Journal of orthopaedics最新文献

{"title":"Mapping tendon stiffness: Two-dimensional versus point shear wave elastography","authors":"Mario Pasurka ,&nbsp;Theo Falck ,&nbsp;Joshua Kubach ,&nbsp;Stefan Söllner ,&nbsp;Deike Strobel ,&nbsp;Mario Perl ,&nbsp;Marcel Betsch","doi":"10.1016/j.jor.2025.08.027","DOIUrl":"10.1016/j.jor.2025.08.027","url":null,"abstract":"<div><h3>Rationale and objectives</h3><div>To date, no study has investigated the comparability between point shear wave elastography (pSWE) and 2D-shear wave elastography (2D-SWE) in assessing patellar tendon (PT) stiffness. In addition to comparing shear wave velocities, this study also evaluated intra- and interrater reliability, as well as measurement time.</div></div><div><h3>Materials and methods</h3><div>Forty healthy subjects (20 females, 20 males; age: 23.3 ± 2.4 years, BMI: 22.46 ± 2.23 kg/m²) were recruited as participants. Each participant underwent a standardized multimodal ultrasound protocol that included B-mode ultrasound (B-US), Color Doppler ultrasound (CD-US), and a shear wave elastography (SWE) examination of the bilateral patellar tendon using both pSWE and 2D-SWE. Stiffness values and examination times were recorded. Intra- and interrater reliability were assessed across two different measurement time points with two investigators for both pSWE and 2D-SWE.</div></div><div><h3>Results</h3><div>Elastography values were slightly higher for pSWE compared to 2D-SWE (pSWE: 4.02 ± 1.07 m/s, 2D-SWE: 3.82 ± 0.73 m/s; p &lt; 0.001). 2D-SWE10 measurements took significantly more time than pSWE (2D-SWE10: 69.89 ± 13.46 s vs. pSWE: 54.85 ± 8.34 s, p &lt; 0.001). However, the time required for 2D-SWE1 was significantly shorter than for pSWE (2D-SWE1: 47.20 ± 8.23 s vs. pSWE: 54.85 ± 8.34 s, p &lt; 0.001). Both interrater and intrarater reliability reached excellent levels for all SWE measurements, with the highest interrater and intrarater ICC values obtained for 2D-SWE1.</div></div><div><h3>Conclusion</h3><div>This is the first study to evaluate and compare pSWE and 2D-SWE in the assessment of patellar tendon stiffness. These findings could have important implications for the clinical use of musculoskeletal SWE, providing insights into measurement time, reliability, and the potential benefits of using 2D-SWE in clinical practice.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"70 ","pages":"Pages 276-282"},"PeriodicalIF":1.5,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144887274","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":"Early initial overnight leave after total knee arthroplasty: A novel strategy for optimizing length of stay and resource utilization","authors":"Yoshinori Ishii ,&nbsp;Hideo Noguchi ,&nbsp;Junko Sato ,&nbsp;Ikuko Takahashi ,&nbsp;Hana Ishii ,&nbsp;Ryo Ishii ,&nbsp;Kai Ishii ,&nbsp;Shin-ichi Toyabe","doi":"10.1016/j.jor.2025.08.028","DOIUrl":"10.1016/j.jor.2025.08.028","url":null,"abstract":"<div><h3>Background</h3><div>Japan's fee-for-service healthcare system leads to longer hospital stays (LOS) after total knee arthroplasty (TKA) compared to Western bundled payment models, driving up costs. Our institution implements early temporary “initial overnight leave” (IOL) to facilitate earlier home discharge and optimize resource use. This study investigates IOL's characteristics and influencing factors after primary TKA.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of 408 osteoarthritis patients (505 knees) undergoing primary TKA between 2002 and 2024. All received standardized surgery and early full weight-bearing rehabilitation. We analyzed IOL and its correlation with patient demographics, surgical parameters, and preoperative health markers. Factors influencing IOL were examined using univariate and multivariate analyses.</div></div><div><h3>Results</h3><div>The median IOL was 15 days (IQR: 10–18), with 42 % of patients achieving leave by day 10 and 79 % by day 20. Univariate analysis showed only age significantly correlated with IOL (p &lt; 0.001, r = 0.216). Neither sex nor American Society of Anesthesiologists Physical Status influenced IOL. A weak but significant correlation existed between IOL and total LOS (p &lt; 0.001, r = 0.300). Multivariate analysis confirmed age as a significant predictor of longer IOL (p = 0.002).