Journal of Orthopaedic Surgery and Research最新文献

{"title":"Does dual-plating offer superior stability in complex distal femoral fracture management?","authors":"Ahmed Naser Elbarbary, Ismail Tawfeek Badr, Emad Badawy, Rasha Yousry Kamel Saleh","doi":"10.1186/s13018-026-06876-3","DOIUrl":"https://doi.org/10.1186/s13018-026-06876-3","url":null,"abstract":"<p><strong>Background: </strong>Distal femoral fractures (DFF) present significant challenges in orthopedic surgery because of their complex biomechanical environment and limited bone stock for fixation. Dual plating (DP), involving the application of both lateral and medial plates, has emerged as a promising alternative to enhance construct stability. We hypothesize that distal femoral DP improves union rates and functional outcomes in patients with complex or non-united DFFs.</p><p><strong>Methods: </strong>This prospective observational study was conducted on 30 cases with DFF who had either complex primary fixation or developed nonunion. Patients were monitored and followed up at regular intervals postoperatively (2 weeks, 6 weeks, 3 months, 6 months, and 12 months). Functional recovery was assessed using the Neer scoring system.</p><p><strong>Results: </strong>The range of motion (ROM) ranged from 70 to 100° with a mean ± SD of 90.17 ± 10.3°. The majority of patients (66.67%) achieved an excellent outcome, and 20% had a good result. Only a small proportion had fair (6.67%) or poor (6.67%) outcomes. There were no cases of malunion or nonunion. However, delayed union and infection were each reported in 3 patients (10%). Patients with excellent outcomes were significantly younger (mean age 24.9 years) and had a lower BMI (24.31 kg/m²) compared to those with poorer outcomes, who were older (≥ 55 years) and had higher BMIs (≥ 28.7 kg/m²).</p><p><strong>Conclusions: </strong>Distal femur dual plating is a viable salvage option for complex primary fixation of complex distal femur fractures. Good to excellent outcomes can be achieved with a low complication rate especially in patients with normal BMI and younger than 55 years of age.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839192","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 minimal-incision and minimal-soft-tissue-injury (MISI) technique for robot-assisted total knee arthroplasty: a preliminary report.","authors":"Ho-Jung Jung, Jonggu Shin, Jong-Keun Kim, Peter K Sculco, Joong-Il Kim","doi":"10.1186/s13018-026-06829-w","DOIUrl":"https://doi.org/10.1186/s13018-026-06829-w","url":null,"abstract":"<p><strong>Background: </strong>Robot-assisted total knee arthroplasty (TKA) with functional alignment enables precise bone cuts and soft-tissue preservation; however, array placement often requires additional or extended incisions, which may increase surgical invasiveness. To address these limitations, we developed the Minimal-Incision and Minimal-Soft-Tissue-Injury (MISI) technique, combining robotic precision with true minimally invasive principles.</p><p><strong>Methods: </strong>The MISI technique utilizes an approximately 10-cm midline incision with a mini-medial parapatellar approach. It allows secure array fixation through the primary incision while applying functional alignment principles to preserve the soft-tissue envelope. Femoral pins are inserted intra-incisionally, and tibial fixation employs a hybrid approach: one intra-incisional pin and a second pin placed through a 5-mm stab incision to reduce skin tension, particularly in flexion. Bone registration and intraoperative planning are performed using the MAKO robotic system within a functional alignment philosophy. All bone cuts are performed using a mobile window technique at 90° flexion, except for the anterior chamfer cut, which is carried out at 120° flexion to allow adequate clearance between the saw blade and the tibial array. This technique was performed in 82 patients, through which we achieved encouraging early wound healing and high patient satisfaction.</p><p><strong>Conclusion: </strong>The MISI technique offers a reproducible, incision-sparing approach to minimize soft-tissue trauma in robotic TKA. Prospective studies evaluating complication rates, recovery, and patient-reported outcomes are warranted to validate its clinical benefits and determine optimal patient selection.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839159","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":"Ultrasound and clinical outcomes of vascularized ulnar nerve transposition.","authors":"Ruben Dukan, Remy Pichard, Pascal Jehanno, Valerie Vuillemin, Benjamin Morino, Maxime Lacroix","doi":"10.1186/s13018-026-06891-4","DOIUrl":"https://doi.org/10.1186/s13018-026-06891-4","url":null,"abstract":"<p><strong>Background: </strong>Ulnar nerve entrapment at the elbow is common but results of ulnar nerve transposition remained uncertain. Chronic nerve ischemia is implicated in the syndrome's pathophysiology, and surgical interventions aim to mitigate related damage. The main hypothesis is that preserving the vascular system during ulnar nerve transposition helps prevent ischemic damage and improves clinical outcomes.