Journal of Orthopaedic Surgery最新文献

BackgroundGamification has emerged as a novel approach in rehabilitation. This systematic review and meta-analysis aimed to evaluate the effectiveness of gamification-based exercises on foot posture in children and adolescents with flatfoot.MethodsA systematic review and meta-analysis were conducted in accordance with PRISMA guidelines, utilizing the PubMed, Scopus, Web of Science, and Google Scholar databases to search for original and peer-reviewed articles with selected keywords from inception to July 2025. The quality of the included studies was assessed using the Joanna Briggs Institute checklist. Statistical analysis was conducted with Comprehensive Meta-Analysis software version 3. To evaluate data heterogeneity, the Q-test and I² statistic were applied. Egger's test was used to assess publication bias.ResultsAfter searching the mentioned databases, 2160 articles were found. Finally, seven articles were included in the current review. It was shown that gamification-based exercise had a significant effect, leading to a reduction in navicular drop (95% CI = -1.796 to -0.516, p = 0.000) and an increase in balance scores (95% CI = -1.647 to -0.462, p = 0.000), compared to the passive control groups that did not receive any intervention. However, no significant differences were seen in the Staheli index (95% CI = -3.298 to 0.023, p = 0.053). High heterogeneity was noted in the navicular drop test (95% CI = -2.412 to -0.603, p = 0.001). Egger's test indicated no statistically significant publication bias for either navicular drop (p = 0.080) or Staheli index (p = 0.210).ConclusionThe results showed that exercise with gamification may be effective in improving foot alignment in children and adolescents. Specifically, positive effects were evident when using the navicular drop test, whereas no significant changes were detected with the Staheli index. However, interpretation should be made cautiously due to the limited number of studies and lack of age or gender stratification.

Study designA retrospective study.ObjectivesThis study aimed to evaluate the clinical and radiological outcomes of pedicle subtraction osteotomy (PSO) at L2 and L3 levels in ankylosing spondylitis (AS) patients with similar kyphotic deformities. The primary focus was to compare these levels in terms of spinal alignment, sagittal balance, and functional improvements.MethodsA retrospective analysis was conducted on 28 AS patients who underwent L2 or L3 level PSO between 2010 and 2021. Patients were divided into two groups based on osteotomy levels (14 in each group) and matched for similar kyphosis angles and deformity patterns. Radiological parameters, including pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), global kyphosis (GK), spinosacral angle (SSA), sagittal vertical axis (SVA), osteotomized vertebral angle (OVA) were measured preoperatively, immediately postoperatively, and at final follow-up using SURGIMAP. Functional outcomes were assessed using VAS, ODI, and BASFI scores.ResultsBoth groups showed significant improvements in sagittal alignment parameters such as PT, LL, and SVA postoperatively (p < 0.01). The L3 group demonstrated better sagittal balance, achieving the recommended SVA value (<47 mm) at follow-up, while the L2 group did not. There was no significant difference in radiological parameters between the groups (p > 0.05). Functional outcomes, including VAS, ODI, and BASFI scores, improved significantly in both groups (p < 0.001), with no significant differences between them.ConclusionsL2 and L3 PSO levels yielded comparable radiological and functional outcomes in AS patients with similar curve patterns. Both levels can be effectively utilized for correcting rigid kyphotic deformities, with L3 providing slightly better sagittal balance.

PurposeKnee joint fibrosis after anterior cruciate ligament (ACL) reconstruction causes dysfunction and requires precise quantification. Magnetic resonance imaging (MRI) is the primary method but has limitations like high cost and long scan times. Computed tomography (CT) offers better accessibility and speed, but its reliability remains unverified. This study compares CT and MRI for quantifying fibrosis volume post-ACL reconstruction.Methods18 fibrosis patients underwent same-day CT (1.0-mm and resliced 3.5-mm) and MRI (3.5-mm). Two observers measured fibrotic volume via three-dimensional (3D) reconstruction. Standardized regions of interest (ROI) were delineated to measure total and regional fibrotic volumes across three imaging modalities: 1.0-mm CT, 3.5-mm CT, and 3.5-mm MRI. Statistical analyses included intraclass correlation coefficient (ICC), Pearson's correlation coefficient, Bland-Altman analysis, one-way ANOVA, and paired-sample t-tests.ResultsBoth Pearson correlation coefficients and ICC values between the two observers exceeded 0.9, indicating excellent correlation and agreement. Bland-Altman analysis showed low mean inter-observer differences (-1.29% to 2.78%). For comparisons between imaging modalities with identical slice thickness (3.5-mm CT vs 3.5-mm MRI), the mean differences were minimal (-3.02% to 1.06%) with Pearson correlation coefficients >0.9. ANOVA analysis revealed no significant differences, demonstrating excellent agreement between CT and MRI. Although 1.0-mm CT did not show statistically significant differences in ANOVA analysis compared to the other two modalities, its thinner slice thickness provided more detailed visualization, resulting in significantly higher volume measurements in Bland-Altman analysis. Nevertheless, it maintained excellent correlation (Pearson's > 0.9) with both 3.5-mm CT and MRI.ConclusionThis study provides a method to quantify anterior knee fibrosis. CT is a feasible tool with performance comparable to MRI. Further studies are needed for multi-regional assessment and integration with other imaging or functional parameters.

BackgroundGlucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed for obesity and type 2 diabetes mellitus (T2DM). While their metabolic benefits are well-established, their impact on postoperative outcomes following total joint arthroplasty (TJA) remains controversial. This study aimed to systematically evaluate the association between GLP-1 RA use and postoperative outcomes in patients undergoing total hip (THA), knee (TKA), or shoulder arthroplasty (TSA).MethodsWe conducted a PRISMA-compliant systematic review and meta-analysis across PubMed, Embase, Web of Science, and Scopus through April 24, 2025. Eligible retrospective cohort studies compared adults undergoing TJA with and without preoperative GLP-1 RA exposure. Primary outcomes were 90-day readmission and all-cause revision. Pooled odds ratios (ORs) and standardized mean differences (SMDs) were calculated under random-effects models. Subgroup analysis based on the type of arthroplasty was conducted where applicable.ResultsFourteen studies (total sample size of 365,154; including 62,117 (17.01%) GLP-1 consumers, and 303,037 (82.98%) control cases) met the inclusion criteria (All studies included primary TJA cases). GLP-1 RA use was associated with lower 90-day readmission (OR = 0.86, 95% CI: 0.74-0.99, p = 0.033) and reduced sepsis incidence (OR = 0.63, 95% CI: 0.46-0.88, p = 0.006). No significant differences were observed for all-cause revision, thromboembolic events, and other medical and surgical complications. Length of stay was marginally shorter in GLP-1 users (SMD = -0.09, p = 0.048). Subgroup analyses showed the strongest sepsis reduction in TSA.ConclusionGLP-1 RA use before TJA is associated with reduced readmission and sepsis risk without increasing surgical or thromboembolic complications. These findings support the potential perioperative benefits of GLP-1 RAs, warranting prospective trials to confirm causality and define optimal perioperative strategies for high-risk arthroplasty patients.

ObjectivesPlantar calcaneal spur (PCS) is a bony outgrowth of the calcaneal tuberosity frequently associated with chronic heel pain. Although its precise etiology remains uncertain, mechanical stress and repetitive traction forces are frequently implicated. Haglund's deformity, defined as a bony enlargement on the posterosuperior calcaneus, results in retrocalcaneal impingement of the Achilles tendon. While both conditions involve stress-related alterations of the calcaneus, their potential association has not been clearly established. This study aimed to evaluate the relationship between PCS and Haglund's deformity by determining the incidence of Haglund's deformity in symptomatic PCS patients and investigating associated factors.MethodsIn this retrospective case-control study, 377 patients aged ≥18 years who underwent weight-bearing lateral foot radiographs between March 2023 and March 2024 were included. The case group (n = 94) consisted of patients with symptomatic PCS, and the control group (n = 283) comprised patients without PCS. Haglund's deformity was assessed radiographically using the BRINK angle, with values >20° considered diagnostic. Demographic characteristics and comorbidities were analyzed.ResultsHaglund's deformity was significantly more prevalent in the PCS group (62/94; 66.0%) compared with controls (53/283; 18.7%) (p = 0.001). Diabetes mellitus showed a significant association with Haglund's deformity (p = 0.01). No significant differences were observed in age, sex, body mass index, or other comorbidities.ConclusionOur findings demonstrate a strong radiological association between PCS and Haglund's deformity, suggesting shared biomechanical stress pathways involving the plantar fascia and Achilles tendon. Prospective studies incorporating biomechanical evaluation are warranted to clarify underlying mechanisms and clinical implications.

PurposeThis study investigates the efficacy of antibiotic-loaded bone cement followed by autogenous iliac bone grafting in managing subacute/chronic phalangeal osteomyelitis (OM), focusing on infection eradication, reconstruction of bone defects, and functional restoration.MethodsWe conducted retrospective analysis involving 14 patients treated between September 2007 and November 2023, with a mean follow-up duration of 18.21 months. The treatment protocol involved staged procedures, beginning with debridement and bone cement insertion, followed by cement extraction and autogenous bone grafting.ResultsComplete infection resolution was achieved for all patients, and radiological evidence of bone union was observed within an average of 46.93 days. Bone defects measured between 10 and 30 mm; most patients received cancellous bone grafts, although cortico-cancellous grafts were utilized in four cases. Functional outcomes, evaluated through the Quick disabilities of the arm, shoulder, and hand questionnaire, demonstrated marked improvement (49.78→10.33). The mean total active motion of the affected digits was 82.14%, with a majority attaining functional use. No cases of recurrent infection were identified, and the staged surgical method demonstrated effectiveness for digit preservation, including those with bone loss exceeding 10 mm.ConclusionThe authors suggest antibiotic-loaded bone cement insertion followed by autogenous iliac bone grafting can be a highly reliable and reproducible intervention for subacute/chronic phalangeal OM. We advocate this approach as a treatment option for phalangeal OM.

