Journal of orthopaedics最新文献

{"title":"Established acetabular radiological reference values can be reliably transferred to reconstructed parallel-beam 2D images from ultra-low-dose pelvic CT","authors":"Arnaud Klopfenstein ,&nbsp;Thomas Marth ,&nbsp;Stefan Sommer ,&nbsp;Reto Sutter ,&nbsp;Patrick O. Zingg ,&nbsp;Dominik Kaiser","doi":"10.1016/j.jor.2025.12.063","DOIUrl":"10.1016/j.jor.2025.12.063","url":null,"abstract":"<div><h3>Background</h3><div>The anteroposterior radiograph of the pelvis is essential for diagnosing hip pathologies. Radiograph-like projections reconstructed as cone-beam images from CT data correlate strongly with conventional radiographs. However, CT inherently uses parallel x-rays rather than a cone-beam geometry. This study aims to determine whether parallel-beam radiograph-like projections from CT provide comparable reference values to cone-beam reconstructions.</div></div><div><h3>Methods</h3><div>63 patients (126 hips) undergoing CT for symptomatic hip pathologies without prior hip surgery were included. From the same CT data, cone-beam and parallel-beam radiograph-like images were reconstructed using a standardized algorithm. Reference values, including lateral center-edge angle (LCEA), medial center-edge angle (MCEA), acetabular index (AI), acetabular arc (AA), extrusion index (EI), crossover sign, and posterior wall sign, were measured on both projection types, eliminating technical bias. Two observers performed all measurements twice to assess inter- and intra-observer reliability, and intraclass correlation coefficients (ICCs) were calculated.</div></div><div><h3>Results</h3><div>126 hips were analyzed: 52 with LCEA &lt;22° (“acetabular undercoverage”), 49 with LCEA 22°–33° (“normal coverage”), and 25 with LCEA &gt;33° (“acetabular overcoverage”). ICCs between observers and between projection types demonstrated good to excellent reliability for all reference values (0.89–0.99).</div></div><div><h3>Conclusion</h3><div>Parallel-beam radiograph-like projections demonstrate good to excellent reliability (ICCs: 0.89–0.99) for key reference values of hip pathologies compared to cone-beam radiograph-like projections from the same CT data. These findings suggest parallel beam projections can be reliably used with established reference values for conventional radiographs.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 73-78"},"PeriodicalIF":1.5,"publicationDate":"2025-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882550","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":"Bibliometric analysis of the top 100 most cited articles related to pathological fractures","authors":"Ömer Büyüktopçu ,&nbsp;Hayati Kart","doi":"10.1016/j.jor.2025.12.060","DOIUrl":"10.1016/j.jor.2025.12.060","url":null,"abstract":"<div><h3>Background</h3><div>The aim of this study was to perform a bibliometric analysis of the 100 most-cited articles on pathological fractures to identify the structure of the literature, research trends, and factors influencing citation behavior.</div></div><div><h3>Methods</h3><div>A search was conducted in the Web of Science database using the keywords “pathologic fracture,” “pathological fracture,” “osteoporotic fracture,” and “fragility fracture” for articles published in English up to the end of June 2025. The 100 most-cited articles were ranked by total citation count and analyzed bibliometrically. Relationships between variables such as publication year, number of authors and institutions, journal type, open access status, funding, number of pages and references, and level of evidence with citation count and citation density were statistically assessed.</div></div><div><h3>Results</h3><div>The majority of contributions came from the USA and European countries, and the highest citation density was observed in articles published between 2010 and 2020. Articles that received funding, were multicenter, and had greater length demonstrated significantly higher citation density (p &lt; 0.05). No significant difference was found between open access status and citation count or density. Additionally, a significant correlation was found between journal impact factor and citation count.</div></div><div><h3>Conclusion</h3><div>This study provides important insights into the current state of scientific output and citation behavior in the field of pathological fractures, serving as a guide for future research. Promoting interdisciplinary collaboration, effectively utilizing funding resources, and prioritizing methodologically robust study designs are essential for enhancing scientific impact in this area.