Orthopaedic Surgery最新文献

{"title":"A Comparative Study of Doppler-Guided Acute Bone Shortening-Lengthening Versus Bone Transport for Infected Tibial Defects Combined With Soft Tissue Defects.","authors":"Zhiming Zhao, Guoqi Ji, Chengkuo Cai, Weiguo Xu","doi":"10.1111/os.70409","DOIUrl":"10.1111/os.70409","url":null,"abstract":"<p><strong>Objective: </strong>The management of infected tibial bone defects with soft tissue defects (ITBD-STD) remains challenging. This study aims to establish a Doppler-guided safety threshold for acute shortening (≤ 3 cm), compare the clinical efficacy and safety of shortening-lengthening (S-L) versus bone transport (BT), quantify the complication burden, and clarify the calculation indices.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on the clinical data of 43 patients with ITBD-STD admitted between January 2021 and January 2024. All patients were treated using the Ilizarov circular external fixation technique and were divided into a bone S-L group and a BT group based on the surgical procedure. In the S-L group, acute shortening was performed under real-time Doppler guidance with a predefined safety cap of 3 cm. The wound healing time (WHT), bone healing index (BHI), external fixation index (EFI), and complication rate were compared and analyzed between the two groups. At a mean follow-up of 19.9 months, bone union and lower limb functional recovery were evaluated using the criteria of the Association for the Study and Application of the Ilizarov Method (ASAMI). Statistical analysis was performed using the independent sample t-test or the χ² test.</p><p><strong>Results: </strong>The WHT in the S-L group was significantly shorter than that in the BT group (68.5 ± 25.2 vs. 85.2 ± 21.5 days, p < 0.05). In the S-L group, acute shortening was successfully performed in all 22 patients under real-time Doppler guidance, with a mean acute shortening distance of 2.8 ± 0.4 cm (capped at 3 cm). No patient experienced Doppler signal loss or required intraoperative termination of shortening due to vascular compromise. The BHI (37.36 ± 10.73 vs. 44.14 ± 11.12 days/cm) and EFI (45.36 ± 11.23 vs. 53.52 ± 12.55 days/cm) in the S-L group were significantly lower than those in the BT group (all p < 0.05). However, there was no statistically significant difference in the overall complication rate between the two groups (45.5% vs. 42.9%, p > 0.05). At the final follow-up, there was also no statistically significant difference in ASAMI scores between the two groups (p > 0.05).</p><p><strong>Conclusion: </strong>Both S-L and BT are effective for ITBD-STD with comparable safety. Under the strict Doppler-guided protocol (≤ 3 cm), S-L significantly shortens WHT without increasing complications, yet this benefit is design-inherent rather than a biological advantage. Given comparable ASAMI functional outcomes, S-L offers no functional superiority over BT. Nonetheless, the Doppler criteria and selection strategy established herein provide a safe, reproducible framework for technique selection, validating the clinical feasibility of acute shortening without compromising final function or safety.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2128-2141"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13518081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148831071","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":"Global Alignment and Proportion (GAP) Score in Predicting Mechanical Complications After Long-Segment Fixation for Chinese Geriatric Patients With Adult Degenerative Scoliosis: A Mid-Term Comparative Study.","authors":"Xiangyao Sun, Jiang Huang, Yuqi Liu, Siyuan Sun, Li Cao, Juyong Wang, Shibao Lu","doi":"10.1111/os.70412","DOIUrl":"10.1111/os.70412","url":null,"abstract":"<p><strong>Objectives: </strong>The predictive value of the global alignment and proportion (GAP) score in the Chinese geriatric population, which has unique demographic and degenerative characteristics, has not been validated. Given the high incidence of mechanical complications in this specific cohort, a dedicated mid-term evaluation is essential to guide surgical planning. To address this gap, this study aimed to analyze the accuracy and characteristics of the GAP assessment system in predicting mechanical complications following long-segment fixation surgery for geriatric patients with adult degenerative scoliosis (ADS) in a mid-term follow up period.