</div></div><div><h3>Conclusions</h3><div>Early initial overnight leave after TKA is associated with shorter LOS and improved ADL independence, particularly in younger patients. This patient-driven practice offers a practical solution to optimize hospital resource utilization and address prolonged hospitalization challenges within Japan's healthcare system, promoting efficient and patient-centered TKA rehabilitation.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"70 ","pages":"Pages 258-262"},"PeriodicalIF":1.5,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144880324","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":"Reliability, minimal detectable change, and standard error of measurement of functional tests for athletes: A systematic review","authors":"Thiago Teixeira Serafim ,&nbsp;Ana Paula Ramos ,&nbsp;Diego Ailton Prudêncio ,&nbsp;Filippo Migliorini ,&nbsp;Nicola Maffulli ,&nbsp;Rodrigo Okubo","doi":"10.1016/j.jor.2025.08.030","DOIUrl":"10.1016/j.jor.2025.08.030","url":null,"abstract":"<div><h3>Introduction</h3><div>Functional tests must be validated for the target population. It is also important that the professionals applying them know which tests are the most reliable. Some tests have a standard error of measurement (SEM), which needs to be considered, as does the minimal detectable change (MDC) used to quantitatively perceive clinical improvement. It is important to know the psychometric properties of a functional test to consider it suitable for its use. This study aims to synthesise values of psychometric properties of functional tests in validation studies for athletic or physically active populations.</div></div><div><h3>Methods</h3><div>This systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search was performed in PubMed, Web of Science, SportDiscus and Cochrane in June 2025. The methodological quality of the included studies was evaluated by the Consensus-based Standards for Health Measurement Instruments (COSMIN) Risk of Bias checklist.</div></div><div><h3>Results</h3><div>The final review included 49 studies. The study samples ranged from 11 to 243, totalling 1713 subjects. The mean age of the subjects studied ranged from 16.47 ± 0.51 to 59.40 ± 8.70 years. The reliability values verified by ICC ranged from 0.26 to 0.99. SEM and MDC values were delivered in percentages and absolute values. All studies evaluated using the COSMIN checklist were classified as “Inadequate.”</div></div><div><h3>Conclusion</h3><div>Functional tests used to assess athletes generally have good reliability values. However, standardisation in the application is necessary. The training of professionals who administer the tests is essential for greater reliability. Furthermore, greater stabilisation of the subject being evaluated is necessary for strength tests to reduce compensations during the test.</div></div><div><h3>Level of evidence</h3><div>I – Systematic review.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"70 ","pages":"Pages 283-291"},"PeriodicalIF":1.5,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144887268","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":"Collared stems are protective against revision due to early periprosthetic femoral fracture: A cross-sectional study","authors":"Danielle DeMoes ,&nbsp;Roham Borazjani ,&nbsp;Isabella Masso ,&nbsp;Anthony Gualtieri ,&nbsp;Stefan Kreuzer","doi":"10.1016/j.jor.2025.08.024","DOIUrl":"10.1016/j.jor.2025.08.024","url":null,"abstract":"<div><h3>Aims &amp; objectives</h3><div>Collared stems have demonstrated acceptable long-term survivorship in cementless total hip arthroplasty (THA). However, their impact on early postoperative periprosthetic femoral fracture (PFF) remains unclear. This study compares early PFF rates requiring revision between collared and collarless stems in cementless THA and identifies risk factors.