Journal of Orthopaedic Surgery最新文献

{"title":"Timing of open reduction and internal fixation for acute pilon fractures in adults: Early versus delayed - A systematic review and meta-analysis.","authors":"Yang Chen, Huan Liu, Yongzhong Cheng, Haibin Sun, Chaolu Wang, Chaoyue Zhao, Rui Li","doi":"10.1177/10225536261480758","DOIUrl":"10.1177/10225536261480758","url":null,"abstract":"<p><p>ObjectiveTo compare the safety, clinical outcomes, and healthcare resource utilization associated with early versus delayed definitive fixation for acute pilon fractures through a systematic review and meta-analysis.MethodSystematic review and meta-analysis. PubMed, Cochrane Library, Embase, Web of Science, CNKI, SinoMed, VIP Database, and Wanfang Data were searched. Eligibility criteria for study selection: Randomized controlled trials and comparative observational studies reporting early versus delayed definitive fixation in adult patients with pilon fractures were included. Data synthesis: The primary outcome was major soft-tissue complications. Secondary outcomes included minor soft-tissue complications, fracture union time, fracture healing complications, quality of reduction, ankle function, and length of hospital stay. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated. Heterogeneity was assessed using the I², chi-square, and τ² statistics.ResultsA total of 21 studies involving 2,600 fractures were included. No significant difference was observed in major soft-tissue complications between early and delayed definitive fixation (OR,1.01 [95%CI, 0.57 to 1.79]). Early fixation was associated with a significantly shorter hospital stay (MD, -7.91 [95%CI,-10.71 to -5.10]). No significant differences were identified in minor soft-tissue complications, fracture healing complications, reduction quality, or ankle function.ConclusionsEarly definitive fixation for pilon fractures does not appear to increase the risk of soft-tissue complications when patients are carefully selected based on soft-tissue condition. Early intervention may reduce hospital stay and improve healthcare efficiency. These findings support an individualized, soft-tissue-driven approach to surgical timing rather than arbitrary time thresholds in pilon fractures, although standardization of soft-tissue assessment criteria based on high-quality randomized trials remains necessary.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"34 2","pages":"10225536261480758"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794277","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":"Targeted muscle reinnervation is associated with significant analgesic-sparing effect in Asian post-amputation patients: Early utilisation and clinical outcomes.","authors":"Kai Chun Augustine Chan, Kelvin Sin Chi Cheung, Raymond Ch Yau, Gabriel Ching Ngai Leung, Margaret Woon Man Fok","doi":"10.1177/10225536261470861","DOIUrl":"https://doi.org/10.1177/10225536261470861","url":null,"abstract":"<p><p>PurposeTo evaluate early clinical outcomes of targeted muscle reinnervation (TMR) for post-amputation pain in an East Asian population and to describe its utilisation in Hong Kong.MethodsAll patients who underwent major limb amputation with TMR at our institution from January 2017 to December 2024 were reviewed. Fourteen patients (16 TMR procedures) with a minimum of 6 months follow-up were case matched to 16 control patients who underwent major limb amputation without TMR. Primary outcomes were post-amputation pain and analgesic use at latest follow-up (≥6 months). Secondary outcomes included operation time, length of stay (LOS), and 30-day and 90-day readmission and reoperation rates. Territory-wide utilisation of TMR was calculated using Hong Kong Public Hospital data system.ResultsOverall TMR utilisation in Hong Kong was 0.46% (35/7529 major amputations) over 8 years. At latest follow-up, only 5 patients (35.7%) in the TMR group required analgesics, while there were 12 patients (75.0%) requiring analgesics in the control group (P=0.030). Opioid analgesic use (with or without other analgesics) was significantly lower in the TMR group compared with controls (7.1% vs 50.0%; P=0.013). Residual limb pain (RLP), phantom limb pain (PLP) and neuropathic pain were numerically lower in the TMR group but did not reach statistical significance. Operation times, LOS, and 30-day and 90-day readmission and reoperation rates were comparable between groups (P>0.05).ConclusionTMR was associated with significantly reduced analgesic use, especially opioids, without increased surgical complications in our cohort of East Asians, verifying that clinical effectiveness of TMR could be reproduced in an Asian locality. Despite growing international evidence supporting TMR, its utilisation in Hong Kong remained very low. Clinician caring for patient with major limb amputation should be aware of the efficacy of TMR and increase its utilisation.