Journal of Orthopaedic Surgery and Research最新文献

{"title":"Performance of artificial intelligence in automated measurement of patellofemoral joint parameters: a systematic review.","authors":"Hongwei Zhan, Zandong Zhao, Qiuzhen Liang, Jiang Zheng, Liang Zhang","doi":"10.1186/s13018-025-06247-4","DOIUrl":"10.1186/s13018-025-06247-4","url":null,"abstract":"<p><strong>Background: </strong>The evaluation of patellofemoral joint parameters is essential for diagnosing patellar dislocation, yet manual measurements exhibit poor reproducibility and demonstrate significant variability dependent on clinician expertise. This systematic review aimed to evaluate the performance of artificial intelligence (AI) models in automatically measuring patellofemoral joint parameters.</p><p><strong>Methods: </strong>A comprehensive literature search of PubMed, Web of Science, Cochrane Library, and Embase databases was conducted from database inception through June 15, 2025. Two investigators independently performed study screening and data extraction, with methodological quality assessment based on the modified MINORS checklist. This systematic review is registered with PROSPERO. A narrative review was conducted to summarize the findings of the included studies.</p><p><strong>Results: </strong>A total of 19 studies comprising 10,490 patients met the inclusion and exclusion criteria, with a mean age of 51.3 years and a mean female proportion of 56.8%. Among these, six studies developed AI models based on radiographic series, nine on CT imaging, and four on MRI. The results demonstrated excellent reliability, with intraclass correlation coefficients (ICCs) ranging from 0.900 to 0.940 for femoral anteversion angle, 0.910-0.920 for trochlear groove depth and 0.930-0.950 for tibial tuberosity-trochlear groove distance. Additionally, good reliability was observed for patellar height (ICCs: 0.880-0.985), sulcus angle (ICCs: 0.878-0.980), and patellar tilt angle (ICCs: 0.790-0.990). Notably, the AI system successfully detected trochlear dysplasia, achieving 88% accuracy, 79% sensitivity, 96% specificity, and an AUC of 0.88.</p><p><strong>Conclusion: </strong>AI-based measurement of patellofemoral joint parameters demonstrates methodological robustness and operational efficiency, showing strong agreement with expert manual measurements. To further establish clinical utility, multicenter prospective studies incorporating rigorous external validation protocols are needed. Such validation would strengthen the model's generalizability and facilitate its integration into clinical decision support systems.</p><p><strong>Systematic review registration: </strong>This systematic review was registered in PROSPERO (CRD420251075068).</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"847"},"PeriodicalIF":2.8,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465275/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145176036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radical surgical treatment of calcaneal osteomyelitis: clinical characteristics and treatment efficacy based on a synthesis analysis of 364 reported cases.","authors":"Zi-Xian Liu, Peng Chen, Li-Li Qiu, Xiao-Li Zheng, Bin Yu, Nan Jiang","doi":"10.1186/s13018-025-06197-x","DOIUrl":"10.1186/s13018-025-06197-x","url":null,"abstract":"<p><strong>Background: </strong>Calcaneal osteomyelitis (CO) poses substantial therapeutic challenges due to the distinctive anatomy and function of the calcaneus. Although multiple treatment modalities are available, severe cases frequently require radical surgical interventions, such as partial or total calcanectomy, and even amputation. Nevertheless, the clinical profile of these patients is not well characterized. Consequently, this study aimed to examine and elucidate clinical characteristics and treatment outcomes of CO patients who have undergone radical surgical interventions.</p><p><strong>Methods: </strong>A systematic literature search was conducted by two independent authors across the PubMed, Embase, and Cochrane Library databases to identify English-language studies published between January 1, 2000, and December 31, 2021, focusing on patients with CO who had undergone partial or total calcanectomy, as well as limb amputation. Studies were selected based on pre-defined inclusion and exclusion criteria. Quality assessment was performed using the National Institutes of Health (NIH) assessment tool, and effective data were extracted and synthesized for analysis.