Journal of orthopaedics最新文献

{"title":"High accuracy of knee alignment following well-balanced image-based robot-assisted total knee arthroplasty; radiographic validation of implant position and knee alignment","authors":"Dries Verbeke ,&nbsp;Hans Van den Wyngaert ,&nbsp;Alex Demurie ,&nbsp;Ignace Ghijselings ,&nbsp;Stefaan Van Onsem","doi":"10.1016/j.jor.2026.01.018","DOIUrl":"10.1016/j.jor.2026.01.018","url":null,"abstract":"<div><div>Image based robotic assisted knee replacement surgery enables surgeons to achieve patient-specific alignment through intraoperative ligament balancing and implant positioning. The purpose of this study was to validate the accuracy of the implant position and lower limb alignment using full-leg weight-bearing postoperative radiographs.</div><div>This retrospective study included 69 patients receiving total knee arthroplasty (TKA) with the use of a MAKO robot and patella-in-place balancer between 01/2023 and 04/2024. All patients received a Triathlon® CS prosthesis with functional alignment philosophy. Coronal parameters (mechanical hip-knee-ankle-angle (mHKA), lateral distal femoral angle (LDFA), and medial proximal tibial angle (MPTA)) and sagittal alignment parameters (femoral flexion and tibial slope) were collected from the intraoperative plan and compared with pre- and postoperative weight-bearing full leg radiographs (FLR).</div><div>Preoperative mean mHKA of 2.4° ± 6.2° varus corrected to 2.2° ± 2.7° varus intraoperatively and 1.4° ± 3.2° varus postoperatively; with no significant differences intra-to postoperatively. LDFA increased significantly from 87.8° ± 3.2° to 90.1° ± 2.2° intraoperatively, but did not differ significantly on postoperative radiographs. Original MPTA angle was preserved intraoperatively at 87.7° ± 1.7°, but increased by 0.9° postoperatively (p = 0.005). Femoral flexion decreased after surgery from 5.8° ± 3.9° to 3.9° ± 2.8° (p &lt; 0.001). Tibial slope decreased intraoperatively from 8.6° to 6.7° (p &lt; 0.001), with no further postoperative change.</div><div>Functional alignment philosophy in combination with a patella in place balancing device in reliably reproduced the targeted limb alignment and implant positioning, with postoperative measurements closely matching intra-operative values across all alignment subgroups. There was no soft-tissue laxity asymmetry detected that had meaningful effect on alignment outcomes, supporting this technique as a precise and consistent surgical strategy.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"75 ","pages":"Pages 25-30"},"PeriodicalIF":1.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146192716","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":"Preoperative fructosamine is comparable to HbA1c as a short-term glycemic marker for predicting postoperative complications in orthopaedic surgery: A systematic review and meta-analysis","authors":"Anil Regmi ,&nbsp;Abdus Sami ,&nbsp;Surakshya Baral ,&nbsp;Vijay Kumar Jain ,&nbsp;Karthikeyan. P. Iyengar","doi":"10.1016/j.jor.2026.02.019","DOIUrl":"10.1016/j.jor.2026.02.019","url":null,"abstract":"<div><h3>Objective</h3><div>This study systematically evaluates the predictive value of preoperative glycaemic biomarkers, including fructosamine, compared with HbA1c and glycated albumin.</div></div><div><h3>Methods</h3><div>The databases of PubMed, Embase, and Scopus were searched from inception to September 2025 for studies that assessed preoperative fructosamine levels and postoperative complications in orthopaedic patients. Cohort studies reporting infections, wound complications, readmissions, or reoperations were included. Data extraction and quality assessment were performed independently. A random-effects meta-analysis was used to pool risk estimates, with heterogeneity quantified using the I² statistic.</div></div><div><h3>Results</h3><div>Seven cohort studies (N = 5217) met the inclusion criteria. Elevated preoperative fructosamine (≈292–293 μmol/L for arthroplasty; ≈238 μmol/L for foot/ankle surgery) was consistently associated with a higher risk of postoperative infection and complications (pooled RR 7.20; 95% CI 1.49–34.91). HbA1c demonstrated a smaller, less consistent effect (pooled RR 2.36; 95% CI 1.04–5.34). Direct comparisons between high fructosamine and high HbA1c cohorts revealed no statistically significant difference, although fructosamine more accurately reflected short-term glycemic status.