Orthopedic Reviews最新文献

Osteoarthritis (OA) is a degenerative joint disease characterized by cartilage erosion, synovial inflammation and pain. Accumulating evidence demonstrates that deubiquitinating enzymes (DUBs) are critical regulators of OA pathogenesis through their ability to rescue key proteins from proteasomal degradation. Among them, USP7 stabilizes NOX4 to amplify ROS-NLRP3-dependent pyroptosis and cartilage catabolism; USP15 deubiquitinates ERK2 and SMAD2 to enhance TGF-β signaling and chondrocyte anabolism; USP13 sustains PTEN and IL-1R8/Sigirr to restrain PI3K/AKT/NF-κB-mediated inflammation and oxidative stress; USP3 and USP49 block TRAF6 ubiquitination and Wnt/β-catenin signaling to attenuate chondrocyte senescence and apoptosis; USP5 and USP14 promote NF-κB activation by stabilizing TRAF6 or deubiquitinating IκBα, driving chondrocyte dedifferentiation and matrix metalloproteinase expression. Pre-clinically, small-molecule USP7 inhibitors (P22077), USP14 inhibitors (IU1) and genetic silencing of USP15 or USP49 have all been shown to reduce cartilage loss and inflammatory pain in mouse OA models. Collectively, these findings establish DUBs as druggable nodes in OA and underscore the need for selective inhibitors that can safely modulate ubiquitin-dependent protein turnover in human joints.However, DUB research remains nascent, requiring further validation of their clinical efficacy and safety. This review elucidates DUB-mediated mechanisms in OA and discusses challenges in developing selective DUB inhibitors for future therapies.

This article documents the influence of treatment history on the success of hip arthroplasty. To prove this, we present the results of a study of a hip endoprosthesis that failed unusually. Intensive damage of the endoprosthesis head made of cobalt alloy was observed, which resulted in advanced metallosis of the tissues surrounding the implant. Macroscopic and microscopic studies combined with EDS analysis were carried out. An X-ray analysis of the endoprosthesis acetabulum was performed using computed tomography and a 3D scan of the endoprosthesis head. The tests showed that the primary wear mechanism of the endoprosthesis head was the abrasive wear caused by the hard particles of porous alumina bioceramics, which were embedded in the polyethylene acetabulum due to the forces acting on the joint. In our examined situation, the particles were immovably affixed to the polyethylene insert, escalating headwear. Alumina bioceramics were used as a tissue engineering element in the patient's previous treatment. The presented results have great practical significance, as they indicate that great care should be taken when using polyethylene components, especially in cases where previous surgeries involved using porous bioceramics to fill damaged bone fragments. This study's findings can potentially improve the long-term success of hip arthroplasty.

Purpose: The purpose of this systematic review is to explore strategies for preventing phantom limb pain in amputated patients. Given the complex mechanisms of peripheral and central sensitization underlying phantom limb pain and the limited effectiveness of current pharmacological and non-pharmacological treatments, prevention is critical to reducing its impact on patients' quality of life and treatment burden.

Methods: Through a comprehensive search from four databases about the prevention of phantom limb pain, 1781 articles published between 2014 and 2024 were identified. Human studies that measured the association between preventive methods for phantom limb pain were considered eligible. The inclusion criteria of the literature were (1) prevention/ prophylactic treatment of phantom limb pain among amputees, (2) publication within the last 10 years, (3) randomized controlled trial or cohort, and (4) study written in English. Animal studies were excluded from this analysis.

Results: Four randomized controlled trials and one cohort were included in this study. To prevent phantom limb pain, various approaches can be taken, both operative and non-operative. Surgery involving a combination of peripheral nerve coaptation, collagen nerve wrapping, and submuscular transposition, when compared to neurectomy alone, has demonstrated satisfactory results. In the non-surgical method, the administration of dexmedetomidine and calcitonin as an epidural injection, oral gabapentin, and mirror therapy gave good results.

Conclusions: A preventive approach to phantom limb pain, in terms of surgical and non-surgical methods, might reduce the incidence of phantom limb pain and increase the quality of life among amputees.

