Journal of orthopaedics最新文献

{"title":"Novel hematological indices SII and NLR: Aiding diagnosis, differentiating subtypes, and reflecting disease activity in juvenile idiopathic arthritis","authors":"XiaoLin Luo ,&nbsp;JianWei Hu ,&nbsp;ShengPing Tang ,&nbsp;ChenYang Li ,&nbsp;ShiJie Liao ,&nbsp;XiaoFei Ding","doi":"10.1016/j.jor.2025.12.014","DOIUrl":"10.1016/j.jor.2025.12.014","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to evaluate the clinical utility of novel hematological indices, particularly the systemic immune-inflammation index (SII) and neutrophil-to-lymphocyte ratio (NLR) in diagnosing juvenile idiopathic arthritis (JIA), differentiating its subtypes, and assessing disease activity.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of 185 JIA patients and 124 healthy controls. Comprehensive clinical and hematological parameters were collected, and immune-inflammatory ratios were calculated. Participants were stratified by JIA subtype according to ILAR criteria and by disease activity based on Wallace criteria. Statistical analyses compared these indices across groups and evaluated their correlations with conventional markers and the JADAS-27 score. Subgroup analyses further assessed their diagnostic potential in patients with normal erythrocyte sedimentation rate (ESR)/C-reactive protein (CRP).</div></div><div><h3>Results</h3><div>SII, NLR, platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) were significantly elevated in JIA patients compared to controls, with AUC values &gt; 0.6 for JIA identification. Notably, systemic JIA (sJIA) showed distinct inflammatory profiles, with significantly higher SII, MLR, PLR, and NLR, and lower monocyte-to-neutrophil ratio (MNR) and platelet-to-neutrophil ratio (PNR), compared to other subtypes. Active JIA patients exhibited elevated SII and NLR and reduced MNR relative to those with inactive disease. SII and NLR demonstrated moderate positive correlations with ESR, CRP, and JADAS-27, whereas MNR was negatively correlated. Although subgroup analyses in patients with normal ESR/CRP did not reach statistical significance, likely due to sample size limitations—the consistent trends support the potential supplementary role of these indices.</div></div><div><h3>Conclusion</h3><div>This study establishes SII and NLR as accessible and informative biomarkers for JIA. They effectively differentiate systemic JIA from other subtypes, reflect disease activity, and correlate with established activity scores. Their low cost and routine availability position them as valuable adjuncts in the diagnostic and monitoring workflow for JIA, particularly when traditional markers are ambiguous or unavailable.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 80-85"},"PeriodicalIF":1.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145734838","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":"The use of liposomal bupivacaine for pain control after hand and wrist surgery: A systematic review and meta-analysis","authors":"Jorge A. Garavito,&nbsp;Joseph E. Nassar,&nbsp;Jacob Johnson,&nbsp;Manjot Singh,&nbsp;Christopher Got,&nbsp;Joseph A. Gil","doi":"10.1016/j.jor.2025.12.030","DOIUrl":"10.1016/j.jor.2025.12.030","url":null,"abstract":"<div><div>Liposomal bupivacaine (LB) has gained interest as a long-acting local anesthetic, although its utility in hand and wrist surgery remains unclear. This systematic review and meta-analysis evaluated randomized controlled trials (RCTs) comparing LB with conventional anesthetics in patients undergoing hand or wrist surgeries. Searches were performed in PubMed, Embase, Cochrane Library, Web of Science, Scopus, and Google Scholar through July 2025. Eligible studies reported pain scores and opioid consumption from postoperative day (POD) 0–5, and overall benefit of analgesia scores (OBAS) from POD 1 to 4. Pooled analyses calculated weighted means for pain scores, opioid use, and OBAS, with subgroup analyses for carpometacarpal (CMC) arthroplasty and distal radius open reduction internal fixation (ORIF). Four RCTs involving 211 patients (105 LB, 106 control) were included. Pain scores were not significantly different between groups across POD 0–5. Opioid consumption was marginally reduced on POD 1 with no significant other differences. OBAS scores were lower in the LB group on POD 2 and 3 with no other significant differences. This limited study found that LB use does not significantly reduce postoperative pain and opioid use or enhance analgesia satisfaction compared to standard bupivacaine in hand and wrist surgery.</div></div><div><h3>Level of evidence</h3><div>Therapeutic II.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 213-220"},"PeriodicalIF":1.