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 54-60"},"PeriodicalIF":1.5,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882594","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":"Orthopedic implant surface modification with nanoengineered [YSZ/HAp-Ag]n multilayer coatings to promote osteoblast adhesion and early differentiation","authors":"E Lorena Medina ,&nbsp;J.J. Vaca-González ,&nbsp;Diego Quexada-Rodríguez ,&nbsp;Salah Ramtani ,&nbsp;Celine Falentin- Daudre ,&nbsp;Diego Garzón-Alvarado","doi":"10.1016/j.jor.2025.12.045","DOIUrl":"10.1016/j.jor.2025.12.045","url":null,"abstract":"<div><h3>Background</h3><div>Metallic implants frequently face three critical challenges that compromise long-term clinical performance: (i) limited biofunctionality that delays osteointegration, (ii) corrosion processes that deteriorate the implant surface and release harmful ions, and (iii) bacterial biofilm formation, which increases the risk of persistent infection. This study explores multilayer [YSZ/HAp-Ag]n coatings engineered to overcome these issues by enhancing osteoblastic response, improving surface stability, and providing antimicrobial potential.</div></div><div><h3>Materials and methods</h3><div>Multilayer coatings with different bilayer numbers (n = 1, 10, 30, 50, 70) were deposited on titanium substrates using magnetron sputtering. Structural and surface characterization included morphology, roughness, wettability, and stiffness. MC3T3-E1 osteoblastic cells were cultured on the coatings to evaluate adhesion, viability (MTT), and differentiation through alkaline phosphatase (ALP) activity at 7 and 14 days.</div></div><div><h3>Results</h3><div>Crater-like surface textures, roughness above 220 nm, and higher hydrophilicity promoted enhanced cell spreading, greater confluence, and decreased circularity, indicative of strong anchorage. All coatings exhibited &gt;70 % cell viability, confirming non-cytotoxic behavior. Rougher and more hydrophilic surfaces outperformed uncoated titanium. Stiffer coatings produced a significant increase in ALP activity at day 7, suggesting accelerated early osteogenic differentiation, followed by a decrease at day 14 consistent with cellular maturation. Among all configurations, the 30-bilayer coating (n30) offered the most balanced structural and mechanical properties, resulting in the highest biological performance.</div></div><div><h3>Conclusions</h3><div>Multilayer [YSZ/HAp-Ag]n coatings effectively stimulate osteoblastic adhesion, viability, and early differentiation while addressing key limitations of metallic implants. Their tunable architecture—especially the n30 configuration—represents a promising strategy to enhance implant integration and long-term functional performance.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 79-90"},"PeriodicalIF":1.5,"publicationDate":"2025-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882595","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":"Comparative analysis of different incision ways of posterior approach for posterior tibial plateau fractures: a systemic review and meta-analysis","authors":"Chun Ru Lin ,&nbsp;You-Rui Lin ,&nbsp;Yi-Chen Liu ,&nbsp;Eric H. Tischler ,&nbsp;Ming-Hao Chen ,&nbsp;Hao-Che Tang ,&nbsp;Chien-Hao Chen ,&nbsp;Chun-Yi Su ,&nbsp;Yi-Sheng Chan ,&nbsp;Sung Huang Laurent Tsai","doi":"10.1016/j.jor.2025.12.062","DOIUrl":"10.1016/j.jor.2025.12.062","url":null,"abstract":"<div><h3>Background</h3><div>Inadequate treatment of posterior tibial plateau fractures can cause instability, yet no agreement exists regarding the optimal surgical approach for achieving favorable outcomes. Hence, the aim of this study is to assess and compare the postoperative outcomes of different posterior surgical techniques, including reverse L-shape, S-shaped, posterior medial, extended posterolateral, and posterolateral prone approaches.</div></div><div><h3>Methods</h3><div>To evaluate the efficacy of surgical approaches, we searched databases such as PubMed, Embase, Web of Science, The Cochrane Library, and Scopus. Studies published before October 26th, 2022 were included, and we followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The study's outcomes comprised complications, infections, range of motion (ROM), operation time, and functional scores, and p-values &lt;0.05 were considered significant. To conduct the meta-analysis, we utilized the R software.