Journal of orthopaedics最新文献

{"title":"Serum metabolomic analysis of lumbar disc herniation at different location based on UPLC-QTOF-MS/MS: a population study","authors":"Xinchang Zhu ,&nbsp;Xingliang Xiang ,&nbsp;Ling Zhu ,&nbsp;Chengwu Song ,&nbsp;Cheng Chen ,&nbsp;Yunzhou Zuo ,&nbsp;Zhaoxiang Zeng ,&nbsp;Xugui Li ,&nbsp;Rongzeng Huang ,&nbsp;Shuna Jin","doi":"10.1016/j.jor.2025.07.018","DOIUrl":"10.1016/j.jor.2025.07.018","url":null,"abstract":"<div><h3>Background</h3><div>Almost all elderly individuals will encounter varying degrees of trouble caused by intervertebral disc degeneration. As a common degenerative spinal disorder, the harm of lumbar disc herniation (LDH) depends on the location of the nucleus pulposus herniation. However, population studies on the mechanisms of disc herniation at different levels are limited. Therefore, we conducted comparative analyses of serum metabolic characteristics in LDH patients with disc herniation at different locations.</div></div><div><h3>Methods</h3><div>In this study, 110 LDH patients (59 patients with L4-L5 protrusion site and 51 patients with L4-L5 protrusion site) were collected from June 2nd to October 1st, 2023 in Wuhan City, China. Untargeted metabolomics analysis based on ultra-high-pressure liquid chromatography coupled with quadrupole time of flight mass spectrometry (UPLC-QTOF-MS/MS) was analyzed the serum metabolic characteristics.</div></div><div><h3>Results</h3><div>As a result of principal component analysis (PCA) analysis, there was a clear separation trend in the metabolic profiles between L4-L5 and L5-S1 LDH patients in males, but not in females. Further, 28 metabolites with significant changes were screened in males with L4-L5 disc herniation compared to males with L5-S1 disc herniation. Among them, 25 metabolites were involved in glycerophospholipid metabolism, sphingolipid metabolism and tryptophan metabolism.</div></div><div><h3>Conclusion</h3><div>These findings demonstrate gender-specific differences in LDH patients. Moreover, the location-specific metabolic signatures in males were uncovered. This study could provide new insights into the gender-specific degenerative mechanisms associated with lesions in different locations, and inform targeted rehabilitation strategies for managing LDH.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 353-360"},"PeriodicalIF":1.5,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144711733","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":"Enhanced anterior capsular repair: A very low dislocation rate in a population at risk with standard implants","authors":"Levonti Ohanisian ,&nbsp;Whisper Grayson ,&nbsp;Emma Watson ,&nbsp;David Watson","doi":"10.1016/j.jor.2025.07.016","DOIUrl":"10.1016/j.jor.2025.07.016","url":null,"abstract":"<div><h3>Background</h3><div>Femoral neck fractures (FNFs) treated with total hip arthroplasty (THA) are at high risk for dislocation. While several techniques have been studied in attempts to address this increased risk, there is a scarcity of literature describing the efficacy of capsular management through anterior approach-based surgeries. In this study, we describe our institutional experience with an enhanced capsular repair (ECR) technique, where the capsule is sutured to the gluteus minimus. We hypothesize that this technique will enhance stability and decrease dislocation rate.</div></div><div><h3>Methods</h3><div>Seventy-nine patients who underwent primary THA for FNF between January 1, 2017–March 30, 2022, with a minimum of one-year follow-up were identified. These patients underwent an anterior approach-based operation where the ECR was performed. All operations were performed by a single fellowship trained arthroplasty surgeon. Primary outcomes included dislocation, revision surgery, and infection rates. Ambulatory status, radiographic parameters, and the Charlson Comorbidity Index (CCI) were also obtained.</div></div><div><h3>Results</h3><div>A total of 79 patients were included with zero dislocations observed. There were two revisions for aseptic loosening and traumatic periprosthetic fracture. Two superficial surgical site infections were successfully treated non-operatively. The average CCI was 3.89 and the average head size was 34 mm. The radiographic parameters postoperatively demonstrated an average abduction angle of 41.6° and average leg length change of +2.33 mm.