Journal of Orthopaedic Surgery最新文献

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.

Orthopaedic surgery is on the cusp of entering a new data-driven era, fuelled by big data and Artificial Intelligence (AI). Medical data is traditional derived from manually inputted medical records. A far richer set of data may be collected via automated means and from population registries leading to an explosion of large and complex datasets termed "big data" which are not well handled by traditional processing tools. Big data truly becomes useful when coupled with the ability to meaningfully process it with current generation AI. These two advances have reshaped possibilities in research and clinical applications. This narrative review outlines emerging opportunities and challenges brought about big data and AI while also exploring the necessary guardrails that are needed for safe application and sustainable progress.

Periprosthetic Joint Infection (PJI) represents a significant complication following joint arthroplasty, highlighting the necessity for accurate diagnostic strategies to guide clinical decision-making. This review highlights advancements in PJI diagnostic techniques, including pathogen identification, biomarker profiling, imaging, and molecular biology techniques. Diagnostic accuracy in culture-based pathogen identification is influenced by factors such as sampling method, antibiotic administration, specimen type, incubation period, and type of culture media. Methods such as ultrasonic agitation and chemical dissolution (e.g., dithiothreitol, DTT) have demonstrated potential in improving pathogen identification in biofilms. Moreover, commonly employed biomarkers include C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), α-defensin, D-dimer, and interleukin-6 (IL-6), though each exhibits variable specificity and sensitivity. Imaging techniques such as X-ray, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography/computed tomography (PET/CT) offer diverse diagnostic capabilities, with PET/CT demonstrating high sensitivity and specificity despite higher costs. Furthermore, molecular biology methods such as Polymerase Chain Reaction (PCR) and next-generation sequencing (NGS) provide rapid and sensitive detection, which is especially valuable in culture-negative and polymicrobial infections. However, financial constraints limit their routine clinical use. Future research should focus on further optimizing diagnostic modality, exploring novel diagnostic techniques (such as machine learning, (ML) analysis and point-of-care, (POC) diagnostics), while integrating multimodal strategies to enhance the accuracy and efficiency of PJI identification.

PurposeThis study aimed to evaluate the clinical and radiological outcomes of lunate excision scaphocapitate fusion (LESCF) using a single headless cannulated compression screw in patients with advanced Kienböck disease (Lichtman IIIb-IV). The hypothesis was that this technique would provide significant pain relief, functional improvement, and comparable union rates to multi-screw methods while reducing implant-related morbidity.MethodsA retrospective single-center case series included 24 patients (8 males, 16 females; mean age 37.3 ± 8.5 years) who underwent LESCF between June 2021 and June 2023. Minimum follow-up was 24 months (mean 33.6 ± 4.1). Clinical evaluation included pain (VAS), wrist function (Modified Mayo Wrist Score), grip strength, and range of motion. Radiological assessment involved union rate and time, radioscaphoid angle (RSA), carpal height ratio (CHR), Modified Carpal Ulnar Distance Ratio (modified-CUDR) and ulnar variance.ResultsRadiographic union was achieved in all cases (100%) at a mean of 3.5 ± 1.2 months. Mean VAS score decreased from 7.2 ± 1.1 to 2.1 ± 1.0 (p < 0.001), and Modified Mayo Wrist Score improved from 47 ± 12 to 74 ± 10 (p < 0.001). Grip strength increased from 55 ± 15% to 75 ± 18% of the contralateral hand (p < 0.01). Flexion-extension arc slightly decreased (81° ± 10 to 76° ± 9; p < 0.05), while radioulnar deviation changes were minimal. RSA improved from 48° ± 7 to 41° ± 6 (p < 0.01), with no significant change in CHR or ulnar variance. Modified CUDR values were found to be 0.834 ± 0.104 in the preoperative period and 0.804 ± 0.116 in the postoperative period. One patient (4.2%) reported mild screw irritation without surgical intervention; no other complications occurred.ConclusionSingle-screw scapho-capitate fusion and lunate excision can be considered a suitable treatment option for advanced Kienböck's disease, offering pain reduction, positive effects on functional recovery, acceptable healing rates, and a low risk of complications. However, larger, prospective studies are needed to demonstrate the long-term results of this method and its comparative effectiveness with other surgical techniques.

