Journal of Clinical Orthopaedics and Trauma最新文献

{"title":"Surgical management of severe neglected adult idiopathic scoliosis: A review article on challenges and contemporary treatment strategies","authors":"Masashi Miyazaki, Tetsutaro Abe, Noriaki Sako, Nobuhiro Kaku","doi":"10.1016/j.jcot.2025.103106","DOIUrl":"10.1016/j.jcot.2025.103106","url":null,"abstract":"<div><div>Neglected adult idiopathic scoliosis (NAdIS) is a spinal deformity characterized by severe rigidity and multiplanar curvature, significantly impairing pain levels, physical function, and health-related quality of life. Its complexity is heightened by longstanding vertebral malalignment, cardiopulmonary compromise, and age-related comorbidities, making surgical management particularly challenging. Despite progress in spinal deformity correction, consensus remains lacking on the optimal treatment strategy for these patients. This narrative review synthesizes contemporary surgical options for NAdIS, including posterior spinal fusion (PSF), posterior column osteotomy (PCO), halo-gravity traction (HGT), temporary internal distraction (TID), vertebral column resection (VCR), anterior release, multilevel lateral lumbar interbody fusion (LLIF), and novel posterior-only techniques such as posterolateral convex discectomy (PCDR) and intervertebral release (IVR). A structured decision-making framework is proposed, taking into account curve severity, location, flexibility, and patient-specific factors. Each technique offers unique advantages and limitations. PSF remains the foundational method for moderate, flexible curves. HGT is a valuable adjunct for enhancing spinal flexibility and pulmonary function in severe cases. TID provides a staged, safer alternative to VCR, enabling gradual correction while preserving spinal cord perfusion. VCR, although powerful for three-dimensional deformity correction, carries high morbidity and is generally reserved for rigid, sharply angulated curves. Anterior release retains value in select thoracic deformities, particularly those with anterior bridging or hypokyphosis. LLIF enables effective coronal realignment and vertebral derotation in thoracolumbar curves with preserved disc mobility. Posterior-only techniques such as PCDR and IVR have emerged as viable, less invasive alternatives to anterior release, especially when used at multiple apical levels. Recent advancements in technology—including 3D printing, intraoperative navigation, and robotic-assisted instrumentation—have further refined surgical planning and execution, offering enhanced accuracy and reduced complication rates. These tools are especially useful in navigating complex spinal anatomy and minimizing neurologic risk. The management of NAdIS necessitates a stepwise, individualized surgical strategy that balances deformity correction with patient safety and functional goals. While posterior-based approaches dominate current practice, selected cases benefit from anterior, staged, or combined interventions based on specific anatomical and physiological considerations. Future progress in the treatment of NAdIS will depend on the continued refinement of evidence-based algorithms and broader integration of enabling technologies. This review aims to support spine surgeons in delivering safe, personalized, and effective care for this uniquely challenging ","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"67 ","pages":"Article 103106"},"PeriodicalIF":0.0,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144489779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Game-based learning in orthopaedics: A comprehensive review","authors":"Marvin Man Ting Chung,&nbsp;Felix Leung,&nbsp;Janus Siu Him Wong,&nbsp;Tak Man Wong","doi":"10.1016/j.jcot.2025.103109","DOIUrl":"10.1016/j.jcot.2025.103109","url":null,"abstract":"<div><div>Game-based learning (GBL) has emerged as a transformative approach in medical education. It has a useful role in orthopaedic education, where the acquisition of both complex knowledge and technical skills is paramount.</div><div>This comprehensive literature review explored the current modalities of GBL in orthopaedic training, including gamified knowledge review and formative assessment, gamification of surgical training tasks, simulation-based training game, and virtual and augmented reality (VR/AR) games. Gamification of knowledge review and formative assessment platforms incorporates game elements such as leaderboards and challenges into educational activities, fostering learners’ engagement during knowledge acquisition. Gamification of surgical training tasks provides an alternative to traditional mode of learning inside operating theatres via gamified approaches such as timed practice, puzzle games and escape rooms. Simulation-based games provide structured environments for practicing surgical techniques, offering objective assessments and feedback to identify areas for improvement. VR/AR technologies further enhance orthopaedic education by creating immersive, interactive simulations that mimic clinical scenarios, enabling trainees to build foundational surgical skills in a safe, controlled environment.