Orthopaedics & Traumatology-Surgery & Research最新文献

{"title":"Response to the letter from Shigeki Matsubara.","authors":"Henri Migaud","doi":"10.1016/j.otsr.2026.104742","DOIUrl":"https://doi.org/10.1016/j.otsr.2026.104742","url":null,"abstract":"","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104742"},"PeriodicalIF":2.2,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dual-Energy CT Assessment of Distal Femur Bone quality for Preventing Early Failure in Cementless Total Knee Arthroplasty.","authors":"Sueen Sohn, Dai-Soon Kwak, Sheen-Woo Lee, Nicole Cho, Se Heon Lee, In Jun Koh","doi":"10.1016/j.otsr.2026.104738","DOIUrl":"https://doi.org/10.1016/j.otsr.2026.104738","url":null,"abstract":"<p><strong>Background: </strong>With the increasing utilization of newer-generation cementless total knee arthroplasty (TKA), the preoperative prediction of bone quality has emerged as a significant concern. Recognizing such limitations of central bone mineral density, attention has turned to Hounsfield units (HU), a measure of the standardized linear attenuation coefficient in computed tomography (CT) imaging, known for its ability to estimate bone marrow density specifically around the knee joint. Consequently, this study aims to investigate the correlation between preoperative dual-energy CT (DECT) HU measurements of the distal femur and the actual bone strength. We hypothesized that DECT-derived HU would (1) significantly correlate with biomechanical bone strength and (2) serve as a reliable tool for identifying suitable candidates for cementless TKA.</p><p><strong>Materials and methods: </strong>In this prospective study, 190 knees that underwent primary posterior stabilized TKA between May 2022 and May 2023 were included. HU of the distal femur was assessed using DECT scan, which utilizes material decomposition to differentiate bone from soft tissue or bone marrow, providing more accurate bone quality assessment than conventional CT, and the actual bone strength of the corresponding bone fragment was measured using an indentation test that serves as a validated surrogate for traditional compression testing. The association between HU and actual bone strength was evaluated using correlation and linear regression analyses. To further assess its diagnostic utility in identifying candidates for cementless TKA, receiver operating characteristic (ROC) curve analysis with calculation of the area under the curve (AUC) was performed to determine both accuracy and the optimal cutoff value.</p><p><strong>Results: </strong>The DECT HU value in coronal plane showed significant correlations with bone strength measured by indentation testing (r = 0.67, p < 0.01). In linear regression analysis, coronal HU was independently predictive of bone strength (β = 0.62, R² = 0.45, p < 0.01). Furthermore, coronal HU showed good discriminative ability for identifying candidates suitable for cementless TKA (AUC = 0.82, 95% CI 0.766-0.880), with an optimal cutoff of 72 HU yielding sensitivity of approximately 73% and specificity of 74%.</p><p><strong>Conclusions: </strong>This study demonstrates that DECT HU is a promising marker for periarticular bone quality, given its strong correlation with distal femoral bone strength and excellent performance in predicting suitability for cementless TKA. However, considering our simplified model, ethnic diversity, and CT scanner variability, these factors should be taken into account before using this threshold as a definitive clinical guide.</p><p><strong>Level of evidence: </strong>II; Prospective diagnostic study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104738"},"PeriodicalIF":2.2,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Antero-Posterior versus Posterio-Anterior Screw Fixation Techniques in Bryan-Morrey Type 4 Capitellum Fractures: A Retrospective Cohort Study.","authors":"Murat Onder, Manuel Kramer, Melisa Ercan, Abdurrahman Aydın, Gökhan Pehlıvanoglu, Kutalmıs Albayrak","doi":"10.1016/j.otsr.2026.104736","DOIUrl":"https://doi.org/10.1016/j.otsr.2026.104736","url":null,"abstract":"<p><strong>Background: </strong>Bryan-Morrey Type 4 capitellum fractures present unique challenges for screw fixation due to their medial extension. Although both anteroposterior (AP) and posteroanterior (PA) screw orientations have been described, their clinical outcomes have not yet been directly compared.