Journal of orthopaedics最新文献

{"title":"Arthroscopic fixation versus open reduction and internal fixation for displaced tibial side posterior cruciate ligament avulsion fractures: A systematic review and meta-analysis","authors":"Rajesh Kumar Rajnish ,&nbsp;Sandeep Kumar Yadav ,&nbsp;Amit Srivastava ,&nbsp;Arvind Prasad Gupta ,&nbsp;Saurabh Gupta ,&nbsp;Abhay Elhence","doi":"10.1016/j.jor.2025.06.021","DOIUrl":"10.1016/j.jor.2025.06.021","url":null,"abstract":"<div><h3>Background</h3><div>The reported incidence of the posterior cruciate ligament (PCL) injury ranges from 3 to 23 % of all knee injuries. Several injury patterns of the PCL have been described, including intra-substance, femoral detachment, and tibial avulsion, of which the last two are more common. Displaced PCL avulsion injury from the tibial side requires surgical fixation; however, there is no consensus in the literature regarding the optimal surgical approach for the fixation of these injuries.</div></div><div><h3>Purpose</h3><div>To perform a systematic review and meta-analysis of the outcomes and complications of arthroscopic and open fixation of displaced tibial side PCL avulsion fractures.</div></div><div><h3>Methods</h3><div>We performed a primary electronic search across PubMed, Embase, Scopus, and Cochrane Library databases and looked for comparative studies that evaluated and compared the outcomes of arthroscopic versus open reduction and fixation of displaced tibial side PCL avulsion fractures. Statistical analyses were executed with the software RevMan-5.4.1.</div></div><div><h3>Results</h3><div>This meta-analysis included two RCTs, one prospective and seven retrospective comparative studies. Evaluation across all ten studies suggested no statistically significant difference for arthroscopic versus open fixation in terms of postoperative International Knee Documentation Committee (IKDC) score (MD 4.43 [-0.73, 9.42; p = 0.09]), Lysholm score (MD 2.69 [-1.07,6.45; p = 0.16], knee range of motion (ROM) (MD -1.08 [-2.80,0.63; p = 0.21]), complications (OR1.75 [0.86, 3.54; P = 0.12]), Tegner activity (MD 0.14 [-0.46,0.74; p = 0.64]), posterior tibial translation (PTT) (MD -0.60 [-1.51,0.31; p = 0.20, posterior drawer test (PDT), operating time (MD 12.03 [-0.47, 24.53; p = 0.06]), and length of hospital stay. The fracture union rate was 98.77 % in the arthroscopic group and 100 % in the open fixation group, with comparable union time. There is a significantly lesser amount of blood loss in the arthroscopic group compared to the open group.</div></div><div><h3>Conclusion</h3><div>Current evidence shows comparable outcomes and complications for tibial side PCL avulsion fracture fixation through arthroscopic or open methods.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"66 ","pages":"Pages 271-281"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144548639","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":"Modeling and biomechanical characterization of femur and tibia bones using the Extended Mooney–Rivlin approach with mathematical validation","authors":"Mohamed Hassan ,&nbsp;A.S. Abdel-Rahman","doi":"10.1016/j.jor.2025.06.035","DOIUrl":"10.1016/j.jor.2025.06.035","url":null,"abstract":"<div><h3>Background</h3><div>Understanding the non-linear mechanical behavior of human bone is critical for improving orthopedic modeling and developing personalized treatment strategies. The Mooney-Rivlin model, traditionally used in soft matters, has been extended to capture the complex stress–strain relationships of hard biological materials like bone.</div></div><div><h3>Objective</h3><div>To apply the Extended Mooney-Rivlin model to human bone specimens and quantify regional variations in mechanical parameters, with the goal of improving finite element simulations and biomechanical interpretations.</div></div><div><h3>Participants and setting</h3><div>The study analyzed bone specimens from the proximal femur as well as the midshaft, distal, and proximal sections of long bones in the lower limb, based on data obtained from the literature.</div></div><div><h3>Methods</h3><div>Experimental stress–strain data were collected from bone samples subjected to uniaxial loading. The Extended Mooney-Rivlin model was fitted to the data to extract four key parameters: <em>B</em> (overall stiffness), <em>C</em>_<em>1</em> (shear resistance), <em>C</em>_<em>2</em> (damping/energy dissipation), and <em>H</em> (non-linearity).