</div><div>Furthermore, this article discusses the benefits and limitations of GBL, and the future directions of development in the context of orthopaedics. GBL modalities have demonstrated significant benefits, including improved psychomotor skills, cognitive engagement, and motivation among trainees. However, barriers such as high costs, technical challenges, and the ceiling effect, where additional training yields diminishing returns, limit widespread adoption. Additionally, long-term outcomes such as skill retention and transferability to live surgery require further investigation. Future advancements in GBL are expected to integrate cutting-edge technologies like artificial intelligence and haptic feedback into VR/AR systems, enhancing realism and effectiveness. With wider adoption, more accessible innovations and development of standardized orthopaedic training frameworks incorporating GBL modalities, GBL can be an important adjunct in preparing the next generation of orthopaedic surgeons in the modern era of orthopaedic education.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"67 ","pages":"Article 103109"},"PeriodicalIF":0.0,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144489778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From data to precision: The transformative role of AI and machine learning in modern orthopaedic practice","authors":"Amit Kumar Yadav ,&nbsp;Prateek Joshi ,&nbsp;Anjali Tiwari ,&nbsp;Sakshi Watarkar ,&nbsp;Ishmita Paul ,&nbsp;Gaurav Bhandari","doi":"10.1016/j.jcot.2025.103101","DOIUrl":"10.1016/j.jcot.2025.103101","url":null,"abstract":"<div><h3>Background</h3><div>Artificial Intelligence (AI) and Machine Learning (ML) are revolutionising orthopaedic surgery by transforming clinical problem-solving into data-driven input-output frameworks. AI allows surgeons and clinicians to analyse problems and offer innovative solutions objectively. It also enables clinicians to view these problems as an input-output continuum rather than an obstacle that needs to be solved from the basic principles upwards. These technologies would allow clinicians to bypass traditional reliance on foundational principles, instead leveraging computational models to optimise decision-making and patient outcomes.</div></div><div><h3>Methods</h3><div>A scoping review was conducted using PubMed, Scopus, and IEEE Xplore databases (2010–2023), targeting peer-reviewed articles with keywords including Artificial Intelligence, Machine Learning, Generative AI, and Clinical Algorithms. Inclusion criteria prioritised studies demonstrating AI/ML applications in Orthopaedic diagnostics, predictive analytics, or surgical planning.</div></div><div><h3>Results</h3><div>Advances in computational power, deep learning architectures, and interoperable data infrastructure have accelerated the development of AI/ML tools for Orthopaedic practice. Key innovations include predictive algorithms for postoperative risk stratification, generative models for patient-specific implant design, and computer vision systems for intraoperative guidance. Ubiquitous adoption of portable data-capture devices (e.g., tablets, voice-recognition systems) and clinician-facing software platforms has further streamlined data aggregation, enhancing model accuracy and clinical relevance.</div></div><div><h3>Conclusion</h3><div>The integration of AI/ML into Orthopaedic surgery is driven by synergistic advancements in hardware and software, offering transformative potential for personalised care, surgical precision, and outcome prediction. Future adoption hinges on addressing ethical, regulatory, and interoperability challenges while fostering interdisciplinary collaboration between engineers, clinicians, and data scientists.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"69 ","pages":"Article 103101"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144330988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transforming orthopedic training: A review of competency-based medical eductaion (CBME)","authors":"Saketh ASPVS ,&nbsp;Krishna Subramanyam ,&nbsp;Kocherlakota Sathya Priyanka ,&nbsp;Vinnisa Nithiakala Vetrivel ,&nbsp;Swaminathan Ramasubramanian","doi":"10.1016/j.jcot.2025.103107","DOIUrl":"10.1016/j.jcot.2025.103107","url":null,"abstract":"<div><h3>Background</h3><div>Competency-based Medical Education (CBME) has emerged as a transformative model for medical training, prioritizing the mastery of specific competencies over the mere completion of prescribed training durations. In the field of orthopaedics, CBME holds significant promise for enhancing clinical competence, refining the educational experience, and ultimately improving patient outcomes. This review critically examines the foundational principles and frameworks underpinning CBME, exploring its application within orthopaedic education. It further discusses the benefits, challenges, and successful case studies associated with CBME adoption.</div></div><div><h3>Materials and methods</h3><div>This umbrella review synthesizes evidence from peer-reviewed journals, educational reports, and expert opinions on CBME in orthopaedics. A comprehensive search of PubMed, Scopus, Web of Science, and Google Scholar (2000–2025) identified relevant studies on CBME principles, frameworks, benefits, challenges, and clinical outcomes in orthopaedics.