Journal of Orthopaedic Surgery and Research最新文献

{"title":"Distinct regional bone quality patterns in L5-S1 isthmic and degenerative spondylolisthesis: implications for pedicle screw loosening risk.","authors":"Ranxu Yang, Zimo Wang, Chuanwei Geng, Caoyang Li, Huan Liu, Jia Li","doi":"10.1186/s13018-026-07085-8","DOIUrl":"10.1186/s13018-026-07085-8","url":null,"abstract":"<p><strong>Background: </strong>Screw loosening remains a major concern after pedicle screw fixation for lumbar spondylolisthesis. Although dual-energy X-ray absorptiometry (DXA) is widely used to assess systemic bone status, it may not fully capture regional bone quality at the pedicle, which is directly involved in screw purchase. This study aimed to compare DXA-based systemic bone status and CT-derived regional Hounsfield unit (HU) values among patients with single-level L5-S1 isthmic spondylolisthesis (IS), patients with degenerative spondylolisthesis (DS), and normal controls, and to evaluate their associations with slip severity and postoperative screw loosening.</p><p><strong>Methods: </strong>Patients who underwent L5-S1 pedicle screw fixation between January 2023 and December 2024 were retrospectively reviewed, and participants without lumbar spondylolisthesis were assigned to the normal control (NL) group. The final cohort included 141 patients with IS, 124 with DS, and 134 NL controls. Bone quality was assessed using DXA and CT-derived Hounsfield unit (HU) measurements of the L5 and S1 vertebral bodies and pedicles. Slip severity was analyzed using Spearman correlation, and screw loosening was assessed radiographically. Adjusted logistic regression and receiver operating characteristic (ROC) analyses were performed in the IS group because the limited number of screw-loosening events in the DS group precluded stable multivariable modeling.</p><p><strong>Results: </strong>DXA-based bone mass classification and T-scores did not differ significantly among the 3 groups. In contrast, L5 vertebral body HU values were significantly higher in both the IS and DS groups than in the NL group, whereas L5 pedicle HU values were significantly lower only in the IS group. No significant intergroup differences were observed in S1 HU values. Slip severity showed weak or no correlations with regional HU values; only L5 pedicle HU in the DS group was weakly negatively correlated with slip severity. Screw loosening occurred in 17.0% of patients with IS and 9.7% of patients with DS. In the IS group, lower L5 vertebral body HU, lower L5 pedicle HU, and older age each remained significantly associated with screw loosening after adjustment. In the IS group, L5 pedicle HU showed a numerically higher AUC than L5 vertebral body HU for screw loosening (AUC 0.746 vs. 0.709). The interobserver and intraobserver ICCs were 0.86 and 0.91, respectively.</p><p><strong>Conclusion: </strong>Single-level L5-S1 IS and DS exhibit distinct regional HU patterns. IS is characterized by reduced pedicle HU despite increased vertebral body HU, suggesting divergent regional bone-quality changes. Pedicle HU may complement DXA in preoperative risk stratification for fixation-related complications, particularly in patients with IS.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13591822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148368810","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":"Application of bupivacaine liposomes for iliac fascia blockade in total hip arthroplasty.","authors":"Luyao Wang, Dan Xu, Dongnan Hou","doi":"10.1186/s13018-026-07083-w","DOIUrl":"10.1186/s13018-026-07083-w","url":null,"abstract":"<p><p>Total hip arthroplasty (THA) is the primary surgical treatment for end-stage hip diseases; however, significant postoperative pain often severely impedes early mobilization and functional recovery. In recent years, the concept of multimodal analgesia has become a consensus in perioperative pain management, aiming to reduce opioid consumption and related complications. Liposomal bupivacaine, as a long-acting sustained-release local anesthetic, provides analgesic effects for up to 72 h following a single injection, offering a new option for postoperative pain control. Leveraging this advantage in combination with the fascia iliaca compartment block (FICB), which provides significant postoperative analgesia, holds promise for further optimizing analgesic strategies and promoting rapid recovery after THA. This article reviews the pharmacological properties of liposomal bupivacaine, the current clinical application status of FICB, and the analgesic efficacy and safety of their combined use in THA, aiming to provide evidence for clinical practice and scientific research.