Journal of Orthopaedic Surgery and Research最新文献

Background: Osteoarthritis (OA) significantly impairs the quality of life of middle-aged and elderly individuals. MicroRNAs (miRNAs) are known to play key regulatory roles in OA progression.

Aims: To investigate the potential role mechanisms of miR-409-5p in OA.

Methods: This study enrolled 93 OA patients and 75 non-OA controls. The expression levels of miR-409-5p, DLST, and OA-related markers were measured using RT-qPCR or Western Blot. The targeting relationship between miR-409-5p and DLST was verified by dual luciferase reporter assays. Cell viability was assessed with the CCK-8 assay, and inflammatory cytokine concentrations were measured via ELISA.

Results: Serum miR-409-5p expression was higher in OA patients than in controls and showed good diagnostic value for OA. Inhibiting miR-409-5p suppressed IL-1β-induced viability in CHON-001 cells, promoted aggrecan expression, suppressed MMP13 expression, and reduced secretion of IL-6 and IL-8. MiR-409-5p directly targeted DLST, and their expression levels were negatively correlated. Knockdown of DLST abolished the beneficial effects of miR-409-5p inhibition on cell viability, extracellular matrix degradation, and inflammatory responses.

Conclusions: MiR-409-5p was highly expressed in OA and may promote disease progression by targeting DLST.

Background: The advent of osseointegrated prosthetic systems marks a significant milestone in the evolution of limb reconstruction and rehabilitation. Osseointegration implants are a direct skeletal interface for artificial limbs, introduced as bone-anchored limb prostheses that may improve many limitations of traditional socket-based prosthetics, such as discomfort, poor fit, skin irritation, and limited range of motion.

Main body: Since the discovery of the osseointegration phenomenon in 1940, several osseointegrated implant systems, such as OPRA, ILP, OPL, and ITAP, with varying biomechanical structures and surgical protocols, have been developed. Regardless of the system types, they have overall demonstrated better outcomes compared to socket-type prostheses. Although osseointegrated systems are not without complications, they are an optimum option if surgically and functionally possible for lower limb amputees, as they improve quality of life.

Short conclusion: This review provides a comparative analysis of current osseointegrated prosthetic systems for lower limb amputees, encompassing both commercially available devices and those under clinical investigation, with a focus on their biomechanical structures, surgical techniques, and reported clinical outcomes. It is hypothesized that these outcomes will continue to improve with newer designs and advancements.

Background: Restoring native hip offset is considered important for optimizing function following total hip arthroplasty (THA), yet the relationships between offset parameters and postoperative outcomes remain inconsistently reported. This study investigated the associations between femoral offset (FO), acetabular offset (AO), and global offset (GO) with functional mobility, hip abductor strength, and postoperative pain.

Methods: A total of 69 patients (mean age: 69.6 years) with unilateral THA were assessed at an average follow-up of 3.3 years. Offset parameters were measured radiographically and classified as decreased, restored, or increased relative to the contralateral hip. Functional outcomes were assessed using the Timed Up and Go (TUG) test and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Hip abductor strength was measured via manual dynamometry, and pain was evaluated using a visual analog scale (VAS).

Results: No significant associations were found between offset parameters and TUG or WOMAC scores. However, patients in the decreased GO group exhibited significantly reduced hip abductor strength in the operated limb, with this asymmetry persisting over time. Additionally, both FO and AO in the non-operated hip were significantly associated with VAS pain scores, and their combined effect appeared to amplify pain perception. These relationships also changed over time during the follow-up period.

Conclusions: While offset restoration did not relate to global functional tests such as TUG or WOMAC, patients with decreased global offset exhibited persistent abductor weakness, and contralateral offset parameters were associated with pain perception. These findings highlight the complexity of the relationship between offset and functional recovery and emphasize the importance of accurate offset restoration and bilateral biomechanical assessment in optimizing long-term outcomes following THA.

Purpose: To evaluate the clinical and radiographic results of a novel partial unicondylar arthroplasty (PUCA) using a three-dimensional-printed (3DP) porous tantalum prosthesis for treating focal osteochondral defects (FOCD) of the femoral condyle, in comparison with unicompartmental knee arthroplasty (UKA).

