Journal of Orthopaedic Research®最新文献

{"title":"Machine Learning Based Diagnostic Models for Hip and Knee Prosthetic Joint Infection: A Systematic Review","authors":"Jaiden Nairne-Nagy,&nbsp;Rudraksh Gupta,&nbsp;Boopalan Ramasamy,&nbsp;Lucian Bogdan Solomon,&nbsp;Stuart A. Callary","doi":"10.1002/jor.70160","DOIUrl":"10.1002/jor.70160","url":null,"abstract":"<p>Prosthetic joint infection (PJI) is a devastating complication that affects up to 1.7% of patients within 2 years following total hip arthroplasty (THA) or total knee arthroplasty (TKA). PJI is associated with significant patient morbidity, reduction in quality of life, prolonged hospitalisation, and healthcare expenditure. With a 5-year mortality reported as high as 21%, PJI is one of the most feared complications of joint arthroplasty. Identification of PJI is of critical importance to ensure successful and definitive treatment. However, diagnosis remains challenging due to the lack of a gold standard, culture-negative infection, and varying sensitivity and specificity of diagnostic tests. The rapid expansion of machine learning (ML) in the literature has led to the emergence of models that utilise patient demographics, clinical features, serological studies, synovial fluid biomarkers, and imaging to improve PJI diagnostics. The purpose of this study was to describe the literature on using ML to diagnose PJI. A systematic review of the literature for original studies describing ML use in PJI diagnostics following THA or TKA was conducted. This review identified 12 studies applying ML to diagnose or predict PJI, through patient demographics, clinical features, and imaging. Most models demonstrated good predictive performance, with Area Under the Curve (AUC) from 0.68 to 0.993. However, few studies validated their models externally. In conclusion, ML presents a promising approach to enhance PJI diagnostic accuracy, which may reduce diagnostic delays and ensure appropriate treatment. Further studies are needed to assess the model's generalisability and validate these models in external cohorts.</p><p><b>Statement of Clinical Significance:</b> The diagnosis of PJI remains a challenge due to limitations in current diagnostic criteria. ML offers a data-driven approach to improve diagnostic accuracy, potentially allowing earlier and more accurate identification to ensure appropriate treatment in a timely manner.</p>","PeriodicalId":16650,"journal":{"name":"Journal of Orthopaedic Research®","volume":"44 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12976461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147433815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Repeated (Weekly) Intra-Articular Injections of Sulfated Galactans Attenuate Cartilage Degeneration in a Rat Model of Osteoarthritis","authors":"Nirada Srianake,&nbsp;Amarin Thongsuk,&nbsp;Scarlett Desclaux,&nbsp;Thitiya Phuagpan,&nbsp;Jiraporn Sriwong,&nbsp;Alita Kongchanagul,&nbsp;Wanwisa Himakhun,&nbsp;Ruedee Hemstapat,&nbsp;Kanokpan Wongprasert","doi":"10.1002/jor.70175","DOIUrl":"10.1002/jor.70175","url":null,"abstract":"<p>Osteoarthritis (OA) is a progressive joint disease characterized primarily by pain, leading to substantial impairment of quality of life. Current treatments primarily alleviate symptoms but have limited efficacy in protecting or repairing articular cartilage. Marine algae have recently gained attention in pharmaceutical research due to their diverse bioactivities. <i>Gracilaria fisheri</i>, a red alga, contains abundant sulfated galactans (SG) that may exert chondroprotective effects. This study investigated the effects of SG on pain-related behaviors and cartilage degeneration in a Wistar rat OA model induced by anterior cruciate ligament transection combined with medial meniscus removal (ACLT + MMx). Pain-related behaviors were monitored weekly using a hind limb weight-bearing distribution test. Four weeks post-surgery, rats received intra-articular injections (50 µL) of normal saline (NSS), hyaluronic acid (HA), or SG (2.5, 50, or 500 µg) once weekly for 4 weeks. SG administration did not significantly ameliorate pain-related behaviors. However, histopathological assessment revealed that the SG (500 µg) significantly attenuated cartilage degeneration compared to OA controls. To further examine direct cellular effects, in vitro experiments using IL-1β–induced human chondrocyte inflammation revealed that SG, in inflamed cells, suppressed matrix-degrading enzymes (MMP-1 and MMP-13) while enhancing cartilage-protective markers (COL2A1 and TIMP-1). Nonetheless, type II collagen expression in vivo remained unchanged. Collectively, these findings indicate that SG from <i>Gracilaria fisheri</i> exerts chondroprotective effects in experimental OA, supporting its potential as a cartilage-preserving candidate for disease-modifying strategies.