Journal of Orthopaedic Surgery最新文献

IntroductionTotal Hip Arthroplasty (THA) is a widely performed orthopaedic surgery, essential for treating severe pain and mobility issues arising from various conditions. The anticipated rise in Total Hip Arthroplasty (THA) procedures underscores the critical importance of their success, which is heavily dependent on the accurate positioning of prosthetic components. Various approaches like the Direct Anterior Approach with Fluoroscopy (DAA-F THA) and Robotic-assisted THA (RA THA) have their limitations. Computer-Navigated THA (CN THA) has emerged as a promising alternative, offering real-time feedback and potentially enhanced accuracy in component placement. This study evaluates the precision of CN THA in correcting leg length discrepancies and accurately positioning the acetabular component.MethodsThe study involved 122 consecutive patients undergoing direct anterior CN THA by the senior author. Exclusions were based on different surgical approaches, need for revision surgery, and infections. The study focused on the precise placement of acetabular components and leg length restoration. CN THA was used for intra-operative measurements, while post-operative radiographs were analyzed with TraumaCad® for comparison. Statistical analyses included Pearson correlation coefficients and descriptive analyses.ResultsCN THA showed high accuracy in leg length restoration with 85.25% of cases showing less than 5 mm discrepancy. Similarly, acetabular component positioning was precise, with 90.98% of inclination and 74.59% of anteversion measurements within acceptable ranges. The correlation between intra-operative and post-operative measurements was strong, indicating the reliability of CN THA measurements.ConclusionCN THA was shown to be highly accurate in correcting leg length discrepancies and achieving proper acetabular component positioning. The strong correlation between intra- and post-operative measurements underscores the reliability of CN THA. The study, however, is limited by its single-surgeon, single-approach design, and lack of a control group. Despite these limitations, CN THA shows considerable potential in improving THA precision, enhancing surgical outcomes, and customizing patient care.

BackgroundDorsal wrist ganglia (DWGs) are common, yet the contribution of carpal morphology to their formation is underexplored. We investigated whether scapholunate joint, lunate, and capitate morphology differ between DWG wrists and controls.MethodsRetrospective MRI case-control study of adults aged 18-60 years, comprising 70 DWG wrists and 70 controls. Categorical variables were lunate type (medial hamatolunate facet present or absent), scapholunate joint morphology (parallel, inverted-Y, point-like parallel), and capitate head shape (flat, round, V-shaped). Quantitative measures included capitate-triquetral distance, mid-joint scapholunate gap, and medial hamatolunate facet length, recorded only when a facet was present.ResultsInterobserver agreement was generally good across both categorical and quantitative measures (categorical κ range: 0.50-0.88; quantitative ICC range: 0.72-0.95). Capitate morphology differed between groups: round heads were more frequent in DWG (71.4%) than in controls (44.3%) (p < 0.05). The scapholunate gap was larger in DWG (mean 1.8 mm) than in controls (1.5 mm) (p < 0.05). No between-group differences were observed for lunate type (Type II: 51.4% vs 38.6%; p = 0.107), scapholunate joint type (p = 0.787), capitate-triquetral distance (p = 0.223), or medial hamatolunate facet length (p = 0.395).ConclusionDWG wrists more often exhibit a round capitate head and a larger scapholunate gap than matched controls, whereas lunate type, scapholunate joint configuration, capitate-triquetral distance, and medial hamatolunate facet length are similar. Capitate head shape may be associated with DWG; however, given the lower agreement for this parameter, this finding should be considered exploratory and requires further validation before any recommendation for routine reporting can be made. The scapholunate gap can be considered supportive context alongside clinical findings. Prospective multicenter studies with multiplanar/loaded MRI or arthroscopic correlation are warranted.

