Journal of orthopaedics最新文献

{"title":"mModPoEs: Multimodal posture estimation and feedback-driven correction of load-bearing human movements using wearable sensors and computer vision","authors":"P. Gokul Thilaak ,&nbsp;G. Malathi ,&nbsp;D. Thiagarajan","doi":"10.1016/j.jor.2025.12.024","DOIUrl":"10.1016/j.jor.2025.12.024","url":null,"abstract":"<div><h3>Objective</h3><div>Improper spinal posture during activities of daily living such as seated posture, upright stance, and ambulation, particularly under load-bearing conditions, has been recognized as a major contributor to musculoskeletal disorders, including chronic back pain and disc degeneration. This study presents a multimodal posture estimation and feedback framework that integrates wearable-sensor data and computer-vision analysis to support spinal health.</div></div><div><h3>Methods</h3><div>The system integrates data from Inertial Measurement Units (IMUs) and flex sensors to quantify postural angles which acts as sensor data, while concurrently extracting key visual features from multi-view (frontal and lateral) video recordings and photographs using the MediaPipe framework. A control group was formed under the guidance of physiotherapist and the data was collected at Tagore College of Physiotherapy located in Chennai, India. This control group comprises of 40 subjects, selected without gender bias, aged between 19 and 22 years. The analysis on multimodal data incorporated specifically, logistic regression (LR), decision tree (DT), random forest (RF), KNN and SVM.</div></div><div><h3>Results</h3><div>Among all evaluated models, the RF algorithm, showed effective performance and balance in all activities of both male and female subjects. The dataset used was a composite collection of both genders, resulting in accuracy rates of 75 %, 95 % and 63 % for sitting, standing, and walking, respectively.</div></div><div><h3>Conclusion</h3><div>The findings highlight that integrating wearable and visual modalities enhances posture classification accuracy. While the findings are preliminary, they establish a methodological foundation for future development of multimodal, feedback-based posture assessment systems.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 101-109"},"PeriodicalIF":1.5,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145734779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Femoral neck system vs conventional fixation: Long-term outcomes from a single-center study","authors":"Grégoire Châtelier ,&nbsp;Romain Huguet ,&nbsp;Igor Benezis ,&nbsp;Johan Lebecque","doi":"10.1016/j.jor.2025.12.021","DOIUrl":"10.1016/j.jor.2025.12.021","url":null,"abstract":"<div><h3>Background</h3><div>The Femoral Neck System (FNS) is a minimally invasive fixation device for femoral neck fractures, but its comparative long-term performance versus conventional fixation remains debated.</div></div><div><h3>Materials and methods</h3><div>In this single-center retrospective study (Jan 2020–Oct 2022) all patients treated surgically for femoral neck fractures were included. Primary outcomes were operative time, peri-operative bleeding, fixation failure, avascular necrosis, reoperation, mortality, and autonomy using Parker score. A multivariable logistic regression assessed risk of postoperative loss of autonomy. FNS results were compared to a large multicenter series from the literature.</div></div><div><h3>Resultsa</h3><div>total of 143 patients (mean age 78.7 ± 13.8 years; 58.7 % women) were included and grouped by implant: 31 FNS, 62 triple cannulated screws, 50 dynamic hip screw (DHS). Operative time differed across groups with DHS being the longest. Peri-operative bleeding, fixation failure, infection, and mortality did not differ significantly between groups. In adjusted analysis, each additional year of age increased the risk of postoperative loss of autonomy by 5.1 % independently of the surgical system. Mean follow-up was approximately two years enabling detection of later complications.</div></div><div><h3>Conclusion</h3><div>FNS provided outcomes broadly comparable to conventional fixation with shorter operative time than DHS. Given the older, more displaced case-mix and longer follow-up, cautious interpretation is warranted. Age emerged as the strongest predictor of functional outcome.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 95-100"},"PeriodicalIF":1.5,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145734777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The management of proximal periprosthetic femoral fractures: Is open reduction and internal fixation a solution for all fractures treated surgically around a polished tapered stem?","authors":"Emily Seymour-Jackson ,&nbsp;Rohan Ramasubbu ,&nbsp;James Doonan ,&nbsp;Kevin Bryceland ,&nbsp;Andrew Stark","doi":"10.1016/j.jor.2025.12.009","DOIUrl":"10.1016/j.jor.2025.12.009","url":null,"abstract":"<div><h3>Aims &amp; objectives</h3><div>The aim of this study is to assess whether open reduction and internal fixation (ORIF) is appropriate for the surgical management of all proximal femoral periprosthetic fractures involving a polished tapered stem.