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"34 2","pages":"10225536261470861"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549542","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":"Association between CBC-derived inflammatory indices and radiographic severity in knee osteoarthritis: A retrospective cohort study.","authors":"Hakan Yolaçan, Hüseyin Erdal, Serkan Güler","doi":"10.1177/10225536261449659","DOIUrl":"10.1177/10225536261449659","url":null,"abstract":"<p><p>ObjectivesThis study aimed to evaluate hematological inflammatory indices in patients with knee osteoarthritis and to investigate their association with radiographic disease severity. It also assessed whether these indices may have adjunctive value in distinguishing early-stage from late-stage osteoarthritis.MethodsThis retrospective study included 2176 patients diagnosed with knee osteoarthritis between January 1, 2023, and July 1, 2025. Patients aged 50-90 years with primary knee osteoarthritis and an available complete blood count (CBC) were included. Age, gender, Kellgren-Lawrence (KL) stage, neutrophil, lymphocyte, monocyte, and platelet counts were recorded. Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR), systemic immune inflammation index (SII), systemic inflammation response index (SIRI), and pan-immune inflammation value (PIV) were calculated. Receiver operating characteristic (ROC) analysis and multivariable binary logistic regression adjusted for age and gender were performed.ResultsNLR (<i>p</i> < 0.001), MLR (<i>p</i> < 0.001), SII (<i>p</i> < 0.001), SIRI (<i>p</i> < 0.001), and PIV (<i>p</i> < 0.001) were significantly higher in patients with late-stage osteoarthritis, whereas PLR did not differ significantly between groups (<i>p</i> = 0.061). ROC analysis showed that NLR, MLR, SII, SIRI, and PIV had statistically significant but poor to modest discriminatory ability for late-stage osteoarthritis. Although SIRI showed the highest AUC among the evaluated indices, its performance remained within the modest range, and none of the markers demonstrated clinically meaningful discriminatory ability. In multivariable binary logistic regression analysis adjusted for age and gender, NLR, MLR, SII, SIRI, and PIV remained associated after adjustment for age and gender with late-stage osteoarthritis.ConclusionNLR, MLR, SII, SIRI, and PIV were associated with greater radiographic severity in knee osteoarthritis. Among the investigated biomarkers, SIRI, PIV, and SII showed relatively better discriminatory performance than the other indices; however, the overall ability of all markers to distinguish early-stage from late-stage osteoarthritis was limited. These findings suggest that CBC-derived inflammatory indices may serve as inexpensive adjunctive markers of radiographic severity, but they should not be used as stand-alone tools in clinical decision-making.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"34 2","pages":"10225536261449659"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147930470","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":"Impact of mood disorders on postoperative outcomes following ankle open reduction and internal fixation.","authors":"Pranav Sivaram, Prajwal Guruprasad, Omkar Anaspure, Cesar de Cesar Netto, Samuel Adams, Connor O'Neill, Albert T Anasastasio","doi":"10.1177/10225536261456332","DOIUrl":"10.1177/10225536261456332","url":null,"abstract":"<p><p>PurposeTo determine whether pre-existing mood disorders (MD) are associated with increased postoperative complications, healthcare utilization, and opioid use following ankle open reduction and internal fixation (ORIF).MethodsThis retrospective, propensity-matched cohort study utilized the TriNetX federated electronic health records database. Adults (≥18 years) undergoing ankle ORIF between January 1, 2004 and December 31, 2024 were stratified by presence or absence of a preoperative MD diagnosis and matched 1:1 for age, sex, race, ethnicity, BMI, diabetes, chronic kidney disease, and nicotine dependence. Outcomes included readmission, emergency department (ED) visits, physical therapy utilization, surgical site infection (SSI), deep vein thrombosis/pulmonary embolism (DVT/PE), and opioid use.ResultsAfter matching, 31,040 patients were included per cohort. At 3 and 6 months, MD patients demonstrated significantly higher rates of readmission (OR 1.69, 1.78), ED visits (OR 1.91, 2.01), physical therapy utilization (OR 1.24, 1.28), SSI (OR 1.55, 1.57), and DVT/PE (OR 1.45, 1.50), respectively (all p < 0.001). Opioid use was significantly elevated at all timepoints from 2 weeks through 1 year (OR range 1.48-1.67; all p < 0.001).ConclusionPre-existing mood disorders are associated with significantly worse outcomes following ankle ORIF, including elevated complication rates, greater healthcare utilization, and prolonged opioid use. These findings support routine preoperative mental health screening and multidisciplinary perioperative management in this population.