</p><p><strong>Methods: </strong>Thirty five patients were included and divided into two groups: 'Vascularized Ulnar Nerve' (UNV+) and 'Non-vascularized Ulnar Nerve' (UNV-). They underwent subcutaneous anterior transposition of the ulnar nerve. Preoperative and postoperative clinical assessment was made using: Bishop score, Visual Analog Scale, Levine-Katz survey, Functional Status Scale, and QuickDash Score. Post operative nerve extrinsic vascularization was assessed with ultrasound.</p><p><strong>Results: </strong>Results after a mean 19.2-month follow-up show superior clinical outcomes, including Bishop and Levine-Katz scores, in the 'Vascularized Ulnar Nerve' group. Despite longer operative times (47 min in UNV + vs. 33 min in UNV-), no vascular complications occurred, supporting the hypothesis that preserving extrinsic vascularization enhances results. Extrinsic vascularization of the ulnar nerve could be continuously observed from proximal to distal in all patients in the UNV+ group. In 4 out of 15 cases in the UNV- group, vascularization was observed along the entire length of the nerve.</p><p><strong>Conclusions: </strong>Ultrasound assessments indicated improved nerve characteristics in the vascularized ulnar nerve group, reinforcing the study's main conclusion: preserving the extrinsic vascular system during ulnar nerve transposition was associated to better clinical outcomes. However, the study acknowledges limitations, urging further research with larger cohorts and electromyographic evaluation for a comprehensive understanding.</p><p><strong>Level of evidence iv: </strong>Case series Therapeutic study.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838890","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":"Powered knee-assisting exoskeletons for gait rehabilitation: a systematic review and meta-analysis on clinical outcomes.","authors":"Mehraneh Movahedi Aliabadi, Saeedeh Ebrahimzadeh-Bideskan, Ali Moradi, Masoumeh Sadeghi, Alireza Akbarzadeh, Maedeh Sharafoddin, Iman Kardan, Mohammad Hossein Gheshlaghi, Mahdi Farsangi, Sania Dolat Abadi, Nafiseh Jirofti, Mahla Daliri","doi":"10.1186/s13018-026-06895-0","DOIUrl":"https://doi.org/10.1186/s13018-026-06895-0","url":null,"abstract":"<p><strong>Background: </strong>This systematic review and meta-analysis aim to evaluate the clinical outcomes of powered knee-assisting exoskeletons (PKAEs) in individuals with gait disorders. The primary goal is to compare functional outcomes and spatiotemporal gait parameters between PKAEs and conventional physiotherapy (CPT).</p><p><strong>Methods: </strong>A comprehensive literature search was conducted in PubMed®, Embase®, Scopus®, and Web of Science™ for articles published up to October 2024. Controlled clinical trials involving PKAE-based rehabilitation in patients with gait disorders were included. Data extraction and bias assessment were independently performed by two reviewers using established tools (RoB-I and ROBINS-I). Effect sizes were calculated using random-effects models.</p><p><strong>Results: </strong>Fifteen studies (9 randomized and 6 non-randomized clinical trials) met the inclusion criteria. Pooled analyses showed significant improvements in gait speed for PKAEs compared to CPT at post-treatment (SMD = 0.40; 95% CI 0.01-0.79), but no significant differences were found in other outcomes, including the 6-min walk test, 10-m walk test, cadence, timed up and go, timed stair test, and functional independence measure, between the PKAE and CPT groups. Other outcomes, such as balance, gait symmetry, and metabolic efficiency, were explored qualitatively due to the insufficient number of studies for meta-analysis.</p><p><strong>Conclusion: </strong>PKAEs demonstrated superior results in gait speed but showed comparable findings to CPT in other outcomes, suggesting their potential in gait rehabilitation. However, further research is required to assess their long-term clinical value and to identify the specific patient populations that would benefit most from their use.</p><p><strong>Study registration: </strong>Registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the code CRD42024626418.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838868","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":"Effect of zoledronic acid combined with simvastatin on postoperative recovery of elderly patients with osteoporotic intertrochanteric fractures.","authors":"Xiaosong Liu, Yalei Zhou, Chun Yuan","doi":"10.1186/s13018-026-06911-3","DOIUrl":"https://doi.org/10.1186/s13018-026-06911-3","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the effects of zoledronic acid combined with simvastatin on postoperative functional recovery in elderly patients with osteoporotic intertrochanteric femoral fractures.