World Journal of Orthopedics最新文献

{"title":"Impact of preoperative frailty on complications, readmissions, and functional recovery following total knee arthroplasty in elderly patients.","authors":"Muhammad Bilal Yasin, Muhammad Raheel, Muhammad Mustafa Ahmed, Sheharyar Ashfaq, Hamdoon Suharwardy Asim, Mohammed Qasim Rauf, Renad Fahim, Rejina Chhetri","doi":"10.5312/wjo.v17.i2.115188","DOIUrl":"10.5312/wjo.v17.i2.115188","url":null,"abstract":"<p><strong>Background: </strong>Total knee arthroplasty (TKA) is increasingly performed in elderly patients with osteoarthritis, yet preoperative frailty is associated with adverse outcomes. Limited data exist from South Asian regions like Pakistan, where resource constraints and high osteoarthritis prevalence may influence these associations.</p><p><strong>Aim: </strong>To evaluate the association between preoperative frailty, assessed by the modified Frailty Index, and postoperative complications, hospital length of stay (LOS), 90-day readmission rates, and 1-year functional recovery in elderly Pakistani patients undergoing primary TKA.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed de-identified records from Bahawal Victoria Hospital, Bahawalpur, Pakistan (from January 2015 to September 2025). Patients aged ≥ 65 years with primary unilateral TKA for osteoarthritis were included. Frail patients (<i>n</i> = 512) were propensity score-matched 1:4 to non-frail controls (<i>n</i> = 2048) using nearest-neighbor matching with a caliper of 0.1. Propensity score estimation followed established methodological standards. Logistic regression, <i>t</i>-tests, <i>χ</i> ² tests, and Kaplan-Meier analyses were used, with <i>P</i> < 0.05 denoting significance. Sensitivity analyses addressed alternative modified Frailty Index thresholds, matching overlap and missing data.</p><p><strong>Results: </strong>Post-matching, groups were balanced. Frail patients had higher composite complications [21.1% <i>vs</i> 9.2%; adjusted odds ratio (OR) = 2.61, 95%CI: 2.05-3.32; <i>P</i> < 0.001], including surgical site infection (OR = 3.12, 95%CI: 2.18-4.46; <i>P</i> < 0.001), deep vein thrombosis (OR = 2.85, 95%CI: 1.92-4.23; <i>P</i> < 0.001), and pulmonary embolism (OR = 4.02, 95%CI: 2.45-6.59; <i>P</i> < 0.001). LOS was prolonged (5.6 ± 1.9 days <i>vs</i> 3.9 ± 1.5 days; <i>P</i> < 0.001), readmissions increased (17% <i>vs</i> 4%; OR = 4.74, 95%CI: 3.56-6.31; <i>P</i> < 0.001), and 1-year Knee Society Score was lower (75.5 ± 10.2 <i>vs</i> 85.1 ± 8.1; <i>P</i> < 0.001), with smaller delta Knee Society Score (30.3 ± 11.4 <i>vs</i> 39.0 ± 10.2; <i>P</i> < 0.001), approaching the minimal clinically important difference of approximately 9 points. Sensitivity analyses confirmed robustness.</p><p><strong>Conclusion: </strong>Preoperative frailty is associated with increased complications, extended LOS, higher readmissions, and impaired functional recovery in elderly TKA patients in this Pakistani cohort. These findings are most directly applicable to tertiary care centers in Pakistan with comparable patient complexity and resource availability. Extrapolation to primary care or markedly different healthcare systems requires further validation. Routine frailty screening may aid risk stratification and perioperative management in similar settings, considering regional challenges such as high tuberculosis prevalence.</p>","PeriodicalId":47843,"journal":{"name":"World Journal of Orthopedics","volume":"17 2","pages":"115188"},"PeriodicalIF":2.3,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12897981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146203398","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":"Music therapy for anxiety reduction in non-acute surgical fracture patients: A systematic review and meta-analysis.","authors":"Yu-Lan Tang, Ying-Xin Zhao, Xiao Wang","doi":"10.5312/wjo.v17.i2.113526","DOIUrl":"10.5312/wjo.v17.i2.113526","url":null,"abstract":"<p><strong>Background: </strong>Anxiety is a common issue among non-acute surgical fracture patients. Non-pharmacological interventions are needed. This meta-analysis aims to synthesize evidence on the efficacy of music therapy for anxiety reduction in this population.</p><p><strong>Aim: </strong>To evaluate the effect of music therapy on anxiety in non-acute surgical fracture patients.