</div></div><div><h3>Conclusions</h3><div>Preoperative fructosamine is a robust short-term glycaemic biomarker that frequently outperforms HbA1c in predicting postoperative infectious complications in arthroplasty and other orthopaedic surgery. Standardised cut-offs, multicenter validation, and interventional trials are needed to define its role in perioperative risk stratification.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"75 ","pages":"Pages 17-24"},"PeriodicalIF":1.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146192683","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":"Patient- and disease-specific factors associated with atrophy of the intrinsic muscles of the ulnar nerve in cubital tunnel syndrome","authors":"Kenichi Asano ,&nbsp;Katsuyuki Iwatsuki ,&nbsp;Hiroki Yokoyama ,&nbsp;Marie Mabuchi ,&nbsp;Michiro Yamamoto","doi":"10.1016/j.jor.2026.02.013","DOIUrl":"10.1016/j.jor.2026.02.013","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients presenting with severe neuropathy are less likely to recover after surgery for cubital tunnel syndrome. The purpose of this study was to investigate patient- and disease-specific factors associated with atrophy at presentation of the intrinsic muscles innervated by the ulnar nerve.</div></div><div><h3>Methods</h3><div>A retrospective data of patients with cubital tunnel syndrome were included in the study. Paralysis of the intrinsic muscles was evaluated as muscle atrophy of the first dorsal interossei, adductor pollicis, or abductor digiti minimi. The muscle atrophy group comprised 64 patients with atrophy of the intrinsic muscles. The non-atrophy group comprised 57 patients without intrinsic muscle atrophy at presentation. Univariate and multivariate regression analyses were conducted to assess patient factors including age, sex, body mass index, disease duration, comorbidities (diabetes mellitus and cervical spondylosis), and other elbow disorders (osteoarthritis of the elbow, presence of a ganglion, and cubitus varus or valgus deformity). A radiographic evaluation of elbow osteoarthritis was conducted using the Broberg and Morrey classification; osteophytes of the ulna were also assessed.</div></div><div><h3>Results</h3><div>Through univariate analysis, patients in the muscle atrophy group were identified as being significantly older, with significantly longer disease duration and more osteophytes of the ulna, than those in the non-atrophy group. Cervical spondylosis and osteoarthritis of the elbow were more frequently observed in the muscle atrophy group than in the non-atrophy group. Multivariate analysis identified patient's age as an independent risk factor related to atrophy of the intrinsic muscles, while other factors were not significant association.</div></div><div><h3>Conclusion</h3><div>There was no association between the intrinsic muscle atrophy in cubital tunnel syndrome and elbow osteoarthritis. Older patients with cubital tunnel syndrome were more likely to present with atrophy of the intrinsic muscles of the ulnar nerve. Knowledge of the factors associated with severe neuropathy may allow for earlier diagnosis and therapeutic intervention.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"75 ","pages":"Pages 12-16"},"PeriodicalIF":1.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146192715","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":"Safety of posterolateral approach with a polished cemented stem and a modular dual mobility implant in patients over 75 years old","authors":"Cesare Meschini ,&nbsp;Mattia Chirico ,&nbsp;Matteo Innocenti ,&nbsp;Giovanni Valentini ,&nbsp;Paolo Salari ,&nbsp;Andrea Baldini","doi":"10.1016/j.jor.2026.02.042","DOIUrl":"10.1016/j.jor.2026.02.042","url":null,"abstract":"<div><h3>Background</h3><div>With increasing life expectancy, total hip arthroplasty (THA) is increasingly performed in patients over 75 years, a population at higher risk of perioperative complications. This study assessed the safety and short-to mid-term outcomes of a standardized THA strategy in elderly patients using a posterolateral approach, a polished cemented stem, and—when indicated—a modular dual mobility (DM) cup.</div></div><div><h3>Methods</h3><div>This retrospective multicenter study included patients &gt;75 years who underwent primary THA with a cemented polished femoral stem and posterolateral approach (2017–2023). Group A received a modular DM cup, while Group B received a fixed-liner acetabular component. Clinical outcomes (Oxford Hip Score, VAS satisfaction) and complications were recorded. Survivorship was evaluated using Kaplan–Meier analysis in best- and worst-case scenarios.