Journal of orthopaedics最新文献_第7页

Clinical performance and durability of short taper-wedge femoral stems in direct anterior total hip arthroplasty: Insights from a five-year retrospective analysis 直接前路全髋关节置换术中短锥形楔形股骨柄的临床表现和耐久性：来自五年回顾性分析的见解

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2026-04-01 Epub Date: 2026-02-03 DOI: 10.1016/j.jor.2026.02.008

Shuvalaxmi D. Haselton, Vivek P. Chadayammuri, Roger H. Emerson

Background

Short-taper-wedge stems have gained increasing adoption in direct anterior total hip arthroplasty owing to their bone-preserving geometry and favorable suitability for implantation through limited exposures. The objective of this study was to assess 5-year clinical and radiographic outcomes, implant survivorship, and risk factors for failure. We hypothesized that mid-term survivorship of short-taper-wedge stems would be equivalent to or exceed that of traditional designs, with a lower complication rate in Dorr-A and B femora.

Methods

A retrospective analysis was conducted on a consecutive cohort of 128 primary-DA-THAs performed with the Taperloc Microplasty stem. Clinical outcomes were measured using the Harris Hip Score (HHS), while radiographic evaluations assessed implant positioning, subsidence, and complications. Follow-up was completed at 2-weeks, 6-weeks, 6-months, 1-year, 2-years, and 5-years.

Results

Revision-free implant survivorship was 92.7% at five-years. The HHS improved significantly from a mean of 47.5 preoperatively to 96.8 at five-years (p < 0.0005). The overall complication rate was 7.03%, comprised of early implant subsidence and periprosthetic fractures in older patients (mean 77.8 years) with diminished bone stock. Multivariate analysis identified increasing age as the sole predictor of complications (p = 0.008), all of which were successfully managed with revision to modular, diaphyseal-engaging-femoral stems.

Conclusions

Short-taper-wedge-femoral stems are a reliable option for primary-DA-THA, with revision-free survivorship of 92.7% at 5-years-postoperatively. Early periprosthetic fractures, the predominant complication in this series, occurred in older patients with brittle bone, supporting use of cemented fixation in this high-risk population. Long-term monitoring is underway to further inform durability and outcomes with use of this stem in primary DA-THA settings.

短锥形楔柄在直接前路全髋关节置换术中越来越多地采用，因为它们具有保骨的几何形状，并且通过有限的暴露有利于植入。本研究的目的是评估5年的临床和影像学结果、种植体存活和失败的危险因素。我们假设短锥形楔柄的中期生存率将等同于或超过传统设计，并且Dorr-A和B股的并发症发生率较低。方法回顾性分析128例经Taperloc显微成形术治疗的原发性da - tha患者。临床结果采用Harris髋关节评分（HHS）测量，同时x线片评估植入物定位、下沉和并发症。随访时间分别为2周、6周、6个月、1年、2年、5年。结果5年无修复种植体成活率为92.7%。HHS从术前的平均47.5分显著提高到5年时的96.8分（p < 0.0005）。总体并发症发生率为7.03%，包括早期种植体下沉和假体周围骨折的老年患者（平均77.8岁），骨量减少。多变量分析表明，年龄增加是并发症的唯一预测因素（p = 0.008），所有并发症均通过模数化、干骺端接合-股骨干翻修成功处理。结论短锥形楔形股骨干是原发性da - tha的可靠选择，术后5年无修复生存率为92.7%。早期假体周围骨折是本系列的主要并发症，发生在骨质脆性的老年患者中，支持在这一高危人群中使用骨水泥固定。正在进行长期监测，以进一步了解在主要DA-THA环境中使用该系统的耐久性和结果。

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引用次数: 0

Meta-analysis of surgical approaches to lateral ankle instability: Open Broström versus arthroscopic Broström versus lasso-loop repair 手术入路治疗外侧踝关节不稳的meta分析：开放Broström与关节镜Broström与套索环修复

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2026-04-01 Epub Date: 2026-02-03 DOI: 10.1016/j.jor.2026.02.014

Thomas Cho, Colin Jones, Shaza Chaudry, Jiayong Liu

Introduction

Anterior talofibular ligament (ATFL) injury is a common cause of chronic lateral ankle instability and is more frequent among those who are active and play sports. There are multiple techniques to repair the ATFL, including the historically gold-standard Open Bröstrom (OB) technique, the Arthroscopic Bröstrom (AB) technique, and the more novel arthroscopic Lasso-Loop (LL) technique. This meta-analysis seeks to compare outcome statistics of these techniques for ATFL repair.

Methods

A literature search was conducted on PubMed and Embase for comparison studies or randomized controlled trials that included at least two of the surgical techniques and at least one relevant functional outcome or complication statistic up until October 2025. Statistical analyses were performed using Review Manager Web, and a P-value ≤0.05 was considered statistically significant.

Results

1426 patients across 21 studies were included in this analysis. When compared to OB, AB had a significantly lower post-operative Visual Analog Scale (VAS) score (P = 0.01), higher Karlsson score (P < 0.001), higher American Orthopaedic Foot and Ankle Society (AOFAS) score (P = 0.003), and shorter time to return to daily work (P = 0.02). Compared to OB, LL had a significantly lower VAS score (P < 0.001) and higher AOFAS score (P = 0.02). However, OB had a lower rate of range of motion (ROM) restriction (P = 0.002) and shorter time to return to running (P = 0.01) when compared to LL. No significant results were found comparing AB and LL.

