Efort Open Reviews最新文献

{"title":"Are free flaps a reliable solution to treat massive soft tissue defects in patients with knee periprosthetic joint infection? A systematic review and meta-analysis.","authors":"Michela Saracco, Vincenzo Ciriello, Domenico Matteo Levita, Giovanni Baldi, Giovanni Balato, Massimo Mariconda","doi":"10.1530/EOR-2025-0161","DOIUrl":"10.1530/EOR-2025-0161","url":null,"abstract":"<p><strong>Purpose: </strong>Large joint arthroplasty is among the most frequently performed procedures in orthopaedic surgery. One of the most common and challenging causes of prosthetic failure is periprosthetic joint infection (PJI). Periprosthetic soft tissue damage is often a critical yet underestimated factor influencing surgical outcomes. The aim of our meta-analysis is to evaluate the clinical efficacy, complications, failure rates, and the overall reliability of free flaps as a reconstructive solution.</p><p><strong>Methods: </strong>PubMed, Embase, and Google Scholar were searched, according to PRISMA guidelines. Studies were included if they reported healing rate, complications, type of free flaps, and pathogen characteristics. A quality evaluation was performed. The overall effect size was reported as survival rate of the free flaps, and the secondary effect sizes were determined as the rate of reinfection or persistent infection after coverage with free flaps and the amputation rate because of non-controlled infection. The statistical analysis was carried out using the software 'R', version 4.5.0 (2025-04-11).</p><p><strong>Results: </strong>Fourteen papers were included, with a total of 185 observations and 161 events (free flap survived). All papers were retrospective studies. The pooled survival rate was 93% (I 2 = 66.7%). The pooled rate of reinfection or persistent infection after the index surgery was 16% (I 2 = 77.6%). The amputation rate was 8%.</p><p><strong>Conclusion: </strong>Free flaps are a reliable solution to manage tissue loss in patients with periprosthetic infection, but the results could be affected by technical errors and non-skilled intra- and post-operative management. Orthoplastic and microsurgical skills are mandatory to be successful.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 7","pages":"737-747"},"PeriodicalIF":4.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13326730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148363096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing diagnosis and management of ONFH, FNSF, and SIF.","authors":"Haley M Cox, Oluwafemi O Gbayisomore, Alejandro J Rivera-Vega, Nils Becker, Sina Habibollahi, Jack Porrino, Daniel Wiznia","doi":"10.1530/EOR-2025-0222","DOIUrl":"10.1530/EOR-2025-0222","url":null,"abstract":"<p><p>Osteonecrosis of the femoral head (ONFH), femoral neck stress fracture (FNSF), and subchondral insufficiency fracture (SIF) are distinct yet clinically overlapping causes of non-arthritic hip pain. All three conditions threaten femoral head viability via distinct pathophysiologic mechanisms and may lead to fracture displacement (FNSF) and irreversible collapse (ONFH, SIF, and displaced FNSF), ultimately necessitating arthroplasty if not identified and managed early. These conditions frequently present with groin pain and unremarkable radiographs in their early stages. Imaging may be normal or show generalized bone marrow edema. MRI is the most sensitive modality for detection; however, accurate diagnosis requires the integration of specific imaging features with the synthesis of the patient's past medical history, including age, activity level, and bone quality. ONFH identified before collapse may be amenable to joint-preserving procedures, such as core decompression. FNSF requires urgent recognition and non-weight-bearing precautions to avoid displacement and vascular injury. SIF may be managed conservatively with protected weight-bearing and monitoring. Despite the expertise of experienced examiners and advanced imaging techniques, the initial diagnosis is frequently incorrect, and treatment options only become clear with timely follow-up and serial imaging. This review highlights diagnostic distinctions among ONFH, FNSF, and SIF, emphasizing clinical context, imaging-based differentiation, and appropriate management. Accurate early classification is crucial for guiding management decisions and preventing collapse of the femoral head or femoral neck displacement.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 7","pages":"791-802"},"PeriodicalIF":4.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13326886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148363219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"THA for DDH: replacement principles and techniques - acetabular side.","authors":"Pedro Dantas, Teresa Clode Araujo, André Medeiros Grenho, Sérgio Rodrigues Gonçalves, Eleftherios Tsiridis","doi":"10.1530/EOR-2026-0073","DOIUrl":"10.1530/EOR-2026-0073","url":null,"abstract":"","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 7","pages":"696-709"},"PeriodicalIF":4.