Archives of Orthopaedic and Trauma Surgery最新文献

{"title":"Analysis of serological markers and synovial fluid cytology in aseptic revision total knee arthroplasty.","authors":"Farouk Khury, Jack Zhong, Garrett Ruff, Anzar Sarfraz, Laith Bahlouli, Vinay K Aggarwal, Ran Schwarzkopf","doi":"10.1007/s00402-026-06536-5","DOIUrl":"https://doi.org/10.1007/s00402-026-06536-5","url":null,"abstract":"<p><strong>Background and aim: </strong>Recent studies examining synovial fluid analysis to differentiate causes for aseptic revision total knee arthroplasty (rTKA) were limited to aseptic loosening and instability. This study aims to establish specific serological and synovial profiles for various rTKA etiologies.</p><p><strong>Methods: </strong>We retrospectively reviewed patients who underwent aseptic rTKA at a single academic institution between 2012 and 2023. Inclusion required complete serum inflammatory markers (erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)) and synovial fluid differentials within three months pre-operatively. Periprosthetic joint infections were strictly excluded utilizing the 2018 International Consensus Meeting criteria. In total, 156 patients were included and stratified into five aseptic etiologies: aseptic loosening (50.6%), instability (28.2%), arthrofibrosis (16.7%), liner wear (2.6%), and component malposition (1.9%). Serological markers were evaluated utilizing a multivariate general linear model adjusting for patient demographics, while synovial markers were assessed via Welch's Analysis of Variance (ANOVA) and Games-Howell post-hoc testing.</p><p><strong>Results: </strong>Multivariate analysis demonstrated that the underlying rTKA indication was not a significant independent predictor of elevated ESR (P = 0.661) or CRP (P = 0.947). Welch's ANOVA revealed significant differences in the percentage of synovial monocytes (P < 0.001) and lymphocytes (P = 0.010), alongside the polymorphonuclear cells/monocyte (P = 0.030) and lymphocyte/monocyte (P = 0.005) ratios. Games-Howell post-hoc testing demonstrated the tibial liner wear group exhibited significantly higher monocyte percentages, paired with lower lymphocyte percentages and cellular ratios, compared to other aseptic etiologies.</p><p><strong>Conclusions: </strong>This study revealed that routine systemic inflammatory markers and standard synovial fluid cell counts do not significantly vary among the common etiologies of aseptic rTKA. Nonetheless, tibial polyethylene liner wear appears to elicit an exploratory, monocyte-predominant and lymphocyte-depleted local macrophage response that is absent in other mechanisms of aseptic failure. Further research with larger cohorts is warranted to validate this association and explore its potential as a diagnostic tool.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227040","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 accuracy of standard practice wrist MRI for scapholunate ligament injuries: a retrospective arthroscopic correlation study.","authors":"Sebastian Spodzieja, Julie Boever, Johannes Rau, Thomas Bruckner, Holger Müller, Jan Wulf, Frank Unglaub, Adrian Cavalcanti Kussmaul","doi":"10.1007/s00402-026-06541-8","DOIUrl":"https://doi.org/10.1007/s00402-026-06541-8","url":null,"abstract":"<p><strong>Introduction: </strong>The scapholunate ligament is the most injured intercarpal ligament. Untreated tears can lead to carpal instability and subsequent radiocarpal and midcarpal osteoarthritis. While wrist arthroscopy remains the gold standard, the diagnostic performance of standard practice preoperative MRI in clinical practice warrants further investigation.</p><p><strong>Methods: </strong>We retrospectively analysed patients who underwent preoperative wrist MRI followed by wrist arthroscopy between 2013 and 2021. MRI findings regarding scapholunate ligament integrity were compared with arthroscopic findings serving as reference standard. Sensitivity and specificity were calculated for detection of any scapholunate ligament lesion (partial or complete tear).</p><p><strong>Results: </strong>A total of 889 patients were included. Complete paired data were available for 864 patients with a mean age of 42.4 ± 15.4 years (range 10-83 years). 51.3% were male. MRI classified the ligament as intact in 83.9%, partially ruptured in 9.1%, and completely ruptured in 6.9%. Arthroscopy identified intact ligaments in 78.2%, partial tears in 12.9%, and complete tears in 8.9%. In this cohort, MRI demonstrated high specificity (91.1%, 95% CI 89.0-93.3) but limited sensitivity (42.0%, 95% CI 35.0-49.1) for scapholunate ligament lesions.