</div></div><div><h3>Conclusion</h3><div>We found that performing an ECR after an anterior approach THA for FNF achieved adequate stability with the use of conventional implants. No significant leg lengthening or changes to ambulatory status were observed post-operatively.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 344-348"},"PeriodicalIF":1.5,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144696772","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":"Use of serotonergic antidepressants and perioperative complications in patients undergoing lower limb arthroplasty: Systematic review and meta-analysis of comparative studies","authors":"Dimitrios Grammatikopoulos ,&nbsp;Eustathios Kenanidis ,&nbsp;Georgios Foukarakis ,&nbsp;Christothea-Alexandra Tsiridis ,&nbsp;Michael Potoupnis ,&nbsp;Eleftherios Tsiridis","doi":"10.1016/j.jor.2025.07.009","DOIUrl":"10.1016/j.jor.2025.07.009","url":null,"abstract":"<div><h3>Background</h3><div>Serotonin Reuptake Inhibitors (SRIs) are commonly utilised antidepressants among populations in Western countries; however, their use has been linked to adverse effects and postoperative complications. This systematic review assessed the risk of both early and late perioperative complications in SRIs users undergoing elective total hip arthroplasty (THA) and knee arthroplasty (TKA) compared to non-users.</div></div><div><h3>Methods</h3><div>This study adhered to the 2020 PRISMA guidelines. A comprehensive search of PubMed, Science Direct/Scopus, and the Cochrane Database of Systematic Reviews was conducted from inception until January 2025. Comparative studies examining SRI users and non-users undergoing elective THA or TKA that addressed at least one postoperative outcome (blood loss, postoperative haemoglobin reduction, transfusion rate, length of stay, readmission and revision rate) were included. The Newcastle-Ottawa Scale was employed to evaluate the quality of the included studies. A meta-analysis was performed to assess the risk of transfusion, utilising a random-effects model.</div></div><div><h3>Results</h3><div>Ten comparative cohort studies, including two prospective and eight retrospective studies, were included in this analysis, involving 2,098,833 patients who underwent either elective THA or TKA. Among these patients, 418,527 were using SRIs during the perioperative period, with a mean age of 65.2 years. Our meta-analysis revealed an odds ratio of 1.78 (95 % CI, 1.11, 2.83; p = 0.02) concerning the blood transfusion rate in patients utilising SRIs, although it was characterised by considerable heterogeneity (I² = 97 %). The findings regarding length of stay, readmission rate, and revision rate were inconclusive.</div></div><div><h3>Conclusion</h3><div>The use of SRIs in patients undergoing elective THA and TKA may be linked to a slightly increased risk of bleeding and need for blood transfusion. However, considering the potential benefits of these medications for this patient group, it remains uncertain whether discontinuing them during the perioperative period is advisable. More high-quality studies are required to establish an etiological relationship.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 318-325"},"PeriodicalIF":1.5,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144680616","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":"Effects of mechanical and electrical stimulation on accelerating greenstick fracture Healing: Insights from finite element analysis and experimental validation","authors":"Mohamed Hassan ,&nbsp;Enas Fawzi Youssef ,&nbsp;Ahmed Rizk Mohamed ,&nbsp;A.R. El-Dhaba ,&nbsp;Mohamed I. Zineldin ,&nbsp;Dina S. Abd Allah","doi":"10.1016/j.jor.2025.07.011","DOIUrl":"10.1016/j.jor.2025.07.011","url":null,"abstract":"<div><h3>Background</h3><div>Greenstick fractures are common forearm injuries in children, with 75–84 % occurring in the distal third of the radius. Conservative treatments such as detachable braces or plaster backslabs permit early physiotherapy intervention, including muscle activation exercises and electrotherapy. This study investigated the biomechanical and electrophysiological effects on fracture healing to improve bone strength and reduce refracture risk, using finite element analysis (FEA) and experimental validation.