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787580","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":"Mental health and pain trends among U.S. adults with arthritis: A comparative analysis of 2019 and 2023 national data","authors":"Nicholas Frappa,&nbsp;Melina Villa,&nbsp;Zachary Tamweber,&nbsp;Ellen Lutnick","doi":"10.1016/j.jor.2025.12.032","DOIUrl":"10.1016/j.jor.2025.12.032","url":null,"abstract":"<div><h3>Introduction</h3><div>The COVID-19 pandemic led to broad increases in depression, anxiety, and psychological distress. Adults with arthritis may be especially vulnerable due to high baseline pain, functional limitations, and longstanding psychosocial burden. This study evaluated changes in depression, anxiety, counseling use, and pain burden from 2019 to 2023 and compared outcomes between adults with and without arthritis using nationally representative U.<em>S. data</em>.</div></div><div><h3>Methods</h3><div>Adults ≥18 years from the 2019 and 2023 National Health Interview Survey (NHIS) Adult Files were analyzed. Outcomes included lifetime depression, lifetime anxiety disorder, current counseling use, and three-month pain frequency and interference. Demographic and clinical characteristics were compared by year and arthritis status. Changes were assessed using proportion comparisons. Multivariable logistic regression examined associations between race/ethnicity and arthritis, mental-health, and pain outcomes, adjusting for age, sex, and survey year.</div></div><div><h3>Results</h3><div>The sample included 61,519 adults (31,997 in 2019; 29,522 in 2023). Depression, anxiety, counseling use, and pain burden all increased significantly from 2019 to 2023 (p &lt; .001). Arthritis prevalence remained stable (25.7 %–26.2 %). Across both years, adults with arthritis had roughly twice the prevalence of depression (28.5 % vs 16.4 % in 2023) and anxiety (24.9 % vs 16.1 %) compared with those without arthritis, and substantially higher frequent pain (53.6 % vs 16.5 %). Within the arthritis cohort, depression and anxiety remained stable, while counseling use increased modestly (7.7 %–9.0 %, p = .004). Racial and ethnic disparities persisted across arthritis, pain, and mental-health outcomes.</div></div><div><h3>Conclusion</h3><div>Adults with arthritis consistently showed higher depression, anxiety, and pain than those without arthritis, with no evidence of post-pandemic worsening. These findings suggest longstanding vulnerability rather than new pandemic-related change and support integrating brief mental-health screening into routine musculoskeletal care to improve timely recognition and referral.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 137-141"},"PeriodicalIF":1.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787586","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":"Comparison of baseline outcomes between surgical and nonoperative management in youth with lower extremity torsional abnormalities","authors":"M. Gagnon ,&nbsp;J.P. Bauer ,&nbsp;K.M. Kruger ,&nbsp;S. Tavukcu ,&nbsp;H. Altiok ,&nbsp;R. Hamdy ,&nbsp;M. Bernstein ,&nbsp;L.N. Veilleux","doi":"10.1016/j.jor.2025.12.038","DOIUrl":"10.1016/j.jor.2025.12.038","url":null,"abstract":"","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 227-233"},"PeriodicalIF":1.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787690","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":"DISTAL (Distal tibia tumors treated with amputation versus limb Salvage): A systematic review and meta-analysis of oncologic, functional, and complication outcomes in malignant bone tumors","authors":"Nikhil Garg ,&nbsp;Prem H. Menon ,&nbsp;Sunil Kumar Bajaj ,&nbsp;Abhijeet Ashok Salunke ,&nbsp;Dhruv Patel ,&nbsp;Vikas Warikoo ,&nbsp;Nandlal Bharwani ,&nbsp;Keval Patel ,&nbsp;Vikas Maheshwari ,&nbsp;Ketul Puj ,&nbsp;Mohit Sharma ,&nbsp;Shashank Pandya","doi":"10.1016/j.jor.2025.11.018","DOIUrl":"10.1016/j.jor.2025.11.018","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Aims&lt;/h3&gt;&lt;div&gt;Primary malignant bone tumors of the distal tibia are uncommon and constitute a distinctive surgical dilemma for musculoskeletal oncologist.The anatomical challenges enhance the probability of postoperative wound complications, infection, and soft-tissue necrosis following large tumor surgical excision. The management of primary malignant bone tumors of the distal tibia remains challenging as what is better treatment option for the patients limb salvage surgery or amputation.The aim of this systematic review and meta-analysis to find an answer for this question and compare the oncological and functional outcomes for patients with malignant bone tumors involving distal tibia treated with limb salvage and amputation surgery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;The protocol was created in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations.A systematic review was performed and we finally obtained three eligible studies (Laitinen et al., 2005; Mavrogenis et al., 2012; Han et al., 2017). Data were extracted for survival, local recurrence, Musculoskeletal Tumor Society (MSTS) function, and complications.The primary objective was to compare differences in local recurrence, with secondary objectives