</div></div><div><h3>Results</h3><div>642 THAs were analyzed (Group A: 460; Group B: 182). Groups were comparable in age and sex distribution. Dislocation rate was significantly lower with DM (0.7% vs 2.75%; p = 0.045). No differences were observed in infection, aseptic loosening, periprosthetic fracture, reoperation, readmission, or mortality. Postoperative OHS was similar, while patient satisfaction (VAS) was higher in Group A (93.0 ± 7.0 vs 81.9 ± 14.2; p &lt; 0.001). Kaplan–Meier analysis demonstrated excellent survivorship in both cohorts, without significant differences. No intraprosthetic dislocations or DM-related mechanical failures occurred.</div></div><div><h3>Conclusion</h3><div>THA using a posterolateral approach and a polished cemented stem is safe in patients over 75 years. Modular DM cups reduced dislocations and improved patient satisfaction without increasing complications. Their selective use may be advantageous in elderly, high-risk patients. Further prospective long-term studies are warranted.</div></div><div><h3>Level of evidence</h3><div>Level III, retrospective cohort study.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"75 ","pages":"Pages 94-100"},"PeriodicalIF":1.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146192554","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":"Restricted kinematic alignment in total knee arthroplasty achieves equivalent or superior functional outcomes to mechanical alignment without compromising implant survivorship: A systematic review","authors":"Amaan A. Merchant ,&nbsp;Maryam Imran ,&nbsp;Mihika Joshi ,&nbsp;Padmanabhan Subramanian ,&nbsp;Farhad Iranpour","doi":"10.1016/j.jor.2026.02.025","DOIUrl":"10.1016/j.jor.2026.02.025","url":null,"abstract":"<div><h3>Purpose</h3><div>This systematic review assesses the viability of restricted kinematic alignment compared to mechanical alignment by assessing clinical outcomes, radiological findings, and patient-reported outcome measures. Median follow-up was 20.3 months. Both RCTs and observational studies are included in this review.</div></div><div><h3>Methods</h3><div>A search was carried out according to PRISMA guidelines over PubMed, Embase, Cochrane and Web of Science databases. The following search string, (‘restricted kinematic alignment’ AND ‘mechanical alignment’) AND (‘total knee arthroplasty’ OR ‘total knee replacement’) was used. Titles, abstracts and keywords were screened against predetermined inclusion and exclusion criteria. Data was extracted by two independent reviewers and conflict was resolved by consensus.</div></div><div><h3>Results</h3><div>A total of 110 papers between 1975 and January 2025 were screened with 11 texts included in the final analysis.</div><div>Restricted kinematic alignment achieved superior FJS (p = 0.044) and KSS (p = 0.028) at 12 and 24 months respectively compared to mechanical alignment. Radiographic analyses confirmed coronal limb alignment and femoral/tibial component positioning remained within defined safe zones, with no significant increase in outliers. Importantly, complication and revision rates did not differ significantly between groups, indicating no compromise in short-term safety which is defined as follow-up less than five years.</div></div><div><h3>Conclusion</h3><div>This analysis suggests restricted kinematic alignment provides functional advantages whilst adhering to strict ‘intraoperative safe zones’ with no increase in short-term complications. However, surgical technique remains variable with some studies using robotic assisted surgery and others utilising calipered kinematic adjustments or navigation-assisted resections. Long-term implant durability also remains a crucial unanswered question.</div></div><div><h3>Level of evidence</h3><div>Level III</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"75 ","pages":"Pages 31-39"},"PeriodicalIF":1.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146192681","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":"Failure of the femoral stem: A case series of intra-prosthetic fractures and proposed classification system","authors":"R. Woods,&nbsp;A. Price,&nbsp;T. Donovan,&nbsp;S.R. Kearns,&nbsp;C.G. Murphy,&nbsp;G.A. Sheridan","doi":"10.1016/j.jor.2026.02.035","DOIUrl":"10.1016/j.jor.2026.02.035","url":null,"abstract":"<div><h3>Background</h3><div>Femoral implant failure is an uncommon but significant complication in orthopaedic surgery associated with significant patient morbidity. This study presents a case series of femoral implant fractures treated at a single institution between 2007 and 2024, alongside a review of the relevant literature, to identify possible risk factors.