BackgroundFemoral neck shortening following internal fixation of unstable femoral neck fractures can compromise functional recovery, particularly in young, active patients. This study aimed to evaluate the efficacy of a length-stable dynamic hip screw (LSD) construct in minimizing postoperative shortening compared to the femoral neck system (FNS).MethodsA retrospective review was conducted on 65 patients with high-grade unstable femoral neck fractures treated between February 2016 and February 2023 at a single institution. Patients underwent either FNS (n = 31) or LSD (n = 34) fixation. Femoral neck shortening was quantified using vector-based analysis derived from contralateral femoral comparison at final follow-up. Functional outcomes were assessed using the Hip Disability and Osteoarthritis Outcome Score (HOOS).ResultsThe LSD group demonstrated significantly less femoral neck shortening compared to the FNS group (5.0 ± 4.6 mm vs 10.4 ± 6.7 mm, p = 0.001). Final HOOS scores were significantly higher in the LSD group in the symptom (88.1 vs 75.8, p = 0.049) and stiffness subdomains. Union was achieved in 31 of 34 patients (91.2%) in the LSD group and 26 of 31 (83.9%) in the FNS group (p = 0.605). Other complications were more frequent in the FNS group but did not reach statistical significance.ConclusionLength-stable fixation using the LSD construct significantly reduced postoperative femoral neck shortening in high-grade unstable fractures, without compromising union rates or functional recovery. Our results support the role of length-stable constructs as a reliable option for maintaining anatomic integrity in unstable femoral neck fractures.

Artificial intelligence (AI) has become pervasive in biomedicine and is transforming orthopaedic research from bench to bedside. Beyond its established roles in robotic surgery and diagnostics, AI now supports advances in biomechanics, imaging, tissue engineering, drug discovery, genomics, and prosthetic control. In biomechanics, AI enables faster finite-element simulations, markerless gait analysis, and data augmentation using synthetic signals. Imaging applications include automated segmentation of the spine and hip, opportunistic screening for osteoporosis, bone metastasis detection, and three-dimensional analysis of knee osteoarthritis. In regenerative medicine, AI assists in scaffold optimization, bioprinting, and personalized cell therapies, while integration with genomic and proteomic data enhances precision orthopaedics. Machine learning-based control systems also improve the usability of prosthetics and exoskeletons, reducing cognitive burden for patients. Despite challenges such as data scarcity, validation, and ethical considerations, AI is emerging as a powerful complement to traditional research methods. By accelerating workflows, improving accuracy, and enabling individualized care, AI holds strong potential to bridge laboratory discoveries with clinical applications in orthopaedics. This review highlights the application of AI in orthopaedic research and assesses how it could integrate into clinical practice in the future.

The Israeli military invasion of 2023-2025 has decimated Gaza's health system, constraining trauma capacity and disrupting prehospital and hospital care. We aimed to characterize emergency department (ED) orthopedic injury patterns. We conducted a multicenter, descriptive cross-sectional study across four referral hospitals in different governorates (September 1-16, 2024). A standardized interviewer-administered instrument and chart review captured demographics, mechanism, injury type/site, soft-tissue and neurovascular findings, acute interventions, disposition, perceived care quality, and time metrics (to first care, ED evaluation, surgery). Primary outcomes were admission and emergency surgery. Analyses included descriptive statistics and bivariable/multivariable logistic regression with hospital-clustered standard errors. Among 449 patients, the cohort was predominantly young, male, and displaced. Most presentations followed explosive violence. Fractures predominated, with a large share open; comminuted and segmental patterns were frequent, and neurovascular compromise was common. Many patients reached some form of care rapidly, yet few received first aid before ED arrival, indicating prehospital collapse amid unsafe transit. Median wait-time was short but highly variable between hospitals. Operative demand exceeded theatre capacity, with notable interhospital variation in time to surgery. Orthopedic trauma care in Gaza continues to be affected by widespread damage, though unevenly across the enclave. Immediate priorities include the entry of essential medical supplies and safe protection for hospitals and healthcare workers to operate.