</p>","PeriodicalId":16650,"journal":{"name":"Journal of Orthopaedic Research®","volume":"44 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12972601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147390361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Fat in Osteoarthritis","authors":"Kelsey H. Collins","doi":"10.1002/jor.70168","DOIUrl":"10.1002/jor.70168","url":null,"abstract":"<div>\u0000 \u0000 <p>Our work challenges the traditional view of osteoarthritis (OA) as a wear-and-tear disease of aging, proposing a paradigm shift toward understanding OA as a systemic condition influenced by metabolic and immune factors. Historically, OA research focused on joint tissues, but our studies highlight adipose (fat) tissue and fat-secreted factors as critical contributors to OA development and pain. Using diet-induced obesity models in rats, we demonstrated that fat mass and adipose-derived factors, rather than body weight alone, strongly correlate with OA severity. Clinical studies in humans further validated this, showing body fat percentage predicts OA incidence more accurately than body mass index (BMI), even in individuals with normal or overweight BMI. In addition, a fat-free mouse model revealed that the absence of fat protects against OA regardless of diet or sex, emphasizing adipose interorgan crosstalk as a key driver of OA. These findings confirmed leptin's role in OA and uncovered complement factor D (FD), a fat-secreted mediator modulated by leptin. FD unexpectedly influences OA structure and pain in distinct ways. Our current research focuses on understanding how FD drives pain through eicosanoids (pain-related lipid mediators) and identifying other fat-derived molecules driving OA. Using advanced spatial multi-omics and proximity labeling technologies, alongside bioengineering tools and translational pain testing strategies, our goal is to redefine OA as a systemic disease. Ultimately, we aim to transform personalized OA care by developing therapies targeting fat-derived mediators that drive pain and joint damage.</p></div>","PeriodicalId":16650,"journal":{"name":"Journal of Orthopaedic Research®","volume":"44 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147377929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Analysis of Tendon Healing in a Clinically Relevant Mouse Model of Achilles Tendon Repair","authors":"Varun Arvind,&nbsp;Elaine Nagahara,&nbsp;Hui Zhang,&nbsp;Peter Shyu,&nbsp;X. Edward Guo,&nbsp;Alice H. Huang","doi":"10.1002/jor.70173","DOIUrl":"10.1002/jor.70173","url":null,"abstract":"<div>\u0000 \u0000 <p>Adult tendon injuries are common and debilitating, with limited regenerative potential. In recent years, the mouse has emerged as a potent tool to identify cell and molecular mechanisms of healing and test novel biologics, however injury models frequently vary between studies. Both non-reconstructive injuries (such as full or partial tenotomies or window defects), as well as full tenotomy followed by surgical repair have been applied. However, direct comparisons of healing between reconstructive and non-reconstructive approaches have rarely been carried out. In this study, we compare three clinically relevant injury models in the Achilles tendon: tenotomy-only injury, tenotomy with cast immobilization, and tenotomy with microsurgical repair and cast immobilization. We find that surgical repair resulted in the most improved functional recovery, with lowest recruitment of inflammatory macrophages, enhanced tenogenic gene expression, and reduced fibrotic gene expression. Lineage tracing further showed enhanced recruitment of <i>Scleraxis</i>-lineage tenocytes. Collectively, these results suggest that there are distinct differences in functional, cellular, and molecular outcomes with and without surgical repair following tenotomy. These differences in healing may be considered when selecting the most appropriate injury model for specific scientific questions.