</p><p><strong>Conclusion: </strong>In standard clinical practice, preoperative wrist MRI shows high specificity but insufficient sensitivity for detecting scapholunate ligament injuries. In this cohort, MRI detected intact ligaments reliably, but a relevant proportion of partial and complete tears remained unrecognized.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227011","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":"Clinical outcomes and feasibility of a fast-track protocol after total ankle replacement: a prospective study.","authors":"Luca Maria Vena, Lucrezia Moggio, Erminia Cofano, Umile Giuseppe Longo, Pim van Dijk, C Niek van Dijk, Giorgio Gasparini, Michele Mercurio","doi":"10.1007/s00402-026-06532-9","DOIUrl":"https://doi.org/10.1007/s00402-026-06532-9","url":null,"abstract":"<p><strong>Purpose: </strong>Postoperative recovery after total ankle replacement remains challenging, and evidence supporting the use of fast-track protocols in this setting is limited. The purpose of this study was to evaluate the short-term clinical outcomes and safety of a fast-track protocol following total ankle replacement.</p><p><strong>Methods: </strong>A prospective observational study was conducted on consecutive adult patients undergoing primary total ankle replacement through an anterior approach between January 2023 and June 2024. All procedures were performed by a single experienced surgeon using the same implant. The fast-track protocol included early postoperative mobilization, multimodal pain management, bleeding control, and structured physiotherapy with standardized discharge criteria. Ankle function was assessed using the American Orthopaedic Foot and Ankle Society's (AOFAS) Ankle Hindfoot Scale preoperatively and at hospital discharge. Secondary outcomes included time to active ankle mobilization, time to assisted ambulation with crutches, length of hospital stay, and wound healing evaluated using the ASEPSIS wound score.</p><p><strong>Results: </strong>Twenty-two patients were included. Median AOFAS Ankle Hindfoot Scale scores improved significantly from 29.0 preoperatively to 68.0 at discharge. Active ankle mobilization was achieved after a median of two days, assisted ambulation after three days, and the median hospital stay was five days. Wound healing outcomes were favourable, with low ASEPSIS scores and only one minor wound complication managed conservatively. No major wound complications, infections, or prosthesis-related adverse events were observed.</p><p><strong>Conclusion: </strong>In this prospective single-arm study, a fast-track protocol following total ankle replacement was feasible and was associated with early functional recovery and favourable short-term safety outcomes. These findings should be interpreted as preliminary and descriptive, given the absence of a control group. Larger comparative studies with longer follow-up are needed to determine its effectiveness relative to conventional postoperative care.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227008","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":"Patient-specific management in high-risk revision total hip arthroplasty: mid-term outcomes of a next-generation constrained acetabular liner.","authors":"Farouk Khury, Blaine Luebbering, Garrett Ruff, Laith Bahlouli, Anzar Sarfraz, Ran Schwarzkopf, Vinay K Aggarwal","doi":"10.1007/s00402-026-06527-6","DOIUrl":"https://doi.org/10.1007/s00402-026-06527-6","url":null,"abstract":"<p><strong>Background: </strong>Managing recurrent instability in revision total hip arthroplasty (rTHA) requires a personalized approach, as traditional constrained liners often yield suboptimal results due to locking-mechanism failure and limited impingement-free range of motion. This study aimed to evaluate the mid-term clinical outcomes of a novel constrained acetabular liner (CAL) when utilized as a patient-specific solution for a high-risk cohort undergoing complex rTHA. By tailoring the constraint to individual biomechanical deficits, this next-generation device seeks to mitigate historic failure modes.</p><p><strong>Methods: </strong>We retrospectively reviewed 32 patients who underwent 37 rTHA procedures with a next-generation CAL at a single urban academic center between March 2017 and October 2023. Average follow-up was 4.7 years (range, 0.3 to 9.7 years). The most common indication for rTHA was instability (70.3%), followed by infection (16.2%), aseptic loosening (10.8%), and polyethylene wear (2.7%). Just over one third of patients (37.5%) had undergone a prior revision. Preoperative constructs included fixed-bearing (37.8%), dual-mobility (32.4%), CAL (24.3%), static spacer (2.7%), and hemiarthroplasty (2.7%).