Methods: This exploratory-retrospective matched-cohort consecutively enrolled study involved 17 patients: 8 in Group A (PUCA with 3DP porous tantalum prosthesis) from a larger trial and 9 in Group B (UKA), matched by age, gender, and BMI. Participants, aged 18-60, had femoral condylar FOCD with complete clinical and imaging data; exclusions included knee instability and incomplete data. Follow-ups were at 6 weeks, 3, 6, 12 months, and annually. The primary outcome was the Hospital for Special Surgery (HSS) knee score, with secondary outcomes including visual analogue scale (VAS), time to full-weight-bearing walking (FWBK), knee injury and osteoarthritis outcome score (KOOS), Lysholm scores and range of motion (ROM). Prosthesis stability and Kellgren-Lawrence (KL) grading were assessed via radiograph, and postoperative complications were compared. Statistical analyses included the Mann-Whitney U test, independent-samples t test, and Fisher's Exact test.

Results: All patients averaged 49.6 years old at surgery with a mean follow-up of 49.6 months. No demographic or complication differences were found between groups, and no revisions were needed. Preoperative scores were similar (P > 0.05). Postoperatively, Group A demonstrated significantly greater improvements in KL grades (1.5 ± 0.5 vs. 2.5 ± 0.5, P = 0.006), VAS (1.3 ± 0.5 vs. 2.5 ± 0.5, P = 0.002), HSS (92.3 ± 1.8 vs. 87.4 ± 1.6, P = 0.000), KOOS (90.9 ± 1.6 vs. 88.3 ± 1.9, P = 0.009), Lysholm (91.4 ± 2.4 vs. 88.5 ± 1.9, P = 0.019), and ROM (133.1° ± 6.5° vs. 115.6° ± 4.0°, P = 0.000), except for FWBK (4.9 ± 0.8 vs. 5.3 ± 0.5 weeks, P = 0.189). However, only the difference in ROM met the minimum clinically important difference. All postoperative scores, except for ROM and KL, showed statistically significant improvement compared with preoperative values in both groups radiographs at final follow-up showed stable prostheses in both groups with no signs of loosening. The statistical power for postoperative HSS was 1.0 (G*Power, effect size = 2.89).

Conclusion: This initial study is the first to apply personalized PUCA with 3DP porous tantalum prostheses for FOCD, demonstrating promising early outcomes compared with UKA, such as delayed progression of osteoarthritis, effective pain relief, and improved knee function and quality of life. PUCA notably preserves more native tissue and adapts to individual defects, making it clinically feasible by offering a potentially better option for future FOCD management.

Purpose: To evaluate whether continuous barbed suturing improves postoperative pain, closure efficiency, and early functional outcomes compared to conventional interrupted suturing in primary total knee arthroplasty (TKA).

Methods: In this double-blinded randomised controlled trial, 143 patients undergoing primary TKA were assigned to continuous barbed (n = 72) or interrupted absorbable (n = 71) sutures for arthrotomy and subcutaneous closure. The primary endpoints were closure time and postoperative pain at 24 h; superiority testing was pre-specified only for VAS at 24 h (one-sided t-test, α = 0.025), whereas closure time was analysed two-sided (α = 0.05). Secondary outcomes included wound healing time, 6-month functional gain (Hospital for Special Surgery score), quality of life (EQ-5D), satisfaction, and complications.

Results: Continuous suturing significantly reduced closure times for both arthrotomy (4.2 ± 1.6 vs 6.5 ± 7.7 min; p < 0.001) and subcutaneous layers (4.8 ± 1.9 vs 5.6 ± 1.4 min; p < 0.001). Pain at 24 h was significantly lower in the continuous group (VAS 2.9 ± 2.1 vs 4.0 ± 2.1; p = 0.017). The continuous group also showed faster wound healing (22.3 vs 24.8 days; p = 0.012) and greater 6-month HSS improvement (24.5 vs 16.0 points; p = 0.040). No significant differences were observed in complication rates, satisfaction, or quality of life.

Conclusion: Continuous barbed suturing improves surgical efficiency, reduces early postoperative pain, accelerates wound healing, and enhances functional recovery without increasing complication rates. This is the first randomised trial to demonstrate superior functional recovery (HSS score) with barbed continuous closure over traditional interrupted techniques, supporting its broader adoption in primary TKA.