</p><p><strong>Methods: </strong>This retrospective study included 150 elderly patients with osteoporotic intertrochanteric femoral fractures who underwent proximal femoral nail antirotation (PFNA) fixation between May 2022 and May 2024. According to postoperative pharmacological regimens, patients were assigned to a conventional group (n = 79), receiving zoledronic acid alone, or a combination group (n = 71), receiving zoledronic acid plus oral simvastatin.Harris Hip Score (HHS), visual analogue scale(VAS)for pain, and serum bone metabolism markers, includingβ-C-terminal telopeptide of type I collagen (β-CTX), procollagen type I N-terminal propeptide (PINP), 25-hydroxyvitamin D[25(OH)D], and osteocalcin, were assessed preoperatively and at 3 and 6 months after surgery. The occurrence of internal fixation failure and refracture was also recorded. Statistical analyses were performed using R software.</p><p><strong>Results: </strong>HHS scores increased progressively at postoperative assessment time points in both groups, whereas VAS scores showed a gradual decline. At 3 and 6 months after surgery, the combination group exhibited higher HHS scores than the conventional group (P < 0.05). 3 months after surgery, the VAS score in the combined group was lower than that in the conventional group (P < 0.05). With respect to bone metabolism, postoperative levels ofβ-CTX, PINP, and osteocalcin decreased over time in both groups, while 25 (OH) D levels increased.Differences in several bone metabolism indicators were observed between groups at postoperative time points. The proportions of internal fixation failure and refracture were lower in the combination group; however, the between-group differences were not statistically significant (P > 0.05).</p><p><strong>Conclusion: </strong>In elderly patients with osteoporotic intertrochanteric femoral fractures treated with PFNA, postoperative administration of zoledronic acid combined with simvastatin was associated with better hip function, favorable changes in bone metabolism and greater short-term improvement in postoperative pain compared with zoledronic acid alonebone metabolism.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816511","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":"Preoperative MRI-based prediction of autograft diameter in ACL reconstruction using hamstring and peroneus longus tendons.","authors":"Aashay Prasad Pande, Atmananda S Hegde, K Suprasanna, Chethan B Shetty, Prajwal Prabhudev Mane, Mayur Narayanchandra Hebsur","doi":"10.1186/s13018-026-06919-9","DOIUrl":"https://doi.org/10.1186/s13018-026-06919-9","url":null,"abstract":"<p><strong>Background: </strong>To evaluate the predictive value of magnetic resonance imaging (MRI)-derived cross-sectional area (CSA) measurements of hamstring and peroneus longus tendons in estimating intraoperative autograft diameter during anterior cruciate ligament (ACL) reconstruction, and to identify clinically useful CSA cut-offs for achieving graft diameters ≥ 8 mm.</p><p><strong>Methods: </strong>Fifty-two patients undergoing primary ACL reconstruction were included in this prospective observational study, with 26 each in the hamstring tendon (HT) and peroneus longus tendon (PLT) autograft groups. Preoperative CSA was measured on axial MRI at specific anatomical levels. Intraoperative graft diameters were recorded post- harvest. Correlation analysis and receiver operating characteristic curves were used to assess predictive value and determine CSA thresholds for adequate graft size.</p><p><strong>Results: </strong>For the HT group, CSA measured at the medial femoral condyle showed the strongest correlation with intraoperative diameter (r = 0.782; p < 0.001), with an optimal CSA cut-off of ≥ 19.15 mm² (AUC 0.917, sensitivity: 85%, specificity: 100%). For the PLT group, ankle-level CSA best predicted graft diameter (cut-off: ≥12.84 mm², AUC 0.958, sensitivity: 95.8%, specificity: 100%).</p><p><strong>Conclusion: </strong>MRI-based CSA measurement provides a reliable, non-invasive method for predicting autograft adequacy. This study establishes clinically relevant CSA thresholds for HT and PLT tendons and is the first to report such values for PLT, aiding preoperative graft selection in ACL reconstruction.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816441","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":"Morphological and postoperative functional comparison of patellar dislocation with or without avulsion fracture of the medial inferior border of the patella.","authors":"Houxin Sun, Yang Zhao, Qiankun Chang, Zhihui Wang, Yuhang Sun, Wei Qin, Jia Li","doi":"10.1186/s13018-026-06910-4","DOIUrl":"https://doi.org/10.1186/s13018-026-06910-4","url":null,"abstract":"<p><strong>Objective: </strong>To investigate specific radiological risk factors in patients with patellar dislocation accompanied by inferomedial patellar margin avulsion fractures and provide evidence for clinical treatment strategy selection, this study conducted comparative analysis of radiographic measurements and clinical function between patients with patellar dislocation with and without such avulsion fractures.