World Journal of Orthopedics最新文献

{"title":"Cemented <i>vs</i> uncemented femoral fixation in total hip arthroplasty: A systematic review and meta-analysis of periprosthetic fracture risk.","authors":"Mohammed H Abushal, Osama M Embaby, Mahmoud Mersal, Emran Badghish, Mohamed Elalfy","doi":"10.5312/wjo.v17.i2.115615","DOIUrl":"10.5312/wjo.v17.i2.115615","url":null,"abstract":"<p><strong>Background: </strong>Periprosthetic femoral fractures (PFFs) represent a devastating complication following primary total hip arthroplasty (THA), associated with significant morbidity, mortality, and healthcare costs. The choice of femoral fixation method - cemented <i>vs</i> uncemented - may influence the risk of postoperative periprosthetic fracture. While uncemented stems have gained popularity due to perceived advantages in younger patients and bone preservation, emerging evidence suggests potential differences in fracture risk between fixation methods, particularly in elderly and osteoporotic populations.</p><p><strong>Aim: </strong>To conduct a systematic review and meta-analysis comparing the risk of PFFs between cemented and uncemented femoral fixation in primary THA.</p><p><strong>Methods: </strong>Following the PRISMA 2020 guidelines, we performed a comprehensive search of PubMed, EMBASE, and the Cochrane Library databases up to October 2025. We included comparative studies reporting periprosthetic fracture rates following primary THA with cemented <i>vs</i> uncemented femoral fixation. The primary outcome was the incidence of PFFs. Data were pooled using a random-effects model. Risk of bias was assessed using the Cochrane RoB 2.0 tool for randomized controlled trials and the Methodological Index for Non-Randomized Studies for observational studies. Publication bias was evaluated using funnel plot analysis and Egger's test.</p><p><strong>Results: </strong>A total of 27 studies were included in the qualitative synthesis, of which three comparative studies, encompassing 2650 patients (772 cemented, 1878 uncemented), provided extractable data for quantitative meta-analysis of periprosthetic fracture incidence. The pooled analysis demonstrated a trend towards a lower risk of periprosthetic fractures in the cemented group compared to the uncemented group (risk ratio = 0.46; 95% confidence interval: 0.14-1.49; <i>P</i> = 0.19); however, this finding was not statistically significant. Substantial heterogeneity was observed among the included studies (<i>I</i> ² = 93.1%, <i>P</i> < 0.001). Funnel plot analysis was limited by the small number of studies but did not suggest significant publication bias.</p><p><strong>Conclusion: </strong>This meta-analysis suggests that cemented femoral fixation in primary THA may be associated with a lower risk of PFFs compared to uncemented fixation, although this finding did not reach statistical significance and was based on limited, heterogeneous data. The choice of fixation method should be individualized based on patient age, bone quality, activity level, and surgeon experience. Cemented fixation may be particularly advantageous in elderly patients and those with poor bone stock. Further high-quality randomized controlled trials with adequate follow-up are needed to provide definitive evidence.</p>","PeriodicalId":47843,"journal":{"name":"World Journal of Orthopedics","volume":"17 2","pages":"115615"},"PeriodicalIF":2.3,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12898574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146203396","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":"Effect of teriparatide on improving fracture union in osteoporotic intertrochanteric fractures: A systematic review and meta-analysis.","authors":"Kumar Keshav, Kumar Kaustubh, Prabhaker Mishra","doi":"10.5312/wjo.v17.i2.113659","DOIUrl":"10.5312/wjo.v17.i2.113659","url":null,"abstract":"<p><strong>Background: </strong>Intertrochanteric or pertrochanteric fractures are common among the elderly population. They are primarily treated by internal fixation. Malunion, delayed union, and implant-related complications are often seen in this population due to osteoporosis, which leads to inadequate bone stock and delayed healing of bone. Teriparatide is an established first-line anabolic treatment for osteoporosis that increases bone turnover and promotes new bone formation. Recent papers have shown its role in fracture union in which it enhanced the callus formation and bridged the fractured ends of the bones.