Orthopaedic Surgery最新文献

{"title":"Robotic-Arm Assisted Direct Anterior Approach Total Hip Arthroplasty Facilitates Tensor Fasciae Latae Preservation and Early Functional Recovery in Obese Patients.","authors":"Shijie Chen, Dasheng Lin, Huihuang Chen, Wentao Lin, Dongmin Xu, Eryou Feng","doi":"10.1111/os.70444","DOIUrl":"10.1111/os.70444","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the efficacy and safety of robotic-arm assisted (RA) direct anterior approach (DAA) total hip arthroplasty (THA) in facilitating tensor fasciae latae (TFL) preservation and subsequent functional recovery, and to explore the correlation between TFL preservation and postoperative inflammation, pain, and early functional recovery in obese patients.</p><p><strong>Methods: </strong>We retrospectively reviewed 69 obese patients (BMI ≥ 30 kg/m<sup>2</sup>) undergoing primary DAA-THA from September 2023 to December 2024 with 12-month follow-up. Surgical procedures were performed by RA technology in 31 patients (RA group) and manual technology in 38 patients (M group). Demographic characteristics, perioperative parameters, TFL injury index, unsupported ambulation duration, creatine kinase (CK), C-reactive protein (CRP), Visual Analog Scale scores (VASs), Harris Hip Scores (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Forgotten Joint Score-12 (FJS-12), radiologic measurements, and complications were retrieved from patients. Student's t-test and Mann-Whitney U test were used to compare continuous data. Fisher test and Chi-square test were used to compare the categorical data. Longitudinal data were evaluated by generalized estimating equations. The relationships between TFL injury index and early clinical outcomes were evaluated using Spearman's correlation analysis.</p><p><strong>Results: </strong>Baseline demographic characteristics of both groups were comparable. RA group demonstrated significantly lower TFL injury index (18.05 [IQR 14.51-30.05] % vs. 38.31 [IQR 20.58-50.70] %, p = 0.001) and shorter unsupported ambulation duration (3.00 [IQR 2.00-4.00] week vs. 5.00 [IQR 3.00-6.00] week, p < 0.001) compared to M group. Besides, TFL injury index showed a strong positive correlation with unsupported ambulation duration (ρ = 0.775) (p < 0.001). Compared to M group, RA group significantly reduced CK, CRP, and VASs at the initial 72 h postoperatively (all p < 0.05). RA group exhibited significantly superior HHS, WOMAC, and FJS-12 compared to M group at postoperative 1 month (all p < 0.01). TFL injury index demonstrated strong positive correlations with CK (ρ = 0.619), CRP (ρ = 0.628), and VASs (ρ = 0.652) at postoperative 72 h (all p < 0.001). Furthermore, it showed a strong negative correlation with HHS (ρ = -0.615) and FJS-12 (ρ = -0.759), and moderate positive correlations with WOMAC-pain (ρ = 0.410) and WOMAC-function (ρ = 0.583) at postoperative 1 month (all p < 0.001). Despite longer operative duration in RA group, it exhibited a significantly higher proportion of acetabular components positioned within the Lewinnek safe zone and a significantly lower incidence of incision-related adverse events compared to M group (all p < 0.05).</p><p><strong>Conclusion: </strong>In obese patients undergoing DAA-THA, RA technology significantly reduced intraoperative injury t","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding Chronic Hip Pain Through the ICF Framework: Implications for Assessment, Diagnosis, and Management.","authors":"Mingke You, Kai Zhou, Xi Chen, Xue Zhang, Jian Li, Gang Chen","doi":"10.1111/os.70416","DOIUrl":"10.1111/os.70416","url":null,"abstract":"<p><p>Chronic hip pain is a prevalent musculoskeletal condition that can impair mobility, physical function, participation, and quality of life. Traditional assessment and management approaches often emphasize structural abnormalities and symptom control, but these approaches may not fully capture the broader functional, psychosocial, and contextual impact of chronic hip pain. The International Classification of Functioning, Disability and Health (ICF) provides a multidimensional framework for understanding health conditions through body structures and functions, activity and participation, and contextual factors. This scoping review aimed to synthesize recent evidence on chronic hip pain using the ICF framework and to clarify how this framework may inform assessment, diagnostic reasoning, and treatment planning. A literature search was conducted in PubMed, Embase, and Ovid for studies published between January 1, 2020, and December 31, 2025. Original studies related to chronic hip pain or hip-related chronic pain were included and classified according to ICF-related domains, including structures and