</div></div><div><h3>Objective</h3><div>To evaluate the effect of controlled isometric muscle contractions and localized electrical stimulation on fracture healing in pediatric distal radius greenstick fractures, integrating computational modeling with experimental case validation.</div></div><div><h3>Participants and setting</h3><div>The experimental component involved two pediatric patients (aged 8–10 years) diagnosed with distal third greenstick fractures of the radius. Clinical management and data collection were conducted in a physiotherapy outpatient department at a tertiary care hospital.</div></div><div><h3>Methods</h3><div>A 3D model of a radius bone with a distal third greenstick fracture was developed. FEA using ANSYS analyzed strain distribution under isometric contraction of the brachioradialis muscle, with repetitions ranging from 5 to 30. COMSOL Multiphysics also simulated electrical stimulation by applying a 6.25 V potential across the fracture site, assessing displacement and strain alterations. Experimental validation included two pediatric cases: Child A received standard conservative treatment with immobilization, while Child B received local electrical stimulation. Healing progression was quantified by measuring fracture gap reduction by MATLAB-based image analysis.</div></div><div><h3>Results</h3><div>ANSYS simulations indicated that low-repetition (3–5) isometric muscle contractions may enhance callus formation. COMSOL simulations demonstrated a low strain gradient with electrical stimulation, but experimental validation showed a significant 58.8 % reduction in fracture gap area using electric stimulation, compared to 31.8 % with conservative treatment.</div></div><div><h3>Conclusions</h3><div>Applying controlled isometric mechanical loading and electrical stimulation may reduce the fracture gap in greenstick distal radius fractures, accelerate healing and recovery. Future studies should explore direct current electrical stimulation (DCES) for potentially more robust effects on bone remodeling.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 308-317"},"PeriodicalIF":1.5,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144665692","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":"Landscape of interventional clinical trials for glenohumeral instability","authors":"Mohamad Y. Fares ,&nbsp;Matthew Como ,&nbsp;Joseph A. Abboud ,&nbsp;Albert Lin","doi":"10.1016/j.jor.2025.07.010","DOIUrl":"10.1016/j.jor.2025.07.010","url":null,"abstract":"<div><h3>Background</h3><div>This study reviews interventional clinical trials to evaluate the efficacy and evolution of current therapeutic strategies for shoulder instability.</div></div><div><h3>Methods</h3><div>ClinicalTrials.gov was queried using key search terms for interventional clinical trials targeting shoulder instability. Data extracted included phase, status, duration, country, population size, age groups, study design, enrollment models, interventions, and outcomes. Publication rate was calculated by the ratio of published articles to total number of included trials.</div></div><div><h3>Results</h3><div>Forty-five interventional trials investigating shoulder instability were included. Most trials did not have a defined phase. Most trials (&gt;90 %) began post-2010 with an average duration of 37 months. Europe/UK/Russia led in trial numbers (55.6 %). Primary endpoints focused on shoulder function and mobility, with the Western-Ontario-Shoulder-Instability-Index being the most common outcome measure. Interventions included surgical procedures (46.7 %), physical therapy (37.8 %), behavioral therapy (4.4 %), and other modalities (11.1 %). Nine trials produced 14 publications, resulting in a publication rate of 25.9 %. Published results varied, including comparisons of treatment efficacy, such as heavy versus light strengthening programs, and outcomes for surgical and non-surgical interventions.</div></div><div><h3>Conclusion</h3><div>Interventional trials on shoulder instability are limited, mostly originating from Europe and North America. Low publication rates and lack of blinding highlight areas for improvement. Publishing results is essential for continuous development and outcome improvement.