Journal of Orthopaedic Surgery and Research最新文献

Background: Patellar tendinopathy symptoms and functional limitations should be evaluated using validated, language-specific assessment tools. Cultural adaptation of these tools can improve their psychometric properties across languages. The VISA-P questionnaire is the only condition-specific tool for measuring symptom severity, but a validated Persian version is not available.

Purpose: To translate, culturally adapt, and evaluate the psychometric properties of the VISA-P questionnaire for use among Persian-speaking athletes.

Study design: Case-control observational study with a test-retest subgroup; Level of evidence, 3.

Methods: The VISA-P was translated into Persian following international guidelines: forward translation, synthesis, back-translation, expert review, pretesting, and validation. Sixty Persian-speaking athletes (30 with patellar tendinopathy, 30 healthy controls) participated in this cross-sectional study. Psychometric evaluation followed COSMIN standards assessing structural validity (exploratory factor analysis), construct validity (Spearman correlation with the Blazina classification), known-groups validity (comparison between symptomatic and healthy athletes using the Mann-Whitney U test)), internal consistency (Cronbach's α), and test-retest reliability (ICC over 24-48 h). Face validity, feasibility, and interpretability were also assessed.

Results: The VISA-P-Pr demonstrated good face and content validity. Factor analysis revealed a two-factor structure explaining 87.1% of variance with strong item loadings. Construct validity was supported by a strong negative correlation with the Blazina classification (r_s = -0.75, p < .001), and known-groups validity showed significantly lower scores in athletes with patellar tendinopathy compared to healthy controls (median 65.0 vs 98.5, p < .001). Test-retest reliability was excellent in the tendinopathy group (ICC = 0.91) with good internal consistency across both assessments (Cronbach's α = 0.88 and 0.89).

Conclusion: The VISA-P-Pr is a reliable and valid instrument with psychometric properties comparable to the original VISA-P, suitable for clinical and research use among Persian-speaking athletes.

Background: Pediatric pelvic fractures are rare but potentially life-threatening injuries associated with high-energy trauma and complex anatomical considerations. Surgical management is often required, necessitating multidisciplinary care. This study aimed to evaluate the clinical outcomes of surgically treated pediatric pelvic fractures, with special emphasis on earthquake-related injuries.

Methods: This retrospective, single-center study included 36 pediatric patients (aged 0-17) who underwent surgical treatment for pelvic fractures between January 2021 and October 2024. Demographics, injury mechanisms, fracture types (Torode and Zieg classification), surgical procedures, and short-term outcomes were analyzed. A subgroup comparison was performed between earthquake-related and non-earthquake trauma cases.

Results: Earthquake-related trauma was the most frequent mechanism (36.1%), followed by motor vehicle accidents (30.6%) and falls from height (25%). Type IVB fractures were the most common (55.6%). Earthquake-related cases showed longer time to surgery (8.5 vs. 2.3 days, p < 0.001) and higher postoperative CRP (116.7 vs. 33.2 mg/L, p < 0.001). Despite greater injury severity, the majority of patients achieved functional recovery: 63.9% regained full mobility, while 33.3% walked normally with limited running. The overall complication rate was low (16.6%), and no life-threatening events occurred. Hospitalization costs were higher in earthquake cases, driven by Intensive Care Unit (ICU) stay and surgical delay.

Conclusion: Surgical stabilization of pediatric pelvic fractures achieved favorable short-term outcomes with low complication rates, even in earthquake-related mass-casualty settings. Earthquake cases presented with more severe patterns, longer time to surgery, and greater inflammatory and resource burdens, underscoring the need for rapid triage, coordinated multidisciplinary care, and early mobilization despite operational constraints. These findings argue for disaster-ready pediatric trauma systems and merit validation in prospective multicenter cohorts with long-term functional and economic endpoints.

Objective: To investigate the clinical and radiographic results of cement and screw reconstruction for bone defects during total knee arthroplasty(TKA).

Methods: From September 2014 to September 2019, 38 patients with Rand type II bone defects who underwent the screw plus cement technique during primary TKA were included in this study. The clinical results were evaluated via the Knee Society Knee Scale (KSKS), Knee Society Function Scale (KSFS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and range of motion (ROM). The hip-knee-ankle angle (HKAA), femorotibial angle (FTA), and radiolucent lines were assessed radiologically.