</p><p><strong>Aim: </strong>To determine the effect of subcutaneous injection of teriparatide on osteoporotic intertrochanteric fractures.</p><p><strong>Methods: </strong>We searched PubMed, EMBASE, Scopus, and Cochrane Library for English language articles that were published by June 3, 2025. We selected articles that compared the use of teriparatide injection with either no injection or placebo in patients with osteoporosis who experienced an intertrochanteric fracture that was treated with internal fixation. Relevant data, including union time (primary outcome variable) and other radiological and functional outcome parameters, were extracted from the included studies. The web version of Cochrane's Review Manager was used for meta-analysis.</p><p><strong>Results: </strong>Six studies (four randomized controlled trials and two non-randomized studies) met the inclusion criteria for this systematic review. A total of 393 patients [teriparatide (<i>n</i> = 175) and control (<i>n</i> = 218)] were included in the studies. Data from five of these studies were combined, and the pooled meta-analysis of the fracture union time [teriparatide (<i>n</i> = 155) and control (<i>n</i> = 198)] showed a significant difference in favor of the teriparatide group (standardized mean difference = -0.77, 95% confidence interval: -0.99 to -0.55, <i>P</i> < 0.00001). Other radiological parameters like varus collapse and incidence of complications were decreased in the teriparatide group. Functional outcomes were better in the early follow-up of patients who received teriparatide. However, the follow-up outcomes were similar in the long term for both groups.</p><p><strong>Conclusion: </strong>The meta-analysis showed that teriparatide reduced union time, varus collapse, and complications in osteoporotic intertrochanteric fractures. However, these findings should be interpreted cautiously due to limited evidence and small sample size.</p>","PeriodicalId":47843,"journal":{"name":"World Journal of Orthopedics","volume":"17 2","pages":"113659"},"PeriodicalIF":2.3,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12898158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146203432","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":"Osteopathia striata with cranial sclerosis, associated with juvenile idiopathic arthritis: A case report and review of literature.","authors":"Alexandr A Yakovlev, Ekaterina V Gaidar, Evgeny N Suspitsin, Polina R Korzun, Mikhail M Kostik","doi":"10.5312/wjo.v17.i2.113473","DOIUrl":"10.5312/wjo.v17.i2.113473","url":null,"abstract":"<p><strong>Background: </strong>Osteopathia striata with cranial stenosis (OSCS) is a rare genetic disorder (Mendelian Inheritance in Man: 300373) inherited in an X-linked dominant pattern. It is classified as a form of skeletal dysplasia and is characterized by linear striations of bone sclerosis, primarily affecting the long bones. OSCS may present as an isolated condition or as part of broader genetic conditions such as Horan-Beighton and Goltz syndromes. Thus far, approximately 100 cases have been reported.</p><p><strong>Case summary: </strong>Herein, we report the case of an 11-year-old girl with OSCS in association with juvenile idiopathic arthritis (JIA). Osteopathia striata was suspected during the examination in a local healthcare facility due to arthritis. The patient was then transferred to the pediatric rheumatology clinic due to the inefficacy of the first-line systemic immunosuppressive therapy. Genetic analysis revealed a previously unreported <i>AMER1</i> c.800C>A (p.Ser267*) variant, which was not detected in the healthy mother. Thus, the diagnosis of OSCS was made based on characteristic bone imaging and the presence of likely pathogenic <i>AMER1</i> variant. This study presents the first detailed description of OSCS occurring in combination with JIA.</p><p><strong>Conclusion: </strong>Diagnosis of OSCS can be challenging due to its rarity and phenotypic heterogeneity. The relationship between JIA and OSCS remains unclear. This case may raise awareness of OSCS.