</div></div><div><h3>Results</h3><div>We included 8 studies with 104 patients. The extended posterolateral approach reduced incidence of complications and improved ROM, while the posterolateral prone approach reduced ROM. Conversely, the S-shaped approach was linked to lower HSS scores. No significant differences were found in infection rates or operative time among the various surgical approaches.</div></div><div><h3>Conclusions</h3><div>The extended posterolateral approach was associated with a lower incidence of complications and greater ROM compared to other surgical approaches. In contrast, the S-shaped approach was linked to lower HSS scores, and the posterolateral prone approach was associated with reduced ROM. These findings suggest that further prospective studies are necessary to establish the optimal surgical approach for posterior tibial plateau fractures.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 91-98"},"PeriodicalIF":1.5,"publicationDate":"2025-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882596","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":"Peroneal tendoscopy for peroneal tendon disorders: A systematic review of indications, diagnostic utility, and clinical outcomes","authors":"Alexander Tham ,&nbsp;Ragul Rajivan ,&nbsp;Jared Rubin ,&nbsp;James J. Butler ,&nbsp;Mark Pianka ,&nbsp;Akshay Nair ,&nbsp;Hillary Campbell ,&nbsp;Nicole Rynecki ,&nbsp;Mackenzie Roof ,&nbsp;John G. Kennedy","doi":"10.1016/j.jor.2025.12.057","DOIUrl":"10.1016/j.jor.2025.12.057","url":null,"abstract":"<div><h3>Background</h3><div>Peroneal tendon disorders span tendinopathy, tenosynovitis, intrasheath subluxation, stenosis, and tears, and may be challenging to diagnose accurately with clinical examination and MRI alone. Peroneal tendoscopy offers a minimally invasive, diagnostic–therapeutic option. We systematically reviewed clinical indications, intraoperative findings, procedures, imaging accuracy, complications, and patient-reported outcomes following peroneal tendoscopy.</div></div><div><h3>Methods</h3><div>Eight studies (190 patients; 195 ankles) were reviewed. Data on demographics, indications, procedures, PROMs, return to sport (RTS), complications/failures, and imaging–tendoscopy agreement were extracted and pooled when constructs aligned. Random-effects meta-analyses generated pooled means or proportions with 95 % CIs (Hartung–Knapp adjustment). Where applicable, diagnostic performance of preoperative assessment was compared with tendoscopy as reference.</div></div><div><h3>Results</h3><div>Across 190 patients (195 ankles), pooled mean age was 32 years (95 % CI 25.0–39.0), follow-up 30.3 months (95 % CI 20.8–39.8); 71 % of ankles had traumatic aetiologies. Indications were broad, with recurrent subluxation/dislocation, intrasheath subluxation, and refractory lateral ankle pain common. Frequently performed procedures included synovectomy/debridement (94 ankles), groove deepening (34 ankles), excision of space occupying lesions (65 ankles; predominantly low-lying muscle bellies [LLMB] and peroneus quartus), tendon repair/tubularization (23 ankles), and tendoscopic retinacular repair (14 ankles). Six studies reported validated PROMS with four reporting AOFAS suitable for pooling. Postoperative AOFAS averaged 96.6 (95 % CI 94.3–99.0) with a pooled mean gain of +19.8 (95 % CI 18.5–21.2); JSSF, FAOS and SF-12 improved significantly. RTS occurred at a pooled 13.3 weeks (95 % CI 10.6–16.0), with RTS of 12.2 ± 0.6 weeks after tendoscopic retinacular stabilization and 14.8 ± 2.0 weeks after groove deepening. Overall complications were 7.6 % (13 events) and mainly consisted of persistent ankle pain and minor wound issues. Failure rate was 1.5 % and two revision surgeries (1.0 %) were reported. Diagnostic agreement was high at the aggregate level (MRI overall sensitivity 0.90, specificity 0.72), but lesion-level performance varied: MRI was strong for tears and tenosynovitis, weaker for stenosis. Composite preoperative diagnosis in a large series showed high specificity (0.97) but only moderate sensitivity (0.76), with LLMB frequently under-recognized preoperatively.</div></div><div><h3>Conclusions</h3><div>Peroneal tendoscopy provides meaningful functional gains, timely RTS, and a low adverse-event burden across a wide indication spectrum, and it complements imaging by clarifying dynamic/space-conflict pathology. Longer, prospective comparative studies are warranted.