Journal of Orthopaedic Science最新文献

{"title":"Platelet-rich plasma in the treatment of delayed union and nonunion fractures: An umbrella meta-analysis","authors":"Jinqiang Zhu ,&nbsp;Dunhu Han ,&nbsp;Yuanyuan Sun ,&nbsp;Chunzeng Zhao","doi":"10.1016/j.jos.2024.10.015","DOIUrl":"10.1016/j.jos.2024.10.015","url":null,"abstract":"<div><h3>Background</h3><div>Long bone fractures may exhibit nonunion/delayed union and the precise mechanism underlying this devastating condition remain unknown. More recently, a series of meta-analyses have examined the effect of local administration of platelet-rich plasma (PRP) in patients suffering from nonunion/delayed union fractures; however, the conclusions of available meta-analyses have remained debatable. This umbrella meta-analysis was performed to synthesize and recalculate available evidence to assess the certainty of the effect of PRP on nonunion/delayed union fractures.</div></div><div><h3>Methods</h3><div>Relevant meta-analyses and individual studies investigating the effect of PRP therapy on nonunion/delayed union fractures were obtained through a systematic search in PubMed, Web of Knowledge, and Scopus up to November 2023. Meta-analyses were re-conducted for healing rate and healing time using a random effects model. The methodology quality of the included meta-analyses and the quality of evidence was assessed using the AMSTAR2 and GRADE criteria, respectively.</div></div><div><h3>Results</h3><div>A total of 5 meta-analyses with 13 individual studies, comprising 1362 patients, were included. The analysis revealed a significant improvement in both healing rate (relative risk (RR) = 1.30, 95%CI: 1.06 to 1.60) and healing time (mean difference (MD): −1.25, 95 % CI: −2.09 to −0.42) of nonunion/delayed union fractures. However, when individual studies were pooled, PRP was not effective in increasing the healing rate, while it was effective in reducing healing time (MD = −2.15, 95 % CI = −3.17 to −1.13). PRP therapy had no significant effect on pain improvement and the Excellent/Good Posttreatment Limb Function. The risk of the adverse side effects was not significant.</div></div><div><h3>Conclusion</h3><div>This umbrella meta-analysis revealed that PRP may reduce healing time in patients with nonunion/delayed union fractures, with no potential side effects. This finding is needed to be confirmed by further studies.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 5","pages":"Pages 894-904"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142687070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reproducibility of dynamic balance and anterior tibiofibular gap measurements in men and women: A menstrual cycle-based longitudinal study","authors":"Rami Mizuta ,&nbsp;Noriaki Maeda ,&nbsp;Tsubasa Tashiro ,&nbsp;Miki Kawai ,&nbsp;Sakura Oda ,&nbsp;Ayano Ishida ,&nbsp;Rurina Yoshiara ,&nbsp;Satoshi Arima ,&nbsp;Yukio Urabe","doi":"10.1016/j.jos.2024.11.008","DOIUrl":"10.1016/j.jos.2024.11.008","url":null,"abstract":"<div><h3>Background</h3><div><span>The reproducibility of dynamic balance is an essential component of athletic performance and injury<span> prevention, although it is affected by sex differences. This study aimed to confirm the reproducibility of repeated dynamic balance measurements and </span></span>ultrasonography assessments of the anterior tibiofibular gap that may contribute to changes in dynamic balance for each sex.</div></div><div><h3>Methods</h3><div><span>This was a longitudinal study involving 48 feet, with 12 men and 12 women. Measurements for men were obtained four times, approximately once a week, and for women, once during each of the four periods of the </span>menstrual cycle<span> (menstrual, follicular, ovulation, and luteal phases). The measures included dynamic balance in a single-leg jump with forward landing and the anterior tibiofibular gap measurement in standing and sitting positions; rate of change in the anterior tibiofibular gap was calculated from the values in standing and sitting positions.</span></div></div><div><h3>Results</h3><div>The intraclass correlation coefficient for dynamic balance was excellent for men at 0.936 (0.881–0.969) and good for women at 0.843 (0.708–0.925). Regarding the anterior tibiofibular gap, the intraclass correlation coefficient for standing and sitting were 0.999 (0.997–0.999) and 0.998 (0.996–0.999), respectively, in men; and 0.976 (0.955–0.988) and 0.991 (0.984–0.996), respectively, in women, with excellent values for both sexes. Whereas no significant changes in dynamic balance and rate of change in the anterior tibiofibular gap were observed in the four measurements in men (p &gt; 0.05), there was a significant variation in women (p &lt; 0.05).