</p><p><strong>Methods: </strong>Twenty-one patients with Bryan-Morrey Type 4 capitellum fractures treated with headless compression screws were retrospectively reviewed. Patients were divided into AP (n = 12) and PA (n = 9) groups based on screw orientation according to the treating surgeon's preference. Primary outcome was the Mayo Elbow Performance Index (MEPI). Secondary outcomes included range of motion, screw angular parameters, analgesic duration, fluoroscopy count, and complications.</p><p><strong>Results: </strong>Both groups achieved excellent functional outcomes with no significant difference in MEPI scores (AP: 87.9 ± 7.8 vs. PA: 90.6 ± 5.8; P = .274). The PA group showed reduced postoperative analgesic duration (6.7 ± 2.2 vs. 14.1 ± 3.5 days; P < .001), lower fluoroscopy exposure (5.6 ± 1.0 vs. 7.2 ± 1.1 images; P = .005), and more parallel screw orientation (9.3 ° ± 1.6 ° vs. 16.8 ° ± 7.1 °; P < .001). Although the complication rate trended lower in the PA group (11.1% vs. 41.7%; P = .178), this difference was not statistically significant. Olecranon fossa penetration and transient neuropraxia occurred exclusively in the AP group.</p><p><strong>Conclusion: </strong>Both AP and PA screw fixation techniques achieved excellent functional outcomes in Bryan-Morrey Type 4 capitellum fractures. The PA technique demonstrated perioperative advantages including reduced analgesic requirements and lower fluoroscopy exposure. These exploratory findings suggest that the PA technique appears promising, but confirmation in larger prospective studies is warranted.</p><p><strong>Level of evidence: </strong>III; Retrospective Comparative Study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104736"},"PeriodicalIF":2.2,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From cadavers to virtual reality: a carbon footprint analysis of surgical simulation for lumbar spine surgery.","authors":"Léonard Swann Chatelain, Antonia Blanié, Emmanuelle Ferrero, Marc Khalifé, Renaud Lafage, Dan Benhamou, Virginie Lafage","doi":"10.1016/j.otsr.2026.104741","DOIUrl":"https://doi.org/10.1016/j.otsr.2026.104741","url":null,"abstract":"<p><strong>Background: </strong>Simulation plays a fundamental role in lumbar spine surgery training. While many studies focus on the carbon footprint of surgeries, limited information is available on the environmental impact of surgical training. Today, surgical simulators can be categorized into three groups: biological specimens (cadavers and animal models), synthetic physical simulators (bench-top models, 3D-printed, high-fidelity models), and virtual simulators (screen-based and Virtual Reality (VR) simulators). This study analyzed the carbon footprint of the main simulators available for lumbar spine surgery training.</p><p><strong>Hypothesis: </strong>The hypothesis was that biological and high-fidelity simulators would have the highest environmental impact.</p><p><strong>Materials and methods: </strong>Available simulators were identified through an extensive digital search, and categorized based on their features. Environmental data from manufacturers' websites were used, and the simulators with the most available data were selected to represent each category. For missing data, the Life Cycle Assessment (LCA) methodology was used, following the ISO 14040 standard, with OpenLCA® software. In cases of uncertainty, data were cross-checked with the Base Empreinte® database (ADEME, France). The setting of the study was conducted in Paris, France, in January 2025. The carbon footprint of digital simulators was reported relative to the device's lifetime. Cadavers were included as a reference, using an environmental study on cremation in the city of Paris. Results were expressed in kg CO₂e.</p><p><strong>Results: </strong>Cadavers had the highest carbon footprint (244.0 ± 48.8 kg CO₂e), followed by porcine models (223.0 ± 44.6 kg CO₂e) and high-fidelity simulators (36.6 ± 7.3 kg CO₂e). The carbon footprints of 3D-printed models and bench-top models were similar, at 8.4 ± 1.7 and 10.5 ± 2.1 kg CO₂e respectively. Screen-based and VR simulators had the lowest footprints, with 0.07 ± 0.01 kg CO₂e per simulation. Simulator production and the sterilization of instruments accounted for the majority of emissions.</p><p><strong>Discussion: </strong>Low-carbon-footprint simulators should be favored for early learners, especially for basic procedures and repeated simulations. Virtual training is often perceived as less sustainable due to the use of rare earth materials, but is actually more environmentally friendly because of the unlimited number of simulations and the absence of instrument sterilization. 