Orthopedic Research and Reviews最新文献

{"title":"Pes Anserine Bursitis: An Underrecognized Cause of Medial Knee Pain - A Review of Diagnosis, Associated Conditions, and Evidence-Based Management.","authors":"Brian Tani, Adam Haddad, Griffin Gleeson, Angel G A Prempeh, Dustin J Kress, Toufic R Jildeh","doi":"10.2147/ORR.S643100","DOIUrl":"10.2147/ORR.S643100","url":null,"abstract":"<p><p>Pes anserine bursitis (PAB) is a frequently underrecognized and misdiagnosed cause of medial knee pain. It occurs when there is inflammation of the bursa interposed between the conjoined pes anserine tendons and the underlying proximal tibia. The purpose of this review is to describe the current knowledge regarding the diagnosis and management of PAB by providing an evidence-based overview of clinical exams and treatment modalities. PAB is prevalent across several high-risk populations, including knee osteoarthritis (OA), obesity, type 2 diabetes mellitus, and athletes engaged in repetitive knee flexion activities. Diagnosis is currently limited by the absence of a validated quantitative clinical assessment tool. The main goal of treatment is to reduce associated bursal inflammation and address the underlying biomechanical and systemic contributing factors. The standard of care is conservative intervention, comprising rest, ice, and short-term NSAID use, then physical therapy and, where symptoms persist, intrabursal corticosteroid injection, with response commonly assessed at eight weeks. Surgery is considered only after these measures have been exhausted. Due to the complexity of overlapping medial knee pathology and the absence of a gold-standard diagnostic method, PAB remains a clinical diagnosis that requires thoughtful history-taking, physical examination, and selective use of imaging. This review summarizes essential clinical examination techniques and treatment options for PAB, emphasizing practical recommendations for orthopedic surgeons. The intended audience also includes sports medicine physicians, rehabilitation specialists, and primary care providers, as most cases are managed conservatively. Referral to orthopedic surgery is appropriate only when symptoms persist despite comprehensive conservative therapy. Although PAB is often diagnosed clinically, structural bursitis is confirmed in only a minority of cases, so management relies primarily on clinical assessment rather than imaging findings.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"18 ","pages":"643100"},"PeriodicalIF":2.0,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13676847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Narrative Review on Intra-Articular Injection Therapies for Knee Osteoarthritis: Current Evidence and Future Perspectives.","authors":"Thanapon Chobpenthai, Nutnicha Rangchaikul, Siwat Sakdejayont, Patcharapol Arunwatthanangkul, Thanate Poosiripinyo","doi":"10.2147/ORR.S642237","DOIUrl":"10.2147/ORR.S642237","url":null,"abstract":"<p><p>This narrative review summarises current evidence on intra-articular injection therapies for knee osteoarthritis. Knee osteoarthritis (OA) is a major global cause of disability, particularly among older adults, prompting growing interest in non-operative strategies that alleviate symptoms, preserve joint function, and delay surgical intervention. Established options including corticosteroids and hyaluronic acid, remain widely utilized for short and intermediate-term symptom relief. Regenerative approaches such as platelet-rich plasma (PRP) and mesenchymal stem cells (MSCs) have gained prominence due to their potential anti-inflammatory and reparative effects. Novel biologic agents, including exosomes, atelocollagen, and isolated growth factors, show promise in supporting tissue repair and modulating joint homeostasis. Given the wide variability in mechanisms, efficacy, and safety profiles, selection of treatment regimen should be individualized based on disease severity, patient goals, and regulatory considerations. Overall, intra-articular injection therapies represent a diverse and rapidly evolving component of knee OA management. Continued high-quality randomized trials and standardized treatment protocols are essential to support evidence-based clinical decision-making and optimize patient outcomes.