Results: Thirty-five patients were followed up for an average of 92.6 months (60-120 months). At the last follow-up visit, the KSKS, KSFS, WOMAC score, and ROM were significantly improved. The HKAA and FTA were corrected postoperatively. In 3 patients, a nonprogressive radiolucent line measuring approximately 1 mm was observed at the interface between the host bone and the cement at 3, 6 and 12 months after surgery, with an incidence of 8.3%, No radiolucent lines were found around the screws and no infection, fracture or prosthesis loosening occurred at the last follow-up visit.

Conclusion: Cement and screw reconstruction for Rand type II bone defects during TKA achieved satisfactory clinical and radiological results and solid fixation. This could be considered an economical and practical method to repair mild and moderate bone defects in primary TKA patients.

Background: As known microbial reservoirs, hospital linens thrown in the operating room (OR) can impact sterility in total joint arthroplasty, where a reduced inoculum may result in periprosthetic joint infection. Herein, we examine the effects of hospital blankets dropped or thrown in the OR on airborne bioburden and contamination.

Methods: A standardized, staged pilot study was developed employing different blanket handling practices in the OR. Airborne bioburden was compared between each of these common scenarios. Settling plates (n = 48) at varying distances from the disturbances were used to detect aerosolized organisms. Test conditions were conducted in the morning and afternoon to assess temporal changes in microbial flora.

Results: Of the 17 (35.4%) microorganism-positive plates, 7 (41.2%) were observed on control and 10 (58.8%) on days with dropped or thrown blankets. Positions near the airflow disturbance were 3× more likely to become contaminated compared to far positions (p = 0.03). Blankets dropped and thrown resulted in 18% more microorganisms compared to control (p = 0.59). Temporally, 58.8% (10/17) of the positive plates were observed following afternoon cases (p = 0.59). All microorganisms were gram positive, of which 93.3% were human colonizers, with Staphylococcus spp. being most common.

Conclusions: This pilot study demonstrated that closer proximity to airflow disruptions negatively impacts sterility, while later time of day and dropped or thrown objects may contribute to contamination. The presented methodologies provide guidance for future studies, and the findings can help curtail OR practices by offering insights into the effects of airflow disruptions beyond the sterile field.

Background: Intervertebral disc degeneration (IDD) underlying molecular mechanisms remain incompletely understood.

Objectives: To explore the role of miR-302a-3p in IDD and elucidate its targeted regulatory mechanism.

Methods: 130 IDD patients and 130 healthy controls were collected. The miR-302a-3p and EPHA2 expressions were measured using reverse transcription quantitative polymerase chain reaction (RT-qPCR). A lipopolysaccharide (LPS)-induced cell injury model was established using human nucleus pulposus (NP) cells. Proliferation was assessed using the cell counting kit-8 (CCK-8) assay, apoptosis was determined by flow cytometry, and the concentrations of inflammatory factors were measured by enzyme-linked immunosorbent assay (ELISA). A dual-luciferase reporter gene assay was conducted to confirm the targeted regulatory interaction.

Results: miR-302a-3p expression was significantly decreased in IDD patients (P < 0.001), and receiver operating characteristic (ROC) curve analysis indicated that it possessed certain diagnostic potential (P < 0.001, AUC = 0.8808, 95% confidence interval (CI) = 0.8400-0.9216). In the LPS-induced NP cell injury model, miR-302a-3p expression was down-regulated, which was accompanied by reduced cell proliferation, increased apoptosis, and elevated tumor necrosis factor-alpha (TNF-α) and interleukin-1 beta (IL-1β) secretion (P < 0.001). However, overexpression of miR-302a-3p could effectively alleviate these injury-related effects. Furthermore, miR-302a-3p directly targeted EPHA2, whose expression was up-regulated in IDD (P < 0.001). Overexpression of EPHA2 partially reversed the protective effects of miR-302a-3p on cell proliferation, apoptosis, and inflammatory responses (P < 0.001).

Conclusion: miR-302a-3p significantly mitigated inflammatory responses and suppressed cell apoptosis by directly targeting and downregulating EPHA2 expression, thereby delaying the progression of IDD.

Background: Rotator cuff injury (RCI), a leading cause of shoulder disability, necessitates effective non-surgical interventions. Despite widespread use of intra-articular injections (corticosteroids, hyaluronic acid [HA], prolotherapy, platelet-rich plasma [PRP]), comparative efficacy across short-, mid-, and long-term outcomes remains unclear due to heterogeneous evidence.

Purpose: To systematically review the literature to compare corticosteroids, hyaluronic acid, prolotherapy, and platelet-rich plasma for rotator cuff injuries, using network meta-analysis stratified by short-, mid-, and long-term outcomes.