BackgroundIntegrating large language models (LLMs) into decision-making and education has shown promise across various healthcare disciplines. The study aimed to evaluate the performance of leading LLMs-ChatGPT-5, Gemini 2, Grok 3, and DeepSeek R1-in accurately responding to structured multiple-choice and open-ended queries about complex case scenarios in hand surgery.MethodsA prospective cross-sectional analysis used 50 clinically relevant, guideline-based case scenarios developed for hand surgery. Each scenario consisted of four open-ended and two multiple-choice questions, totaling 300 points per LLM. Responses were independently assessed by blinded expert reviewers using a standardized six-point Likert scale evaluating accuracy, completeness, and adherence to international surgical guidelines.ResultsIn multiple-choice queries, Gemini (5.9 ± 0.2) and Grok (5.9 ± 0.1) outperformed ChatGPT (5.7 ± 0.3; p = 0.031 and p = 0.009, respectively) and DeepSeek (5.6 ± 0.4; p = 0.004 and p = 0.001, respectively). In open-ended queries, Gemini (5.6 ± 0.3 accuracy) and Grok (5.5 ± 0.4 accuracy) demonstrated superior results across all measured dimensions-accuracy, completeness, and guideline adherence-markedly surpassing ChatGPT (5.1 ± 0.5 accuracy, p < 0.001) and DeepSeek (4.9 ± 0.6 accuracy; p < 0.001). Notably, Gemini and Grok demonstrated consistently high performance with minimal variability, while ChatGPT, particularly DeepSeek, exhibited considerable inconsistency in complex clinical judgments.ConclusionGemini 2 and Grok 3 showed reliable and clinically relevant performance, positioning them as promising adjunctive tools for decision-making and education in hand surgery. The limitations in ChatGPT-5 and the significant shortcomings of DeepSeek underscore the necessity for cautious deployment and continued refinement.

AimsThis study aims to evaluate the long-term durability of a unicompartmental knee arthroplasty (UKA) implant using a fixed-bearing all-polyethylene tibial tray with a Cobalt-Chromium (Co-Cr) femoral condyle, stratified by patient age. It also aims to compare implant survivorship between inlay and onlay tibial implantation techniques.MethodsData from the New Zealand Joint Registry (NZJR) was used to evaluate survival of Smith & Nephew Genesis II^® UKA performed between February 2000 and December 2011 in which two different tibial implant techniques (inlay and onlay) were used. The primary endpoint was revision surgery.ResultsAt a minimum follow-up of 10 years, 57 revisions were performed at an average of 6.6 years from index surgery. The revision rate per 100 component years was 1.29 (CI: 0.97 - 1.66), with a significant difference between the over-75 years cohort compared with the under-65 cohort, in favour of the older cohort (p < 0.05). There was a significant difference in survival between inlay and onlay techniques, in favour of the inlay technique (p < 0.05).ConclusionFixed-bearing all-polyethylene tibial UKA show acceptable outcomes at an average 12-year follow-up, especially in elderly patients and use of inlay tibial tray implantation technique.

PurposeFew studies have assessed the link between tibial tubercle (TT) morphology and anterior cruciate ligament (ACL) injury, and most focus only on the TT-trochlear groove (TT-TG) distance. This study aimed to examine the relationship between ACL injury, TT morphology, and posterior tibial slope (PTS) by comprehensively evaluating TT-related radiological parameters.MethodsRadiological images of 100 patients who underwent isolated ACL reconstruction for non-contact injury between 2016 and 2022 and 100 demographically matched controls with no relevant abnormalities on knee MRI were retrospectively analyzed. Thirteen radiological parameters were measured and compared, including PTS; TT torsion (TTT); TT-rotational angle (TT-RA); plateau axis-tuberosity axis (PA-TA); TT-TG; TT-PCL distance and ratio; TT lateralization (TTL) distance and ratio; TT height (TTH); and TT angle (TTA). Associations between these parameters and ACL injury, as well as interparameter correlations, were evaluated using t-tests, logistic regression, ROC analysis, and Pearson correlation.ResultsMean TTT, TT-RA and PA-TA values were significantly lower in the ACL injury group (5.68° vs 8.34°, p < .001; 7.96° vs 12.09°, p < .001; 8.41° vs 11.58°, p < .001). Conversely, TT-TG, PTS and TTH were higher (10.69 mm vs 8.17 mm, p < .001; 12.84° vs 10.61°, p < .001; 11.69 mm vs 10.02 mm, p < .001). Logistic regression showed TTT (OR = -0.849), TT-RA (OR = -0.822), TT-TG (OR = 1.298), PTS (OR = 1.177), and TTH (OR = 1.327) independently associated with ACL injury.ConclusionIn isolated ACL injury patients, TT torsion was lower and TT prominence higher. TT morphology assessment may help personalize ACL reconstruction, identify high-risk individuals, and support future clinical and biomechanical research on ACL injury susceptibility.