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"18 ","pages":"642237"},"PeriodicalIF":2.0,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149195973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Finite Element Analysis of Three Acetabular Plate Designs with Different Bridge Geometries.","authors":"Nurgeldi Manap, Nagmet Mursalov, Mehool Acharya, Boris Gorbunov, Mukhtar Abilmazhinov, Darkhan Sultanov","doi":"10.2147/ORR.S613671","DOIUrl":"https://doi.org/10.2147/ORR.S613671","url":null,"abstract":"<p><strong>Background: </strong>Acetabular fractures are complex injuries of the hip joint. Careful design of fixation plates is crucial for achieving stable osteosynthesis, especially in patients with poor bone quality. Finite element analysis (FEA) is widely used for biomechanical evaluation of orthopedic implants.</p><p><strong>Objective: </strong>The aim of this study was to perform a comparative finite element analysis of three acetabular plate designs differing in bridge geometry and to identify the configuration with the most favourable biomechanical performance. We hypothesized that a plate with two parallel bridges would provide more favourable stress distribution and a higher safety factor compared to single-bridge and non-parallel-bridge designs.</p><p><strong>Methods: </strong>A three-dimensional model of the pelvic bone was reconstructed from CT data. Three titanium alloy (Ti-6Al-4V, thickness 2.5 mm) plates with different bridge configurations (single bridge, two parallel bridges, two non-parallel bridges) were virtually implanted using CAD software (KOMPAS-3D, Autodesk Inventor). The FEA model included cortical and cancellous bone with mechanical properties taken from the literature. A load of 250 N applied at 15° to the inner plate surface simulated partial weight-bearing in the early postoperative period. Von Mises equivalent stress, linear displacement, and safety factor were evaluated.</p><p><strong>Results: </strong>Maximum von Mises equivalent stresses were 207 MPa for the single-bridge plate, 170 MPa for the two-parallel-bridge plate, and 344 MPa for the two-non-parallel-bridge plate. The corresponding minimum safety factors were 1.33, 1.62, and 0.8. The obtained stress values are consistent with findings from similar studies.</p><p><strong>Conclusion: </strong>The plate with two parallel bridges exhibited the highest safety factor and appears to be the most promising candidate for further experimental evaluation based on the present computational findings. The single-bridge and two-non-parallel-bridge designs require further design modification, particularly in the bridge cross-sections, because of their lower static safety margins. FEA is a useful tool for comparative biomechanical assessment of implant designs.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"18 ","pages":"613671"},"PeriodicalIF":2.0,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extreme Diagnostic and Therapeutic Heterogeneity Limits Treatment Conclusions in Iliotibial Band Syndrome: A Systematic Review with Level-of-Evidence Stratification.","authors":"Andrea Ferrero, Alex Moro, Marco Minelli, Maria Giulia Marcolin, Pietro Conte, Francesco Patrucco, Daniele D'Arrigo, Elizaveta Kon, Giuseppe Anzillotti","doi":"10.2147/ORR.S629195","DOIUrl":"10.2147/ORR.S629195","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Iliotibial band syndrome (ITBS) is a leading cause of lateral knee pain in runners and endurance athletes, yet clinical decision-making remains inconsistent and largely unsupported by high-quality comparative evidence. No comprehensive synthesis has previously integrated all available treatment modalities using a standardized evidence framework, and the evidence base for individual injection-based therapies continues to evolve rapidly.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate all available treatment strategies for ITBS and stratify their efficacy according to the Oxford Centre for Evidence-Based Medicine (CEBM) levels of evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic review was conducted following PRISMA 2020 guidelines. The protocol was registered in PROSPERO (CRD420261374567) on 20 April 2026. PubMed, Embase, and Web of Science were searched from database inception to 29 April 2026. Screening, data extraction, and the subsequent review processes were completed by 21 May 2026. An updated search subsequently identified one further eligible trial, published after the original cut-off. Eligible studies included RCTs, prospective and retrospective cohort studies, and case series reporting outcomes in adults with clinically diagnosed ITBS. Studies were classified into five treatment categories: therapeutic exercise, instrumental physical therapy, manual therapy and minimally invasive techniques, injection-based, pharmacological and biologic treatments, and surgical interventions. The primary outcomes were pain reduction and functional improvement; secondary outcomes included return to sport, recurrence, quality of life, patient satisfaction, and adverse events. Risk of bias was assessed using the Cochrane RoB 2 tool and NIH Quality Assessment Tools.