including survival, functional outcomes, and comorbidities. A random-effects meta-analysis evaluated the odds of local recurrence between limb salvage and amputation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A meta-analysis of 136 patients with chondrosarcoma (89 treated with limb-salvage surgery [LSS] and 47 with amputation [AMP]) compared oncological and functional outcomes.While overall survival rates were similar between LSS (80–84 %) and AMP (70–74 %), local recurrence was numerically higher in the limb-salvage group (10.1 % vs. 0 %). However, pooled statistical analysis found this difference was not statistically significant (Pooled OR: 2.66; 95 % CI 0.25–28.56), as the confidence interval spanned unity. The pooled mean MSTS score was 81 % for LSS compared to 69 % for amputation, representing a clinically meaningful advantage.This functional benefit was counterbalanced by a higher risk of surgical complications. The LSS group had a combined complication rate of 11.2 % (versus 6.4 % for AMP), including a critical 4.5 % rate of secondary amputation, primarily due to deep infection in earlier studies.Limb-salvage surgery provides a significant functional advantage over amputation but is associated with a non-significant trend toward higher local recurrence and a greater risk of post-operative complications, including a small but notable risk of ultimately requiring amputation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Malignant bone tumors involving distal tibia tumor treated with Limb-salvage surgery provides equivalent survival and local control compared with amputation when adequate margins and reconstruction are achieved according to the DISTAL (Distal Tibia Tumors Treated wi","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 21-29"},"PeriodicalIF":1.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145734702","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":"mModPoEs: Multimodal posture estimation and feedback-driven correction of load-bearing human movements using wearable sensors and computer vision","authors":"P. Gokul Thilaak ,&nbsp;G. Malathi ,&nbsp;D. Thiagarajan","doi":"10.1016/j.jor.2025.12.024","DOIUrl":"10.1016/j.jor.2025.12.024","url":null,"abstract":"<div><h3>Objective</h3><div>Improper spinal posture during activities of daily living such as seated posture, upright stance, and ambulation, particularly under load-bearing conditions, has been recognized as a major contributor to musculoskeletal disorders, including chronic back pain and disc degeneration. This study presents a multimodal posture estimation and feedback framework that integrates wearable-sensor data and computer-vision analysis to support spinal health.</div></div><div><h3>Methods</h3><div>The system integrates data from Inertial Measurement Units (IMUs) and flex sensors to quantify postural angles which acts as sensor data, while concurrently extracting key visual features from multi-view (frontal and lateral) video recordings and photographs using the MediaPipe framework. A control group was formed under the guidance of physiotherapist and the data was collected at Tagore College of Physiotherapy located in Chennai, India. This control group comprises of 40 subjects, selected without gender bias, aged between 19 and 22 years. The analysis on multimodal data incorporated specifically, logistic regression (LR), decision tree (DT), random forest (RF), KNN and SVM.</div></div><div><h3>Results</h3><div>Among all evaluated models, the RF algorithm, showed effective performance and balance in all activities of both male and female subjects. The dataset used was a composite collection of both genders, resulting in accuracy rates of 75 %, 95 % and 63 % for sitting, standing, and walking, respectively.</div></div><div><h3>Conclusion</h3><div>The findings highlight that integrating wearable and visual modalities enhances posture classification accuracy. While the findings are preliminary, they establish a methodological foundation for future development of multimodal, feedback-based posture assessment systems.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 101-109"},"PeriodicalIF":1.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145734779","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":"Comparing early practice outcomes of the direct anterior approach in total hip arthroplasty vs alternative approaches in direct anterior fellowship trained surgeons","authors":"Spencer E. Talentino ,&nbsp;Nicholas Pappa ,&nbsp;Kathryn Fideler ,&nbsp;Nicholas J. Greco","doi":"10.1016/j.jor.2025.12.033","DOIUrl":"10.1016/j.jor.2025.12.033","url":null,"abstract":"<div><h3>Aims</h3><div>Total hip arthroplasty (THA) approach typically depends on surgeon preference and training. The direct anterior approach (DAA) has increased appeal due to its muscle sparing planes. We evaluated complications of DAA and non-DAA THA by DAA fellowship trained surgeons. We hypothesized complications of DAA THAs would have a noninferior complication profile compared to alternative approaches.