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148368792","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 study of O-arm navigation-assisted OLIF 360 versus traditional OLIF combined with Mazor Renaissance robot-assisted posterior fixation for single-level lumbar spondylolisthesis: clinical and radiographic outcomes.","authors":"Yuanrun Wei, Haixin Wei, Lei Li, Wenhao Zhao, Hao Zhang, Xuexiao Ma, Yan Wang","doi":"10.1186/s13018-026-07068-9","DOIUrl":"10.1186/s13018-026-07068-9","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to compare the perioperative efficiency, clinical outcomes, and radiographic outcomes of single-position O-arm navigation-assisted oblique lumbar interbody fusion (OLIF) 360 with those of dual-position traditional OLIF combined with Mazor Renaissance robot-assisted posterior fixation in patients with single-level lumbar spondylolisthesis.</p><p><strong>Methods: </strong>This retrospective study included 110 patients with single-level L4-L5 lumbar spondylolisthesis who underwent surgery between March 2022 and January 2025. Of these, 50 patients underwent traditional OLIF combined with robot-assisted posterior fixation, and 60 underwent O-arm navigation-assisted OLIF 360. The severity of spondylolisthesis was classified according to the Meyerding grading system. Baseline characteristics; intraoperative parameters, including operative time, estimated blood loss, and radiation dose; postoperative outcomes, including length of hospital stay, clinical scores, and radiographic changes; and fusion rates and complications were compared between the two groups.</p><p><strong>Results: </strong>All patients completed 12 months of postoperative follow-up. Both groups showed significant improvements in Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores compared with preoperative values (p < 0.05). No significant differences in VAS or ODI scores were observed between the groups at the 3- or 12-month follow-up. Compared with the robot-assisted group, the navigation-assisted group had a significantly shorter operative time, lower intraoperative blood loss, and lower total intraoperative radiation dose (p < 0.05). No significant intergroup differences were observed in the improvement rates of spinal canal area (SCA) or disc height (DH), changes in lumbar lordosis (LL), screw placement accuracy, or BSF-defined radiographic fusion rates.</p><p><strong>Conclusion: </strong>O-arm navigation-assisted OLIF 360 was associated with improved perioperative efficiency, including shorter operative time, reduced intraoperative blood loss, and lower radiation exposure, while achieving clinical and radiographic outcomes comparable to those of traditional OLIF combined with robot-assisted posterior fixation. Screw placement accuracy and BSF-defined radiographic fusion rates were also similar between the two techniques.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13591872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148368855","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":"The Clock^Δ19 mutation promotes osteoarthritis via impairing SIRT3-mediated mitochondrial homeostasis in mice.","authors":"Qijing Zhang, Yanhong Liu, Yuwen Chen, Yanqing Zhou, Zuoqin Yan, Ruizhe Qian, Chao Lu, Bingxuan Hua","doi":"10.1186/s13018-026-07050-5","DOIUrl":"10.1186/s13018-026-07050-5","url":null,"abstract":"<p><strong>Background: </strong>Osteoarthritis (OA) is a chronic degenerative joint disease characterized by cartilage breakdown and disrupted joint homeostasis. Mitochondrial dysfunction in chondrocytes contributes to cartilage degeneration, but the mechanisms linking circadian dysregulation to mitochondrial homeostasis in OA remain incompletely understood. Clock^Δ19 mice are a well-established model of impaired CLOCK-dependent circadian transcriptional regulation and exhibit metabolic and mitochondrial abnormalities.</p><p><strong>Methods: </strong>Two Gene Expression Omnibus datasets of human OA cartilage were integrated for bioinformatics analysis. OA severity was assessed in Clock^Δ19 mice and wild-type littermates subjected to destabilization of the medial meniscus (DMM). Primary chondrocytes were treated with interleukin-1β to mimic the inflammatory microenvironment of OA. Mitochondrial membrane potential, reactive oxygen species production, and NAD⁺/NADH ratio were evaluated by JC-1 staining, DHE staining, and biochemical assay, respectively. Protein expression and relative SOD2 K68 acetylation were examined by western blotting, immunoprecipitation, and immunostaining. CLOCK binding to the Sirt3 promoter was analyzed by chromatin immunoprecipitation. The role of SIRT3 was further examined by lentiviral overexpression in Clock^Δ19 chondrocytes.