</div></div><div><h3>Results</h3><div>The model demonstrated strong goodness-of-fit across all specimens (<em>R</em>^<em>2</em> &gt; 0.95). Stiffness (<em>B</em>) was significantly higher in midshaft regions compared to distal regions. Damping capacity (<em>C</em>_<em>2</em>) and linearity (<em>H</em>) were elevated in distal regions <em>C</em>_<em>2</em>, indicating enhanced shock-absorbing properties. Surprisingly, shear resistance (<em>C</em>_<em>1</em>) was also greater in trabecular-rich regions, reflecting greater adaptability to complex loading environments.</div></div><div><h3>Conclusions</h3><div>The Extended Mooney-Rivlin model effectively captures regional variations in bone mechanics, with clear distinctions between cortical and trabecular bone behavior. These findings support its application in advanced biomechanical modeling and suggest new directions for personalized orthopedic treatment. Future work should explore the influence of age, bone mineral density, and pathological changes on these mechanical parameters.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"66 ","pages":"Pages 263-270"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144548648","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":"Outcomes of total knee arthroplasty in people with diabetes: An overview of systematic reviews and meta-analysis","authors":"Raju Vaishya ,&nbsp;Mohit Kumar Patralekh ,&nbsp;Anoop Misra ,&nbsp;Abhishek Vaish","doi":"10.1016/j.jor.2025.06.023","DOIUrl":"10.1016/j.jor.2025.06.023","url":null,"abstract":"<div><h3>Background and aims</h3><div>Total knee arthroplasty (TKA) in people with diabetes is associated with increased risks of postoperative complications. This review evaluates how diabetes influences complication rates and overall outcomes following TKA.</div></div><div><h3>Methods</h3><div>An overview of systematic reviews and meta-analyses was conducted, with a comprehensive search performed across databases including PubMed, Scopus, Web of Science, and the Cochrane Library. The protocol was registered on PROSPERO on December 12, 2024.</div></div><div><h3>Results</h3><div>People with diabetes undergoing TKA face a 43 % higher risk of periprosthetic joint infection (PJI) and are 45 % more likely to experience deep vein thrombosis (DVT). The rates of hospital readmissions were significantly higher, showing a 28 % increased likelihood. Subpopulations with insulin-treated diabetes exhibited a 60 % greater incidence of perioperative adverse events. Notably, people with diabetes undergoing TKA had significantly higher odds of developing infection (OR 1.97, 95 % CI 1.48–2.61, p = 0.004) and deep PJI (OR 2.10, 95 % CI 1.49–2.95, p &lt; 0.001). Significantly higher odds of DVT were observed in people with diabetes (OR 1.43, 95 % CI 1.23–1.66, p &lt; 0.0000). Inadequate perioperative glycemic control was identified as a modifiable risk factor, although definitions varied widely across studies.</div></div><div><h3>Conclusions</h3><div>The presence of diabetes significantly impacts post-TKA outcomes, leading to higher complication rates and negatively affecting physical function and quality of life. Further rigorous studies are needed to establish standardized definitions for glycemic control and to investigate mechanisms contributing to increased risks, facilitating improved preoperative risk stratification and management strategies for diabetic patients undergoing TKA.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"65 ","pages":"Pages 336-345"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144535924","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":"Pediatric lower extremity fracture treatments: a statistical review of randomized controlled trials","authors":"Matthew D. Ramey ,&nbsp;Niklas H. Koehne ,&nbsp;Auston R. Locke ,&nbsp;Jonathan J. Huang ,&nbsp;Laurel Wong ,&nbsp;Nikan Namiri ,&nbsp;Robert L. Parisien","doi":"10.1016/j.jor.2025.06.011","DOIUrl":"10.1016/j.jor.2025.06.011","url":null,"abstract":"<div><h3>Introduction</h3><div>Pediatric lower extremity fractures present with significant clinical challenges and largely rely on randomized controlled trials (RCTs) for intervention evaluation. The statistical robustness of these trials is seldom evaluated, but when examined reveals issues such as small sample sizes and underpowered results. Therefore, this study aimed to test the statistical robustness of RCTs evaluating pediatric lower extremity fracture interventions using fragility statistics.</div></div><div><h3>Methods</h3><div>PubMed, Embase, and MEDLINE were systematically searched for recent RCTs (2000–2023) assessing outcomes for pediatric patients with lower extremity fractures. The fragility index (FI), or number of event reversals required to alter statistical significance, was calculated for all dichotomous outcomes. The fragility quotient (FQ) was then determined by dividing the FI by the study sample size.