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Twenty-four studies involving 1012 patients were included. Improvements in pain and function were reported across all treatment categories. Manual therapy, corticosteroid/pharmacological injections, and platelet-rich plasma reached Level I evidence; therapeutic exercise and instrumental physical therapy Level Ib; surgical treatments Level IV. A single, adequately powered, placebo-controlled trial now provides Level I evidence for ultrasound-guided platelet-rich plasma (PRP) in refractory ITBS, whereas TECAR (Transfer of Energy Capacitive And Resistive), low-level laser, prolotherapy, and hyaluronic acid still lacked any ITBS-specific controlled evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Despite a broad therapeutic landscape, most treatment modalities cannot yet be recommended over one another. Structured rehabilitation remains the reasonable first-line approach for newly diagnosed ITBS. For refractory ITBS, emerging Level I evidence supports ultrasound-guided PRP as a promising, though not yet independently replicated, minimally invasive option; corticosteroid injection, instrumental therapies and surgery may be considered in s","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"18 ","pages":"629195"},"PeriodicalIF":2.0,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current Concepts in Periprosthetic Joint Infection: Modern Biomarkers, Microbiome Insights, Molecular Diagnostics, and Emerging Prevention Strategies.","authors":"Johnny Elie Saadeh, Rita Saad, Fouad Assaf, Rima Osman, Angelo A Chami, Bilal Ali Harb, Wendy Ghanem, Mohamad Badra, Ramzi Moucharafieh","doi":"10.2147/ORR.S634292","DOIUrl":"10.2147/ORR.S634292","url":null,"abstract":"<p><strong>Aim: </strong>Periprosthetic joint infection (PJI) remains one of the leading causes of revision arthroplasty and is associated with substantial morbidity, mortality, and healthcare costs. Diagnosis remains challenging because of heterogeneous clinical presentations, the limited sensitivity of conventional inflammatory markers in chronic and low-grade infections, culture-negative cases, and biofilm-mediated pathogen persistence. This narrative review summarizes recent advances in the diagnosis and prevention of PJI, with a particular focus on synovial and serum biomarkers, microbiome-related susceptibility, molecular diagnostics, artificial intelligence, and emerging anti-biofilm and implant-surface technologies. Synovial biomarkers, including alpha-defensin, leukocyte esterase, calprotectin, and D-lactate, have demonstrated improved diagnostic performance, particularly in equivocal and culture-negative cases. However, none has sufficient evidence to replace established diagnostic criteria, and current data support their use as adjunctive tools in selected clinical scenarios rather than as standalone tests. Serum biomarkers beyond erythrocyte sedimentation rate and C-reactive protein, such as fibrinogen and protein fraction alterations, may provide additional diagnostic value but require further validation and standardized diagnostic thresholds. Molecular approaches, particularly metagenomic next-generation sequencing, improve pathogen detection in complex infections but remain limited by cost, protocol variability, and challenges in distinguishing clinically relevant pathogens from contaminants. Preventive strategies targeting bacterial adhesion and biofilm formation through local antibiotic delivery, surface modification, and nanotechnology-enabled implants are promising, although long-term efficacy, safety, and cost-effectiveness remain to be established. Overall, PJI management is evolving toward integrated, multimodal diagnostic strategies and biologically informed prevention. Current evidence supports the selective clinical use of synovial biomarker testing as an adjunctive tool within established diagnostic criteria, while continued research is needed before widespread routine implementation can be recommended.</p><p><strong>Statement of clinical significance: </strong>Modern synovial biomarkers provide valuable adjunctive information that may improve diagnostic confidence in challenging periprosthetic joint infection cases when incorporated into a multidisciplinary diagnostic approach involving clinical assessment, laboratory evaluation, microbiological analysis, and established consensus criteria. Emerging preventive strategies targeting biofilm formation and host-microbe interactions represent promising approaches, although their ability to reduce revision rates and improve patient outcomes requires further clinical validation.