</p><p><strong>Methods: </strong>We systematically searched CNKI, PubMed, EMBASE, Cochrane Library, VIP, and MEDLINE databases for randomized controlled trials. Data were pooled using a random-effects model. The primary outcome was anxiety scores measured by standardized scales.</p><p><strong>Results: </strong>Twelve randomized-controlled trials comprising 1257 patients (628 receiving music therapy, 629 in control groups) are included. Music therapy markedly reduces anxiety [the standardized mean difference (SMD<i>)</i> = -2.09, 95%confidence interval (CI): -2.63 to -1.55), <i>P</i> < 0.001], pain (SMD = -2.22, 95%CI: -3.39 to -1.05, <i>P</i> < 0.001) and depression (SMD = -2.05, 95%CI: -3.75 to -1.25, <i>P</i> < 0.001) <i>vs</i> standard care.</p><p><strong>Conclusion: </strong>Music therapy significantly reduces anxiety in non-acute surgical fracture patients and should be considered as a complementary therapy.</p>","PeriodicalId":47843,"journal":{"name":"World Journal of Orthopedics","volume":"17 2","pages":"113526"},"PeriodicalIF":2.3,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12898857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146202816","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":"Orthopedic trinity: Arthroscopy, sports medicine, and regenerative orthopedics.","authors":"Madhan Jeyaraman, A S P V S Saketh, Naveen Jeyaraman, Swaminathan Ramasubramanian, Arulkumar Nallakumarasamy, Sathish Muthu","doi":"10.5312/wjo.v17.i2.113197","DOIUrl":"10.5312/wjo.v17.i2.113197","url":null,"abstract":"<p><p>Musculoskeletal conditions are among the leading causes of disability worldwide, necessitating the development of effective, specialized treatment approaches. In response, orthopedic practice has evolved into three distinct specialties: Arthroscopy, sports medicine, and regenerative orthopedics. Each domain represents a fundamentally different approach to musculoskeletal care: Arthroscopy addresses structural pathology through surgical intervention, sports medicine optimizes function through rehabilitation, and regenerative orthopedics modulates healing through biological therapies. These distinct methodologies serve different patient populations and clinical scenarios, requiring specialized training, equipment, and expertise. This review explores the historical evolution, unique therapeutic modalities, and independent clinical applications of these three fields, with emphasis on the Indian orthopedic landscape. Through a narrative synthesis of literature indexed in PubMed, Scopus, and peer-reviewed Indian sources, we delineate specific indications, outcome metrics, and innovations unique to each specialty. The future of orthopedic care lies not in forced integration but in the strategic application of the most appropriate specialty for each clinical scenario, ensuring optimal resource utilization and maintaining clinical excellence within each distinct discipline.</p>","PeriodicalId":47843,"journal":{"name":"World Journal of Orthopedics","volume":"17 2","pages":"113197"},"PeriodicalIF":2.3,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12898710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146202825","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":"Laminectomy alone <i>vs</i> laminectomy with posterior fusion in lumbar spinal stenosis: The role of instability.","authors":"Mikail Chatzivasiliadis, Panagiotis Konstantinou, Dimitrios Koulalis, Lazaros Kostretzis, Nikolaos Gkantsinikoudis, Constantinos Chaniotakis, Krikor Gkoumousian, Stylianos Kapetanakis","doi":"10.5312/wjo.v17.i2.113932","DOIUrl":"10.5312/wjo.v17.i2.113932","url":null,"abstract":"<p><p>Lumbar spinal stenosis (LSS) is a common degenerative spinal disorder in older adults and a leading indication for surgery. Decompression <i>via</i> laminectomy remains the gold standard when conservative measures fail, but the addition of posterior fusion in cases without clear instability remains controversial. Anatomical and biomechanical considerations lie at the center of this debate. Central canal stenosis, lateral recess narrowing, and degenerative spondylolisthesis represent the main contributors to LSS, but they also raise the question of whether they signal true instability. Definitions