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13326721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148363151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sagittal spinal alignment in adolescent idiopathic scoliosis: a narrative review of pre- and post-treatment characteristics.","authors":"Yu Song, Yimin Yan, Cao Yang, Kun Wang","doi":"10.1530/EOR-2025-0263","DOIUrl":"10.1530/EOR-2025-0263","url":null,"abstract":"<p><p>Adolescent idiopathic scoliosis (AIS) involves significant sagittal plane abnormalities, most consistently characterized by reduced thoracic kyphosis (TK), with compensatory changes in lumbar lordosis (LL) and cervical lordosis (CL). Brace treatment effectively controls coronal curve progression but commonly reduces TK and LL, potentially leading to a flatback deformity, while global sagittal balance is often maintained through spinal and pelvic compensation. Surgical intervention, particularly posterior spinal fusion, reliably improves sagittal alignment, with the most pronounced restoration of TK and CL observed in patients with preexisting sagittal malalignment. Despite regional alterations, global sagittal balance typically remains stable posttreatment, underscoring the body's inherent compensatory mechanisms to maintain an energy-efficient upright posture. Pelvic parameters exhibit considerable individual variability but adapt to help sustain overall spinal equilibrium, with a tendency toward retroversion when compensating for spinal imbalances. Clinical management of AIS should integrate personalized, three-dimensional assessment and correction strategies, balancing coronal correction with the imperative of achieving optimal sagittal alignment to ensure favorable long-term outcomes.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 6","pages":"614-626"},"PeriodicalIF":4.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13240638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148145076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathological changes and therapeutic strategies for sarcopenia.","authors":"Keda Yang, Shengyao Peng, Chi Zhang, Lan Guo, Dong Liang, Lin Tao","doi":"10.1530/EOR-2025-0066","DOIUrl":"10.1530/EOR-2025-0066","url":null,"abstract":"<p><p>Sarcopenia is becoming a major public health concern for older adults. The incidence rate in people over 70 years of age is 30-50%. Patients with sarcopenia not only have difficulty moving and are prone to falls and fractures, but in severe cases, they may also experience heart and lung failure and even death. Early diagnosis and prevention in high-risk populations can effectively prevent the deterioration of muscle atrophy. In this review, we describe the physiological mechanism of muscle contraction and reveal common pathological changes in sarcopenic patients, including oxidative stress, inflammation, insulin resistance, hypoxia, and disturbance of the gut microbiota. These pathological changes synergistically inhibit the mass and strength of skeletal muscles. We also discuss nonpharmacological therapeutic methods for sarcopenia, such as nutrient supplementation and exercise, especially resistance training. On the basis of a thorough analysis of the pathogenesis of sarcopenia in high-risk populations, we believe that tissue synthesis and energy supply are the foundation for maintaining the normal physiological functions of muscles. Mitochondria are potential targets for the optimization of intervention methods. Targeted delivery of functional mitochondria to skeletal muscle cells contributes to improving biological oxidation, redox balance, and tissue remodeling. Additionally, stem cell transplantation with the stimulation of growth factors may also be an available method for the further treatment of sarcopenia.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 6","pages":"480-511"},"PeriodicalIF":4.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13238992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148145064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Considerations for removal of cephalomedullary screws and blades following intertrochanteric femoral fracture healing: a narrative review.","authors":"Jee Young Lee, Gyu Min Kong","doi":"10.1530/EOR-2026-0013","DOIUrl":"10.1530/EOR-2026-0013","url":null,"abstract":"<p><strong>Background: </strong>Cephalomedullary fixation using intramedullary nails combined with proximal lag screws or helical blades is widely accepted as the standard surgical treatment for unstable intertrochanteric femoral fractures. Although fracture union is reliably achieved in most patients, management of retained implants after healing remains controversial. Despite limited evidence supporting clinical benefit, elective implant removal continues to be performed in routine practice.</p><p><strong>Purpose: </strong>This review synthesizes biomechanical, clinical, and health-economic evidence regarding the removal of cephalomedullary screws and helical blades after intertrochanteric fracture union. Particular emphasis is placed on mechanism-based structural failure, femoral head collapse, and age-dependent risk-benefit profiles.