOIUrl":"https://doi.org/10.1177/10225536261496398","url":null,"abstract":"<p><p>ObjectiveNonunions of humeral surgical neck fractures (HSNF) are rare and complex problems. This study aimed to evaluate the clinical and functional outcomes of antegrade straight interlocking intramedullary nail (ASIIN) combined with autogenous iliac crest bone graft (ICBG) for treating nonunions of HSNF and to analyze the impact of initial treatment on nonunion repair outcomes.MethodsWe conducted a retrospective analysis of patients with nonunions of HSNF treated with ASIIN combined with autogenous ICBG at our institution. Patients were divided into two groups based on initial treatment: primary nonunion group or secondary revision of internal fixation group. All patients were followed up for a minimum of 2 years. Outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS) pain score, and shoulder range of motion (ROM). Statistical analyses were performed to compare outcomes before and after nonunion repair and between the two groups.ResultsBetween June 2014 and May 2022, 29 patients with HSNF nonunions treated with ASIIN combined with autogenous ICBG were included in the study. The cohort comprised 11 patients initially treated conservatively and 18 patients who initially underwent locking plate fixation. Union was achieved in all patients at a mean of 5.6 months post-repair. At the final follow-up, significant improvements were observed in mean ASES scores, VAS pain scores, and active shoulder ROM compared to preoperative values. However, no significant differences were noted between the two groups. The mean union time was significantly shorter in the primary nonunion group.ConclusionASIIN combined with autogenous ICBG provides stable fixation and an active biological environment, offering an effective treatment for complex HSNF nonunions. Although initial treatment modality did not significantly affect clinical outcomes, patients initially treated conservatively achieved union faster than those treated surgically.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"34 3","pages":"10225536261496398"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182308","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":"Mini-open intramedullary fixation with attempted supraclavicular nerve preservation versus plate fixation for midshaft clavicle fractures: A retrospective comparative study.","authors":"Kesai Yang, Jiaxing Sun, Yongtao Li, Changqing Hu","doi":"10.1177/10225536261492755","DOIUrl":"https://doi.org/10.1177/10225536261492755","url":null,"abstract":"<p><p>PurposeTo compare mini-open intramedullary fixation and plate fixation for Robinson type II midshaft clavicle fractures, with supraclavicular nerve preservation attempted in both approaches, regarding postoperative numbness, pain, shoulder function, perioperative outcomes, and fracture healing.MethodsThis retrospective study included 75 adults with Robinson type II midshaft clavicle fractures treated between September 2019 and January 2025. Group A (n=35) underwent mini-open intramedullary fixation with a 2.0-2.5-mm titanium Kirschner wire, and Group B (n=40) underwent plate fixation; supraclavicular nerve preservation was attempted in both groups. Incision length, blood loss, operation time, postoperative numbness, visual analogue scale pain scores, Constant-Murley scores, nonunion, and implant-related events were assessed, using generalized estimating equations and linear mixed-effects models.ResultsBaseline characteristics were comparable. Group A had a shorter incision (mean difference, -8.99 cm), less blood loss (-38.42 mL), and a shorter operation time (-24.96 min; all P<0.001). Numbness rates were lower in Group A at 2 weeks, 3 months, and 6 months; at 12 months, 5.7% versus 22.5% (P=0.053). Group B had higher overall odds of postoperative numbness (OR=3.98, 95% CI 1.58-9.98; P=0.003). Pain scores decreased in both groups (group-by-time interaction, P<0.001), with no significant between-group difference at 12 months (P=0.163). Constant-Murley scores were lower in Group A at 3 months (89.4±4.4 vs 93.0±4.9; P=0.001) but similar at 6 and 12 months; the group-by-time interaction was significant (P=0.003). Nonunion rates were similar. Implant irritation occurred in 2/35 Group A patients (5.7%).ConclusionMini-open intramedullary fixation with attempted supraclavicular nerve preservation was associated with less surgical trauma, lower early postoperative pain, and lower overall odds of numbness than plate fixation. The 3-month Constant-Murley advantage of plating was not sustained at 6 or 12 months, and fracture healing was comparable. Implant irritation occurred in 5.7% of Group A patients.