Background: Metatarsalgia is a frequent cause of forefoot pain, often linked to isolated gastrocnemius tightness, which increases forefoot pressure during gait. Gastrocnemius recession has been proposed as a surgical treatment to correct this biomechanical dysfunction. This systematic review aims to evaluate the clinical outcomes, complication rates, and quality of evidence regarding gastrocnemius recession performed exclusively for the treatment of isolated metatarsalgia. Materials and Methods: A systematic search of PubMed, MEDLINE, and the Cochrane Library was conducted in February 2025 following PRISMA guidelines. Studies were included if they reported outcomes of gastrocnemius release performed solely for isolated metatarsalgia. Data on surgical techniques, clinical outcomes, complications, and follow-up durations were extracted and analyzed. Results: Three studies met the inclusion criteria, encompassing a total of 86 operated feet with a mean follow-up of 37.5 months. Surgical techniques varied across studies, including proximal medial gastrocnemius release and musculotendinous junction recession. All studies reported significant improvements in Visual Analogue Scale (VAS) scores, along with high rates of patient satisfaction. Nevertheless, approximately 30% of patients required adjunctive forefoot procedures. The complication rate was low and predominantly involved minor nerve symptoms and transient bruising. Conclusion: Gastrocnemius recession appears to be an effective and safe surgical option for the management of isolated metatarsalgia, providing substantial pain relief and high patient satisfaction. However, the multifactorial nature of metatarsalgia often necessitates additional forefoot procedures. Standardization of surgical techniques, postoperative protocols, and outcome measures is essential to enhance clinical decision-making and future research quality.

BackgroundArtificial intelligence (AI) has rapidly gained momentum in the field of orthopaedics, with an increasing number of systematic reviews and meta-analyses providing synthesised evidence. However, most studies have focused on individual subspecialties or specific applications, and a comprehensive overview across the discipline is lacking.AimThe aim of this study is to chart publication trends and geographical distribution, classify clinical and anatomical focus, and map AI methodologies and applications in orthopaedic settings, thereby highlighting research opportunities in underexplored areas.MethodsWe conducted a scoping review of freely accessible systematic reviews with and without meta-analysis across PubMed, Web of Science and Scopus databases from year 2015 up to July 2025 that evaluated the use of AI in orthopaedics. Data were extracted on publication characteristics, geographical origin, orthopaedic subspecialty focus, anatomical region, AI methodologies, data modalities, and application types. The methodological quality of the included reviews was appraised using the A Measurement Tool to Assess Systematic Reviews-2 (AMSTAR-2). Descriptive trends were summarised, and associations between variables were analysed using R software.ResultsWe identified 183 eligible systematic reviews published in the last 10 years, with an exponential increase in publications over the past 5 years. Most reviews concentrated on fractures, arthroplasty, and surgery-related studies, particularly in the spine, knee, and hip. Imaging datasets predominated, with deep learning most frequently applied to radiological tasks, while machine learning methods were more common in structured clinical data applications. Notable gaps remain in underrepresented anatomical regions and in underexplored applications such as prescriptive modelling.ConclusionOur review highlights that while there is rapid growth in AI research across orthopaedics, certain clinical domains remain underexplored. These gaps represent opportunities for future work to align AI methods with clinical needs. By addressing these areas, AI has the potential to effectively support orthopaedic care and improve patient outcomes.

IntroductionFirst metatarsophalangeal (MTP) joint arthrodesis is the gold-standard treatment for end-stage arthritis and hallux deformities. Successful fusion is improved by achieving adequate compression across the joint. Traditional plating systems provide single-point compression, whereas the Arthrex MTP valgus plate is designed for double compression, potentially improving stability and union rates. This study aimed to confirm double compression and compare two anchoring methods: K-wire and olive tip guide wire (BB-tack).MethodsTwelve cadaveric feet were randomised to plate fixation using either K-wire or BB-tack anchoring. Compression was measured with Tekscan sensors during three stages: after seating the first compression screw, after seating the second screw, and after reseating the second screw without the stabilising K-wire. Peak force and contact pressure were analysed using ANOVA and t-tests (α = 0.05).ResultsBoth techniques achieved measurable compression after the first screw, which increased significantly with the second screw (mean pressure: 0.55-0.62 MPa; peak force: 18.3-22.2 N). Removing the stabilising K-wire before reseating reduced peak force but maintained comparable pressure. No significant differences were found between anchoring methods (p > 0.05).ConclusionThe Arthrex MTP valgus plate achieves double compression, enhancing construct rigidity compared to single-compression systems. Further clinical studies are warranted to validate these biomechanical advantages.