</p>","PeriodicalId":47843,"journal":{"name":"World Journal of Orthopedics","volume":"17 2","pages":"113473"},"PeriodicalIF":2.3,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12898134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146202912","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":"Weight-adjusted low molecular weight heparin with surgery morning dose administration: Impact on hip hemiarthroplasty early infections.","authors":"Ahmed M Nageeb Mahmoud, Hemil Hasmukh Maniar, Juan Bernate, Daniel S Horwitz","doi":"10.5312/wjo.v17.i2.112757","DOIUrl":"10.5312/wjo.v17.i2.112757","url":null,"abstract":"<p><strong>Background: </strong>Several studies have questioned the efficacy of the standard perioperative low-molecular-weight heparin (LMWH) dose in preventing venous thromboembolic complications and have recommended dose escalation to a weight-based regimen. Other studies, however, have cautioned that higher anticoagulation regimens may be associated with an elevated risk of wound complications and periprosthetic joint infections. This dichotomy underscores the need for identifying the safety of the thromboprophylaxis approach in surgical settings.</p><p><strong>Aim: </strong>To analyze the effect of LMWH regimen modification to weight-based with dose administration the morning of surgery on the incidence of early (within 3 months) postoperative prosthetic joint infection (PJI) in patients with hip hemiarthroplasty (HA).</p><p><strong>Methods: </strong>At our multi-hospital health system, LMWH dose escalation to the weight-based regimen without holding the morning dose on the day of surgery started in mid-June 2019. We have reviewed all cases of HA performed at our institution from 2007 to 2024 and divided them into two groups: Before and after the dose modification protocol. The number of early PJI cases has been studied in each group.</p><p><strong>Results: </strong>A total of 33 HA early PJI cases fit the study selection criteria and were included in this study. Of the 1517 cases performed before the new protocol, 19 cases (1.25%) had early infections, while within the modified protocol (weight-based with morning dose), 14 cases (1.49%) had infections out of a total of 937 cases. The difference between the two groups was found to be not statistically significant (<i>z</i> = -0.5, <i>P</i> = 0.6).</p><p><strong>Conclusion: </strong>Our results indicate that LMWH dose escalation to a weight-based regimen without withholding the LMWH morning dose on the day of surgery did not lead to a significant change in the rate of early PJI in this study. A larger, multicenter study would be ideal for providing stronger evidence.</p>","PeriodicalId":47843,"journal":{"name":"World Journal of Orthopedics","volume":"17 2","pages":"112757"},"PeriodicalIF":2.3,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12898058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146203314","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":"Early dislocation in primary total hip arthroplasty: Evaluation of treatment options following closed reduction.","authors":"Dario Regis, Romolo Borgese, Francesco Bagnis, Bruno Magnan, Elena Manuela Samaila","doi":"10.5312/wjo.v17.i2.113367","DOIUrl":"10.5312/wjo.v17.i2.113367","url":null,"abstract":"<p><p>Although total hip arthroplasty (THA) is a very successful orthopedic operation with high long-term survival rates, some failures may occur and considerably influence the final outcome. Early dislocation following primary THA is a rare but challenging complication, which may affect functional recovery and patient satisfaction, especially in case of recurrence. Moreover, it is one of the most common reasons for revision, and is associated with substantial social, health, and economic costs. The aim is to critically review the current evidence on the management of early dislocation after primary THA, with particular focus on post-reduction treatment strategies and the role of immobilization techniques. Particular attention was given to the evidence base supporting various clinical approaches. The review highlights a lack of consensus regarding optimal post-reduction management. Several methods have been proposed, but most are supported by limited data and small case series. Comparative studies are scarce, and clinical outcomes are inconsistent. Based on current findings, the recommended post-reduction management practice remains controversial, but the effectiveness of immobilization in preventing recurrence is not supported by clinical evidence, and therefore should be avoided. Further high-quality studies are needed to establish standardized, evidence-based protocols that can improve patient outcomes and reduce the risk of recurrence.