</div></div><div><h3>Methods</h3><div>This retrospective case series assessed the five year follow-up of 105 consecutive patients treated with ORIF following proximal femoral periprosthetic fractures with minimum 12-month follow-up. Primary outcome measure of this study was union at one year following surgery and secondary outcome measures included reoperation, post-operative infection and dislocation.</div></div><div><h3>Results</h3><div>105 patients had periprosthetic fractures over 10 years (B1 n = 31; B2 n = 64; and C n = 10). Union within one year of periprosthetic fractures were achieved in 76.7 % of short oblique/transverse fractures and 100 % of long spiral fractures. The fracture pattern and fracture location with B1, B2 and C type were disturbed in a statistically significant pattern. Importantly, each periprosthetic fractures that did not achieve union by one year resulted in plate breakage which resulted in further major revision surgery.</div></div><div><h3>Conclusions</h3><div>We advocate that ORIF should be attempted in all proximal femoral periprosthetic fractures as only a small number of patients develop non-union and go on to require further surgery. Short oblique fractures at the tip of the stem are higher risk for non-union and dual plating could be considered in these cases.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 110-115"},"PeriodicalIF":1.5,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145734865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel hematological indices SII and NLR: Aiding diagnosis, differentiating subtypes, and reflecting disease activity in juvenile idiopathic arthritis","authors":"XiaoLin Luo ,&nbsp;JianWei Hu ,&nbsp;ShengPing Tang ,&nbsp;ChenYang Li ,&nbsp;ShiJie Liao ,&nbsp;XiaoFei Ding","doi":"10.1016/j.jor.2025.12.014","DOIUrl":"10.1016/j.jor.2025.12.014","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to evaluate the clinical utility of novel hematological indices, particularly the systemic immune-inflammation index (SII) and neutrophil-to-lymphocyte ratio (NLR) in diagnosing juvenile idiopathic arthritis (JIA), differentiating its subtypes, and assessing disease activity.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of 185 JIA patients and 124 healthy controls. Comprehensive clinical and hematological parameters were collected, and immune-inflammatory ratios were calculated. Participants were stratified by JIA subtype according to ILAR criteria and by disease activity based on Wallace criteria. Statistical analyses compared these indices across groups and evaluated their correlations with conventional markers and the JADAS-27 score. Subgroup analyses further assessed their diagnostic potential in patients with normal erythrocyte sedimentation rate (ESR)/C-reactive protein (CRP).</div></div><div><h3>Results</h3><div>SII, NLR, platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) were significantly elevated in JIA patients compared to controls, with AUC values &gt; 0.6 for JIA identification. Notably, systemic JIA (sJIA) showed distinct inflammatory profiles, with significantly higher SII, MLR, PLR, and NLR, and lower monocyte-to-neutrophil ratio (MNR) and platelet-to-neutrophil ratio (PNR), compared to other subtypes. Active JIA patients exhibited elevated SII and NLR and reduced MNR relative to those with inactive disease. SII and NLR demonstrated moderate positive correlations with ESR, CRP, and JADAS-27, whereas MNR was negatively correlated. Although subgroup analyses in patients with normal ESR/CRP did not reach statistical significance, likely due to sample size limitations—the consistent trends support the potential supplementary role of these indices.</div></div><div><h3>Conclusion</h3><div>This study establishes SII and NLR as accessible and informative biomarkers for JIA. They effectively differentiate systemic JIA from other subtypes, reflect disease activity, and correlate with established activity scores. Their low cost and routine availability position them as valuable adjuncts in the diagnostic and monitoring workflow for JIA, particularly when traditional markers are ambiguous or unavailable.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 80-85"},"PeriodicalIF":1.5,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145734838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Greening orthopaedic surgery: Carbon footprint, waste generation, environmental impact, and mitigation strategies","authors":"Anil Regmi ,&nbsp;Surakshya Baral ,&nbsp;Abdus Sami ,&nbsp;Vijay Kumar Jain","doi":"10.1016/j.jor.2025.12.018","DOIUrl":"10.1016/j.jor.2025.12.018","url":null,"abstract":"<div><h3>Background</h3><div>Orthopaedic surgery is among the most resource-intensive areas of healthcare, generating substantial waste, energy consumption, and carbon emissions. Operating rooms contribute disproportionately to a hospital's environmental footprint due to their high energy loads, extensive use of consumables, and complex supply chains. Despite rising global attention to sustainable healthcare, evidence specific to orthopaedic practice remains fragmented.