Conclusion

This study found that AB had a significantly lower VAS score, significantly higher Karlsson and AOFAS scores, and significantly shorter time to return to daily work compared to OB. LL also had significantly lower VAS and significantly higher AOFAS scores compared to OB. However, OB had a significantly lower risk of ROM restriction and significantly shorter time to return to running than LL. The minimally invasive AB and LL techniques seem to be the superior treatment methods for ATFL injuries when compared to OB repair, with no clinically significant differences seen between the two.

Level of evidence

3

距腓骨前韧带（ATFL）损伤是慢性踝关节外侧不稳定的常见原因，在活跃和运动的人群中更为常见。有多种技术可以修复ATFL，包括历史上黄金标准的Open Bröstrom （OB）技术、关节镜Bröstrom （AB）技术和更新颖的关节镜Lasso-Loop （LL）技术。本荟萃分析旨在比较这些技术用于ATFL修复的结果统计。方法在PubMed和Embase上检索文献，检索截至2025年10月至少两种手术技术和至少一种相关功能结局或并发症统计数据的比较研究或随机对照试验。使用Review Manager Web进行统计分析，p值≤0.05被认为具有统计学意义。结果21项研究共纳入1426例患者。与OB相比，AB组术后视觉模拟评分（VAS）明显低于OB组（P = 0.01）， Karlsson评分明显高于OB组（P < 0.001），美国骨科足踝学会（AOFAS）评分明显高于AB组（P = 0.003），恢复日常工作时间明显短于OB组（P = 0.02）。与OB相比，LL组VAS评分显著低于OB组（P < 0.001）， AOFAS评分显著高于OB组（P = 0.02）。然而，与LL相比，OB有更低的活动范围限制率（P = 0.002）和更短的恢复跑步时间（P = 0.01）。AB与LL比较无显著性结果。结论本研究发现AB组VAS评分明显低于OB组，Karlsson评分和AOFAS评分明显高于OB组，恢复日常工作时间明显短于OB组。LL组VAS评分明显低于OB组，AOFAS评分明显高于OB组。但OB组ROM限制风险明显低于OB组，恢复跑步时间明显短于OB组。与OB修复相比，微创AB和LL技术似乎是ATFL损伤的优越治疗方法，两者之间没有临床显着差异。证据水平3

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引用次数: 0

Combined partial knee arthroplasty versus total knee arthroplasty: A systematic review and meta-analysis of randomised control trials 联合部分膝关节置换术与全膝关节置换术：随机对照试验的系统回顾和荟萃分析

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2026-04-01 Epub Date: 2026-02-03 DOI: 10.1016/j.jor.2026.02.018

Raven Joseph , Chinmay Tijare , Khalis Boksh , Arijit Ghosh , Amit Bishnoi , Muhammad Tawfiq Korim , Randeep Aujla

Purpose

Total knee arthroplasty (TKA), the standard surgical treatment for knee osteoarthritis (OA) which resurfaces all three compartments, has disadvantages including inferior kinematics and high patient dissatisfaction rates. Combined Partial Knee Arthroplasty (CPKA), which encompasses Bicompartmental knee arthroplasty (BCA) and Bi-unicompartmental knee arthroplasty (Bi-UKA), is a tissue-sparing alternative for patients with bicompartmental disease. High quality evidence is limited, therefore this systematic review and meta-analysis aims to synthesise randomised controlled trial (RCT) data comparing outcomes and complications between BCA or Bi-UKA and TKA.

Methods

A systematic review and meta-analysis were conducted following PRISMA guidelines, searching Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Database of Systematic Reviews from inception to July 14, 2025. RCTs comparing CPKA with TKA were included. Seven publications (four unique RCTs) were selected: four comparing BCA-M (medial) to TKA and three comparing Bi-UKA to TKA. Data on patient-reported outcome measures (PROMs), range of motion (ROM), functional tests and complications were extracted and analysed. A random-effects model was used for meta-analysis of revision risk.

Results

TKA showed a statistically significant advantage compared to Bi-UKA in the total and clinical New Knee Society Score (NKSS) at two years. BCA-M patients had superior ROM but an increased incidence of patellar subluxation and meta-analysis found a significantly higher risk of revision compared with TKA (RR 1.75, 95% CI 1.17–2.61, p = 0.007). No other significant differences in PROMs, functional tests or gait analysis were identified.

Conclusions

Outcomes of CPKA are comparable to TKA with few statistically significant differences. While BCA-M showed a greater postoperative ROM, there was a higher incidence of patellar subluxation and meta-analysis found a higher risk of revision. However, current evidence is limited therefore larger long-term RCTs are needed to define the role of CPKA in managing bicompartmental knee OA.

