Indian Journal of Orthopaedics最新文献

Objective: Artificial intelligence (AI) is emerging as a transformative force in spine medicine, offering support in diagnosis, surgical planning, and postoperative care through advanced algorithms. We aim to perform a comprehensive bibliometric analysis of AI applications in spine medicine to uncover research trends and inform future directions.

Methods: We screened English-language publications on AI in spine medicine from 2005 to 2024 in the Web of Science Core Collection. We utilized the CiteSpace, VOSviewer, and Bibliometrix R packages to analyze publication years, countries, institutions, authors, journals, references, and keywords, and to generate social network graphs. Scimago Graphica, Origin, and Microsoft Charticulator were used for additional visualization results.

Results: 1344 papers were included. The development of AI in spine medicine can be divided into two phases: slow-growing (2005-2018) and fast-growing (2019-2024). The most productive countries and institutions were the USA and the University of California System, respectively. Galbusera F was the most prolific and influential author. European Spine Journal accepted the most articles, and Spine was cited the most. Analyzing the references and keywords, we found that the current research hotspots are mainly in AI subfields such as machine learning and deep learning, as well as combining AI with imaging technologies such as MRI to assist in diagnosis and classification. Current research frontiers include augmented reality, osteoporosis, and spinal deformities.

Conclusions: AI in spine medicine is evolving rapidly. Author collaboration across teams should be enhanced. The existing studies are more focused on imaging diagnosis and classification. Future studies may increasingly explore spinal intraoperative navigation systems and disease progression prediction.

Objective: To analyze the temporal trend and regional distribution of hip arthroplasty procedures performed within Brazil's Unified Health System (SUS) between 2014 and 2024, as well as associated costs, hospital stay, and in-hospital mortality.

Methods: This ecological time series study used SIH/SUS data on hip arthroplasties performed between 2014 and 2024. Surgical subgroups were classified according to SIGTAP codes. Annual rates standardized per 100,000 inhabitants were calculated and stratified by regions and states. Temporal trends were assessed using Pearson's correlation. Mean hospital length of stay, annual costs, and in-hospital mortality were also analyzed.

Results: There was a progressive increase in national hip arthroplasty rates, from 1.85 to 28.23 per 100,000 inhabitants between 2014 and 2024. A significant upward trend was observed in most regions, notably in the Northeast (r = 0.68; p = 0.02). Marked inequalities were found, with higher rates in the South and Southeast and lower rates in the North and Northeast. Partial hip arthroplasty was the most frequent subgroup, accounting for most emergency procedures and the largest share of financial resources. Mean hospital stay varied among subgroups, with an overall average of 8.46 days. A significant reduction in in-hospital mortality was observed for partial arthroplasty.

Conclusion: Between 2014 and 2024, there was a substantial increase in hip arthroplasties performed in the SUS, with important regional inequalities and variations in costs and outcomes. These findings underscore the need for public policies to expand equitable access and optimize healthcare resource use.

Objective: This study aimed to obtain accurate axes for rotational alignment of the distal femur using magnetic resonance imaging (MRI) and evaluate their correlation with X-ray measurements.

Methods: A total of 160 participants were included in the osteoarthritis (OA) group, and 160 were included in control group. The participants were placed in the supine position with fully extended knee joints and the patella facing forward for MRI examination. A series of axial MRI images of the distal femur overlapped using an imaging program to achieve more accurate rotational alignment of the distal femur. Rotational angles of the distal femur were measured along the posterior condylar axis (PCA), transepicondylar axis (TEA) and anteroposterior (AP) axis. Teleradiographs and weight-bearing anteroposterior radiographs of the entire lower extremity were obtained in the standing position for all participants. The hip-knee-ankle (H-K-A) angle measured on teleradiographs and the X-ray TEA-PCA angle measured in the Rosenberg view were compared with the rotational angle measured on MRI images.

