Journal of Orthopaedic Surgery and Research最新文献

Background: The optimal surgical approach for total hip arthroplasty (THA) remains a subject of ongoing debate. Posterior, direct lateral, and direct anterior techniques differ in their soft-tissue handling, complication patterns, and applicability in complex reconstruction. This systematic review synthesizes contemporary evidence comparing functional outcomes, perioperative complications, and revision suitability across major THA approaches.

Methods: A systematic search of PubMed, Scopus, and Web of Science was conducted according to PRISMA guidelines. Eligible studies directly compared at least two THA approaches, reported clinical or functional outcomes with ≥ 12 months of follow-up, and were published between 2015 and 2025. Data were extracted on functional scores, early recovery parameters, dislocation rates, nerve injury profiles, intraoperative complications, and revision-specific considerations. Due to heterogeneity in outcome definitions, follow-up intervals, and incomplete reporting of numerical outcome data, a formal quantitative meta-analysis was not feasible. Therefore, the review provides a structured narrative synthesis rather than pooled effect estimates.

Results: Across comparative studies, the direct anterior approach (DAA) consistently demonstrated faster early functional recovery and reduced short-term pain compared with the posterior approach, although long-term functional outcomes were similar between approaches. Anterior-based approaches generally showed lower dislocation rates, while the direct lateral approach (DLA) provided intrinsic stability but was associated with a higher incidence of transient abductor weakness. Complication patterns were approach-specific: lateral femoral cutaneous nerve symptoms occurred predominantly with DAA, superior gluteal nerve irritation with DLA, and sciatic nerve palsy was rare and primarily associated with posterior THA. In revision and complex cases, the posterior approach remained favored due to its extensile exposure and ease of acetabular and femoral access.

Conclusions: All major surgical approaches for THA can achieve excellent long-term outcomes when performed by experienced surgeons. The DAA offers advantages in early recovery, whereas the posterior approach remains the most versatile for complex or revision arthroplasty. Selection of surgical approach should be individualized based on patient anatomy, surgeon expertise, and reconstructive requirements.

Trial registration: Not applicable. This study is a retrospective systematic review. The protocol was not registered in PROSPERO because data extraction had begun before submission, and retrospective registration is not permitted by the registry.

Background: The demand for revision hip and knee arthroplasty (rTHA/rTKA) is increasing, while they continue to be associated with greater perioperative risks, higher resource demands, and greater variability in outcomes compared with primary procedures. Identifying precise risk factors is essential for effective perioperative management and resource planning.

Methods: A retrospective analysis of 2,123 revision total hip (rTHA, n = 1,301) and knee arthroplasties (rTKA, n = 822) performed from 2010 to 2019 at a tertiary German centre was conducted. Adverse events (AE), length of hospital stay (LOS), and predictors including age, Elixhauser Comorbidity Index (EI), joint type, and indication were analysed using multivariate regression models.

Results: The overall AE rate was 13.1%, significantly higher in rTHA than in rTKA (12.6% vs. 8.8%; p = 0.008), particularly for infections and mechanical complications. Mean LOS was 19 ± 14 days. Infection, age, EI, joint type, dislocation, and periprosthetic fracture independently predicted AE and LOS. Infection was the strongest predictor overall (AE: OR 5.4; LOS: Coefficient 1.6), with periprosthetic fractures being highly predictive in rTKA (OR 9.8).

Conclusions: Infection (in all revisions), periprosthetic fractures (in rTKA), advanced age, and high comorbidity burden were critical determinants of perioperative adverse events and hospital utilisation. Focused perioperative care strategies targeting these risk groups are essential to mitigate adverse outcomes and optimise healthcare resources.

Background: Due to the obscuration by the sternum, trachea, and major blood vessels, the anterior surgical approach for cervicothoracic junction disc herniation (CTJDH) is extremely challenging. Delta large-channel endoscopy and unilateral biportal endoscopy (UBE) provide posterior decompression and have demonstrated promising clinical potential. This prospective randomized controlled study aims to compare the clinical outcomes of Delta and UBE endoscopic surgeries.