</div></div><div><h3>Materials &amp; methods</h3><div>All consecutive patients undergoing primary, navigated, cementless unilateral THAs at our center from 2018 to 2024 were included. Non-navigated, cemented, or revision THAs were excluded. Early PFFs, defined as fractures within 90 days, were classified using the Vancouver system.</div></div><div><h3>Results</h3><div>Among 2859 patients (mean age 63.79 ± 10.58), 64.4 % received collarless stems. They were significantly younger (60.92 ± 10.49 vs. 68.99 ± 8.57, <em>p</em> &lt; 0.001). Most in the collared group were female (62.7 %), while collarless recipients were mainly male (55.1 %, p &lt; 0.001). Patients with ASA ≥3 were more likely to receive collared stems (72.6 % vs. 37.0 %, <em>p</em> &lt; 0.001). Fifteen PFFs requiring revision were identified, all Vancouver B2, with 86.6 % classified as early PFFs. The fracture rates were comparable in univariate analysis (<em>p</em> = 0.128). Regression analysis showed collared stems significantly reduced PFF risk (OR: 0.081, 95 % CI: 0.01–0.39, <em>p</em> = 0.001). Conversely, increasing age (OR: 1.157 per year, 95 % CI: 1.07–1.27, <em>p</em> &lt; 0.001) was associated with higher risk.</div></div><div><h3>Conclusion</h3><div>Collared stems significantly reduced PFF risk after adjusting for confounders, while older age independently increased fracture risk. Therefore, careful patient selection is crucial, especially for older patients.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"70 ","pages":"Pages 270-275"},"PeriodicalIF":1.5,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144880316","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":"Patellar dislocation after total knee Arthroplasty: Stabilization technique using medial flap and suture anchors","authors":"Walter F. Martínez ,&nbsp;Luis Camacho Terceros ,&nbsp;Ezequiel Becker ,&nbsp;Florencia Garbini ,&nbsp;Eduardo J. Bochatey ,&nbsp;Fernando A. Lopreite","doi":"10.1016/j.jor.2025.08.026","DOIUrl":"10.1016/j.jor.2025.08.026","url":null,"abstract":"<div><h3>Introduction</h3><div>Patellar dislocation following total knee arthroplasty (TKA) is an uncommon but functionally significant complication. Its management requires careful evaluation of prosthetic alignment, patellofemoral mechanics, and soft tissue integrity. The aim of this study was to describe a surgical stabilization technique using a medial retinacular flap fixed to the patella with suture anchors, combined with controlled lateral retinacular release, and to analyze its clinical and functional outcomes.</div></div><div><h3>Materials and methods</h3><div>We conducted a retrospective case series between 2011 and 2023 in two specialized orthopedic centers. Fourteen patients with patellar dislocation after primary TKA—without prosthetic loosening or significant malrotation—were included. Clinical evaluation included pain (VAS), function (Lysholm score), satisfaction (Likert scale), and return to daily activities. Mean follow-up was 8.3 years.</div></div><div><h3>Results</h3><div>All patients achieved a functional range of motion (≥0°–100°) without recurrence or instability. Lysholm scores improved significantly from 46.4 ± 3.05 to 83.8 ± 5.85 (p &lt; 0.0001), and VAS pain scores decreased from 6.0 ± 0.71 to 1.2 ± 0.84 (p = 0.0012). No infections, hematomas, or reoperations were recorded. Overall satisfaction was high, with 85.7 % of patients reporting being satisfied or very satisfied.</div></div><div><h3>Conclusion</h3><div>The medial flap technique with suture anchor fixation is effective, reproducible, and low in morbidity. It represents a safe and less invasive alternative for the treatment of patellar dislocation following TKA in patients without mechanical failure.</div></div><div><h3>Level of evidence</h3><div>IV. Case series.