</p><p><strong>Methods: </strong>A total of 73 patients with patellar dislocation who underwent medial patellofemoral ligament (MPFL) reconstruction at the Affiliated Hospital of Chengde Medical University were included. Basic patient data, affected side, injury mechanism, and type of patellar dislocation were collected. The subjects were subsequently divided into an experimental group and a control group based on the presence or absence of a concomitant inferomedial patellar marginal avulsion fracture. Imaging evaluations, including MRI, CT, and X-ray examinations, were comprehensively performed for comparative analysis. MRI was used to assess the height of the vastus medialis obliquus (VMO); CT was used to measure patellar thickness, patellar width, lateral patellar facet angle, Wiberg angle, Wiberg index, the length ratio of lateral to medial patellar facets, trochlear depth index, sulcus angle, lateral trochlear inclination, tibial tubercle-trochlear groove (TT-TG) distance, the cross-sectional area ratio of VMO to vastus lateralis muscle (VLM), medial-lateral width of the femoral condyle, and the length of different regions of the femoral condyle, as well as to classify the patella and trochlea. The Caton-Deschamps index was measured on X-ray. Additionally, clinical function was evaluated and compared using Lysholm score, IKDC score, Tegner score, and VAS score preoperatively and at 6 months postoperatively.</p><p><strong>Results: </strong>Statistically significant differences were observed between the experimental and control groups regarding injury mechanism, type of patellar dislocation, the ratio of lateral to medial patella facet length, and Wiberg scores (P < 0.05).</p><p><strong>Conclusion: </strong>Injury mechanism, types of patellar dislocation, the Wiberg angle, and the length ratio of the lateral to medial patellar facets have significant predictive value for the occurrence of avulsion fractures of the inferomedial patellar margin following patellar dislocation. Furthermore, patients with patellar dislocation, whether accompanied by avulsion fractures of the inferomedial patellar margin or not, undergoing isolated medial patellofemoral ligament reconstruction show no difference in postoperative clinical function.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816286","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":"Investigation of acute and chronic injury mechanisms of the deltoid ligament: insights from finite element analysis and animal study.","authors":"Yuandong Li, Qingqing Yang, Qiang Zhang, Huizhi Wang, Cheng-Kung Cheng","doi":"10.1186/s13018-026-06860-x","DOIUrl":"https://doi.org/10.1186/s13018-026-06860-x","url":null,"abstract":"<p><strong>Background: </strong>The deltoid ligament (DL) is the primary stabilizer of the medial ankle, but its injury mechanisms remain poorly understood. This study aimed to investigate the injury risk and mechanisms of individual DL bundles under both acute and chronic conditions to inform prevention and treatment strategies.</p><p><strong>Methods: </strong>A validated finite element model of the human foot was used to examine peak stresses in DL bundles under four acute loading scenarios. Chronic loading was simulated by applying gait loads after transecting the lateral ligaments, and the resulting DL stresses were compared with those of the intact model. Additionally, thirty-nine rats were assigned to three groups: a lateral ligament rupture group (LR, n = 13), a tibialis posterior tendon rupture group (TPR, n = 13), and a sham group (n = 13). After 6 weeks of treadmill running, the mechanical properties and histological characteristics of the DL, along with ankle joint morphology and articular stresses, were evaluated to further verify the hypothesized mechanisms of chronic injury.</p><p><strong>Results: </strong>Under acute loadings, the tibiocalcaneal ligament (TCL), anterior tibiotalar ligament (ATTL), and deep posterior tibiotalar ligament (dPTTL) showed the highest stress under pronation-external rotation loading. Lateral ligament rupture increased DL stress during gait. After 6 weeks of treadmill running, the LR and TPR groups showed roughened articular surfaces with osteophyte formation, increased articular stress, decreased talar bone volume fraction, lower failure load and stiffness ratios of the DL (p < 0.01), reduced fluorescence intensity of COL1, and elevated levels of COL3, MMP-2 and IL-1β compared with the sham group (p < 0.01).