</div></div><div><h3>Results</h3><div>After screening, 14 studies were included for analysis. Across 83 total dichotomous outcomes, the median FI was 5 (IQR 3–6) with an associated median FQ of 0.070 (IQR 0.033–0.107), suggesting that just event reversal in 5 patients, or 7.0 % of the study population, would alter significance for 50 % of outcomes. 15 outcomes were statistically significant (FQ = 0.029), and 68 outcomes were non-significant (FQ = 0.083). Outcomes were grouped into three categories, including fracture reduction or union (28 outcomes), functional improvement and patient satisfaction (26 outcomes), and adverse events (29 outcomes). Category FQs were 0.061, 0.069, and 0.076, respectively. 47 outcomes were extracted from studies published prior to 2018 (FQ = 0.086), while the 36 outcomes published in 2018 or later resulted in a median FQ of 0.048. Three fracture types were assessed, including tibia (37 outcomes), femur (39 outcomes), and ankle (7 outcomes) fractures, with FQs of 0.075, 0.060, and 0.050, respectively. Across the 59 outcomes from studies with operative interventions, the FQ was 0.075, whereas the 24 outcomes from studies with non-operative interventions reported a FQ of 0.060.</div></div><div><h3>Conclusion</h3><div>The efficacy of treatments in pediatric lower extremity fractures from RCTs are slightly fragile, particularly among significant outcomes. Over time, these studies have become less robust. Larger RCTs that combine the reporting of p-values with FI and FQ metrics may provide more robust evidence for guiding effective treatment strategies in pediatric lower extremity fractures.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"65 ","pages":"Pages 329-335"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144536067","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":"Ferulic acid/GRB2/NF-κB signaling pathway that alleviates ferroptosis-induced apoptosis of nucleus pulposus cells is a potential mechanism for intervertebral disc degeneration","authors":"Minde Li ,&nbsp;Xinya Liu","doi":"10.1016/j.jor.2025.06.013","DOIUrl":"10.1016/j.jor.2025.06.013","url":null,"abstract":"<div><h3>Background</h3><div>Intervertebral disc degeneration (IDD) is one of the main causes of low back pain, and its pathogenesis involves the gradual loss of nucleus pulposus cells (NPCs). However, the molecular mechanisms linking these pathways are not yet fully understood.</div></div><div><h3>Objective</h3><div>This study aims to investigate the role of ferulic acid (FA) in IDD and its potential mechanisms of action, providing potential therapeutic targets for IDD.</div></div><div><h3>Methods</h3><div>Analysis of 10 common traditional Chinese medicine prescriptions for lumbar disc herniation revealed that ferulic acid (Ferulic acid, FA) is a major active pharmaceutical ingredient. CCK8 confirmed that FA promotes the proliferation of NP cells. Edu results showed that FA promotes NP cell proliferation, while ferroptosis inhibits NP proliferation. Moreover, FA can alleviate the inhibitory effect of ferroptosis on NP cell proliferation. Subsequently, animal experiments confirmed that FA alleviates IDD in rats, and safranin O-fast green staining results confirmed that FA has a role in alleviating IDD lesions. Analysis of the GSE15227 and GSE23130 datasets showed that GRB2 is a hub gene in the progression of IDD, and molecular docking results showed that FA can bind to GRB2. WB demonstrated that FA significantly increased the expression of IκBα in ferroptosis-induced NP cells, thereby promoting proliferation. Meanwhile, the addition of the NF-κB agonist (TNF-α) significantly reduced IκBα expression and significantly inhibited NP cell proliferation.</div></div><div><h3>Results</h3><div>FA significantly inhibited ferroptosis markers and NPC proliferation in NPCs. GRB2 is one of the hub genes of IDD, and molecular docking results showed that FA has binding sites with GRB2. Meanwhile, FA upregulated IκBα, inhibiting the nuclear translocation of NF-κB and its downstream pro-inflammatory cytokines.</div></div><div><h3>Conclusion</h3><div>FA can significantly alleviate the progression of IDD. FA may inhibit NPC inflammation and lipid peroxidation through the GRB2/NF-κB pathway, The FA-GRB2/NF-κB axis is a potential therapeutic target for intervertebral disc degeneration.