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"70 ","pages":"Pages 241-246"},"PeriodicalIF":1.5,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144866474","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":"Mechanical and kinematic alignment in total knee arthroplasty: A comparative study on sizing discrepancies","authors":"Jakub Gocal ,&nbsp;Amy Wozniak ,&nbsp;Michael Murphy ,&nbsp;Nicholas Brown","doi":"10.1016/j.jor.2025.08.029","DOIUrl":"10.1016/j.jor.2025.08.029","url":null,"abstract":"<div><h3>Background</h3><div>Kinematic alignment (KA) in total knee arthroplasty (TKA) aims to restore natural knee kinematics by aligning components to the patient's pre-arthritic anatomy, unlike mechanical alignment (MA), which prioritizes the mechanical axis. Proper prosthesis sizing is essential for optimizing knee kinematics, yet most systems are designed around a MA philosophy, potentially affecting sizing when utilizing a KA philosophy. This study investigated whether intrinsic differences between kinematic and mechanical alignment techniques lead to discrepancies in femoral and tibial prosthesis sizing in primary TKA.</div></div><div><h3>Methods</h3><div>Demographic and operative data, including femoral and tibial component sizes, were collected on 324 patients undergoing primary TKA. Patients were categorized into mechanical and kinematic alignment groups. Predicted component sizes were calculated using established equations incorporating patient variables. Discrepancies between predicted and implanted sizes were categorized and analyzed.</div></div><div><h3>Results</h3><div>Kinematic alignment was associated with a higher incidence of femoral components being smaller than tibial components (10.7 vs. 1.4 %, <em>P</em> &lt; 0.001) and equal-sized femoral and tibial components (51.1 vs. 28.8 %, p &lt; 0.001). Conversely, MA resulted in a greater proportion of femoral components larger than tibial components (69.9 vs. 38.2 %, <em>P</em> &lt; 0.001). Predicted versus actual size analysis indicated KA led to smaller femoral implants, with a higher incidence of predicted femoral sizes exceeding actual sizes (68.7 vs. 53.6 %, <em>P</em> = 0.012).</div></div><div><h3>Conclusion</h3><div>Femoral sizing distributions vary significantly between kinematic and mechanical techniques, underscoring the need to consider alignment methods in component design. As KA adoption increases, recognizing these differences is essential for optimizing implant selection and improving outcomes.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"70 ","pages":"Pages 297-300"},"PeriodicalIF":1.5,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889531","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":"Factors influencing the insertion of a size 1 minimum-sized tibial baseplate in fixed-bearing unicompartmental knee arthroplasty for Japanese patients","authors":"Hironao Shioiri ,&nbsp;Tsuneari Takahashi ,&nbsp;Katsushi Takeshita","doi":"10.1016/j.jor.2025.08.025","DOIUrl":"10.1016/j.jor.2025.08.025","url":null,"abstract":"<div><h3>Background</h3><div>An overhang of the tibial baseplate in unicompartmental knee arthroplasty (UKA) has been associated with postoperative pain and impaired function.</div></div><div><h3>Hypothesis</h3><div>There are significant patient factors that influence the insertion of a size 1 minimum-sized tibial baseplate in fixed-bearing (FB) UKA for Japanese patients with varus knee osteoarthritis (KOA).</div></div><div><h3>Purpose</h3><div>This study investigated the above-hypothesized factors.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study of 74 consecutive patients who underwent FB-UKA between March 2023 and July 2025. The endpoints were the Kellgren and Lawrence (KL) grade; patient height (m); weight (kg); body mass index (BMI, kg/m²); preoperative extension and flexion range of motion (ROM); preoperative hip–knee angle (HKA); and preoperative and postoperative medial proximal tibial angle (MPTA) and posterior tibial slope (PTS). Following surgery, calipers were used to measure the medial resection amounts of the distal and dorsal femur and the proximal tibia. The sizes of the femoral and tibial components that were actually inserted were recorded. Logistic regression analyses were performed to clarify the factors influencing the insertion of a size 1 minimum-sized tibial baseplate.