</p><p><strong>Results: </strong>Altogether 364 CO patients were enrolled, with a male-to-female ratio of 1.88:1 (188 males and 100 females). The median age at diagnosis was 58.5 years. Diabetic foot ulcers emerged as the predominant cause, and pathogen cultures indicated a high positivity rate of 97.2% (106/109). Staphylococcus aureus was the most commonly isolated strain at 33.3% (20/60), with polymicrobial infection accounting for 24.1% (19/79). The overall infection recurrence rate was 33.1% (105/317), with total calcanectomy and partial calcanectomy being 45% (18/40) and 30.4% (72/237), respectively. Among the 104 patients who underwent amputation procedures, 49 patients were subjected to primary amputations, with the remaining 55 patients receiving secondary amputations following partial or total calcanectomy. The majority of secondary amputations, specifically 78.2% (43/55), occurred after partial calcanectomy, whereas 21.8% (12/55) followed total calcanectomy. The overall mortality rate across all the 345 patients was 5.8%, with no fatalities being directly attributable to CO.</p><p><strong>Conclusions: </strong>In this cohort of patients that received radical surgical interventions, the majority were middle-aged males, and the diabetic foot ulcer was the leading cause. Staphylococcus aureus continued to be the most frequently isolated pathogen. Even among patients who received partial and total calcanectomy, clinical efficacy remained unsatisfactory due to high rates of infection recurrence, leading to a high incidence of secondary limb amputation.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"838"},"PeriodicalIF":2.8,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12466052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145176094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiomics-based machine learning model integrating preoperative vertebral computed tomography and clinical features to predict cage subsidence after single-level anterior cervical discectomy and fusion with a zero-profile anchored spacer.","authors":"Bin Zheng, Panfeng Yu, Ke Ma, Zhenqi Zhu, Yan Liang, Haiying Liu","doi":"10.1186/s13018-025-06286-x","DOIUrl":"10.1186/s13018-025-06286-x","url":null,"abstract":"<p><strong>Objective: </strong>To develop machine-learning model that combines pre-operative vertebral-body CT radiomics with clinical data to predict cage subsidence after single-level ACDF with Zero-P.</p><p><strong>Methods: </strong>We retrospectively review 253 patients (2016-2023). Subsidence is defined as ≥ 3 mm loss of fused-segment height at final follow-up. Patients are split 8:2 into a training set (n = 202; 39 subsidence) and an independent test set (n = 51; 14 subsidence). Vertebral bodies adjacent to the target level are segmented on pre-operative CT, and high-throughput radiomic features are extracted with PyRadiomics. Features are z-score-normalized, then reduced by variance, correlation and LASSO. Age, vertebral Hounsfield units (HU) and T1-slope entered a clinical model. Eight classifiers are tuned by cross-validation; performance is assessed by AUC and related metrics, with thresholds optimized on the training cohort.</p><p><strong>Results: </strong>Subsidence patients are older, lower HU and higher T1-slope (all P < 0.05). LASSO retained 11 radiomic features. In the independent test set, the clinical model had limited discrimination (AUC 0.595). The radiomics model improved performance (AUC 0.775; sensitivity 100%; specificity 60%). The combined model is best (AUC 0.813; sensitivity 80%; specificity 80%) and surpassed both single-source models (P < 0.05).</p><p><strong>Conclusion: </strong>A pre-operative model integrating CT-based radiomic signatures with key clinical variables predicts cage subsidence after ACDF with good accuracy. This tool may facilitate individualized risk stratification and guide strategies-such as endplate protection, implant choice and bone-quality optimization-to mitigate subsidence risk. Multicentre prospective validation is warranted.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"851"},"PeriodicalIF":2.8,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145176092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparative analysis of three distinct approaches for the management of type A1 traumatic thoracolumbar fractures: a retrospective cohort study with a minimum 6-year follow-up.","authors":"Jiangtao Wang, Huiming Yang, Mario Ganau, Yuhang Wang, Junxian Miao, Liang Yan, Biao Wang","doi":"10.1186/s13018-025-06262-5","DOIUrl":"10.1186/s13018-025-06262-5","url":null,"abstract":"<p><strong>Objective: </strong>Comparing the efficacy of conservative treatment, percutaneous pedicle screw fixation and percutaneous balloon kyphoplasty with calcium sulphate particles in the treatment of AO Spine type A1 traumatic thoracolumbar fractures.