Results: The AP-TEA and AP-PCA angles in the OA group were more externally rotated than those in the control groups. The TEA-PCA angle was significantly greater in the OA group than in the control group. Increased H-K-A was negatively correlated with the AP-TEA and AP-PCA angles and positively correlated with the TEA-PCA angle. The increased radiographic TEA-PCA angle was negatively correlated with the AP-TEA angle and positively correlated with the TEA-PCA angle. These results may help surgeons to determine the rotational alignment of femoral implants for successful TKA.

Conclusions: When determining the rotational alignment of the distal femur in TKA, the differences in rotational alignment according to the patient must be considered. Moreover, even in the absence of a preoperative axial MRI, the TEA-PCA angle can be measured indirectly using the X-ray TEA-PCA angle in the Rosenberg view.

Background: α10β1 integrin (CD11c/CD29) receptor plays a critical role in anchoring chondrocytes to the extracellular matrix and mediating essential collagen type II interactions being its primary receptor, thereby influencing cartilage integrity, matrix synthesis, and organization. Given the challenges with hyaline cartilage regeneration, particularly the tendency of chondrocytes to adopt a fibrocartilaginous phenotype due to donor variability and extensive passage, this study sought to discern differences in chondrogenic potential between high and low donor groups based on CD11c expression and assess its potential as a tool for selecting high-potential donors to streamline the evaluation process.

Materials and methods: Enzymatically isolated chondrocytes from six donors underwent FACS analysis to determine CD11c expression levels, and based on the median levels, the chondrocytes were categorized into low and high expression groups, and their chondrogenic potential was compared using FACS for putative markers of chondrogenesis, gene expression patterns, differentiation studies and biochemical analysis of total glycosaminoglycan/DNA ratios and total Collagen type II levels.

Result: High donor group displayed higher variability with CD29 and CD146 but comparability with the low donor group. Although the high donor group exhibited lower expression of hypertrophic markers (COL1A1 and RUNX2), suggesting potential phenotypic advantages, no significant differences were observed in chondrogenic potential or ECM properties between the two groups.

Conclusion: The novel data demonstrate that moderate CD11c percentage expression with fresh chondrocytes is not a reliable marker for distinguishing donors with superior chondrogenic potential. Reanalysis using higher percentage expressions and exploring alternative combinations of markers would help identify optimal donors.

Supplementary information: The online version contains supplementary material available at 10.1007/s43465-025-01577-1.

Background: Current methods for measuring the knee aspect ratio vary in accuracy. The objective of the study was to conduct a scoping review of the mean values of aspect ratio using Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) among Indians, and, to compare these results with those of a descriptive study assessing the same using manual anthropometry.

Methodology: The scoping review was conducted to ascertain the mean aspect ratio among adult Indians, obtained using CT or MRI between 2004 and 2024, and published in English. Studies were eligible for inclusion if they presented mean values for anteroposterior (fAP, tAP), mediolateral diameters (fML, tML) and aspect ratios (fAR, tAR) for femur and tibia obtained by CT or MRI. PubMed, Scopus, Google Scholar, Web of Science, and Cochrane Library were screened and exported using Zotero 7.0.16 and Microsoft Excel. For comparison with manual morphometry, cadaveric dry bones of femurs and tibias available at two teaching institutions were measured with a Sliding Digital Caliper (ROBUST, Germany).

Results: Out of 144 studies from the five databases, six publications that describe 736 femurs and 680 tibias were included in the review. The aspect ratios from these studies were compared with the mean of 177 femurs and 161 tibias measured by manual morphometry. CT with three-dimensional modeling proved to be less variable than MRI and closer to manual anthropometry.

Conclusion: The study suggests that CT scans can be used as a valid measurement tool for assessing knee morphometry while choosing prostheses for Indian patients.

Background: Subsidence has been identified as a cause of early failure in total hip arthroplasty. Our study's main goal was to examine the subsidence rates of two femoral stem designs-HA-coated and non-HA-coated (grit-blasted) stems-that are used in total hip arthroplasty. The secondary aim of our study was to evaluate the influence of anatomical parameters on subsidence of the femoral stem and to compare the rates of revision for aseptic loosening between these two femoral stem designs.