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 24-32"},"PeriodicalIF":1.5,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839356","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":"Preoperative blood transfusion is an independent risk factor for postoperative infection, readmission, and mortality following surgery for femoral shaft fractures","authors":"Jason M. Dayan,&nbsp;Peter K. Twining,&nbsp;Bruce B. Zhang,&nbsp;David H. Mai,&nbsp;Carl B. Paulino,&nbsp;Qais Naziri,&nbsp;Aden N. Malik","doi":"10.1016/j.jor.2025.12.050","DOIUrl":"10.1016/j.jor.2025.12.050","url":null,"abstract":"<div><h3>Background</h3><div>Femoral shaft fractures (FSFs) are often associated with significant blood loss, frequently necessitating preoperative blood transfusion, which may increase the risk of complications. This study evaluated the relationship between preoperative transfusion and postoperative outcomes, including infection, readmission, reoperation, hemodynamic complications, and mortality in patients undergoing surgical fixation for FSF.</div></div><div><h3>Methods</h3><div>A retrospective cohort analysis was conducted using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2012 to 2021. Adult patients (≥18 years) who underwent surgical fixation for FSF were included. The primary exposure was transfusion of ≥1 unit of whole or packed red blood cells within 72 h before surgery. Patients were grouped by transfusion status. Demographic, clinical, and procedural variables were compared using chi-square tests, and multivariable regression adjusted for potential confounders. Primary outcomes were 30-day postoperative infection, hospital readmission, reoperation, hemodynamic complications, and mortality.</div></div><div><h3>Results</h3><div>Of 6812 patients identified, 373 (5.5 %) received a preoperative transfusion. Most patients were 80–89 years, White, female, non-Hispanic, ASA 3, with normal BMI, independent functional status, hypertension, low hematocrit, normal WBC, and non-emergent cases. Most were nonsmokers and without major comorbidities (COPD, CHF, cancer, diabetes, immunosuppression, bleeding disorders, or weight loss) [Table 1]. After adjustment, preoperative transfusion was independently associated with increased odds of postoperative infection (OR 1.67, 95 % CI 1.12–2.42, p = 0.009), hospital readmission (OR 1.49, 95 % CI 1.03–2.13, p = 0.031), and mortality (OR 1.73, 95 % CI 1.15–2.55, p = 0.007). No significant associations were found for reoperation (p = 0.207) or hemodynamic complications (p = 0.57) [Table 4].</div></div><div><h3>Conclusions</h3><div>Preoperative blood transfusion in patients undergoing surgical fixation for femoral shaft fractures is associated with higher risks of infection, readmission, and mortality. No significant differences were observed for hemodynamic complications or reoperation. These findings can help guide surgeons as they balance optimal hemoglobin levels preoperatively with risks of postoperative complications associated with transfusion.</div></div><div><h3>Level of evidence</h3><div>Level III.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 17-23"},"PeriodicalIF":1.5,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839445","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":"Analysis of the burden of rheumatoid arthritis in BRICS countries and globally from 1990 to 2021 and projections of future trends to 2036: Insights from the global burden of disease study 2021","authors":"Jian Gao ,&nbsp;Jing Xu ,&nbsp;Hui Li ,&nbsp;Chong Gao","doi":"10.1016/j.jor.2025.12.049","DOIUrl":"10.1016/j.jor.2025.12.049","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aims to evaluate the global and BRICS-specific burden of rheumatoid arthritis (RA) from 1990 to 2021, analyzing temporal trends in incidence, prevalence, and disability-adjusted life years (DALYs), as well as projecting future disease burden to 2035.</div></div><div><h3>Methods</h3><div>Data were obtained from the Global Burden of Disease (GBD) 2021 database. Age-standardized incidence rate (ASIR), prevalence rate (ASPR), and DALY rate (ASDR) were assessed globally and across BRICS countries using Joinpoint regression to estimate average annual percent change (AAPC). Subgroup analyses were conducted by age, sex, and region, with projections modeled to 2035.</div></div><div><h3>Results</h3><div>From 1990 to 2021, global RA incidence and prevalence exhibited significant upward trends (ASIR: 10.42 to 11.8 per 100,000; ASPR: 182.54 to 208.9 per 100,000). The global ASDR remained relatively stable (36.42–35.89 per 100,000). Among BRICS nations, India demonstrated the steepest rise in both ASIR and ASPR, while South Africa experienced declines in both prevalence and DALY rates. Females consistently bore a higher RA burden across all age groups. Burden projections to 2035 indicate continued increases in ASIR and ASPR globally and in most BRICS nations, whereas ASDR is expected to remain stable or decline.