Journal of orthopaedics最新文献

{"title":"Comparative analysis of radiation doses in total hip arthroplasty: Evaluating conventional, navigation, and robotic modalities","authors":"A. Saad,&nbsp;A.I.W. Mayne,&nbsp;P. McGookin,&nbsp;J. Pagkalos,&nbsp;Y. Agrawal,&nbsp;R. Botchu,&nbsp;A.D. Sharma,&nbsp;E.T. Davis","doi":"10.1016/j.jor.2026.05.010","DOIUrl":"10.1016/j.jor.2026.05.010","url":null,"abstract":"<div><h3>Background</h3><div>Total hip arthroplasty (THA) is an effective procedure for relieving the symptoms of hip arthritis, with accurate component positioning being essential for optimal outcomes. Advances in robotic and navigation-assisted THA have introduced imaging protocols that incorporate standard radiographs, functional radiographs, and CT-based imaging. While these approaches improve surgical accuracy, they may also increase radiation exposure. This study aims to evaluate and compare radiation exposure associated with imaging modalities used in conventional, navigated, and robotic THA.</div></div><div><h3>Methods</h3><div>A retrospective analysis of 104 patients was performed. Of these, 50 underwent Mako robotic-assisted THA, 23 underwent Corin OPS-assisted THA, 18 underwent conventional THA with standard AP radiographs, and 13 underwent lateral radiographic imaging. Imaging data were obtained from radiology records. Dose-length product (DLP) was recorded for CT scans and dose-area product (DAP) for radiographs. Effective doses (E) were calculated using specialised software, including the ImPACT CT Dosimetry Calculator and the PCXMC Dose Calculator. Statistical comparisons between imaging modalities were conducted using ANOVA testing, with statistical significance defined as p &lt; 0.05.</div></div><div><h3>Results</h3><div>The Mako CT protocol demonstrated a mean effective dose (E) of 8.3 mSv, while the Corin OPS CT protocol showed a lower mean E of 6.6 mSv. Functional radiographs used in the OPS pathway contributed an additional mean E of 0.73 mSv. Conventional AP and lateral radiographs were associated with the lowest mean E at 0.174 mSv.</div></div><div><h3>Conclusion</h3><div>This study highlights the importance of monitoring and optimising radiation exposure in preoperative imaging for THA. The implementation of low-dose CT protocols and alternative imaging strategies may reduce radiation exposure while maintaining diagnostic accuracy. Further research and collaboration are required to develop standardised guidelines for radiation dose optimisation in THA.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"77 ","pages":"Pages 151-156"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148737807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Titanium-coated PEEK versus 3D-printed porous titanium cages in transforaminal lumbar interbody fusion: A meta-analysis","authors":"Youngmin Yu,&nbsp;Thomas Cho,&nbsp;Jiayong Liu","doi":"10.1016/j.jor.2026.05.013","DOIUrl":"10.1016/j.jor.2026.05.013","url":null,"abstract":"<div><h3>Background</h3><div>Transforaminal lumbar interbody fusion (TLIF) is a common procedure for degenerative spinal conditions. While polyetheretherketone (PEEK) and titanium (Ti) are established cage materials, titanium-coated PEEK (Ti-PEEK) was developed to combine PEEK's favorable modulus with Ti's osteoconductive surface. This meta-analysis compares the radiographic and clinical outcomes of modern 3D-printed porous titanium (3D-Ti) and Ti-PEEK cages in TLIF.</div></div><div><h3>Methods</h3><div>A systematic search of PubMed, Embase, and Google Scholar was conducted up to April 2025 following PRISMA guidelines. Studies comparing 3D-Ti and/or Ti-PEEK cages in TLIF, reporting outcomes of fusion, subsidence, reoperation, or visual analogue scale (VAS) scores with a minimum 6-month follow-up were included. Given the scarcity of direct comparisons, an indirect comparison was performed using single-arm random-effects meta-analyses for each material, followed by meta-regression to estimate differences. Risk of bias was assessed using the Cochrane Risk of Bias tool for RCTs and ROBINS-I for observational studies.