Journal of orthopaedics最新文献

{"title":"The influence of stem length on perioperative complications following cemented hip arthroplasty in metastatic femoral disease: A systematic review","authors":"Joseph D. Giacalone ,&nbsp;Jared Garfinkle ,&nbsp;Surabhi Panda ,&nbsp;Jason Abraham ,&nbsp;Kassandra Parrales ,&nbsp;Christopher Haydel","doi":"10.1016/j.jor.2025.07.029","DOIUrl":"10.1016/j.jor.2025.07.029","url":null,"abstract":"<div><h3>Introduction</h3><div>Long stem cemented hip arthroplasty remains a common surgical treatment for metastatic disease to the proximal femur. However, long stems may increase the risk of cardiopulmonary complications due to embolic events. This study presents the first systematic review directly comparing perioperative complication rates between long and short/standard cemented femoral stems in this patient population.</div></div><div><h3>Methods</h3><div>A systematic search of PubMed, EMBASE, Web of Science, and Cochrane Library was conducted in accordance with PRISMA guidelines. Studies were included if they reported on cemented hip arthroplasty for proximal femoral metastases, defined femoral stem length (short/standard: &lt;250 mm vs. long: ≥250 mm), and described perioperative cardiopulmonary complications.</div></div><div><h3>Results</h3><div>Seven studies met inclusion criteria, encompassing 379 femurs (160 short/standard stems and 219 long stems). Patients who received long-stem constructs had significantly higher rates of total perioperative cardiopulmonary complications (26.0 % vs. 3.1 %). Total complication rates were also higher in the long-stem group (28.8 % vs. 10.6 %). Only five cases (1.3 %) of new distal metastatic lesions were reported.</div></div><div><h3>Conclusion</h3><div>Long cemented femoral stems are associated with higher perioperative complication rates than short or standard stems in patients undergoing hip arthroplasty for proximal femoral metastases. Given the low observed incidence of new distal lesions, the rationale for routinely using long stems warrants reconsideration. Future prospective studies should adopt standardized definitions for cardiopulmonary complications and stem length, report BCIS using validated criteria, and evaluate the true incidence of new distal metastases to guide surgical decision-making in this high-risk population.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"68 ","pages":"Pages 276-282"},"PeriodicalIF":1.5,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144771520","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":"Anterior-only decompression insufficient in concentric stenosis in degenerative cervical myelopathy","authors":"Yazan Noufal ,&nbsp;Marcus Richter ,&nbsp;Philipp Hartung ,&nbsp;Philipp Drees ,&nbsp;Yama Afghanyar ,&nbsp;Martin Naisan","doi":"10.1016/j.jor.2025.07.019","DOIUrl":"10.1016/j.jor.2025.07.019","url":null,"abstract":"<div><h3>Aims &amp; objectives</h3><div>The compression of the spinal cord can result in degenerative cervical myelopathy (DCM), a condition characterized by progressive neurological dysfunction.</div><div>This study examines clinical outcomes after anterior decompression and predictors of secondary posterior decompression after initial anterior surgery.</div></div><div><h3>Materials &amp; methods</h3><div>We conducted a retrospective review of 94 consecutive patients who underwent anterior-only cervical decompression in DCM. Preoperative variables (demographics, neurological and clinical status, spine anatomy) were entered into a multivariate logistic regression to determine associations with secondary posterior decompression. Neurologic function was assessed by the JOA score.</div></div><div><h3>Results</h3><div>Nine of 94 patients (9.6 %) underwent secondary posterior decompression for persistent myelopathic symptoms, of which all presented with a concentric spinal canal stenosis. In multivariate analysis, higher ASA score (p = 0.042), concentric stenosis (p = 0.008) and osteoporosis (p = 0.044) were independently associated with increased revision risk. At six weeks, the anterior-only cohort achieved a mean JOA score of 15.44, compared to 12.60 in those undergoing revision (measured pre-revision).