目的全膝关节置换术（TKA）是膝关节骨性关节炎（OA）的标准手术治疗方法，其缺点包括运动学差和患者不满意率高。联合部分膝关节置换术（CPKA），包括双腔室膝关节置换术（BCA）和双单腔室膝关节置换术（Bi-UKA），是双腔室疾病患者的一种保留组织的替代方法。高质量的证据有限，因此本系统综述和荟萃分析旨在综合随机对照试验（RCT）数据，比较BCA或Bi-UKA和TKA的结果和并发症。方法按照PRISMA指南，检索Medline、Embase、Cochrane Central Register of Controlled Trials （Central）和Cochrane Database of systematic Reviews（2025年7月14日），进行系统评价和荟萃分析。纳入比较CPKA与TKA的随机对照试验。选择了7篇出版物（4篇独特的随机对照试验）：4篇比较BCA-M（医学）与TKA， 3篇比较Bi-UKA与TKA。提取并分析了患者报告的结果测量（PROMs）、活动范围（ROM）、功能测试和并发症的数据。采用随机效应模型对修订风险进行meta分析。结果与Bi-UKA相比，stka在2年的总新膝关节社会评分（NKSS）和临床新膝关节社会评分（NKSS）方面具有统计学上的显著优势。BCA-M患者有更好的ROM，但髌骨半脱位的发生率增加，荟萃分析发现与TKA相比，翻修的风险明显更高（RR 1.75, 95% CI 1.17-2.61, p = 0.007）。在PROMs、功能测试或步态分析方面没有发现其他显著差异。结论CPKA与TKA疗效相当，差异无统计学意义。虽然BCA-M术后ROM更大，但髌骨半脱位的发生率更高，荟萃分析发现翻修的风险更高。然而，目前的证据有限，因此需要更大的长期随机对照试验来确定CPKA在治疗双室膝关节OA中的作用。

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引用次数: 0

Occult pelvic fractures following primary total hip arthroplasty: A retrospective CT-Based cohort study 原发性全髋关节置换术后隐蔽性骨盆骨折：一项基于ct的回顾性队列研究

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2026-04-01 Epub Date: 2026-02-02 DOI: 10.1016/j.jor.2026.02.003

Gavin King , Haron Obaid , Michaela Nickol , Johannes M. van der Merwe

Introduction

Postoperative pelvic fractures are a rare but under-recognized complication of total hip arthroplasty (THA), particularly in the setting of cementless, press-fit acetabular components. This study aimed to determine the incidence, radiographic detectability, risk factors, and early clinical impact of occult pelvic fractures following primary THA.

Methods

In this retrospective cohort, 60 primary THAs (59 patients) performed by a single surgeon at a tertiary center between June 2024 and September 2025 were evaluated. All patients underwent posterolateral THA using a hemispherical uncemented acetabular component with routine screw augmentation. Immediate postoperative radiographs and pelvic CTs were obtained, and images were independently reviewed by a dedicated musculoskeletal radiologist and a second radiologist to identify pelvic fractures and assess agreement. Demographics, comorbidities, surgical factors, and early postoperative outcomes were recorded. At 6 weeks, pain (VAS), Oxford Hip Score, and EQ-5D–based quality-of-life scores were collected. Multivariable logistic regression explored associations between fractures, risk factors, and early outcomes.

Results

Occult pelvic fractures were identified on CT in 22 of 61 hips (36.1%), whereas radiographs detected fractures in only 10% of cases. Fractures most commonly involved the ilium, followed by the posterior column and pubic rami. Interobserver agreement for fracture detection on radiographs was high by percentage (90%). No individual patient-, operative-, or early postoperative factor was independently associated with fracture occurrence. At 6 weeks, there were no statistically significant differences in pain scores, functional PROMs, or use of assistive devices or opioids between patients with and without occult fractures.

Conclusion

We found that occult pelvic fractures were common after a THA, but did not lead to worse functional or clinical outcomes. In addition, we determined that postoperative radiographs dramatically under-detect postoperative acetabular fractures. We were unable to find independent predictors (patient-, operative- and postoperative factors) of postoperative acetabular fractures.

前言术后骨盆骨折是全髋关节置换术（THA）的一种罕见但未被充分认识的并发症，特别是在无骨水泥、压合髋臼假体的情况下。本研究旨在确定原发性全髋关节置换术后隐蔽性骨盆骨折的发生率、影像学检出率、危险因素和早期临床影响。方法回顾性分析2024年6月至2025年9月在某三级中心由一名外科医生实施的60例原发性tha（59例患者）。所有患者均采用半球形非骨水泥髋臼假体进行后外侧THA，常规螺钉增强。立即获得术后x线片和骨盆ct，图像由专门的肌肉骨骼放射科医生和第二位放射科医生独立审查，以确定骨盆骨折并评估一致性。记录人口统计学、合并症、手术因素和术后早期结果。6周时，收集疼痛（VAS）、牛津髋关节评分（Oxford Hip Score）和基于eq - 5d的生活质量评分。多变量logistic回归探讨了骨折、危险因素和早期预后之间的关系。结果61例髋部中22例（36.1%）在CT上发现骨臼骨折，而x线片仅10%发现骨臼骨折。骨折最常累及髂骨，其次是后柱和耻骨支。x线片上骨折检测的观察者间一致性很高（90%）。没有单独的患者、手术或术后早期因素与骨折发生独立相关。6周时，有和没有隐匿性骨折的患者在疼痛评分、功能性PROMs、辅助装置或阿片类药物的使用方面没有统计学上的显著差异。结论：我们发现髋关节置换术后隐匿性骨盆骨折很常见，但不会导致更差的功能或临床结果。此外，我们确定术后x线片明显低于术后髋臼骨折。我们无法找到术后髋臼骨折的独立预测因素（患者、手术和术后因素）。

