Journal of Orthopaedic Surgery and Research最新文献

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.

Background: Medial Meniscus Posterior Root Tears (MMPRTs) are known to accelerate medial compartment knee osteoarthritis (OA). This study aimed to evaluate the short-term clinical outcomes of arthroscopic all-suture anchor (ASA) repair combined with high tibial osteotomy (HTO) for patients with medial compartment OA and MMPRTs, offering a potential new surgical approach for this condition.

Methods: This study retrospectively reviewed 36 patients undergoing arthroscopic ASA repair combined with HTO for medial compartment OA with MMPRTs at our institution between June 2022 and June 2023. All patients underwent second-look arthroscopy during hardware removal. We collected demographic data (age, sex, affected side, duration of symptoms, complications), preoperative and postoperative Tegner activity scores, Lysholm scores, International Knee Documentation Committee (IKDC) scores, and Knee injury and Osteoarthritis Outcome Scores (KOOS). Radiographic comparisons (pre- and post-op) included Kellgren-Lawrence (K-L) grading, hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), and posterior tibial slope (PTS). Medial meniscus extrusion rate (MMER) was also assessed. At second-look arthroscopy, the healing status of the medial meniscus posterior root was evaluated. Patients were subgrouped based on root healing status to examine correlations with clinical scores, MMER, K-L grade, and symptom duration.

Results: The cohort comprised 30 females (83.3%) and 6 males (16.7%), with a mean age of 59 years. Mean follow-up was 24.8 ± 2.4 months. Significant improvements were observed in all final scores: Lysholm (46.58 ± 16.04 to 79.08 ± 14.29), IKDC (37.08 ± 14.57 to 65.81 ± 12.33), KOOS total scores (116.50 ± 26.13 to 65.89 ± 15.50), and Tegner (1.00 ± 1.27 to 2.33 ± 1.15) (all P < 0.001). Subgroup analysis revealed no significant differences between healed and non-healed groups regarding Lysholm, IKDC, KOOS, Tegner scores, symptom duration, or K-L grade. No complications (infection, nonunion, neurovascular issues) occurred by final follow-up.

Conclusion: ASA repair combined with HTO provides significant short-term improvement in clinical outcomes for MMPRTs with medial compartment OA. However, meniscal root healing did not correlate with clinical improvement, suggesting mechanical realignment plays a primary role.

Background: Open reduction and internal fixation (ORIF) has been a long-established and accepted technique for the treatment of lateral malleolar fractures. However, minimally invasive percutaneous plate osteosynthesis (MIPPO) may be preferred in cases with compromised soft tissue conditions or in the presence of comorbidities. MIPPO is increasingly being used in the treatment of long bone fractures. The aim of this study was to compare the clinical, functional and radiological outcomes of the MIPPO technique for lateral malleolus fractures with those of ORIF.

Methods: This prospective randomized controlled study analysed patients who underwent surgery for lateral malleolus fractures treated with ORIF or MIPPO between the years 2022 and 2024. The study included patients with lateral malleolus fractures of Danis-Weber types B and C requiring surgical intervention. Postoperative pain, the American Orthopaedic Foot and Ankle Society (AOFAS) score, hospital stay, surgical time, fluoroscopy time, and radiological measurements were compared.

Results: The study included 68 patients (ORIF n = 34, MIPPO n = 34). The minimum follow-up for all the patients was 12 months and maximum was 24 months with a mean of 18,20 months postoperatively. The postoperative pain scores at 8 h (p = 0.001), 24 h (p < 0.001) and 2 weeks (p = 0.003) were lower in the MIPPO group. Pain scores were similar between the preoperative measurement and those observed at 4 weeks, 6 weeks, 3 months, 6 months and 1 year postoperatively. AOFAS scores were similar between both groups at 3 months, 6 months and 1 year postoperatively. Surgical time and the postoperative hospitalisation period were shorter in the MIPPO group (p < 0.001, p = 0.005). A higher level of fluoroscopy exposure was observed in the MIPPO group (p = 0.001). Similar results were obtained in radiological measurements between groups.