</p>","PeriodicalId":47843,"journal":{"name":"World Journal of Orthopedics","volume":"17 2","pages":"113367"},"PeriodicalIF":2.3,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12897908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146203459","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":"Critical appraisal of bone graft meta-analysis in tibial plateau fractures.","authors":"Eşref Selçuk, Murat Erem, Savaş Yıldırım","doi":"10.5312/wjo.v17.i2.114188","DOIUrl":"10.5312/wjo.v17.i2.114188","url":null,"abstract":"<p><p>We read with great interest the meta-analysis by Alshahrani <i>et al</i>, which compared autologous bone grafts and bone substitutes in the management of tibial plateau fractures. This comprehensive review offers valuable data; however, several methodological aspects should be carefully considered to strengthen the interpretation of its findings. Tibial plateau fractures exhibit wide variability in terms of injury mechanism and prognosis. In the included studies, fracture classification was not consistently reported, and studies on simple, mixed, and complex patterns were pooled together, which may have introduced bias. Furthermore, the bone substitutes assessed, namely, calcium phosphate cement, calcium sulfate, bioactive glass, and various composites, differ greatly in composition, mechanical properties, and degradation behavior. The primary outcome of joint depression was analyzed in very small subgroups, limiting statistical power, and was treated as continuous data despite the small sample sizes. The follow-up durations were short, although bone graft incorporation may take months to years, and shorter follow-up may miss later complications. Finally, the search strategy did not specify language criteria, which may have contributed to the inability to locate one of the included studies during our search, potentially indicating the inclusion of non-English articles. Addressing these methodological concerns would increase the robustness, validity, and clinical applicability of this important meta-analysis.</p>","PeriodicalId":47843,"journal":{"name":"World Journal of Orthopedics","volume":"17 2","pages":"114188"},"PeriodicalIF":2.3,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12898154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146203326","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":"Lipid metabolism disorders and osteoarthritis progression: Potential intervention with plant active ingredients.","authors":"Tao Zhang, Jin-Long Liu, Wei Wang, Ke Ren, Xiao-Mei Liu, Ke Cao, Zhen Li, Xi-Yao Cheng, Xin-Yu Zhang, Wen-Sheng Xu","doi":"10.5312/wjo.v17.i2.113405","DOIUrl":"10.5312/wjo.v17.i2.113405","url":null,"abstract":"<p><p>Osteoarthritis (OA) is a degenerative joint disease characterized by progressive articular cartilage destruction, subchondral bone alterations, and localized inflammation. With global population aging, the prevalence of OA continues to rise, imposing a substantial social and economic burden. In recent years, lipid metabolism disorders have been identified as key contributors to the development and progression of OA. Adipose tissue functions not only as an energy reservoir but also as an endocrine organ that regulates immune responses, inflammation, and cartilage degradation through the secretion of adipokines (<i>e.g.</i>, leptin and lipocalin). Abnormal fatty acid metabolism, particularly the imbalance between fatty acid synthesis and catabolism and the dysregulated secretion of adipokines, is closely associated with OA pathogenesis. Bioactive phytochemicals are increasingly recognized as promising therapeutic agents for regulating lipid metabolism and slowing OA progression, due to their favorable biological activity and low toxicity. This review summarizes the relationship between lipid metabolism disorders and OA, highlights the mechanisms by which representative phytochemicals (<i>e.g.</i>, curcumin, green tea polyphenols, and resveratrol) regulate lipid metabolism and attenuate OA progression, and further analyzes the endocrine role of adipose tissue, the impact of fatty acid metabolism on OA, and the therapeutic potential of phytochemicals through lipid metabolism modulation.