</p><p><strong>Results: </strong>Integrated analysis of public datasets revealed circadian rhythm- related transcriptional alterations in human OA cartilage. Clock^Δ19 mice developed more severe cartilage degeneration after DMM surgery than wild-type controls. In vitro and in vivo, Clock^Δ19 mutation was associated with reduced SIRT3 expression and increased relative SOD2 K68 acetylation or Ac-SOD2 K68 immunoreactivity. In Clock^Δ19 chondrocytes, these changes were accompanied by elevated oxidative stress, decreased mitochondrial membrane potential, and a reduced NAD⁺/NADH ratio under interleukin-1β stimulation. Mechanistically, CLOCK occupied the Sirt3 promoter, and Clock^Δ19 chondrocytes showed reduced Sirt3 expression. Moreover, SIRT3 overexpression alleviated mitochondrial dysfunction and oxidative stress in Clock^Δ19 chondrocytes.</p><p><strong>Conclusion: </strong>CLOCK contributes to mitochondrial homeostasis in chondrocytes by regulating Sirt3 transcription and modulating the SIRT3-SOD2 K68 acetylation pathway. Disruption of this regulatory pathway may represent a mechanism linking circadian dysfunction to OA progression.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13584504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148352322","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":"Slope-reducing tibial osteotomy yields better posterior horn healing performance of longitudinal and bucket-handle tears of medial meniscus in patients undergoing ACL reconstruction: a minimum 2-year follow-up study with second-look arthroscopy.","authors":"Tong Zheng, Daofeng Wang, Guanyang Song, Hui Zhang","doi":"10.1186/s13018-026-07070-1","DOIUrl":"10.1186/s13018-026-07070-1","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the effect of additional slope-reducing tibial osteotomy (SRTO) on the healing rate of repaired meniscus posterior horn tears (MPHTs) in ACL-injured patients with steep PTS and excessive anterior tibial subluxation (ATS).</p><p><strong>Methods: </strong>This retrospective study evaluated patients undergoing primary ACLR between 2016 and 2023 who met three inclusion criteria: PTS ≥ 15°, ATS≥6 mm, and repaired longitudinal and bucket-handle tears involving the meniscus posterior horn. Participants were stratified into an osteotomy group (ACLR + SRTO, n = 20) and a control group (ACLR alone, n = 48), with both cohorts maintaining ≥ 2-year follow-up. The primary endpoint compared meniscal horn healing rates between groups. Second, the associations between meniscal healing status and graft outcomes, as well as postoperative knee stability, were investigated.</p><p><strong>Results: </strong>Both groups were comparable in terms of age, gender, side, BMI, PTS, graft diameter, time from injury to surgery, ATS, KT side-to-side differences, and pivot-shift grade (all P > 0.05). In the osteotomy group, 17 medial meniscus tears were identified (11 longitudinal and 6 bucket-handle tears). At the final follow-up, partial healing of medial MPHTs was achieved in 1 longitudinal tear, resulting in an overall healing rate of 94.1% (16/17). The control group presented with 34 meniscal tears (23 longitudinal + 11 bucket-handle tears). The final follow-up assessment revealed partial healing of medial MPHTs in 8 longitudinal and 2 bucket-handle tears, yielding a significantly lower overall healing rate of 70.6% (24/34) compared with the osteotomy group (P = 0.036). For lateral meniscus tears, the osteotomy group demonstrated partial healing of lateral MPHTs in 1 of 10 cases, compared with 5 of 33 cases in the control group, with no significant difference in overall healing rates between groups (90% vs. 84.8%, P = 0.680). In addition, partial healing of medial MPHTs was associated with residual graft laxity (50% vs. 16.7%, p = 0.045) compared to those with complete healing.</p><p><strong>Conclusion: </strong>For ACL-injured patients with steep PTS (≥ 15°) and excessive ATS (≥ 6 mm), the repaired medial MPHTs may benefit from the additional SRTO. In addition, incomplete healing of the posterior horn of the medial meniscus may be associated with residual ACL graft laxity.</p><p><strong>Clinical relevance: </strong>An additional slope-reducing tibial osteotomy may be indicated to facilitate medial meniscal healing in ACL injuries with excessive PTS and a concomitant posterior meniscal horn tear.</p><p><strong>Level of evidence: </strong>Cohort study III.