{"title":"Occult pelvic fractures following primary total hip arthroplasty: A retrospective CT-Based cohort study","authors":"Gavin King , Haron Obaid , Michaela Nickol , Johannes M. van der Merwe","doi":"10.1016/j.jor.2026.02.003","DOIUrl":"10.1016/j.jor.2026.02.003","url":null,"abstract":"<div><h3>Introduction</h3><div>Postoperative pelvic fractures are a rare but under-recognized complication of total hip arthroplasty (THA), particularly in the setting of cementless, press-fit acetabular components. This study aimed to determine the incidence, radiographic detectability, risk factors, and early clinical impact of occult pelvic fractures following primary THA.</div></div><div><h3>Methods</h3><div>In this retrospective cohort, 60 primary THAs (59 patients) performed by a single surgeon at a tertiary center between June 2024 and September 2025 were evaluated. All patients underwent posterolateral THA using a hemispherical uncemented acetabular component with routine screw augmentation. Immediate postoperative radiographs and pelvic CTs were obtained, and images were independently reviewed by a dedicated musculoskeletal radiologist and a second radiologist to identify pelvic fractures and assess agreement. Demographics, comorbidities, surgical factors, and early postoperative outcomes were recorded. At 6 weeks, pain (VAS), Oxford Hip Score, and EQ-5D–based quality-of-life scores were collected. Multivariable logistic regression explored associations between fractures, risk factors, and early outcomes.</div></div><div><h3>Results</h3><div>Occult pelvic fractures were identified on CT in 22 of 61 hips (36.1%), whereas radiographs detected fractures in only 10% of cases. Fractures most commonly involved the ilium, followed by the posterior column and pubic rami. Interobserver agreement for fracture detection on radiographs was high by percentage (90%). No individual patient-, operative-, or early postoperative factor was independently associated with fracture occurrence. At 6 weeks, there were no statistically significant differences in pain scores, functional PROMs, or use of assistive devices or opioids between patients with and without occult fractures.</div></div><div><h3>Conclusion</h3><div>We found that occult pelvic fractures were common after a THA, but did not lead to worse functional or clinical outcomes. In addition, we determined that postoperative radiographs dramatically under-detect postoperative acetabular fractures. We were unable to find independent predictors (patient-, operative- and postoperative factors) of postoperative acetabular fractures.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 358-363"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146170354","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}

引用次数: 0

Bibliometric analysis of the top 100 most cited articles related to pathological fractures 病理性骨折相关的前100篇被引文章的文献计量分析

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2026-04-01 Epub Date: 2025-12-26 DOI: 10.1016/j.jor.2025.12.060

Ömer Büyüktopçu , Hayati Kart

Background

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.

Methods

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.

Results

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 < 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.

Conclusion

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.

本研究的目的是对100篇被引次数最多的病理性骨折论文进行文献计量学分析，以确定文献结构、研究趋势和影响被引行为的因素。方法在Web of Science数据库中以“病理骨折”、“病理骨折”、“骨质疏松性骨折”和“脆性骨折”为关键词检索截至2025年6月底发表的英文论文。被引用次数最多的100篇文章根据总引用次数进行排名，并进行文献计量学分析。对发表年份、作者和机构数量、期刊类型、开放获取状态、资金、页数和参考文献数量、证据水平与引文数量和引文密度等变量之间的关系进行统计评估。结果2010 - 2020年的论文被引密度最高，主要来自美国和欧洲国家。获得资助、多中心、较长的文章，其引用密度显著较高（p < 0.05）。开放获取状态与被引数或密度之间没有显著差异。此外，期刊影响因子与被引次数之间存在显著的相关性。结论本研究对了解病理性骨折领域的科研产出现状和被引行为具有重要意义，对今后的研究具有指导意义。促进跨学科合作，有效利用资金资源，优先考虑方法学上可靠的研究设计，对于增强该领域的科学影响至关重要。

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引用次数: 0

Internal fixation versus hemiarthroplasty for valgus impacted femoral neck fractures: Results from an institutional ortho-geriatric hip fracture registry 内固定与半关节置换术治疗外翻冲击股骨颈骨折：来自机构老年髋部骨折登记的结果

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2026-04-01 Epub Date: 2025-12-23 DOI: 10.1016/j.jor.2025.12.058

Brian Rui Kye Chee, Emrick Sen Hui Quah, Daniel Xing Fu Hap

Purpose

The ideal surgical treatment type for valgus impacted Garden I (AO 31B1.1) femoral neck fractures (FNFs) remains controversial. The primary aim of this study was to compare functional outcomes, mortality and reoperation rates between valgus impacted FNF patients treated with internal fixation (IF) or hemiarthroplasty (HA). The secondary outcomes studied were length of acute hospital stay, and postoperative medical complications.

Methods

A retrospective cohort study was performed in a single level I trauma center. All patients aged 60 years and above who were treated surgically for valgus impacted Garden I (AO 31B1.1) femoral neck fractures between January 2014 and December 2021 were included. Case matching based on gender, age, American Society of Anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI) score and MBI score was performed.

Results

208 patients (IF n = 104, HA n = 104) were included in the final study group. The IF group showed better mobility at six months compared to the HA group (31.4 % independent without aid vs 17.1 %, p-value = 0.047). However, at 12 months, this difference was no longer present (39.8 % independent without aid vs 34.4 %, p-value = 0.915). The HA group had higher rates of acute urinary retention compared to the IF group (37.5 % vs 24.0 %, p = 0.049). There was no statistically significant difference in MBI scores, reoperation rate, mortality rate, or length of hospital stay between the two groups.

Conclusions

Internal fixation showed better mobility at the 6 month mark and lower postoperative urinary retention rates, with similar reoperation and mortality rates compared to hemiarthroplasty in the treatment of valgus-impacted femoral neck fractures.