</p><p><strong>Methods: </strong>The 220 patients with type A1 thoracolumbar fractures were divided into group A (n = 63, conservative treatment), group B (n = 85, percutaneous pedicle screw fixation), and group C (n = 72, percutaneous balloon kyphoplasty with calcium sulphate particle). Before treatment, 1 months and 2 years after treatment, and at the final follow-up, the efficacy was measured and compared between the three groups. Calcium sulphate particles ossification was assessed in patients from group C at 9 and 12 months postoperatively using computed tomography scans.</p><p><strong>Results: </strong>At the corresponding time points, the anterior vertebral body height ratio and Cobb angle were significantly better in groups B and C than in group A (all P < 0.05). At 1-month follow-up, visual analogue scale and oswestry disability index scores were significantly lower in groups B and C than in group A (P < 0.05), but the difference was not significant between the three groups at the subsequent follow-up (P > 0.05). Group C had significantly shorter operation time, less intraoperative blood loss, and shorter incision length compared to group B (all P < 0.05). At 12 months after surgery, computed tomography scan showed that the calcium sulphate particle disappeared and was replaced by autologous newly formed bone in patients of group C.</p><p><strong>Conclusion: </strong>For the management of type A1 thoracolumbar fractures, all three treatment methods demonstrated satisfactory clinical efficacy. After interim follow-up, similar levels of pain relief and functional improvement were observed across the three methods. Both percutaneous pedicle screw fixation and kyphoplasty with calcium sulphate particle exhibited similar efficacy in correcting kyphotic Cobb angle and restoring vertebral body height, with both being superior to conservative treatment. Notably, percutaneous balloon kyphoplasty with calcium sulphate particle exhibited a more minimally invasive profile compared with percutaneous pedicle screw fixation.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"856"},"PeriodicalIF":2.8,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465858/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145176082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of related factors affecting the postoperative clinical outcome of cervical ossification of the posterior longitudinal ligament.","authors":"Shuqing Chen, Changlin Lv, Xuanyu Dong, Ziang Zhang, Jianyi Li, Tianyu Bai, Xiaofan Du, Guodong Zhang, Jianwei Guo, Jiale Shao, Jiayan Li, Yukun Du, Jun Dong, Yongming Xi","doi":"10.1186/s13018-025-06276-z","DOIUrl":"10.1186/s13018-025-06276-z","url":null,"abstract":"<p><strong>Purpose: </strong>To establish a risk prediction model for postoperative outcomes in patients with ossification of the posterior longitudinal ligament (OPLL), identify key risk factors, and provide a theoretical basis for personalized treatment.</p><p><strong>Methods: </strong>Clinical data of 384 OPLL patients undergoing cervical spine surgery were retrospectively analyzed. Potential predictors were screened using univariate analysis, and independent risk factors were determined through multivariate logistic regression. A dynamic nomogram was constructed, and its performance was evaluated with the concordance index (C-index), receiver operating characteristic (ROC) curve, Hosmer-Lemeshow test, and decision curve analysis (DCA).</p><p><strong>Results: </strong>Four independent risk factors were identified and incorporated into the prediction model. The model demonstrated high accuracy and stability, with C-index values of 0.880 (training cohort) and 0.915 (validation cohort). ROC curve analysis confirmed excellent discrimination, while calibration and DCA showed good clinical applicability.</p><p><strong>Conclusion: </strong>Advanced age, history of trauma, surgical approach, and spinal cord T2 hyperintensity on imaging are independent predictors of postoperative outcomes in OPLL patients. The developed nomogram provides a reliable tool for individualized risk assessment and clinical decision-making. These findings warrant further validation in multicenter cohorts.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"849"},"PeriodicalIF":2.8,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145176143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opportunistic screening of osteoporosis in lung transplant recipients: diagnostic value of pre-transplant thoracic CT using vertebral Hounsfield units.","authors":"Fei Zeng, Yandie Wang, Peipei Gu, Xinhong Wang, Meijuan Lan","doi":"10.1186/s13018-025-06271-4","DOIUrl":"10.1186/s13018-025-06271-4","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the diagnostic performance of pre-transplant chest computed tomography (CT) as an opportunistic screening tool for predicting osteoporosis 1 year after lung transplantation.