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"65 ","pages":"Pages 302-309"},"PeriodicalIF":1.5,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144490344","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 role of body composition and visceral fat in osteoporosis subtype differentiation: Insights from bioelectrical impedance analysis","authors":"N. Wergen ,&nbsp;U. Maus ,&nbsp;K. Schultz ,&nbsp;H. Frohnhofen ,&nbsp;D. Latz ,&nbsp;C. Somsen ,&nbsp;L. Mueller ,&nbsp;C. Beyersdorf","doi":"10.1016/j.jor.2025.06.014","DOIUrl":"10.1016/j.jor.2025.06.014","url":null,"abstract":"<div><h3>Background</h3><div>Recent studies have demonstrated a close link between body composition and the development and progression of osteoporosis. Visceral fat, in particular, appears to influence bone loss through its pro-inflammatory properties. However, it remains unclear whether this mechanism is equally relevant across different forms of osteoporosis.</div></div><div><h3>Objective</h3><div>To investigate whether body composition—especially visceral fat— differs between postmenopausal and senile osteoporosis.</div></div><div><h3>Participants and setting</h3><div>A total of 47 patients were prospectively enrolled. The senile osteoporosis group included patients aged ≥80 years (n = 20, mean age 87.4), the postmenopausal osteoporosis group included patients aged ≤75 years (n = 14, mean age 68.8), and the control group consisted of patients aged ≤75 years (n = 13, mean age 68.8) without osteoporotic fractures or other osteoporosis-specific risk factors.</div></div><div><h3>Methods</h3><div>Participants underwent bioelectrical impedance analysis (BIA) to assess body composition. Additional assessments included basic osteological laboratory testing, geriatric evaluation, sarcopenia screening (SARC-F), and frailty screening using the Clinical Frailty Scale (CFS).</div></div><div><h3>Results</h3><div>Muscle mass, total body water, fat-free mass, and BMI were significantly reduced in the senile osteoporosis group compared to controls. Similar trends were observed in the postmenopausal group, though without statistical significance. Notably, the senile osteoporosis group had a significantly higher proportion of visceral fat relative to total fat mass than both the control and postmenopausal groups.</div></div><div><h3>Conclusion</h3><div>Patients with senile and postmenopausal osteoporosis exhibit distinct differences in body composition compared to individuals without osteoporosis. In particular, the strong association between visceral fat and senile osteoporosis highlights a potential role for BIA in early risk detection and the development of tailored therapeutic strategies.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"65 ","pages":"Pages 276-282"},"PeriodicalIF":1.5,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144322391","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":"Long-term clinical and radiographic outcomes of pegged vs. keeled glenoid components in total shoulder arthroplasty: A matched cohort study","authors":"Akiro H. Duey ,&nbsp;John J. Corvi ,&nbsp;Troy Li ,&nbsp;Alexander Park ,&nbsp;Suhas Etigunta ,&nbsp;Akshar V. Patel ,&nbsp;Dennis Bienstock ,&nbsp;William Ranson ,&nbsp;David E. Kantrowitz ,&nbsp;Eoghan Hurley ,&nbsp;Dave Shukla ,&nbsp;Bradford O. Parsons ,&nbsp;Evan L. Flatow ,&nbsp;Paul J. Cagle","doi":"10.1016/j.jor.2025.06.010","DOIUrl":"10.1016/j.jor.2025.06.010","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aimed to compare outcomes between glenoid components in shoulder replacement surgery. Our focus was on clinical and radiographic outcomes in a matched cohort study with long-term follow-up.</div></div><div><h3>Methods</h3><div>This study included anatomic TSA cases performed by one fellowship-trained shoulder and elbow surgeon at one institution between 2001 and 2015. The choice of glenoid implant type was made intraoperatively. All glenoids were cemented. A cardinal matching algorithm using the Matchit package in R was employed to create a 1:2 cohort of patients receiving polyethylene keeled and pegged glenoid designs. The cohort groups were matched for age, sex, pre-op ASES score, and Walch classification. Shoulder ROM and PROs were measured throughout the study. Glenoid loosening was assessed radiographically using the Lazarus scoring system.