</div></div><div><h3>Results</h3><div>Successful CBME implementations in orthopaedics highlight key factors such as early faculty involvement, clear communication of objectives, continuous feedback, standardized assessment tools, and personalized learning pathways. These practices ensure consistent competency evaluation, tailored resident progression, and enhanced clinical training, ultimately improving resident performance and patient outcomes across orthopaedic programs.</div></div><div><h3>Conclusion</h3><div>The review concludes with strategic recommendations for the integration of CBME into orthopaedic curricula and offers a forward-looking perspective on future research and curricular development in this domain.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"69 ","pages":"Article 103107"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144338586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective comparative study between conservative management and surgical fixation of pelvic insufficiency fractures","authors":"Jacqueline Hui Juan Tan,&nbsp;Michael Gui Jie Yam","doi":"10.1016/j.jcot.2025.103105","DOIUrl":"10.1016/j.jcot.2025.103105","url":null,"abstract":"<div><h3>Background</h3><div>Pelvic insufficiency fractures (PIFs) are commonly underdiagnosed and delays in treatment can lead to complications including impaired mobility. This study compared outcomes between conservative treatment and surgical fixation in patients with PIFs.</div></div><div><h3>Methods</h3><div>A retrospective study of 19 patients with pelvic fractures between July 2023 and February 2024 was performed. Patients with isolated sacral and pelvic insufficiency fractures with no concomitant fracture that requires rehabilitation were included. Xray and Magnetic Resonance Imaging (MRI) images, and patient demographic data was collected. Primary study endpoints included the relative change in patient ambulation status from pre-injury to discharge. Patients were followed up outpatient 6 weeks and 3 months after discharge.</div></div><div><h3>Results</h3><div>Surgical fixation was performed in 7 patients at an average of 10.1 days after injury (range 4–18 days). Mean duration of diagnosis was 2.74 days. Mean duration of diagnosis among patients requiring an MRI was 4.75 days. Length of inpatient stay in the non-operative and operative groups was 32.1 and 39.8 days respectively. Non-operative patients ambulated 3.5 days after admission with minimal pain. In the operative group, patients underwent a trial of conservative therapy for an average of 6 days (range 3–9 days) before deciding for surgical fixation. Patients were ambulatory 1 day post-fixation on average. There was no significant difference in ambulatory status between both groups at discharge.</div></div><div><h3>Conclusion</h3><div>Awareness of the sequelae of PIFs is required among clinicians and patients. Surgical intervention is a potentially effective treatment option for patients with unstable PIF and severe pain, as it can provide more rapid relief of symptoms and faster recovery. More robust protocols should be developed for PIF treatment to improve patient outcomes. More studies are required to determine the best framework for the management of PIFs to guide optimal care and outcomes.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"67 ","pages":"Article 103105"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Future perspectives after the guidelines of degenerative cervical myelopathy: A narrative review","authors":"Narihito Nagoshi ,&nbsp;Yoshiharu Kawaguchi","doi":"10.1016/j.jcot.2025.103104","DOIUrl":"10.1016/j.jcot.2025.103104","url":null,"abstract":"<div><div>Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in adults, often resulting from cervical spondylotic myelopathy (CSM) or ossification of the posterior longitudinal ligament (OPLL). As the aging population increases, the prevalence of DCM is expected to rise, making the optimization of treatment strategies crucial. While surgical decompression is widely accepted for moderate to severe cases, the management of mild DCM remains controversial. Some studies report significant neurological improvement with surgery, while others find no difference between surgical and conservative approaches. Current guidelines suggest conservative management may be considered for mild cases, with surgical intervention recommended if symptoms progress or do not respond to non-operative treatment.</div><div>Non-surgical approaches such as cervical traction therapy and orthotic treatment have been explored, though their long-term effectiveness remains unclear. Pharmacological treatments, including NSAIDs, muscle relaxants, and corticosteroids, are commonly prescribed for symptomatic relief, yet their effectiveness in treating myelopathy-specific symptoms has not been established. According to current guidelines, patients with a modified Japanese Orthopaedic Association (mJOA) score of 15 or higher are considered suitable candidates for conservative management. However, surgical intervention should be considered if there is evidence of symptom progression.