</p><p><strong>Methods: </strong>A narrative literature review was conducted, incorporating biomechanical experiments, finite-element analyses, cadaveric studies, clinical case series, cohort studies, registry-based investigations, and health-economic analyses related to implant removal after intertrochanteric fracture fixation.</p><p><strong>Results: </strong>Removal of proximal cephalic components produces a residual bone defect within the femoral head and neck, resulting in stress concentration and reduced structural integrity. Clinical studies report femoral neck fracture, varus collapse, and femoral head insufficiency, often occurring shortly after removal and frequently without significant trauma. These complications disproportionately affect elderly patients with osteoporotic bone. In contrast, symptomatic improvement after implant removal, particularly pain relief, is inconsistent and unpredictable.</p><p><strong>Conclusion: </strong>Routine removal of cephalomedullary screws or helical blades after intertrochanteric fracture union is not supported by current evidence. Implant retention should be considered the default strategy, particularly in elderly patients, while selective removal may be considered only in carefully selected younger individuals with preserved bone quality and clear indications.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 6","pages":"591-597"},"PeriodicalIF":4.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13261623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148145055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-reconstructive/salvage hip surgery in cerebral palsy: a systematic review.","authors":"Janneta Kisel, John Amen, Thomas Lewis, Dimitris Karanikas, Emma Fossett, Konstantinos Kafchitsas, Michail Kokkinakis","doi":"10.1530/EOR-2025-0084","DOIUrl":"10.1530/EOR-2025-0084","url":null,"abstract":"<p><strong>Purpose: </strong>Hip displacement is common in patients with cerebral palsy, carrying high morbidity without surgical intervention (pain, seating tolerance, perineal hygiene, and care). Operative techniques commonly used for non-reconstructive/salvage hip surgery are proximal femoral resection (PFR), valgus osteotomy (VO), and arthrodesis. There is limited literature comparing the outcomes between these operations. The main aim of this study is to provide an up-to-date comparison to guide surgical decision-making.</p><p><strong>Methods: </strong>This study was registered with PROSPERO (registration no.: CRD42022364078). A literature search was conducted using Cochrane Library, PubMed, MEDLINE, and EMBASE. English publications were included with no date restriction, including prospective, retrospective, and comparative studies. Data were extracted, including, but not limited to, pain improvement, increased sitting tolerance, seating time, parent and caregiver satisfaction, range of movement (ROM), heterotopic ossification (HO) rate, and ease of hygiene.</p><p><strong>Results: </strong>Forty-two studies fulfilled our inclusion criteria, totalling 1,261 hips in 1,103 patients. The pain relief was comparable between PFR and VO (95 vs 100%), with PFR having a higher patient/carer satisfaction rate (100 vs 80%) and much higher rates of heterotopic ossification (52 vs 13%). PFR provided a more favourable ROM. Arthrodesis had a higher rate of secondary surgery (24%) than PFR (16%) and VO (10%).</p><p><strong>Conclusion: </strong>This systematic review found that PFR has a higher patient/carer satisfaction rate and ROM with comparable pain relief to VO and a higher rate of HO. More research is needed to understand the clinical impact of HO. Arthrodesis was less commonly performed.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 6","pages":"570-578"},"PeriodicalIF":4.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13238975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148145078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current concepts in the management of high-energy tibial plateau fractures: a narrative review.","authors":"Nicolas Franulic, Marco Koch, José Tomás Muñoz, Rodrigo Olivieri, Nicolas Gaggero, Rodrigo Pesantez","doi":"10.1530/EOR-2025-0167","DOIUrl":"10.1530/EOR-2025-0167","url":null,"abstract":"<p><p>Tibial plateau fractures are complex intra-articular injuries where fracture morphology, trauma mechanism, and soft tissue condition critically influence treatment complexity and injury prognosis. Medial plateau fractures typically involve metaphyseal blocks with limited articular comminution, whereas lateral plateau fractures often present with greater fragmentation and depression. The Schatzker and AO/OTA classification systems are widely used, while those proposed by Luo, Krause, and Kfuri have enhanced the three-dimensional understanding and surgical planning of tibial plateau fractures. Associated soft tissue injuries can be divided into soft tissue coverage (skin, subcutaneous tissue, and muscle), which require early assessment and continuous monitoring, and structural injuries (ligaments and meniscus), which need more detailed evaluation and subsequent imaging studies. Open fractures and acute compartment syndrome are entities frequently associated with high-energy tibial plateau fractures. Early diagnosis and treatment - with early intravenous antibiotic prophylaxis, surgical debridement, prompt fasciotomies, and fracture stabilization - are needed to prevent further complications, such as fracture-related infections. Although immediate internal fixation can be safe in selected patients, a staged management approach with initial external fixation in complex or high-energy fractures enables soft tissue coverage healing while minimizing complications. The enhanced three-dimensional understanding of these fractures justifies a 360° surgical approach, addressing each fragment through specific approaches and fixation.