Journal of Orthopaedic Surgery and Research最新文献

Objective: Fear of falling (FOF) after ankle fracture surgery significantly hinders rehabilitation in elderly patients, yet the optimal timing for physical therapy (PT) remains debated. This study examines how PT initiation time affects FOF and functional recovery.

Methods: In this single-center retrospective cohort study, we analyzed 2,816 patients (aged ≥ 65) with ankle fractures (2014-2023), stratified into early (≤ 2 weeks post-operation) and conventional PT (>2 weeks) groups. Primary outcomes were changes in FES-I and AOFAS scores; secondary outcomes included complication rates and time to resuming daily activities. Propensity score matching controlled for confounders, and interaction analysis assessed the moderating effect of fracture type (Weber classification).

Results: At 12 months, the early PT group showed significantly lower FES-I scores (median 19 [IQR 17-23] vs. 17 [IQR 22-27], P < 0.001), and higher AOFAS scores (85.5 [78-92] vs. 77 [70-86], P < 0.001). Weber type B fractures benefited most, with early PT yielding greater FES-I improvements (2.8-point difference; 95% CI 1.8-3.8, P < 0.001) and AOFAS gains (10.0 points; 95% CI 8.4-11.6, P < 0.001). Complication rates were similar (9.2% early vs. 11.8% conventional, P = 0.078), but early PT had lower deep vein thrombosis incidence (3.5% vs. 5.7%, P = 0.035).

Conclusion: Early PT significantly reduces FOF and enhances functional recovery, particularly in Weber type B fractures. We recommend individualized PT protocols based on fracture type and bone density.

Trial registration: Retrospectively registered.

Background: Rotator cuff (RC) repairs heal unreliably, particularly in chronic disease. The molecular mechanisms underlying failed repair remain poorly understood. While individual studies have examined protein expression in diseased RC tissue, no synthesis has investigated these findings across various disease stages. This systematic review explores the stage-specific protein expression of human RC degeneration using immunohistochemistry.

Methods: Following PRISMA guidelines, MEDLINE, Embase, and Cochrane Library were systematically searched to September 2025 for human studies that use immunohistochemistry to evaluate protein expression in intraoperative RC tendon or muscle biopsies. Study quality was appraised with Joanna Briggs Institute (JBI) tools. No meta-analysis was performed due to heterogeneity.

Results: Forty-seven studies were included. Despite methodological heterogeneity, convergent molecular patterns emerged within disease stages. Partial and small tears demonstrated hypoxic-inflammatory-apoptotic signatures (HIF-1α, BNip3, IL-6, IL-1β, MMP-1/3/9) with preserved regenerative markers (Ki67, CD34), suggesting reparative potential. Medium tears exhibited sustained angiogenic activity (VEGF) and emerging adipogenic drift (PPARγ, C/EBPα). Large and massive tears showed depletion of anabolic factors (TGF-β1, BMP-5), M2-macrophage predominance (CD206, CD163), and fibrofatty infiltration. Patient comorbidities (diabetes, vitamin D deficiency, smoking) amplified inflammatory and adipogenic signatures.

Conclusions: Cross-sectional human immunohistochemical evidence infers a stage-associated molecular trajectory: inflammatory-hypoxic stress with retained reparative capacity at earlier disease stages to fibrotic-adipogenic failure at later stages. This molecular framework may support future approaches to surgical decision-making and precision therapies.

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.

Background: Annular tears after lumbar discectomy can lead to reherniation and poor long-term outcomes. Traditional I-shaped sutures often fail to achieve sufficient closure strength at the annular defect. This study aimed to evaluate the clinical efficacy and safety of a novel V-shaped annular suture technique compared with the traditional I-shaped suture during unilateral biportal endoscopic lumbar discectomy.

Methods: A retrospective study was conducted on 50 patients who underwent single-level lumbar discectomy with annular repair between January 2022 and June 2024. Patients were divided into two groups based on the suture method: the I-shaped suture group (n = 27) and the V-shaped suture group (n = 23). Operative parameters (suture time, intraoperative blood loss), postoperative pain (visual analogue scale, VAS), functional recovery (Oswestry Disability Index, ODI), disc degeneration (Pfirrmann grade), complication rate, and recurrence rate were compared between groups. Statistical analyses were performed using independent-sample t tests or chi-square tests as appropriate.

Results: The mean follow-up duration was 14.5 ± 3.2 months. By the final follow-up, the recurrence rate was 11.1% (3/27) in the I-shaped group, while no recurrence was observed in the V-shaped group during follow-up. Both groups showed significant improvement in postoperative VAS and ODI scores compared with preoperative values (P < 0.05), but no significant intergroup difference was found (P > 0.05). Pfirrmann grades significantly improved postoperatively in both groups (P < 0.05), with no difference between groups (P > 0.05). According to the modified MacNab criteria, the excellent-to-good rate was higher in the V-shaped group (78.3%) than in the I-shaped group (70.4%), though not statistically significant (P = 0.199). No severe complications were observed in either group.

Conclusions: The V-shaped annular suture provides improved closure stability and may reduce the risk of postoperative recurrence compared with the traditional I-shaped suture. Although technically more demanding, this technique is safe and effective, showing promising clinical applicability for lumbar annular repair.

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.