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"34 2","pages":"10225536261456332"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148016103","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":"Unilateral biportal endoscopic decompression for stable adjacent segment disease after lumbar fusion: Clinical and radiological outcomes.","authors":"Ali Gulec, Ebubekir Eravsar, Abdullah Balcı, Ayse Gulec, Bahattin Kerem Aydin, Sadettin Ciftci","doi":"10.1177/10225536261456331","DOIUrl":"10.1177/10225536261456331","url":null,"abstract":"<p><p>PurposeAdjacent segment disease (ASD) is a recognized complication following lumbar fusion, characterized by new symptomatic and radiological degeneration at levels adjacent to the fused segment. While revision decompression with extended fusion has traditionally been performed, minimally invasive fusion-sparing strategies such as unilateral biportal endoscopic (UBE) decompression have gained attention. High-level evidence regarding their effectiveness in carefully selected stable ASD remains limited.MethodsThis retrospective cohort study included 17 consecutive patients with clinically and radiologically confirmed ASD treated with isolated UBE posterior decompression between 2022 and 2025. Patients with radiographic instability requiring fusion were excluded. Clinical outcomes included Visual Analog Scale (VAS) scores for back and leg pain, Oswestry Disability Index (ODI), and walking capacity assessed by the self-paced walking test (SPWT). Radiological evaluation included MRI-based canal measurements and standing lateral radiographs assessing segmental kyphosis and sagittal alignment. Pre-post comparisons were performed using paired statistical analyses.ResultsMedian age was 66 years (IQR 64-70). Significant postoperative improvements were observed in SPWT distance and duration (<i>p</i> < 0.001), VAS-back and VAS-leg scores (<i>p</i> < 0.001), and ODI (<i>p</i> < 0.001). MRI demonstrated significant enlargement of canal dimensions at the ASD level (<i>p</i> < 0.001). Segmental kyphosis improved modestly without deterioration of global sagittal balance. Two perioperative complications (one dural tear, one epidural hematoma) were managed successfully without permanent neurological deficit.ConclusionIn carefully selected patients with stable ASD, UBE posterior decompression provides meaningful pain relief, functional improvement, and effective neural decompression while preserving sagittal alignment. This tissue-sparing approach may be considered a treatment option in selected high-risk or elderly patients.Level of evidenceIV.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"34 2","pages":"10225536261456331"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148156874","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":"Automating methodological quality assessment in orthopedic systematic reviews using large language models.","authors":"Yu-Jui Huang, Kai-Cheng Chang, Ying-Chen Kuo, Cheng-Chen Tai, Cheng-Pang Yang","doi":"10.1177/10225536261459518","DOIUrl":"10.1177/10225536261459518","url":null,"abstract":"<p><p>BackgroundSystematic reviews represent the foundation of evidence-based orthopedic practice, yet their methodological rigor relies heavily on accurate and consistent methodological quality assessment. This step remains time-consuming, labor-intensive, and prone to subjectivity. Recent advances in large language models (LLMs) suggest potential for automating parts of evidence synthesis.PurposeThis study examined whether LLMs can perform AMSTAR-1-based methodological quality assessment evaluations in orthopedic systematic reviews with accuracy comparable to human experts.MethodsTen sports medicine knee reviews were analyzed using three LLMs-GPT-4o, GPT-5, and GPT Consensus-and their binary responses were compared against expert AMSTAR-1 ratings from a published umbrella review (110 decisions). An external validation set of four reviews published between 2022 and 2025 was included to assess generalizability and safeguard against information leakage.ResultsAgreement with human reviewers reached 87% for GPT-4o, 89% for GPT-5, and 90% for GPT Consensus; all models achieved 84% agreement in the validation set. Concordance was strongest for structured, explicitly reported domains such as a priori design, literature search, and study characteristics, and lowest for judgment-based items including grey literature inclusion, publication bias, and conflict of interest.ConclusionsLLMs cannot yet replace human reviewers, they can serve as reliable adjunct tools to enhance efficiency, transparency, and reproducibility in systematic review workflows within orthopedic research.