Methods: A comprehensive search was conducted across PubMed, Embase, Cochrane Library, Web of Science, Scopus, CNKI, VIPC, and Wanfang Data up to May 2025. Pain (VAS) and functional outcomes (e.g., Constant-Murley Score) were assessed at short- (≤ 1 month), mid- (1-3 months), and long-term (> 3 months) intervals. Frequentist models with random effects ranked interventions via SUCRA.

Results: Twenty-nine RCTs (1800 patients) were included. For pain relief, prolotherapy consistently ranked highest across all timeframes. PRP also exhibited favorable long-term analgesic efficacy. Corticosteroids showed short-term benefits but inferior long-term efficacy. For functional improvement, HA demonstrated the best short-term results, whereas prolotherapy was optimal for mid-term recovery. Long-term functional outcomes favored HA and prolotherapy. The detailed SUCRA values and rankings for all interventions and timepoints are presented in Table 2.

Conclusions: Comparative efficacy analysis suggests temporal variations in treatment outcomes: prolotherapy and HA offer the most favorable early (≤ 3 months) symptom control for both pain and function. For sustained pain relief (> 3 months), prolotherapy and PRP rank highest, while HA and prolotherapy are associated with better long-term functional outcomes. Corticosteroids appear most effective for short-term analgesia, with diminishing efficacy over longer durations. This evidence supports a shift from using a single injection agent towards a tailored strategy that selects different injections based on the patient's symptoms and the specific treatment phase to achieve optimal outcomes. PROSPERO registration: PROSPERO registration number: CRD42025632416.

Level of evidence: Level I Systematic Review and MetaAnalysis.

Introduction: As shoulder arthroplasty volume increases in the UK, capacity challenges within a stretched health service mean that day case shoulder arthroplasty offers a value based solution. Patient selection for this is crucial and there is lack of evidence that informs guidance on patient selection for day case surgery. This study aims to use a large population reflective database, The National Joint Registry (NJR), to identify independent predictors for day case shoulder arthroplasty as well as develop a statistical tool that aids patient selection.

Method: All shoulder arthroplasty procedures were requested from 1st April 2012 to 31st March 2022 from the NJR. These were then linked to the Hospital Episode Statistics for England (HES) to identify patient co-morbidities. A multivariable regression model was used to identify independent predictors of day case surgery. These predictors were then used to develop a clinical tool to predict likelihood of day case surgery with clinician inputted parameters.

Results: There were 40,877 patients available for analysis. Younger age, being male having a lower ASA score, being operated on Monday-Thursday and having a Total Shoulder Arthroplasty or a Hemiarthroplasty rather than a Reverse Shoulder arthroplasty were significant predictors of having day case surgery. Having a diagnosis of dementia or paraplegia reduced the risk of having day case surgery. Using these predictive variables an excel prediction tool was developed with moderate predictive ability (AUC 0.65 GOF 0.82).

Conclusion: This study has identified independent predictors for day case surgery and has developed a tool that can act as an adjunct for clinicians selecting patients for day case shoulder arthroplasty.

Background: Ossification of the posterior longitudinal ligament (OPLL) causes progressive narrowing of the cervical canal and neurological deficits. Cervical laminoplasty (LP) and staged anterior-posterior fusion (APF) are widely used, but their comparative outcomes remain controversial. This study compared clinical and radiographic outcomes of LP and APF for multilevel OPLL, with analysis according to OPLL subtype.

Methods: We retrospectively reviewed 217 patients with cervical OPLL who underwent LP (n = 135) or APF (n = 82) between 2014 and 2023. All patients had ≥ 3 operated levels and ≥ 1-year follow-up. Clinical outcomes included Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI), visual analog scale (VAS) for pain, and subjective improvement rate (IR). Radiographic outcomes included C2-7 lordosis and sagittal vertical axis (SVA). Assessments were performed preoperatively and at 6 months, 1 year, and 2 years. Between-group comparisons and longitudinal analyses were performed using t-tests, chi-square tests, and repeated-measures ANOVA.

Results: Baseline characteristics were comparable between groups. Both LP and APF significantly improved neck and arm pain and JOA scores, with no group difference at 2 years. APF achieved greater correction of sagittal alignment, with larger improvements in C2-7 lordosis across all OPLL types (p < 0.001). However, APF patients had consistently higher NDI scores during early follow-up (p < 0.001), particularly in domains requiring cervical motion (personal care, lifting, work, driving). Subgroup analysis showed that patients with segmental-type OPLL experienced the greatest postoperative disability after fusion due to higher preoperative motion. These differences gradually decreased by 2 years, indicating functional adaptation. Although the difference did not reach statistical significance (p = 0.0719), there was a trend toward higher IR in the APF group.

