World Journal of Orthopedics最新文献

Background: There has been an increasing focus in recent years on health-care disparities. Studies investigating return to work (RTW) or sports are often performed in large, urban areas. Relatively few studies have investigated rates of return to farming or other heavy labor that is of interest to patients in rural areas.

Aim: To evaluate the literature regarding RTW in farming or heavy labor after orthopedic hip, knee, or shoulder surgery.

Methods: A search was performed in the PubMed and EMBASE databases using Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Studies were included if they reported patients employed in farming or heavy labor, RTW rates after orthopedic surgery of the hip, knee, or shoulder, and had a minimum 6-month follow-up. A meta-analysis of proportions using a random-effects model was performed on three single-arm observational studies to estimate the pooled RTW rate following arthroscopic shoulder surgery.

Results: Ten studies were included, and 101 farmers were identified among 440 total patients. One study involved hip surgery, two studies involved knee surgery, and seven studies involved shoulder surgery. RTW rates across studies varied by type of surgery and follow-up interval, ranging from 24% to 100%. The RTW rate was only 53.6% at 1 year following total hip arthroplasty. No studies investigated RTW in farmers following total knee arthroplasty. Among non-comparative studies, meta-analysis revealed a pooled RTW rate of 89% following arthroscopic shoulder surgery, with low heterogeneity (I ² = 30.1%). Among comparative studies, one study reported significantly higher RTW odds for patients undergoing anatomic total shoulder arthroplasty compared to reverse shoulder arthroplasty (odds ratio = 5.45). Overall, surgical intervention for shoulder pathology was associated with a high likelihood of RTW across multiple techniques, with particularly favorable outcomes for anatomic total shoulder arthroplasty.

Conclusion: This systematic review highlights the high rates of RTW in farmers and heavy laborers after shoulder surgery. However, our findings also underscore the need for more rural-specific research to guide patient counseling, rehabilitation expectations, and shared decision-making in this underserved population, particularly for orthopedic surgery of the hip and knee.

Background: Aseptic loosening remains the leading cause of revision in primary total hip arthroplasty (pTHA). However, the literature demonstrates significant variability regarding the relative contributions of different factors.

Aim: To investigate the key determinants of aseptic loosening, we performed a systematic review and meta-analysis.

Methods: A comprehensive search of PubMed, Web of Science, EMBASE, and the Cochrane Library was conducted, encompassing studies from database inception to January 1, 2025. Meta-analyses were performed to evaluate factors associated with aseptic loosening following pTHA. Inclusion and exclusion criteria were systematically applied at each stage to ensure methodological transparency and reproducibility. Study quality was assessed using standardized categories. Pooled odds ratio (OR) with corresponding 95% confidence interval were calculated with random- or fixed-effects models to generate reliability estimates, and study heterogeneity was visualized using forest plots. Ten factors, categorized into patient-, surgeon-, and device-related domains, were reviewed and meta-analyzed. Funnel plot analysis demonstrated a relatively symmetrical distribution, suggesting minimal publication bias.

Results: A meta-analysis of 20 studies (520789 participants) found a pooled prevalence of 1.96%. Significant risk factors for aseptic loosening after pTHA included elevated body mass index (OR = 1.116, P < 0.001), higher Charlson comorbidity index (OR = 1.378, P < 0.001), prosthesis-related factors (OR = 1.497, P < 0.001), and adverse lifestyles (OR = 2.198, P = 0.037). Protective factors were non-white race (OR = 0.445, P < 0.001) and favorable genetics (OR = 0.723, P < 0.001). Male sex increased risk (OR = 1.232, P = 0.016), while age and anatomy were not significant. Surgical expertise showed a slight protective effect (OR = 1.048, P < 0.001). A comprehensive understanding of the modifiable and non-modifiable factors contributing to aseptic loosening after pTHA requires consideration of patient-related factors, surgical expertise, and prosthesis characteristics.

Conclusion: The identification of these factors is critical for risk mitigation. High-risk patients should receive targeted counseling regarding individualized profiles. Further studies are warranted to establish clearer causal relationships and identify additional contributing factors.

Molecular hydrogen (H₂) demonstrates selective antioxidant and anti-inflammatory properties with therapeutic potential across musculoskeletal conditions including osteoarthritis, rheumatoid arthritis, exercise-induced muscle damage, chronic pain syndromes, tendinopathies, and muscle atrophy. This review critically evaluates preclinical and clinical evidence for H₂ therapy and identifies research gaps. A comprehensive search of PubMed, EMBASE, and Cochrane Library (up to April 2025) yielded 45 eligible studies: 25 preclinical and 20 clinical trials. Preclinical models consistently showed reductions in reactive oxygen species, inflammatory cytokines, and improved cell viability. Clinical trials reported symptomatic relief in osteoarthritis, decreased Disease Activity Score 28 in rheumatoid arthritis, and accelerated clearance of muscle damage markers. Delivery methods varied - hydrogen-rich water, gas inhalation, and saline infusion - hindering direct comparison. Mechanistic biomarkers were inconsistently reported, limiting understanding of target engagement. Common limitations included small sample sizes, short durations, and protocol heterogeneity. Despite these constraints, findings suggest H₂ may serve as a promising adjunctive therapy via antioxidant, anti-inflammatory, and cytoprotective mechanisms. Future research should prioritize standardized delivery protocols, robust mechanistic endpoints, and longer-term randomized trials to validate clinical efficacy and optimize therapeutic strategies.