3D printing enables on-demand production of only the required parts, directly on-site. High-fidelity mannequins should be reserved for advanced users, who can better benefit from their realistic features.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104741"},"PeriodicalIF":2.2,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic performance of the Francophone Arthroscopic Society (SFA) score for anterior cruciate ligament rupture and intra-articular knee lesions in the emergency department: a prospective multicenter study.","authors":"Laetitia Bordes, Théophile Stoclet, Matthieu Lalevée, Nicolas Kloek, Mehdi Taalba, Jonathan Curado","doi":"10.1016/j.otsr.2026.104739","DOIUrl":"10.1016/j.otsr.2026.104739","url":null,"abstract":"<p><strong>Background: </strong>The Francophone Arthroscopic Society (SFA) score was designed to identify patients with anterior cruciate ligament (ACL) rupture in the immediate post-traumatic period, based on history alone (pain intensity, immediate post-traumatic functional impairment, history of a \"pop,\" feeling of instability, and knee swelling). The aim of this multicenter study was to assess the external validity of the SFA score for ACL injury screening in the emergency department and to evaluate its ability to predict other significant intra-articular knee lesions.</p><p><strong>Hypothesis: </strong>The SFA score is a reliable screening tool for ACL rupture in emergency departments and can also help identify patients at high risk of severe intra-articular knee injuries.</p><p><strong>Patients and methods: </strong>This prospective multicenter observational study enrolled 150 consecutive patients aged 18-55 years who presented to the emergency department within 9 days after a knee trauma and had no fracture on standard radiographs. Patients were excluded if the trauma required immediate surgical management or if they had a history of trauma or surgery on the same knee. The SFA score was assessed by the emergency physician at first presentation. The reference diagnosis (ACL rupture, other intra-articular lesions or no lesion) was established at follow-up by an orthopedic surgeon, based on clinical examination or MRI.</p><p><strong>Results: </strong>Of the 150 included patients, 115 completed follow-up and were analyzed; 48 had an ACL rupture and 67 an intact ACL. For ACL injury screening, the SFA score showed an AUC of 0.759 (95% CI 0.673-0.845). A score ≤4 demonstrated a sensitivity of 100% and a NPV of 100% for ruling out ACL rupture, whereas a score ≥8 indicated a high probability of ACL tear (specificity 77.6%, PPV 67.4%). For severe intra-articular knee lesions as a whole, the AUC was 0.82 (95% CI: 0.745-0.895).</p><p><strong>Discussion: </strong>This study supported the external validity of the SFA score for screening ACL rupture and other significant intra-articular knee lesions in the emergency department setting. The score appears to be a useful decision-making tool to guide triage, imaging, and orthopedic referral in patients presenting with acute knee trauma.</p><p><strong>Level of evidence: </strong>III; prospective observational multicenter study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104739"},"PeriodicalIF":2.2,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recession wedge trochleoplasty yields superior postoperative functional outcomes in primary procedures when compared to revisions for treating recurrent patellar dislocations with high grade trochlear dysplasia.","authors":"Manon Pignero, Azeddine Djebara, Vasileios Giovanoulis, Nicolas Pujol","doi":"10.1016/j.otsr.2026.104737","DOIUrl":"https://doi.org/10.1016/j.otsr.2026.104737","url":null,"abstract":"<p><strong>Background: </strong>To compare long-term clinical and functional outcomes of patients undergoing a recession wedge trochleoplasty in either primary or revision patellar stabilizing procedures in patients with a high grade trochlear dysplasia.</p><p><strong>Hypothesis: </strong>Primary trochleoplasty would result in superior functional outcomes.</p><p><strong>Methods: </strong>This retrospective, monocentric, comparative study was conducted at a knee surgery center included 43 knees treated with trochleoplasty between January 1, 2008, and December 31, 2023. Of these, 33 cases underwent a trochleoplasty in primary procedures, while 10 trochleoplasties were performed as revision procedures. The groups were comparable. In both groups, surgeries were systematically combined with additional surgical procedures (distal tibial tubercle transfer and/or medialization, MPFL reconstruction, or lateral retinacular release), without any difference between groups. The primary outcome was postoperative functional assessment using three validated scores: Kujala, IKDC, and the Lille score. Secondary outcomes included patient satisfaction, recurrence of patellofemoral dislocation, subjective instability, postoperative complications, reoperation rates, postoperative pain, pre-to-postoperative Tegner activity score change, and return to sport (rate and time).