</p><p><strong>Method: </strong>We retrospectively enrolled lung transplant patients from a tertiary center in Zhejiang, China, between September 2022 and December 2023. Standardized regions of interest were placed on the first thoracic vertebra (T1) through the first lumbar vertebra (L1) to measure CT-derived Hounsfield unit (HU) values. Patients were categorized into normal BMD, osteopenia, and osteoporosis groups on the basis of their baseline dual-energy X-ray absorptiometry (DEXA) T-scores. Clinical baseline characteristics and HU values were compared among the three groups. The correlation between pre-transplant HU values and DEXA T-scores was analyzed, and receiver operating characteristic (ROC) curves were used to assess the diagnostic performance of pre-transplant HU values in predicting post-transplant osteopenia and osteoporosis.</p><p><strong>Results: </strong>A total of 139 lung transplant patients were included in the study, among whom 60 had normal bone mass, 51 had osteopenia, and 28 had osteoporosis at baseline. Notably, HU values significantly differed among the three groups (P < 0.05). The HU values of T1-L1 were weakly to moderately positively correlated with the T-scores of the lumbar spine (LS), femoral neck (FN), and total hip (TH; r = 0.28-0.51, P < 0.01). After lung transplantation, the proportion of patients with low bone mineral density (BMD) increased, and T-scores of the FN and TH decreased (P < 0.01). Baseline HU values showed good diagnostic performance for detecting bone abnormalities 1 year after transplantation, with T2 showing particular potential for distinguishing osteoporosis from non-osteoporosis and T9 for distinguishing low BMD from normal BMD.</p><p><strong>Conclusions: </strong>Pretransplant thoracic CT provides a clinically feasible and opportunistic screening approach to stratify osteoporosis risk in lung transplant candidates without additional radiation exposure. By quantifying T2 and T9 vertebral HU values, clinicians can identify high-risk patients for timely intervention, potentially reducing fracture-related morbidity.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"843"},"PeriodicalIF":2.8,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early-stage lumbar paraspinal muscle injury: endoscopic versus transforaminal lumbar interbody fusion: a retrospective comparative analysis.","authors":"Wenbin Xuan, Qinghua Cheng, Yucheng Gao, Ziyi Song, Zengxin Gao","doi":"10.1186/s13018-025-06235-8","DOIUrl":"10.1186/s13018-025-06235-8","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;While previous studies frequently reported the clinical efficacy and minimal invasiveness of endoscopic lumbar interbody fusion (Endo-LIF) for lumbar spinal stenosis (LSS), few existing studies quantitatively measure early-stage postoperative paraspinal muscle injury. This study aimed to preliminarily quantify differences in early postoperative paraspinal muscle changes between Endo-LIF and transforaminal lumbar interbody fusion (TLIF) for single-level LSS. The observed alterations, if substantiated in future studies, might offer considerations for tailoring postoperative rehabilitation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective cohort included 90 severe LSS patients undergoing single-level fusion, allocated to Endo-LIF group (n = 48) or TLIF group (n = 42). Comprehensive data encompassed demographics, operative metrics, patient-reported outcomes (PROs) including Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS), and acute paraspinal muscle trauma biomarkers ((creatine kinase (CK), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)). The cross-sectional area (CSA) of paraspinal musculature (multifidus and erector spinae) was quantified at the index instrumented level using axial T2-weighted magnetic resonance imaging (MRI), with measurements obtained preoperatively and during early follow-up (FU). Muscle boundaries were delineated using semi-automated tools (ITK-SNAP v4.0.2) with manual correction, and CSA values were calculated via MATLAB-based custom algorithms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Preoperative demographics, leg/back pain VAS, ODI, and inflammatory markers were comparable between Endo-LIF and TLIF groups. At 3 days postoperatively, Endo-LIF demonstrated superior back VAS and ODI (P &lt; 0.001) but comparable leg pain VAS. Both groups achieved significant PRO improvements (P &lt; 0.001). TLIF had significantly higher low back myofascitis incidence (P &lt; 0.001). Endo-LIF showed significantly reduced blood loss (58.3[IQR 50, 75] days vs. 214.3[IQR 150, 250] mL) and shorter hospitalization (5.2 [IQR 5, 6] days vs. 7.1 [IQR 7, 8] days) (both P &lt; 