</div></div><div><h3>Methods</h3><div>Retrospective review of first 50 DAA and first 50 alternative-approach THAs performed by three fellowship-trained adult reconstruction surgeon's first year practice. Patient demographics, comorbidities, complications, radiographic acetabular inclination, acetabular anteversion, and femoral stem alignment were analyzed. Power analysis, univariate, multivariate regression models completed for analysis.</div></div><div><h3>Results</h3><div>150 cases (DAA) and 150 controls (alternative-approach) with median follow-up of 27.7 weeks (194 days). There was a significant difference in sex (56.7 % vs 35.3 % males) and median BMI (29.2 kg/m2 vs 36.5 kg/m2) between groups and no significant difference in total perioperative complications between cases (n = 51 events) and controls (n = 53 events). There were significantly reduced odds of 30 day re-admissions and 90-day ED visits in the DAA patients in univariate analysis (OR = 0.301, p = 0.008 and OR = 0.553, p = 0.045) but no significance in multivariate regression analysis (OR = 0.071, p = 0.104 and OR = 0.445, p = 0.251). Radiographic acetabular cup inclination (p = 0.31), acetabular cup anteversion (p = 1.00) and femoral stem alignment (p = 0.21) had no significant difference between groups.</div></div><div><h3>Conclusion</h3><div>Formal fellowship training in the DAA, including appropriate technique and patient selection, demonstrates no difference in perioperative complications, 30-day re-admissions, 90-day ED visits compared to alternative approaches, offering DAA fellowship trained surgeons immediate successful outcomes.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 387-393"},"PeriodicalIF":1.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145837331","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":"Comparative analysis of early versus delayed rehabilitation protocols following rotator cuff repair: A randomized controlled trial","authors":"Aran Nikpay,&nbsp;Alireza Rouhani,&nbsp;Asghar Elmi,&nbsp;Shahab Mahdipour","doi":"10.1016/j.jor.2025.12.048","DOIUrl":"10.1016/j.jor.2025.12.048","url":null,"abstract":"<div><h3>Background</h3><div>The optimal timing for initiating shoulder motion after rotator cuff repair remains controversial, balancing re-tear risk against stiffness from immobilization. This trial compared clinical and structural outcomes of early versus delayed rehabilitation.</div></div><div><h3>Methods</h3><div>From March 2024 to February 2025, 120 patients undergoing arthroscopic (single-row) or open (double-row) repair of full-thickness tears were randomized to an early-motion group (EMG; n = 60) or a delayed-motion group (DMG; n = 60). The EMG began supervised passive forward flexion and abduction within 24 h postoperatively. The DMG underwent strict immobilization for 6 weeks before starting identical rehabilitation. Primary outcomes at 6 months included pain (VAS), function (UCLA score), active range of motion (ROM), and re-tear rate on MRI (Sugaya IV/V). Secondary outcomes covered satisfaction, complications, and return to activities. Demographic, clinical, and surgical factors were analyzed.</div></div><div><h3>Results</h3><div>At 6 months, the EMG showed significantly lower pain (VAS: 1.7 ± 0.8 vs. 2.9 ± 1.1; p = 0.02), higher function (UCLA: 33.7 ± 2.1 vs. 29.4 ± 3.3; p = 0.01), greater ROM, and lower stiffness (5 % vs. 15 %; p = 0.03). Re-tear rates did not differ significantly (EMG: 3.3 % vs. DMG: 1.7 %; p = 0.56). All three re-tears occurred in patients with large tears (&gt;3 cm) and high-grade fatty infiltration (Goutallier ≥3). Multivariate analysis confirmed early motion as an independent predictor of better outcomes. Surgical technique did not alter the primary findings.</div></div><div><h3>Conclusions</h3><div>Supervised early passive motion is safe and superior to delayed immobilization, providing better functional recovery and lower stiffness without increasing re-tear risk. However, patients with large tears and advanced fatty infiltration represent a high-risk subgroup, necessitating personalized, cautious rehabilitation.</div></div><div><h3>Level of evidence</h3><div>Therapeutic Level I.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 381-386"},"PeriodicalIF":1.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145837330","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":"The Cost of PRP: Disparities in orthobiologic utilization","authors":"Ellen Lutnick,&nbsp;Eoin Devoy,&nbsp;Nicholas Frappa,&nbsp;Joseph Barbarino,&nbsp;Robert Ablove","doi":"10.1016/j.jor.2025.12.047","DOIUrl":"10.1016/j.jor.2025.12.047","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aims to assess cost and access to orthobiologic injection via platelet rich plasma (PRP).