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 6","pages":"676-690"},"PeriodicalIF":4.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13240633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148145094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of exercise therapy on dynamic posture control and self-report function in individuals with chronic ankle instability: a systematic review with pairwise and network meta-analysis.","authors":"Peng Chen, Huiwu Zuo, Yixue Gong, Lulu Yin, Lin Wang","doi":"10.1530/EOR-2025-0024","DOIUrl":"10.1530/EOR-2025-0024","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to compare the effects of different exercise therapies on dynamic postural control and self-reported function in individuals with chronic ankle instability (CAI) and provide an evidence-based medical basis for selecting the optimal exercise therapy.</p><p><strong>Methods: </strong>A systematic search for randomized controlled trials (RCTs) involving exercise interventions in CAI individuals was conducted across five electronic databases, encompassing data from their inception up to December 2024. This review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered in PROSPERO (registration number: CRD42024620821).</p><p><strong>Results: </strong>A total of 48 RCTs including 1,630 individuals with CAI were included. Seven exercise therapies were involved: balance training, strength training, comprehensive training, plyometric training, whole-body vibration training, blood flow restriction training, and visual occlusion balance training. All exercise therapies significantly improved dynamic posture control. Visual occlusion balance training was superior to plyometric training (SMD = 0.72, 95% CI: 0.01-1.43). Six exercise therapies significantly improved self-reported function, except for whole-body vibration training, for which evidence was lacking. Blood flow restriction training (SMD = 1.49, 95% CI: 0.59-2.40) and visual occlusion balance training (SMD = 0.90, 95% CI: 0.06-1.75) were superior to strength training.</p><p><strong>Conclusions: </strong>Visual occlusion balance training may be the most effective exercise therapy for improving dynamic postural control in CAI individuals. Blood flow restriction training and visual occlusion training may be the most effective exercise therapies in improving self-reported function. However, interventions should be chosen with caution because the certainty of evidence is very low.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 6","pages":"470-479"},"PeriodicalIF":4.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13238967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148145131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Orthostatic intolerance following total joint arthroplasty remains a significant barrier to successful same-day discharge: a narrative review of an underreported complication.","authors":"Papa Kyei, Mabua Chuene, Jurek Rt Pietrzak, Allan Roy Sekeitto, Nkhodiseni Sikhauli, Lipalo Mokete, Collen Nkosi","doi":"10.1530/EOR-2025-0223","DOIUrl":"10.1530/EOR-2025-0223","url":null,"abstract":"<p><p>Early mobilisation following total joint arthroplasty is crucial in considering patients for successful same-day discharge (SDD). Recent years have seen an increase in SDD after total joint arthroplasty, with complication rates comparable to those with prolonged hospital stays. Orthostatic intolerance (OI) is a significant barrier to successful SDD after total hip and knee arthroplasties, with up to 52% of patients experiencing it. Patient-related factors include being female, being elderly, having multiple comorbidities, possessing a higher American Society of Anesthesiologists (ASA) status, experiencing pain levels exceeding 5/10, and using gabapentin. Surgery-related risk factors identified were spinal anaesthesia versus general anaesthesia, hip replacement versus knee replacement, and postoperative opioid use. Non-pharmacological and pharmacological approaches can be used to categorise management strategies. However, no treatment has conclusively proven to address OI fully.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 6","pages":"598-604"},"PeriodicalIF":4.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13240630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148145068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}