</p><p><strong>Methods: </strong>A retrospective analysis was conducted to select eligible ADS patients who had undergone long-segment fixation surgery at Xuanwu Hospital Capital Medical University between December 2016 and October 2020. Patients were divided into groups with mechanical complications (MC) and nonmechanical complications (NMC) for comparison. The GAP score and its classification were calculated based on the measurements. The association between GAP scores and mechanical complications was examined using logistic regression analysis. Additionally, the receiver operating characteristic curve (ROC) was utilized to evaluate the predictive performance of the GAP score for mechanical complications and to determine the threshold of the assessment system.</p><p><strong>Results: </strong>A total of 133 ADS patients were included, with 65 in the MC group and 68 in the NMC group. The GAP score (area under the curve, AUC = 0.654) outperformed the GAP categories (AUC = 0.650) in predicting mechanical complications, and it was particularly accurate for proximal junctional kyphosis (PJK) (AUC = 0.872). However, both the GAP score (AUC = 0.201) and GAP categories (AUC = 0.181) demonstrated poor accuracy in predicting internal fixation breakage.</p><p><strong>Conclusion: </strong>The GAP score varied in its predictive performance and thresholds for different mechanical complications and internal fixation-related issues, exhibiting high accuracy for predicting PJK. However, it did not effectively indicate the risk of internal fixation breakage.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2195-2204"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13537926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881420","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":"Biomechanical Superiority of the Chinese Knotting Technique in Posterior Cruciate Ligament Reconstruction: A Cadaveric Study.","authors":"Zhengliang Shi, Rui Han, Ping Yuan, Zhaohui Ruan, Hongmai Yang, Wenting Tang, Kaiquan Li, Xianguang Yang, Yang Yu, Yanlin Li","doi":"10.1111/os.70403","DOIUrl":"10.1111/os.70403","url":null,"abstract":"<p><strong>Objective: </strong>We previously developed a novel internal tension-relieving augmentation suture, the Chinese knotting technique (CKT), which demonstrated better knee kinematic recovery and clinical outcomes when assisting posterior cruciate ligament (PCL) reconstruction. This study evaluated the biomechanical effect of the CKT in cadaveric PCL reconstruction and provided experimental evidence for its clinical application.</p><p><strong>Methods: </strong>Ten fresh-frozen adult knee joint specimens were randomly divided into the conventional reconstruction (CR; n = 5) and CKT (n = 5) groups. First, all native PCLs underwent cyclic fatigue testing with a standardized fixation method, and the relaxation length was recorded. The native PCL was then transected and reconstructed. After reconstruction, the same fixation method was applied for biomechanical testing to measure stiffness, elastic modulus, maximum load, and relaxation length.</p><p><strong>Results: </strong>No statistically significant differences were observed between the two groups in donor age (54.40 ± 5.94 years vs 56.60 ± 5.98 years), gender distribution (male: 80.00% vs. 60.00%), or specimen side (left: 60.00% vs. 40.00%) (p > 0.05). All specimens underwent successful reconstruction and testing with no instances of tissue damage or fixation abnormalities. The biomechanical testing revealed no statistically significant differences in stiffness (68.60 ± 8.62 N/mm vs. 65.40 ± 12.14 N/mm) or elastic modulus (147.60 ± 5.68 MPa vs. 142.60 ± 1.52 MPa) between the two groups (p > 0.05). However, the CKT group demonstrated a significantly higher maximum load (603.20 ± 77.44 N) compared with the CR group (442.20 ± 20.52 N) and a significantly lower relaxation length (1.50 ± 0.09 mm vs. 2.46 ± 0.02 mm) (p < 0.05).</p><p><strong>Conclusion: </strong>The CKT preserved the basic mechanical properties of the graft in PCL reconstruction. This technique significantly increased the maximum load and reduced residual deformation after cyclic loading, thereby providing enhanced biomechanical protection for the graft. This approach may offer technical support for early postoperative rehabilitation and a reduced risk of graft failure.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2183-2194"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13451386/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148689475","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":"Body Mass Index Modifies the Effect of Hemovac Drainage on Blood Loss After Total Knee Arthroplasty.","authors":"Shih-Hao Huang, Shu-Jung Chen, Cheng-Chang Lu, Carson Keeter, Po-Chih Shen, Hsuan-Ti Huang","doi":"10.1111/os.70397","DOIUrl":"10.1111/os.70397","url":null,"abstract":"<p><strong>Objectives: </strong>The role of Hemovac drainage after TKA remains uncertain in the tranexamic acid (TXA) era, particularly across patient subgroups. This study investigated whether body mass index (BMI) modifies the association between drainage use and blood loss in patients undergoing TKA.