Methods: A total of 63 patients were randomly assigned to either the Delta group (n = 32) or the UBE group (n = 31). The primary outcomes were the Neck Disability Index (NDI) and intraoperative blood loss (IBL). Secondary outcomes included VAS, JOA scores, modified MacNab criteria, operative time, hospital stay duration, perioperative complications, and radiographic parameters.

Results: During the follow-up period, 62 patients (98.4%) completed the 6-month assessment. The Delta group consistently demonstrated lower NDI scores than the UBE group. Significant differences were observed at postoperative day 14 (p = 0.040) and one month (p = 0.035), favoring the Delta technique. Intraoperative blood loss was significantly lower in the Delta group than in the UBE group (p < 0.001). At postoperative day 3 (p = 0.037), day 7 (p = 0.034), day 14 (p = 0.041), and 1 month (p = 0.027), neck VAS scores were lower in the Delta group. Operative time was shorter in the UBE group (p < 0.001). Both groups showed significant postoperative increases in the C2-C7 Cobb angle (p < 0.001) and reductions in cervical sagittal vertical axis (cSVA) (p < 0.05). Delta group patients with osteophytes had consistently higher NDI scores than those without osteophytes.

Conclusion: Both surgical techniques demonstrated favorable safety profiles and clinical efficacy in the treatment of CTJDH. Compared with UBE, the Delta large-channel endoscopic approach resulted in less intraoperative blood loss and faster postoperative recovery, although it required a longer operative time. For patients with CTJDH accompanied by osteophytes or bony overgrowth, UBE provided equally satisfactory outcomes, whereas the Delta technique showed relatively poorer results in such cases. Therefore, the choice of surgical approach should be individualized based on each patient's anatomical characteristics and clinical presentation. Trial registration Name of the registry: Chinese Clinical Trial Registry chictr.org.cn. Unique Identifying number or registration ID: ChiCTR2500097522.

Background: Chronic lateral ankle instability (CLAI) is a common condition caused by recurrent ankle sprains, leading to persistent pain and functional impairment. Surgical treatments, including the modified Broström repair and lateral ligament augmentation, aim to restore stability and function. This meta-analysis compares the outcomes of these two interventions, focusing on talar tilt angle (TTA), anterior talar translation (ATT), functional scores, and adverse event incidence.

Methos: In this meta-analysis, we searched PubMed, Embase, Cochrane Library, CNKI, Wanfang, CQVIP, and CBM databases from their inception to Dec 2024. We included studies comparing lateral ligament augmentation with modified Broström repair in treating CLAI, excluding animal studies, reviews, and publications with incomplete data. Data were analyzed using Review Manager 5.3.

Results: Eight RCT studies with a total of 425 patients were included. The results showed that lateral ligament augmentation significantly improved both TTA and ATT compared to modified Broström repair, indicating better mechanical stability. Functional outcomes were also better in the augmentation group as measured by FAOS, though no significant differences were found in the FAAM scores. The incidence of adverse events was similar between the two interventions.

Conclusion: Lateral ligament augmentation demonstrates superior mechanical stability and functional outcomes compared to the modified Broström repair in treating CLAI. However, both procedures show similar rates of adverse events, and further high-quality studies are needed to confirm these findings.

Background: Osteoporotic fractures (OPF) cause pain and trigger physical and mental health problems for patients. However, the underlying mechanism of OPF remains unclear. This study aims to investigate the diagnostic value and inhibitory effect on fracture healing of miR-204 in OPF.

Methods: A total of 104 osteoporosis patients and 119 OPF patients were included from the clinic. The RT-qPCR was performed to detect serum miR-204 level. The ROC curves were plotted based on miR-204 expression. Correlations between miR-204 and clinical factors were analyzed by the chi-square test in the OPF group. Independent risk factors were analyzed by multivariate logistic regression. The effect of miR-204 on fracture healing was explored in vitro experiments on BMSCs cells. The expression of miR-204 and TGF-β1 was assayed by the RT-qPCR in BMSCs transfected with miR-204 mimic NC, mimic, inhibitor NC, and inhibitor. The CCK-8 was applied to detect cell proliferation.