Level of evidence: Level I, randomised controlled trial.

Background: Previous studies have shown that let-7c-5p is significantly expressed at a lower level in the serum of fracture patients, suggesting that it may play a role in bone repair. Therefore, this study aims to explore how let-7c-5p regulates osteogenic differentiation in tibial fractures.

Methods: A total of 80 patients with tibial fractures and 83 healthy individuals were included in this study. The level of let-7c-5p in the serum were detected by RT-qPCR. Osteoblast cell line (MC3T3-E1) were cultured in vitro to induce osteogenic differentiation. RT-qPCR was used to detect the expression of let-7c-5p and osteogenic differentiation markers. The activity of alkaline phosphatase (ALP) was determined using an ALP assay kit. Dual-luciferase reporter gene assay and RNA immunoprecipitation were used to verify the targeting relationship between let-7c-5p and CDK8.

Results: In the early stage of tibial fractures, the level of let-7c-5p in the patient's serum was significantly lower than that of the control group, and as the healing processes progressed, its level gradually increased. In osteogenic induction, let-7c-5p, the activity of ALP, and the levels of osteogenic markers all increase. Increasing the level of let-7c-5p significantly enhanced the expression of osteogenic markers, while inhibiting its expression would weaken this effect. let-7c-5p directly targeted and negatively regulated the expression of cyclin-dependent kinase 8 (CDK8). Overexpression of CDK8 could reverse the osteogenic effect mediated by let-7c-5p.

Conclusion: During the healing process of tibial fractures, let-7c-5p promotes osteogenic differentiation by inhibiting CDK8, thereby accelerating fracture healing.

Excessive inflammation driven by macrophage phenotype imbalance is a key pathological barrier hindering neural repair after spinal cord injury (SCI). Here, methacryloyl gelatin hydrogel (GelMA) loaded with natural anti-inflammatory agent resveratrol (Res) was designed and synthesized. Scanning electron microscopy (SEM), x-ray diffraction (XRD), fourier-transform infrared spectroscopy (FT-IR), Ultraviolet (UV) and rheological characterization confirmed that Res-loaded GelMA hydrogel (Res@GelMA) was successfully synthesized. High-Performance Liquid Chromatography (HPLC) analysis demonstrated sustained Res release. CCK8 and cell adhesion experiments confirmed that Res@GelMA treatment did not affect the cell function of RAW264.7 and had good cell compatibility. Flow cytometry, Enzyme-Linked Immunosorbent Assay (ELISA) and western blot assays revealed that Res@GelMA treatment promoted RAW264.7 to M2 polarization, while reducing the levels of inflammatory factors (IL-1β, IL-6, TNF-α) and down-regulating the expression of IL-1R1/MyD88/TNFR1 inflammatory signaling proteins. Transcriptome sequencing combined with functional screening identified C-type lectin receptor Clec7a as a key target gene regulated by Res@GelMA. Importantly, knockdown of Clec7a and Res@GelMA were both anti-inflammatory, promoted M2 polarization, and blocked the activation of the TLR2/TLR4-p38 MAPK signaling axis. In the SCI mouse model, local implantation of Res@GelMA significantly improved tissue pathological damage and enhanced motor function recovery compared with free Res or blank GelMA. In addition, Res@GelMA achieved systemic anti-inflammation by downregulating the Clec7a-TLR-p38 pathway in the injured area and promoting M2 polarization. This study developed an anti-inflammatory hydrogel material that can regulate the phenotype of macrophages, laying a theoretical and technical foundation for the development of neural repair strategies targeting the inflammatory microenvironment.

Background: Screw cut-out remains a major mechanical complication after proximal femoral nailing (PFN) for intertrochanteric fractures. Traditional predictors such as tip-apex distance (TAD) and reduction quality do not account for individual femoral anatomy. This study aimed to determine whether deviation from the contralateral collodiaphyseal (CCD) angle (|Δ angle|) independently predicts screw cut-out after PFN.

Methods: A total of 354 patients (mean age 77.6 ± 12.0 years; 58% female) treated with PFN between 2015 and 2020 were retrospectively analyzed. Radiographic parameters included TAD and the absolute difference between postoperative and contralateral collodiaphyseal (CCD) angles (|Δ angle|), representing patient-specific alignment. Functional outcomes were assessed using the Harris Hip Score, Barthel Index, and time to full weight bearing. Univariate and multivariable logistic regression analyses were performed to identify independent predictors of screw cut-out.