</div><div>Surgical strategies for DCM vary based on the severity and location of spinal cord compression. The Japanese CSM and OPLL guidelines have extensively compared different surgical approaches. For CSM treatment, while anterior cervical discectomy and fusion (ACDF) and laminoplasty provide similar neurological recovery, ACDF offers better sagittal alignment but carries a higher risk of reoperation. Comparisons between ACDF and posterior decompression and fusion (PDF) indicate that both procedures yield comparable neurological outcomes, though ACDF has been associated with better patient-reported quality of life. In OPLL patients, anterior surgery may be preferable for those with severe kyphosis and extensive anterior compression, despite an increased risk of complications.</div><div>Future research should focus on refining diagnostic tools, optimizing surgical decision-making, and assessing the effectiveness of conservative management strategies. Standardizing intraoperative ultrasonography criteria, evaluating the role of postoperative cervical collar immobilization, and investigating rehabilitation protocols are key areas requiring further study.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"68 ","pages":"Article 103104"},"PeriodicalIF":0.0,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the role of artificial intelligence in orthopedic medical education: A narrative review","authors":"Lakshmana S. Das ,&nbsp;Deepanjan Das ,&nbsp;Denish Chandrakar ,&nbsp;Prashant Bhavani ,&nbsp;Amol Dubepuria ,&nbsp;Sitanshu Barik","doi":"10.1016/j.jcot.2025.103100","DOIUrl":"10.1016/j.jcot.2025.103100","url":null,"abstract":"<div><div>Artificial intelligence (AI) is transforming orthopedic medical education by enhancing diagnostic accuracy, surgical training, and personalized learning. This narrative review explores AI's applications, including machine learning (ML) and computer vision for interpreting imaging studies, virtual reality (VR) and augmented reality (AR) for immersive surgical simulations, and natural language processing (NLP) for streamlining clinical workflows. AI-powered tools offer objective feedback, adaptive learning modules, and risk-free environments for skill acquisition, bridging gaps in traditional training methods. However, challenges such as data privacy, algorithmic bias, and the need for robust validation remain. Ethical considerations, including patient trust and trainee over-reliance on AI, must also be addressed. Despite these barriers, AI democratizes access to high-quality education, particularly in resource-limited settings, through cloud-based platforms and mobile applications. The future of AI in orthopedics is promising, with advancements in predictive analytics, robotic-assisted surgery, and haptic feedback technologies poised to further revolutionize training. Collaborative efforts among educators, clinicians, and developers are essential to ensure responsible integration. This review highlights AI's potential to reshape orthopedic education while emphasizing the importance of preserving the mentor-trainee relationship and fostering evidence-based adoption.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"69 ","pages":"Article 103100"},"PeriodicalIF":0.0,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144330986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Routine post-operative full blood count assessment is not necessary in elective hip and knee arthroplasty: A prospective cohort study","authors":"David Moore ,&nbsp;Henry Turner ,&nbsp;Jess Rotaru ,&nbsp;Ciara Doran ,&nbsp;James Cashman","doi":"10.1016/j.jcot.2025.103099","DOIUrl":"10.1016/j.jcot.2025.103099","url":null,"abstract":"<div><h3>Background</h3><div>Hip and knee arthroplasty are among the commonest orthopaedic procedures performed worldwide and can be associated with significant blood loss. Routine haemoglobin sampling increases transfusion rates without an overall reduction in morbidity and mortality, yet providers commonly adopt an absolute numerical value as warranting transfusion post-operatively. Our aim was to establish what proportion of patients had a significant reduction in haemoglobin requiring transfusion thus assessing the necessity of routine post-operative haemoglobin assessment in an inpatient and outpatient patient cohort undergoing total joint replacement.</div></div><div><h3>Methods</h3><div>We performed a review of prospectively collected data in an institutional database of all primary elective hip and knee arthroplasty cases performed by a single surgeon at an urban tertiary referral centre from 2018 to 2023. We assessed pre-operative and post-operative variables amongst patients to identify predictors for transfusion following surgery. All statistics were performed using Stata release 17.</div></div><div><h3>Results</h3><div>490 elective primary hip or knee arthroplasty procedures were performed within the six year period of which the mean drop in haemoglobin was 2.1 g/dL (SD 1.0, Range −5.6 to +1) post-operatively. Four patients (0.8 %) had a haemoglobin drop below 8 g/dL and 19 (3.9 %) had a level below 9 g/dL, however only 4 patients (0.8 %) required allogenic blood transfusion. One hundred and six patients (21.9 %) underwent day-case arthroplasty of which there was no re-admissions or complications within 90 days of surgery.