of instability vary considerably across studies and guidelines, and thresholds for diagnosis remain inconsistent. While fusion is appropriate in the presence of instability, the lack of standardized criteria causes an uncertainty that may influence surgeons to fuse in cases without having definitive radiographic criteria for instability. The aim of this review is to compare laminectomy alone with laminectomy plus posterior fusion in the surgical management of LSS. Emphasis is given on anatomical and biomechanical considerations, instability definitions, clinical outcomes, and guideline recommendations. High-quality multicenter randomized trials are needed to develop universally accepted instability definitions, guide management of borderline cases, and optimize patient outcomes.</p>","PeriodicalId":47843,"journal":{"name":"World Journal of Orthopedics","volume":"17 2","pages":"113932"},"PeriodicalIF":2.3,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12898318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146202793","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":"Necessity of grafting in scaphoid nonunion fixation: A comparative outcome analysis.","authors":"Amr Elshahhat, Moheib Ahmed, Ahmed Saleh, Yasser Abed, Hany Elashmawy, Khaled Nour","doi":"10.5312/wjo.v17.i2.112889","DOIUrl":"10.5312/wjo.v17.i2.112889","url":null,"abstract":"<p><strong>Background: </strong>Scaphoid nonunion (SNU) presents substantial functional limitations, frequently necessitating surgical intervention to restore wrist mobility and prevent degenerative changes. While the traditional approach to managing SNUs has relied on open fixation combined with bone grafting, the universal necessity of grafting, especially in stable nonunion (NU), is increasingly questioned. Emerging evidence indicates that graft-less fixation can deliver favorable outcomes, with notable healing observed in such cases.</p><p><strong>Aim: </strong>To compare the outcomes of graft-less <i>vs</i> graft-augmented fixation in stable SNU, focusing on union rates (URs), healing time (HT), and functional recovery.</p><p><strong>Methods: </strong>A retrospective analysis of 44 patients with stable SNUs (Slade grades I-V) managed by either graft-less (<i>n</i> = 21) or graft-augmented (<i>n</i> = 23) fixation. Subgroup analysis included non-vascularized (<i>n</i> = 12) and vascularized grafts (<i>n</i> = 11). Clinical and radiological outcomes were assessed over a minimum 24-month follow-up. HT and UR were compared across groups concerning NU type, bone resorption, duration, and anatomical location.</p><p><strong>Results: </strong>Overall UR was 81.8%. URs did not differ significantly between groups (<i>P</i> > 0.05), whereas HT was significantly shorter with graft augmentation (<i>P</i> < 0.001). Graft-less fixation yielded superior grip strength (<i>P</i> < 0.001), radial/ulnar tilt (<i>P</i> = 0.004, < 0.001), and Mayo modified wrist scores (<i>P</i> = 0.01). Graft augmentation particularly improved outcomes in cystic SNUs, those with ≥ 5 mm bone loss, and NUs ≥ 1 year. Non-vascularized and vascularized grafts demonstrated comparable outcomes (UR: 91.7% <i>vs</i> 81.8%, <i>P</i> = 0.5). Smoking showed a significant association with delayed healing in graft-augmented fixation (<i>P</i> = 0.04), whereas no such relationship was observed in graft-less fixation.</p><p><strong>Conclusion: </strong>Fixation without grafting is viable in selected stable SNUs, offering comparable union and superior function, albeit with longer HT. Bone grafting remains advantageous in cystic, long-standing, or biologically compromised NUs. Treatment should be tailored based on NU characteristics and patient factors.