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"18 ","pages":"634292"},"PeriodicalIF":2.0,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13577183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neck and Low Back Pain in China and Globally: Divergent Trends Among Women of Reproductive Age-An Analysis of the Global Burden of Disease Study 2023.","authors":"Ruihuan Du, Juan Zhao, Zixuan Xiong, Bo Wang","doi":"10.2147/ORR.S623701","DOIUrl":"10.2147/ORR.S623701","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate global and China-specific spinal pain burden and trends among women aged 15-49 years from 1990 to 2023 and to examine regional and Socio‑demographic Index (SDI) variations.</p><p><strong>Methods: </strong>Using the Global Burden of Disease (GBD) 2023 data, we retrieved data on the incidence and years lived with disability (YLDs) of low back pain (LBP) and neck pain among women aged 15-49 years in 204 countries and territories from 1990 to 2023. Estimated annual percentage changes (EAPC) in the age‑standardized incidence and YLDs rates were calculated to quantify the temporal trends. Spearman correlation analysis was used to examine the relationship between age‑standardized rates and the SDI. Bayesian age‑period‑cohort models with integrated nested Laplace approximations were applied to project incidence trajectories through 2040.</p><p><strong>Results: </strong>From 1990 to 2023, the absolute burden of LBP and neck pain increased globally, with divergent trends across regions. Globally, the age‑standardized incidence rate declined for LBP [EAPC -6.0% (95% CI, -8.1 to -3.3)] but increased for neck pain [EAPC 6.2% (95% CI, 0.5 to 13.9)]. The age‑standardized YLDs rate followed a similar directional pattern for each condition. In 2023, the age‑standardized incidence of LBP was highest in high‑SDI regions, while the age‑standardized incidence of neck pain was most pronounced in the Middle East and North Africa. Correlation analyses revealed a significant positive association between LBP and SDI at both the regional (incidence: r=0.673, p<0.0001; YLDs: r=0.678, p<0.0001) and national levels (incidence: r=0.664, p<0.0001; YLDs: r=0.653, p<0.0001). In contrast, no such correlation was observed for neck pain. China showed a distinct pattern: it achieved the steepest global decline in both LBP incidence [EAPC -20.9% (95% CI, -26.4 to -15.0)] and YLDs [EAPC -21.7% (95% CI, -26.6 to -16.0)], yet its neck pain YLDs rate rose sharply [EAPC 17.6% (95% CI, 2.5 to 37.1)]. Projections to 2040 suggest that while age‑standardized rates for both conditions will continue to decline globally and in China, the absolute number of cases and YLDs will remain substantial.</p><p><strong>Conclusion: </strong>This study reveals divergent global trends in spinal pain among women of reproductive age-LBP declining, neck pain rising-with striking geographical heterogeneity. Australasia recorded the highest LBP rates alongside the lowest neck pain rates worldwide, while China achieved one of the steepest global declines in LBP but experienced one of the sharpest rises in neck pain‑related disability. These divergent patterns underscore substantial regional health inequalities in spinal pain burden and highlight the need for tailored, population‑specific prevention strategies, with implementation research urgently needed to evaluate context‑specific effectiveness, particularly in resource‑limited settings.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"18 ","pages":"623701"},"PeriodicalIF":2.0,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13564467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Forearm Nonunion and Segmental Bone Defects: A Focused Review of Masquelet Reconstruction and Free Vascularized Bone Grafting.","authors":"Rita Saad, Johnny Saadeh, Fouad Assaf, Antoine Saber, Saadeddine Abouzahr, Elyssa Kiwan, Wendy Ghanem, Mohamad Badra, Ramzi Moucharafieh","doi":"10.2147/ORR.S616753","DOIUrl":"10.2147/ORR.S616753","url":null,"abstract":"<p><p>Segmental bone loss and chronic nonunion of the forearm present major reconstructive challenges due to the forearm's unique functional anatomy and the frequent coexistence of biological compromise, infection, and soft-tissue deficiency. The purpose of this review is to analyze the pathophysiology of forearm nonunion and to compare the Masquelet induced membrane technique (IMT) and free vascularized bone grafting (VBG) as contemporary reconstructive strategies, focusing on indications, biological rationale, outcomes, and complications. A narrative review of the English-language literature was conducted using PubMed, Embase, and the Cochrane Library, with searches performed through December to February 