PurposeTo assess whether the preoperative triglyceride-glucose (TyG) index is associated with 30-day surgical site infection (SSI) after instrumented posterior lumbar fusion (PLF) and to examine its predictive performance.MethodsWe retrospectively reviewed consecutive adults who underwent elective one- or two-level instrumented PLF between 2017 and 2024 at a tertiary center. Patients with active infection, revision surgery, tumor, trauma, or incomplete 30-day follow-up were excluded. Preoperative fasting triglycerides and glucose were used to calculate the TyG index as ln[(triglycerides × glucose)/2]. The primary outcome was 30-day SSI defined by Centers for Disease Control and Prevention criteria. Multivariable logistic regression evaluated the association between TyG and SSI, and receiver operating characteristic analysis assessed discrimination and identified an optimal cut-off. Incremental predictive value was examined by comparing a clinical model with and without TyG using AUC, likelihood ratio testing, reclassification metrics, calibration, Brier score, and decision curve analysis with bootstrap internal validation.ResultsAmong 438 patients, 29 (6.6%) developed SSI (24 superficial, 2 deep, 3 organ/space). Patients with SSI had higher TyG values than non-SSI patients (9.1 ± 0.5 vs 8.6 ± 0.6; p < 0.001). Each 1-unit increase in TyG was independently associated with higher odds of SSI (adjusted odds ratio 3.65; 95% confidence interval 1.62-8.24; p = 0.002). TyG alone yielded an area under the curve of 0.73, and a cut-off of 8.80 identified a high-risk group with an SSI rate of 11.8% versus 2.5% in the low-TyG group. Beyond standard clinical factors, adding TyG improved model fit (LRT χ² = 10.98; p = 0.001) and improved reclassification.ConclusionA higher preoperative TyG index is independently associated with 30-day SSI after PLF and provides moderate discriminative ability as a simple predictor. Incorporating TyG into preoperative risk assessment may help refine perioperative optimization and infection surveillance strategies in lumbar fusion surgery.

PurposeDespite systemic antibiotics and topical vancomycin powder, deep surgical-site infections (SSIs) remain a devastating complication of major posterior spine surgery, driving morbidity, costs, and antimicrobial resistance. In this study, we aimed to compare deep surgical-site infection (SSI) incidence following major posterior spine surgery between patients receiving intraoperative hypochlorous acid (HOCl) lavage and a historical control group receiving intrawound vancomycin powder.MethodsIn this retrospective comparative study, 161 patients undergoing major posterior spinal surgery received ≥2L of topical HOCl lavage, while 88 historical controls received intra-wound vancomycin powder. The primary endpoint was deep SSI incidence within 12 months. Demographics, operative variables, and microbiological data were analyzed with rigorous statistical methods.ResultsDeep SSI rates were nearly identical: 3.1% (5/161) with HOCl versus 3.4% (3/88) with vancomycin (p = 0.999), with no HOCl-related adverse effects. Pathogen profiles (including MRSA, S. epidermidis, and E. coli) were comparable between groups, underscoring HOCl's broad-spectrum efficacy.ConclusionHOCl lavage showed similar deep SSI rates to intrawound vancomycin powder in this retrospective cohort; prospective multicenter studies are warranted to validate these findings and define optimal protocols.