目的外翻冲击型Garden I （AO 31B1.1）股骨颈骨折的理想手术治疗方式仍有争议。本研究的主要目的是比较外翻影响的FNF患者接受内固定（IF）或半关节置换术（HA）治疗的功能结局、死亡率和再手术率。研究的次要结局是急性住院时间和术后医疗并发症。方法在某一级创伤中心进行回顾性队列研究。2014年1月至2021年12月，所有年龄在60岁及以上，因外翻影响型Garden I （AO 31B1.1）股骨颈骨折接受手术治疗的患者。根据性别、年龄、美国麻醉医师协会（ASA）评分、Charlson合并症指数（CCI）评分和MBI评分进行病例匹配。结果最终研究组共纳入208例患者（IF n = 104, HA n = 104）。与HA组相比，IF组在6个月时表现出更好的活动能力（31.4%独立无辅助vs 17.1%， p值= 0.047）。然而，在12个月时，这种差异不再存在（39.8%独立无援助vs 34.4%， p值= 0.915）。与IF组相比，HA组的急性尿潴留率更高（37.5% vs 24.0%, p = 0.049）。两组患者在MBI评分、再手术率、死亡率、住院时间等方面均无统计学差异。结论与半关节置换术相比，内固定治疗外翻型股骨颈骨折在6个月时具有更好的活动能力和更低的术后尿潴留率，再手术率和死亡率相似。

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引用次数: 0

Intraoperative vasopressor use as a risk factor for early periprosthetic joint infection after total joint arthroplasty: A retrospective cohort study 术中使用血管加压素是全关节置换术后早期假体周围关节感染的危险因素：一项回顾性队列研究

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2026-04-01 Epub Date: 2026-01-31 DOI: 10.1016/j.jor.2026.01.016

Alexander Burbelo , Trace Clark , Salvia Zafar , Marcus Voigt , Brett Lowden , Brian Ferguson , Jay Shepherd , Matthew Bullock

Background

Periprosthetic joint infection (PJI) is a serious complication following total joint arthroplasty (TJA), but intraoperative vasopressor use has not been previously evaluated as a risk factor. This study investigates whether the number of vasopressors administered intraoperatively is a risk factor for early PJI in TJA.

Methods

We retrospectively reviewed 1286 patients who underwent primary TJA (896 TKAs and 390 THAs) at our institution from 2020 to 2025. Patients were stratified into three groups according to the number of vasopressors administered intraoperatively: 0, 1, or ≥2. Demographics, comorbidities, procedure type, anesthesia type, and intraoperative hypotension (minutes with MAP <65 mmHg, MIN65) were compared between groups. Multivariable logistic regression was used to identify independent predictors of PJI within 90 days.

Results

494 patients (38.4%) received no vasopressors intraoperatively, 557 (43.3%) received one vasopressor, and 235 (18.3%) received 2 or more. 9 patients (0.7%) had a PJI within 90 days. 30 and 90-day all-cause readmission rates were not significantly different regardless of vasopressor use. Receiving ≥2 vasopressors was an independent predictor of increased PJI risk (OR 17.2, 95% CI 2.18–369.0, p = 0.017), as was increased American Society of Anesthesiologists class (ASA) (OR 13.80, 95% CI 2.2–87.10, p = 0.0049) while regional spinal anesthesia was independently protective (OR 0.136, 95% CI: 0.03–0.56, p = 0.0059).

Conclusion

In this study, use of ≥2 vasopressors intraoperatively was independently associated with an increased risk of PJI within 90 days, which may represent refractory intraoperative hypotension or physiological stress. This novel finding indicates that further research with larger cohort sizes is warranted, and these findings should be interpreted with caution and be considered exploratory.

背景：假体周围关节感染（PJI）是全关节置换术（TJA）后的一个严重并发症，但术中使用血管加压素以前没有作为一个危险因素进行评估。本研究探讨术中使用血管加压药物的数量是否是TJA患者早期PJI的危险因素。方法回顾性分析2020年至2025年我院1286例原发性TJA患者（896例tka和390例tha）。根据术中使用血管加压药物的数量将患者分为三组：0、1或≥2。比较两组患者的人口统计学特征、合并症、手术方式、麻醉方式和术中低血压（min with MAP <65 mmHg, MIN65）。采用多变量logistic回归确定90天内PJI的独立预测因子。结果494例（38.4%）患者术中未使用血管加压素，557例（43.3%）患者术中使用一种血管加压素，235例（18.3%）患者术中使用两种及以上血管加压素。9例（0.7%）患者在90天内出现PJI。无论使用何种血管加压剂，30天和90天的全因再入院率均无显著差异。接受≥2种血管加压药物是PJI风险增加的独立预测因子（OR 17.2, 95% CI 2.18-369.0, p = 0.017），美国麻醉师学会（ASA）等级增加（OR 13.80, 95% CI 2.2-87.10, p = 0.0049），而区域脊髓麻醉是独立保护因子（OR 0.136, 95% CI: 0.03-0.56, p = 0.0059）。结论在本研究中，术中使用≥2种血管加压药物与90天内PJI风险增加独立相关，这可能代表难治性术中低血压或生理应激。这一新发现表明，进一步的研究需要更大的队列规模，这些发现应该谨慎解释，并被认为是探索性的。

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引用次数: 0

Patient acceptable symptom state (PASS) thresholds for the Hip disability and Osteoarthritis Outcome Score (HOOS) after total hip arthroplasty 全髋关节置换术后患者可接受症状状态（PASS）阈值和骨关节炎结局评分（HOOS）

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2026-04-01 Epub Date: 2025-12-23 DOI: 10.1016/j.jor.2025.12.056

Junji Nishimoto , Rikumi Kurahashi , Kotaro Tamari , Ryo Tanaka

Background

Total hip arthroplasty (THA) is an effective treatment for hip osteoarthritis (OA). The patient acceptable symptom state (PASS) provides meaningful thresholds for patient-reported outcomes. However, short-term PASS after THA remains underexplored, despite its importance in identifying early recovery status, guiding timely postoperative interventions, and supporting patient expectations during the critical early rehabilitation phase. This study aimed to determine short-term PASS thresholds for each Hip disability and Osteoarthritis Outcome Score (HOOS) subscale.