functions, activity and participation, personal factors, and environmental factors. A total of 39 studies were included. A total of 19 studies, accounting for 48.7% of the included literature, were classified under structures and functions. These studies mainly addressed structural abnormalities, pain mechanisms, clinical assessment, pharmacological treatment, interventional procedures, and other symptom-oriented interventions. A total of 11 studies were classified under activity and participation, focusing on movement performance, functional activities, physical activity, quality of life, and community-based outcomes. Seven studies examined personal factors, including psychological status, sleep quality, opioid use, race, and pain management strategies. Only two studies addressed environmental factors, mainly involving community-based care and online education. Overall, current research on chronic hip pain remains predominantly focused on body-level impairments and symptom management, whereas participation-level outcomes and environmental factors are comparatively underrepresented. The ICF framework offers a useful structure for integrating structural findings with functional limitations, psychosocial factors, and contextual influences. Applying this framework may support more comprehensive assessment, clinically meaningful diagnostic reasoning, and individualized treatment planning for people with chronic hip pain. Future studies should place greater emphasis on participation and environmental factors to better inform patient-centered rehabilitation and long-term management.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13649625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidimensional Management of Degenerative Scoliosis: A Comprehensive Narrative Review Integrating Diagnostic Assessment, Surgical Decision-Making, and Patient-Centered Outcomes.","authors":"Yaobin Wang, Xingyu Zhao, Kai Wang, Zhenlei Liu, Lei Zhang, Shanhang Jia, He Wang, Weikang Zhang, Yuhua Yang, Tong Xu, Hao Wu","doi":"10.1111/os.70451","DOIUrl":"10.1111/os.70451","url":null,"abstract":"<p><p>Degenerative scoliosis (DS) is a common spinal deformity in aging populations and an important contributor to low back pain, neurological symptoms, and functional decline. Unlike adolescent idiopathic scoliosis, DS develops in a previously non-scoliotic spine through progressive asymmetric degeneration of the intervertebral disks, facet joints, and supporting spinal structures. Despite its growing clinical burden, management remains heterogeneous, with decision-making often fragmented across radiographic assessment, treatment planning, and postoperative outcome evaluation. Building on previous reviews of DS, this article provides a structured clinical update that organizes contemporary evidence across diagnostic assessment, individualized treatment selection, perioperative risk optimization, and patient-centered outcomes. A narrative literature review was conducted to evaluate current concepts in DS diagnosis, risk stratification, treatment strategies, and patient-centered outcomes. Relevant literature from major biomedical databases was identified and qualitatively synthesized according to clinical relevance. Current evidence supports a comprehensive assessment of DS that integrates deformity morphology, spinopelvic alignment, segmental degeneration, neurological status, bone quality, and patient-specific risk factors. Beyond coronal Cobb angle measurement, advanced imaging and alignment parameters may provide complementary information for phenotyping and treatment planning. The literature increasingly supports individualized treatment selection based on deformity severity, sagittal imbalance, physiological reserve, neurological status, and functional goals, with options ranging from nonoperative care to minimally invasive or more extensive reconstructive procedures. Surgical planning may also incorporate alignment objectives, biomechanical considerations, complication risk, frailty, and patient-reported outcomes. DS management is evolving from deformity correction-centered strategies toward a multidimensional, patient-centered paradigm. This narrative review synthesizes current evidence across diagnostic evaluation, individualized treatment selection, surgical planning, and outcome assessment while recognizing that many management strategies remain supported by heterogeneous evidence and require patient-specific consideration. Future research is needed to refine predictive models, personalized alignment strategies, and emerging technology-assisted approaches.