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"68 ","pages":"Pages 302-309"},"PeriodicalIF":1.5,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144779267","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":"Seventeen-year outcomes for a contemporary total hip resurfacing prosthesis in Australia: an analysis of registry data with comparison to best performing conventional and most prevalent resurfacing prostheses","authors":"Cameron J. Wilson ,&nbsp;Michelle F. Lorimer ,&nbsp;Carl Holder ,&nbsp;James D. Stoney ,&nbsp;Patrick C.L. Weinrauch","doi":"10.1016/j.jor.2025.07.012","DOIUrl":"10.1016/j.jor.2025.07.012","url":null,"abstract":"<div><h3>Background</h3><div>This study addresses survivorship up to 17 years for the hip resurfacing arthroplasty (HRA) system most commonly used in Australia at present. Here we compare overall and age-stratified revision rates of the study HRA to a benchmark HRA and the five conventional prostheses with the lowest 10-year cumulative percent revision (5THA) in the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). We further compare outcomes for the resurfacing target cohort of men under 65 years. Finally, we compare revision diagnoses for the study prosthesis and benchmarks.</div></div><div><h3>Methods</h3><div>AOANJRR data were analysed for osteoarthritis patients who underwent total hip arthroplasty, to the end of 2023. Using Cox proportional hazards models, we compared revision rates (estimated using Kaplan–Meier survival curves with 95 % confidence intervals) across the three groups. Femoral head sizes &lt;50 mm for HRA and &lt;32 mm for 5THA were excluded. Cumulative incidence plots were used to compare revision diagnoses.</div></div><div><h3>Results</h3><div>For the study HRA, the 17-year survivorship was 94 %, with revision risks comparable to the benchmark HRA but inferior to 5THA. For patients under 55 years, revision rates were comparable to those of 5THA and superior to the benchmark HRA. Revision risks were not significantly different between the three groups for men under 65 (95 % survivorship for the study HRA). Fracture and metal-related pathology were the most likely reasons for early and late revision respectively, while loosening and fracture were the most common revision diagnoses for the benchmark HRA and 5THA respectively.</div></div><div><h3>Conclusion</h3><div>The study HRA achieved similar survivorship to the benchmark HRA and 5THA in men &lt;65 years, but inferior to 5THA overall. Outcomes were best for younger patients. Adverse metal reactions remain a concern, with longer follow-up essential to assess their impacts and other trends in revision diagnoses.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 299-307"},"PeriodicalIF":1.5,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144663131","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":"Risk factors for revision of Birmingham Hip Resurfacing arthroplasty. A single-center study with a median 13-year follow-up","authors":"Alexander Oxblom ,&nbsp;Håkan Hedlund ,&nbsp;Li Felländer-Tsai ,&nbsp;Ola Rolfson ,&nbsp;Harald Brismar","doi":"10.1016/j.jor.2025.07.013","DOIUrl":"10.1016/j.jor.2025.07.013","url":null,"abstract":"<div><h3>Background</h3><div>Consensus is lacking regarding follow-up after metal-on-metal hip resurfacing (MoM-HR). This study examines risk factors for revision and evaluates the need for sequential follow-up.</div></div><div><h3>Patients and methods</h3><div>288 consecutive patients operated on with a unilateral Birmingham Hip Resurfacing (BHR) 2001–2014, having at least one x-ray and one metal ion sampling, were followed until 2022. Hazard ratios (HR) of revision were calculated for sex, age, femoral component head size, implant positioning, serum cobalt (sCo), and serum chrome (sCr) concentrations. The relative risk (RR) of revision if risk factors were present was calculated. Radiologic changes in component positioning were analyzed in 288 patients, and metal ion changes in 147 patients.</div></div><div><h3>Results</h3><div>The median follow-up was 13 years. Factors associated with revision were sCo and/or sCr &gt;5 μg/l at first follow-up, a post-operative anteversion &lt;5 or &gt;25°, and femoral head component size &lt;50 mm. Patients with one or more risk factors at first follow-up had a RR of 10 (95 % CI 2.5–42) to be revised compared to those without risk factors. A ≥10° change in the stem shaft angle was associated with an increased OR of revision (OR 14, 95 % CI 4.4–43). A change in sCo and/or sCr from ≤5 to &gt;5 μg/l between follow-ups was associated with an increased risk of revision (OR 8.5, 95 % CI 1.3–55).