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148361212","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":"Application of gut microbiota metabolites in the treatment of knee osteoarthritis: a network pharmacology study.","authors":"Fengjiao Chen, Yufeng Tao, Jing Deng, Leyi Zhang, Lanlan Yu, Zhuoxi Yang, Yixuan Zhang, Siru Chen, Chi Zhang","doi":"10.1186/s13018-026-07023-8","DOIUrl":"10.1186/s13018-026-07023-8","url":null,"abstract":"<p><strong>Background: </strong>Knee osteoarthritis (KOA) is a prevalent degenerative joint disease affecting approximately 654 million people worldwide. The gut-joint axis theory suggests a intrinsic link between gut microbiota(GM) metabolites and KOA pathogenesis. This study employs network pharmacology to investigate the protective effects of GM metabolites against KOA and elucidate their underlying molecular mechanisms.</p><p><strong>Methods: </strong>KOA-related targets and GM metabolite targets were retrieved from public databases. After deduplication, intersecting targets were identified and subjected to protein-protein interaction (PPI) network analysis, Gene Ontology (GO) enrichment, and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis to identify core targets and pathways. Functional association analysis was performed on core targets, followed by GO, KEGG, and functional clustering analyses. Results from both analytical rounds were compared. A \"Gut Microbiota-Target-Metabolite\" network was constructed to screen key metabolites and targets, which were subsequently validated using molecular docking, drug-like property assessment, and toxicity analysis.</p><p><strong>Results: </strong>By integrating multi-source target prediction, network analysis, and molecular docking validation, this study first identified IL6, IL1B, and NFKB1 as core targets regulating KOA processes via GM metabolites. GO analysis revealed their functions primarily concentrate on immune response and inflammatory regulation. KEGG analysis highlighted the lipid and atherosclerosis pathway and TNF signaling pathway as key mechanisms. Butyrate, acetate, propionate, and trimethylamine oxide emerged as core metabolites. Molecular docking confirmed strong binding affinities with core targets. All four metabolites exhibited favorable bioavailability, acceptable Lipinski's rule violations, and no hepatotoxicity or carcinogenicity.</p><p><strong>Conclusion: </strong>This study provides novel network pharmacology evidence supporting the gut-joint axis theory, revealing a potential mechanism whereby GM metabolites may synergistically intervene in KOA through multiple targets and pathways. It also identifies candidate targets and metabolites for gut microbiome-based prevention and treatment strategies for KOA.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148361052","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":"Extrapedicular approach for basivertebral nerve radiofrequency ablation: a conceptual review.","authors":"Jimmy Wen, Megan Kou, Nathaniel Duong, Adam Razick, Arsh Alam, Sugamjot Badhan, Jose Silva, Megan Hsu, Sam Warner, Rohin Thomas, Foad Elahi","doi":"10.1186/s13018-026-07074-x","DOIUrl":"10.1186/s13018-026-07074-x","url":null,"abstract":"<p><strong>Background: </strong>Chronic axial low back pain (LBP) of vertebrogenic origin is increasingly recognized as a distinct clinical entity responsive to basivertebral nerve (BVN) radiofrequency ablation (RFA). This analysis synthesizes the anatomical, biomechanical, and safety considerations of both access routes and evaluates their clinical implications.</p><p><strong>Methods: </strong>A literature review was conducted in PubMed for articles on BVNRFA anatomy, techniques, and access routes published through December 1, 2025. Given the limited literature on extrapedicular BVNRFA, studies from the vertebral augmentation literature were included if appropriate for access route considerations.</p><p><strong>Results: </strong>The standard technique for BVNRFA utilizes a transpedicular trajectory to access the vertebral body, which provides a consistent trajectory using the pedicle but places the introducer in proximity to the facet joints, dorsal root ganglion, exiting spinal nerve, and paraspinal muscles. Emerging evidence has described the extrapedicular approach, which follows a lateral pathway, may be considered for select patients with anatomical challenges, such as narrow pedicles or preexisting pedicle instrumentation.</p><p><strong>Conclusion: </strong>Currently, there is no clinical evidence to suggest the superiority of the extrapedicular approach over the traditional transpedicular approach. Each has its own anatomical considerations, technical challenges, and risks to consider, which require imaging guidance and careful adherence to anatomical landmarks. Further biomechanical, cadaveric, animal model, and clinical studies are warranted to assess the relative efficacy, safety, and long-term implications of each approach.