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"34 3","pages":"10225536261492755"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194684","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":"Validation of the PERSARC scoring system for overall survival in Malaysian patients with soft tissue sarcoma: A retrospective cohort study.","authors":"Tan Yuet Yang, Vivek Ajit Singh, Nor Faissal Yasin","doi":"10.1177/10225536261490152","DOIUrl":"10.1177/10225536261490152","url":null,"abstract":"<p><p>PurposeTo evaluate the reliability and calibration of the Personalised Sarcoma Care (PERSARC) scoring system in predicting overall survival (OS) for Malaysian patients with high-grade soft tissue sarcoma (STS) of the extremities, and to determine whether PERSARC can effectively stratify patients into risk groups to guide treatment decisions in a Malaysian clinical setting.MethodsWe conducted a retrospective observational study at a tertiary sarcoma treatment centre in Malaysia, including 115 patients with primary high-grade extremity STS treated between January 2002 and December 2019. PERSARC-predicted 5-year overall survival was compared with observed survival. In accordance with TRIPOD recommendations for external validation, model performance was assessed using discrimination (Harrell's C-index with bootstrapped confidence intervals and time-dependent area under the curve at 3, 5 and 10 years) and calibration (calibration plot of predicted versus Kaplan-Meier observed survival by quartile of predicted risk, calibration slope, observed-to-expected ratio, and Brier score). A secondary exploratory analysis examined prognostic factors for overall survival using Cox proportional hazards regression.ResultsOver a median follow-up of 7.0 years, 42 of 115 patients (36.5%) died. PERSARC showed good discrimination, with a Harrell's C-index of 0.80 (95% CI 0.73-0.86) and time-dependent AUCs of 0.80, 0.84 and 0.78 at 3, 5 and 10 years, respectively. Risk stratification was clear, with observed 5-year overall survival of 40.0% in the group predicted to have less than 50% 5-year survival, versus 88.8% in the group predicted to exceed it (log-rank p < 0.001). Calibration, however, was imperfect: PERSARC systematically underestimated observed survival across the entire range of predicted risk (observed-to-expected ratio 1.12; calibration slope 0.78, 95% CI 0.53-1.03), with the largest discrepancy in the poorest-prognosis quartile (predicted 22.4% versus observed 37.9%). In the secondary analysis, age, tumour size and distant metastasis were independently associated with mortality, with distant metastasis carrying the greatest hazard.ConclusionsIn this single-centre Malaysian cohort, PERSARC effectively discriminated between high- and low-risk patients with high-grade extremity STS, supporting its potential value as a structured aid to multidisciplinary discussion and shared decision-making. Calibration was less satisfactory, with consistent underestimation of survival. Therefore, absolute PERSARC-derived survival probabilities should be interpreted with caution in this population. Given the retrospective, single-centre design and modest sample size, these findings should be regarded as preliminary evidence supporting the applicability of PERSARC in Malaysian patients, pending larger multicentre validation and local recalibration.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"34 3","pages":"10225536261490152"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919711","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":"Supplementary fixation enhances bone union in extracorporeal irradiated autograft reconstruction for malignant bone tumors: A competing-risk analysis from a tertiary referral center.","authors":"Warapong Jansrila, Pichitchai Atthakomol, Pongsiri Piakong, Apiruk Sangsin, Dumnoensun Pruksakorn, Ronnakrit Maethungkul","doi":"10.1177/10225536261494735","DOIUrl":"https://doi.org/10.1177/10225536261494735","url":null,"abstract":"<p><p>PurposeExtracorporeal irradiation (ECRT) autograft reconstruction is an established option after limb-salvage resection of primary bone malignancy. Prior series have reported the proportion of junctions uniting rather than the rate of union, seldom accounting for oncologic mortality. We examined factors influencing union using competing-risk methods.MethodsOf 63 eligible patients undergoing wide resection and ECRT reconstruction between 2006 and 2024 at a single tertiary academic center, 50 (68 graft-host junctions) with complete data were reviewed retrospectively. Time to union was analyzed by Fine-Gray subdistribution hazard regression, with death, graft removal, and loss to follow-up as competing events. Eight covariates, including supplementary fixation, were entered into the multivariable model.ResultsOf 68 junctions, 57 (83.8%) united, six (8.8%) sustained a competing event before union, and five (7.4%) were censored. Median follow-up was 38 months (IQR 18-64). Supplementary fixation was independently associated with accelerated union (subdistribution hazard ratio 3.42, 95% CI 1.78-6.60, p < 0.001), whereas demographic and tumor-related variables were not. Cumulative incidence of union without versus with supplementary fixation was 63% (95% CI 49-74%) versus 100% at 12 months, and 78% (95% CI 64-87%) versus 100% at 24 months. Complications included late infection (13.2%), graft resorption (10.3%), and non-union requiring reoperation (1.5%). Local recurrence occurred in 9 patients (18.0%).ConclusionsSupplementary fixation was independently associated with faster union after ECRT autograft reconstruction. Fixation was applied selectively when intraoperative stability was judged insufficient, so confounding by indication cannot be excluded. These findings are hypothesis-generating and require confirmation in larger prospective cohorts.