Anterior cruciate ligament (ACL) avulsion fracture is an uncommon injury in the pediatric population, typically involving a bony avulsion at the tibial insertion of the ligament. Diagnosis is usually established on plain radiographs, particularly in the lateral view, and further characterized by magnetic resonance imaging (MRI). Treatment may be conservative or surgical, depending on the degree of displacement and rotation of the bony fragment according to the Meyers and McKeever (MM) classification, as well as the presence of associated soft-tissue injuries. However, the optimal management of Type II fractures remains debated, making individual case reports valuable to guide clinical decision-making. We report the case of a five-year-old child with a Type II MM ACL avulsion fracture managed successfully with conservative treatment. The patient was immobilized in extension with a long leg cast for 30 days, and follow-up imaging demonstrated complete healing without complications. At two-year follow-up, clinical examination confirmed full recovery with a stable knee and no residual laxity. This case emphasizes that, in the absence of concomitant intra-articular lesions on MRI, conservative management can represent a safe and effective option for Type II ACL avulsion fractures in very young patients.

Background: Non-unions are one of the major challenges that orthopaedic surgeons must face. Vascularized bone transplants are widely used to treat these bony defects.

Objectives: The aim of this systematic review and meta-analysis was to investigate whether venous anastomosis in the bone-only graft increases the survival rate of the flap.

Methods: We conducted this review in accordance with the PRISMA guidelines. PubMed, Embase, and the Cochrane Library were systematically searched from the inception through January 2025. Studies reporting results about bone graft performed with microsurgical anastomosis of both vein and artery and studies reporting the results of bone graft with only arterial anastomosis were selected and compared. Data quality was assessed using the Newcastle-Ottawa Scale (NOS).

Results: The literature search yielded 1.140 papers, but only 26 papers were included in the systematic review. Heterogeneity was high, so a subgroup analysis was performed. Twenty papers dealt with only arterial anastomosis with a pooled failure rate at 4.5%. On the other side, six papers reported both vein and artery anastomosis with a pooled failure rate at 1.6%. The subgroup analysis of the papers in which venous anastomosis was made, however, did not allow to demonstrate that the venous anastomosis is truly protective (p = 0.3133).

Conclusion: Bone vascularized grafts are an indispensable therapeutic technique. The results of this review are not definitive about the role of the venous anastomosis, but it is not possible to exclude its protective role on the transplant survival. More targeted studies are essential to confirm it.

Introduction: Gluteus medius tendon (GMT) tears are a widely recognized source of lateral hip pain and weakness. While surgical repair often leads to symptom relief, outcomes are less favorable in cases involving chronic or high-grade tears. To improve healing, a variety of biologic augmentation strategies have been explored, including platelet-rich plasma (PRP), platelet-rich fibrin matrix (PRFM), collagen patches, dermal allografts, synthetic scaffolds, and bone marrow aspirate concentrate (BMAC). However, their effectiveness remains uncertain.

Objective: To systematically review published clinical outcomes associated with different biologic augmentation techniques used in GMT repair.

Methods: A systematic literature search was conducted through PubMed, Cochrane Library, and Embase for studies published between 2000 and 2025 reporting on the surgical repair of GMT tears with biologic augmentation. Data extracted included study design, type of biologic intervention, and postoperative clinical and imaging outcomes.

Results: A total of four studies comprising 123 hips were included, and all studies reported improvements in patient reported outcomes following surgical repair. However, the two available comparative studies found no significant differences in pain or function between augmented and unaugmented repairs. Case series of collagen patch augmentation demonstrated favorable structural healing in early clinical outcomes, while synthetic mesh combined with muscle transfer showed improvement in patients with irreparable tears.

Conclusion: While biologic augmentation in GMT repair appears safe and technically feasible, more data needs to be published relative to the results obtained with commonly used orthobiologic augmentation to determine if and under what circumstances such treatment provides consistent clinical advantage over standard repair.