</div></div><div><h3>Conclusions</h3><div>Patients with risk factors at first follow-up, a change from serum metal ions ≤5 to &gt;5 μg/l, and a ≥10° change in the stem shaft angle at sequential follow-ups warrant continuous follow-up even if asymptomatic.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 294-298"},"PeriodicalIF":1.5,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144656037","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":"Impact of tracheostomy timing on postoperative outcomes following anterior cervical discectomy and fusion for sub-axial cervical fractures: A retrospective analysis","authors":"Hanzhi Yang,&nbsp;Jialun A. Chi,&nbsp;Li Jin,&nbsp;Jesse Wang,&nbsp;Lawal Labaran,&nbsp;Xudong Li","doi":"10.1016/j.jor.2025.07.007","DOIUrl":"10.1016/j.jor.2025.07.007","url":null,"abstract":"<div><h3>Aims &amp; objectives</h3><div>To evaluate the association between tracheostomy timing after anterior cervical discectomy and fusion (ACDF) for sub-axial cervical spine injuries and 90-day postoperative complications.</div></div><div><h3>Materials &amp; methods</h3><div>A retrospective cohort study was conducted. Patients aged 18–84 years who had fractures of the sub-axial cervical spine and underwent ACDF were identified using CPT and ICD codes from the PearlDiver database (2010-2022Q2) and stratified into early (0–5 days), intermediate (6–10 days), and late (11–20 days) tracheostomy groups post-ACDF. Exclusion criteria included prior cervical spine infection, malignancy, and posterior surgical approaches. Baseline comorbidities and surgical characteristics were assessed. 90-day primary and secondary outcomes were assessed with multivariable logistic regression.</div></div><div><h3>Results</h3><div>Among 594 patients, baseline differences were noted: the late group had higher rates of COPD (15.3 %), CHF (15.3 %), and pre-tracheostomy ventilator use (52.3 %) (all p &lt; 0.05). Vertebral artery dissection was most common in the early group (17.0 %, p = 0.017). Intermediate tracheostomy was associated with a lower pneumonia rate vs. early (OR 0.59, 95 % CI: 0.38–0.93; p = 0.022). Late tracheostomy was associated with a lower cerebrovascular accident (CVA) rate vs. early (OR 0.05, 95 % CI: 0.00–0.40; p = 0.014). No significant differences were observed in wound infections, other complications, or ventilator dependence at discharge.</div></div><div><h3>Conclusion</h3><div>Early tracheostomy after ACDF was not associated with increased surgical site infection, supporting its safety. However, the early group had a higher incidence of vertebral artery dissection pre-tracheostomy and was linked to higher 90-day pneumonia and CVA rates compared to intermediate and late groups, respectively.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 286-293"},"PeriodicalIF":1.5,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144631649","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":"Pain and pain management following manual versus robotic assisted unicondylar knee arthroplasty","authors":"Felix C. Oettl ,&nbsp;Aaron I. Weinblatt ,&nbsp;Yu-Fen Chiu ,&nbsp;Gwo-Chin Lee ,&nbsp;Stephen Lyman ,&nbsp;Brian Chalmers ,&nbsp;Matthew Austin ,&nbsp;Alejandro Gonzalez Della Valle","doi":"10.1016/j.jor.2025.07.008","DOIUrl":"10.1016/j.jor.2025.07.008","url":null,"abstract":"<div><h3>Aims</h3><div>The adoption of robotic assistance for unicondylar knee arthroplasty (UKA) is increasing, driven by reports of improved implant positioning. However, its impact on short-term patient outcomes remains debated. This study aimed to compare postoperative pain, opioid consumption, and length of hospital stay between manual (maUKA) and robotic-assisted (raUKA) procedures in a large, real-world cohort.</div></div><div><h3>Materials and methods</h3><div>We retrospectively identified 1369 opioid-naïve patients undergoing medial, unilateral UKA at a single institution between 2019 and 2023 (417 manual, 952 robotic). We collected data on Numeric Pain Rating Scale (NRS) scores, opioid consumption in morphine milligram equivalents (MMEs), and length of hospital stay. Multivariable linear regression was used to compare outcomes while controlling for patient-level confounders.