PurposeThis study aimed to compare the radiological and clinical outcomes of unilateral biportal endoscopic lumbar decompression (UBELD) performed with 0-degree and 30-degree endoscopes.MethodsPatients with single-level lumbar spinal stenosis without instability were included in this single-center retrospective study. The patients were categorized into two groups on the basis of the angle of the endoscope used by the surgeon. Clinical outcome measures included JOA scores, Oswestry Disability Index (ODI), and VAS scores for low back and leg pain, assessed preoperatively and at 12 months postoperatively. Ipsilateral and contralateral osteotomy angles, overhang distance, and ipsilateral inferior articular process (IAP) area were measured.ResultsAmong the 81 patients who met the inclusion criteria, a 30-degree endoscope was used in 51 patients, while a 0-degree endoscope was used in 30 patients. The JOA score, VAS-leg score, VAS-low back pain score, and ODI significantly improved in both groups at the final follow-up period (p < 0.001). Postoperative VAS-low back pain score in the 30-degree endoscope group was significantly lower than that in the 0-degree endoscope group (1.4 vs 2.9, p < 0.001). Significant differences were also observed in the ipsilateral osteotomy angle (77.8° vs 87.8°, p < 0.001), overhang distance (-1.16 mm vs -4.39 mm, p < 0.001), and the postop/preop ratio of ipsilateral IAP area (0.74 vs 0.69, p = 0.006). Radiological parameters for facet preservation were better in the 30-degree endoscope group.ConclusionSuccessful clinical improvements were achieved with both endoscope angles. However, facet preservation parameters were more favorable in the 30-degree endoscope group compared to the 0-degree endoscope group.

ObjectiveThe study aimed to investigate the mechanical distribution around knee joint after open wedge high tibial osteotomy (OWHTO) in different osteotomy distraction gaps (ODG) and confirm the safe ranges of correction after OWHTO.MethodsA three-dimensional finite element analysis (FEA) was performed to observe the max stress distribution for three compartments of knee joint in each OWHTO model under the different ODG (1, 1.5, 2, 2.5, 3 cm), and measure the joint line height (JLH), Blackburne Peel Index (BPI), Insall-Salvati index (ISI), and joint line convergence angle (JLCA). Moreover, a retrospective clinical study involving 50 patients underwent OWHTO (7 males with 8 knees and 40 females with 42 knees; aged from 42 to 67 years old, BMI ranged from 18.80 to 32.17 kg/m², duration from 12 to 38 months) was implemented to further reveal the role of different ODG on the clinical outcomes of patients after OWHTO.ResultsIn the FEA, the ODG after OWHTO were positively correlated with the JLH (R² = 0.980), negatively correlated with the BPI (R² = 0.995) and the JLCA (R² = 0.989), and not correlated with the ISI. Additionally, the turning point for the stress alterations of the three compartments of the knee joint was found when the ODG ranged from 2 to 2.5 cm. In the clinical study, a significant correlation was investigated between the two classifications (Kellgren-Lawrence and Iwano grading) and correction angle (r = 0.447, p < .001; r = 0.592, p < .001). A lower grading was observed in the correction angle within the range of 9-12°, compared with that in other ranges (χ² = 31.733, p < .001; χ² = 34.899, p < .001).ConclusionsThe ODG could affect the stress distribution of three compartments of the knee joint by altering the JLH, JLCA and BPI. As result of this, limited correction angle should be fully considered in the preoperative planning to avoid overcorrection and patellofemoral joint disorders.

BackgroundTraumatic arthritis leads to progressive cartilage degeneration, ultimately causing joint dysfunction. Due to cartilage's limited ability to self-repair, damage often extends to bone and joint tissues. This study investigates the correlation between prostaglandin-endoperoxide synthase 2 (PTGS2) expression and cartilage injury in traumatic arthritis, aiming to assess PTGS2 as a potential biomarker for early diagnosis.MethodsWe analyzed data from 181 patients diagnosed with traumatic arthritis between January 2022 and August 2024. Serum levels of PTGS2 and cartilage biomarkers were measured and compared between patients with and without cartilage injury. Logistic regression and ROC curve analysis were used to evaluate the diagnostic efficacy of PTGS2.ResultsPTGS2 levels were significantly higher in patients with cartilage injury compared to those without (p < 0.05). Correlation analysis showed that PTGS2 was positively correlated with cartilage biomarkers (COMP, CTX-II) and identified as an independent risk factor for cartilage injury. ROC analysis revealed that PTGS2 had good diagnostic performance with an AUC of 0.820, sensitivity of 94%, and specificity of 68.42%.ConclusionPTGS2 is a promising biomarker for diagnosing cartilage injury in post-traumatic osteoarthritis and may serve as a target for early diagnosis and treatment.