</div></div><div><h3>Conclusion</h3><div>The routine monitoring of haemoglobin following elective TJA is costly and unnecessary whilst not contributing to actionable information. We recommend that patients with a pre-operative level greater than 11 g/dL may not require routine post-operative full blood count as mean drop in haemoglobin of less than 3 g/dL can be expected. We continue to advocate that day-case arthroplasty is safe in appropriately selected patients as defined by ASA grade at anaesthetic pre-assessment.</div></div><div><h3>Level of evidence</h3><div>Level II – Prospective cohort study.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"69 ","pages":"Article 103099"},"PeriodicalIF":0.0,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144330933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unlocking effective decision-making and critical thinking in orthopaedics: Insights from a narrative review","authors":"A.S.P.V.S. Saketh ,&nbsp;Krishna Subramanyam ,&nbsp;Satvik N. Pai ,&nbsp;Karthika Padmavathy ,&nbsp;Karthick Rangasamy ,&nbsp;Purushothaman Muthukanagaraj","doi":"10.1016/j.jcot.2025.103098","DOIUrl":"10.1016/j.jcot.2025.103098","url":null,"abstract":"<div><h3>Background</h3><div>Clinical decision-making and critical thinking are vital in orthopaedic practice, directly impacting patient outcomes. Surgeons often face complex cases requiring both experience and systematic reasoning to ensure the best treatment approach. This review aims to explore the factors influencing decision-making in orthopaedics, focusing on the role of critical thinking in enhancing clinical choices. It examines decision-making frameworks, cognitive biases, and the importance of evidence-based practices. Additionally, the review discusses the increasing role of artificial intelligence (AI) and decision support systems in aiding clinical decisions.</div></div><div><h3>Methods</h3><div>This review analyzes peer-reviewed literature published from 2011 to 2024, covering case studies, surveys, qualitative research, and systematic reviews. Databases like PubMed, Scopus, Web of Science (WoS), and Google Scholar were used to source relevant articles. The focus was on decision-making frameworks, cognitive biases, and AI integration in orthopaedics, particularly studies on AI and data analytics in improving decision support systems.</div></div><div><h3>Results</h3><div>Structured decision-making frameworks and mentorship play a key role in enhancing critical thinking. Cognitive biases, such as confirmation and anchoring bias, are significant challenges. AI and evidence-based guidelines help improve clinical decisions by offering data-driven insights.</div></div><div><h3>Conclusions</h3><div>Optimizing clinical decision-making requires structured education, critical thinking development, and AI integration to improve patient outcomes and streamline decision-making.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"68 ","pages":"Article 103098"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Direct Anterior Approach for Total Hip Arthroplasty in bony ankylosis of hips - comparison with historical series performed by posterior approach","authors":"Rajesh Malhotra ,&nbsp;Vikrant Manhas ,&nbsp;Sahil Batra ,&nbsp;Arpit Sahu ,&nbsp;Deepak Gautam","doi":"10.1016/j.jcot.2025.103103","DOIUrl":"10.1016/j.jcot.2025.103103","url":null,"abstract":"<div><h3>Introduction</h3><div>We performed a retrospective study to assess the intraoperative course and postoperative outcome of Direct Anterior Approach (DAA) in supine position for Total Hip Arthroplasty (THA) in bony ankylosis of hips and compare with historical series of THA in bony ankylosis performed by posterior approach.</div></div><div><h3>Methods</h3><div>Inpatient details with intra and post operative data were retrieved from the service arthroplasty register and medical records. All patients were followed up till a minimum of 2 years post-surgery with x-rays and clinical score.</div></div><div><h3>Results</h3><div>Twenty-two patients (28 hips), all males (mean age 33.5 years), underwent THA via DAA in 16 unilateral and 6 bilateral hips. There was no opioids requirement beyond 48 h of surgery with mean hospital stay of 3.6 days for both the groups. The Harris Hip Score improved from preoperative 32 to 88.4 at 2 years. All the hips were stable at 2 years with no radiolucencies and/or component migration/position change. Comparison with the historical series (n = 54 &amp; n = 41), revealed no dislocation, no nerve symptoms and no infection in any of the patients in either series.</div></div><div><h3>Discussion &amp; conclusion</h3><div>Although technically demanding, the preliminary result of THA by DAA in bony ankylosis of hips is promising. Even in this small cohort, the less analgesic requirement, less hospital stay and no incidence of dislocation should be considered as the advantages of DAA when compared to posterior approach.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"69 ","pages":"Article 103103"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144338587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}