</div></div><div><h3>Conclusions</h3><div>RA remains a major public health challenge worldwide, with substantial heterogeneity across BRICS countries. Differences are largely driven by demographic aging, environmental exposures, lifestyle risk factors (e.g., smoking, obesity), and disparities in healthcare access. Targeted prevention, strengthened primary care, and equitable health resource allocation are essential to mitigate the rising RA burden, particularly in emerging economies.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 39-53"},"PeriodicalIF":1.5,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839446","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":"Evaluating single-stage cartilage treatments in the knee: A systematic review and meta-analysis of osteochondral autograft transfer surgery (OATS) and minced cartilage repair (MCR) techniques","authors":"Jason Jia Shyan Ong ,&nbsp;Christopher Busby ,&nbsp;Francisco Barbosa ,&nbsp;Thomas Kurien ,&nbsp;Jimmy Wui Guan Ng","doi":"10.1016/j.jor.2025.12.052","DOIUrl":"10.1016/j.jor.2025.12.052","url":null,"abstract":"<div><h3>Background</h3><div>Focal chondral lesions of the knee remain challenging to treat. Although small defects may respond to conservative management, moderate-sized lesions often require surgical intervention. Single-stage cartilage restoration procedures—osteochondral autograft transfer (OATS) and minced cartilage repair (MCR)—are gaining popularity due to lower morbidity, faster rehabilitation, and reduced cost compared with two-stage techniques. However, comparative evidence between these options is limited. This systematic review evaluates current literature and compares clinical and radiologic outcomes of OATS and MCR.</div></div><div><h3>Methods</h3><div>Following PRISMA guidelines, studies were included if they reported clinical outcomes of OATS or MCR for moderate-sized chondral knee lesions, enrolled ≥10 patients, and had ≥12 months of follow-up. Clinical outcomes were extracted using International Knee Documentation Committee (IKDC) and Visual Analog Scale (VAS) scores, and radiologic outcomes using Magnetic Resonance Imaging Score and Classification System (MOCART) scoring.</div></div><div><h3>Results</h3><div>19 studies (14 OATS, 5 MCR) comprising 736 patients (OATS n = 524; MCR n = 212) met inclusion criteria. No direct comparative trials were identified. Patients undergoing OATS (mean age 38.7 ± 12.8 years) demonstrated greater improvements in IKDC (40.49) and VAS scores (−4.27) than those treated with MCR (mean age 31.7 ± 6.8 years; IKDC 30.9; VAS –3.7). Mean defect sizes were similar (OATS 3.36 ± 1.80 cm²; MCR 3.39 ± 0.72 cm²). Twelve-month MOCART scores were comparable between groups (OATS 62.7; MCR 65). Longer follow-up in OATS studies (54.2 vs 32.9 months) may partially account for superior clinical outcomes.</div></div><div><h3>Conclusion</h3><div>Both OATS and MCR yield favourable results for focal chondral knee lesions. Current evidence suggests greater clinical improvement with OATS, although radiologic findings appear similar in the short term. High-quality, long-term comparative studies are needed to clarify the relative durability and efficacy of these single-stage techniques.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 61-72"},"PeriodicalIF":1.5,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882551","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":"Cost analysis for patients with adult spinal deformity by surgical approach and technique: A systematic review of the literature","authors":"Omkar S. Anaspure ,&nbsp;Anthony N. Baumann ,&nbsp;Dalton McGlamery ,&nbsp;Jessica Vitrano ,&nbsp;Grayson Talaski ,&nbsp;Nicholas I. Chiaramonti ,&nbsp;Keegan T. Conry ,&nbsp;Gordon Preston ,&nbsp;Jacob C. Hoffmann","doi":"10.1016/j.jor.2025.12.059","DOIUrl":"10.1016/j.jor.2025.12.059","url":null,"abstract":"<div><h3>Introduction</h3><div>Adult spinal deformity (ASD) correction approaches span transforaminal lumbar interbody fusion (TLIF) and posterior‐only (PO) fusion, with more complex options emerging such as combined anterior-posterior (AP) constructs, lateral lumbar interbody fusion (LLIF), and multilevel osteotomies. Given the substantially variable hospital costs associated with these diverse strategies, this systematic review quantifies and compares their economic impact to inform value‐based decision‐making in ASD surgery.