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"34 2","pages":"10225536261459518"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148194730","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":"Implementation of a nine-grid thinking model to optimize operating room nursing pathways for older adults undergoing total knee arthroplasty.","authors":"Yuquan Tian, Meng Qi, Qing Wang, Huijun Zhang","doi":"10.1177/10225536261459490","DOIUrl":"10.1177/10225536261459490","url":null,"abstract":"<p><p>ObjectiveTo assess the effectiveness of operating room nursing pathways based on the nine-grid thinking model in older adults undergoing total knee arthroplasty (TKA).Methods110 older adults scheduled for TKA were randomly assigned to either a control group, which received conventional operating room nursing, or a intervention group, which received nursing care guided by the nine-grid thinking model. Key outcomes included surgical efficiency, nursing quality, satisfaction among patients and physicians, incidence of complications, and rehabilitation outcomes were compared between the two groups.ResultsThe intervention group had significantly shorter surgical prep (t = 9.106), operative (t = 5.294), and turnover times (t = 14.110) than controls (<i>p</i> < 0.05). After the intervention, the intervention group scored higher on sterile technique (t = 21.850) and overall nursing performance (t = 12.440). Their nurses also reported greater satisfaction with admission education (t = 8.591), positioning (t = 11.940), and overall care (t = 7.182) (<i>p</i> < 0.05). Surgeons rated the intervention group higher for instrument prep (t = 9.629), intraoperative coordination (t = 13.860), instrument delivery (t = 11.490), and overall satisfaction (t = 16.670) (<i>p</i> < 0.05). Deep-vein-thrombosis incidence was lower (χ2 = 4.949), postoperative pain scores were lower (t = 39.980), and ambulation and functional-recovery scores were higher in the intervention group (all <i>p</i> < 0.05).ConclusionThe application of the nine-grid thinking model significantly enhanced the quality and efficiency of perioperative care for older adults undergoing TKA.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"34 2","pages":"10225536261459490"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148352235","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":"The protective effect of medial wall integrity on ventral blade insertion in PFNA: Clinical and biomechanical evidence.","authors":"Tao Zhong, Wenqiang Xu, Yue Xu, Xin Zeng, Lijunpeng Jia, Dong Li, Jingchi Li, Zengru Xie","doi":"10.1177/10225536261464252","DOIUrl":"https://doi.org/10.1177/10225536261464252","url":null,"abstract":"<p><p>BackgroundThe impact of screw trajectory on the stability of internal fixation devices has been widely investigated. Previous studies indicate that ventrally directed blade insertion may compromise fixation stability and exacerbate femoral head varus in proximal femoral nail anti-rotation (PFNA) models of unstable intertrochanteric fractures with combined medial and lateral wall defects (AO/OTA 31-A2.3). According to the AO/OTA classification, the unstable fracture type involving an isolated lateral wall defect (AO/OTA 31-A2.2) is also commonly encountered in clinical practice. Preservation of medial support has been suggested to mitigate instability-related complications; however, whether such preservation can counteract the adverse biomechanical effects of ventral blade insertion remains insufficiently explored in the existing literature.MethodsIn the clinical component, a series of patients with A2.2-type unstable intertrochanteric fractures (isolated lateral wall defect) treated with PFNA fixation were enrolled. The influence of blade trajectory on femoral head varus at nearly 6 months postoperatively was evaluated using both comparative and regression analyses. Additionally, the biomechanical consequences of blade orientation were assessed using a simulated A2.2 unstable fracture model.ResultsConsistent trends were observed across clinical and biomechanical analyses. Specifically, no significant difference in femoral head varus angle was detected between ventral and dorsal blade orientations (Ventral blade: 3.86±4.14°; Dorsal blade: 3.14±5.13°, p=0.565). Blade trajectory was not identified as an independent predictor of varus severity in this patient cohort with isolated lateral wall defects (p=0.565). Biomechanically, variations in blade direction resulted in only minimal differences in stress distribution and displacement of both the blade and femoral head under compressive and physiological loading conditions.ConclusionsThe preservation of medial support appears to mitigate the detrimental effect of ventral blade insertion on fixation stability in patients with PFNA-treated intertrochanteric fractures. This study substantiates, from a novel perspective, the biomechanical importance of medial support in maintaining stable fixation.