Journal of Orthopaedic Surgery最新文献

Total hip and knee arthroplasty are common surgical procedures aimed at improving mobility and quality of life. Despite surgical advances, postoperative complications remain a concern, particularly for patients with comorbidities and poor nutritional status. Immunonutrition, the targeted administration of nutrients that modulate inflammation, such as arginine, omega-3 fatty acids, and antioxidants, has been shown to reduce infections, complications in wound healing, and shorten hospital length of stay. This review examines current evidence on the role of immunonutrition in hip and knee arthroplasty, focusing on the mechanisms of key nutrients, clinical application of supplementation, and areas for future investigation. Despite promising outcomes, further research is needed within orthopedics to establish guidelines for patient screening, nutrient dosage, and timing of administration.

ObjectiveIt aimed to explore the nursing effect of intermittent pneumatic compression pump (IPC) plus enteral nutrition support (ENS) in the prevention of deep venous thrombosis (DVT) in lower limbs of patients after orthopedic surgery (OS).Methods235 patients who underwent hip joint surgery between January 2021 and January 2022 were enrolled as regular group (RG, routine care plan), and 268 patients who underwent hip joint surgery between February 2022 and February 2023 were enrolled as joint group (JG, IPC combined with ENS care plan). The RG only received routine nursing, and the JG received IPC plus ENS nursing. The subjects' coagulation indicators, DVT incidence, postoperative recovery, and other indicators were sorted out.ResultsAfter IPC plus ENS nursing, hemoglobin (Hb) and platelet (PLT) in the JG were visibly lower as against the RG (p < .05); As against the RG, the diameter of bilateral common femoral vein (CFV) did not decrease, and the maximum blood flow velocity (BFV) and average BFV of bilateral CFV were visibly higher in the JG (p < .05). In the JG, fibrinogen (FIB), prothrombin time (PT), activated partial thromboplastin time (APTT) were visibly increased, while D-dimer (D-D) and thrombin time (TT) were visibly decreased; the incidence of DVT was visibly lower; the immobile time in bed and hospital stay was visibly shortened, and the nursing satisfaction of patients was visibly increased (all p < .05).ConclusionIPC plus ENS in the nursing of patients after OS can effectively reduce the incidence of DVT and promote postoperative recovery.

IntroductionProximal femoral tumor resection poses a major challenge in orthopaedic oncology, particularly in very young pediatric patients (<9 years), where the need to preserve function and limb length collides with the limited availability of reconstructive options (3D-printed implants, endoprostheses, biological constructs such as vascularized fibular grafts, and allograft-prosthetic composites) or leads to amputation.ObjectiveTo describe in detail the surgical technique for proximal femoral tumor resection and reconstruction using an allograft-prosthetic composite (APC) with a proximal humerus allograft plus a hip prosthesis, documenting its applicability and outcomes regarding function, allograft survival, and oncologic disease status in two pediatric cases treated at a national cancer referral center in Bogotá, Colombia.MethodsWe report two pediatric cases and detail the surgical technique used for proximal femoral reconstruction after tumor resection, based on an APC (proximal humerus allograft + hip prosthesis). Data were collected from medical records with radiological and functional follow-up.ResultsIn both patients, proximal femoral reconstruction using our technique yielded a stable construct with preservation of limb function (MSTS >72), documented graft incorporation at 3 months, local disease control, and only one recorded complication (contact dermatitis).ConclusionProximal femoral reconstruction using an APC with a proximal humerus allograft is a viable and safe surgical option in pediatric patients with Ewing sarcoma. In our experience, the technique was successfully applied in two patients, allowing limb preservation with a favorable course. Thus, it offers a functional and reliable option for limb salvage in selected cases.

PurposeHeart failure (HF), classified as preserved (HFpEF) or reduced ejection fraction (HFrEF), is associated with heightened perioperative risk. This study assessed postoperative outcomes after total knee arthroplasty (TKA) in HF patients, by ejection fraction (EF), comorbidities, laboratory values, and pharmacotherapy on complications and mortality.MethodsUsing the TriNetX database (2005-2025), adults undergoing elective primary TKA with HFpEF or HFrEF were propensity score-matched to healthy controls. Matching included demographics, comorbidities, medication use, and labs: BMI, INR, hemoglobin A1c, troponin, and B-type natriuretic peptide (BNP). Outcomes included 90-days and 1-year systemic complications and mortality. Cox regression evaluated independent risk predictors.ResultsFinal cohorts included 2611 HFpEF and 554 HFrEF patients with matched controls. Both subtypes demonstrated elevated 90-days mortality (OR 7.48 HFpEF; OR 7.43 HFrEF). HFpEF patients had significantly increased risks of MI (OR 13.96), atrial fibrillation (OR 19.31), stroke (OR 9.93), sepsis (OR 10.36), pulmonary embolism (OR 6.55), and AKI (OR 5.25). HFrEF patients showed similar patterns, including atrial fibrillation (OR 17.01), AKI (OR 9.17), and MI (OR 6.91). Cox regression identified age, male sex, elevated BNP, dialysis, chronic kidney disease, and prior MI or stroke as predictors of mortality. Medication analysis revealed ACE inhibitors, ARBs, SGLT2 inhibitors, GLP-1 agonists, and beta blockers as protective, whereas calcium channel blockers and loop diuretics increased risk.ConclusionHF patients undergoing TKA face increased complications and mortality. Stratifying risk by EF, comorbidities, and laboratory markers, particularly BNP and INR, along with tailored pharmacotherapy, may improve perioperative management and outcomes.