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"34 3","pages":"10225536261494735"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137010","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":"Early functional recovery after operative treatment for fragility fracture of the pelvis: A prospective observational study.","authors":"Nobutoshi Takamatsu, Keizo Wada, Hiroki Iguchi, Akihiro Nitta, Fumio Hayashi, Toshinori Sakai, Koichi Oba, Koichi Sairyo","doi":"10.1177/10225536261496984","DOIUrl":"10.1177/10225536261496984","url":null,"abstract":"<p><p>PurposeFragility fractures of the pelvis (FFPs) are associated with substantial morbidity and mortality in elderly patients. Although operative treatment is often performed for FFP to facilitate early mobilization, its overall clinical benefit remains controversial. This study aimed to determine whether operative treatment is associated with clinically meaningful recovery after FFP.MethodsThis prospective observational study included 46 consecutive patients aged ≥65 years who were treated for FFP at our institution between July 2023 and February 2025. Baseline clinical, functional, and laboratory data were collected at admission. The primary outcome was favorable recovery at 3 months, defined as a composite of survival, computed tomography-confirmed radiographic union, and functional recovery as determined by a modified Majeed pelvic score ≥55. Secondary outcomes included favorable recovery at 6 and 12 months.ResultsOf the 46 patients, 16 underwent operative treatment and 30 received non-operative management. Favorable recovery was significantly more common at 3 months in the operative group than in the non-operative group (43.8% vs 13.3%, p = 0.032) but not at 6 months (50.0% vs 46.7%, p > 0.999) or 12 months (50.0% vs 40.0%, p = 0.548). Baseline characteristics did not differ significantly between the groups; although the non-operative group was approximately 5 years older, this between-group difference decreased over time.ConclusionOperative treatment of FFP was associated with a higher favorable recovery rate at 3 months but not at 6 or 12 months. Given the small sample size and non-randomized treatment allocation, these findings should be interpreted cautiously.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"34 3","pages":"10225536261496984"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127880","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":"Corrigendum to \"Dual mini-plate versus mini-plus-standard plate fixation for displaced medial clavicle fractures: A retrospective comparative study\".","authors":"","doi":"10.1177/10225536261494366","DOIUrl":"https://doi.org/10.1177/10225536261494366","url":null,"abstract":"","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"34 3","pages":"10225536261494366"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074981","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":"Current applications and challenges of artificial intelligence in orthopedic imaging: A narrative review.","authors":"Taylor F Faust, Joshua L Dale, Francisco Matos, Quinn T Astrachan, Ryan M Leverant, Grace V Gilbert, Brian Lynch","doi":"10.1177/10225536261466359","DOIUrl":"https://doi.org/10.1177/10225536261466359","url":null,"abstract":"<p><p>BackgroundArtificial intelligence (AI), especially machine and deep learning, is an emerging tool in medicine with growing applications in orthopedic imaging. Given imaging's central role in diagnosis, surgical planning, and treatment monitoring, this narrative review maps the current and potential uses of AI in orthopedics, identifies underdevelopment sections, and emphasizes limitations in clinical practice.MethodsA PubMed search used the terms \"Orthopedic,\" \"Imaging,\" and \"Artificial Intelligence.\" Studies were screened by title and abstract, excluding non-orthopedic or non-AI studies, animal research, pediatric populations, and robotics or pharmacology papers. Eighty-five peer-reviewed articles were analyzed for imaging modality, clinical application, AI technique, and assigned a level of evidence. They were selected based on relevance to AI in orthopedic imaging.ResultsAI applications spanned radiography, CT, MRI, DTI, and ultrasound. For bone pathology, AI aided fracture detection and osteoarthritis prediction with clinician-level accuracy. In soft tissue injuries, models assisted in rotator cuff and meniscus tear detection and muscle segmentation. AI-driven 3D reconstructions and virtual reduction models enhanced surgical planning, particularly in joint replacement and trauma. Spine imaging benefited from vertebral segmentation, disc degeneration classification, and paraspinal muscle analysis, improving preoperative planning and outcome prediction. radiography, CT, MRI, DTI, and ultrasound. An important distinction is that many of these models generated outputs that surrounded conditional probabilities rather than categorical diagnoses. Many pitfalls remain including single-center overfitting, data leakage, and inter-reader variability.ConclusionsAI demonstrates potential to enhance diagnostic accuracy, streamline surgical planning, and improve workflow efficiency. Challenges remain, including data bias, regulatory constraints, and ethical considerations, warranting caution to its blanket application in medicine. Continued integration and validation are needed for optimal clinical use.Clinical RelevanceAI may serve as an adjunct to clinicians, supporting imaging interpretation and surgical decision-making while preserving human judgment.