Methods: A retrospective review was conducted of the digital radiographs of 121 consecutive cementless primary total hip arthroplasties with two different types of stems. For the assessment of femoral morphology, we calculated the Canal Flare Index (CFI) and Canal-to-Calcar Ratio (CCR) on pre-operative radiographs. Subsidence was calculated between two radiographs, the immediate post-operative radiograph and the radiograph obtained at the latest follow-up. A threshold of > 3 mm was considered as a clinically significant migration.

Results: The mean follow-up duration was 54.04 months. The mean subsidence of the HA-coated stems cohort was 1.02 mm (SD 1.43), and for the non-HA-coated cohort, it was 1.48 mm (SD 0.73). The mean overall subsidence of all 121 THAs together was 0.86 mm. No anatomical parameter (CFI and CCR) or demographic parameter (age, gender) could be identified as a risk factor for subsidence.

Conclusion: The presence or absence of HA coating and the proximal femoral morphology had no statistically significant effect on the subsidence of collarless cementless femoral stems.

Purpose: Total knee arthroplasty (TKA) in patients with prior knee hardware presents unique surgical challenges and may increase complication risks. However, data on patient-reported outcome measures (PROMs) and healthcare utilization in this population are limited. This study aimed to compare clinically significant improvements in 1-year PROMs, healthcare utilization, and survivorship free from reoperation at 1 year among three groups: plate and screws, intramedullary nail, and control.

Methods: From 2016 to 2023, 51 TKAs with prior knee hardware (36 plate and screws, 15 intramedullary nails) were matched to 102 controls. PROMs included 1-year Knee injury Osteoarthritis Outcome Score (KOOS) for Pain, Joint Replacement (JR), and Physical function Shortform (PS), assessed by achievement of Minimal Clinically Important Difference (MCID) and Patient Acceptable Symptom State (PASS). Healthcare utilization metrics included length of stay (LOS), 90-day readmissions, emergency department (ED) visits, discharge disposition (DD), and utilization of stems. Survivorship was determined by 1-year mortality and reoperations.

Results: There were no significant differences in 1-year KOOS-Pain (p = 0.94), PS (p = 0.91), and JR (p = 0.9). Rates of achieving MCID and PASS thresholds were similar. Differences in LOS (p = 0.15), 90-day readmissions (p = 0.61), ED visits (p = 0.11), DD (p = 0.13), and stem use (p > 0.05) were insignificant. Mortality (p = 1) and reoperation rates (p = 0.69) were also comparable.

Conclusions: TKA in patients with prior knee hardware yielded similar 1-year PROMs, healthcare utilization, and survivorship to those without hardware. Understanding management strategies is crucial to optimize outcomes in this complex patient population.

Background: The clinical outcomes of arthroscopic repair of isolated lateral meniscal injuries in middle-aged patients remain unclear. We compared the clinical outcomes of lateral meniscal repair between young and middle-aged patients, hypothesising that both groups could achieve satisfactory clinical outcomes.

Methods: This retrospective study included patients who underwent arthroscopic repair of isolated lateral meniscal injuries between 2013 and 2021. The inclusion criteria were: (1) age ≥ 15 years; (2) Kellgren-Lawrence grade ≤ 2; (3) at least 2 years postoperative follow-up; and (4) traumatic meniscus tear. Patients were divided into two groups: those aged < 35 years (Group Y) and those aged > 35 years (Group M). Clinical outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Patient Acceptable Symptom State (PASS) achievement rates for the KOOS at the final follow-up.

Results: Groups Y and M included 40 and 32 patients, respectively. At the final follow-up, all KOOS subscales had significantly improved in both groups; Group Y showed significantly better outcomes than did Group M. No significant differences were found between the groups in PASS achievement rates for symptoms, pain, or quality of life (QOL).