</p><p><strong>Results: </strong>In most procedures (70.3%), the CAL was implanted into a pre-existing acetabular cup, whereas 29.7% involved both cup and liner revision. Following rTHA, no cases of implant wear, breakage, acetabular cup aseptic loosening, or periprosthetic fracture were observed. Six patients (18.8%) underwent a total of sixteen subsequent reoperations after CAL implantation-10 for instability and 6 for infection. Among instability-related reoperations, 4 involved revision to a new next-generation CAL. Survivorship free from all-cause reoperation was 83.8% at one year and 72.6% at latest follow-up.</p><p><strong>Conclusions: </strong>This study demonstrates favorable mid-term clinical outcomes and reoperation-free survivorship following complex revision THA using a novel constrained acetabular liner system. For patient cohorts suffering from severe recurrent dislocation, this next-generation CAL provides an effective, tailored tool in the surgical armamentarium by adapting to unique patient anatomy and soft-tissue compromises. Further research with larger sample sizes and extended follow-up is needed to assess long-term durability.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227036","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":"Correction: Robotic-arm assistance in revision total hip arthroplasty improves the accuracy of acetabular component positioning: a cadaver-based study","authors":"Kailey Fitzgerald,&nbsp;Ilya Borukhov,&nbsp;Varun Chandra,&nbsp;Chase Smitterberg,&nbsp;Michael A. Mont,&nbsp;Sally LiArno","doi":"10.1007/s00402-026-06533-8","DOIUrl":"10.1007/s00402-026-06533-8","url":null,"abstract":"","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06533-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149189493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expert evaluation of ChatGPT-generated responses to patient questions in conventional and fast-track total knee arthroplasty","authors":"Bartosz Maciag,&nbsp;Dawid Jegierski,&nbsp;Andrzej Frankiewicz,&nbsp;Piotr Tarkowski,&nbsp;Krystian Żarnovsky,&nbsp;Filip Mietlicki,&nbsp;Artur Stolarczyk","doi":"10.1007/s00402-026-06534-7","DOIUrl":"10.1007/s00402-026-06534-7","url":null,"abstract":"<div><h3>Background</h3><p>Fast-track total knee arthroplasty (TKA) asks patients to understand early mobilization, early discharge, opioid-sparing analgesia, and selective use of drains and catheters. We evaluated expert-rated quality of ChatGPT responses to patient questions about these pathway-specific concepts alongside conventional TKA questions.</p><h3>Materials and methods</h3><p>In this cross-sectional evaluation, three arthroplasty surgeons independently scored responses to 50 conventional TKA and 20 investigator-developed fast-track questions in four domains on 5-point scales. The conventional questions were selected by a multidisciplinary panel; the fast-track questions did not undergo the same selection process. Response-level means were compared descriptively and with exploratory Mann-Whitney U tests.</p><h3>Results</h3><p>Seventy responses received 210 expert assessments. Recalculated mean ± SD scores across individual ratings were 4.99 ± 0.15 for accuracy, 4.98 ± 0.14 for completeness, 4.98 ± 0.17 for safety, and 5.00 ± 0.07 for readability. Each of the 20 fast-track responses received a score of 5 from each of the three raters in all four domains (Supplementary Table S1). Nevertheless, question-set construction differed and scores clustered at the ceiling, so the exploratory comparison does not establish equivalence.</p><h3>Conclusions</h3><p>Experts gave high ratings to the evaluated responses, including those on fast-track concepts. The observed data do not establish equivalence between question sets: the fast-track ratings require source-data verification, the sets were selected differently, and scores were concentrated at the maximum. Clinician review remains appropriate for protocol-dependent and safety-related advice.</p><h3>Trial registration</h3><p>Not applicable.