</div></div><div><h3>Conclusion</h3><div>Concentric stenosis morphology, compromised bone quality, and elevated ASA status independently predict failure of anterior-only decompression. In patients exhibiting this high-risk profile, a primary combined anterior–posterior approach should be strongly considered to ensure circumferential decompression and optimize early neurologic recovery.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"68 ","pages":"Pages 270-275"},"PeriodicalIF":1.5,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144749259","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":"High rates of return-to-play and No deterioration in performance following ankle fractures in National Hockey League players","authors":"Alexander Tham ,&nbsp;Katherine L. Esser ,&nbsp;Jared Rubin ,&nbsp;Bradley A. Lezak ,&nbsp;Nathaniel P. Mercer ,&nbsp;James J. Butler ,&nbsp;Hayden Hartman ,&nbsp;Andrew J. Rosenbaum ,&nbsp;John G. Kennedy","doi":"10.1016/j.jor.2025.07.033","DOIUrl":"10.1016/j.jor.2025.07.033","url":null,"abstract":"<div><h3>Background</h3><div>Ankle fractures are common injuries in high-impact sports but have not been extensively studied in professional hockey. Given the high-speed, collision-heavy nature of the National Hockey League (NHL), ankle fractures may significantly affect player performance and team resources.</div></div><div><h3>Purpose</h3><div>To investigate the incidence, management, and impact of ankle fractures on return-to-play (RTP) and performance metrics among NHL players.</div></div><div><h3>Methods</h3><div>A retrospective review of NHL players from 2013 to 2023 identified 30 athletes who sustained ankle fractures. Injury data, treatment intervention (surgical vs. non-surgical), and mechanism of injury were recorded from an online databse. Performance metrics were compared between pre- and post-injury seasons using non-parametric statistical methods.</div></div><div><h3>Results</h3><div>The calculated rate of occurrence was 0.52 ankle fractures per 10,000 athlete exposures. All players returned to NHL play, with a mean time to return of 1.8 ± 1.0 months. There were no significant differences in performance metrics, including goals, assists, points, time on ice, or shooting efficiency, between pre- and post-injury seasons. Surgically treated players had a longer recovery time (2.7 vs. 1.4 months; <em>p</em> = 0.007) but missed a similar number of games compared to non-surgically treated players (16.6 ± 14.5 vs 16.2 ± 12.1 games missed, p = 0.756). Puck impact injuries were more likely to require surgery than contact-related injuries (<em>p</em> = 0.038). No player sustained a refracture.</div></div><div><h3>Conclusion</h3><div>This study found that ankle fractures are a rare injury sustained by NHL players but do not lead to statistically significant deterioration in player performance metrics. All NHL players successfully returned to play at the NHL level at a mean time to RTP of 1.8 months. Taken together, these findings indicate that ankle fractures in NHL players have minimal effect on their ability to return to and maintain pre-injury performance levels.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"68 ","pages":"Pages 331-335"},"PeriodicalIF":1.5,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144813833","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 between femoral nerve block and pericapsular nerve group block as preemptive analgesia in geriatric intertrochanteric fractures: A prospective randomised controlled clinical trial","authors":"Ashuthosh Kumar Gupta ,&nbsp;Karthik Ramachandran ,&nbsp;Kartik Sonawane ,&nbsp;Ajoy Prasad Shetty ,&nbsp;Palanichamy Gurumoorthi ,&nbsp;Jagannathan Balavenkatasubramaniam ,&nbsp;Shanmuganathan Rajasekaran","doi":"10.1016/j.jor.2025.07.026","DOIUrl":"10.1016/j.jor.2025.07.026","url":null,"abstract":"<div><h3>Purpose</h3><div>Regional blocks such as femoral nerve block (FNB) and Pericapsular nerve group (PENG) block are frequently used for postoperative pain relief in fractures around the hip joint. This study compares the analgesic efficacy of PENG block with FNB in the management of intertrochanteric fractures.