</div></div><div><h3>Results</h3><div>The study analyzed 36 TSAs, comprising 12 keeled glenoid components and 24 pegged components. The average follow-up was 8.9 years (range 5.0-13.4) in the keeled glenoid group and 9.2 (range 3.5-17.3) years in the pegged glenoid groups, respectively. Demographic characteristics were not significantly different. Both keeled and pegged glenoid groups showed significant improvements in all ROM and PRO measurements postoperatively. When directly compared, there were no significant differences in postoperative ROM: forward elevation (p=0.333), external rotation (p=0.462), or internal rotation (p=0.411). Similarly, no significant differences were found in postoperative PRO scores: ASES (p=0.192), SST (p=0.662), or VAS (p=0.101). A Lazarus score of 0 was the most glenoid loosening score in both cohorts, although this was not statistically significant (66.7% vs. 83.3%; p=0.479). None of the other glenoid loosening scores showed significant differences between groups. Among the 36 TSAs, one keeled glenoid (8.3%) was revised after 9.95 years due to glenoid loosening.</div></div><div><h3>Discussion and conclusion:</h3><div>Both glenoid configurations led to sustained postoperative improvements in ROM and PROs, and there was no meaningful variation in radiographic stability when pegged and keeled glenoids were compared.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"65 ","pages":"Pages 290-295"},"PeriodicalIF":1.5,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144335700","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":"3D-printed titanium vertebra in the treatment of cervical spondylotic myelopathy: A comparative analysis of perioperative, radiographic, and clinical outcomes","authors":"Gelin Zhang ,&nbsp;Ting Zhang ,&nbsp;Xuyan Zhang ,&nbsp;Yurui Guo ,&nbsp;Liying Fan ,&nbsp;Bin Cheng ,&nbsp;Leilei Pei ,&nbsp;Jun Dong","doi":"10.1016/j.jor.2025.06.015","DOIUrl":"10.1016/j.jor.2025.06.015","url":null,"abstract":"<div><h3>Objective</h3><div>Anterior cervical corpectomy and fusion (ACCF) using a titanium mesh cage (TMC) is associated with a high rate of subsidence. This study aims to evaluate the potential advantages of utilizing 3D-printed titanium vertebrae as an alternative to TMC in ACCF procedures.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on patients who underwent ACCF at our hospital between March 2017 and June 2023. Patient demographics, surgical parameters (operation duration and blood loss), functional assessments (Barthel score, Morse Fall Scale (MFS), anterior cervical corpectomy index (aCCI)), hospitalization duration, costs, postoperative complications, unplanned reoperations, ICU admissions, and patient-reported outcomes (Japanese Orthopedic Association (JOA) score, Visual Analog Scale (VAS) score, Neck Disability Index (NDI) score) were recorded. Radiographic outcomes, including C2-C7 Cobb angles, segmental lordosis, and subsidence, were assessed via lateral cervical spine X-rays. Statistical analysis was performed using the Chi-square test and Mann-Whitney test.</div></div><div><h3>Results</h3><div>A total of 92 patients were included in the study, with 48 patients in the 3D-vertebra group and 44 in the TMC group. Baseline characteristics were comparable between groups. The 3D-vertebra group demonstrated significantly shorter operative time, reduced blood loss, and improved functional scores compared to the TMC group (p &lt; 0.05). Postoperatively, the 3D-vertebra group exhibited lower JOA and VAS scores at both one-week and final follow-up. NDI scores were comparable at one week but were significantly higher in the TMC group at follow-up. While segmental lordosis remained similar between groups, C2-C7 Cobb angles showed significant differences at follow-up. The TMC group experienced an average subsidence of 2.5 mm, whereas the 3D-vertebra group had minimal subsidence.</div></div><div><h3>Conclusion</h3><div>The use of 3D-printed titanium vertebrae in ACCF surgery offers superior perioperative parameters, radiographic outcomes, and clinical scores compared to TMC implants. Further long-term studies are warranted to establish the extended benefits of 3D-printed vertebrae. Limitations should be considered when interpreting the findings, and prospective, randomized controlled studies are warranted to validate our conclusions.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"65 ","pages":"Pages 283-289"},"PeriodicalIF":1.5,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144335699","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 association between restoration of tibial slope and total knee arthroplasty outcomes","authors":"Asher Selznick ,&nbsp;Hassaan Abdel Khalik ,&nbsp;Prushoth Vivekanantha ,&nbsp;Bryan Sun ,&nbsp;Kamal Bali","doi":"10.1016/j.jor.2025.06.012","DOIUrl":"10.1016/j.jor.2025.06.012","url":null,"abstract":"<div><h3>Background</h3><div>The proximal tibia has a characteristic posterior slope, varying between individuals and implicated in biomechanical function. This study evaluated whether restoring the native posterior tibial slope during primary total knee arthroplasty (TKA) improves postoperative functional outcomes.