</p><p><strong>Results: </strong>Functional outcomes were significantly better in the primary trochleoplasty group versus revision group, as reflected by the mean Kujala and Lille scores (72.2 ± 17.1 versus 59.1 ± 12.9 (p < 0.02) and 77.5 ± 17.9 versus 65.1 ± 16.7 (p < 0.04), respectively). Postoperative subjective patellofemoral instability was higher in the revision group, than in the primary group (9 out of 10 patients (90%) versus 14 out of 33 patients (43.8%), respectively (p < 0.04)).</p><p><strong>Discussion: </strong>Recession wedge trochleoplasty yields superior postoperative functional outcomes in primary procedures when compared to revisions for treating recurrent patellar dislocations with high grade trochlear dysplasia. These findings suggest that deferring an indicated trochleoplasty during initial surgical management may negatively affect long-term functional outcomes, thereby supporting its consideration earlier in the treatment algorithm.</p><p><strong>Level of evidence: </strong>III; retrospective comparative study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104737"},"PeriodicalIF":2.2,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Demographics, disparities and delays: why can't geriatric hip fractures get fixed within one day?","authors":"Charles C Lin, Ibraheem Qureshi, Michelle A Richardson, Utkarsh Anil, Kenneth A Egol","doi":"10.1016/j.otsr.2026.104735","DOIUrl":"https://doi.org/10.1016/j.otsr.2026.104735","url":null,"abstract":"<p><strong>Background: </strong>Morbidity and mortality following geriatric hip fracture remains high. Increased time from hospital admission to hip fracture surgery is a factor that has been associated with adverse outcomes. The purpose of this study was to identify factors associated with delays to surgery greater than 1 day in geriatric hip fracture patients. The primary aim of this study was to identify and compare comorbidities between patients who underwent surgery within 1 day and those who did not using a large national data base. The null hypothesis was that patients with more acute medical comorbidities would not have a higher association with delays to surgery greater than 1 day.</p><p><strong>Methods: </strong>Patients over the age of 65 who underwent a surgical repair for a hip fracture from 2005 to 2019 were identified from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Patients were grouped into those who had surgery less than 1 day after admission (n = 74,072) and those who had surgery greater than 1 day after admission (n = 21,481). Demographic data and comorbidities were collected and compared. Univariate regressions were performed to assess the effect of comorbidities on risk of surgery more than 1 day after admission.</p><p><strong>Results: </strong>Hip fracture patients who did not undergo surgery within 1 day were older, more likely to be male, non-white, have lower functional status and greater ASA class. These patients had significantly greater preoperative comorbidities such as hypertension, bleeding disorder or anticoagulated status, obesity, chronic obstructive pulmonary disease (COPD) or congestive heart failure (CHF). Patients who were ventilator dependent (OR: 10.09; 95% CI: [6.65, 15.79], p < 0.001), had preoperative transfusions (OR: 3.89; 95% CI: [3.64, 4.16], p < 0.001) or CHF (OR: 2.88, 95% CI: [2.68, 3.09], p < 0.001) had the greatest odds of not having surgery within 1 day.</p><p><strong>Conclusions: </strong>Hip fracture patients who did not get surgery within 1 day, had a greater preoperative comorbidity profile than those who did. Patients with certain comorbidities such as ventilator dependence, need for preoperative blood transfusion and congestive heart failure had greater odds of having surgery delayed beyond 1 day. Attention should be placed on patients who arrive with these risk factors and clinical pathways should be designed to expedite preoperative medical optimization and surgical treatment.