</p>","PeriodicalId":47843,"journal":{"name":"World Journal of Orthopedics","volume":"17 2","pages":"113405"},"PeriodicalIF":2.3,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12898534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146202862","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":"Risk factors for thoracic-osteoporotic thoracic vertebral compression fractures during the normalized prevention and control period of COVID-19.","authors":"Yi-Fan Li, Chen-Qiong Wu, Yang Long, Qi-Feng Yu, Wei Xu, Jian-Jie Zhao, Xiang-Yang Zhang, Zhi-Kun Li","doi":"10.5312/wjo.v17.i2.114984","DOIUrl":"10.5312/wjo.v17.i2.114984","url":null,"abstract":"<p><strong>Background: </strong>Some scholars believe that there is a certain correlation between coronavirus disease 2019 (COVID-19) infection and the occurrence of osteoporotic vertebral compression fractures (OVCF), but no relevant domestic research reports have been published yet. This study retrospectively analyzed the clinical data of patients admitted for OVCF and treated with percutaneous vertebroplasty during the normalized prevention and control period of COVID-19 in Shanghai (after June 1, 2022), aiming to explore the individual differences of OVCF patients during this special period and analyze the risk factors for OVCF.</p><p><strong>Aim: </strong>To explore risk factors for senile OVCF during COVID-19 normalization.</p><p><strong>Methods: </strong>Retrospective analysis of 230 OVCF patients (June 2022 to June 2023, percutaneous vertebroplasty, observation group) and 236 controls (June 2020 to June 2021, OVCF surgery). Observation group was split into nucleic acid-positive (<i>n</i> = 85) and negative (<i>n</i> = 145) subgroups. Fracture location/cause, visual analogue scale, activity scores were compared; risk factors identified.</p><p><strong>Results: </strong>Observation group had 42.2% thoracic fractures and 38.2% cough-induced fractures (both higher than controls, <i>P</i> < 0.05). No significant differences in post-op visual analogue scale (1 day, 1 month) or activity scores (<i>P</i> > 0.05). Nucleic acid results, fracture cause/location correlated (<i>P</i> < 0.05; cause-location <i>r</i> = 0.827). Logistic regression showed fracture cause, nucleic acid result, body mass index, bone mineral density as high-risk factors.</p><p><strong>Conclusion: </strong>During COVID-19 normalization, cough is the top OVCF cause; thoracic fractures rise. The four factors above are independent risks. For elderly COVID-positive patients with recurrent cough, lung disease treatment, anti-osteoporosis therapy, and thoracic braces prevent thoracic OVCF.</p>","PeriodicalId":47843,"journal":{"name":"World Journal of Orthopedics","volume":"17 2","pages":"114984"},"PeriodicalIF":2.3,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12898869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146203124","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":"Return to farming after orthopedic surgery: A systematic review.","authors":"Eva Lehtonen, Ruja Kambli, Krishna Mandalia, Kaley Beall, Sarav S Shah","doi":"10.5312/wjo.v17.i1.112625","DOIUrl":"https://doi.org/10.5312/wjo.v17.i1.112625","url":null,"abstract":"<p><strong>Background: </strong>There has been an increasing focus in recent years on health-care disparities. Studies investigating return to work (RTW) or sports are often performed in large, urban areas. Relatively few studies have investigated rates of return to farming or other heavy labor that is of interest to patients in rural areas.</p><p><strong>Aim: </strong>To evaluate the literature regarding RTW in farming or heavy labor after orthopedic hip, knee, or shoulder surgery.</p><p><strong>Methods: </strong>A search was performed in the PubMed and EMBASE databases using Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Studies were included if they reported patients employed in farming or heavy labor, RTW rates after orthopedic surgery of the hip, knee, or shoulder, and had a minimum 6-month follow-up. A meta-analysis of proportions using a random-effects model was performed on three single-arm observational studies to estimate the pooled RTW rate following arthroscopic shoulder surgery.