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13649347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Duloxetine on the Perioperative Anxiety Status and Stress Response Following Total Hip Arthroplasty: A Randomized Controlled Trial.","authors":"Bohua Li, Manxue Zhang, Qianhao Li, Lijun Cai, Liyile Chen, Xiaobing Pu, Pengde Kang","doi":"10.1111/os.70436","DOIUrl":"10.1111/os.70436","url":null,"abstract":"<p><strong>Objective: </strong>The impact of psychological factors on surgical stress response has garnered extensive attention. However, perioperative intervention strategies are still lacking for the total hip arthroplasty (THA) population without psychiatric comorbidities. This study aimed to assess the efficacy of duloxetine in perioperative anxiety status and stress response in these patients.</p><p><strong>Methods: </strong>This was a double-blind randomized controlled trial conducted between September 2021 and August 2024. Eligible patients aged over 18 years scheduled for unilateral primary total hip arthroplasty were recruited, with exclusion of patients with diagnosed mental diseases, endocrine disorders, previous psychiatric medication use, or severe hepatorenal dysfunction. A computer-generated random sequence was used to assign 100 patients to either the duloxetine group or the placebo group. The patients received 60 mg of duloxetine or the placebo daily starting 2 days before the surgery to postoperative day two. The primary outcome was the anxiety status assessed using the Hamilton anxiety scale (HAMA). The self-rating anxiety scale (SAS), stress response-related inflammatory levels and neuroendocrine levels, visual analog scale (VAS), patient satisfaction, quality of recovery-15 (QoR-15) score, Harris hip score (HHS), University of California Los Angeles (UCLA) activity score, and adverse effects were also compared. Continuous outcomes with multiple time points were analyzed using linear mixed models, while single time point outcomes used t-test or Mann-Whitney U test. Preoperative to POD1 differences were assessed with paired t-test or Wilcoxon test. Categorical variables and response rate were analyzed using chi-square or Fisher's exact test. Correlation analysis examined anxiety and stress biomarker relationships. Statistical significance was set at p < 0.05.</p><p><strong>Results: </strong>The duloxetine group had significantly lower HAMA and SAS scores than the placebo group on POD2 (both p < 0.05). The VAS score during walking was significantly lower in the duloxetine group (p < 0.05). Patients in the duloxetine group exhibited higher QoR-15, HHS, and UCLA scores and better satisfaction (all p < 0.05). The erythrocyte sedimentation rate (ESR), neutrophil/lymphocyte ratio (NLR), tumor necrosis factor alpha (TNF-α), adrenocorticotropic hormone (ACTH), plasma cortisol (PTC), and blood glucose (BG) were significantly lower in the duloxetine group (all p < 0.05). The ESR and HAMA, ACTH and SAS, and PTC and SAS were respectively correlated (all p < 0.05).</p><p><strong>Conclusion: </strong>The perioperative administration of duloxetine alleviated anxiety, reduced postoperative walking pain, improved the quality of functional recovery and satisfaction, and may reduce the stress response in patients undergoing THA.</p><p><strong>Trial registration: </strong>Clinical Trial Register: ChiCTR2100051099.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13649348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Meniscal Repair Achieves Comparable Mid-Term Functional Performance to Partial Meniscectomy Following Anterior Cruciate Ligament Reconstruction in Highly Active Patients.","authors":"Hao Duan, Haiyang Zhang, Jingyi Sun, Xiaohan Zhang, Tao Li, Jingbin Zhou","doi":"10.1111/os.70419","DOIUrl":"10.1111/os.70419","url":null,"abstract":"<p><strong>Objective: </strong>Concomitant meniscal injuries accompany 40%-60% of anterior cruciate ligament (ACL) ruptures. Surgeons often face a clinical choice between meniscal repair, which prioritizes long-term joint preservation, and partial meniscectomy, which is traditionally perceived to facilitate earlier functional recovery. Despite the biological advantages of repair, persistent concerns remain that its restrictive postoperative protocols might impede mid-term functional performance compared to meniscectomy. This study aims to compare quadriceps/hamstring strength, dynamic balance, functional hop performance, and patient-reported outcomes (PROMs) at 2-5 years post-ACLR between patients undergoing concomitant meniscal repair versus partial meniscectomy.