</p><p><strong>Level of evidence: </strong>III; Retrospective Comparative Study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104735"},"PeriodicalIF":2.2,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term follow-up of 2 techniques to fill Total Ankle Replacement cysts: autograft and/or PCa substitute versus PMAA cement.","authors":"Florian Voirin, Conor Moran, Marcelle Mercier, Anthony Viste, Jean-Luc Besse","doi":"10.1016/j.otsr.2026.104740","DOIUrl":"10.1016/j.otsr.2026.104740","url":null,"abstract":"<p><strong>Introduction: </strong>Periprosthetic cysts are a frequent cause of Total Ankle Replacement (TAR) revision. Curettage and backfill is a common treatment for cyst formation. We have compared functional and radiological results for two types of backfill.</p><p><strong>Materials and methods: </strong>This was a continuous, single-center, single-surgeon series of 32 TARs reoperated for cysts (22 AES, 10 Hintegra; 47% osteorathritis on laxity, 41% post-fracture; mean age at revision: 65.3 years) at a mean 6.4 years (2.4-14.5). Two types of filling were used successively: Group A - bone grafting, 7 cancellous autografts (May 2008-March 2009) and 4 calcium-phosphate substitutes (September 2009-April 2010), then, due to early cyst recurrence, (Group B) 21 PMMA-Genta cement (October 2010-May 2020). Lesion locations included 27 tibial, 26 talar, and 5 malleolar cysts. Patients underwent the same clinical, functional and radiographic evaluation (standard X-ray and CT scan).</p><p><strong>Results: </strong>Mean follow up was 7.1 years (1-16.7). One patient died in each group. There was a significant difference between groups, with 8 revision surgeries in group A (6 arthrodesis, 1 infection, 1 new PMMA graft) and 2 in group B (1 PE exchange for fracture and 1 cement debridement). Radiologically, the difference was significant at last FU. In group A, CT showed 100% cyst worsening (>25 mm); group B showed 79% good-quality cementing and/or interface radiolucency (1-2 mm), 4 cyst worsening, and 3 new cysts.</p><p><strong>Conclusion: </strong>PMMA cement filling achieved satisfactory clinical and radiological outcomes, with no secondary arthrodesis or prosthetic revision during follow-up.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104740"},"PeriodicalIF":2.2,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between dynamic hip motion during gait and passive hip range of motion and muscle strength before and after total hip arthroplasty","authors":"Hideaki Matsuo ,&nbsp;Masafumi Kubota ,&nbsp;Yudai Watabe ,&nbsp;Hiroaki Naruse ,&nbsp;Kazuki Shoji ,&nbsp;Makoto Kitade ,&nbsp;Yasuo Kokubo ,&nbsp;Akihiko Matsumine","doi":"10.1016/j.otsr.2025.104419","DOIUrl":"10.1016/j.otsr.2025.104419","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;While total hip arthroplasty (THA) for osteoarthritis (OA) provides pain relief and functional improvement, the postoperative recovery of gait patterns remains challenging. Residual abnormalities in hip biomechanics during gait may persist beyond one year postoperatively and are associated with joint overload, implant wear, and fall risk. Passive hip range of motion (ROM) and muscle strength are important determinants of joint mechanics, and should be examined in detail in relation to gait parameters. Understanding these relationships both before and in the early postoperative period is essential for developing individualized rehabilitation strategies.&lt;/div&gt;&lt;div&gt;This study aimed to answer the following question: Do the maximum hip extension and adduction angles during the stance phase associate with the passive hip ROM and muscle strength before and after THA?&lt;/div&gt;&lt;div&gt;In addition, we explored the potential contribution of muscle strength to these gait parameters, particularly in the early postoperative period.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Hypothesis&lt;/h3&gt;&lt;div&gt;We hypothesized that reduced passive hip ROM would be associated with smaller maximum hip extension and adduction angles during the stance phase, both before and after THA.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patients and methods&lt;/h3&gt;&lt;div&gt;Twenty-five patients undergoing THA (mean age 66.5 ± 9.4 years, 72% female) were evaluated preoperatively and at discharge (23.6 ± 4.1 days postoperatively). Three-dimensional gait analysis was performed to assess maximum hip extension and adduction angles during the stance phase. Passive hip ROM was measured with a goniometer, and muscle strength was assessed using the hand-held dynamometer. Univariate and multivariate regression analyses were conducted to examine associations between gait parameters and ROM or muscle strength.