</div></div><div><h3>Methods</h3><div>A retrospective review of 9569 TKA patients from 1998 to 2022 was conducted using a single-centre arthroplasty database. Patients were categorized based on changes in tibial slope: decreased (Group 1, Δ slope &lt;3°), re-created (Group 2, Δ slope −3 to +3°), or increased (Group 3, Δ slope &gt;3°). Preoperative and postoperative anterior and posterior femoral offset ratios were also calculated and analyzed as covariates. Postoperative functional outcomes and range of motion (ROM) were assessed using analyses of covariance (ANCOVAS) and post-hoc pairwise comparisons.</div></div><div><h3>Results</h3><div>Among 609 included patients, tibial slope was decreased in 278 patients (46%, Group 1), re-created in 253 (42%, Group 2), and increased in 78 (13%, Group 3). Group 2 exhibited a 4.8-point higher Knee Society Score at six weeks postoperatively compared to Group 1 (p = 0.004), though scores at other time points and Oxford Knee Scores across all time points showed no significant differences between groups (p &gt; 0.05). Maximal flexion did not differ significantly across groups. These findings were consistent after adjusting for femoral offset ratio changes.</div></div><div><h3>Conclusion</h3><div>Recreation of native tibial slope was associated with a statistically significant but clinically minor improvement in postoperative functional outcome scores. Increasing tibial slope was not associated with improvements in maximal flexion, although this may be confounded by variations in implants utilized.</div></div><div><h3>Loe</h3><div>III (Retrospective cohort study).</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"65 ","pages":"Pages 296-301"},"PeriodicalIF":1.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144364610","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":"Machine-learning prediction of 90-day readmission after primary total hip Arthroplasty: Analysis of 1,340 cases from the Michigan Arthroplasty Registry (MARCQI)","authors":"Zachary Crespi ,&nbsp;Usher Khan ,&nbsp;Abdul-Lateef Shafau ,&nbsp;Fong Nham ,&nbsp;Chaoyang Chen ,&nbsp;Bryan Little ,&nbsp;Hussein Darwiche","doi":"10.1016/j.jor.2025.06.006","DOIUrl":"10.1016/j.jor.2025.06.006","url":null,"abstract":"<div><h3>Background</h3><div>Ninety-day readmission after total hip arthroplasty (THA) drives cost and signals sub-optimal recovery, yet existing risk-stratification tools are imprecise. We aimed to develop and validate a machine-learning model to predict 90-day readmissions and to identify modifiable risk factors.</div></div><div><h3>Methods</h3><div>The Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) was queried for all primary THAs performed between 2012 and 2023 at a single institution. All surgeries were performed by fellowship-trained adult reconstruction surgeons. Demographics, comorbidities, peri-operative variables, and discharge dispositions were extracted. Univariate analyses compared patients readmitted within 90 days with those not readmitted. A multilayer perceptron neural network (MPNN) was trained on 70% of the cohort and tested on the remaining 30%. Model discrimination was assessed with area under the receiver-operating-characteristic curve (AUC), and variable importance was calculated.</div></div><div><h3>Results</h3><div>Of 1,340 THA patients, 69 (5.1%) were readmitted within 90 days, with rates climbing from 0% in ASA I to 24% in ASA IV (p &lt; .001). Spearman correlations pinpointed length of stay (LOS) as the strongest readmission predictor (midnights ρ = 0.130; hours ρ = 0.123; both p &lt; .001), followed by discharge to post-acute care (ρ = −0.074; p = .007), smoking (ρ = 0.084; p = .002), and alcohol use (ρ = −0.072; p = .008). No other demographic or comorbidity variables reached significance.</div><div>An MPNN model achieved 94.7 % training accuracy, 95.2% testing accuracy, and an AUC of 0.71, ranking length of stay, ASA score, and bleeding disorders as its top three predictors.</div></div><div><h3>Conclusion</h3><div>Prolonged hospital stays and higher ASA status are key drivers of 90-day readmission after THA. Integrating machine-learning risk stratification with strategies to shorten LOS, enhance preoperative optimization, and refine discharge planning may reduce readmission rates.</div></div><div><h3>Level of evidence</h3><div>Prognostic Level III.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"65 ","pages":"Pages 270-275"},"PeriodicalIF":1.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144314299","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}