Conclusion: Both LP and APF provided significant neurological recovery and pain relief in multilevel OPLL. APF yielded superior sagittal alignment but was associated with higher early postoperative disability, most pronounced in segmental-type OPLL. Differences diminished by the second postoperative year, suggesting patient adaptation. Surgical decision-making should consider OPLL subtype, preoperative mobility, and the trade-off between motion preservation and alignment correction.

Background: An individualized, and evidence-based approach is needed for effective management of proximal humerus fractures (PHF). As a first step toward this goal, expert agreement is needed on the fracture features that are relevant to management decisions. In this study, we utilize an e-Delphi method to obtain consensus on a comprehensive list of fracture features important to PHF management.

Methods: A literature review was conducted to identify all PHF features of importance. A panel of trauma and shoulder surgeons with expertise in treating PHF were recruited. The e-Delphi method consisted of two rounds of 4-point Likert scale questions. In the first-round participating surgeons were asked to assess each feature's level of importance on management decisions, and had the option of proposing modifications to current feature definitions and recommending new features for inclusion in Round 2. Final consensus was reached for a fracture feature if at least 78% of surgeons indicated it was "Very Important" or "Important" in Round 2. The 78% consensus threshold was chosen based on prior item content validity threshold recommendations.

Results: The e-Delphi participants consisted of 29 physicians which completed two rounds of surveys. Round 1 began with 10 features and two additional features, bone quality and humeral head subluxation, were recommended by participants. Of a total of 12 features, 8 reached consensus in Round 2 which included: dislocation (100%), head split fracture (100%), topographical parts (97%), head shaft translation (93%), displacement of parts (90%), bone quality (83%), head impaction (83%), and head shaft angulation (83%).

Conclusions: Consistent with prior research, we identified dislocation, head split fracture, topographical parts, and displacement of parts as important features guiding management decisions for PHF. Our results also distinguish head shaft angulation, head shaft translation, head impaction, and bone quality as key PHF features that are relevant when making treatment decisions. We anticipate that these results can provide a foundation for future research efforts to identify patient subgroups and evaluate comparative treatment outcomes for PHF.

Background: Effective therapies remain elusive for devastating osteolysis in osseous echinococcosis, thus necessitating mechanistic exploration. To elucidate the molecular mechanism by which echinococcal infection promotes osteoclast differentiation and activation via the IL-1β/c-Fos/NFATc1 signaling axis in pathological osteolysis of osseous echinococcosis.

Methods: Retrospective RT-qPCR analysis quantified mRNA expression of osteoclastogenesis-associated inflammatory factors (TNF-α, IL-1β, IL-6, IL-8) in bone cyst tissues from 21 osseous echinococcosis patients versus histologically normal bone adjacent to tumors in 21 matched bone tumor controls. Murine RAW 264.7 monocytes/macrophages were divided into: (i) Untreated control; (ii) Osteoclast induction (100 ng/mL RANKL + 25 ng/mL M-CSF); (iii-v) Induction + hydatid antigen B (25/50/75 ng/mL); (vi) Induction + antigen B (75 ng/mL) + IL-1β antagonist (canakinumab, 10 ng/mL). TRAP staining identified osteoclasts (≥ 3 nuclei), with positive cell percentage calculated across ≥ 5 random fields. ELISA measured cytokine levels in supernatants; Western blot quantified c-Fos, NFATc1, Cathepsin K, and MMP9 expression.

Results: Bone cyst tissues exhibited elevated TNF-α, IL-1β, IL-6, and IL-8 mRNA versus controls (P < 0.05). Antigen B (25-75 ng/mL) dose-dependently increased TRAP⁺ cells and inflammatory cytokines versus induction group (P < 0.05). c-Fos, NFATc1, Cathepsin K, and MMP9 were upregulated in induction and antigen B (75 ng/mL) groups versus control (P < 0.05), with further elevation in antigen B (75 ng/mL) group versus induction (P < 0.05). Canakinumab reversed these protein increases versus antigen B (75 ng/mL) group (P < 0.05).

Conclusion: Echinococcal infection promotes pathological osteoclastogenesis and osteolysis through IL-1β/c-Fos/NFATc1 signaling activation.