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"34 3","pages":"10225536261466359"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182223","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":"Serum evaluation of synovial fluid biomarkers in osteoarthritis.","authors":"Lvlin Yang, BinYang Wang, Junjie Wang, Qing Ma, Yinghao Cheng","doi":"10.1177/10225536261498974","DOIUrl":"https://doi.org/10.1177/10225536261498974","url":null,"abstract":"<p><p>ObjectiveIn our previous study, we identified forty-seven differentially expressed proteins in the synovial fluid of osteoarthritis (OA) patients. Given that serum testing is less invasive and remains the first-line screening tool, this study aimed to explore whether these synovial fluid-derived protein candidates could be detected in serum and whether they might serve as translatable biomarkers for OA.MethodsUsing antibody array technology, we analyzed the expression levels of these forty-seven proteins in serum samples from forty OA patients and forty healthy controls.ResultsCompared to healthy individuals, seventeen proteins were significantly differentially expressed in the serum of OA patients, showing consistent trends with their levels in synovial fluid. Among these, LASSO regression analysis identified seven proteins including GITR L, Osteoactivin, BAFF, NT-4, PAI-1, EG-VEGF, and GROa, which had superior diagnostic and predictive properties for OA. These proteins demonstrated high sensitivity and specificity in ROC curve analysis and were significantly correlated with WOMAC and MOAKS scores. Notably, this study is the first to report abnormal levels of these seven proteins in the serum of OA patients.ConclusionOur findings suggest that these seven proteins may serve as novel serum biomarkers for OA, offering potential for improved diagnosis and disease monitoring.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"34 3","pages":"10225536261498974"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194598","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":"Longitudinal changes in postoperative physical activity are associated with psychosocial and functional recovery after hip fracture surgery.","authors":"Kyo Goto, Hideki Kataoka, Mihoko Shibuya, Koichi Nakagawa, Kaoru Morita, Yuki Nishi, Junya Sakamoto, Minoru Okita","doi":"10.1177/10225536261498095","DOIUrl":"10.1177/10225536261498095","url":null,"abstract":"<p><p>BackgroundPhysical activity is markedly reduced after hip fracture surgery, but the clinical relevance of changes in physical activity during postoperative recovery remains unclear. This study investigated whether the rate of change in physical activity during the 1-4 postoperative weeks was independently associated with clinical outcomes at discharge.MethodsThis prospective observational cohort study included 70 patients after hip fracture surgery. Physical activity was measured using an accelerometer, and the slope of weekly mean physical activity over postoperative weeks 1-4 was calculated using simple linear regression. Multivariable linear regression analyses examined associations between the physical activity slope and discharge outcomes, adjusting for age, sex, pre-admission Tokyo Metropolitan Institute of Gerontology Index of Competence, period from surgery to walking initiation, and physical activity at postoperative week 1. Multivariable logistic regression examined decline in walking ability from before admission to discharge.ResultsA greater physical activity slope was independently associated with higher physical activity at discharge (β = 0.27), lower Geriatric Depression Scale scores (β = -0.29), longer 6-minute walk distance (β = 0.33), and higher motor Functional Independence Measure scores (β = 0.29) (all p < 0.05). The physical activity slope was not independently associated with pain intensity, pain catastrophizing, fear of falling, handgrip strength, five-times sit-to-stand, or Timed Up and Go. A greater physical activity slope was also associated with lower odds of decline in walking ability (odds ratio = 0.13, 95% confidence interval = 0.02- 0.89, p = 0.01).ConclusionGreater increases in physical activity during the 1-4 postoperative weeks were independently associated with fewer depressive symptoms, greater exercise tolerance, better activities of daily living, and lower odds of decline in walking ability at discharge. Monitoring longitudinal changes in physical activity may help identify patients with limited recovery and support individualized postoperative rehabilitation.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"34 3","pages":"10225536261498095"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182295","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}