</div></div><div><h3>Objectives</h3><div>This narrative review synthesises current evidence on the environmental impact of orthopaedic surgery, identifies major contributors to waste and carbon footprint, and outlines effective mitigation strategies applicable at institutional, clinical, and policy levels.</div></div><div><h3>Methods</h3><div>A structured search was conducted using MeSH and keyword combinations related to carbon footprint, sustainability, and orthopaedic surgery. Eligible studies included original research, reviews, and institutional reports assessing waste generation, CO₂e emissions, energy use, or sustainability interventions. Two reviewers independently screened studies and performed thematic synthesis.</div></div><div><h3>Results</h3><div>Orthopaedic procedures generate 4–10 kg of waste per case, with plastics comprising nearly half. Life-cycle assessments report procedure-level emissions ranging from 28 to &gt;150 kg CO₂e, highest in arthroplasty and spine surgery. Major footprint contributors include OR energy use, single-use consumables, implant manufacturing, sterilisation, and anaesthetic gases. Evidence demonstrates that tray optimisation, reusable systems, improved waste segregation, low-flow anaesthesia, and environmentally preferable procurement can reduce environmental impact by 20–70 %. However, methodological heterogeneity and limited data from low-income settings hinder the benchmarking process.</div></div><div><h3>Conclusion</h3><div>Orthopaedic surgery carries a significant environmental burden; however, multiple evidence-based strategies can substantially reduce its environmental footprint. Standardised assessment methods and broader global data are essential to guide sustainable surgical practice.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 86-94"},"PeriodicalIF":1.5,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145734791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Platelet rich plasma augmentation for meniscus repair reduces failure but not complication rates or outcomes: A systematic review and meta-analysis","authors":"Udit Dave ,&nbsp;Jared Rubin ,&nbsp;Nicole Chang ,&nbsp;Nurudeen Alli ,&nbsp;Myles Atkins ,&nbsp;Thomas E. Moran ,&nbsp;Andrew S. Bi ,&nbsp;Monique Haynes ,&nbsp;Nikhil N. Verma ,&nbsp;Jorge Chahla","doi":"10.1016/j.jor.2025.12.015","DOIUrl":"10.1016/j.jor.2025.12.015","url":null,"abstract":"<div><h3>Introduction</h3><div>Platelet rich plasma (PRP) has been shown to promote healing, especially in areas with poor vascularity, such as the inner third of the meniscus. The purpose of this systematic review and meta-analysis was to compare post-operative outcomes and complications among patients who have undergone meniscus repair with and without PRP augmentation.</div></div><div><h3>Methods</h3><div>In accordance with PRISMA guidelines, PubMed, Embase, and Cochrane Library databases were searched in December 2024 for studies published after 2004. Studies met inclusion criteria if they included patients who underwent meniscal repair without concomitant procedures and were comparative studies evaluating outcomes in patients who underwent meniscal repair with and without PRP treatment. Studies not written in English or not directly comparing patients undergoing meniscus repair with and without PRP were excluded. Two-proportion z-tests were performed to assess for a statistically significant difference in the proportion of each complication within the PRP cohort versus the control cohort. Risk of bias was assessed with the Cochrane Risk of Bias 2 tool for RCTs and MINORS criteria for non-RCTs.</div></div><div><h3>Results</h3><div>The initial search identified 862 studies, of which 8 were included, each with sufficiently low risk of bias. A total of 354 patients were included with 180 patients in the PRP cohort and 174 patients in the control cohort. Mean age across cohorts ranged from 26.0 to 70.0 years. Mean follow-up times ranged from 3.0 to 48.0 months. Similar mean values were reported in patient-reported outcomes including Lysholm, VAS, IKDC, and WOMAC scores across both cohorts. Patients undergoing meniscus repair with PRP augmentation had significantly fewer re-tears/failures (18.2 %) than patients undergoing repair without PRP augmentation (30.5 %), (p = 0.0188); however, there was no significant difference in rate of re-operations, wound complications, or infection between the two cohorts.</div></div><div><h3>Conclusions</h3><div>While significant heterogeneity in study methodology exists within the comparative literature, limited evidence exists suggesting a significantly decreased rate of re-tear or failure in patients undergoing meniscus repair with PRP augmentation versus without PRP augmentation.</div></div><div><h3>Level of evidence</h3><div>Level III, Systematic Review and Meta-Analysis of Level I-III studies.