Results: Screw cut-out occurred in 56 patients (15.8%) and was associated with larger TAD, greater |Δ angle| deviation, and poorer reduction quality (all p < 0.01). In multivariable analysis, TAD, |Δ angle|, and reduction quality independently predicted cut-out. Patients with cut-out exhibited lower functional scores and delayed weight bearing, indicating substantial impairment in postoperative recovery.

Conclusion: Patient-specific anatomical alignment, along with TAD and reduction quality, independently predicts screw cut-out. Deviations ≥ 9° from native CCD alignment increase mechanical failure risk and delay functional recovery.

Background: Understanding the microstructural basis of anterior cruciate ligament (ACL) mechanics is important for advancing reconstruction strategies and rehabilitation. Histological studies indicate that collagen and elastin are distributed in a region-specific manner within the ligament, but such heterogeneity has rarely been incorporated into computational models. Finite element (FE) simulations are widely applied in ligament biomechanics, yet their validation against clinically used tools such as the Lachman test with KT2000 arthrometry remains limited. This study aimed to investigate how regional collagen-elastin variations affect ligament mechanics, whether histology-informed models provide improved agreement with experimental data, and how closely such models align with clinical assessment.

Methods: Porcine ACLs were selected as surrogates for the human ligament due to their structural similarity. Regional collagen and elastin distributions were quantified using histological imaging and integrated into a crosslinked collagen-elastin fiber network model. FE analyses were performed under tensile, shear, and torsional loading. Model predictions were compared with uniaxial tensile testing of ACL specimens and with force-displacement curves obtained from KT2000 arthrometry during Lachman testing. Simulations were conducted at both millimeter and micrometer scales to assess multi-scale applicability.

Results: The histology-informed fiber model reproduced ligament stiffness more consistently than a uniform sheet representation, particularly under tensile loading. Its stiffness characteristics showed partial agreement with experimental uniaxial data and with KT2000 arthrometer measurements in normal and injured knees. Comparable outcomes across different model scales suggested that the framework is adaptable to multi-scale analyses.

Conclusion: This study highlights the contribution of region-specific elastin distribution to ACL mechanical behavior and demonstrates that histology-informed FE models may improve biological relevance compared with uniform representations. While still preliminary, the partial alignment with both experimental and clinical measurements suggests that such models may provide a useful foundation for bridging microstructural mechanics and joint-level function. With further refinement, this approach could support individualized planning, rehabilitation monitoring, and the design of biomimetic grafts.

Introduction: The critical shoulder angle (CSA), a radiographic measure reflecting the relationship between glenoid inclination and lateral acromial coverage, has garnered increased attention for its potential influence on shoulder arthroplasty outcomes. Despite its significance, the impact of CSA on shoulder arthroplasty outcomes remains uncertain, as conflicting evidence persists in the literature. The purpose of this systematic review was to conduct a comprehensive analysis of the available literature, focusing on the functional outcomes and complications associated with CSA in the context of shoulder arthroplasty.

Materials and methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.The English-language articles were screened from databases such as PubMed, EMBASE, the Web of Science, and the Cochrane Library Database. Studies involving patients who underwent shoulder arthroplasty and evaluated the influence of CSA on complications, clinical scores, and range of motion (ROM) were included. The data were independently extracted by two authors, and evidence quality and bias risk were assessed collectively.

Results: Nine studies were included-six cohort studies, one case series, and two case-control studies. When a meta-analysis was not conducted, a consistent trend emerged. A higher CSA was linked to an increased risk of revision surgery after shoulder arthroplasty, primarily due to complications such as prosthetic loosening, glenoid lucency, and secondary rotator cuff failure. However, no substantial correlation was found between the CSA and postoperative clinical score or ROM.

Conclusions: A higher CSA correlates with an increased revision rate following shoulder arthroplasty, primarily due to complications such as prosthetic loosening. However, the CSA was not significantly correlated with postoperative clinical score or ROM. This finding underscores the value of the CSA as a predictive factor for revision risk while emphasizing its limited impact on clinical outcomes and shoulder joint ROM.

Level of evidence: Level IV; Systematic Review.