2026. Search terms included combinations of: <i>forearm nonunion, segmental bone defect, Masquelet technique, induced membrane, vascularized bone graft, free fibular graft, upper extremity reconstruction</i>, and <i>forearm fracture</i>. Clinical and experimental studies addressing forearm nonunion or segmental defects treated with IMT or VBG were included; non-English publications and studies not reporting union or functional outcomes were excluded. Emphasis was placed on biological principles, surgical techniques, union rates, functional outcomes, complication profiles, and factors influencing technique selection. Based on predominantly retrospective, single-center series with heterogeneous defect characteristics, both IMT and VBG appear to demonstrate favorable union rates when applied in appropriately selected patients; however, direct forearm-specific comparative evidence remains limited and largely low-level. IMT provides a staged, biologically favorable environment for graft incorporation and is particularly effective in infected or moderate-sized defects, while avoiding microsurgical complexity. VBGs, especially free vascularized fibular grafts, offer intrinsic vascularity and structural stability, making them advantageous for large defects, compromised local biology, or salvage after failed reconstruction, though with increased technical demands and donor-site morbidity. IMT and VBG are complementary rather than competing strategies in forearm reconstruction. Given the scarcity of high-quality comparative data, outcome optimization relies on individualized decision-making informed by defect size, biological environment, soft-tissue status, patient factors, and surgical expertise, pending more robust prospective evidence.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"18 ","pages":"616753"},"PeriodicalIF":2.0,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13565383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Second-Stage Knee Pain is Not Increased After Staged Bilateral Total Knee Arthroplasty: A Retrospective Linear Mixed-Effects Analysis of 72-Hour Postoperative Pain.","authors":"Khanin Iamthanaporn, Arnan Wiwatboworn, Pawin Wanasitchaiwat, Peeranut Purngpiputtrakul, Varah Yuenyongviwat","doi":"10.2147/ORR.S621187","DOIUrl":"10.2147/ORR.S621187","url":null,"abstract":"<p><strong>Purpose: </strong>Pain perception following staged bilateral total knee arthroplasty (TKA) remains controversial, with previous studies suggesting increased pain after the second knee attributed to central sensitization. This retrospective observational study aimed to compare postoperative pain between first- and second-stage TKA using a linear mixed-effects model adjusted for opioid consumption and peripheral nerve block type.</p><p><strong>Patients and methods: </strong>This retrospective observational study included 155 patients who underwent staged bilateral TKA under spinal anesthesia between 2015 and 2020 at Prince of Songkla University Hospital, Hat Yai, Thailand. Pain was assessed using a verbal numerical rating scale (VNRS) every 4 hours for 72 hours postoperatively. A linear mixed-effects model with a random intercept for each patient was used for the primary analysis, with last observation carried forward (LOCF) as sensitivity analysis.</p><p><strong>Results: </strong>Among the 155 patients included, no significant difference in pain was found between the first and second TKAs (β = -0.027; 95% CI, -0.139 to 0.085; P = 0.638). Pain decreased significantly over time (β = -0.073 per 4-hour interval; 95% CI, -0.083 to -0.063; P < 0.001). Femoral nerve block was associated with reduced pain (β = -0.321; 95% CI, -0.509 to -0.133; P = 0.001). Higher opioid consumption was associated with increased pain (β = 0.018; 95% CI, 0.014 to 0.022; P < 0.001). The LOCF sensitivity analysis confirmed no significant difference between stages (β = -0.051; 95% CI, -0.147 to 0.045; P = 0.300).</p><p><strong>Conclusion: </strong>Within the first 72 hours, pain following second-stage TKA was not significantly different from that following first-stage TKA. These findings do not support central sensitization as an inevitable cause of increased second-knee pain and suggest that previously reported increases may have been confounded by uncontrolled opioid exposure. As an observational analysis, these results cannot establish causation.