Results: Serum miR-204 level was significantly increased in the OPF group. The ROC curve confirmed the diagnostic value of miR-204 for OPF. The levels of Ca²⁺, β-CTX, 25(OH)D3, and T-score were correlated with miR-204 expression. The levels of Ca²⁺, miR-204, and T-score were identified as risk factors for OPF. miR-204 overexpression inhibited the proliferation of BMSCs, reduced the expression of osteogenic differentiation factors (ALP and BSP), and decreased the expression of factors (TGF-β1 and BMP) that promote fracture healing.

Conclusion: Elevating miR-204 promotes OPF development and impairs BMSC-mediated osteogenic differentiation and repair of fractures, warranting further in vivo validation. Inhibition of miR-204 may enhance osteogenic differentiation and fracture healing, representing a potential avenue for future therapeutic investigation in OPF.

Background: The follow-up scales following total knee arthroplasty (TKA) are numerous and complex, which may adversely affect completion rates. The growing popularity of rehabilitation applications facilitates the collection of patient information at any time. However, no efforts have been made to leverage this capability to enhance follow-up scales.

Objective: This study aimed to develop a novel mode of scale follow-up utilizing rehabilitation applications. The completion rate of this new mode was assessed, and the differences in assessment results between the two methods at various time points were analyzed comparatively.

Methods: In this prospective study, a total of 120 patients who underwent total knee arthroplasty (TKA) were enrolled using the Vital Health app. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Knee Society Score (KSS) scales were combined to create a set of 31 questions. Four to five questions were sent to patients daily via the app, and patients responded during interactive question-and-answer sessions. WOMAC and KSS scores were aggregated weekly. During the 6-week and 12-week outpatient follow-ups, the complete WOMAC and KSS questionnaires were administered, with all questions answered in a single session.

Results: The completion rate for the new follow-up mode at both 6 weeks and 12 weeks post-surgery was 100%. There was no significant difference in the evaluation scores of patients following TKA surgery between the new mode and conventional follow-up methods. Both the Interclass Correlation Coefficient (ICC) and the Bland-Altman plot demonstrated a strong consistency in the assessment scores between the two follow-up strategies.

Conclusions: The new survey mode, based on the rehabilitation app, demonstrated a high level of consistency with the conventional mode of scale investigation regarding assessment scores. This innovative approach has the potential to replace the traditional scale. Furthermore, the new mode significantly reduces the response burden on patients while enhancing the completion rate of follow-up assessments.

Objective: The Closed Flowing Vacuum-Assisted Technique (CFVAT) is an innovative approach achieving continuous irrigation within a sealed wound environment, which enables active fluid circulation and establishes an efficient flowing-drainage mode under negative pressure. This study aims to conduct the first evaluation comparing the clinical outcomes of CFVAT versus the traditional Vacuum Sealing Drainage (VSD) technique in the management of early (≤ 6 weeks) fracture-related infection (FRI) involving internal fixation and classified as Cierny-Mader type II.

Methods: A retrospective study was conducted on 33 patients with early FRI (≤ 6 weeks, Cierny-Mader II) following internal fixation between 2021 and 2024. All patients underwent debridement with retention of internal fixation. The study group (n = 13) received CFVAT, while the control group (n = 20) received VSD. Patient demographics, fracture site, time from initial surgery to infection, inflammatory markers, number of required surgeries, total treatment duration, and costs were compared.

Results: The primary healing rate was 92.3% in the CFVAT group and 60% in the VSD group. The one-year long-term healing rates were 92.3% and 90%, respectively. The CFVAT group demonstrated advantages in the number of surgeries, treatment duration, and overall cost (P < 0.05).