Methods

This multicenter prospective cohort study evaluated 150 patients with hip OA who underwent primary unilateral THA. PASS thresholds for the HOOS subscales—symptoms, pain, activities of daily living (ADL), sport and recreation (SR), and quality of life (QOL)—were calculated at 3 and 6 months after THA using both the 25th percentile method and receiver operating characteristic (ROC) analysis, anchored to the Global Rating of Change scale.

Results

At 3 months post-THA, the PASS thresholds (percentile/ROC) were: symptoms 60.0/47.5, pain 70.0/56.3, ADL 60.3/72.8, SR 37.5/28.1, and QOL 37.5/28.1. At 6 months post-THA, the PASS thresholds (percentile/ROC) were: symptoms 70.0/52.5, pain 82.5/72.5, ADL 77.9/72.8, SR 37.5/37.0, and QOL 62.5/46.9.

Conclusions

This study provides preliminary short-term PASS thresholds for the HOOS subscales after THA in patients with hip OA. These early benchmarks may assist clinicians in identifying patients who appear to be experiencing suboptimal recovery as early as 3 months post-THA, potentially enabling timely postoperative support. Short-term PASS thresholds may offer helpful indicators of expected early recovery and support shared decision-making during follow-up. While these findings suggest potential clinical practice value, further studies with larger and more diverse populations are needed to enhance generalizability and confirm applicability.

背景：全髋关节置换术（THA）是治疗髋关节骨关节炎（OA）的有效方法。患者可接受症状状态（PASS）为患者报告的结果提供了有意义的阈值。然而，尽管短期PASS在识别早期恢复状态，指导及时的术后干预以及在关键的早期康复阶段支持患者期望方面具有重要意义，但其在THA后的短期PASS仍未得到充分研究。本研究旨在确定每个髋关节残疾和骨关节炎结局评分（HOOS）亚量表的短期PASS阈值。方法本多中心前瞻性队列研究评估了150例髋关节OA患者行原发性单侧THA。HOOS亚量表(症状、疼痛、日常生活活动（ADL）、运动和娱乐（SR）和生活质量（QOL）的通过阈值在THA后3个月和6个月使用25个百分点法和受试者工作特征（ROC）分析计算，并锚定在全球变化评级量表上。结果tha术后3个月，PASS阈值（百分位数/ROC）分别为：症状60.0/47.5、疼痛70.0/56.3、ADL 60.3/72.8、SR 37.5/28.1、QOL 37.5/28.1。tha后6个月，PASS阈值（百分位数/ROC）为：症状70.0/52.5，疼痛82.5/72.5,ADL 77.9/72.8, SR 37.5/37.0, QOL 62.5/46.9。本研究为髋关节骨关节炎患者THA后HOOS亚量表提供了初步的短期PASS阈值。这些早期基准可以帮助临床医生识别那些在tha术后3个月出现恢复不佳的患者，从而有可能及时提供术后支持。短期PASS阈值可以提供预期早期恢复的有用指标，并支持随访期间的共同决策。虽然这些发现具有潜在的临床应用价值，但需要在更大、更多样化的人群中进行进一步的研究，以增强通用性和确认适用性。

{"title":"Patient acceptable symptom state (PASS) thresholds for the Hip disability and Osteoarthritis Outcome Score (HOOS) after total hip arthroplasty","authors":"Junji Nishimoto , Rikumi Kurahashi , Kotaro Tamari , Ryo Tanaka","doi":"10.1016/j.jor.2025.12.056","DOIUrl":"10.1016/j.jor.2025.12.056","url":null,"abstract":"<div><h3>Background</h3><div>Total hip arthroplasty (THA) is an effective treatment for hip osteoarthritis (OA). The patient acceptable symptom state (PASS) provides meaningful thresholds for patient-reported outcomes. However, short-term PASS after THA remains underexplored, despite its importance in identifying early recovery status, guiding timely postoperative interventions, and supporting patient expectations during the critical early rehabilitation phase. This study aimed to determine short-term PASS thresholds for each Hip disability and Osteoarthritis Outcome Score (HOOS) subscale.</div></div><div><h3>Methods</h3><div>This multicenter prospective cohort study evaluated 150 patients with hip OA who underwent primary unilateral THA. PASS thresholds for the HOOS subscales—symptoms, pain, activities of daily living (ADL), sport and recreation (SR), and quality of life (QOL)—were calculated at 3 and 6 months after THA using both the 25th percentile method and receiver operating characteristic (ROC) analysis, anchored to the Global Rating of Change scale.</div></div><div><h3>Results</h3><div>At 3 months post-THA, the PASS thresholds (percentile/ROC) were: symptoms 60.0/47.5, pain 70.0/56.3, ADL 60.3/72.8, SR 37.5/28.1, and QOL 37.5/28.1. At 6 months post-THA, the PASS thresholds (percentile/ROC) were: symptoms 70.0/52.5, pain 82.5/72.5, ADL 77.9/72.8, SR 37.5/37.0, and QOL 62.5/46.9.</div></div><div><h3>Conclusions</h3><div>This study provides preliminary short-term PASS thresholds for the HOOS subscales after THA in patients with hip OA. These early benchmarks may assist clinicians in identifying patients who appear to be experiencing suboptimal recovery as early as 3 months post-THA, potentially enabling timely postoperative support. Short-term PASS thresholds may offer helpful indicators of expected early recovery and support shared decision-making during follow-up. While these findings suggest potential clinical practice value, further studies with larger and more diverse populations are needed to enhance generalizability and confirm applicability.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 33-38"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839440","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}