</div></div><div><h3>Methods</h3><div>A retrospective analysis of patients with femoral implant fractures was, over a 17-year period, conducted at a single academic institution. Data collected included patient demographics, implant type, time to failure, treatment approach and postoperative outcomes. A literature review was performed to contextualise findings within existing research. We also propose a pragmatic and reproducible classification system based on anatomical location of the fractures within the stem.</div></div><div><h3>Results</h3><div>A total of fourteen cases were identified across the defined study period with implant fractures occurring at a mean of 129 months postoperatively. The mean age of patients in this study was 71.76. Seven of the fourteen cases involved polished taper slip (PTS) stems, while twelve of the fourteen intra-prosthetic fractures occurred around cemented stems. The most frequent fracture sites were the middle third of the stem. Each of the cases were treated with revision arthroplasty. Postoperative complications and functional outcomes varied based on fracture type and patient factors. Four types of fracture are described based on the fracture location – Type A-D.</div></div><div><h3>Conclusion</h3><div>Femoral implant fractures remain a challenging issue in orthopaedic surgery. Identifying risk factors and optimising implant selection and surgical technique are crucial for complication prevention. This case series highlights key patterns and management strategies, contributing to the growing body of evidence on implant longevity and failure mechanisms. Further research is needed to improve early detection and intervention strategies for at-risk patients. A simple, pragmatic, location-based classification system could improve communication and standardisation of revision strategies.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"75 ","pages":"Pages 143-147"},"PeriodicalIF":1.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146192520","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":"Femoroacetabular impingement–related deformities correlate with advanced osteoarthritis in asymptomatic caucasians over 60: A CT-based cross-sectional study","authors":"Sophia Freya Ulrike Blum ,&nbsp;Felix Schön ,&nbsp;Katja Brauer ,&nbsp;Petri Bellova ,&nbsp;Jens-Peter Kühn ,&nbsp;Ralf-Thorsten Hoffmann ,&nbsp;Klaus-Peter Günther ,&nbsp;Jens Goronzy","doi":"10.1016/j.jor.2026.02.041","DOIUrl":"10.1016/j.jor.2026.02.041","url":null,"abstract":"<div><h3>Objective</h3><div>Osteoarthritis (OA) is a common finding in the elderly population. Femoroacetabular Impingement (FAI)-related deformities can cause OA. Their prevalence and clinical relevance in the asymptomatic elderly population are unclear. This study aims to determine the prevalence of cam and pincer deformities in asymptomatic, non-orthopedic Caucasian patients over 60 years in computed tomography (CT) and correlate the presence of those deformities with radiological signs of OA.</div></div><div><h3>Design</h3><div>CTs of oncological patients over 60 years without any previous history of hip pathology or pain, containing a complete scan of both hips, were included. All hips were analysed for signs of OA according to the Kellgren-Lawrence (KL) classification. The acetabular anteversion, acetabular sector angles (ASA), and alpha angles were measured in clockwise positions of the hip. All angles were modeled conditionally on KL, sex, age, and obesity using random-effects median regression.</div></div><div><h3>Results</h3><div>One hundred ninety-five non-orthopedic patients (130 male, 65 female; mean age 70.4 years; 290 hips) were included. Signs of severe OA (KL 3/4) were found in 19.2 %. Patients over 80 years had significantly higher alpha angles at 9-11 o'clock, higher ASA at 9-12 o'clock, and a higher acetabular anteversion at the level of the acetabular roof. Individuals with advanced OA showed higher alpha angles, higher ASA, and a lower acetabular anteversion than those without/with moderate OA.