Conclusion: For a narrow clinical scenario-specifically early FRI (≤ 6 weeks) with retained internal fixation and Cierny-Mader type II anatomy-CFVAT may yield better outcomes than VSD in selected process and cost endpoints. These findings suggest that CFVAT has the potential to achieve wound closure after initial debridement while controlling infection. However, VSD remains a standard adjuvant therapy in FRI care, and the superiority of CFVAT requires validation through prospective randomized controlled trials.

Clinical trial number: Not applicable.

Background: Nel-like molecule-1 (Nell-1) could prevent the damage of cartilage in osteoarthritis (OA), including temporomandibular joint osteoarthritis (TMJOA), though, the definite mechanism of the process is unclear. Fibrocartilage stem cells (FCSCs) were discovered in the temporomandibular joint (TMJ), and were associated with the TMJ health and disease. However, little information is available on the effect of Nell-1 on FCSCs fate in TMJOA progression.

Methods: In this study, TMJOA was induced in rabbits through collagenase injection. 8 weeks after injection, the left and right joints of the rabbits were injected with AAV9-CMV-Nell-1 and AAV9 vector virus supernatant respectively. FCSCs were isolated, cultured, and transfected with recombinant AdNell-1. Histology staining, immunofluorescence staining, micro-CT, qRT-PCR and western blot were applied to detect the condition of FCSCs and condyles in vitro and in vivo.

Results: In the collagenase injection group, we observed histological changes consistent with OA, meanwhile, the expression of Nell-1 was decreased, but Indian hedgehog (Ihh) and Sonic hedgehog (Shh) were significantly elevated in FCSCs and condylar cartilage. Further in vitro and in vivo analyses revealed that Nell-1 markedly reduced Ihh and Shh. In addition, Nell-1 induced the chondrogenic differentiation of FCSCs by stimulating the expression of Collagen II, Aggrecan and Sox-9.

Conclusion: Nell-1 leads to improved chondrogenic capacity of FCSCs in TMJOA and demonstrated an inhibitory effect on Hh signal transduction while concurrently facilitating the process of cartilage remodeling. Collectively, Nell-1 may be a promising drug candidate for the treatment of TMJOA.

Objective: The primary purpose of this study was to determine whether open reduction and internal fixation (ORIF) utilizing parallel or orthogonal dual plating resulted in improved function, as measured by the Mayo Elbow Performance Score (MEPS). Additionally, this study investigated whether union time was influenced by the method of fixation.

Methods: A systematic review and pooled analysis were conducted utilizing five databases to search for articles examining orthogonal and parallel dual plating methods for the treatment of distal humerus fractures. Statistical analysis was conducted utilizing IBM SPSS Statistics for Windows, version 29. Included studies were randomized controlled trials and prospective cohort studies. Outcomes of interest were the Mayo Elbow Performance Score (MEPS) and fracture union time.

Results: MEPS were assessed across six studies via pooled analysis. The orthogonal plating group included five studies with 152 participants. MEPS was evaluated at 6, 12, and 24 months, yielding scores of 75.35 ± 3.18, 88.11 ± 0.18, and 85.10 ± 0.00, respectively. MEPS for the parallel plating group were assessed across four studies containing 176 participants at 6, 12, and 24 months postoperatively. The analysis yielded scores of 78.73 ± 0.00, 93.61 ± 0.00, and 88.745 ± 0.92, respectively. Union time was assessed across five studies. Pooled analysis for the orthogonal plating group across four studies (n = 89 participants) revealed a union time of 22.96 ± 5.05 weeks. Pooled analysis for the parallel plating group across four studies (n = 100 participants) revealed a union time of 19.59 ± 6.08 weeks.

Conclusion: A comparative pooled analysis of orthogonal plate repair versus parallel plate repair for distal humerus fractures revealed that parallel fixation provided superior MEPS scores across all time points and achieved fracture union approximately three weeks earlier than the orthogonal group.