</div></div><div><h3>Results</h3><div>Twelve studies (4 RCTs, 8 cohorts) comprising 627 patients and 812 fused levels were included. Single-arm analyses showed high and comparable fusion rates (3D-Ti: 91%, Ti-PEEK: 88%) and similar subsidence (3D-Ti: 19%, Ti-PEEK: 20%) and reoperation rates. Indirect meta-regression found no statistically significant differences between materials for fusion (OR 0.68, 95% CI 0.30–1.50; p = 0.335), subsidence (OR 1.04, 95% CI 0.33–3.22; p = 0.951), reoperation (OR 1.23, 95% CI 0.29–5.24; p = 0.777), or VAS-back (mean difference −0.88, 95% CI -2.49 to 0.73; p = 0.286). Residual heterogeneity was substantial for subsidence (I² = 84%) and VAS-back (I² = 89%), moderate for fusion (I² = 47%), and low for reoperation (I² = 34%). Risk of bias for RCTs was unclear to high (Cochrane RoB), driven primarily by performance bias from unblinded surgeons, and moderate to serious for cohorts (ROBINS-I).</div></div><div><h3>Conclusion</h3><div>This meta-analysis found no significant differences in radiographic or key clinical outcomes between 3D-Ti and Ti-PEEK cages at intermediate-term follow-up. The evidence suggests clinical equivalence, supporting that cage selection can be guided by factors such as surgeon familiarity, cost, and specific patient imaging needs rather than material properties alone.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"77 ","pages":"Pages 124-132"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13324303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148376076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Balanced Turbo Field Echo MRI as a radiation-free adjunct for spinal bone imaging: A prospective study of 526 patients","authors":"Abhishek Soni,&nbsp;Akhil Xavier Joseph,&nbsp;Vidyadhara S.,&nbsp;Balamurugan T.,&nbsp;Ullas V. Acharya,&nbsp;Sharath K. Rao","doi":"10.1016/j.jor.2026.05.014","DOIUrl":"10.1016/j.jor.2026.05.014","url":null,"abstract":"<div><h3>Study Design:</h3><div>Single-centre, prospective, within-subject observational imaging-quality study with a single experienced reader.</div></div><div><h3>Aims &amp; Objectives:</h3><div>To evaluate whether adding a 3D Balanced Turbo Field Echo (BTFE) sequence to routine 3T spine MRI improves visualization of osseous spinal pathology compared with conventional T1/T2-weighted MRI and plain radiographs.</div></div><div><h3>Materials &amp; Methods:</h3><div>Between March and November 2024, 526 consecutive adults underwent spine imaging including T1/T2-weighted and BTFE MRI on a 3T scanner plus plain radiographs; thin-section CT served as confirmatory reference in a small ligamentum flavum ossification (LFO) subgroup. Six osseous pathologies were scored: disc osteophyte complex, OPLL, LFO, spondylolisthesis, spondylolysis and vertebral fracture. A single senior consultant radiologist (<span><math><mo>&gt;</mo></math></span>10 years’ experience), blinded to other modalities and clinical details, graded visualization on a 3-point ordinal scale in separate, randomized, washed-out sessions. Modalities were compared per pathology with Friedman’s test and Holm-corrected Wilcoxon post-hoc tests.</div></div><div><h3>Results:</h3><div>Mean age was <span><math><mrow><mn>60.2</mn><mo>±</mo><mn>11.8</mn></mrow></math></span> years; 297 (56.5%) were female; thoraco-lumbar scans accounted for 454 (86.3%). Disc osteophyte was most common (n = 229, 43.5%). BTFE scored significantly higher than routine MRI and plain radiographs for every pathology (all <span><math><mrow><mi>p</mi><mo>&lt;</mo><mn>0.001</mn></mrow></math></span>). OPLL was invisible on radiographs but well delineated on BTFE. For LFO, BTFE meaningfully outperformed routine MRI, representing a radiation-free improvement over standard MRI practice.</div></div><div><h3>Conclusion:</h3><div>Adding a widely available BTFE sequence to routine 3T spine MRI improved visualization of spinal osseous pathology without ionizing radiation. BTFE should be regarded as a candidate bone-imaging adjunct; head-to-head comparison with CT and with established CT-like MRI sequences (ZTE, FRACTURE, 3D FLASH, T1-spoiled gradient-echo, synthetic CT) is needed.