</div></div><div><h3>Conclusions</h3><div><span>While reproducibility of dynamic balance and anterior tibiofibular gap measurements was high overall, it was lower in women than in men. Women exhibited variations in these measurements during each period of the menstrual cycle, peaking during ovulation. Recognizing these fluctuations could inform injury </span>prevention strategies tailored to sex-specific differences in dynamic balance and ligament extensibility.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 5","pages":"Pages 844-849"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-intensity strength training improves mobility in patients after hip fracture: A meta-analysis of randomized controlled trials","authors":"Fengfei Lin ,&nbsp;Bin Chen ,&nbsp;Ke Zheng ,&nbsp;Chaohui Lin","doi":"10.1016/j.jos.2024.11.009","DOIUrl":"10.1016/j.jos.2024.11.009","url":null,"abstract":"<div><h3>Background</h3><div>Hip fracture affects millions of persons and is associated with excess morbidity and mortality. More knowledge is needed to regard the prolonged effects of intensive exercise in relatively frail hip fracture patients. In this meta-analysis, we want to determine whether intensity strength training in patients after hip fracture is superior to general exercises in improving physical function.</div></div><div><h3>Methods</h3><div><span>We searched electronic literature databases, including Pubmed, Cochrane, MEDLINE, Google Scholar, and Embase from inception to November 2023 for </span>randomized controlled trials<span> (RCTs) comparing training group with control group in patients after hip fracture. The primary endpoint of this meta-analysis was Berg balance scale (BBS). The secondary outcomes were Short-Form 36 physical function score (SF-36 physical function score) and Six-minute walk test (6MWT).</span></div></div><div><h3>Results</h3><div>We included 7 RCTs with a total of 665 patients. The BBS and SF-36 physical function score were significantly better in the training group (MD = 4.45, 95%CI 1.47 to 7.43, Z = 2.93, P = 0.003) and (MD = 16.31, 95%CI 4.92 to 27.69, Z = 2.81, P = 0.005) respectively. The result showed that the 6MWT was significantly longer in the training group (MD = 83.32, 95%CI 46.73 to 119.91, Z = 4.46, P &lt; 0.00001).</div></div><div><h3>Conclusions</h3><div>Our meta-analysis shows that intensity strength training, including strength training, balance task-specific training, and upper-body exercise training in patients after hip fracture, is superior to general exercises in improving BBS, SF-36 physical function score and 6MWT.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 5","pages":"Pages 913-921"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is the appropriate revascularisation approach in traumatic popliteal artery injury?","authors":"Yuta Izawa,&nbsp;Kentaro Futamura,&nbsp;Masahiro Nishida,&nbsp;Masayuki Hasegawa,&nbsp;Takafumi Suzuki,&nbsp;Kanako Tsuihiji,&nbsp;Yoshihiko Tsuchida","doi":"10.1016/j.jos.2024.11.001","DOIUrl":"10.1016/j.jos.2024.11.001","url":null,"abstract":"<div><h3>Background</h3><div>Popliteal artery injury<span> (PAI) is sometimes accompanied by proximal tibial fracture<span> or knee dislocation<span>. We hypothesized that revascularisation approach should be selected depending on the associated injury. The purpose of this study is to propose revascularisation approach that does not interfere with definitive surgery.</span></span></span></div></div><div><h3>Methods</h3><div>Patients with PAI who were treated between 2013 and 2023 were included. Associated injuries, revascularisation approach, and skin incision for the definitive surgery were investigated. We investigated whether varus-valgus instability remained as an outcome.</div></div><div><h3>Results</h3><div>21 limbs with PAI were included. There were 6 cases with proximal tibial fracture. Medial incision was used in 2 cases and crank shaped incision in 4 cases. In 4 cases of crank shaped incision, osteosynthesis was performed through a crank shaped incision. There were 8 cases with knee dislocation. Medial incision was used in 1 case, S shaped incision in 4 cases, and crank shaped incision in 3 cases. In cases of S shaped incision, extra-articular ligament was repaired through independent incisions. In three cases of crank shaped incision, it was not possible to repair extra-articular ligament because of interfere with the initial incision. As a result, knee joint instability remained. There were 7 cases without proximal tibial fracture or knee dislocation. Medial incision was used in 1 case, S shaped incision in 3 cases, and crank shaped incision in 3 cases. There was no interference between the incisions for revascularisation and for definitive surgery.</div></div><div><h3>Conclusion</h3><div>For PAI, revascularisation approaches should be selected depending on the associated injury.