</p><p><strong>Conclusion: </strong>The TCL, ATTL, and dPTTL bundles are particularly susceptible to acute injury, with pronation-external rotation posing the greatest risk. Chronic degeneration of the DL occurs following rupture of the lateral ligament or tibialis posterior tendon, with a more pronounced effect after lateral ligament rupture.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815415","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":"Medial meniscus RAMP lesions: a novel magnetic resonance arthrography-based classification.","authors":"Luigi Tessitore, Chiara Macina, Attilio Prato, Marco Calvi, Eugenio Annibale Genovese","doi":"10.1186/s13018-026-06906-0","DOIUrl":"https://doi.org/10.1186/s13018-026-06906-0","url":null,"abstract":"<p><p>Meniscal ramp lesions (RAMP) are longitudinal tears at the meniscocapsular or meniscotibial attachments of the posterior horn of the medial meniscus, commonly associated with anterior cruciate ligament (ACL) tears. Their preoperative detection on standard MRI remains limited, especially for \"hidden\" variants. Magnetic resonance arthrography (MRA) may theoretically enhance visualization of the posteromedial compartment through capsular distension and improved tissue contrast; however, its diagnostic superiority remains to be validated. This pictorial review introduces a conceptual MRA-based framework for describing ramp lesions (types A-E), derived from previously reported anatomical and imaging concepts in the literature and illustrated with representative institutional cases. The proposed framework emphasizes lesion topography, morphology, and contrast-medium behavior on MRA and is intended as an educational and hypothesis-generating model rather than as a validated diagnostic tool. Further studies with arthroscopic correlation, reproducibility assessment, and prospective validation are needed to determine the diagnostic and clinical value of this framework.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816302","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":"Safety and efficacy of robot-assisted total knee arthroplasty: a network meta-analysis and systematic review.","authors":"Jixiong Yong, Han Li, Zhenhua Wu, Zhong Cao","doi":"10.1186/s13018-026-06889-y","DOIUrl":"https://doi.org/10.1186/s13018-026-06889-y","url":null,"abstract":"<p><strong>Background: </strong>In the context of the aging of the global population, the prevalence of knee joint disorders continues to rise. Concurrently, the integration of robotic systems and intelligent implants represents an inevitable trend in orthopedic surgery. A comprehensive evaluation of the safety and effectiveness of robot-assisted total knee arthroplasty (RA-TKA) is therefore urgently needed to inform clinical decision-making.</p><p><strong>Objective: </strong>To explore the advantages of 9 RA-TKAs across 8 outcomes.</p><p><strong>Methods: </strong>A systematic literature search was conducted in the PubMed, Web of Science, Embase, Cochrane Library, CBM, CNKI, Wanfang, and VIP databases from inception to December 1, 2025. The risk of bias and methodological quality were assessed via Review Manager (version 5.4). Network meta-analysis was performed via RStudio (version 4.4.1).</p><p><strong>Results: </strong>A total of 36 studies involving 2841 patients were included. In direct comparisons, conventional TKA (C-TKA) yielded shorter operative times than MAKO, HURWA, SkyWalker, ROSA, and Brainlab Knee did. CORI also had a shorter operative time than Brainlab Knee did. Compared with the C-TKA, MAKO, HURWA, SkyWalker and TiRobot groups, the ROSA group presented higher KSS-knee scores. In addition, C-TKA, HURWA, and CORI presented higher KSS-knee scores than did SkyWalker. For the KSS-function scores, the C-TKA and ROSA scores were higher than the HURWA score. C-TKA demonstrated a greater postoperative ROM than HURWA did. For HKA angle deviation, C-TKA resulted in greater deviation than MAKO, HURWA, SkyWalker, TiRobot, and EPMEDBOT did. In the comprehensive best probability ranking, C-TKA (93%) ranked highest in terms of operative time. SkyWalker (87%) ranked highest in terms of blood loss. SkyWalker (91%) ranked highest in terms of the KSS-knee scores. HURWA (87%) ranked highest in terms of the KSS function scores. MAKO (85%) ranked highest for HSS. The YUANHUA (76%) ranked highest for the WOMAC. The CORI (69%) ranked highest for ROM. SkyWalker (87%) ranked highest for HKA angle deviation.</p><p><strong>Conclusions: </strong>Overall, RA-TKA demonstrated superior safety and effectiveness compared with C-TKA, with different robotic systems exhibiting distinct advantages across outcome measures. Nevertheless, C-TKA retains a significant advantage in reducing the operative time, highlighting an important area for further optimization of robotic-assisted TKA.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816487","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}