0.001), but longer operative time and greater fluoroscopy use (P &lt; 0.001). Complication rates were similar (P = 0.27). CRP and CK levels at postoperative day 1 were significantly higher in TLIF (P &lt; 0.001). Long-term follow-up revealed no significant intergroup differences in PROs (all P &gt; 0.01). Postoperative paraspinal muscle CSA decreased in both cohorts, with a more pronounced reduction observed in the TLIF group, statistically associated with surgical approach and smoking status (both P &lt; 0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Compared with TLIF, Endo-LIF demonstrated relatively early back pain relief, reduced intraoperative blood loss, shorter hospital stays, and lower levels of acute muscle injury markers. These potential benefits were counterbalanced by longer operative durations and greater reliance on fluoroscopy. Both a","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"841"},"PeriodicalIF":2.8,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective analysis of the use of orthopedic reduction robots in treating low-energy osteoporotic unstable pelvic fractures in the elderly.","authors":"Zhe Lu, Hou Xiuxiu, Baorui Xing","doi":"10.1186/s13018-025-06258-1","DOIUrl":"10.1186/s13018-025-06258-1","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the clinical efficacy of the Rossum Robot in assisting full-process closed reduction and internal fixation for low-energy osteoporotic unstable pelvic fractures in elderly patients.</p><p><strong>Methods: </strong>We performed a retrospective analysis of the clinical data of 37 patients with osteoporotic unstable pelvic fractures due to low-energy trauma, who underwent robotic reduction and internal fixation surgery between October 2023 and May 2024. Eighteen patients underwent Rossum Robot-assisted full-process closed reduction and internal fixation (RoRobot group), while 19 patients underwent percutaneous screw fixation with TiRobot assistance (TiRobot group). We compared the excellent and good rate of fracture reduction (EGR), the accuracy of screw placement (ASP), and the degree of fracture healing between the two groups. Efficacy indicators included changes in the Visual Analogue Scale (VAS) for pain and the Majeed score at preoperative, 1-week, 1-month, 3-month, and 6-month follow-ups. Statistical correlations were assessed using independent t-tests, chi-square tests, and non-parametric tests.</p><p><strong>Result: </strong>The EGR in the RoRobot assistance group was significantly higher than that in the control group (P = 0.019). No significant difference was observed in fracture healing between the two groups post-surgery (P = 0.157). No significant difference was found in ASP between the RoRobot and TiRobot assistant groups (P = 0.619). No significant difference was observed in the preoperative VAS and Majeed scores between the two groups (P = 0.611, P = 0.939). Both groups showed significant improvement in VAS scores post-surgery. One week and one month after surgery, the VAS score in the RoRobot assisted group was significantly lower than in the TiRobot assisted group (P = 0.000, P = 0.001). Majeed scores significantly increased in both groups post-surgery, and during multiple follow-ups within six months, the RoRobot assisted group showed significantly higher Majeed scores than the TiRobot assisted group.</p><p><strong>Conclusion: </strong>In elderly patients with osteoporotic unstable pelvic fractures resulting from low-energy injuries, Rossum robot-assisted pelvic fracture closed reduction and internal fixation surgery leads to less tissue damage, more effective fracture reduction, better postoperative pain relief, and faster recovery compared to TiRobot-assisted internal fixation surgery.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"844"},"PeriodicalIF":2.8,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145176071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Periprosthetic joint infection after arthroplasty: advances and future prospects.","authors":"Xianghua Xiong, Jiongnan Xu, Bin Zhou, Mingyan Luo, Junjie Gao, Qing Bi, Qifeng Ying, Jun Zhang","doi":"10.1186/s13018-025-06257-2","DOIUrl":"10.1186/s13018-025-06257-2","url":null,"abstract":"<p><strong>Objective: </strong>To comprehensively analyze the prevention, diagnosis and management strategies of periprosthetic joint infections(PJIs), provide new ideas for overcoming PJI, and provide references for clinicians.</p><p><strong>Methods: </strong>By synthesizing the latest research results at home and abroad, this study deeply analyzed the multidimensional prevention strategies, diagnostic criteria and technological advances, and treatment management strategies for PJI.