</div></div><div><h3>Methods</h3><div>This randomised controlled clinical trial included patients aged 65–80 years with intertrochanteric fractures who were planned for closed reduction and cephalomedullary nailing. The patients were randomised into two groups: Group 1 (n = 40) received FNB, while Group 2 (n = 40) received PENG block preoperatively. The outcome measures were postoperative VAS score, total opioid consumption, quadriceps power, and duration of mobilisation.</div></div><div><h3>Results</h3><div>There was a significant reduction in postoperative pain in both groups. A comparison between the FNB and PENG blocks showed no significant difference in VAS scores at 6, 12, 18, 24, 36, and 48 h. The PENG group had better quadriceps strength preservation at 12 h (p &lt; 0.05), with no significant difference between the two groups at 60 h. The total opioid consumption in the first 48 h was similar in both groups (8.03 Morphine milliequivalents (MME) in PENG and 7.07 MME in the FNB group, p-value &gt;0.05).</div></div><div><h3>Conclusion</h3><div>PENG block and FNB are equally effective in pain relief and in reducing opioid requirements in elderly patients with intertrochanteric fractures. However, the PENG group showed better preservation of quadriceps strength at 12 h.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"68 ","pages":"Pages 251-255"},"PeriodicalIF":1.5,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144738539","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":"Indomethacin versus Ketorolac for the prevention of heterotopic ossification in hip arthroscopy patients","authors":"Christopher S. Frey ,&nbsp;Thomas M. Spears ,&nbsp;Daniel Puczko ,&nbsp;Alicia M. Hymel ,&nbsp;Candler G. Mathews ,&nbsp;Patrick M. Luchini ,&nbsp;Katherine D. Van Schaik ,&nbsp;Jessica R. Leschied ,&nbsp;Jaron Sullivan","doi":"10.1016/j.jor.2025.07.032","DOIUrl":"10.1016/j.jor.2025.07.032","url":null,"abstract":"<div><h3>Background</h3><div>Nonsteroidal anti-inflammatory drugs are commonly utilized to reduce the risk of developing heterotopic ossification (HO) after hip arthroscopy. However, it is not known which regimen is optimal.</div></div><div><h3>Purpose</h3><div>The purpose of this study is to determine the rate of HO formation after hip arthroscopy in response to different NSAID protocols.</div></div><div><h3>Methods</h3><div>Consecutive cases of a single fellowship-trained surgeon at a tertiary referral center were retrospectively reviewed. Patients received a regimen of two medications, starting with four days of either Ketorolac or Indomethacin and ending with either Celecoxib, Meloxicam, Diclofenac, or Naproxen. Two reviewers assessed HO on postoperative radiographs.</div></div><div><h3>Results</h3><div>323 cases were included for retrospective review. 48 (15 %) were found to develop HO after hip arthroscopy. Patients who also underwent labral repair (p = 0.046) and those with larger corrections in alpha angle (p = 0.048) were found to have higher rates of HO. Multivariate regression found that receiving Meloxicam as a second medication was found to have a significantly higher risk of HO than Celecoxib (OR 4.72, p = 0.035). Male gender (OR 2.36, p = 0.013), was also found to be associated with a higher likelihood of HO formation according to the model.</div></div><div><h3>Conclusion</h3><div>While taking Meloxicam as the second NSAID was associated with a significantly higher rate of HO than Celecoxib, no one regimen was found to be superior. Additionally, male gender was found to be a significant predictor of HO development.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"68 ","pages":"Pages 283-286"},"PeriodicalIF":1.5,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144771322","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":"Genicular artery embolization for knee osteoarthritis: A systematic review of sham-controlled randomized trials","authors":"Fathi Milhem ,&nbsp;Muhammad Takhman ,&nbsp;Mohamed S. Elgendy ,&nbsp;Anas Abu Zahra ,&nbsp;Sarah Saife ,&nbsp;Sakeena Saife ,&nbsp;Waseem Shehadeh ,&nbsp;Mohammad Bdair ,&nbsp;Omar Abu-Khazneh ,&nbsp;Yazan Hamdan ,&nbsp;Qutayba Z. Ayaseh ,&nbsp;Orabi Hajjeh ,&nbsp;Ayesha Younas ,&nbsp;Walaa Abu Alya ,&nbsp;Ahmad Mohammad ,&nbsp;Anwar Zaitoun","doi":"10.1016/j.jor.2025.07.022","DOIUrl":"10.1016/j.jor.2025.07.022","url":null,"abstract":"<div><h3>Background</h3><div>Knee osteoarthritis (KOA) is a degenerative joint disease associated with chronic pain and functional decline. Genicular artery embolization (GAE) is a minimally invasive intervention that targets abnormal synovial neovascularization. This systematic review evaluates the efficacy and safety of GAE compared with sham procedures in patients with symptomatic KOA.