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"77 ","pages":"Pages 133-141"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Top-cited vs. highest altmetric-ranked shoulder arthroplasty articles: Does citation rate reflect online relevance and dissemination?","authors":"Hao Yik Lim,&nbsp;Liam O'Dwyer,&nbsp;Eilis Fitzgerald,&nbsp;J. Tristan Cassidy","doi":"10.1016/j.jor.2026.03.028","DOIUrl":"10.1016/j.jor.2026.03.028","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare the top 20 most cited articles with the 20 highest ranked by altmetric performance related to shoulder arthroplasty.</div></div><div><h3>Background</h3><div>Ongoing research is crucial for improving surgical outcomes. Citation count has long been the primary method of quantifying the importance and influence of research. However, the scientific forum is changing. Altmetric analysis offers a complementary approach to capture broader media of dissemination and influence.</div></div><div><h3>Methods</h3><div>The top-20 studies with the highest AAS (Altmetric Attention Score) were retrieved from <span><span>http://www.altmetric.com/</span><svg><path></path></svg></span>. Web of Science database was used to retrieve the 20 most cited studies. Study groups were compared based on respective AAS, citation counts, citation density, level of evidence and impact factor of the journal's identified.</div></div><div><h3>Results</h3><div>The top-20 altmetric articles had an average AAS of 144.95 ± 139.38 (47-567) and average citation count of 25.32 ± 34.93 (0-141). The top-20 bibliometric articles had an average citation count of 167.45 ± 52.99 (107-270) and an average AAS of 10.4 ± 10.95 (0-47). The most cited article (270) had an AAS of 10. The highest AAS (567) had zero citations. The bibliometric search had one level I study. There was no level I study on the altmetric list and no level II study on either list. There was no significant correlation between AAS and citations.</div></div><div><h3>Conclusions</h3><div>There is no significant correlation between the AAS and citation count among the most influential paper relating to shoulder arthroplasty. Altmetrics highlighted recent, clinically focused work. Whereas bibliometrics captured studies with established academic impact. Combining both approaches offers a clearer picture of which research is shaping current discussion and underpinning long-term evidence. There is a paucity of high-quality research among the most influential studies from the past decade relating to shoulder arthroplasty.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"77 ","pages":"Pages 165-171"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148737808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to “Modular versus non-modular humeral stems in shoulder arthroplasty for proximal humerus fracture: a multicenter retrospective cohort study” [J Orthopaed 77 (2026) 36-41]","authors":"Aaron M. Atlas,&nbsp;Shawn J. Geffken,&nbsp;Matthew T. Geiselmann,&nbsp;Benjamin Hershfeld,&nbsp;Anthony Modica,&nbsp;Randy M. Cohn,&nbsp;Brett A. Lenart","doi":"10.1016/j.jor.2026.07.001","DOIUrl":"10.1016/j.jor.2026.07.001","url":null,"abstract":"","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"77 ","pages":"Page 150"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13393787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148579008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic posterior shoulder dislocation: Current evidence, treatment options, and a decision-making algorithm","authors":"Raju Vaishya,&nbsp;Ayaz Saiyed,&nbsp;Abhishek Vaish,&nbsp;Rajesh Botchu,&nbsp;Patinharayil Gopinathan,&nbsp;Srinivas SB. Kambhampati,&nbsp;Filippo Migliorini","doi":"10.1016/j.jor.2026.05.015","DOIUrl":"10.1016/j.jor.2026.05.015","url":null,"abstract":"<div><h3>Background and aims</h3><div>Chronic posterior shoulder dislocation (CPSD), also known as locked or chronic posterior glenohumeral dislocation, is a rare but frequently missed injury, accounting for 2–5% of shoulder dislocations. It often results from trauma, seizures, or electrical shock, leading to reverse Hill-Sachs lesion (rHSL), posterior glenoid erosion, and soft-tissue contractures. Delayed diagnosis (50–79% initially overlooked) transforms acute cases into chronic ones (&gt;3–6 weeks), complicating management and increasing risks of instability, osteoarthritis, and poor function. This narrative literature review aims to synthesise current evidence on the aetiology, diagnosis, imaging, treatment strategies, and outcomes of CPSD, and to propose a surgical decision-making algorithm to guide clinicians.