</p>","PeriodicalId":47843,"journal":{"name":"World Journal of Orthopedics","volume":"17 2","pages":"112889"},"PeriodicalIF":2.3,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12898285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146202814","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":"Magnetic resonance imaging tissue bridges: An emerging biomarker for prognostication in traumatic spinal cord injury.","authors":"Yao Peng, Ni-Na Luo, Ling Gan, Jia-Qi Zhang","doi":"10.5312/wjo.v17.i2.115848","DOIUrl":"10.5312/wjo.v17.i2.115848","url":null,"abstract":"<p><p>Traumatic spinal cord injury (SCI) remains one of the most challenging conditions in neuro-orthopedics, and functional recovery outcomes are mainly unpredictable. A recent prospective study provided compelling evidence that quantitative magnetic resonance imaging biomarkers, particularly midsagittal tissue bridge dimensions, could serve as valuable predictors of neurological recovery following acute SCI. By correlating tissue bridge measurements at 1 month and 6 months with motor and sensory improvements, a clinically meaningful imaging-based prognostic model was developed. Moreover, the inverse association among canal compromise, lesion size, and functional outcomes highlighted the importance of early structural preservation in SCI management. This study emphasized the growing potential of magnetic resonance imaging as both a diagnostic and prognostic tool, with significant implications for patient stratification in clinical and research settings. Future research incorporating tissue bridge biomarkers with advanced imaging techniques and neuroregenerative therapies may further refine personalized rehabilitation strategies for SCI patients.</p>","PeriodicalId":47843,"journal":{"name":"World Journal of Orthopedics","volume":"17 2","pages":"115848"},"PeriodicalIF":2.3,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12898891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146202876","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":"Barriers to orthopedic surgery research productivity in Saudi Arabia.","authors":"Abdulrahman Alaseem, Sara Alhomaidhi, Shahad Aljudi, Waleed Albishi","doi":"10.5312/wjo.v17.i2.113461","DOIUrl":"10.5312/wjo.v17.i2.113461","url":null,"abstract":"<p><strong>Background: </strong>Research productivity is a cornerstone of academic medicine, driving evidence-based practice, innovation, and professional advancement. In surgical specialties such as orthopedics, active research engagement is essential to improving patient outcomes and advancing clinical techniques. However, despite notable progress in Saudi Arabia's medical research landscape, orthopedic research output remains limited and concentrated within a few institutions. Understanding the barriers that hinder orthopedic surgeons from conducting research is therefore crucial to strengthening national research capacity and aligning with Saudi Vision 2030's goal of fostering scientific excellence.</p><p><strong>Aim: </strong>To identify the barriers that limit research productivity among orthopedic surgeons in Saudi Arabia and explore the goals and motivations influencing their engagement in research across different subspecialties and levels of practice.</p><p><strong>Methods: </strong>We used a descriptive, cross-sectional, quantitative design, employing a structured online questionnaire distributed to 105 orthopedic surgeons across Saudi Arabia. The questionnaire was adapted from validated tools and reviewed for validity. Participants reported practice patterns, research activity, and barriers to productivity. Associations between variables were analyzed using univariate and multivariate methods.</p><p><strong>Results: </strong>A total of 105 orthopedic surgeons completed the survey. A statistically significant association was found between prior research experience and having served as a primary investigator within the past 5 years. Additionally, a highly significant association was found with co-authorship in the last 5 years (<i>P</i> < 0.001), as 52 participants (55.3%) had contributed as co-authors at least once. However, there was no significant association between prior research experience and factors such as allocated research time (<i>P</i> = 0.280), level of practice (<i>P</i> = 0.147), years in practice (<i>P</i> = 0.826), or the number of patients seen per week (<i>P</i> = 0.885). Univariate analysis revealed several barriers to research productivity: (1) Insufficient research time (71; 67.6%); (2) Lack of research assistants (57; 54.3%); (3) Inadequate research training (48; 45.7%); (4) Lack of funding (42; 40%); (5) Lack of research collaboration (39; 37.1%); (6) Lack of reward/incentive (38; 36.2%); and (7) No personal interest (20; 19.04%).