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 62-71"},"PeriodicalIF":1.5,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145734781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Classical non-traumatic osteonecrosis versus osteonecrosis of the jaw: Distinct manifestations of a shared pathophysiological spectrum","authors":"Edward Y. Cheng,&nbsp;Alireza Mirzaei","doi":"10.1016/j.jor.2025.12.017","DOIUrl":"10.1016/j.jor.2025.12.017","url":null,"abstract":"<div><h3>Introduction</h3><div>Classical non-traumatic osteonecrosis (NTON)—most commonly affecting the femoral head—and osteonecrosis of the jaw (ONJ) represent two major forms of osteonecrosis. Ongoing debate persists regarding whether these conditions reflect manifestations of a shared underlying pathology or represent distinct clinical entities.</div></div><div><h3>Hypothesis</h3><div>We hypothesize that although NTON and ONJ share core mechanisms, their initiating events, osteoclastic responses, and reactions to anti-resorptive therapy differ sufficiently.</div></div><div><h3>Methods</h3><div>A comprehensive literature review was conducted using PubMed, Scopus, Web of Science, and the Cochrane Library. Evidence was synthesized regarding anatomical and mechanical differences, etiologic factors, pathogenic mechanisms, and therapeutic responses in NTON and ONJ.</div></div><div><h3>Results</h3><div>In NTON, compromised vascular supply is widely recognized as the primary initiating event, leading to hypoxia, increased osteoclastogenesis, and excessive bone resorption. In ONJ, impaired blood flow occurs secondarily, typically following dental trauma, infection, or anti-resorptive therapy. While both conditions involve disturbed bone homeostasis, NTON is characterized by heightened osteoclast activity, whereas ONJ features suppressed osteoclast function. This contrast results in divergent pharmacologic behavior: bisphosphonates and denosumab may be protective during the resorptive stage of NTON but significantly increase the risk of ONJ.</div></div><div><h3>Conclusion</h3><div>Although NTON and ONJ share fundamental disruptions in bone homeostasis and vascular regulation, their distinct initiating events, osteoclastic dynamics, and responses to anti-resorptive therapy suggest they are best viewed as separate clinical entities rather than variations of a single disease.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 55-61"},"PeriodicalIF":1.5,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145734780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridge Enhanced ACL Repair (BEAR) versus Bone Patella Tendon Bone (BPTB) ACL reconstruction among young athletes: A systematic review and meta-analysis","authors":"Kunal P. Shah ,&nbsp;Timothy Gelatt ,&nbsp;Kunal Damaraju ,&nbsp;Jonathan Elias ,&nbsp;Sameer Shah ,&nbsp;Elizabeth Ford ,&nbsp;Sean McMillan","doi":"10.1016/j.jor.2025.12.008","DOIUrl":"10.1016/j.jor.2025.12.008","url":null,"abstract":"<div><h3>Introduction</h3><div>Anterior cruciate ligament (ACL) tears are among the leading causes of injuries among young athletes and are traditionally treated with surgical intervention. Recently, the Bridge Enhanced ACL Restoration (BEAR) procedure has gained popularity among surgeons as an alternative to ACL reconstruction (ACLR). Previously, BEAR has been compared to hamstring ACLR; however, little has been reported in comparison to bone-patella-tendon-bone (BPTB) ACLR, auto-, and allograft.</div></div><div><h3>Purpose</h3><div>To examine differences in the International Knee Documentation Committee (IKDC) scores of patients undergoing the BEAR procedure compared to BPTB for ACL tears.</div></div><div><h3>Methods</h3><div>A comprehensive search was conducted utilizing PRISMA 2020 guidelines. The search yielded 261 studies. Using Rayyan.ai, after the initial inclusion and exclusion, 14 studies underwent a full-text review. Inclusion criteria were randomized clinical trials for patients receiving either BEAR or BPTB with IKDC scores at 12- and 24-months. Statistical analysis was performed for random-effects meta-analysis using SPSS for the extracted IKDC scores.</div></div><div><h3>Results</h3><div>5 studies were included in the meta-analysis. At 12 months, comparison of BEAR (Cohen's d = 3.14) and BPTB (Cohen's d = 2.68) demonstrated no statistical difference. BEAR was found to have a higher clinical significance with an effect size difference of 0.48. A 24-month analysis yielded no clinical or statistical significance for BEAR (Cohen's d = 3.56) compared to BPTB (Cohen's d = 3.39).</div></div><div><h3>Conclusion</h3><div>Both BEAR and BPTB ACLR seemed to obtain comparable IKDC scores for addressing ACL injuries at 12- and 24-months post-procedure.