</p><p><strong>Methods: </strong>This retrospective cohort study compared 201 TKA patients divided into a drain group (n = 101) and a non-drain group (n = 100). All procedures incorporated standardized intravenous and intra-articular administration of tranexamic acid. Primary outcomes included hemoglobin (Hb), hematocrit (Hct), erythrocyte count, and estimated blood loss (EBL). Secondary outcomes were hospital stay duration, knee range of motion, and complications. Between-group comparisons were performed using independent-samples t-tests and chi-squared tests, and multiple linear regression assessed the interaction between BMI and drain use on EBL.</p><p><strong>Results: </strong>No significant between-group differences were observed in Hb, Hct, or erythrocyte count at baseline or on postoperative Day 1. In patients with BMI ≥ 25 kg/m², EBL was significantly lower in the drain group compared to the non-drain group (p = 0.044). Regression analysis revealed a significant interaction between drain use and BMI (p = 0.013). Patients without drains showed an increase in EBL with BMI, whereas the drain group demonstrated a relatively flat relationship. Secondary outcomes were comparable between groups.</p><p><strong>Conclusion: </strong>Hemovac drains were associated with modestly lower EBL in patients with BMI ≥ 25 kg/m² undergoing TKA. No differences in clinical outcomes were observed. These findings suggest that the effect of drainage may vary across patient subgroups and support a more individualized approach.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2083-2089"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13498959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148796411","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":"Dorsal C1-2 Spinal Cord Compression After Reduction of Atlantoaxial Posterior Dislocation Associated With Os Odontoideum: A Case Report and Literature Review.","authors":"Jianzhi Wang, Jin Chen, Junhu Li, Shuxin Zheng, Lei Wang, Xi Yang, Yueming Song","doi":"10.1111/os.70425","DOIUrl":"10.1111/os.70425","url":null,"abstract":"<p><strong>Background: </strong>Atlantoaxial posterior dislocation associated with os odontoideum is uncommon, and experience with its surgical management remains limited. Posterior reduction and C1-2 fixation can usually restore atlantoaxial alignment and stability. However, neurological safety after reduction depends not only on the quality of realignment but also on the residual space available for the spinal cord. In patients with congenital atlas hypoplasia or posterior arch osteophytes, reduction may unmask or aggravate dorsal C1-2 canal compromise. This mechanism of postoperative neurological deterioration has received little attention.</p><p><strong>Case presentation: </strong>A 61-year-old man presented with progressive limb numbness and weakness, gait disturbance, and incomplete quadriplegia. Imaging demonstrated chronic atlantoaxial posterior dislocation associated with os odontoideum and congenital atlas hypoplasia. Posterior C1-2 open reduction, fixation, and fusion were performed. His neurological symptoms initially improved but soon worsened, with increased limb numbness and weakness and mild respiratory difficulty. Postoperative radiographs and computed tomography confirmed satisfactory reduction and appropriate implant positioning. However, magnetic resonance imaging revealed clinically significant dorsal C1-2 spinal cord compression after realignment, caused by the preexisting hypoplastic C1 posterior arch and posterior arch osteophyte. Emergency C1 posterior arch resection was therefore performed. Neurological function improved rapidly after decompression. At the 3-month follow-up, the patient had recovered well, and imaging showed maintained reduction without radiographic evidence of instability and a patent spinal canal.</p><p><strong>Conclusion: </strong>This case illustrates that satisfactory radiographic reduction may not ensure adequate space for the spinal cord when congenital atlas hypoplasia or posterior arch osteophytes limit the dorsal canal reserve. In patients with similar imaging features, careful assessment of the anticipated postreduction C1-2 canal space may help determine whether concomitant C1 posterior arch decompression should be considered.