</div></div><div><h3>Methods</h3><div>Retrospective review at one academic affiliated orthopedic practice identified PRP injections for musculoskeletal indications in adult patients between January 1, 2010 and January 1, 2025 via CPT code. Cost of injection per patient category including race, sex, and anatomic location of the injection was analyzed, and US census data utilized to determine correlations between injection utilization and social determinants of health (SDoH) via ZIP code. Comparisons were performed via Wilcoxon rank-sum test or Kruskal–Wallis test. Injection counts aggregated at the ZIP code level were linked to publicly available ZIP-level SDoH variables. Analyses using per-capita injection rates were performed. P &lt; 0.05 was significant. Analyses were performed using R version 4.5.0.</div></div><div><h3>Results</h3><div>Of 727 PRP injections analyzed (57.4 % male, age of 53.0 ± 18.2 years, BMI 28.2 ± 5.5 kg/m²), patient race was predominantly White (87.2 %), followed by Black/African American (8.0 %). The mean charge was $574 ± 362. Males incurred higher charges than females ($598 vs $541; p = 0.001); charges did not differ by race (p = 0.64). Injection utilization demonstrated a strong socioeconomic gradient. The highest-income quartile (mean income ∼$115k) accounted for 40.7 % of injections; the lowest-income quartile (mean ∼$46k) accounted for only 13.6 % (χ²(3) = 114.7, p &lt; 0.001). Education level correlated positively with injection counts; uninsured rate correlated negatively. Injection distribution across income quartiles remained highly unequal after adjusting for population share (χ²(3) = 81.2, p &lt; 0.001). The uninsured rate was the only independent predictor of per-capita injection volume (IRR = 0.90, 95 % CI 0.85–0.95, p &lt; 0.001): each 1 % increase in uninsured residents was associated with a ∼10 % decrease in utilization.</div></div><div><h3>Conclusion</h3><div>PRP injections are disproportionately utilized by older, white, and insured patients from higher-income communities. Given the lack of universal insurance coverage and high out-of-pocket costs, these treatments remain inaccessible for many uninsured and lower-income patients.</div></div><div><h3>Level of evidence</h3><div>Level III; retrospective cohort study.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 370-373"},"PeriodicalIF":1.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145837456","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":"Industry 6.0 capabilities in orthopaedics: Towards hyper-personalized and autonomous surgical care","authors":"Anil Regmi ,&nbsp;Vivaan Jain ,&nbsp;Surakshya Baral ,&nbsp;Vijay Kumar Jain ,&nbsp;Karthikeyan P. Iyengar","doi":"10.1016/j.jor.2025.11.042","DOIUrl":"10.1016/j.jor.2025.11.042","url":null,"abstract":"<div><h3>Background</h3><div>Industry 6.0 represents the next frontier in technological evolution, integrating artificial intelligence (AI), autonomous robotics, digital twins, hyper-personalization, and predictive analytics to create adaptive, precision-driven systems. This comprehensive narrative review explores the current and emerging applications of Industry 6.0 in orthopaedics, focusing on AI-driven diagnostics, robotic-assisted surgery, patient-specific implants, wearable monitoring systems, and immersive Augmented Reality/Virtual Reality interfaces.</div></div><div><h3>Materials and methods</h3><div>A comprehensive electronic search was performed on the databases, PubMed, Embase, Scopus, and Web of Science, to identify Industry 6.0 relevant literature published up to October 2025. A narrative synthesis was undertaken to summarize its evolution, current clinical applications of each technology in trauma and orthopaedics, reported advantages, limitations, and regulatory considerations and future trajectories and integration models under the Industry 6.0 framework.</div></div><div><h3>Results</h3><div>AI systems and Robotic platforms facilitate surgical planning with seamless, autonomous human–AI co-surgery. Digital twins allow patient-specific simulations for peri-operative planning. Advanced 3D printing and biomaterials support hyper-personalized implants and regenerative applications, while Internet of Things (IoT)-enabled wearables and smart implants provide continuous, data-driven insights into rehabilitation and recovery. Blockchain frameworks offer secure, interoperable data management.</div></div><div><h3>Conclusion</h3><div>Industry 6.0 offers a roadmap for safer, more efficient, and individualized orthopaedic surgery in the coming decade. Though barriers such as high costs, regulatory gaps, cybersecurity concerns, and integration challenges remain, the convergence of multi-omics, predictive modeling, and sustainable, human-centric design has the potential to redefine orthopaedic care from reactive, standardized intervention to hyper-personalized, autonomous, and preventative paradigms.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 184-192"},"PeriodicalIF":1.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787582","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}