</div></div><div><h3>Results</h3><div>Univariate analysis revealed significant difference between the group concerning patient height (1.47 ± 0.1 in Group 1 and 1.57 ± 0.1 in Group O, P &lt; 0.001). Logistic regression demonstrated that shorter height (OR: 3.07e-19, 95 % CI: 7.54e-35– 1.25e-03, P = 0.020), the size of the femoral component that were actually inserted (OR: 9.16e-3, 95 % CI: 1.48e-4-0.57, P = 0.026). ROC analysis identified cutoff values of &lt;1.51 m for patient height (AUC: 0.872, 95 % CI: 0.765–0.980), and size 2 femoral component (AUC: 0.832, 95 % CI: 0.748–0.917).</div></div><div><h3>Conclusion</h3><div>Patient height and femoral component size were significant factors that influence the insertion of a size 1 minimum-sized tibial baseplate in FB-UKA for Japanese patients with varus KOA.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"70 ","pages":"Pages 292-296"},"PeriodicalIF":1.5,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889530","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 outcomes of anterior versus posterior fixation in odontoid fractures: A longitudinal population-based analysis","authors":"Nnaemeka Okorie,&nbsp;Julian Peregoff,&nbsp;Bradley Osemwengie,&nbsp;David Casper,&nbsp;Amrit Khalsa","doi":"10.1016/j.jor.2025.08.032","DOIUrl":"10.1016/j.jor.2025.08.032","url":null,"abstract":"<div><h3>Introduction</h3><div>The optimal surgical strategy for managing odontoid fractures in geriatric populations remains controversial, especially regarding the trade-offs between nonunion risk, perioperative complications, and long-term morbidity. This study aimed to compare postoperative outcomes between anterior odontoid fixation and posterior C1–C2 fusion approaches in older adults.</div></div><div><h3>Methods</h3><div>Using the TriNetX Diamond Network, we retrospectively identified patients aged ≥65 years who underwent anterior vs posterior cervical fixation for odontoid fractures from 2007 to 2023. Propensity score matching (PSM) was used to control for baseline characteristics across 23 variables, yielding two cohorts of 715 patients each. Outcomes were assessed at 90 days and 1-year, including opioid utilization, mortality, myocardial infarction (MI), deep vein thrombosis/pulmonary embolism (DVT/PE), surgical site infection (SSI), and hardware complications.</div></div><div><h3>Results</h3><div>Anterior fixation was associated with significantly lower rates of opioid utilization at both 90 days (RR 0.85, 95 % CI 0.796–0.901; p &lt; 0.05) and 1-year (RR 0.867, 95 % CI 0.818–0.919; p &lt; 0.05). No significant differences were observed in rates of MI, DVT/PE, SSI, hardware complications, or mortality between groups.</div></div><div><h3>Conclusion</h3><div>Among geriatric patients with odontoid fractures, anterior fixation was associated with lower opioid consumption at 90 days and 1-year postoperatively. Other complication rates were comparable, suggesting that surgical approach can be tailored to patient anatomy and surgeon preference without compromising safety.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"70 ","pages":"Pages 247-251"},"PeriodicalIF":1.5,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144866475","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":"Perineural dexamethasone enhances analgesic duration of erector spinae plane block in total hip arthroplasty: A randomized quadruple-blind controlled trial","authors":"Tomasz Reysner ,&nbsp;Paweł Pietraszek ,&nbsp;Tomasz Purat ,&nbsp;Grzegorz Kowalski ,&nbsp;Aleksander Mularski ,&nbsp;Przemyslaw Daroszewski ,&nbsp;Malgorzata Reysner","doi":"10.1016/j.jor.2025.08.033","DOIUrl":"10.1016/j.jor.2025.08.033","url":null,"abstract":"<div><h3>Background</h3><div>Total hip arthroplasty (THA) is associated with significant postoperative pain, which can impair early mobilization and recovery. Erector spinae plane block (ESPB) has emerged as a promising regional anesthesia technique for lower limb surgeries. However, the duration of single-shot ESPB is limited. This study aimed to assess the effect of perineural dexamethasone as an adjunct to ropivacaine in prolonging analgesia and reducing opioid requirements in patients undergoing THA.