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Preoperatively, the hip extension and adduction angles during the stance phase were significantly associated with hip extension (&lt;em&gt;r&lt;/em&gt; = 0.413, &lt;em&gt;p&lt;/em&gt; = 0.040) and adduction (&lt;em&gt;r&lt;/em&gt; = 0.575, &lt;em&gt;p&lt;/em&gt; = 0.003) ROM, respectively, indicating that smaller joint angles were linked to reduced ROM. Conversely, in the early postoperative period, the hip extension angle was significantly associated with extension ROM (&lt;em&gt;r&lt;/em&gt; = 0.480, &lt;em&gt;p&lt;/em&gt; = 0.015) and extensor strength (&lt;em&gt;r&lt;/em&gt; = 0.484, &lt;em&gt;p&lt;/em&gt; = 0.014), such that smaller angles were observed in patients with reduced ROM and lower strength. However, the adduction angle was not associated with hip ROM and muscle strength.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Discussion&lt;/h3&gt;&lt;div&gt;This study suggests that rehabilitation should focus on hip extension ROM and extensor strength to improve gait patterns during the early postoperative period after THA. These results provide useful insights for the development of individualized postoperative rehabilitation plans.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Level of evidence&lt;/h3&gt;&lt;div&gt;III; single-center, retrospective obs","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 3","pages":"Article 104419"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of enhanced recovery after surgery on psychological outcomes in total hip arthroplasty","authors":"Guangwei Xing ,&nbsp;Dong Wu ,&nbsp;Jinneng Yin ,&nbsp;Mingjie Xu ,&nbsp;Xiaobo Jing","doi":"10.1016/j.otsr.2025.104222","DOIUrl":"10.1016/j.otsr.2025.104222","url":null,"abstract":"<div><h3>Background</h3><div><span><span>The occurrence of pain catastrophizing, depression, and anxiety is prevalent among patients undergoing primary </span>total hip arthroplasty (THA). The </span>Enhanced Recovery After Surgery protocol (ERAS-P) has demonstrated its efficacy in alleviating peri-operative stress responses in such patients. This study endeavors to explore the influence of ERAS-P on patient satisfaction, as well as the levels of pain catastrophizing, surgery-related anxiety, and depression following primary THA.</div></div><div><h3>Hypothesis</h3><div>ERAS-P exerts a beneficial influence on patient satisfaction, mitigating pain catastrophizing, and reducing surgery-related anxiety and depression following primary THA.</div></div><div><h3>Patients and methods</h3><div>Data were retrospectively reviewed for patients who underwent primary THA between 2017 and 2020. Patients in the control group who received usual care were matched in a 1:1 ratio for baseline characteristics to patients in the ERAS-P group who followed ERAS-P. All patients were evaluated and analyzed for pain catastrophizing, depression and anxiety using the Pain Catastrophizing Scale (PCS) and Hospital Anxiety and Depression Scale (HADS) at postoperative 1 weeks, 6 weeks, 3 months, 6 months and 1 year.</div></div><div><h3>Results</h3><div><span>182 patients in the ERAS-P group and 182 in the control group were analyzed using propensity score matching (PSM). Compared to the control group, ERAS-P patients showed significantly higher satisfaction levels (</span><em>p</em> = 0.002). They also experienced a notable reduction in pain catastrophizing at 1 week, 6 weeks, and 3 months postoperatively (<em>p</em> &lt; 0.05 for all). Anxiety levels decreased markedly at 1 week and 6 weeks (<em>p</em> &lt; 0.001 for both). Depression scores in the ERAS-P group declined significantly at these same time points up to 6 months (<em>p</em> &lt; 0.05 for all). Remarkably, ERAS-P patients exhibited a greater decrease in peri-operative pain catastrophizing and anxiety, accompanied by a faster recovery. However, its effectiveness waned over time, with both groups reporting comparable outcomes within a few months.</div></div><div><h3>Discussion</h3><div>Patients undergoing THA after adhering to the ERAS-P exhibit a more favorable outcome in improving peri-operative patient-reported depression, anxiety, and pain catastrophizing screenings compared to those following the traditional care scheme. Although these advantages gradually diminished over time, the outcomes for both groups converged to be similar within a few months. Nonetheless, ERAS-P retains its notable advantages for THA patients who grapple with psychological symptoms.</div><div>Level of evidence: III.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 3","pages":"Article 104222"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}