</div></div><div><h3>Conclusions</h3><div>This study provides an estimate of the distribution of FAI-related deformities within a population of individuals over 60 years with asymptomatic hips. The prevalence of these deformities is correlated with advanced OA.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"75 ","pages":"Pages 126-135"},"PeriodicalIF":1.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146192555","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":"Imageless robotic assisted TKA: a systematic review","authors":"Alessandro El Motassime ,&nbsp;Greta Tanzi Germani ,&nbsp;Rudy Sangaletti ,&nbsp;Luca Andriollo ,&nbsp;Virginia Cinelli ,&nbsp;Francesco Benazzo ,&nbsp;Stefano Marco Paolo Rossi","doi":"10.1016/j.jor.2026.02.046","DOIUrl":"10.1016/j.jor.2026.02.046","url":null,"abstract":"<div><h3>Background</h3><div>Imageless robotic-assisted TKA (RATKA) has arisen as a potential technology designed to improve surgical accuracy, advance clinical outcomes, and reduce complications. This systematic review evaluates the clinical efficacy, safety, and radiological accuracy of imageless RATKA.</div></div><div><h3>Methods</h3><div>Review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and PROSPERO registered (CRD1161673). A thorough search of PubMed, Scopus, and Web of Science databases was conducted through April 2025. Data were independently withdrawn by reviewers, and study quality was assessed using the Modified Coleman Score and RoB 2 and ROBINS-I tools. Descriptive synthesis and weighted mean analysis were performed.</div></div><div><h3>Results</h3><div>A total of 8 studies involving 612 knees were included. Mean patient age was 67.7 years and mean follow-up was 15.8 months. The overall methodological quality was moderate (mean Modified Coleman Score: 70/100). The preoperative and postoperative functional scores combined demonstrated significant improvement: KSS increased from 34.2 (95% CI, 27.2–41.1) to 88.5 (95% CI, 77.9–91.1), KSS-F increased from 44.5 (95% CI, 38.1–50.9) to 83.1 (95% CI, 74.2–92.1), and KOOS-JR increased from 30.3 (95% CI, 23.4–37.2) to 87.7 (95% CI, 76.8–98.5). Across all studies, the overall complication rate was 2.4%, with the most common adverse event being surgical site infection.</div></div><div><h3>Conclusions</h3><div>Imageless robotic-assisted TKA is distinguished by significant functional and radiologic gains, minimal rate of complications, and acceptable short-term safety. Homogeneity of combined PROMs and alignment data validates accuracy and reliability of imageless systems.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"75 ","pages":"Pages 154-162"},"PeriodicalIF":1.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146192675","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 the clinical efficacy of full-endoscopic large-channel interbody decompression and fusion with unilateral versus bilateral pedicle-screw fixation in the treatment of lumbar degenerative disease","authors":"Yukai Cui ,&nbsp;Haoran Zhang ,&nbsp;Xiaohao Sun ,&nbsp;Junliang Xu ,&nbsp;Wen Yin ,&nbsp;Xilong Cui ,&nbsp;Wei Jiao","doi":"10.1016/j.jor.2026.02.045","DOIUrl":"10.1016/j.jor.2026.02.045","url":null,"abstract":"<div><h3>Background</h3><div>Comparison of the clinical efficacy of full-endoscopic large-channel interbody decompression and fusion combined with unilateral versus bilateral pedicle-screw fixation in the treatment of single-level lumbar degenerative disease.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of the clinical data of 56 patients with single-level lumbar degenerative disease who underwent full-endoscopic large-channel interbody decompression, fusion, and internal fixation surgery at our hospital. Among them, 26 patients underwent unilateral pedicle screw fixation (UPSF), and 30 patients underwent bilateral pedicle screw fixation (BPSF).The comparison included the following parameters: surgical time, intraoperative fluoroscopy frequency, hospitalization costs, length of hospital stay, changes in hemoglobin levels before and after surgery, and complication rates. Preoperative and postoperative pain were assessed using the Visual Analog Scale (VAS) at 3 days, 3 months, and 1 year. Functional disability was evaluated using the Oswestry Disability Index (ODI) at preoperative, 3-month, and 1-year follow-ups. One year post-surgery, interbody fusion was evaluated by CT, and clinical outcomes were assessed using the modified MacNab criteria.