</div></div><div><h3>Methods</h3><div>A systematic search of PubMed, EMBASE, Scopus, and Web of Science was conducted through March 2025. Only sham-controlled randomized controlled trials (RCTs) enrolling adults with symptomatic KOA were included. Data were extracted on study design, patient characteristics, interventions, outcomes, and adverse events. Risk of bias was assessed using the Cochrane RoB 2.0 tool.</div></div><div><h3>Results</h3><div>Three sham-controlled RCTs with a total of 138 patients were included. GAE demonstrated short-term pain reduction, particularly in VAS scores, with one trial showing a significant improvement at 1 month (−50.8 vs −0.5). KOOS pain scores improved modestly across studies but lacked statistical significance. Functional outcomes were mixed; one trial reported significant improvement in WOMAC function, and another found enhanced quality of life in patients undergoing complete embolization. No serious adverse events occurred; minor complications such as catheter-site bruising were infrequent and self-limited.</div></div><div><h3>Conclusions</h3><div>GAE appears to be a safe and minimally invasive treatment that may provide short-term symptomatic relief in select KOA patients. However, limited sample sizes, methodological variability, and short follow-up periods constrain definitive conclusions. Larger, standardized trials with longer follow-up are necessary to confirm efficacy and optimize patient selection.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 361-368"},"PeriodicalIF":1.5,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144721201","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":"Can contaminated musculoskeletal autografts and allografts Be safely and effectively used in Patients? A systematic review","authors":"Patrick Ryan ,&nbsp;Bryce W. Rigden ,&nbsp;Clayton W. Nuelle ,&nbsp;James P. Stannard ,&nbsp;Steven F. DeFroda ,&nbsp;James L. Cook","doi":"10.1016/j.jor.2025.07.025","DOIUrl":"10.1016/j.jor.2025.07.025","url":null,"abstract":"<div><h3>Background</h3><div>Musculoskeletal autografts and allografts are used frequently in orthopaedics, and contamination of the grafts can occur. When intraoperative contamination is recognized, the graft can be salvaged for use and postoperative complications minimized with effective decontamination. The purpose of this systematic review was to critically evaluate safety and efficacy of decontamination protocols for tendon, meniscus, and osteochondral grafts in order to provide evidence-based guidelines for graft salvage.</div></div><div><h3>Methods</h3><div>Using PRISMA guidelines, a literature search was performed to identify eligible studies for systematic review of tendon-ligament, osteochondral, and meniscal graft decontamination protocols. Separate searches for tendon, for ligament (tendon-ligament), osteochondral, and meniscal protocols were performed using keywords: (1) “operative”, (2) “dropped OR contamination OR sterilization”, and (3a) “tendon” or (3b) “ligament” or (3c) “osteochondral” or (3d) “meniscus”.</div></div><div><h3>Results</h3><div>A total of 16 studies for tendon-ligament and 6 studies for osteochondral grafts met inclusion criteria. For all graft types, dropping the tissue onto the operating room floor is the most commonly reported method of contamination. The most common decontaminants used were 10 % povidone-iodine and 4 % chlorhexidine with the typical soaking time being 10 min. For both tissue types, chlorhexidine-based protocols were most consistently effective at eradicating bacterial contaminants. Clinical outcome measures were limited to assessments of subsequent infections with none reported in the very few studies that provided outcome data.