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 5","pages":"Pages 905-912"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of cancer multigene panel testing for osteosarcoma in pediatric and adults using the center for cancer genomics and advanced therapeutics database in Japan","authors":"Yoshiyuki Suehara ,&nbsp;Rina Kitada ,&nbsp;Satoshi Kamio ,&nbsp;Koichi Ogura ,&nbsp;Shintaro Iwata ,&nbsp;Eisuke Kobayashi ,&nbsp;Akira Kawai ,&nbsp;Shinji Khosaka","doi":"10.1016/j.jos.2024.10.016","DOIUrl":"10.1016/j.jos.2024.10.016","url":null,"abstract":"<div><h3>Background</h3><div><span>Osteosarcoma (OS) is the most common primary malignant bone tumor. Despite advances in </span>multimodal chemotherapy, prognosis for metastatic or recurrent OS remains poor. Next-generation sequencing (NGS) can uncover new therapeutic options by identifying potentially targetable alterations. This study analyzed NGS data from the Center for Cancer Genomics and Advanced Therapeutics (C-CAT) database in Japan, comparing findings with the Memorial Sloan–Kettering-Integrated Mutation Profiling of Actionable Cancer Targets (MSK-IMPACT) data from the United States.</div></div><div><h3>Methods</h3><div><span>We sequenced tumor and/or germline<span> DNA from 223 high-grade OS samples using the FoundationOne® CDx or OncoGuideTM NCC Oncopanel System, and the FoundationOne® Liquid CDx for multigene panel testing (2019–2023). Genomic alterations were interpreted using the Cancer Knowledge Database (CKDB), with potentially actionable </span></span>genetic events categorized into A-F levels.</div></div><div><h3>Results</h3><div><span><span>Analysis of 223 high-grade OS samples revealed 1684 somatic mutations in 167 genes and 1114 copy number alterations in 89 genes. Potentially actionable alterations were identified in 94 patients (42.2 %) at CKDB Levels A-C. These included 2 cases with </span>NTRK fusions (0.9 %; Level A), one case with TMB-high (0.4 %; Level A), 3 with ERBB amplifications (1.3 %; Level B), and 88 cases (39.5 %) with alterations such as </span><em>CDK4</em> amplification, <em>PTEN</em> deletion/mutation, and others (Level C). Co-occurring amplifications of <em>KIT</em>, <em>KDR</em>, and <span><em>PDGFRA</em></span> at the 4q12 locus were found in 8 cases (3.6 %), while VEGFA and <em>CCND3</em><span> co-amplifications at the 6p12-21 locus were seen in 33 cases (14.8 %). These gene amplifications, also reported in US studies, are targetable by multi-kinase inhibitors, although the C-CAT cohort's profiles differed from US cohorts like MSK-IMPACT.</span></div></div><div><h3>Conclusions</h3><div><span>Precision medicine for rare tumors still poses challenges. In this Japanese cohort, 42.2 % of high-grade OSs had potentially actionable alterations per CKDB. Concurrent gene amplifications of </span><em>KIT</em>, <em>KDR</em>, and <em>PDGFRA</em> at 4q12, and <em>VEGFA</em> and CCND3 at 6p12-21, might offer promising therapeutic options for patients with recurrent/metastatic OS resistant to conventional chemotherapy.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 5","pages":"Pages 946-953"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142676024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on Mehmet et al.: Relationship between systemic immune inflammation index and amputation in patients with diabetic foot ulcer","authors":"Xiaohua Jiang,&nbsp;Yabin Liu,&nbsp;Guowu Chen","doi":"10.1016/j.jos.2024.08.006","DOIUrl":"10.1016/j.jos.2024.08.006","url":null,"abstract":"","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 5","pages":"Pages 974-975"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation between medial meniscus degenerative tears and medial meniscus extrusion and dynamics using ultrasonography","authors":"Kazuki Asai ,&nbsp;Junsuke Nakase ,&nbsp;Yosuke Shima ,&nbsp;Kenichi Goshima ,&nbsp;Kazunari Kuroda ,&nbsp;Takeshi Oshima ,&nbsp;Mitsuhiro Kimura ,&nbsp;Kengo Shimozaki ,&nbsp;Tomoyuki Kanayama ,&nbsp;Naoki Takemoto ,&nbsp;Manase Nishimura ,&nbsp;Satoru Demura","doi":"10.1016/j.jos.2024.12.008","DOIUrl":"10.1016/j.jos.2024.12.008","url":null,"abstract":"<div><h3>Background</h3><div><span>Evaluating the correlation between degenerative meniscus tears and </span>medial meniscus<span><span> extrusion is necessary to determine the appropriate treatment plan for early-stage knee osteoarthritis<span><span>. This study evaluated the relationship between degenerative meniscal tears and medial meniscus extrusion in early-stage knee </span>osteoarthritis by using </span></span>ultrasonography.