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2269-2275"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13559772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920459","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 Arthroscopic Annular Release Around the Greater Trochanter in Severe Gluteal Muscle Contracture Cases: A Technical Note and Case Series.","authors":"Zi-Ren Zhou, Ruo-Fan Li, Fei-Er Song, Fan Yang, Jian-Quan Wang, Jia-Yi Shao, Hong-Jie Huang","doi":"10.1111/os.70427","DOIUrl":"10.1111/os.70427","url":null,"abstract":"<p><strong>Objective: </strong>Severe gluteal muscle contracture often requires surgical release, yet conventional open procedures are associated with extensive soft tissue trauma, significant postoperative pain, and prolonged rehabilitation. This study aimed to introduce an arthroscopic annular release technique for severe gluteal muscle contracture and evaluate its clinical outcomes.</p><p><strong>Methods: </strong>A retrospective review was conducted using data from patients with severe gluteal muscle contracture who underwent arthroscopic treatment between September 2019 and October 2022. Inclusion criteria were patients presented positive preoperative signs, including squatting and crouching impairment, difficulty in crossing the legs, a positive Ober's sign, with or without clicking sounds during hip rotation. The annular release treatment was done around the greater trochanter, which has a sparse distribution of muscle and neuromuscular tissues. Arthroscopic observation and intraoperative physical examination were used to assess the adequacy of the release. Additionally, clinical assessments included the Gluteal Muscle Contracture Disability Scale (GDS), Visual Analogue Scale (VAS), and pain frequency, which were evaluated pre- and postoperatively. A paired Student's t-test was applied to compare the GDS, VAS, and pain frequency scores before and after surgery.</p><p><strong>Results: </strong>A total of 22 patients were included in the final analysis, with an average follow-up of 2 years. All operations were successfully completed, with no intraoperative conversion to alternative surgical methods. After surgery, most patients achieved satisfactory postoperative outcomes; isolated limitations persisted in one patient who reported persistent squatting difficulty, and two patients continued to have trouble crossing their legs. The GDS score was 43.8 ± 13.3 preoperatively and 72.7 ± 9.6 at the final follow-up, showing a statistically significant improvement (p < 0.01). The VAS score was 1.8 ± 2.0 preoperatively and 0.9 ± 1.3 postoperatively, with a significant difference observed (p = 0.015). Pain frequency was 2.4 ± 2.7 preoperatively and 0.8 ± 1.2 at final follow-up, with a statistically significant improvement (p < 0.01). No neurologic injuries or other complications were observed during the follow-up period.</p><p><strong>Conclusion: </strong>Arthroscopic annular release around the greater trochanter showed adequate contracture band exposure and favorable clinical outcomes in this retrospective case series. It may be a feasible minimally invasive option for severe gluteal muscle contracture.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2260-2268"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13580013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977598","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":"A Retrospective Comparative Study on Arthroscopic-Assisted Uni-Portal Spinal Surgery (AUSS/UNSES) Versus Unilateral Biportal Endoscopy for Double-Segment Lumbar Spinal Stenosis.","authors":"Zhide Liu, En Song, Shiyuan Hao, XiangLong Li, Yabo Yao, Jianfeng Zhong","doi":"10.1111/os.70413","DOIUrl":"10.1111/os.70413","url":null,"abstract":"<p><strong>Objective: </strong>Conventional endoscopic decompression for double-segment lumbar spinal stenosis (LSS) generally requires multiple portals and incisions, which may increase tissue disruption, procedural complexity, and radiation exposure. Evidence is limited on whether two adjacent levels can be adequately decompressed through a single-incision, non-coaxial approach. To compare the clinical efficacy, perioperative outcomes, and safety of double-segment arthroscopic-assisted uni-portal spinal surgery (DS-AUSS/DS-UNSES) with double-segment unilateral biportal endoscopy (DS-UBE) for unilateral laminotomy with bilateral decompression (ULBD).</p><p><strong>Methods: </strong>This retrospective comparative study included 103 patients who underwent double-segment ULBD between January 2022 and January 2024 (DS-AUSS, n = 55; DS-UBE, n = 48). Visual Analog Scale (VAS), Oswestry Disability Index (ODI), anterior-posterior diameter of the canal, Schizas stenosis grade, modified MacNab criteria, perioperative parameters, and complications were evaluated. Independent-samples t-tests, Mann-Whitney U tests, Chi-square or Fisher exact tests, and mixed-design repeated-measures analysis of variance with Bonferroni-corrected post hoc comparisons were used.