</div></div><div><h3>Conclusion</h3><div>The currently available evidence for intraoperative decontamination of musculoskeletal autografts and allografts supports the use of chlorhexidine-based soaking protocols for treatment of tendon autografts and allografts, as well as fresh (viable) osteochondral allografts, in order to most effectively prevent related infections. Additional data is required to determine optimal protocols with respect to disinfectant types and concentrations, inclusion of antibiotics, exposure durations, and use of “mechanical agitation” that sufficiently eradicate pathogens and preserve essential cell viability, material properties, and biocompatibility for each tissue type in order to prevent tissue waste, morbidity, complications, failures, and associated costs while promoting successful outcomes for patients.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"68 ","pages":"Pages 238-250"},"PeriodicalIF":1.5,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144721701","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 effects of continuing aspirin and clopidogrel on perioperative outcomes in primary elective total knee and hip replacement: A systematic review and meta-analysis","authors":"M.M. Farhan-Alanie ,&nbsp;A. Abdul-Hussein ,&nbsp;A. Stephens ,&nbsp;M. Blankstein","doi":"10.1016/j.jor.2025.07.024","DOIUrl":"10.1016/j.jor.2025.07.024","url":null,"abstract":"<div><h3>Introduction</h3><div>Approximately 20 % of patients undergoing primary elective total hip (THR) or knee replacement (TKR) take an antiplatelet medication. The two main management strategies are continuing or discontinuing the antiplatelet medication pre-operatively. Continuing antiplatelets may increase the risk of bleeding, wound complications, and infection. Discontinuing antiplatelets may increase the risk of cardiac and cerebrovascular adverse events. This systematic review and meta-analysis evaluated the effects of continuing aspirin or clopidogrel on the perioperative outcomes of patients undergoing THR or TKR.</div></div><div><h3>Methods</h3><div>Medline, Embase, Web of Science, and Cochrane Library were searched for randomised controlled trials and cohort studies reporting on outcomes blood loss, infection, wound complications, operative duration, length of stay, venous thromboembolism, cardiac and cerebrovascular events, mortality, and others. Random effects meta-analysis was performed.</div></div><div><h3>Results</h3><div>Eight studies enabled inclusion of data on 928 THRs and 3526 TKRs. Continuing antiplatelet therapy did not affect intraoperative blood loss in THR (MD -16.57 ml, 95 % CI -120.75–87.61, p = 0.76) or TKR (MD -0.06 ml, 95 %CI -6.04–5.91, p = 0.98). However, TKR patients continuing antiplatelet therapy had a higher risk of blood transfusion (OR 1.63, 95 %CI 1.25–2.13, p = 0.0003) although there were no differences observed in THR patients (OR 1.71, 95 %CI 0.84–3.49, p = 0.14). No significant differences were found for outcomes infection, cardiac and cerebrovascular events, and post-operative mortality between patient groups following THR and TKR.</div></div><div><h3>Conclusions</h3><div>Continuing antiplatelet use during TKR, but not THR, was associated with an increased risk of blood transfusion. Surgical complications and medical adverse events were not influenced by antiplatelet use. Further research with larger sample sizes is needed to draw definitive conclusions.</div><div>PROSPERO (CRD42024470601)</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 369-377"},"PeriodicalIF":1.5,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144721202","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":"Developing and validating machine learning models to predict acetabular cup size in total hip arthroplasty","authors":"Felix C. Oettl ,&nbsp;Aaron I. Weinblatt ,&nbsp;Brian Chalmers ,&nbsp;David Kolin ,&nbsp;Alejandro Gonzalez Della Valle","doi":"10.1016/j.jor.2025.07.021","DOIUrl":"10.1016/j.jor.2025.07.021","url":null,"abstract":"<div><h3>Aims</h3><div>Adequate implant inventory management can improve efficiency, storage space, and result in cost savings in arthroplasty. This study investigates if the prediction of cup size in elective primary total hip arthroplasty (THA) cound be improved with the use of advanced machine learning.