</span></div></div><div><h3>Methods</h3><div><span>A total of 132 knees from 123 patients with early-stage knee osteoarthritis were evaluated retrospectively. Medial meniscus extrusion at knee flexion angles of 0° and 90°, and meniscal degenerative tears, were evaluated using </span>ultrasonography<span> and magnetic resonance imaging. Medial meniscus extrusion was classified into four grades, while degenerative meniscal tears were categorized into five types as follows: type 0, no tear or only degenerative changes; type 1, horizontal tear only in the posterior segment of the medial meniscus; type 2, horizontal tear shown in both the posterior and middle segments of the medial meniscus; type 3, flap tear or maceration of the medial meniscus; type 4, medial meniscus posterior root tear or radial tear. Correlations between the type of meniscal tear and the medial meniscus extrusion grade in each meniscal tear group were evaluated.</span></div></div><div><h3>Results</h3><div>The meniscal tear type was significantly correlated with the medial meniscus extrusion grade (r = 0.518, p = 0.001). The percentages of cases with medial meniscus extrusion grade 2 or 3 (i.e., medial meniscus extrusion &gt;3 mm at knee flexion angle of 0°) were 23.8 %, 50.0 %, 86.8 %, 94.1 %, and 92.3 % for types 0–4, respectively. The percentages of cases with medial meniscus extrusion &gt;3 mm at knee flexion angles of 0° and 90° were 0 %, 20.0 %, 52.6 %, 70.6 %, and 50.0 % for types 0–4, respectively.</div></div><div><h3>Conclusion</h3><div>The more severe the meniscal degenerative tear, the greater the medial meniscus extrusion and the more abnormal the dynamics in early-stage knee osteoarthritis.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 5","pages":"Pages 850-855"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An alternative choice for overweight pediatric patient with femoral shaft fracture when rigid nail is contraindicated due to narrow intramedullary canal: Elastic stable intramedullary nail plus temporary external fixator","authors":"Xin Tang ,&nbsp;Jiaxin Liang ,&nbsp;Baowen Zhang ,&nbsp;Saroj Rai ,&nbsp;Qingyi Hu ,&nbsp;Yan Zou ,&nbsp;Pan Hong","doi":"10.1016/j.jos.2025.01.002","DOIUrl":"10.1016/j.jos.2025.01.002","url":null,"abstract":"<div><h3>Background</h3><div>Length unstable femoral shaft fractures in school-aged children usually demand surgical treatment, but the optimal choice remains controversial, especially in overweight adolescents. This study aimed to compare the clinical results of locking compression plates (LCP) and elastic stable intramedullary nails (ESIN) combined with temporary external fixator (TEF) in school-aged children weighing over 50 kg.</div></div><div><h3>Methods</h3><div>Between January 2010 and January 2018, children over 50 kg with length unstable femoral shaft fracture treated with ESIN &amp; EF in the authors’ institute were included in this study. Adolescent patients with matched age, sex, body weight and fracture type receiving LCP were retrieved from hospital database. The Flynn Score System was used to evaluate the clinical outcomes of treatments at the last follow-up.</div></div><div><h3>Results</h3><div>A total of 30 young children aged 10–14 years were included. Fifteen patients (9 male and 6 female) received ESIN &amp; EF treatment, while the other fifteen (9 male and 6 female) received LCP treatment. All patients were followed up for more than 12 months post-surgery (14–26 months). In all, less operation time, less estimated blood loss and shortened hospital stay (P &lt; 0.001), faster union time (P = 0.031) were observed in ESIN &amp; EF group, compared with the Plating group. All surgeries in the ESIN &amp; EF group were performed without exposing the fracture site. In contrast, 60 % (9/15) of the surgeries in the Plating group were performed with the fracture site exposed. Every patient scored satisfactory or excellent on the Flynn Score System without major complications demanding revision surgeries.</div></div><div><h3>Conclusions</h3><div>ESIN plus EF produces satisfactory clinical outcome for overweight pediatric patients with femoral shaft fracture when rigid nail is contraindicated due to narrow medullary canal.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 5","pages":"Pages 941-945"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delirium following total hip or knee arthroplasty: A retrospective, single-center study","authors":"Takenori Tomite ,&nbsp;Hidetomo Saito ,&nbsp;Hiroaki Kijima ,&nbsp;Yuji Hatakeyama ,&nbsp;Hiroshi Tazawa ,&nbsp;Toru Wachi ,&nbsp;Naohisa Miyakoshi (professor)","doi":"10.1016/j.jos.2024.11.006","DOIUrl":"10.1016/j.jos.2024.11.006","url":null,"abstract":"<div><h3>Background</h3><div>Delirium is a postoperative complication<span><span> that may occur in older patients. This study aimed to investigate the incidence of postoperative delirium and its risk factors in patients who had undergone total hip </span>arthroplasty<span> (THA) or total knee arthroplasty (TKA). Few reports have addressed the occurrence of delirium when different methods of pain control are used following total joint arthroplasty, and, therefore, whether its incidence varied depending on differences in pain control was investigated.