Conclusions: The key finding of this study was that the PASS achievement rates for the KOOS regarding symptoms, pain, and QOL after arthroscopic repair of isolated lateral meniscal injuries were not significantly different between young and middle-aged patients. Therefore, arthroscopic repair represents a potentially viable treatment option for isolated lateral meniscal injuries in middle-aged patients.

Background: Accurate prosthesis sizing is crucial for successful unicompartmental knee arthroplasty (UKA). Indian patients have distinct knee morphometry due to cultural practices requiring deep flexion. Understanding these anatomical nuances is essential to optimize implant fit and functional outcomes.

Methods: A comprehensive review analyzed knee morphology among Indian, Caucasian, and other ethnic populations. Data were sourced from PubMed, Scopus, and Google Scholar using keywords such as "knee morphology," "unicompartmental knee arthroplasty," "Indian population," and "prosthesis design." Key parameters, including anteroposterior (AP) and mediolateral (ML) dimensions, tibial plateau morphology, and aspect ratios, were statistically compared (p < 0.05).

Results: Significant ethnic and gender-based differences in knee morphology were observed. Indian males had a smaller femoral AP dimension (57.5 ± 3.1 mm) than Caucasian males (59.6 ± 3.2 mm), p < 0.001, while Indian females had 52.8 ± 3.1 mm compared to 55.4 ± 2.8 mm in Caucasian females (p < 0.001). Tibial ML dimensions were also smaller in Indian knees (males: 69.1 ± 5.5 mm vs. Caucasian males 79.4 ± 4.3 mm, p < 0.001; females: 65.4 ± 4.7 mm vs. Caucasian females 70.2 ± 2.7 mm, p < 0.001). Approximately 25% of Indian patients did not achieve optimal tibial fit.

Conclusions: Western-designed UKA implants do not fully accommodate Indian knee anatomy, leading to ML overhang, AP undersizing, and compromised stability. Although statistically significant variations exist, their clinical impact warrants further investigation. Developing population- and gender-specific prosthetic designs is essential to improve implant fit, stability, and long-term surgical outcomes for Indian patients.

Introduction: Osteoporosis, a significant health concern among postmenopausal women, is influenced by estrogen deficiency, which affects bone metabolism. Current diagnostic methods, such as dual-energy X-ray absorptiometry (DXA), have limitations in sensitivity, necessitating the identification of novel biomarkers for early diagnosis. This study investigates the role of circulating exosomal miR-19b as a potential biomarker for estrogen-associated osteoporosis.

Methods: We analyzed the expression of miR-19b in MC3T3-E1 preosteoblast cells treated with 10 pM estradiol and assessed its antagonistic effects using 10 nM anastrozole. Serum exosomes were isolated from premenopausal (PR-M) and postmenopausal (PT-M) women using microfluidics-based extracellular vesicle (EV) isolation. Exosomal miR-19b expression was quantified using qRT-PCR, and its correlation with age, estrogen levels, and osteoporosis risk was evaluated. Characterization of exosomes was performed using transmission electron microscopy (TEM) and tunable resistive pulse sensing (TRPS), while protein markers CD9, CD63, and β-actin were confirmed through Western blot analysis.

Results: Our findings demonstrate that estrogen downregulates exosomal miR-19b expression, with a significant difference observed between the PR-M and PT-M groups. Receiver operating characteristic (ROC) analysis revealed that miR-19b effectively differentiates between these groups, with an area under the curve (AUC) of 0.9911. Pearson correlation analysis further confirmed the strong association between miR-19b expression, estrogen levels, and age. Additionally, miR-19b inhibition was found to regulate IGF-1 expression, influencing bone cell differentiation and osteoporosis progression.

Conclusion: This study establishes exosomal miR-19b as a novel biomarker for estrogen-related osteoporosis, providing a foundation for early diagnosis and therapeutic targeting. Our findings highlight the potential of exosomal miRNAs in advancing precision medicine for osteoporosis management.