</div></div><div><h3>Methods</h3><div>Using the arthroplasty registry of a single institution, we identified 30,583 patients who underwent primary THA between 2016 and 2024. No data was missing or incomplete. A total of 9 parameters readily available preoperatively were included as potential predictor variables. The data corpus was partitioned into training (80 %) and hold-out test (20 %) samples. Two distinct machine learning models were trained on regression tasks. The models were technically evaluated utilizing Root Mean Squared Error (RMSE) and Mean Absolute Error (MAE). Spearman correlation coefficient was calculated to assess alignment with implanted cup. 95 % confidence intervals (95 % CI) were calculated via bootstrapping. Real world useability was assessed by the percent of correct predictions within ±2 mm from implanted cup.</div></div><div><h3>Results</h3><div>The quantile regression forest outperformed the explainable boosted machine (EBM) in terms of MAE (1.69 [95 % CI 1.64, 1.73] vs 1.73 [1.69, 1.77]) and real-world usability, with an accuracy of 82.85 % within ±2 mm and 97.27 % within ±4 mm. The EBM outperformed the QRF by RMSE and Spearman Correlation coefficient, weighing outliers heavier. The most important factors in order were Sex, height, age, weight, surgical approach and BMI.</div></div><div><h3>Conclusion</h3><div>Machine learning models can predict implant sizing with very high accuracy based on a few metrics available preoperatively. This model can help decrease overall cost of THA by improving orthopaedic manufacturers' supply chains and hospitals’ inventory management.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 349-352"},"PeriodicalIF":1.5,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144702644","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":"Accuracy of femoral head center reconstruction using a straight cementless rectangular stem: An in-silico study comparing elderly and middle-aged patients","authors":"Hidde D. Veldman ,&nbsp;Ide C. Heyligers ,&nbsp;Philip C. Noble ,&nbsp;Tim A.E.J. Boymans","doi":"10.1016/j.jor.2025.07.017","DOIUrl":"10.1016/j.jor.2025.07.017","url":null,"abstract":"<div><h3>Introduction</h3><div>Accurate reconstruction of the femoral head center (FHC) is essential for restoring hip biomechanics in total hip arthroplasty (THA). Previously described age-related morphological changes—such as canal widening and a mediocaudal FHC shift—may complicate anatomical reconstruction in all age-categories using a single non-modular cementless stem. This study assessed the capacity of such implant to achieve adequate FHC reconstruction across age groups and sexes.</div></div><div><h3>Methods</h3><div>Virtual implantation of a non-modular cementless stem (SL-PLUS™) was performed in CT-based 3D reconstructions of 148 femora from middle-aged (&lt;80 years) and very elderly (≥80 years) subjects. For each case, the optimal implant size, type (standard or lateral), and modular head (-4 mm, 0 mm or +4 mm) were selected. FHC deviation was measured in three dimensions; reconstructions were considered adequate if &lt; 5 mm in all directions.</div></div><div><h3>Results</h3><div>Overall, 92.4 % of reconstructions were considered adequate. No significant differences in reconstruction accuracy could be detected between age or sex groups. Very elderly males required significantly larger stem sizes than middle-aged males (mean size 6.4 vs. 5.1; p &lt; 0.001). Lateralized stems were used more frequently in very elderly males (76.0 %) than in middle-aged males (44.4 %; p = 0.001). Reconstruction failure occurred in 11 cases, mostly due to a reduced mediolateral offset in femora with high native ML-offsets and/or low neck-shaft angles (8 out of 11 cases).</div></div><div><h3>Conclusions</h3><div>A single non-modular cementless stem enables satisfactory FHC reconstruction in most patients, regardless of age or sex. However, certain anatomical configurations may exceed its reconstructive capacity. Careful preoperative planning is essential to identify cases that may need an alternative approach.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"68 ","pages":"Pages 336-344"},"PeriodicalIF":1.5,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144878418","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}