ObjectiveThis study aimed to evaluate the clinical efficacy of different rotational alignment techniques for the tibial component in total knee arthroplasty (TKA) using a Medial Pivot (MP) knee system, providing improved strategies for tibial prosthesis positioning.MethodsA retrospective analysis included 115 patients with end-stage osteoarthritis who underwent MP-TKA at our hospital from January 2022 to June 2025. Patients were grouped based on tibial alignment reference points: the medial one-third of the tibial tubercle (medial 1/3 group) and the midpoint of the tibial tubercle (midpoint group). Intraoperative variables-operation time, incision length, blood loss-were recorded. Postoperative knee function was assessed using the Hospital for Special Surgery (HSS) score, Visual Analogue Scale (VAS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Tibial posterior slope angles evaluated prosthesis positioning accuracy, and postoperative complications (infection, anterior knee pain, deep vein thrombosis) were documented.ResultsThe average follow-up was 15.87 ± 3.87 months. Baseline and intraoperative data showed no significant differences between groups (p > 0.05). The medial 1/3 group reported one incision infection and four cases of anterior knee pain; the midpoint group had no infections and two cases of anterior knee pain, all resolved with treatment. At 1 and 6 months postoperatively, the midpoint group had significantly higher HSS scores and lower VAS and WOMAC scores compared to the medial 1/3 group (p < 0.05). Tibial posterior slope <1° was more frequent in the midpoint group (75.86% vs 59.65%), indicating more accurate alignment.ConclusionUsing the tibial tubercle midpoint for tibial component alignment in MP-TKA results in better prosthesis fit, improved knee function, and reduced anterior knee pain compared to the medial one-third reference, offering a preferable clinical approach.

Generative artificial intelligence (AI) is a powerful class of machine learning that moves beyond simply analysing data to actually creating new and original content, such as medical images or clinical text. The use of generative AI is varied in orthopaedic surgery. Generative AI moves us from one-size-fits-all surgical planning to highly personalised surgical blueprints for each patient's unique anatomy and condition. While generative AI in surgery is new, it can provide real-time intelligent help to a surgeon's skill and decision-making. Most practitioners see the use of AI as a tool to improve diagnosis and treatment, with some expressing their concern that it will conversely worsen diagnosis and treatment. With its use and potential, the use of generative AI currently should be supervised and validated, as it has been shown that sometimes the generated content does not reference to any actual source. Policies and economic values are also detrimental to the integration of AI technologies in clinical orthopaedics. Ethical issues, practitioners view and perspective, and the high overall cost of AI technology use, are among the barriers that may emerge. This comprehensive review addresses the opportunities, challenges, and future direction of integrating generative AI in orthopaedic surgery.

ObjectiveIn revision total knee arthroplasty (rTKA), metaphyseal sleeves represent an effective modality for managing metaphyseal bone defects. The purpose of this study was to clearly stratify patients with different grades of metaphyseal bone defects while evaluating the mid-term clinical outcomes and survival rate of metaphyseal sleeves.MethodsA retrospective study was conducted on 58 patients who underwent revision total knee arthroplasty (rTKA) with metaphyseal sleeves between May 2018 and September 2022. Bone defects were classified using the Anderson Orthopaedic Research Institute (AORI) classification system: patients with AORI type I and IIA defects were categorized as having mild bone defects, while those with AORI type IIB and III defects were defined as severe bone defects. Clinical outcomes, including the visual analog scale (VAS) for pain, range of motion (ROM), Hospital for Special Surgery (HSS) score, Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Short Form-12 (SF-12) health survey, were recorded preoperatively and during the entire follow-up period. Linear mixed-effects models were employed to analyze repeated-measure outcomes, and Kaplan-Meier analysis was utilized to estimate the survivorship of metaphyseal sleeves.ResultsThe mean duration of follow-up was 66.6 months, with a range of 30 to 85 months. All clinical outcome metrics exhibited a statistically significant improvement compared with preoperative values (p < 0.001), and both the mild and severe defect groups demonstrated analogous postoperative recovery trajectories. No sleeve-related complications or failures were observed, including aseptic loosening, periprosthetic fracture, or deep periprosthetic infection. Kaplan-Meier analysis yielded an estimated 5-years metaphyseal sleeve survivorship of 100%.ConclusionThese findings demonstrate that metaphyseal sleeves provide reliable midterm fixation and significant functional improvements in patients undergoing revision total knee arthroplasty (rTKA), irrespective of the severity of metaphyseal bone defects.