</div></div><div><h3>Methods</h3><div>A comprehensive search was conducted (up to March 13, 2026). Inclusion criteria included peer-reviewed articles (2006–2026) on adult patients with chronic PSD, focusing on interventions, clinical outcomes (pain, ROM, function, complications), and rehabilitation. Narrative synthesis was performed.</div></div><div><h3>Results</h3><div>Aetiology is predominantly traumatic; pathoanatomy features rHSL (30–90% of cases) and posterior capsulolabral damage. Diagnosis relies on axillary radiographs, CT for bony defects, and MRI for soft tissues. Treatment depends on dislocation duration, rHSL size, glenoid integrity, and patient factors. A stepwise algorithm integrates reducibility, defect size, and associated pathologies.</div></div><div><h3>Conclusion</h3><div>CPSD requires high clinical suspicion and advanced imaging for timely diagnosis. Joint-preserving reconstructions yield superior outcomes in moderate defects with early intervention; arthroplasty is preferred for extensive damage. The proposed algorithm provides structured guidance, though high-level evidence remains limited due to rarity and study heterogeneity. Future multicenter RCTs and standardised classifications are needed.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"77 ","pages":"Pages 142-149"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148523369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NEAT1/miR-139-5p as biomarkers for opioid tolerance following total knee arthroplasty","authors":"Qiu Chen,&nbsp;Dongli Jie,&nbsp;Yanfei Dong","doi":"10.1016/j.jor.2026.03.040","DOIUrl":"10.1016/j.jor.2026.03.040","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the predictive value and regulatory relationship of serum long non-coding RNA NEAT1 and microRNA miR-139-5p for acute opioid tolerance following Total Knee Arthroplasty (TKA).</div></div><div><h3>Methods</h3><div>A prospective cohort of TKA patients was enrolled and divided into the opioid tolerance group (OTG) and the non-opioid tolerance group (ONTG). The expression levels of NEAT1 and miR-139-5p in serum were measured at preoperative, postoperative day 1, and day 3 using qRT-PCR. Their clinical value was evaluated using correlation analysis, multivariate logistic regression, and ROC curve analysis.</div></div><div><h3>Results</h3><div>Compared to the ONTG group, the OTG group showed significantly upregulated NEAT1 and downregulated miR-139-5p (both <em>P</em> &lt; 0.001), with a strong negative correlation between the two (r = −0.843∼-0.876). NEAT1 was positively correlated with postoperative opioid consumption and VAS scores, while miR-139-5p showed a negative correlation (all <em>P</em> &lt; 0.001). Multivariate logistic regression confirmed that NEAT1 and miR-139-5p on postoperative day 1 and day 3 were independent predictive factors (both <em>P</em> &lt; 0.05). ROC curve analysis demonstrated that both markers had good predictive accuracy on postoperative day 1 (AUC = 0.792, 0.845) and day 3 (AUC = 0.819, 0.867).</div></div><div><h3>Conclusion</h3><div>NEAT1 and miR-139-5p participate in TKA postoperative opioid tolerance through the ceRNA mechanism. Their expression levels on postoperative day 1 are independent risk factors with good predictive accuracy for postoperative opioid tolerance, making them potential early predictive biomarkers.