</p><p><strong>Results: </strong>Both groups showed significant postoperative improvements in VAS, ODI, and stenosis grade (p < 0.05). Compared with DS-UBE, DS-AUSS produced lower VAS scores at postoperative Day 3 (mean difference, -0.75; 95% CI, -1.08 to -0.42; p < 0.001) and lower ODI at 3 months (mean difference, -5.53%; 95% CI, -8.84 to -2.22; p = 0.001). DS-AUSS also reduced operative time (mean difference, -16.94 min; p < 0.001), intraoperative blood loss (median difference, -12.0 mL; p = 0.024), postoperative drainage (mean difference, -16.14 mL; p < 0.001), fluoroscopy frequency (median difference, -2.0; p < 0.001), and hospital stay (mean difference, -1.18 days; p = 0.007). At 12 months, Grade A/B stenosis improvement (96.4% vs. 93.8%; p = 0.490) and MacNab excellent/good rates (92.73% in both groups; p = 0.633) were comparable. Overall complication rates were 7.3% and 14.6%, respectively (p = 0.350).</p><p><strong>Conclusion: </strong>DS-AUSS achieved 1-year clinical and radiographic outcomes comparable to DS-UBE while improving perioperative efficiency, reducing tissue trauma and fluoroscopy exposure, and accelerating early recovery. It is a feasible minimally invasive option for selected patients with double-segment LSS.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2142-2152"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13507686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819241","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":"Rethinking Knee Arthroplasty: Bicompartmental Unicompartmental Knee Arthroplasty as a Biomechanically Personalized, Function-Preserving Solution for Knee Osteoarthritis.","authors":"Yishu Liu, Yong Zhou, Xi Zhang, Shengyuan Yu, Bing Xue, Xuefeng Liu","doi":"10.1111/os.70406","DOIUrl":"10.1111/os.70406","url":null,"abstract":"<p><strong>Aims: </strong>Although total knee arthroplasty (TKA) remains the standard treatment for advanced knee osteoarthritis (OA), it often compromises joint proprioception and natural kinematics. Bicompartmental unicompartmental knee arthroplasty (bi-UKA), which preserves both the cruciate ligaments and patellofemoral joint, offers a joint-preserving alternative for selected patients with bicompartmental OA. This study aimed to compare the early- and mid-term outcomes of bi-UKA and TKA.</p><p><strong>Methods: </strong>This single-center, prospective, real-world observational study included patients with knee osteoarthritis who were treated between January and October 2022. Eligible patients underwent either bi-UKA or TKA according to routine clinical decision-making and patient preference. Functional outcomes were assessed using the Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), range of motion (ROM), timed up and go test (TUG), and 2-min walk test over a 2-year follow-up period. Preference-related selection bias was reduced using inverse probability of treatment weighting (IPTW) based on a five-item preoperative preference assessment tool, and longitudinal outcomes were analyzed using IPTW-weighted mixed-effects models.</p><p><strong>Results: </strong>Eighty patients were included in this study (bi-UKA: n = 35, TKA: n = 45). After inverse probability of treatment weighting (IPTW) adjustment, the bi-UKA group showed more favorable early outcomes: higher 1-month KSS functional scores (p = 0.001); better WOMAC scores at 1, 6, and 12 months (p < 0.05); greater ROM throughout follow-up (p < 0.0001); shorter TUG times; and longer 2MWT distances at early time points. The Forgotten Joint Score (FJS) scores at 1 and 2 years also favored bi-UKA, indicating greater satisfaction.</p><p><strong>Conclusion: </strong>Bi-UKA was associated with more favorable early functional recovery. By preserving the key anatomical structures and enabling more physiological motion, bi-UKA may be a feasible alternative in selected patients.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2101-2117"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148796024","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":"Annular Repair Using an All-Suture Anchor Under Unilateral Biportal Endoscopy: Technical Note and Case Series.","authors":"Pengzhi Shi, Jiarui Liu, Chao Li, Mingyu Gao, Sheng Chang, Xuexiao Ma, Hongfei Xiang","doi":"10.1111/os.70415","DOIUrl":"10.1111/os.70415","url":null,"abstract":"<p><strong>Objective: </strong>Large annular defects after lumbar discectomy remain a major risk factor for recurrent herniation, particularly when the annular tear is located adjacent to the bony endplate, for which no well-established endoscopic repair strategy is currently available. To evaluate the feasibility and early clinical outcomes of a novel endoscopic annular-repair technique using an all-suture anchor implanted into the superior surface of the inferior vertebral endplate, performed entirely through unilateral biportal endoscopy (UBE), for closure of large annular defects near the endplate after lumbar discectomy.