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06534-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149189569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology, determinants, and microbiological profile of implant-associated infections following intramedullary nailing in a tertiary hospital in Ethiopia","authors":"Abebaw Muhabaw Zegeye,&nbsp;Suleiman Ayalew Belay,&nbsp;Ephrem Bekele Kebede,&nbsp;Birlew Teshome Alemayehu,&nbsp;Sileshi Serebe Zeleke,&nbsp;Yohannis Derbew Molla","doi":"10.1007/s00402-026-06535-6","DOIUrl":"10.1007/s00402-026-06535-6","url":null,"abstract":"<div><h3>Background</h3><p>Implant-associated infections after intramedullary nailing (IMN) are a major cause of morbidity in patients with long bone fractures. This study aimed to determine the magnitude, determinants, and microbiological profile of such infections in a tertiary hospital in Ethiopia.</p><h3>Methods</h3><p>A hospital-based cross-sectional study was conducted among 260 patients who underwent IMN for lower extremity long bone fractures between January 2021 and December 2023. Clinical data, operative details, and microbiological results were collected, and logistic regression was applied to identify determinants of infection.</p><h3>Results</h3><p>The overall infection rate was 8.46% (95% CI: 5.38–12.53; 22/260), comprising 4.62% deep and 3.85% superficial infections. We found that emergency surgery and hospital stay longer than 14 days were independently associated with an increased risk of infection. Among the limited number of culture-positive infections, Gram-negative bacteria predominated, with Escherichia coli as the most frequently identified pathogen.</p><h3>Conclusion</h3><p>The infection rate was higher than in many other settings, underscoring the need for improved perioperative infection prevention and reduced hospital stays. Findings highlight the importance of perioperative optimization and hospital infection control in LMICs.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06535-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Notch-referenced mediolateral verification of tibial tunnel position in anterior cruciate ligament reconstruction: a 3D imaging validation study","authors":"Vu Tu Nam,&nbsp;Vu Duc Thang,&nbsp;Le Duc Huy,&nbsp;Luu Huu Phuc,&nbsp;Luong Nhat Anh,&nbsp;Le Duc Thinh,&nbsp;Chu Hoang Long,&nbsp;Nguyen Ngoc Huyen,&nbsp;Nguyen Duc Trung,&nbsp;Ta Van Thanh Nam,&nbsp;Ho Ngoc Minh,&nbsp;Tran Trung Dung","doi":"10.1007/s00402-026-06442-w","DOIUrl":"10.1007/s00402-026-06442-w","url":null,"abstract":"<div><h3>Background</h3><p>Non-anatomic tibial tunnel placement remains a leading contributor to anterior cruciate ligament reconstruction (ACLR) failure. Mediolateral (ML) tunnel positioning is particularly difficult intraoperatively because no consistent bony landmark defines the lateral footprint border.</p><h3>Purpose</h3><p>To evaluate the accuracy of a novel intraoperative Notch-Referenced Mediolateral (NRML) verification technique by comparing the ML position of the tibial tunnel center (TTC) on postoperative 3D CT with the native tibial footprint center (TFC) on preoperative 3D MRI.</p><h3>Methods</h3><p>In this retrospective cross-sectional study, 108 consecutive patients underwent primary all-inside single-bundle ACLR with intraoperative NRML verification. This arthroscopic technique uses the intercondylar notch as a visual reference to verify mediolateral tibial tunnel position before definitive drilling.</p><p>TFC and TTC were independently measured on preoperative 3D MRI and postoperative 3D CT using a standardized quadrant-grid protocol by two blinded observers. The primary outcome was ML deviation (tunnel - footprint). MRI–CT agreement and measurement reliability were assessed with intraclass correlation coefficients (ICC) and Bland–Altman analysis.</p><h3>Results</h3><p>The anatomical TFC was located at 46.1 ± 2.3% of tibial plateau width in the ML direction, versus 44.8 ± 2.0% for the TTC. Mean ML deviation was −1.01 ± 1.52 mm (p &lt; 0.001), a small but statistically significant medial bias; 91.7% (95% CI 84.9–95.6%) of tunnels fell within ±3 mm of the native footprint. MRI–CT agreement was good (ICC 0.81–0.85), and inter/intraobserver reliability was good to excellent (ICC 0.78–0.89). No significant associations were found between ML deviation and sex, injury chronicity, graft diameter, or plateau size.</p><h3>Conclusion</h3><p>In this single-arm cohort,NRML verification is a simple, equipment-free technique that placed the tibial tunnel within ~1 mm of the native ML footprint, with high measurement reliability. Prospective comparative and outcome studies are needed to confirm its clinical value.</p><h3>Level of evidence</h3><p>IV.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06442-w.