引用次数: 0

METTL14 regulate LRIG1 expression via m6A to affect nucleus pulposus cell senescence in intervertebral disc degeneration METTL14通过m6A调控LRIG1表达，影响椎间盘退变中髓核细胞衰老

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2026-04-01 Epub Date: 2026-01-05 DOI: 10.1016/j.jor.2026.01.004

Ruihai Xiao , Qunying Yang , Yingqun Yin , Shanshan Peng , Xigao Cheng

Objectives

This study aims to explore the role of METTL14, a key m6A “writer” in regulating LRIG1 expression and its involvement in IVDD pathogenesis.

Methods

METTL14 expression was evaluated in nucleus pulposus (NP) tissues from IVDD patients at different degeneration stages using immunohistochemistry. In vitro experiments were conducted with METTL14 knockdown and TNF-α-induced cellular degeneration in NP cells. The effects on cellular senescence markers, ECM components, and m6A RNA methylation were examined. m6A RNA immunoprecipitation was employed to assess m6A modification levels. Bioinformatics tools predicted potential m6A sites on LRIG1 mRNA, which were further validated by luciferase reporter assays.

Results

METTL14 expression was significantly upregulated in NP tissues from patients with severe IVDD. METTL14 knockdown in NP cells led to reduced m6A enrichment on LRIG1 mRNA, destabilizing LRIG1 transcripts and increasing cellular senescence marker P21. TNF-α stimulation further induced METTL14 expression, exacerbated ECM degradation, and accelerated cellular senescence. Restoration of LRIG1 expression through overexpression mitigated the degenerative changes caused by METTL14 knockdown. Luciferase assays confirmed that METTL14 regulates LRIG1 mRNA stability via specific m6A sites, establishing a METTL14-LRIG1 axis in cellular senescence.

Conclusions

This study identifies METTL14 as a critical regulator of LRIG1-mediated ECM stability and cellular senescence in IVDD pathogenesis. The METTL14-LRIG1 axis, driven by m6A modifications, provides new mechanistic insights into the inflammatory and degenerative processes underlying IVDD. Targeting METTL14 or the associated m6A pathway may offer novel therapeutic strategies for IVDD.

目的探讨m6A关键“作者”METTL14在调控LRIG1表达及其参与IVDD发病机制中的作用。方法采用免疫组化方法检测不同退行性变阶段IVDD患者髓核（NP）组织中smettl14的表达。体外实验采用METTL14敲除和TNF-α-诱导NP细胞变性。研究了其对细胞衰老标志物、ECM成分和m6A RNA甲基化的影响。m6A RNA免疫沉淀法评估m6A修饰水平。生物信息学工具预测了LRIG1 mRNA上潜在的m6A位点，并通过荧光素酶报告基因试验进一步验证了这一预测。结果重度IVDD患者NP组织中mettl14表达明显上调。NP细胞中METTL14敲低导致LRIG1 mRNA上m6A富集减少，LRIG1转录物不稳定，细胞衰老标志物P21增加。TNF-α刺激进一步诱导METTL14表达，加剧ECM降解，加速细胞衰老。通过过表达恢复LRIG1的表达可以减轻METTL14敲低引起的退行性变化。荧光素酶测定证实，METTL14通过特定的m6A位点调节LRIG1 mRNA的稳定性，在细胞衰老过程中建立了METTL14-LRIG1轴。结论本研究确定METTL14在IVDD发病过程中是lrig1介导的ECM稳定性和细胞衰老的关键调节因子。由m6A修饰驱动的METTL14-LRIG1轴为IVDD的炎症和退行性过程提供了新的机制见解。靶向METTL14或相关的m6A通路可能为IVDD提供新的治疗策略。

{"title":"METTL14 regulate LRIG1 expression via m6A to affect nucleus pulposus cell senescence in intervertebral disc degeneration","authors":"Ruihai Xiao , Qunying Yang , Yingqun Yin , Shanshan Peng , Xigao Cheng","doi":"10.1016/j.jor.2026.01.004","DOIUrl":"10.1016/j.jor.2026.01.004","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aims to explore the role of METTL14, a key m6A “writer” in regulating LRIG1 expression and its involvement in IVDD pathogenesis.</div></div><div><h3>Methods</h3><div>METTL14 expression was evaluated in nucleus pulposus (NP) tissues from IVDD patients at different degeneration stages using immunohistochemistry. In vitro experiments were conducted with METTL14 knockdown and TNF-α-induced cellular degeneration in NP cells. The effects on cellular senescence markers, ECM components, and m6A RNA methylation were examined. m6A RNA immunoprecipitation was employed to assess m6A modification levels. Bioinformatics tools predicted potential m6A sites on LRIG1 mRNA, which were further validated by luciferase reporter assays.</div></div><div><h3>Results</h3><div>METTL14 expression was significantly upregulated in NP tissues from patients with severe IVDD. METTL14 knockdown in NP cells led to reduced m6A enrichment on LRIG1 mRNA, destabilizing LRIG1 transcripts and increasing cellular senescence marker P21. TNF-α stimulation further induced METTL14 expression, exacerbated ECM degradation, and accelerated cellular senescence. Restoration of LRIG1 expression through overexpression mitigated the degenerative changes caused by METTL14 knockdown. Luciferase assays confirmed that METTL14 regulates LRIG1 mRNA stability via specific m6A sites, establishing a METTL14-LRIG1 axis in cellular senescence.</div></div><div><h3>Conclusions</h3><div>This study identifies METTL14 as a critical regulator of LRIG1-mediated ECM stability and cellular senescence in IVDD pathogenesis. The METTL14-LRIG1 axis, driven by m6A modifications, provides new mechanistic insights into the inflammatory and degenerative processes underlying IVDD. Targeting METTL14 or the associated m6A pathway may offer novel therapeutic strategies for IVDD.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 195-204"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978364","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}