</div></div><div><h3>Methods</h3><div>We conducted a PROSPERO-registered systematic review and meta-analysis (CRD42025644391) of comparative studies to evaluate cost differences for various surgical interventions for ASD patients. We queried PubMed, CINAHL, MEDLINE, and Web of Science from inception through January 28th, 2025.</div></div><div><h3>Results</h3><div>Six observational studies of moderate quality (n = 7297; operative patients n = 7,095, 97.23 %) with a mean age 47.0 ± 5.3 years were included. Approaches included PO, LLIF, TLIF and combined AP. Osteotomies included grade 2 osteotomy and three-column osteotomies (3CO). One study found LLIF to have higher index hospitalization costs compared to TLIF ($65,937 vs. $50,945; p &lt; 0.01) and higher 2-year cumulative costs ($70,847 vs. $53,657; p &lt; 0.01), driven by increased OR expenses. Two studies found AP fusion to incur substantially higher index hospitalization costs compared to PO (range $84,329-$103,275 for AP vs. $58,789-$64,281 for PO; p ≤ 0.001), maintaining a significant cost gap at 2 years ($89,824 vs. $73,904; p = 0.011). However, the findings for quality-adjusted life years (QALY) were heterogenous for AP vs PO approaches. Osteotomy added an estimated $21,000 at 2 years, with 3-column osteotomy (3CO) having higher 90-day and 1-year costs than posterior-column osteotomy, but with higher complication and readmission rates. One study found that over 2 years, LLIF trended toward the lowest cost-per-QALY ($463,798) vs. grade-2 ($509,370) vs. 3CO ($518,406), with no significant differences.</div></div><div><h3>Conclusion</h3><div>Complex ASD procedures observed higher index and two-year costs than TLIF or PO approaches, with cost-per-QALY ratios showing no clear benefit for higher-cost techniques. These findings are limited by heterogenous cost definitions and sparse utility data, warranting cautious interpretation and underscore the need for prospective, standardized cost-effectiveness studies with extended follow-up.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 374-380"},"PeriodicalIF":1.5,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145837455","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":"Comparative analysis of early versus delayed rehabilitation protocols following rotator cuff repair: A randomized controlled trial","authors":"Aran Nikpay,&nbsp;Alireza Rouhani,&nbsp;Asghar Elmi,&nbsp;Shahab Mahdipour","doi":"10.1016/j.jor.2025.12.048","DOIUrl":"10.1016/j.jor.2025.12.048","url":null,"abstract":"<div><h3>Background</h3><div>The optimal timing for initiating shoulder motion after rotator cuff repair remains controversial, balancing re-tear risk against stiffness from immobilization. This trial compared clinical and structural outcomes of early versus delayed rehabilitation.</div></div><div><h3>Methods</h3><div>From March 2024 to February 2025, 120 patients undergoing arthroscopic (single-row) or open (double-row) repair of full-thickness tears were randomized to an early-motion group (EMG; n = 60) or a delayed-motion group (DMG; n = 60). The EMG began supervised passive forward flexion and abduction within 24 h postoperatively. The DMG underwent strict immobilization for 6 weeks before starting identical rehabilitation. Primary outcomes at 6 months included pain (VAS), function (UCLA score), active range of motion (ROM), and re-tear rate on MRI (Sugaya IV/V). Secondary outcomes covered satisfaction, complications, and return to activities. Demographic, clinical, and surgical factors were analyzed.</div></div><div><h3>Results</h3><div>At 6 months, the EMG showed significantly lower pain (VAS: 1.7 ± 0.8 vs. 2.9 ± 1.1; p = 0.02), higher function (UCLA: 33.7 ± 2.1 vs. 29.4 ± 3.3; p = 0.01), greater ROM, and lower stiffness (5 % vs. 15 %; p = 0.03). Re-tear rates did not differ significantly (EMG: 3.3 % vs. DMG: 1.7 %; p = 0.56). All three re-tears occurred in patients with large tears (&gt;3 cm) and high-grade fatty infiltration (Goutallier ≥3). Multivariate analysis confirmed early motion as an independent predictor of better outcomes. Surgical technique did not alter the primary findings.</div></div><div><h3>Conclusions</h3><div>Supervised early passive motion is safe and superior to delayed immobilization, providing better functional recovery and lower stiffness without increasing re-tear risk. However, patients with large tears and advanced fatty infiltration represent a high-risk subgroup, necessitating personalized, cautious rehabilitation.</div></div><div><h3>Level of evidence</h3><div>Therapeutic Level I.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 381-386"},"PeriodicalIF":1.5,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145837330","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}