Purpose: Revision surgery is widely recognized as the main performance index for Total Joint Arthroplasty (TJA). Whereas long-term revision rate is used for measuring implant durability, "early revision" is still not clearly defined, with timeframes ranging from 3 to 6 months until 2 or even 3 years used in the literature. Aim of this work is to review the current literature specifically related to "early" revisions, in order to provide an overview over reasons for early revision surgery.

Methods: Because of lack of definitions, a narrative review approach was chosen. Literature review of articles published within the last 10 years retrieved 254 articles. After applying exclusion and inclusion criteria, 55 publications were analysed. An accepted standard for narrative review was used.

Results: The analysed articles showed a marked heterogeneity in reported timeframes for early revision, but we found values labelled as "early" between 1 month and 5 years. 3-months revision rates ranged between 0.5% - 1.5% for total hip arthroplasty (THA), and were approximately 0.5% for total knee arthroplasty (TKA) for all causes. 5-year revision rates were between 2% - 4% for THA and between 3% - 5% for TKA for all causes. Furthermore, we found that the heterogeneity for the applied time definitions in early revisions do not allow a direct comparison for all-cause revision procedures.

Conclusions: Similarly to long term revision results, there is heterogeneity in short term revision results. It can be useful to take into account homogenous groups when comparing early revision outcomes, for example among same reason for revision. Moreover, several paper contributions suggested a significant dependence on modifiable patient characteristics at primary procedure.

Myxedema coma is a rare, life-threatening complication of severe, long-standing hypothyroidism, often precipitated by physiological stress such as infection, trauma, or surgery. Perioperative presentations of myxedema coma are especially uncommon. This case report describes a 71-year-old male with a history of poorly controlled hypothyroidism who underwent emergent surgical fixation of a traumatic left intertrochanteric femur fracture who developed intraoperative myxedema coma. Timely diagnosis and intervention-including intravenous thyroid hormone replacement, corticosteroids, hemodynamic support, and close anesthetic management were crucial to optimizing the patient's outcome. This report highlights the critical role of anesthetic management in myxedema coma cases, emphasizing the importance of endocrine and hemodynamic support. Furthermore, it promotes multidisciplinary coordination when managing endocrinological emergencies in high-risk surgical patients.

Acute Diabetic Charcot Arthropathy (ADCA) is a severe complication of diabetes mellitus in patients with peripheral neuropathy, often misdiagnosed due to its similarity to cellulitis or deep vein thrombosis. This review examines ADCA's pathophysiology, emphasizing early diagnosis to prevent progression. We explore the roles of inflammatory cytokines (TNF-α, IL-1β, IL-6) in bone loss and joint degeneration, and investigate potential biomarkers and therapeutic targets in Wnt and IL-17 signaling pathways. The impact of metabolic imbalances and comorbidities on ADCA development is also discussed. Our analysis reveals ADCA's complex, multifactorial nature, involving neuropathy, inflammatory responses, and metabolic dysregulation. A comprehensive management approach aimed at achieving a stable, ulcer-free foot is essential to improve patient mobility and quality of life. We conclude that early intervention is crucial, focusing on reducing stress on affected regions in inflammatory stages. This is achieved by highlighting and implementing the advances in clinical practice, integration of recent research, education of patients on the importance of early intervention alongside developing improvements to current treatments.

Introduction Ischial tuberosity apophyseal avulsion fractures (ITAFs) are rare injuries occurring primarily in adolescent males. ITAFs are typically caused by a strong eccentric hamstring contraction that avulses the ischial apophysis before it is fully fused. However, there is currently no consensus on its therapeutic paradigm. Case Presentation A 13-year-old male presented with posterior thigh pain after a twisting injury. On exam, he had ischial tenderness, limited hip flexion, and lower extremity paresthesias. Imaging revealed a proximally displaced ischial tuberosity apophyseal avulsion fracture. Management and Outcomes He underwent open reduction and hybrid fixation with suture anchors and a cannulated screw, and sciatic nerve neurolysis. Postoperatively, neurologic symptoms resolved, and he resumed full activity within five months. Conclusion This case demonstrates the successful and novel use of hybrid fixation for a displaced ITAF with neurologic symptoms. Hybrid fixation provides a stable repair, enabling a safe and timely return to sports for adolescents.