</p>\u0000 </div>","PeriodicalId":16650,"journal":{"name":"Journal of Orthopaedic Research®","volume":"44 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147369635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tendon Omics: A Survey-Based Perspective on Obstacles and Opportunities","authors":"Anne E. C. Nichols,&nbsp;Stephanie G. Dakin,&nbsp;Dianne Little,&nbsp;Sarah J. B. Snelling,&nbsp;Alayna E. Loiselle","doi":"10.1002/jor.70174","DOIUrl":"10.1002/jor.70174","url":null,"abstract":"<div>\u0000 \u0000 <p>Until recently, our fundamental understanding of tendon biology, from development to post-natal growth, aging, and response to injury, has been limited to bulk transcriptomic profiling and low-throughput molecular biology techniques. Recent advances in omics technologies have provided a critical opportunity to define and interrogate the cellular and molecular landscape across different tissue states, with the ultimate goal of informing translational strategies to retain or restore tendon health. However, there are clear gaps, including infrastructure and expertise that have limited the ability to fully leverage the potential of these datasets. Therefore, in preparation for the 2024 Orthopaedic Research Society Tendon Section Satellite Meeting at the Mayo Clinic, a survey of the tendon community was circulated in Fall 2023 to understand the most-pressing challenges in tendon omics that should be addressed at this meeting. Through this survey, three dominant themes emerged: (1) data sharing, emphasizing the need for open-source tools to query existing datasets; (2) data reporting, with a focus on the need for consistent reporting of associated metadata; and (3) data use and annotation, identifying the need for consensus molecular definition of different cell populations. These priorities then informed both the plenary and breakout sessions at the Satellite meeting. This perspective article summarizes and synthesizes the survey data, plenary sessions, and discussion groups that developed community-driven priorities and actionable items to generate a community roadmap to enhance the impact of tendon omics research.</p></div>","PeriodicalId":16650,"journal":{"name":"Journal of Orthopaedic Research®","volume":"44 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147369699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2025 International Consensus Meeting on Musculoskeletal Infection: Summary From Biofilm Workgroup on Treatment of Biofilm-Related Infection and Preclinical Models","authors":"Jessica Amber Jennings,&nbsp;Hesham Abdelbary,&nbsp;Fatima S. Abdulla,&nbsp;Orfan Arafah,&nbsp;Tarek Benzouak,&nbsp;Hyonmin Choe,&nbsp;Tom Coenye,&nbsp;Débora C. Coraça-Huber,&nbsp;Lorenzo Drago,&nbsp;R. Gustavo Garcia,&nbsp;Graham S. Goh,&nbsp;John Hamilton,&nbsp;Rami Hamoudeh,&nbsp;Noreen J. Hickok,&nbsp;Louise Kruse Jensen,&nbsp;Hernando Gaitan Lee,&nbsp;Bingyun Li,&nbsp;Mojieb Manzary,&nbsp;Adrienn Markovics,&nbsp;Katya McDonald,&nbsp;T. Fintan Moriarty,&nbsp;Gowrishankar Muthukrishnan,&nbsp;Kohei Nishitani,&nbsp;Nicholas J. Norton,&nbsp;Ebru Oral,&nbsp;Javad Parvizi,&nbsp;Jose Del Pozo,&nbsp;Lauren B. Priddy,&nbsp;Dina Raafat,&nbsp;Kordo Saeed,&nbsp;Christopher Spiegel,&nbsp;Edward M. Schwarz,&nbsp;Claudia Siverino,&nbsp;Margarita Trobos,&nbsp;Andie Tubbs,&nbsp;Rabeta Yeasmin","doi":"10.1002/jor.70169","DOIUrl":"10.1002/jor.70169","url":null,"abstract":"<p>Despite advancements in surgical techniques, musculoskeletal infections (MSKI) remain severe complications following orthopedic surgery, imposing a substantial financial and personal burden on patients and healthcare systems globally. To establish the current state of knowledge in this field, International Consensus Meetings (ICM) were held in 2013, 2018, and 2025, including a Biofilm Section focused on establishing state-of-the-art basic science and translational research. The latest ICM utilized a 2-year-long Delphi process that commenced on May 31, 2023, and culminated in an in-person meeting involving voting on 30 questions by 47 delegates on May 8–10, 2025, in Istanbul, Turkey. Following the voting process, the Biofilm Section formed three workgroups (Biofilm Basic Science, Biofilm Treatment, and Research Priorities) to interpret the results and disseminate the findings in Consensus Articles that highlight priorities. The following is the summation of the Biofilm Treatment Workgroup, which aims to shape future pre-clinical MSKI research directions and grant funding with respect to: (1) elevating scientific rigor to ensure reproducibility and high-quality data in preclinical research; (2) transitioning mature therapeutic concepts into rigorous in vivo models to definitively prove their clinical feasibility; and (3) accelerating the development of novel molecular targets and advanced drug-delivery systems. Finally, the workgroup acknowledged a critical shift in the funding landscape. As government support faces future challenges, there is an urgent need for increased investment from industry and philanthropic partners. Such support is essential to develop effective treatments for serious orthopedic infections and to improve outcomes for patients facing life-altering illnesses.