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"34 2","pages":"10225536261464252"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148361095","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":"Negative pressure wound therapy versus conventional tie-over dressing for split-thickness skin graft fixation: A retrospective comparative study with defect size-based subgroup analysis.","authors":"Ha Jun Jang, Sang Ki Lee","doi":"10.1177/10225536261475728","DOIUrl":"https://doi.org/10.1177/10225536261475728","url":null,"abstract":"<p><p>BackgroundSplit-thickness skin grafting (STSG) is commonly used for traumatic soft-tissue defects; however, graft instability and suboptimal scar outcomes remain concerns. Negative pressure wound therapy (NPWT) has emerged as an alternative fixation method to the conventional tie-over dressing. This study compared clinical outcomes between NPWT and tie-over fixation and evaluated whether defect size influenced their comparative effectiveness.MethodsSeventy-five patients who underwent STSG for traumatic soft-tissue defects between March 2020 and February 2025 were retrospectively reviewed. Patients were divided according to fixation method into NPWT (n = 38) and tie-over dressing groups (n = 37). Outcomes included operative time, complete graft-take rate, postoperative complications, and Vancouver Scar Scale (VSS) scores at 2 weeks and 6 months. Subgroup analysis was performed according to defect size (<100 cm² vs ≥100 cm²).ResultsAt 2 weeks postoperatively, the NPWT group demonstrated significantly lower VSS scores for vascularity, pliability, and height compared with the tie-over group (p < 0.05). At 6 months, significantly lower pliability scores were observed in the NPWT group; in the ≥100 cm² subgroup, NPWT also showed a significantly lower height score (p < 0.05). Operative time was significantly shorter in the NPWT group than in the tie-over group (p < 0.001). Complete graft-take rates were comparable overall; however, in defects ≥100 cm², NPWT achieved a significantly higher complete graft-take rate (p = 0.048).ConclusionsNPWT was associated with shorter operative time and early scar-related outcomes, particularly in larger defects. However, given the retrospective design and limited subgroup size, these findings should be interpreted cautiously, and NPWT may be considered as a useful option in selected mechanically demanding cases rather than a universal fixation method.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"34 2","pages":"10225536261475728"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148663928","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":"Robotic-assisted total knee arthroplasty in extra-articular post-traumatic deformities: A case series with one-year outcomes.","authors":"Mariam Zaighum, Patrick Ze-En Ng, Wai Kit Wong, Hwa Sen Chua","doi":"10.1177/10225536261459489","DOIUrl":"10.1177/10225536261459489","url":null,"abstract":"<p><p>PurposeExtra-articular femoral or tibial malunion can distort anatomical landmarks, compromise the reliability of conventional alignment guides, and complicate total knee arthroplasty (TKA). Robotic-assisted TKA (RA-TKA) may improve the precision and reproducibility of bone preparation and component positioning in these anatomically challenging cases. This study reports one-year clinical and radiographic outcomes after single-stage RA-TKA performed without corrective osteotomy in patients with post-traumatic extra-articular deformities.MethodsThis retrospective case series included nine patients (ten knees; one bilateral case) with symptomatic Kellgren-Lawrence grade 4 post-traumatic knee arthritis and associated extra-articular deformity who underwent CT-based RA-TKA using the Robotic Arm Interactive Orthopedic System (RIO; Mako SmartRobotics™, Stryker). Clinical outcomes included Knee Society Score (KSS 2011), Knee Injury and Osteoarthritis Outcome Score (KOOS), visual analogue scale (VAS) pain, and range of motion (ROM) assessed preoperatively and postoperatively at 2 weeks, 6 weeks, 3 months, and 1 year. Radiographic alignment was assessed using Hip-Knee-Ankle (HKA) angle on scanograms and arithmetic hip-knee-ankle angle (aHKA) derived from CT-based planning and intraoperative console values.ResultsMean HKA improved from 168.3° ± 3.8° preoperatively to 177.7° ± 1.4° postoperatively (mean correction 9.4° ± 2.8° toward neutral). Mean aHKA improved from -4.6° ± 5.0° to -0.6° ± 2.7° (mean correction +4.0°). Mean ROM increased from 95.5° ± 21.7° preoperatively to 119.5° ± 17.4° at 1 year. PROMs improved across timepoints. No major complications, including tracker pin site infection or periprosthetic fracture, were observed.ConclusionIn selected patients with post-traumatic extra-articular deformity deemed suitable for intra-articular compensation, single-stage RA-TKA without corrective osteotomy achieved consistent coronal alignment correction toward neutral and meaningful improvements in pain, ROM, and patient-reported outcomes at 1 year.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"34 2","pages":"10225536261459489"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148204839","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}