</div></div><div><h3>Methods</h3><div>In this randomized, quadruple-blinded, controlled trial, 60 patients aged ≥65 years scheduled for elective THA under spinal anesthesia were assigned to receive ultrasound-guided ESPB with either 20 mL of 0.2 % ropivacaine plus 2 mL saline (control group) or 20 mL of 0.2 % ropivacaine plus 4 mg perineural dexamethasone (dexamethasone group). The primary outcome was time to first rescue opioid analgesia. Secondary outcomes included total opioid consumption, Numerical Rating Scale (NRS) pain scores, motor strength, nerve safety, and blood glucose levels over 48 h postoperatively.</div></div><div><h3>Results</h3><div>The dexamethasone group showed a significantly prolonged time to first opioid use (16.0 ± 1.3 vs. 8.9 ± 1.7 h; p &lt; 0.0001) and reduced opioid consumption (3.5 ± 4.8 vs. 19.2 ± 12.2 MME; p &lt; 0.0001). NRS scores were consistently lower beyond the 4-h time point. No motor deficits, nerve injuries, or hyperglycemia were observed.</div></div><div><h3>Conclusions</h3><div>Perineural dexamethasone significantly enhances the analgesic efficacy of ESPB in THA without compromising safety. This simple adjunct offers substantial benefit in postoperative pain control and opioid reduction.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"70 ","pages":"Pages 263-269"},"PeriodicalIF":1.5,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144880315","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":"Expanding implant options in robot-assisted thoracolumbar spine surgery through novel customized instrumentation","authors":"Abhishek Soni ,&nbsp;Vidyadhara S ,&nbsp;Balamurugan T ,&nbsp;Alia Vidyadhara","doi":"10.1016/j.jor.2025.08.031","DOIUrl":"10.1016/j.jor.2025.08.031","url":null,"abstract":"<div><h3>Background</h3><div>Robot-assisted pedicle screw placement demonstrates superior accuracy over conventional techniques, yet proprietary ecosystems limit implant compatibility and surgical choice. Can a custom screwdriver enable third-party instrumentation while maintaining navigational precision within the Mazor X Stealth Edition robotic system?</div></div><div><h3>Methods</h3><div>This retrospective comparative single-center study analysed 100 consecutive patients undergoing robot-assisted thoracolumbar fusion using custom screwdriver instrumentation (July–December 2024) versus 100 historical controls using standard proprietary instrumentation (October 2023–June 2024). The custom screwdriver had shaft dimensions matched to the robotic arm guide and navigation tracker compatibility. Primary outcomes included pedicle screw placement accuracy using Gertzbein-Robbins classification and technical feasibility.</div></div><div><h3>Results</h3><div>A total of 708 screws were placed in the custom screwdriver group versus 760 in controls. Clinically acceptable screw placement (Gertzbein-Robbins grades A&amp;B) was achieved in 99.15 % (702/708) versus 99.07 % (753/760) respectively (difference: 0.08 %, 95 % CI: 1.14 %–1.30 %, p = 0.880). Non-inferiority was demonstrated with the lower confidence interval (−1.14 %) exceeding the predefined margin (−3 %). Technical feasibility was 100 % with no conversion required. Operative time (142.3 ± 38.5 vs 148.7 ± 40.2 min, p = 0.239), blood loss (537.2 ± 328.0 vs 550.0 ± 359.0 ml, p = 0.793), and per-screw placement time (6.2 ± 1.8 vs 6.4 ± 1.7 min, p = 0.426) were comparable. Implant costs were significantly lower in the custom screwdriver group (USD 559.50 ± 224.35 vs 1973.47 ± 934.80, p &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Custom instrument design successfully maintained surgical precision while enabling third-party implant integration within robotic spine surgery workflows. This approach demonstrates enhancement of robotic system modularity without compromising accuracy, safety, or operational efficiency.</div></div><div><h3>Clinical relevance</h3><div>This innovation enables surgeons to select optimal implants based on clinical evidence rather than proprietary constraints, potentially improving patient outcomes while reducing healthcare costs through enhanced system flexibility.</div></div><div><h3>Level of evidence</h3><div>III.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"70 ","pages":"Pages 252-257"},"PeriodicalIF":1.5,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144866476","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}