</p>","PeriodicalId":16650,"journal":{"name":"Journal of Orthopaedic Research®","volume":"44 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jor.70169","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147326360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal Density and Volume Changes of Periacetabular Cancellous and Cortical Bone","authors":"Thomas Robertson,&nbsp;Xiangyu Dong,&nbsp;John Abrahams,&nbsp;Bogdan Solomon,&nbsp;Rob Nelissen,&nbsp;Stuart Callary","doi":"10.1002/jor.70167","DOIUrl":"10.1002/jor.70167","url":null,"abstract":"<p>Longitudinal structural bone changes within the periacetabular region have potential implications for fracture risk as well implant or arthroplasty fixation within the pelvis. This study presents the first CT-based longitudinal quantitative measurements of bone density and volume in a total of 235 patients. Each patient had a repeat pelvic CT performed &gt; 10 years apart for various indications in South Australia's public hospitals. All slices of each scan were segmented and calibrated with Simpleware software. Cortical and cancellous bone density and volume were measured in defined periacetabular regions of interest. Pelvic bone volume remained constant with increase in age, but the volume of cortical bone decreased whilst the cancellous volume increased. Conversely, the density of cancellous bone decreased whilst cortical bone density increased with age. The patterns of bone loss correlate to bone remodeling due to preferential superomedial loading of the hip. The results also confirm reduced bone density of the anterior column with increasing age in keeping with susceptibility of the geriatric patient to anterior column acetabular fractures. The overall findings show that with time the periacetabular region develops a sclerotic thinner wall, which may be susceptible to fracture and when combined with reduced cancellous bone density potentially less amenable to implant fixation.</p>","PeriodicalId":16650,"journal":{"name":"Journal of Orthopaedic Research®","volume":"44 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12949342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147317270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Molecular Mechanisms of Rotator Cuff Degeneration Identified by Spatial Transcriptomics and Multiplex Immunofluorescence","authors":"Shiyi Yao,&nbsp;Renhao Yang,&nbsp;Shifeng Ling,&nbsp;Gen Li,&nbsp;Hanyu Wang,&nbsp;Renxuan Li,&nbsp;Yang Xu,&nbsp;Yin Zhang,&nbsp;Chengyu Zhuang,&nbsp;Lei Wang","doi":"10.1002/jor.70163","DOIUrl":"10.1002/jor.70163","url":null,"abstract":"<p>Rotator cuff tear (RCT) is a prevalent age-related condition whose underlying mechanisms remain poorly understood. This study employed spatial transcriptomics and multiplex immunofluorescence (mIF) to investigate gene expression and spatial heterogeneity in rotator cuff tissues from elderly RCT patients compared to age-matched controls, aiming to uncover key molecular pathways. Tendon samples were collected from RCT patients (<i>n</i> = 10) and controls (<i>n</i> = 10). Five from each group underwent spatial transcriptomic sequencing for differential gene expression, functional enrichment, and cell interaction analyzes. Results were validated with mIF on the remaining samples. Compared to controls, the RCT group showed 1261 downregulated and 2789 upregulated genes. Spatial analysis revealed distinct expression gradients: COMP and CHI3L1 were upregulated in the bone region, CHI3L1 and MT1X in the mid-tendon, and MT1X and FMOD in the tendon area—confirmed by mIF. Biological processes also varied regionally: cartilage development and extracellular matrix (ECM) organization were enriched in the bone, while ECM and collagen fibril organization dominated mid-tendon and tendon regions. The PI3K-AKT and ECM-receptor interaction pathways were central to these processes. Tenogenic progenitor-like cells (TPLCs) were significantly reduced in RCT (<i>p</i> &lt; 0.0001), whereas mesenchymal cells increased in bone and mid-tendon areas (<i>p</i> &lt; 0.001, <i>p</i> &lt; 0.01), consistent with structural gradients. These findings suggest that elderly RCT may arise from chronic inflammation, ECM dysregulation, and failed regeneration. Spatial transcriptomics identified repair-related genes (COMP, CHI3L1, MT1X, FMOD) with region-specific expression, providing new insights into pathology and potential therapeutic targets.