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"77 ","pages":"Pages 157-164"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148737796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anteromedial drilling improves rotational stability but not clinical outcomes in anterior cruciate ligament reconstruction: an umbrella review of level I meta-analyses","authors":"Filippo Migliorini,&nbsp;Luise Schäfer,&nbsp;Marco Pilone,&nbsp;Riccardo Giai Via,&nbsp;Marcel Betsch,&nbsp;Philipp Boosz","doi":"10.1016/j.jor.2026.05.016","DOIUrl":"10.1016/j.jor.2026.05.016","url":null,"abstract":"<div><h3>Background</h3><div>Anterior cruciate ligament (ACL) injuries are among the most common knee injuries. Treatment options include conservative management as well as surgical repair and reconstruction. Given the well-documented risk of secondary joint damage, such as meniscal injury, cartilage degeneration, and the progression to osteoarthritis in persistently unstable knees, ACL reconstruction has become a widely accepted standard of care. Various surgical techniques have been developed. Among these, anteromedial femoral tunnel drilling has gained increasing attention as a more anatomic alternative to the transtibial technique, with the potential to overcome its limitations and improve clinical outcomes.</div></div><div><h3>Methods</h3><div>An umbrella review of meta-analyses was conducted in accordance with established methodological standards. Meta-analyses of randomised controlled trials (RCTs) directly comparing anteromedial (transportal) and transtibial femoral tunnel drilling techniques in primary ACL reconstruction were included. Quantitative data were extracted for patient-reported outcome measures (PROMs) and consistently reported clinical endpoints, including subjective and objective International Knee Documentation Committee (IKDC) scores, Lysholm and Tegner scores, graft failure rates, instrumented laxity, and clinical stability tests (Lachman and pivot-shift tests). Pooled effect estimates with corresponding confidence intervals were calculated using random-effects models. Between-study heterogeneity was assessed using the I² statistic, and the robustness of the findings was evaluated through sensitivity analyses.</div></div><div><h3>Results</h3><div>Four level I meta-analyses were included. Graft failure rates did not differ significantly between anteromedial and transtibial drilling techniques (RR 0.67, 95% CI 0.42–1.09). Functional outcomes were largely comparable, with no significant differences observed in objective IKDC, Lysholm, or Tegner scores; subjective IKDC scores demonstrated only a small advantage for the anteromedial technique (MD 1.02, 95% CI 0.04–2.00). In contrast, anteromedial drilling was consistently associated with improved clinical stability, reflected by higher rates of negative Lachman (RR 1.12, 95% CI 1.05–1.19) and pivot-shift tests (RR 1.17, 95% CI 1.10–1.24). Sensitivity analyses confirmed the robustness of the stability outcomes, whereas functional measures appeared more susceptible to heterogeneity.</div></div><div><h3>Conclusions</h3><div>Anteromedial femoral tunnel drilling in ACL reconstruction confers superior rotational knee stability compared with the transtibial technique; however, this biomechanical advantage fails to translate into clinically meaningful improvements in functional outcomes or patient-reported measures.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"77 ","pages":"Pages 116-123"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13324301/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148376116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Xylosyltransferase-I in knee arthrofibrosis: Mechanistic insights and translational implications","authors":"Yong Huang ,&nbsp;Chao Lou ,&nbsp;Michael Jagodzinski","doi":"10.1016/j.jor.2026.02.031","DOIUrl":"10.1016/j.jor.2026.02.031","url":null,"abstract":"<div><h3>Background</h3><div>Arthrofibrosis is a frequent complication after total knee arthroplasty (TKA) and remains difficult to diagnose early due to the lack of reliable biomarkers. Excessive extracellular matrix (ECM) remodeling is driven by core signaling cascades, notably the Transforming Growth Factor-beta 1 (TGF-ß1) and Wnt/ß-catenin pathways. Xylosyltransferase-I (XT-I), a key enzyme regulating proteoglycan biosynthesis, has emerged as a critical downstream effector and potential indicator of early fibrotic activity.