引用次数: 0

From fracture to function: return-to-sport after acetabular fractures 从骨折到功能：髋臼骨折后恢复运动

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2026-04-01 Epub Date: 2025-12-23 DOI: 10.1016/j.jor.2025.12.053

Anna L. Schiltenwolf , Tina Histing , Florian Laux , Markus A. Kueper , Stefan Doebele , Steven C. Herath

Background and aim of the study

Acetabular fractures can affect young, athletically active patients. This study aimed to describe the previously unexplored interaction between injury severity, return to sport, and subjective attitude towards sport.

Material and methods

Twenty-two patients with acetabular fracture treated at a Level I Trauma Center between Jan. 2009–Dec. 2020 were retrospectively included. Patients received a postal questionnaire assessing activity level and sporting activity before trauma (PRE) and after trauma (POST). The median follow-up was 145 (IQR 75.5–166) months. Patients also reported whether the injury altered their subjective attitude towards exercise.

Results

Participants were divided into two subgroups according to ISS: ISS <16 = ‘no polytrauma’ (n = 8) and ISS ≥16 = ‘polytrauma’ (n = 14). The mean highest UCLA Activity Score decreased more in the ‘no polytrauma’ subgroup (−39.7 %) than in the ‘polytrauma’ subgroup (−23.4 %). The POST sports break lasted over five times longer in the ‘polytrauma’ subgroup, who more often underwent longer inpatient rehabilitation. In the ‘no polytrauma’ subgroup, 50 % (3/6) of previously active athletes returned to sport, whereas all PRE active patients in the ‘polytrauma’ subgroup returned (10/10). POST sport level was lower in the ‘no polytrauma’ subgroup (0 % club sports (0/8), 37.5 % occasional (3/8); 0 % high-impact (0/8), 37.5 % low-impact (3/8)) compared with the ‘polytrauma’ subgroup (21.4 % club sports (3/14), 50 % occasional (7/14); 35.7 % high-impact (5/14), 35.7 % low-impact (3/8)). A negative change in the subjective attitude towards exercise occurred in 12.5 % (1/8) of ‘no polytrauma’ patients and 42.9 % (6/14) of ‘polytrauma’ patients.

Conclusion

Sporting activity was reduced after acetabular fracture. Although ‘polytrauma’ participants reported more negative shifts in exercise attitude, they demonstrated higher return-to-sport rates compared with ‘non-polytrauma’ participants. Potentially the longer sport interruption and inpatient rehabilitation may facilitate more effective reintegration. Further studies with larger study groups are warranted.

研究背景和目的髋臼骨折可影响年轻、运动活跃的患者。本研究旨在描述以前未探索的损伤严重程度、重返运动和对运动的主观态度之间的相互作用。材料与方法2009年1月- 12月在某一级外伤中心治疗的22例髋臼骨折患者。回顾性纳入2020例。患者收到一份邮寄问卷，评估创伤前（PRE）和创伤后（POST）的活动水平和运动活动。中位随访时间为145个月（IQR 75.5-166）。患者还报告了损伤是否改变了他们对运动的主观态度。结果根据ISS将参与者分为两组：ISS <；16 =“无多发伤”（n = 8）和ISS≥16 =“多发伤”（n = 14）。平均最高UCLA活动评分在“无多发伤”亚组（- 39.7%）比“多发伤”亚组（- 23.4%）下降更多。在“多重创伤”亚组中，POST运动休息时间延长了5倍多，他们通常需要更长时间的住院康复。在“无多发创伤”亚组中，50%（3/6）以前活跃的运动员恢复了运动，而在“多发创伤”亚组中所有PRE活跃的患者都恢复了运动（10/10）。“无多发伤”亚组的POST运动水平较低(0%俱乐部运动（0/8），37.5%偶尔运动（3/8）；与“多发创伤”亚组相比（21.4%为俱乐部运动（3/14），50%为偶发（7/14）），高冲击（0/8），低冲击（3/8）占37.5%；低强度高35.7%(5/14),35.7%(3/8))。12.5%（1/8）的“无多发伤”患者和42.9%（6/14）的“多发伤”患者对运动的主观态度发生了负面变化。结论髋臼骨折后运动能力降低。尽管“多重创伤”的参与者报告了更多的运动态度的负面转变，但与“非多重创伤”的参与者相比，他们表现出更高的运动回归率。长期的运动中断和住院康复可能会促进更有效的重返社会。有必要在更大的研究小组中进行进一步的研究。

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引用次数: 0