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"18 ","pages":"621187"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Systematic Review of Recent Developments in Platelet-Rich Plasma Therapy in Hip Osteoarthritis: Variability in Protocols and Clinical Outcomes (2019-2024).","authors":"Emily Awdish, Marlena Muszynska, Konrad Lautenschlager, Ali Hamade, Matthew Caid","doi":"10.2147/ORR.S570844","DOIUrl":"10.2147/ORR.S570844","url":null,"abstract":"<p><p>Hip osteoarthritis (OA) is a chronic, progressive degenerative joint disorder associated with significant morbidity and limited non-surgical treatment options. Over the past 20 years, Platelet-rich plasma (PRP) has garnered increasing interest as a conservative intervention in the setting of OA; however, its clinical efficacy in hip OA remains inconclusive due to substantial heterogeneity in preparation protocols and administration methods. This systematic review aims to examine randomized controlled trials (RCTs) published between 2019 and 2024 that evaluated the efficacy of PRP in the management of hip OA, with specific criteria including the use of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and/or the Visual Analog Scale (VAS) for outcome measurement. Three RCTs met the eligibility criteria. While short-term improvements in pain and function were observed in patients with mild to moderate OA, long-term benefits were inconsistent. Considerable variability in PRP composition (leukocyte-rich versus leukocyte-poor), activation techniques, injection schedules, and follow-up durations was evident across studies. Particularly, one trial demonstrated no significant advantage of PRP over placebo. Methodological limitations, including lack of blinding, underreporting of PRP characteristics, and protocol heterogeneity, impeded the ability to draw definitive conclusions. Although PRP may provide short-term symptomatic relief in early-stage hip OA, the absence of standardized protocols highlights the need for rigorous, long-term randomized controlled trials that employ consistent classification systems (eg, PAW or MARSPILL) and stratified patient populations to inform evidence-based clinical guidelines.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"18 ","pages":"570844"},"PeriodicalIF":2.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal Trends and Projected Burden of Bone and Articular Cartilage Malignancies in East Asia: A Systematic Analysis for the Global Burden of Disease Study 2023.","authors":"Karlen Ka Pui Law, Alex Kwan Ho Yau, Henry Chung Ngai Chan, Angela On Kei Lai, Agnes King Yan Lam, Kenney Ki Lee Lau","doi":"10.2147/ORR.S622366","DOIUrl":"10.2147/ORR.S622366","url":null,"abstract":"<p><strong>Background: </strong>Malignant neoplasm of bone and articular cartilage (MNBAC) is a rare malignancy associated with substantial premature mortality and disability, particularly among younger populations. Comprehensive, region‑specific assessments in East Asia remain limited despite evolving demographic and epidemiologic patterns. Therefore, this study provides the first East Asia-specific epidemiological assessment of MNBAC with future projections.</p><p><strong>Methods: </strong>Utilizing estimates from the Global Burden of Disease (GBD) 2023 study, we quantified incidence, prevalence, deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) attributable to MNBAC in five East Asian countries and territories from 1990 to 2023, with projections extending to 2050 under multiple foresight scenarios. Data are presented as absolute counts and age-standardized rates with 95% uncertainty intervals.</p><p><strong>Results: </strong>Between 1990 and 2023, in East Asia, the number of incident cases increased from 9,054 to 29,877. DALYs rose from 256,249 to 615,434. Over the same period, age-standardized incidence rates per 100,000 population increased modestly, death rates declined from 3.60 to 3.09, and DALY rates decreased from 138.61 to 112.04. Projections indicate that continued increases in absolute deaths (38,467 by 2050 under the reference scenario) and DALYs (804,272), with similar or higher estimates under alternative scenarios. In contrast, age‑standardized death and DALY rates are projected to remain broadly stable or decline slightly across scenarios.</p><p><strong>Conclusion: </strong>The burden of MNBAC in East Asia was increasing, with projections indicating a continuing upward trend through 2050. While declines in age-standardized death and DALYrates suggest improved health outcomes, these metrics do not necessarily reflect substantive changes in healthcare systems. Overall, advancements in population health are unlikely to fully counterbalance the rising MNBAC burden. Targeted treatment strategies focusing on MNBAC, as well as enhancements to registries and data collection, are essential for mitigating future health losses.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"18 ","pages":"622366"},"PeriodicalIF":2.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}