Journal of Orthopaedic Surgery and Research最新文献

Objective: To evaluate the accuracy and agreement of three widely used blood-loss estimation methods-visual estimation, gravimetric measurement, and the Gross formula method-against the reference HbMass method in patients undergoing posterior lumbar interbody fusion (PLIF).

Methods: A single-center retrospective cohort study included 1000 consecutive elective PLIF patients (2021-2024). Intra-operative blood loss was quantified intra-procedurally by visual, gravimetric, and Gross formula method approaches; HbMass was calculated from pre- and post-operative hemoglobin with patient blood volume estimated by the Nadler equation. Agreement was assessed with Bland-Altman 95% limits of agreement (LoA) and Spearman correlation; sensitivity analyses examined fusion extent, irrigation volume, and sampling timing.

Results: Mean blood loss was 663.8 ± 155.6 mL by HbMass. Visual, gravimetric, and Gross estimates averaged 456.5 ± 175.0 mL, 599.8 ± 167.5 mL, and 608.0 ± 115.0 mL, respectively (all P < 0.001). Correlation with HbMass was negligible (ρ = 0.185), weak (ρ = 0.424), and moderate-to-strong (ρ = 0.742). Bland-Altman biases (95% LoA) were - 238.85 mL (- 631.46, 153.76), - 45.33 mL (- 377.55, 286.90), and - 28.57 mL (- 216.66, 159.52). Sensitivity analyses confirmed robustness.

Conclusion: Among routine methods, the Gross formula method offers the smallest bias and narrowest agreement limits versus HbMass, whereas visual estimation is clinically unreliable. PLIF-enhanced recovery pathways should replace sole reliance on visual assessment with the Gross formula method, supplemented by HbMass in high-risk cases, to optimize peri-operative volume therapy and reduce transfusion-related complications.

Background: Patient-reported outcome measures (PROMs) are the clinical standard for assessing recovery after total knee arthroplasty (TKA) which reflect patients' perceived function, whereas smartwatch step counts capture real-world activity. Whether their changes align after TKA is uncertain. We therefore assessed correlations between changes in daily steps and changes in PROMs.

Methods: In this prospective single-centre cohort, 86 patients undergoing unilateral primary TKA received a consumer-grade smartwatch (Polar A370™). Daily steps and PROMs were recorded 1 month pre-operatively and at 3 and 6 months post-operatively. PROMs comprised the Oxford Knee Score (OKS; 0-48, higher =  better) and the KOOS-Physical Function Short-form (KOOS-PS; 0-28, higher =  worse). Change scores were computed so that positive values indicated improvement. Pearson correlations assessed associations between change in steps and change in PROMs; paired t-tests compared pre-operative with 6-month values.

Results: Of 96 enrolled patients, 86 (89.6%) completed the 6-month follow-up. At 6 months, functional outcomes improved substantially: OKS increased from 26.4 (6.6) to 38.4 (5.8) (p <  0.001), and KOOS-PS decreased from 14.1 (4.3) to 9.8 (2.7) (p <  0.001). Daily steps increased modestly from 6651 (4,294) to 7807 (4,363) (p =  0.008). Correlations between change in steps and change in PROMs were negligible: OKS r =  0.055 (95% CI -  0.159 to 0.264) and KOOS-PS r =  0.071 (95% CI -  0.143 to 0.279).

Conclusions: Although PROMs improved markedly after TKA, they showed little correlation with smartwatch-measured step counts. Patient-reported outcomes and objective activity data reflect different aspects of recovery and should be interpreted as complementary rather than hierarchical measures. IRB approval: Si COA 582/2022.

Objective: This study evaluated the clinical utility of short-segment cement-augmented pedicle screw (SCAPS) fixation combined with vertebroplasty in patients with stage III Kummell's disease (KD).

Methods: A retrospective analysis was conducted on 42 patients with stage III KD treated between January 2018 and December 2023. Frankel grades included C (n = 7), D (n = 15), and E (n = 20). All patients underwent SCAPS fixation with vertebroplasty. Perioperative variables, including operative duration and intraoperative blood loss, were recorded. Visual Analog Scale (VAS) pain scores, Oswestry Disability Index (ODI), anterior vertebral height (AVH), posterior vertebral height (PVH), Cobb angle, and Frankel grade were assessed preoperatively, one week postoperatively, and at the final follow-up. Complications were also documented.

Results: All patients completed follow-up for 18 to 30 months (mean 24.52 ± 3.20 months). At one week postoperatively and at final follow-up, VAS, ODI, AVH, PVH, and Cobb angle demonstrated significant improvement relative to preoperative measurements (p < 0.05). At final follow-up, neurological function improved to Frankel grade E in 40 patients (95.2%). Asymptomatic cement leakage occurred in seven cases. Two adjacent vertebral fractures related to trauma were managed successfully with percutaneous kyphoplasty. No complications related to internal fixation were identified.

Conclusions: SCAPS fixation combined with vertebroplasty appears to be a safe and effective surgical approach for stage III KD, with significant correction of spinal kyphosis, restoration of vertebral height, improvement in neurological function, and maintenance of long-term spinal stability.