PurposeClinically, metastatic pathological fractures of the humeral shaft remain a challenging issue. Plate osteosynthesis and intramedullary nailing are common fixation methods; however, the optimal strategy remains debated, especially in patients with limited life expectancy where surgical goals include rapid pain relief, functional recovery, and fewer reoperations.MethodsWe retrospectively reviewed 27 patients with metastatic humeral shaft fractures treated surgically during 2009-2019. Patients were grouped by plate osteosynthesis (n = 17) and antegrade intramedullary nailing (n = 10), and operative time, intraoperative blood loss, pain relief (visual analog scale), functional outcomes (Musculoskeletal Tumor Society scoring system), postoperative survival, complications were compared.ResultsIntramedullary nailing was associated with significantly less blood loss (298 ± 61 vs 557 ± 124 mL, p < 0.001) and better MSTS score (22.1 ± 3.34 vs 17.41 ± 6.2, p < 0.05) compared with plating, whereas postoperative pain relief was comparable. Postoperative survival did not differ significantly between the two groups. Complication rates did not different significantly, although implant failure-mediated reoperation occurred only in the plate group.ConclusionsBoth fixation methods achieved pain relief and functional improvement. However, intramedullary nailing demonstrated distinct advantages, reducing surgical morbidity, minimizing reoperation and superior functional outcomes which will benefit metastatic patients with low life expectancy. Overall, these results support intramedullary nailing as a reliable first-line option for most humeral shaft pathological fractures, whereas plate fixation may be reserved for proximal or distal lesions.

The integration of Artificial Intelligence (AI) in orthopaedic surgery has been rapidly evolving, offering innovative solutions to enhance diagnosis, treatment planning, surgical precision, and patient care. This comprehensive review explores the various applications of AI in orthopaedics, highlighting its potential benefits, limitations, and future prospects.

Background: Osteoporosis (OP) is a common complication in patients with type 2 diabetes mellitus (T2DM), significantly increasing fracture risk and mortality. Body roundness index (BRI), a novel obesity assessment index, accurately reflects body fat distribution, but its relationship with OP risk in T2DM patients has not been clarified. The aim of this study was to investigate the nonlinear relationship between BRI and OP risk in patients with T2DM. Methods: In this study, based on data from the 2005-2018 National Health and Nutrition Examination Survey, we conducted a cross-sectional study involving 3,178 people with T2DM. Femoral bone mineral density was measured using dual-energy X-ray absorptiometry. Generalized additive model was used to assess the non-linear relationship between BRI and OP risk. Multiple logistic regression analyses were used to assess the relationship between BRI and OP risk, adjusted for various covariates. Subgroup analyses for age, sex, and ethnicity were also performed to assess the consistency and robustness of the results. Results: Generalized additive model analyses demonstrated an L-shaped relationship between BRI and OP risk, and logistic regression analyses indicated that BRI exhibited a negative association with OP risk. The risk of OP exhibited a significant decrease with increasing BRI and appeared to saturate at a BRI of approximately 5.08. When the BRI was below 5.08, the risk of OP was reduced by 49% for each 1-unit increase (OR = 0.51, 95% CI: 0.37-0.71, p < .001); However, when the BRI exceeded 5.08, the protective effect diminished and became statistically non-significant (OR = 0.99, 95% CI: 0.88-1.11, p = .824). The log-likelihood ratio test demonstrated a significant model fit superiority (p < .001). Subgroup analyses and interaction tests demonstrated that this association remained stable across various demographic and socioeconomic groups, including age, sex, education, poverty-to-income ratio, exercise, and smoking. However, race had an interaction association with BRI and OP risk (p interaction < 0.050). Conclusion: Our study demonstrated that a negative association was found between BRI and OP risk in the United States population with T2DM and that this relationship was nonlinear. Further studies are needed to validate this.