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 30-41"},"PeriodicalIF":1.5,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145734866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of implant generation on the outcomes in medial pivot total knee arthroplasty: a systematic review","authors":"Filippo Migliorini ,&nbsp;Marco Pilone ,&nbsp;Luise Schäfer ,&nbsp;Raju Vaishya ,&nbsp;Michael Memminger ,&nbsp;Nicola Maffulli","doi":"10.1016/j.jor.2025.12.007","DOIUrl":"10.1016/j.jor.2025.12.007","url":null,"abstract":"<div><h3>Introduction</h3><div>Medial pivot total knee arthroplasty (TKA) was developed to reproduce native knee kinematics and improve function. Second-generation designs introduced refinements to enhance medial conformity and lateral rollback, but their clinical benefit remains uncertain. This systematic review compared outcomes of first- and second-generation medial pivot implants.</div></div><div><h3>Methods</h3><div>A comprehensive search of PubMed, Web of Science, Embase, and Google Scholar was performed in August 2025 following PRISMA guidelines. Comparative and non-comparative studies reporting outcomes after first- or second-generation medial pivot TKA were included. Primary endpoints were Knee Society Score (KSS), functional subscale (KSS-F), Oxford Knee Score (OKS), WOMAC, Forgotten Joint Score (FJS), range of motion (ROM), and revision rates.</div></div><div><h3>Results</h3><div>Twenty-four studies including 4686 patients (3541 first-generation; 1145 s-generation) were analysed. Most baseline variables were comparable, though BMI, follow-up duration, and baseline WOMAC and ROM showed minor differences. At the latest follow-up, KSS, KSS-F, WOMAC, and FJS showed no significant differences. Revision rates were similar. OKS was slightly lower in the second-generation cohort (MD −2.5, p = 0.04), and ROM was greater (MD 4.6°, p = 0.01), but both fell below minimal clinically important difference thresholds.</div></div><div><h3>Conclusion</h3><div>First- and second-generation medial pivot TKAs achieved comparable outcomes and survivorship. Although second-generation designs showed statistical improvements in ROM and OKS, these were not clinically relevant. These findings suggest that while design refinements of second-generation implants may offer minor biomechanical advantages, they do not translate into significant improvements in patient-reported outcomes. Surgical decision-making should be based on the surgeon's experience, implant availability, and patient-specific factors rather than expectations of superior performance from newer designs.</div></div><div><h3>Level of evidence</h3><div>Level III.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 42-49"},"PeriodicalIF":1.5,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145734867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethnic and sex-specific differences in proximal femoral geometry and its implications for prosthetic design in total hip arthroplasty - A systematic analysis","authors":"Ram Sudhan S ,&nbsp;Yashwanth Krishna ,&nbsp;Vinayak Prabhu ,&nbsp;Nahas R ,&nbsp;Mohamed Azhaarudeen A ,&nbsp;Naveen P. Gopinath ,&nbsp;Daku Jadav ,&nbsp;Hishanil Rasheed N.K ,&nbsp;Avinash TP ,&nbsp;Sharat Balemane","doi":"10.1016/j.jor.2025.12.005","DOIUrl":"10.1016/j.jor.2025.12.005","url":null,"abstract":"<div><div>Restoration of proximal femoral geometry is critical for total hip arthroplasty (THA) success, yet ethnic and sex-based morphological variations remain inadequately characterised. This systematic review synthesises morphometric evidence across multiple ethnic cohorts to inform implant design and surgical planning. A 3-year systematic review was conducted at Yenepoya Medical College (June 2022–present), searching multiple databases for studies reporting proximal femoral parameters in Chinese, Korean, Japanese, European, and Brazilian populations using radiography and 3D-CT imaging. An in-vivo Indian cohort of 96 hips was included for clinical correlation. Studies lacking ethnic/sex stratification, involving pediatric populations, or with inadequate methodology were excluded. Quality assessment used the Newcastle–Ottawa Scale (≥6 points retained). Sex-stratified data extraction was performed using fixed/random-effects meta-analyses, with meta-regression evaluating ethnicity and sex as predictors of geometric parameters (α = 0.05). Six studies were analyzed, representing six ethnic populations plus one in-vivo cohort (n = 727 femurs). Korean males showed the largest femoral head diameter (48.50 ± 2.23 mm) compared to Brazilian males (31.1 ± 2.7 mm), a 17.4 mm disparity. Neck-shaft angles varied between 126.35° and 132.1° across populations. Chinese females exhibited the highest anteversion (29.03 ± 2.73°) versus males (11.66 ± 1.55°), representing a 149 % difference. Brazilian populations displayed minimal sexual dimorphism (&lt;2 %). Indian CT measurements revealed systematically lower head diameter values compared to radiography (43.0 ± 2.6 vs 48.4 ± 2.6 mm in males). Substantial ethnic and sex-specific differences in proximal femoral geometry necessitate ethnicity-conscious and sex-specific implant modularity or customization to prevent offset under-restoration, impingement, and accelerated bone resorption, rather than relying on universal implant designs.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 116-127"},"PeriodicalIF":1.5,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145734701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}