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13579743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148352299","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":"Kinesiophobia and knee biomechanical characteristics in patients with postoperative tibial plateau fractures across body mass index categories: a cross-sectional mediation analysis.","authors":"Gangqiang Du, Zihao Sun, Bixuan Duan, Lina Zhang, Pei Ma, Li Yu, Wei Li","doi":"10.1186/s13018-026-06886-1","DOIUrl":"10.1186/s13018-026-06886-1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To investigate knee biomechanical characteristics and kinesiophobia levels across different body mass index (BMI) categories in patients following tibial plateau fracture surgery, and to examine the mediating role of kinesiophobia in the relationship between BMI and knee biomechanical outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A cross-sectional controlled study was conducted. Sixty postoperative tibial plateau fracture patients were stratified into Group A (obese, BMI ≥ 28 kg/m&lt;sup&gt;2&lt;/sup&gt;), Group B (overweight, BMI 24.0-27.9 kg/m&lt;sup&gt;2&lt;/sup&gt;), and Group C (normal weight, BMI 18.5-23.9 kg/m&lt;sup&gt;2&lt;/sup&gt;), with 20 patients per group, alongside 20 healthy controls (Group D). Kinesiophobia and knee function were assessed using the Tampa Scale for Kinesiophobia-17 (TSK-17) and the Lysholm Knee Scoring Scale, respectively. A three-dimensional motion capture system synchronized with a force platform was used to collect spatiotemporal gait parameters and knee kinematic and kinetic data. Between- and within-group bilateral limb differences were analyzed, and correlation analysis, multiple linear regression, and bootstrap mediation analysis were performed to examine the mediating effect of kinesiophobia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Between-group comparisons revealed that Lysholm scores progressively decreased (Group A: 73.80 ± 4.74; Group B: 77.95 ± 2.86; Group C: 81.65 ± 3.63), whereas TSK-17 scores progressively increased (Group A: 57.00 ± 3.88; Group B: 51.40 ± 3.44; Group C: 46.70 ± 4.66) with increasing BMI (P &lt; 0.01). On the affected side, cadence (Group A: 60.90 ± 12.56; Group D: 105.90 ± 4.61 steps/min), gait velocity (Group A: 0.58 ± 0.19; Group D: 1.08 ± 0.06 m/s), and sagittal plane range of motion (Group A: 47.46° ± 9.46°; Group D: 67.23° ± 2.82°) progressively decreased, whereas sagittal plane moments progressively increased (Group A: 680.35 ± 130.98; Group D: 225.13 ± 85.78 N·m) across BMI groups (P &lt; 0.01). Within-group comparisons demonstrated that sagittal plane range of motion on the affected side was significantly smaller than that on the unaffected side, and that joint moments were significantly greater on the affected side across all three patient groups (P &lt; 0.05); however, no significant bilateral differences were observed in the control group. Mediation analysis indicated that kinesiophobia partially mediated the relationship between BMI and gait velocity on the unaffected side (indirect effect =  - 0.01; 95% CI [- 0.03, - 0.00]) as well as between BMI and sagittal plane moments on the affected side (indirect effect = 7.45; 95% CI [0.43, 18.56]), with mediation proportions of 48.4% and 27.5%, respectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Patients with postoperative tibial plateau fractures and higher BMI exhibited significantly worse knee function, greater kinesiophobia, and compromised biomechanical characteristics, including slower gait, reduced sagittal plane range of motion, and elevated knee","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13576183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148352325","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":"The influence of retaining osteophyte on the coronal alignment and joint line height following medial unicompartmental knee arthroplasty.","authors":"Guanghui Zhao, Chengyuan Ma, Jianbing Ma, Jianpeng Wang","doi":"10.1186/s13018-026-07071-0","DOIUrl":"10.1186/s13018-026-07071-0","url":null,"abstract":"<p><strong>Background: </strong>The retention of osteophytes may influence the postoperative hip-knee-ankle (HKA) angle and joint line height (JLH) following unicompartmental knee arthroplasty (UKA); however, the specific impact remains poorly characterized. This study aimed to evaluate the effect of retaining the medial femoral condylar osteophyte on these parameters after medial UKA.