</div></div><div><h3>Methods</h3><div>This narrative review summarizes clinical and experimental findings on XT-I in joint fibrosis, with emphasis on its role within the molecular network of key pro-fibrotic signaling and its diagnostic and translational potential in knee arthrofibrosis.</div></div><div><h3>Results</h3><div>XT-I is consistently upregulated in fibrotic synovial fibroblasts and synovial fluid of arthrofibrotic knees, correlating with ECM remodeling and myofibroblast activation induced by both TGF-ß1and Wnt/ß-catenin signaling. XT-I demonstrates local rather than systemic diagnostic value and may serve as an early fibrosis indicator.</div></div><div><h3>Conclusion</h3><div>XT-I holds promise as a synovial biomarker and potential therapeutic target in arthrofibrosis. Targeting XT-I, potentially in combination with core pathway inhibitors (e.g., Wnt/ß-catenin inhibitors), may offer a refined strategy for early diagnosis and postoperative management in TKA patients.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"75 ","pages":"Pages 40-45"},"PeriodicalIF":1.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146192676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Calculating and comparing value in orthopaedic hip trauma: A systematic review","authors":"Lindsay Maier ,&nbsp;Zachary Chen ,&nbsp;Mithil Gudi ,&nbsp;Spencer Barlow ,&nbsp;Trae Hill ,&nbsp;Charles S. Day","doi":"10.1016/j.jor.2026.02.043","DOIUrl":"10.1016/j.jor.2026.02.043","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the existing literature on value comparisons between treatment strategies in orthopaedic hip fracture care using real-world clinical data and standardized cost-effectiveness metrics.</div><div>Materials and Methods</div></div><div><h3>Data sources</h3><div>A comprehensive search of PubMed, Embase, and Web of Science was conducted for studies published between January 1, 2003, and May 30, 2024. Only English-language articles were included.</div></div><div><h3>Study selection</h3><div>Eligible studies directly compared two or more treatment strategies for hip fracture care and included a value-based economic evaluation using clinical (non-simulated) data. Exclusion criteria included simulation models, protocols, case reports, systematic reviews, and meta-analyses.</div></div><div><h3>Data extraction</h3><div>Two independent reviewers screened titles, abstracts, and full texts using PRISMA guidelines. Discrepancies were resolved by a third reviewer. Extracted variables included study design, intervention type, cost perspective, quality metric used, and economic evaluation method.</div></div><div><h3>Data synthesis</h3><div>Studies were analyzed descriptively. Outcome measures included cost-effectiveness ratios such as ICER, ICUR, and NMB. QALYs were used to enable cross-study comparisons.</div></div><div><h3>Results</h3><div>Sixteen of 935 screened full-text articles met inclusion criteria. Most studies evaluated surgical interventions. Cemented hemiarthroplasty showed a favorable NMB compared to uncemented implants. Liposomal bupivacaine and tranexamic acid were cost-effective due to lower operating costs and shorter hospital stays. Internal fixation was more cost-effective than hemiarthroplasty in some settings despite lower quality outcomes. Operative treatment in frail, institutionalized patients offered minimal QALY benefit at high cost. Home-based post-acute care and fracture liaison services improved value, while outreach rehab lacked long-term cost-effectiveness. Most studies used public payer perspectives and EQ-5D-derived QALYs.</div></div><div><h3>Conclusion</h3><div>There is significant variability in how value is calculated and reported in hip fracture care. Standardized value frameworks using a hospital/clinic perspective, patient-reported outcomes transformed into QALYs, and cost-utility ratios compared with the ICER equation should be utilized in future studies.</div></div><div><h3>Level of evidence</h3><div>Level III (Systematic Review of Comparative Studies)</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"75 ","pages":"Pages 168-176"},"PeriodicalIF":1.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146192677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}