</p><p><strong>Methods: </strong>This retrospective cohort study evaluated highly active patients who underwent ACLR between 2019 and 2023. Of 68 patients who underwent ACLR with a concomitant meniscal injury and a pre-injury Tegner score ≥ 6,16 were excluded: 5 due to revision ACLR or secondary meniscal procedures during the follow-up period, 8 due to concurrent multi-ligament injuries or full-thickness articular cartilage defects requiring surgery, and 3 due to knee joint deformities (varus or valgus malalignment > 5°)The remaining 52 patients were stratified into meniscal repair (n = 20) or partial meniscectomy (n = 32) groups. Outcomes included isokinetic strength (60°/s, 180°/s; Limb Symmetry Index, LSI), Y-balance test, single-leg hop (SLH), and PROMs (IKDC, Lysholm, and ACL-RSI).</p><p><strong>Results: </strong>At mid-term follow-up (mean 4.1 ± 1.2 years for repair, 4.2 ± 1.2 years for meniscectomy; p = 0.59), no significant differences existed in strength (quadriceps/hamstring LSI 60°/s and 180°/s), dynamic balance (Y-balance), hop tests (SLH, SLCH, and SLTH), or PROMs (all p > 0.05).</p><p><strong>Conclusion: </strong>At mid-term follow-up (2-5 years), concomitant meniscal repair yielded objective functional performance and patient-reported outcomes equivalent to partial meniscectomy in highly active patients undergoing ACLR, despite more restrictive early rehabilitation. These findings indicate that the initial postoperative restrictions associated with repair do not result in persistent functional deficits. Although meniscal preservation confers established long-term chondroprotective advantages, the present analysis addresses functional parity only; the surgical strategy should weigh both mid-term function and long-term joint health on an individual basis.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13649328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidimensional Characteristics of Musculoskeletal Pain and Risk of Falls Among Elderly Adults: The Cross-Sectional Evidence From CHARLS.","authors":"Fengyao Mei, Jiao Jiao Li, Jianhao Lin, Shengjie Dong, Peng Zhang, Dan Xing","doi":"10.1111/os.70407","DOIUrl":"10.1111/os.70407","url":null,"abstract":"<p><strong>Objective: </strong>Falls are common particularly in elderly people and usually associated with poor prognosis or healing outcomes. Musculoskeletal pain is considered an independent risk factor for falls, by being associated with joint pathology and instability, neuromuscular effects of pain, and changes in cognitive and psychological function. Understanding the relationship between musculoskeletal pain and the risk of falls will help with falls prevention among older adults.</p><p><strong>Methods: </strong>A nationally representative sample for the Chinese population was derived from the China Health and Retirement Longitudinal Study (CHARLS). Information on the patients' demographic characteristics, socioeconomic status, other health-related behaviors, as well as history on musculoskeletal pain and falls was obtained. Univariate and multivariate analyses were used to explore the effect factors of falls, including individual factors and musculoskeletal pain factors. p for trend test was performed to examine the trend of each continuous variable.</p><p><strong>Results: </strong>Among 18,813 respondents, 3697 have experienced a fall. The risk of falls was lower for respondents who were male, lived in urban areas, had higher education level, and were married (p < 0.05). The risk of falls increased with higher age (p < 0.05), as well as for respondents who were still drinking alcohol or who used to drink alcohol at the time of the survey (p < 0.05). The risk of falls also increased for respondents who had suffered from pain in the fingers, waist, legs and knees (p < 0.05), as well as for those who had a higher number of painful sites (p < 0.05).</p><p><strong>Conclusion: </strong>Factors such as gender, age, education level, and health-related behaviors may influence the risk of falls. Additionally, musculoskeletal pain has been identified as a potential contributor to falls. Effectively managing musculoskeletal pain represents a significant intervention that can be targeted to help prevent falls among older individuals.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2118-2127"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13481141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148796011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes of an Improved Arthroscopic Suture-Bridge Technique Assisted by a \"5 O'clock\" Portal for Acute Bony Bankart Lesions.","authors":"Fan Jiang, Qing Yang, Chao Qi, Yi Zhang, Jinlong Ma, Tengbo Yu, Youliang Shen","doi":"10.1111/os.70381","DOIUrl":"https://doi.org/10.1111/os.70381","url":null,"abstract":"<p><strong>Purpose: </strong>Bony Bankart lesion is a primary cause of traumatic shoulder instability. Although the arthroscopic suture bridge technique has been applied clinically, its operative complexity remains a challenge. This study aimed to evaluate the mid-term clinical and radiological efficacy of a modified suture bridge technique combined with anchor insertion through a \"5 o'clock\" accessory portal for treating acute bony Bankart lesions.