</p><p><strong>Methods: </strong>This sequential historical cohort study included patients who underwent medial UKA between January 1, 2025, and December 31, 2025. The patient cohort comprised an osteophyte removal group and an osteophyte retention group. Preoperative HKA, medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), osteophyte width, postoperative HKA, and the change in JLH were measured. The arithmetic HKA (aHKA) and the change in coronal alignment (ΔHKA) were calculated as follows: aHKA = MPTA - LDFA + 180°, and ΔHKA = aHKA - postoperative HKA. The postoperative outcomes of interest were the change in HKA and the change in JLH. Spearman's rank correlation coefficient was used to assess the relationships between osteophyte width and both ΔHKA and the change in JLH.</p><p><strong>Results: </strong>This study included 141 patients (141 knees). The osteophyte removal group comprised 80 patients (mean age 65.5 ± 6.9 years), and the osteophyte retention group comprised 61 patients (mean age 65.9 ± 6.5 years). The postoperative HKA was significantly greater (176.11° ± 3.29° vs. 174.97° ± 2.73°, p = 0.032) and the ΔHKA was significantly smaller (0.57° ± 2.52° vs. 1.50° ± 1.99°, p = 0.041) in the removal group. Correlation analysis revealed a significant positive correlation between ΔHKA and osteophyte width (r = 0.527, p < 0.001). Radiographic assessment of JLH showed a distal migration of 2.67 ± 1.37 mm in the osteophyte removal group, compared with 1.79 ± 1.21 mm in the retention group (p = 0.001). Furthermore, the change in JLH demonstrated a significant negative correlation with osteophyte width (r = -0.484, p < 0.001).</p><p><strong>Conclusions: </strong>Retention of the medial femoral condylar osteophyte appears to be associated with a reduction in the postoperative HKA angle and elevation of the joint line; however, the decision to retain or excise the osteophyte warrants further research.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13579748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148352370","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":"Robot-assisted versus conventional posterior lumbar interbody fusion for lumbar spinal stenosis: a propensity score-matched cohort study on total and hidden blood loss.","authors":"Junjie Qiao, Xinyao Lv, Yuyu Fan, Ruizhao Zhao, Xiutong Fang","doi":"10.1186/s13018-026-07066-x","DOIUrl":"10.1186/s13018-026-07066-x","url":null,"abstract":"<p><strong>Background: </strong>Hidden blood loss (HBL) represents an important component of perioperative bleeding after posterior lumbar interbody fusion (PLIF), especially in multilevel procedures. Whether robot-assisted PLIF (R-PLIF) is associated with lower total blood loss (TBL) and HBL than conventional PLIF remains uncertain.</p><p><strong>Methods: </strong>This was a single-center retrospective cohort study of consecutive patients who underwent robot-assisted PLIF (R-PLIF) or conventional PLIF between January 2019 and December 2023. After common-support restriction and 1:1 propensity score matching with an exact-match constraint on fused levels, 102 R-PLIF cases were matched to 102 controls; 58 patients fell outside the region of overlap and 138 additional eligible patients were not retained because no acceptable match was available under the prespecified caliper. TBL was calculated using Nadler's and Gross's formulae; visible blood loss (VBL) was defined as intraoperative loss plus postoperative drainage; HBL was derived rather than directly measured, using HBL = TBL - VBL + transfusion volume; the postoperative hematocrit used for the Gross calculation was obtained on postoperative day 1 (within 24 h). A linear model with robust standard errors clustered by matched pair was used to assess the interaction between surgical approach and number of levels.</p><p><strong>Results: </strong>TBL was significantly lower in the R-PLIF group (500.5 ± 276.6 mL) than in the PLIF group (629.0 ± 293.0 mL) (MD - 128.4 mL, 95% CI - 148.7 to - 108.1; P < 0.001). Compared with conventional PLIF, R-PLIF was associated with lower VBL (308.1 ± 146.6 vs. 401.4 ± 173.8 mL; P < 0.001) and lower HBL (224.8 ± 175.0 vs. 282.5 ± 194.9 mL; MD - 57.8 mL; P = 0.001). An exploratory approach × level interaction (P < 0.001) suggested that the between-group difference in TBL was larger among patients undergoing ≥ 2-level fusion.</p><p><strong>Conclusions: </strong>In this propensity score-matched retrospective cohort, R-PLIF was associated with lower estimated TBL, VBL, and formula-derived HBL than conventional PLIF. However, causality cannot be established, residual confounding may persist, and the clinical significance of the approximately 128-mL mean TBL difference remains uncertain.</p><p><strong>Trial registration: </strong>Not applicable.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13576127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148352293","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}