</div></div><div><h3>Results</h3><div>After multivariable adjustment, we found no statistically significant difference between the manual and robotic groups in length of hospital stay (p = 0.6206) or total 90-day opioid consumption. Patients in the raUKA group reported slightly higher pain scores at the first postoperative measurement (Estimate −0.7, p &lt; 0.001); however, no significant differences were observed in average, minimum, or maximum in-hospital pain scores. There was no significant difference in total inpatient opioid consumption.</div></div><div><h3>Conclusion</h3><div>In this large single-institution analysis, robotic assistance was not associated with improvements in postoperative pain, opioid use, or length of hospital stay compared to the manual technique. These findings suggest that potential benefits of robotic UKA related to implant accuracy may not translate to improved short-term clinical outcomes, a crucial consideration in the context of technology acquisition and healthcare costs.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 267-272"},"PeriodicalIF":1.5,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604496","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":"Revision surgery for aseptic prosthetic loosening in patients treated for knee tumors: Role of gait and imaging parameters","authors":"Sheng-Rui Chu ,&nbsp;Meng-Yu Chen ,&nbsp;Yang Liu ,&nbsp;Kai Zhu ,&nbsp;Jing-Yu Zhang ,&nbsp;Yong-Cheng Hu ,&nbsp;Yan-Cheng Liu ,&nbsp;Jun Miao","doi":"10.1016/j.jor.2025.07.006","DOIUrl":"10.1016/j.jor.2025.07.006","url":null,"abstract":"<div><h3>Objective</h3><div>Revision surgeries for aseptic loosening following prosthesis implantation in patients treated for knee tumors have become increasingly prevalent, although analyses of associated risk factors remain limited. This study aimed to systematically identify risk factors for aseptic knee prosthetic loosening following implantation and establish early predictive indicators through multimodal analysis integrating clinical, radiographic, and quantitative gait parameters.</div></div><div><h3>Methods</h3><div>Data from patients treated for knee tumors between January 2020 and December 2024 were retrospectively collected via a case‒control design. Patients were divided into two groups: an experimental group (n = 11) requiring revision due to aseptic loosening and a matched control group (n = 11) with stable prostheses. All patients underwent the same type of rotationally hinged knee prosthetic implantation performed by a team of experienced joint surgeons. To explore the risk factors for aseptic loosening, clinical data, gait parameters, and imaging characteristics were analyzed. Multivariate logistic regression analyses were implemented to quantify associations between clinical data and the risk of aseptic prosthetic loosening. Gait parameters were quantitatively analyzed via the Intelligent Device for Energy Expenditure and Activity (IDEEA® v3.1, MiniSun LLC) to predict early indicators of aseptic loosening.</div></div><div><h3>Results</h3><div>According to the regression models, a higher body mass index (BMI) and hip–knee-ankle angle (HKAA) were significant (<em>p</em> = 0.04, <em>p</em> = 0.043), whereas sex and age at first prosthetic implantation were not significant. The femoral internal diameter at 20 cm proximal to the knee was significant according to the univariate regression analysis (<em>p</em> = 0.05) but not according to the multivariate regression model. The difference in the cortical bone thickness was not significant. Significant reductions in the single-support phase time (<em>p</em> = 0.045) and energy expenditure (<em>p</em> = 0.05) were observed in patients who underwent revision for aseptic loosening relative to those in the control group.</div></div><div><h3>Conclusion</h3><div>Aseptic loosening after knee prosthetic implantation for knee tumor treatment is associated with several factors, and a higher BMI and HKAA constitute significant risk factors. A decreased single-support phase time and reduced energy expenditure in gait analysis can assist in predicting early signs of loosening and facilitate early clinical intervention.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 259-266"},"PeriodicalIF":1.5,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144595635","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}