</p>","PeriodicalId":16650,"journal":{"name":"Journal of Orthopaedic Research®","volume":"44 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12954832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147317248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fluorapatite-Coated Percutaneous Osseointegrated Prostheses Limit Epidermal Downgrowth and Promote Periprosthetic Healing in a Weight-Bearing Sheep Model—A Preliminary Study","authors":"Samantha K. Steyl,&nbsp;James P. Beck,&nbsp;Jill Shea,&nbsp;Ruben Sundramurti,&nbsp;David Rou,&nbsp;Kent N. Bachus,&nbsp;Jay Agarwal,&nbsp;Sujee Jeyapalina","doi":"10.1002/jor.70170","DOIUrl":"10.1002/jor.70170","url":null,"abstract":"<p>Percutaneous osseointegrated (OI) devices offer an advanced alternative to socket prosthetic suspension systems for amputees but can face clinical limitations due to complications at the skin-implant interface. Titanium (Ti) and its alloys, though mechanically suitable and promoting osseointegration, are unable to support epidermal cell adhesion, leading to chronic wounds, sinus tract formation, and infections. To improve epidermal tissue integration, this study explored the use of fluorapatite (FA)—a natural tooth mineral known to allow epithelial adhesion through hemidesmosomes. It was hypothesized that FA-coated Ti surfaces would enhance epidermal cell attachment, promote wound healing, and prevent epithelial downgrowth. To test this idea, FA-coated Ti devices were implanted into the transected fused 3–4 metacarpals of five sheep and evaluated at 12 weeks post-implantation. The results revealed that FA-coatings significantly improved healing outcomes and limited epithelial migration along the implant surface. These findings support FA as a promising strategy for promoting a biological seal around percutaneous implants.</p>","PeriodicalId":16650,"journal":{"name":"Journal of Orthopaedic Research®","volume":"44 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12949347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147317239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A New Normative Zone for Acetabular Anteversion Positioning in ASD Patients","authors":"Marc Boutros,&nbsp;Ayman Assi,&nbsp;Bassel G. Diebo,&nbsp;Gilles Prince,&nbsp;Mohammad Karam,&nbsp;Mohammad Daher,&nbsp;Christopher P. Ames,&nbsp;Shay Bess,&nbsp;Alan H. Daniels,&nbsp;Munish C. Gupta,&nbsp;Richard Hostin,&nbsp;Han Jo Kim,&nbsp;Eric O. Klineberg,&nbsp;Lawrence G. Lenke,&nbsp;Pierce D. Nunley,&nbsp;Peter G. Passias,&nbsp;Frank J. Schwab,&nbsp;Christopher I. Shaffrey,&nbsp;Justin S. Smith,&nbsp;Renaud Lafage,&nbsp;Virginie Lafage,&nbsp;International Spine Study Group","doi":"10.1002/jor.70171","DOIUrl":"10.1002/jor.70171","url":null,"abstract":"<div>\u0000 \u0000 <p>Adult spinal deformity patients undergoing total hip arthroplasty experience higher hip dislocation rates than those with normal spinal alignment. The traditional Lewinnek safe zone does not account for spinopelvic variation such as pelvic retroversion. To address this, three patient-specific normative zones for acetabular anteversion were defined. A multicenter retrospective analysis of 146 adult spinal deformity patients and 47 asymptomatic controls was performed using three-dimensional biplanar radiograph reconstructions to measure spinopelvic alignment and acetabular orientation. Normative Zone 1, for patients not undergoing spinal realignment, was delineated by the 95% confidence interval limits: minimum anteversion = 0.3182 × pelvic tilt +2.947 and maximum anteversion = 0.3317 × pelvic tilt +25.823. Normative Zone 2, for patients following spinal realignment, was based on pelvic incidence: minimum anteversion = 0.0682 × pelvic incidence +9.7749 and maximum anteversion = 0.0698 × pelvic incidence +21.5218. Normative Zone 3, intended for cases with uncertain spinal correction plans, was defined as the intersection of Zones 1 and 2, yielding a narrower target anteversion range. These zones enable patient-specific cup placement that accounts for existing or planned spinal alignment, with the potential to reduce dislocation risk.</p>\u0000 <p><b>Clinical Significance:</b> This study provides acetabular cup orientation tailored to each patient's spinopelvic alignment and surgical plan, potentially reducing dislocation rates in spinal malalignment patients.</p>\u0000 </div>","PeriodicalId":16650,"journal":{"name":"Journal of Orthopaedic Research®","volume":"44 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147317307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}