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative pain and achievement of the minimal clinically important difference for physical function one year after total hip arthroplasty: a prospective cohort study","authors":"Rubén Gajardo-Burgos,&nbsp;Ricardo Arteaga San Martín,&nbsp;Jorge Fuentes,&nbsp;Manuel Monrroy Uarac,&nbsp;Cristhian Saavedra-Santiesteban,&nbsp;Claudio Bascour-Sandoval,&nbsp;Eduardo Sáez de Villarreal","doi":"10.1007/s00402-026-06516-9","DOIUrl":"10.1007/s00402-026-06516-9","url":null,"abstract":"<div><h3>Purpose</h3><p>To examine the association between preoperative social, clinical, and biological variables and the achievement of the minimal clinically important difference (MCID) on the WOMAC-function subscale one year post total hip arthroplasty (THA).</p><h3>Methods</h3><p>In this prospective cohort study, 85 patients (aged ≥ 65) completed baseline preoperative assessment, and 53 completed the 12-month follow-up (32 lost to follow-up; 66.0% achieved MCID). The outcome was achieving WOMAC-function MCID (≥ 26.54 points). Multivariable logistic regression adjusted for baseline pain, age, sex, and BMI were performed. ROC curves evaluated discriminative capacity.</p><h3>Results</h3><p>An exploratory ROC analysis identified a baseline pain threshold of 6.5 on the Numerical Rating Scale yielded an AUC of 0.740 (70% sensitivity, 77% specificity).</p><h3>Conclusions</h3><p>Preoperative pain intensity independently associated with clinically meaningful functional improvement post-THA. An exploratory pain threshold of 6.5 on the NRS may provide an exploratory benchmark for future risk stratification.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06516-9.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The boundary between microbial detection and implant-related infection: a structured narrative review of analytical credibility, biological persistence, host response, and clinical causality","authors":"Liao Chang-sheng,&nbsp;Lan feng-jun,&nbsp;Liu huan-sheng,&nbsp;Huang qiang,&nbsp;Zhou zong-ke","doi":"10.1007/s00402-026-06505-y","DOIUrl":"10.1007/s00402-026-06505-y","url":null,"abstract":"<div><h3>Background</h3><p>Unexpected microbial signals are frequently encountered in patients with orthopaedic implants who do not satisfy validated criteria for confirmed infection. The central interpretive problem is not limited to periprosthetic joint infection (PJI); it also arises in fracture-fixation and spinal instrumentation, and it involves conventional culture, sonication, histopathology, broad-range polymerase chain reaction (PCR), 16 S rRNA sequencing, and metagenomic next-generation sequencing (mNGS).</p><h3>Methods</h3><p>We performed a structured narrative review of literature identified in PubMed, Embase, and Web of Science, updated through 27 June 2026. Eligible publications addressed microbial or biofilm-associated signals in orthopaedic implants without unequivocal infection at the time of sampling, or reported outcomes after unexpected positive cultures. Evidence was organized by implant type, indication for implant removal, detection method, host-response evidence, and longitudinal outcome. Particular attention was paid to the distinction between routinely removed fracture-fixation devices and failure-related arthroplasty or spinal revisions.</p><h3>Results</h3><p>Routine removal of fracture-fixation devices provides the least confounded clinical window and demonstrates that microbial signals may be recovered from implants in the absence of recognized failure or overt infection. By contrast, arthroplasty and spinal cohorts labelled “presumed aseptic” are intrinsically confounded because pain, loosening, osteolysis, or pseudarthrosis may represent occult infection. Molecular positivity is further limited by low-biomass contamination and inability to distinguish viable organisms from relic DNA. Favorable outcomes after revision do not prove that infection was never present, because revision surgery itself may eradicate or substantially reduce an occult microbial burden.</p><h3>Conclusions</h3><p>Microbial detection should be interpreted through three sequential domains: analytical credibility, biological activity or persistence, and clinical causality supported by host response or implant-related pathology. “Stable coexistence” is best treated as a longitudinal clinical phenotype or testable mechanistic hypothesis, not as an established diagnostic category. This framework complements, but does not replace, validated PJI, fracture-related infection (FRI), or other implant-specific definitions.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}