</p><p><strong>Conclusion: </strong>Addressing protected time, support staff, and research training may enhance orthopedic research productivity. This study highlights key institutional and educational gaps that can guide policy reforms and strengthen national orthopedic research capacity.</p>","PeriodicalId":47843,"journal":{"name":"World Journal of Orthopedics","volume":"17 2","pages":"113461"},"PeriodicalIF":2.3,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12898755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146203381","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":"Does surgeon handedness affect the outcomes after primary total knee arthroplasty? A retrospective cohort study.","authors":"Ahmed A Khalifa, Ahmed M Abdelaal, Mohamed Ma Moustafa","doi":"10.5312/wjo.v17.i2.113696","DOIUrl":"10.5312/wjo.v17.i2.113696","url":null,"abstract":"<p><strong>Background: </strong>Various factors affecting the outcomes after primary total knee arthroplasty (TKA) have been investigated in the literature; however, the effect of surgeon handedness on outcomes has rarely been addressed.</p><p><strong>Aim: </strong>To assess whether the radiological and functional outcomes differ between right and left primary TKA when operated by right-handed surgeons.</p><p><strong>Methods: </strong>A retrospective evaluation of 370 TKAs performed by right-handed surgeons [47.8% right TKAs, dominant side (Group D), and 52.2% left TKAs, non-dominant side (Group N)]. The radiological outcomes were the overall alignment measured as the hip-knee-ankle (HKA) angle, and the tibial and femoral component alignment in the coronal plane measured as the medial tibial proximal angle (MPTA) and mechanical lateral distal femoral angle (mLDFA). The percentage of each alignment outside the accepted safe zone values (outliers) were calculated. The functional outcome at the last follow up was evaluated per the Knee Society Score (KSS) System for 206 knees only.</p><p><strong>Results: </strong>There were no difference in patients' basic characteristics or in postoperative radiological or functional outcomes between Group D and Group N as follows: HKA, 177.96° ± 3.13° <i>vs</i> 178.55° ± 3.38° (<i>P</i> = 0.082), MPTA, 88.90° ± 2.61° <i>vs</i> 89.43° ± 2.71° (<i>P</i> = 0.056), mLDFA, 90.16° ± 2.54° <i>vs</i> 89.76° ± 2.53° (<i>P</i> = 0.140), and KSS, 80.59 ± 14.73 <i>vs</i> 79.56 ± 15.64 (<i>P</i> = 0.628). There was no significant difference in the percentage of outliers in the HKA and mLDFA between groups. For the MPTA, Group D had significantly more implants within the safe zone than Group N, 53.7% <i>vs</i> 41.4% (<i>P</i> = 0.022). There was no difference regarding using intramedullary (IM) <i>vs</i> extramedullary (EM) alignment for the tibial cut between both groups (<i>P</i> = 0.687). In Group D, there was no significant difference in mean MPTA between IM (88.86° ± 3.26°) and EM (88.93° ± 1.76°) methods (<i>P</i> = 0.862); however, EM resulted in significantly fewer outliers compared to IM (29.2% <i>vs</i> 63.6% respectively; <i>P</i> < 0.001). In Group N, the EM method produced a significantly more valgus alignment than IM (90.38° ± 1.99° <i>vs</i> 88.56° ± 3.00°, <i>P</i> < 0.001), but this did not translate into a significant reduction in outliers (<i>P</i> = 0.650).</p><p><strong>Conclusion: </strong>The overall radiological and functional outcomes after primary TKA were unaffected by the surgeon's handedness; however, the placement of the tibial component was significantly more precise on the dominant side with fewer outliers.</p>","PeriodicalId":47843,"journal":{"name":"World Journal of Orthopedics","volume":"17 2","pages":"113696"},"PeriodicalIF":2.3,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12898334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146203468","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":"Phosphatidylinositol-3-kinase/protein kinase B signaling dysregulation in steroid-induced osteonecrosis of the femoral head: A minireview of therapeutic implications.","authors":"Ya-Nan Wang, Jun-Xia Jiang, Cheng-Xiang Pang, Lei Sun, Ran Sun, Feng-Ming Wang, Hong-Jiang Jiang","doi":"10.5312/wjo.v17.i2.110517","DOIUrl":"10.5312/wjo.v17.i2.110517","url":null,"abstract":"<p><p>Steroid-induced osteonecrosis of the femoral head (SIONFH) is a serious complication of glucocorticoid (GC) therapy and is characterized by progressive bone collapse, ischemia, and impaired bone regeneration. The phosphatidylinositol-3-kinase/protein kinase B (PI3K/AKT) signaling pathway plays a pivotal role in maintaining bone homeostasis by regulating proliferation, differentiation, and survival of osteoblasts, osteoclasts, mesenchymal stem cells, and vascular endothelial cells. This minireview summarizes the mechanisms by which GCs disrupt PI3K/AKT signaling and the pathological consequences. The main results from the literature indicate that GCs suppress PI3K/AKT signaling in osteoblasts, leading to increased apoptosis and reduced bone formation. GCs also alter PI3K/ AKT-mediated signaling to promote osteoclast activity, shift bone marrow stromal cell differentiation toward adipogenesis, and induce endothelial dysfunction, all of which contribute to SIONFH pathogenesis. Consequently, targeting the PI3K/AKT pathway has emerged as a promising therapeutic strategy. Emerging interventions, including PI3K/AKT activators like insulin growth factor 1, stem cell therapies, and exosome-based treatments, have shown preclinical efficacy. In conclusion, the PI3K/AKT pathway is a central hub in SIONFH pathogenesis, and its modulation offers a promising avenue for developing novel targeted and personalized therapeutic approaches. Further investigation is essential to translate these preclinical findings into effective clinical treatments.</p>","PeriodicalId":47843,"journal":{"name":"World Journal of Orthopedics","volume":"17 2","pages":"110517"},"PeriodicalIF":2.3,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12898572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146202962","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":"Value of \"true\" leukocytosis formula in determining total knee arthroplasty prosthetic joint infection in the community hospital setting.","authors":"Brendan M Sweeney, Shaan Sadhwani, Timothy Edwards, Matthew Kelly","doi":"10.5312/wjo.v17.i2.113667","DOIUrl":"10.5312/wjo.v17.i2.113667","url":null,"abstract":"<p><strong>Background: </strong>With the advent of recent point of care testing to evaluate for prosthetic joint infection (PJI) such as alpha-defensin and calprotectin, the diagnosis of PJI has reached a new paramount. The most widely accepted diagnostic criteria in the literature at this time is the international consensus meeting (ICM) score by Parvizi <i>et al</i> in 2018. One of the proposed limitations of the ICM criteria is determining if fluid analysis can be trusted for bloody joint aspirations. A proposed formula to correct red blood cells in aspirations was described in 2008 but has not been explored since then.</p><p><strong>Aim: </strong>To determine if the \"true leukocytosis\" formula for prosthetic joint aspirations is useful in determining PJIs.</p><p><strong>Methods: </strong>Of 158 cases with International Classification of Diseases, 10^th revision diagnoses of total knee arthroplasty PJIs from 2020-2021 from a single health system were reviewed and preoperative ICM scores were calculated. Inclusion criteria involved preoperative scores indicating infection, first time diagnoses, and culture positive infections. Culture positivity remained our gold standard for infection confirmation. We compared sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve for preoperative ICM score and corrected preoperative ICM score.</p><p><strong>Results: </strong>Of 81 cases met the inclusion criteria and had preoperative ICM scores calculated. Of the 81 cases that met inclusion criteria, no cases were found to have different preoperative ICM scores after applying the correction formula for \"true leukocytosis\" proposed by Ghanem <i>et al</i> in 2008.</p><p><strong>Conclusion: </strong>Given the lack of variance in ICM score following the proposed correction formula, it appears that the proposed \"true leukocytosis\" formula is not a useful adjuvant in treatment decision making.</p>","PeriodicalId":47843,"journal":{"name":"World Journal of Orthopedics","volume":"17 2","pages":"113667"},"PeriodicalIF":2.3,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12898235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146203170","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}