Conclusion: The MIPPO technique leads to lower pain scores in the short term, shorter surgery times, and earlier discharge. In the long term, it provides similar clinical, functional, and radiological results to those obtained with ORIF.

Background: The pericapsular nerve group (PENG) block has proven to be an effective strategy for postoperative pain management in total hip arthroplasty (THA). However, its implementation requires specialized equipment and expertise, which limits its reproducibility. The objective of this study was to describe the technique of direct visualization-guided PENG block (PENG-DV) and assess its outcomes for postoperative pain control.

Methods: A retrospective cohort study was conducted in patients who underwent THA through a direct anterior approach (DAA) and received the PENG-DV block as part of a standardized multimodal analgesia protocol. Demographic variables, pain score on the visual analogue scale (VAS), opioid consumption, muscle strength, and ambulation within the first 24 h were evaluated.

Results: Of the 128 patients identified, 112 were included in the analysis. The cohort was predominantly female (60.7%), with a mean age of 63 years. The median postoperative VAS score was 2 and 3 at 12 and 24 h respectively, increasing to 5 during physical therapy. By postoperative day one, 83.9% of patients ambulated, and most achieved muscle strength ≥ 3 for both hip flexion and knee extension. A total of 54.5% of patients required opioid rescue, with a mean morphine equivalent consumption of 10 mg within the first 24 h.

Conclusion: PENG-DV for THA via DAA appears to be a promising strategy for effective pain control in the immediate postoperative period, as part of a multimodal analgesic approach designed to reduce opioid consumption and promote early mobilization.

Objective: Surgical site infections (SSIs) particularly periprosthetic joint infection (PJI, a deep/organ-space infection) remain devastating after total hip arthroplasty (THA). Because routine systemic perioperative antibiotics are standard of care, we focused on the added value of intrawound (local) prophylaxis. We evaluated whether intrawound antibiotics, used in addition to standard systemic prophylaxis, reduce infection after THA and explored effects across surgery type (primary vs. revision).

Methods: We searched PubMed, Cochrane Library, ScienceDirect, EMBASE, CNKI, VIP, Wanfang, and CBM (January 2010 to final search) for cohort studies comparing intrawound antibiotic prophylaxis + standard systemic prophylaxis versus standard systemic prophylaxis alone. We systematically searched studies published since 2010 to include the most recent and relevant data, ensuring that the research included reflects modern surgical techniques, standardized reporting, and advancements in the use of intrawound antibiotics. Two reviewers independently screened, extracted data, and assessed risk of bias; meta-analysis used RevMan 5.3.

Results: Eight cohort studies (n = 16,939) met criteria. Heterogeneity for PJI was low (Chi² = 7.57, df = 7, P = 0.37; I² = 8%). Intrawound prophylaxis plus systemic prophylaxis was associated with lower PJI risk than systemic prophylaxis alone (OR = 0.42, 95% CI: 0.30-0.58, P < 0.00001). Subgroup analysis showed consistent benefit in both primary and revision THA (OR = 0.30, 95% CI: 0.20-0.47, P < 0.00001; I² = 0%). Superficial incisional SSI (skin/subcutaneous) showed no significant difference (OR = 0.41, 95% CI: 0.10-1.66, P = 0.92), and adverse events did not differ significantly (OR = 0.89, 95% CI: 0.45-1.78, P = 0.75). Funnel plots suggested possible publication bias.

Conclusion: There is limited evidence, with a possible risk of publication bias, suggesting that intrawound (local) antibiotic prophylaxis, when added to standard systemic antibiotics, may be associated with reduced postoperative PJI after THA across primary and revision procedures. Evidence for superficial SSI and safety remains limited by few contributing studies. Standardized, head-to-head randomized trials are needed to define optimal regimens (agent, dose, timing) and long-term safety (including antimicrobial resistance).