Background: Gouty arthritis (GA) is an inflammatory joint disease driven by monosodium urate (MSU) crystal deposition. The NOD-like receptor thermal protein domain associated protein 3 (NLRP3) inflammasome-mediated pyroptosis is central to GA pathogenesis, yet potential regulatory targets remain limited. The role of β-1,3-galactosyltransferase 2 (B3GALT2), a glycosyltransferase, is entirely unknown in GA. This study aims to identify novel biomarkers for GA and investigate the role and regulatory mechanism of B3GALT2.

Methods: Differentially expressed genes (DEGs) analysis was performed on the GSE160170 dataset. Machine learning algorithms, including least absolute shrinkage and selection operator (LASSO) regression and random forest (RF), were applied to identify key candidate genes. B3GALT2 expression and its diagnostic value were validated in clinical peripheral blood samples from GA patients and healthy controls. In vitro GA models were established using THP-1 cells stimulated with lipopolysaccharide (LPS) and MSU. Gain- and loss-of-function experiments assessed the effects of B3GALT2 and transcription factor activator protein-2 A (TFAP2A) on pyroptosis. Chromatin immunoprecipitation (ChIP)-qPCR and dual-luciferase reporter assays were used to verify the transcriptional regulation of B3GALT2 by TFAP2A.

Results: B3GALT2 was identified as a key down-regulated gene in GA through integrated bioinformatics and machine learning. Clinically, B3GALT2 expression was significantly decreased in GA patients, showed high diagnostic accuracy, and was negatively correlated with inflammatory markers, including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and interleukin-6 (IL-6). Functionally, B3GALT2 overexpression in LPS/MSU-induced cell models inhibited NLRP3 inflammasome activation (reducing NLRP3, apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC), caspase1 p20) and pyroptosis (decreasing N-terminal gasdermin-D (GSDMD-N), lactate dehydrogenase (LDH) release, and IL-1β/IL-18 secretion). Mechanistically, TFAP2A was predicted and experimentally confirmed to bind directly to the B3GALT2 promoter, activating its transcription. Importantly, the anti-pyroptotic effects of TFAP2A overexpression were largely abolished upon B3GALT2 knockdown.

Conclusion: This study identifies B3GALT2 as a promising diagnostic biomarker for GA and further reveals a novel TFAP2A/B3GALT2 axis that plays a critical protective role in GA by suppressing NLRP3 inflammasome-mediated pyroptosis. These findings provide new insights into GA pathogenesis and highlight potential therapeutic targets.

Background: Avascular necrosis (AVN) of the femoral head is a progressive condition that leads to collapse of the femoral head in 85% of symptomatic patients when left untreated. As it is typically a disease that occurs among the younger population, the consequent arthroplasty of the hip is a radical procedure. In this study, we investigated the effect of intravenous zoledronate infusion in patients with avascular necrosis of the femoral head.

Methods: This retrospective study included 94 hips diagnosed with AVN of the femoral head that were treated off-label with 4 mg intravenous zoledronate once or twice in 3-month intervals during the years 2007-2019 at Oulu University Hospital.

Results: We found that 38% of the zoledronate-treated hips did not require arthroplasty; 75% of patients not requiring arthroplasty were men. Risk factors for arthroplasty were high Association Research Circulation Osseous (ARCO) stage, large volume of osteonecrosis and edema at baseline, 3, and 6 months of follow-up. High resorption activity indicated by higher levels of cross-linked carboxy- terminal telopeptide of type I collagen (ICTP) after zoledronate infusion in hips classified as ARCO IV predicted a poor outcome (p=0.002). The mean follow-up for those not requiring arthroplasty was 102.4 months.

Conclusion: Zoledronate treatment is more likely to be effective in male patients with early-stage osteonecrosis (ARCO I-II), whereas advanced-stage disease (ARCO III-IV) may not respond well. Moreover, an accelerated bone resorption rate, indicated by elevated ICTP levels after zoledronate infusion, is associated with an increased risk of treatment failure.

Background: The endoscopic direct anterior approach (Endo-DAA) for total hip arthroplasty (THA) aims to minimize soft-tissue trauma and accelerate recovery. Whether adding a disposable wound protector can further reduce early muscle injury and enhance recovery remains unclear. This randomized controlled trial evaluated the impact of wound protector use on biological, clinical, and functional outcomes after Endo-DAA THA.

Methods: Seventy-six patients undergoing primary Endo-DAA THA were prospectively randomized (1:1) to either a wound protector or control group. The only intraoperative difference between groups was the use of a wound protector. The primary outcome was serum creatine kinase (CK) at 24 h postoperatively. Secondary outcomes included serum myoglobin at 6 h, C-reactive protein at 24 h, pain visual analog scale (VAS) during activity, independent ambulation within 12 h, lateral femoral cutaneous nerve (LFCN) symptoms, wound complications and satisfaction, and functional scores using the Harris Hip Score (HHS) and Forgotten Joint Score-12 (FJS-12). Statistical significance was defined as P < 0.05.