</p><p><strong>Methods: </strong>This study retrospectively analyzed 36 patients with acute bony Bankart lesions who underwent the modified surgical treatment between January 2019 and February 2023. All patients were followed up for at least 2 years. Preoperative and final follow-up assessments included VAS, Constant-Murley, ASES, UCLA, and Rowe scores, as well as shoulder range of motion (ROM). Statistical analysis was performed using paired t-tests to compare preoperative and postoperative clinical scores and ROM. Fracture reduction and healing were assessed via CT 3D reconstruction at 6 months postoperatively.</p><p><strong>Results: </strong>The mean follow-up period was 28.8 months. At the final follow-up, all clinical functional scores and ROM showed significant improvement compared to the preoperative status (p < 0.001). CT 3D reconstruction at 6 months postoperatively showed successful reduction of the fracture fragment in all patients. The mean glenoid bone loss decreased from 18.2% ± 6.5% preoperatively to 2.5% ± 1.5% at follow-up (p < 0.001). The fracture healing rate was 97.2%. Eighty percent of patients successfully returned to a pre-injury or higher level of sport. The redislocation rate was 2.8%, and the total complication rate was 5.6%.</p><p><strong>Conclusion: </strong>The modified suture-bridge technique using a \"5 o'clock\" accessory portal is a reliable and reproducible method for treating acute bony Bankart lesions. This approach achieves anatomical fracture reduction and yields excellent mid-term clinical and radiological outcomes with a low risk of complications.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative Fluoroscopy for Minimally Invasive Periacetabular Osteotomy: A Standardized Step-By-Step Operative Technique.","authors":"Matthias Wittauer, Batool Bosakhar, Jitendra Balakumar","doi":"10.1111/os.70426","DOIUrl":"10.1111/os.70426","url":null,"abstract":"<p><strong>Background: </strong>Periacetabular osteotomy (PAO) is an established joint-preserving procedure for symptomatic acetabular dysplasia and other forms of acetabular malalignment. Although minimally invasive techniques have reduced surgical morbidity while maintaining correctional accuracy, the procedure remains technically demanding and relies heavily on intraoperative fluoroscopic guidance. Existing descriptions of minimally invasive PAO provide limited detail regarding the systematic use of fluoroscopy throughout the osteotomy sequence. This article describes a standardized fluoroscopy-guided technique for minimally invasive PAO.</p><p><strong>Operative technique: </strong>The procedure is performed through an 8-10 cm inguinal incision with preservation of key soft-tissue structures. A sequential series of fluoroscopically guided osteotomies of the superior pubic ramus, ischium, supra-acetabular region, and posterior column are performed using defined radiographic landmarks and checkpoints. Biplanar fluoroscopy is integrated throughout the procedure to confirm osteotome trajectory, osteotomy depth, fragment mobility, and final acetabular correction. Intraoperative assessment includes restoration of acetabular coverage, version, and inclination, with confirmation of lateral center-edge angle, Tönnis angle, anterior wall index, and posterior wall index. Technical pearls, pitfalls, and strategies to minimize neurovascular injury are highlighted.</p><p><strong>Conclusion: </strong>This standardized fluoroscopic protocol provides a reproducible framework for minimally invasive PAO. By integrating step-specific radiographic guidance with key anatomical landmarks, the technique aims to improve osteotomy control, optimize acetabular correction, and enhance procedural safety, particularly during the learning phase of this complex hip-preserving procedure.