</span></span></div></div><div><h3>Methods</h3><div>The study included 500 patients (250 cases of THA and 250 of TKA). They were divided into two groups according to the occurrence of postoperative delirium<span>, and risk factors for delirium (patient factors and operative factors) were investigated. As pain control, all patients were given a Ranawat cocktail injection, with the concomitant use of one of epidural anesthesia, nerve block, or intravenous patient-controlled analgesia (IVPCA), and the occurrence of delirium in patients using each method was investigated.</span></div></div><div><h3>Results</h3><div>On univariate analysis<span><span><span>, advanced age, low serum albumin, </span>nonbenzodiazepine use, and anti-parkinsonian drug use were identified as patient factors, and low postoperative minimum hemoglobin, non-use of epidural anesthesia, and non-use of nerve block were identified as operative factors associated with a significantly higher incidence of delirium. A receiver-operating characteristic curve was created for age and delirium, and the cutoff age was 77 years. On binomial </span>logistic regression analysis for age ≥77 years, epidural anesthesia, IVPCA, and nerve block, the only factor associated with the occurrence of delirium was age, irrespective of the type of pain relief used, and the odds ratio for the occurrence of delirium at age ≥77 years was 4.64.</span></div></div><div><h3>Conclusions</h3><div>To prevent delirium following total joint arthroplasty, it is important to improve anemia and nutritional status, check and manage regular medications, and provide appropriate pain control while avoiding opioid use.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 5","pages":"Pages 837-843"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of cirrhosis severity with outcomes after hip fracture repairs: A propensity-score matched analysis using a large inpatient database","authors":"Osamu Hamada ,&nbsp;Takahiko Tsutsumi ,&nbsp;Ayako Tsunemitsu ,&nbsp;Noriko Sasaki ,&nbsp;Susumu Kunisawa ,&nbsp;Kiyohide Fushimi ,&nbsp;Yuichi Imanaka","doi":"10.1016/j.jos.2025.01.006","DOIUrl":"10.1016/j.jos.2025.01.006","url":null,"abstract":"<div><h3>Background</h3><div>Advanced cirrhosis is associated with increased mortality in certain surgeries, but the impact of cirrhosis severity on outcomes in patients with hip fractures remains unclear.</div></div><div><h3>Methods</h3><div>In a large nationwide administrative database of hospitalized patients, we compared postoperative outcomes in patients with hip fractures across different Child-Pugh classes of cirrhosis in Japan. Using the Japanese Diagnosis Procedure Combination Database, we identified 833,648 eligible patients diagnosed with hip fractures and underwent surgery between July 2010 and March 2021. Three sets of 1:1 propensity-score matching were performed for four groups: non-cirrhosis cases and Child-Pugh classes A, B, and C. We compared in-hospital mortality, length of stay, hospitalization fees, readmission, and complications in non-cirrhosis cases vs. Child-Pugh class A, Child-Pugh class A vs. B, and Child-Pugh class B vs. C.</div></div><div><h3>Results</h3><div>Propensity-score matching created 1065 pairs for non-cirrhosis vs. Child-Pugh class A, 1012 for Child-Pugh class A vs. B, and 489 for Child-Pugh class B vs. C. In-hospital mortality did not differ between non-cirrhosis cases and those with Child-Pugh class A. However, in-hospital mortality was significantly higher in patients with Child-Pugh class B than in those with class A (1.5 % vs. 5.9 %; RD 4.45 %; 95 % CI: 2.79%–6.10 %), and higher in patients with Child-Pugh class C compared with class B (6.3 % vs. 28.4 %; RD 22.09 %; 95 % CI: 17.54%–26.63 %). Patients in more severe Child-Pugh classes had longer hospital stays, higher hospitalization fees, and higher complication rates.</div></div><div><h3>Conclusion</h3><div>Patients with hip fractures and cirrhosis who are at high risk of poor postoperative outcomes could be identified. This study highlights the significantly higher in-hospital mortality observed in patients with Child-Pugh class C cirrhosis undergoing hip fracture surgery compared to those with class B. These findings underscore the need for careful risk-benefit discussions, considering the severity of cirrhosis, surgical risks, and care goals for each patient.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 5","pages":"Pages 933-940"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}