Results: Baseline characteristics were comparable between groups. The wound protector group had significantly lower postoperative CK (422.5 vs. 665.5 U/L; median difference: -228.0; 95% CI: -354.0 to -109.0; P < 0.001), myoglobin (299.9 vs. 481.2 ng/mL; P < 0.001), and C-reactive protein levels (30.3 vs. 45.1 mg/L; P = 0.024). Pain scores were lower at 12 and 24 h, and more patients achieved independent ambulation within 12 h (86.8% vs. 55.3%; risk ratio [RR]: 1.57; 95% CI: 1.14 to 2.16; P = 0.002). Fewer wound complications (7.8% vs. 34.2%; RR: 0.23; 95% CI: 0.07 to 0.75; P = 0.005) and LFCN symptoms (36.8% vs. 65.7%; P = 0.012) were observed. Early functional scores were higher in the protector group, while midterm outcomes were similar.

Conclusions: In Endo-DAA THA, the use of a disposable wound protector significantly reduced early muscle injury and systemic inflammation, alleviated immediate postoperative pain, facilitated earlier mobilization, and enhanced early wound healing and functional recovery without increasing operative time or hospital stay. These benefits were primarily observed during the early postoperative phase, which aligns with the principles of enhanced recovery after surgery.

Trial registration: Chinese Clinical Trial Registry, ChiCTR2300076225. Registered on September 27, 2023.

Purpose: To explore the clinical significance of the artificial intelligence (AI)-assisted three-dimensional (3D) planning system AI-HIP in total hip arthroplasty (THA) and evaluate its accuracy and efficacy in clinical practice.

Methods: Preoperative planning was done using the AI-HIP system in the AI group and two-dimensional (2D) template measurements in the conventional group. The two groups were compared for postoperative radiographic results, perioperative monitoring indicators, and the degree of consistency between preoperative planning and actual implant size. Postoperative Harris scores, hip joint range of motion (ROM), and Barthel index were used to evaluate clinical effectiveness.

Results: None of the patients who ultimately completed the 6-months follow-up experienced adverse events such as hip dislocation and infection during follow-up. Compared to the conventional group, the AI group had significantly higher Harris scores (P = 0.026), hip ROM (P = 0.018), Barthel index (P = 0.042) at 6 months postoperatively, and conformity rates of the acetabular (P = 0.001) and femoral components (P < 0.001) between intraoperative application of prosthesis model and preoperative planning. Additionally, the AI group had significantly shorter operation time (P = 0.041), less intraoperative blood loss (P = 0.012), and smaller discrepancy between bilateral acetabular offset (P = 0.032) and vertical distance of hip center of rotation (P = 0.011). However, no statistically significant intergroup differences were observed for the acetabular abduction angle, anteversion angle, femoral offset and leg length discrepancy.

Conclusion: Preoperative planning for THA using the AI-HIP system has a high accuracy rate and allows for effective reconstruction of the rotation center and acetabular offset, reduction of surgical time, and early recovery of joint function. Further research is needed to confirm its potential clinical value.

Clinical registration number: ChiCTR210004826, Date:28/03/2021, https://www.chictr.org.cn/showproj.html? proj=52846.

Background/objectives: Patients suffering from Worker's Compensation (WC) injuries typically demonstrate poorer outcomes despite optimal surgical management. In the occupational setting, shoulder pathology is the most implicated musculoskeletal disease. We recently described the Human Disharmony Loop (HDL), a clinical model of chronic, historically intractable pain of the neck, upper back, shoulder, and arm (Sharma and Friedman in Clin Med 14(5):1769, 2025. https://doi.org/10.3390/jcm14051769; Sharma et al. in J Clin Med 14(16):5650, 2025. https://doi.org/10.3390/jcm14165650; Friedman et al. in PLoS ONE 20(10):e0326815, 2025). Specifically, the asymmetric lower trunk innervation to the pectoralis minor (PM) can deform the scapula's numerous connections and derange the full anatomy of the upper limb girdle, often after trauma. The purpose of this study was to retrospectively review our cohort of Workers' Compensation patients (WCP) who met HDL diagnostic criteria and underwent treatment consisting of pectoralis minor release with infraclavicular neurolysis (PM + ICN). We hypothesize that WCP evaluated and treated for the HDL would show decreased pain, increased shoulder function, and a high rate of return to work.

Methods: This is a retrospective study of consecutive WCP meeting HDL criteria treated via PM + ICN. 6-month follow-up minimum was required. Outcomes included self-reported pain and headaches, shoulder range of motion, presence of neuropathy on exam, and return to work (RTW).

Results: 36 patients were included. Average age was 48, sex was 61% male. Median follow-up was 10 months. Median preoperative pain was 8/10, headache prevalence was 69%, shoulder abduction was 90 degrees. Following treatment, median postoperative pain was 3/10, headache prevalence was 14%, and shoulder abduction was 180 degrees. 86% of patients returned to work. 25% required secondary neurolysis of the axillary, radial, cubital, and/or median nerves for persistent neuropathy.

Conclusions: In WCP who meet HDL criteria, PM + ICN provides significant clinical improvement in terms of dramatic reductions in pain and high rates of RTW. WCP with refractory pain preventing RTW should be evaluated and treated for the HDL.