</p><p><strong>Methods: </strong>We present a novel annular repair technique performed entirely under UBE using an all-suture anchor implanted into the superior surface of the inferior vertebral endplate, which is particularly suitable for lumbar disc herniation (LDH) cases involving downward migration of disc fragments. A monofilament shuttle is advanced across the annular tear, enabling passage of high-strength sutures that approximate the torn annulus to bone. We developed a bone-to-annulus repair method in which a monofilament shuttle is passed across the annular tear under direct UBE visualization to deliver high-strength braided sutures through the defect; these sutures are then secured to an all-suture anchor placed in the endplate, tension-tested, and the knot buried within the annulus. The technique was applied in a preliminary consecutive series of five patients presenting with 5-6 mm full-thickness annular defects discovered intraoperatively during UBE discectomy. Procedural time, intraoperative complications, and early clinical and radiographic outcomes were recorded, follow-up included one-month clinical assessment and imaging.</p><p><strong>Results: </strong>The annular repair was technically feasible in all five cases, with the repair step adding a mean of 16 min to the standard discectomy. There were no intraoperative complications related to anchor placement or suture passage. All patients reported rapid relief of radicular symptoms and were mobilized early postoperatively. At one-month follow-up, clinical examination and imaging demonstrated intact annular repairs with no evidence of recurrent herniation or implant migration.</p><p><strong>Conclusion: </strong>The described UBE all-suture anchor technique enables direct bone-to-annulus fixation and safe closure of moderate (5-6 mm) full-thickness annular defects through standard endoscopic portals. Early results indicate technical feasibility, safety, and promising short-term clinical outcomes. Further biomechanical validation and longer-term, larger-cohort studies are required to determine its effectiveness in reducing recurrent LDH.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2230-2237"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13533650/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875489","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":"Chinese Guideline on Risk Management of Osteoporosis in the General Public.","authors":"Shiyong Zhang, Jinqiu Yuan, Zhuojing Luo, Jiacan Su, Weibo Xia, Kehu Yang, Fuxin Wei","doi":"10.1111/os.70386","DOIUrl":"10.1111/os.70386","url":null,"abstract":"<p><strong>Background: </strong>Osteoporosis is a common chronic skeletal disorder characterized by decreased bone mass and microarchitectural deterioration, resulting in increased fragility and fracture risk. With rapid population aging in China, the prevalence of osteoporosis is rising, while public awareness and engagement in prevention remain insufficient. Existing national guidelines mainly target healthcare professionals and lack accessible, evidence-based recommendations for the general public. This guideline aims to provide practical guidance for osteoporosis risk assessment and prevention at the population level.</p><p><strong>Methods: </strong>The guideline was developed by the Chinese Health Risk Management Collaboration-Osteoporosis Group in accordance with the WHO Handbook for Guideline Development, the Principles for Developing or Revising Clinical Practice Guidelines in China (2022), and AGREE II and RIGHT frameworks. Evidence from both English and Chinese databases was synthesized and graded using the GRADE approach. Fourteen key questions were formulated through a modified Delphi consensus process.</p><p><strong>Results: </strong>A total of 15 recommendations were developed, covering osteoporosis risk screening (OSTA, IOF One-Minute Test, FRAX), dietary and nutritional strategies (protein, dairy, calcium, vitamin D, fruits and vegetables), lifestyle interventions (exercise, bodyweight control, sunlight exposure, smoking cessation, alcohol reduction, tea drinking), and fracture prevention in patients with osteoporosis.</p><p><strong>Conclusion: </strong>This guideline provides practical, evidence-based strategies to improve public awareness and promote risk management of osteoporosis among the general population, potentially reducing fracture incidence and public health burden.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2015-2031"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13459694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148707207","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}