</p><p><strong>Results: </strong>The management of PJI remains a significant challenge in orthopedic surgery, which warrants focused attention. The prevention of PJI holds paramount priority and should be integrated throughout the perioperative period. Although diagnostic criteria for PJI have undergone multiple updates, the 2011 MSIS criteria remain the most widely adopted, requiring comprehensive evaluation of laboratory, pathological, and imaging examinations for diagnosis. PJI treatment necessitates combined antibiotic and surgical interventions. Antibiotic therapy includes empirical treatment after diagnosis, targeted therapy following pathogen identification, and suppressive antibiotic therapy(SAT) for non-surgical candidates. Surgical options comprise debridement, antibiotics, and implant retention(DAIR), one-stage/two-stage revision, and salvage procedures.</p><p><strong>Conclusion: </strong>Implementation of standardized infection prevention protocols, rational antibiotic use, surgical technical innovations, and advancements in biomaterials have contributed to a reduction in PJI incidence. However, the spread of bacterial resistance and multidrug-resistant organisms in healthcare settings pose new challenges for PJI prevention and treatment. In the future, the research and development of new antimicrobial materials, the innovation of biofilm control technology and the application of precision medicine are expected to further reduce the incidence of PJI, improve the quality of life of patients, and promote a breakthrough in the field of arthroplasty regarding this issue.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"850"},"PeriodicalIF":2.8,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145176154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of obturator and femoral nerve blocks on pain and kinematic gait parameters in patients undergoing unicompartmental knee arthroplasty: a retrospective cohort study.","authors":"Tianxiang Yang, Yunpeng Hei, Xueqi Liu, Jun Li, He Shang, Tao Ma, Desheng Chen","doi":"10.1186/s13018-025-06278-x","DOIUrl":"10.1186/s13018-025-06278-x","url":null,"abstract":"<p><strong>Background: </strong>Postoperative data indicate that 15-30% of patients undergoing unicompartmental knee arthroplasty (UKA) experience moderate-to-severe pain during the early recovery period, impeding rehabilitation. Due to the complex innervation in the knee, continuous femoral nerve block (FNB) is often administered but provides incomplete analgesia. Although the analgesic effects of nerve blocks are well studied, less is understood about their effects on postoperative rehabilitation and gait kinematics. Thus, in this study, we aimed to investigate the impact of ultrasound-guided obturator nerve block (ONB) combined with FNB on gait kinematics in patients undergoing UKA. This is the first study to quantify the biomechanical benefits of ONB combined with FNB in patients undergoing UKA by gait analysis.</p><p><strong>Methods: </strong>Patients undergoing UKA and admitted to the Department of Orthopedics, People's Hospital of Ningxia Hui Autonomous Region between March 2024 and December 2024 were retrospectively enrolled. The patients were allocated based on their postoperative nerve block procedure into the FNB or FNB + ONB group, with 30 cases in each group. The FNB group underwent ultrasound-guided, single-shot FNB with catheterization, whereas the FNB + ONB group underwent additional ipsilateral ONB. Patient demographics, preoperative and postoperative visual analog scale (VAS) scores (at rest and during 30° knee flexion), adverse events, kinematic gait parameters, Knee Society Score, and range of motion were recorded.</p><p><strong>Results: </strong>No intergroup differences were observed in the preoperative VAS scores (P > 0.05). Both groups showed improved postoperative VAS scores (P < 0.05) with comparable resting VAS scores (P > 0.05). The FNB + ONB group demonstrated significantly lower activity-associated VAS scores than did the FNB group (P < 0.05). Analgesic rescue needs and adverse event rates showed no intergroup differences (P > 0.05). The FNB + ONB group exhibited superior postoperative Knee Society Scores, greater range of motion, and reduced kinematic gait abnormalities compared with the FNB group (all, P < 0.05).</p><p><strong>Conclusion: </strong>ONB combined with FNB provides superior postoperative analgesia compared with FNB alone in patients undergoing UKA, particularly during activity, thereby facilitating early rehabilitation and mitigating postoperative gait disturbances.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"845"},"PeriodicalIF":2.8,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145176059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}