</p><p><strong>Results: </strong>Ten studies were included, and 101 farmers were identified among 440 total patients. One study involved hip surgery, two studies involved knee surgery, and seven studies involved shoulder surgery. RTW rates across studies varied by type of surgery and follow-up interval, ranging from 24% to 100%. The RTW rate was only 53.6% at 1 year following total hip arthroplasty. No studies investigated RTW in farmers following total knee arthroplasty. Among non-comparative studies, meta-analysis revealed a pooled RTW rate of 89% following arthroscopic shoulder surgery, with low heterogeneity (<i>I</i> ² = 30.1%). Among comparative studies, one study reported significantly higher RTW odds for patients undergoing anatomic total shoulder arthroplasty compared to reverse shoulder arthroplasty (odds ratio = 5.45). Overall, surgical intervention for shoulder pathology was associated with a high likelihood of RTW across multiple techniques, with particularly favorable outcomes for anatomic total shoulder arthroplasty.</p><p><strong>Conclusion: </strong>This systematic review highlights the high rates of RTW in farmers and heavy laborers after shoulder surgery. However, our findings also underscore the need for more rural-specific research to guide patient counseling, rehabilitation expectations, and shared decision-making in this underserved population, particularly for orthopedic surgery of the hip and knee.</p>","PeriodicalId":47843,"journal":{"name":"World Journal of Orthopedics","volume":"17 1","pages":"112625"},"PeriodicalIF":2.3,"publicationDate":"2026-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12836169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146093468","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":"Factors associated with aseptic loosening after primary total hip arthroplasty: A systematic review and meta-analysis.","authors":"Guo-Qing Li, Ji Zhang, Yong Huang","doi":"10.5312/wjo.v17.i1.114482","DOIUrl":"https://doi.org/10.5312/wjo.v17.i1.114482","url":null,"abstract":"<p><strong>Background: </strong>Aseptic loosening remains the leading cause of revision in primary total hip arthroplasty (pTHA). However, the literature demonstrates significant variability regarding the relative contributions of different factors.</p><p><strong>Aim: </strong>To investigate the key determinants of aseptic loosening, we performed a systematic review and meta-analysis.</p><p><strong>Methods: </strong>A comprehensive search of PubMed, Web of Science, EMBASE, and the Cochrane Library was conducted, encompassing studies from database inception to January 1, 2025. Meta-analyses were performed to evaluate factors associated with aseptic loosening following pTHA. Inclusion and exclusion criteria were systematically applied at each stage to ensure methodological transparency and reproducibility. Study quality was assessed using standardized categories. Pooled odds ratio (OR) with corresponding 95% confidence interval were calculated with random- or fixed-effects models to generate reliability estimates, and study heterogeneity was visualized using forest plots. Ten factors, categorized into patient-, surgeon-, and device-related domains, were reviewed and meta-analyzed. Funnel plot analysis demonstrated a relatively symmetrical distribution, suggesting minimal publication bias.</p><p><strong>Results: </strong>A meta-analysis of 20 studies (520789 participants) found a pooled prevalence of 1.96%. Significant risk factors for aseptic loosening after pTHA included elevated body mass index (OR = 1.116, <i>P</i> < 0.001), higher Charlson comorbidity index (OR = 1.378, <i>P</i> < 0.001), prosthesis-related factors (OR = 1.497, <i>P</i> < 0.001), and adverse lifestyles (OR = 2.198, <i>P</i> = 0.037). Protective factors were non-white race (OR = 0.445, <i>P</i> < 0.001) and favorable genetics (OR = 0.723, <i>P</i> < 0.001). Male sex increased risk (OR = 1.232, <i>P</i> = 0.016), while age and anatomy were not significant. Surgical expertise showed a slight protective effect (OR = 1.048, <i>P</i> < 0.001). A comprehensive understanding of the modifiable and non-modifiable factors contributing to aseptic loosening after pTHA requires consideration of patient-related factors, surgical expertise, and prosthesis characteristics.</p><p><strong>Conclusion: </strong>The identification of these factors is critical for risk mitigation. High-risk patients should receive targeted counseling regarding individualized profiles. Further studies are warranted to establish clearer causal relationships and identify additional contributing factors.</p>","PeriodicalId":47843,"journal":{"name":"World Journal of Orthopedics","volume":"17 1","pages":"114482"},"PeriodicalIF":2.3,"publicationDate":"2026-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12836167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146094550","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}