</div></div><div><h3>Results</h3><div>The surgical time, intraoperative fluoroscopy frequency, hospitalization costs, and length of hospital stay were significantly higher in the BPSF group compared to the UPSF group (P &lt; 0.05). There was no statistical difference in the changes in hemoglobin levels between the two groups postoperatively (P &gt; 0.05). The VAS scores at 3 days, 3 months, and 1 year, as well as the ODI scores at 3 months and 1 year, were significantly lower than preoperative values in both groups (P &lt; 0.05). However, there were no significant differences in the VAS and ODI scores at the same time points between the two groups (P &gt; 0.05). The complication rates, fusion rates at 1 year, and the excellent rate according to the modified MacNab criteria were not significantly different between the two groups (P &gt; 0.05).</div></div><div><h3>Conclusions</h3><div>The treatment of single-segment lumbar degenerative disease using a large-channel full-endoscopic intervertebral decompression and fusion combined with UPSF is safe and effective. Compared with BPSF group, UPSF group has advantages in terms of fewer fluoroscopy times, shorter surgical duration, lower hospitalization costs, and shorter hospital stays.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"75 ","pages":"Pages 136-142"},"PeriodicalIF":1.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146192519","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":"Traditional and alternative metrics in the 100 most-cited articles utilizing PearlDiver: Mapping clinical and scientific influence through bibliometric analysis","authors":"Reginald O. Chinweze ,&nbsp;David Dallas-Orr ,&nbsp;Preston Lee ,&nbsp;Sean T. Campbell ,&nbsp;Zachary C. Lum ,&nbsp;Barton L. Wise","doi":"10.1016/j.jor.2025.12.010","DOIUrl":"10.1016/j.jor.2025.12.010","url":null,"abstract":"<div><h3>Background</h3><div>PearlDiver (PD) is a widely used claims database, especially in orthopaedics, yet its academic footprint remains ill-defined. This study aimed to identify the 100 most-cited PD publications, and evaluate the topics described, sub-stratify the most “viral” articles, and compare the change over time of several article performance metrics. We hypothesized that the most cited articles would (1) address epidemiological questions, and (2) focus on arthroplasty, spine, and sports medicine.</div></div><div><h3>Methods</h3><div>Cross-sectional bibliometric study of the 100 most-cited PD articles identified in Web of Science. Records were ranked by total citations and screened in Covidence. Inclusion required full-text confirmation that PD was used as a data source. Extracted variables included total citations, citations per year (CPY) or citation density, Altmetric Attention Score (AAS), and number of X (formerly Twitter) posts. Keyword co-occurrence networks were generated, and correlations among metrics were assessed using Pearson coefficients.</div></div><div><h3>Results</h3><div>The top 100 accumulated 6756 total citations (median 54, IQR 38–92). Sports (n = 39), spine (n = 29), and arthroplasty (n = 20) dominated subspecialty representation. The leading studies included Buckland et al. (Bone Joint J, 2017; 227 citations), Montgomery et al. (Arthroscopy, 2013; 303 citations), and Abrams et al. (Am J Sports Med, 2013; 297 citations). Citation density was highest among recent sports and hip arthroscopy studies (Zusmanovich et al., Arthroscopy, 2022; 26.2 citations/year). Arthroplasty papers showed greater AAS and online visibility (mean AAS 41.8 vs sports 16.2; p = 0.041). CPY correlated strongly with total citations (r = .813, p &lt; 0.01), and moderately with X posts (r = .430, p &lt; 0.01), with weaker correlation with AAS (r = .368, p &lt; 0.01). Keyword networks revealed clustering around utilization, complications, and revision themes.</div></div><div><h3>Conclusion</h3><div>PearlDiver research is concentrated in sports medicine, spine, and arthroplasty. While PD studies are cost-efficient and highly visible, they remain constrained by reliance on billing codes and limited clinical granularity. The database is most impactful for hypothesis generation, policy guidance, and national utilization analyses rather than directly in clinical practice and decision making.</div></div><div><h3>Level of evidence</h3><div>Level III</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"75 ","pages":"Pages 87-93"},"PeriodicalIF":1.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146192550","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}