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2247-2259"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13545017/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Extracorporeal Shockwave Therapy in Tendinopathy: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.","authors":"Ning-Yi Guo, Si-Qi Wang, Wei Liu, Zi-Mu Mao, Jian-Quan Wang, Bing-Bing Xu","doi":"10.1111/os.70408","DOIUrl":"10.1111/os.70408","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In recent years, numerous meta-analyses have been published on the effectiveness of ESWT in treating various tendinopathies. However, due to limitations such as the small number of included studies, it remains unclear whether ESWT is definitively effective for all types of tendinopathies and what its comparative value is relative to other conservative treatments. The objective of this meta-analysis is to compare ESWT with other conservative treatments to determine its effectiveness in alleviating pain and improving the severity of tendinopathies. Additionally, through network meta-analysis, we aim to compare the efficacy of ESWT and other conservative treatments across different types of tendinopathies. This will help establish the value of ESWT in each type of tendinopathy, providing a theoretical basis for clinical decision-making regarding ESWT treatment for various tendinopathies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the PubMed, Embase, and Cochrane Library databases along with other databases were searched to identify relevant randomized controlled trials (RCTs). The quality of the selected studies was evaluated using risk of bias assessments, and the data were extracted. Network meta-analysis was performed using random effects models to evaluate the effects of different treatment modalities on reducing pain and improving functional outcomes, reduction and functional improvement. The evidence of the included studies was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;This study included 65 publications from 2002 to 2024, with a total sample size of 3,921 cases. The included studies covered five types of tendinopathies: lateral epicondylitis, rotator cuff tendinopathy, Achilles tendinopathy, greater trochanteric pain syndrome, and patellar tendinopathy. Through pairwise subgroup meta-analyses, we obtained the following representative results: for VAS in lateral epicondylitis, ESWT versus US, SMD -2.53 [95% CI -3.03 to -2.03], I&lt;sup&gt;2&lt;/sup&gt; = 64.7%; ESWT versus PLACEBO, SMD -0.53 [95% CI -0.76 to -0.30], I&lt;sup&gt;2&lt;/sup&gt; = 39.0%; for VAS in Achilles tendinopathy, ESWT versus PLACEBO, SMD -0.49 [95% CI -0.83 to -0.16], I&lt;sup&gt;2&lt;/sup&gt; = 0; for VISA-P in patellar tendinopathy, ESWT versus PLACEBO, SMD -0.15 [95% CI -0.42 to 0.12], I&lt;sup&gt;2&lt;/sup&gt; = 0; for VAS in rotator cuff tendinopathy, ESWT versus PLACEBO, SMD -1.25 [95% CI -1.61 to -0.89], I&lt;sup&gt;2&lt;/sup&gt; = 89.1%; for GTPS, ESWT versus EX, SMD -0.41 [95% CI -0.70 to -0.11], I&lt;sup&gt;2&lt;/sup&gt; = 10.2%. In the network meta-analysis, the following representative results were obtained: in LE, ESWT ranked second in SUCRA for improving VAS and PRTEE, with no significant difference from the first rank (ESWT vs. PDRN, MD 0.44 [95% CI -2.76 to 3.64]; ESWT vs. KT, MD 0.39 [95% CI -0.88 to ","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2060-2082"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13572833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Osteoarthritis Therapeutics: From Microenvironment Understanding to Regenerative Intervention-Current Advances and Future Perspectives.","authors":"Yongbiao Meng, Shenghua Wu, Quanchun Liu","doi":"10.1111/os.70422","DOIUrl":"10.1111/os.70422","url":null,"abstract":"<p><p>Osteoarthritis (OA) is a prevalent, chronic degenerative joint disease characterized by progressive cartilage degeneration and impaired joint function. Its rising global incidence poses a significant health and socioeconomic burden. Traditional therapies primarily offer symptomatic relief but fail to halt disease progression and are associated with notable limitations. The contemporary understanding of OA pathogenesis has evolved from a model of mechanical wear to one emphasizing systemic imbalance within the joint microenvironment, involving immune dysregulation, metabolic disturbances, cellular senescence, and the gut-joint axis. This paradigm shift supports the development of innovative, disease-modifying strategies. This review is structured around a unifying multi-axis microenvironmental imbalance model for osteoarthritis. It systematically integrates the crosstalk and cascade-amplifying mechanisms of immune dysregulation, cellular senescence, metabolic disturbances, and the gut-joint axis, clarifying that multi-dimensional microenvironmental disruption collectively forms the pathological core of OA. We focus on how renewable biomaterials, engineered exosomes, and their composite systems target and regulate the pathological network to restore joint homeostasis, enabling a paradigm shift from symptomatic management to root-cause intervention. This work provides an integrated theoretical and translational roadmap for next-generation disease-modifying OA therapies.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2032-2044"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}