Background: Orthobiologics-biological substances like platelet-rich plasma (PRP), bone marrow aspirate concentrate, and stem cells-are increasingly used in musculoskeletal care to promote tissue repair and reduce reliance on invasive surgery. Despite global momentum, India's clinical adoption remains underexplored.

Aim: To inform education, policy, and resource allocation for the safe and effective adoption of orthobiologics in musculoskeletal care.

Methods: A cross-sectional electronic survey was conducted from January to March 2025 among orthopaedic surgeons, academicians, and trainees across India. The questionnaire assessed demographics, knowledge of orthobiologics, attitudes toward training and subspecialization, usage trends, regulatory awareness, and perceived barriers. Data were analyzed using descriptive statistics and χ ²/Fisher's exact tests, with P < 0.05 considered significant.

Results: A total of 1280 valid responses were collected. Awareness of orthobiologics was high (97%), with PRP being the most familiar and widely used (80%). Formal training was reported by only 31%, though 85% showed interest in structured education, and 68% supported orthobiologics as a subspecialty. Satisfaction with clinical outcomes averaged 6.5 ± 2.3 out of 10 points. Barriers included high treatment cost (64%), poor patient awareness (90%), and limited access to biologics labs (18%). Regulatory understanding was moderate, with academic-affiliated clinicians more informed about stem cell guidelines.

Conclusion: Indian orthopaedic professionals demonstrate strong awareness and optimism toward orthobiologics, but widespread gaps in training, infrastructure, and regulation hinder broader adoption. Strategic investments in education, standardized protocols, and accessible facilities are essential to support safe and evidence-driven integration of regenerative therapies into clinical practice.

Musculoskeletal injuries are among the most common causes of disability worldwide, with early detection and appropriate intervention critical to minimizing long-term complications. Infrared thermography (IRT) has emerged as a non-invasive, real-time imaging modality that captures superficial temperature changes reflecting underlying physiological processes such as inflammation and vascular alterations. This review explores the fundamental principles of medical thermography, differentiates between passive and active approaches, and outlines key technological advancements including artificial intelligence integration. The clinical utility of IRT is discussed in various contexts - ranging from acute soft tissue injuries and overuse syndromes to chronic pain and rehabilitation monitoring. Comparative insights with conventional imaging techniques such as ultrasound and magnetic resonance imaging are also presented. While IRT offers functional imaging capabilities with advantages in portability, safety, and speed, its limitations - such as lack of deep-tissue penetration and protocol standardization - remain significant barriers to broader adoption. Future directions include the integration of IRT with other imaging modalities and digital health platforms to enhance musculoskeletal assessment and injury prevention strategies.

Background: Orthopaedic surgical education has traditionally depended on the apprenticeship model of "see one, do one, teach one". However, reduced operative exposure, stricter work-hour regulations, medicolegal constraints, and patient safety concerns have constrained its practicality. Simulation-based training has become a reliable, safe, and cost-efficient alternative. Dry lab techniques, especially virtual and augmented reality, make up 78% of current dry lab research, whereas wet labs still set the standard for anatomical realism.

Aim: To evaluate the effectiveness, limitations, and future directions of wet and dry lab simulation in orthopaedic training.

Methods: A scoping review was carried out across four databases-PubMed, Cochrane Library, Web of Science, and EBSCOhost-up to 2025. Medical Subject Headings included: "Orthopaedic Education", "Wet Lab", "Dry Lab", "Simulation Training", "Virtual Reality", and "Surgical Procedure". Eligible studies focused on orthopaedic or spinal surgical education, employed wet or dry lab techniques, and assessed training effectiveness. Exclusion criteria consisted of non-English publications, abstracts only, non-orthopaedic research, and studies unrelated to simulation. Two reviewers independently screened titles, abstracts, and full texts, resolving discrepancies with a third reviewer.

Results: From 1851 records, 101 studies met inclusion: 78 on dry labs, 7 on wet labs, 4 on both. Virtual reality (VR) simulations were most common, with AI increasingly used for feedback and assessment. Cadaveric training remains the gold standard for accuracy and tactile feedback, while dry labs-especially VR-offer scalability, lower cost (40%-60% savings in five studies), and accessibility for novices. Senior residents prefer wet labs for complex tasks; juniors favour dry labs for basics. Challenges include limited transferability data, lack of standard outcome metrics, and ethical concerns about cadaver use and AI assessment.

Conclusion: Wet and dry labs each have unique strengths in orthopaedic training. A hybrid approach combining both, supported by standardised assessments and outcome studies, is most effective. Future efforts should aim for uniform reporting, integrating new technologies, and policy support for hybrid curricula to enhance skills and patient care.

Background: Anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone (BPTB) autografts remains the gold standard for young, active individuals due to its superior biomechanical strength and bone-to-bone healing. However, donor site morbidity, particularly anterior knee pain (AKP), limits its utilization despite its advantages. Various techniques have been proposed to reduce AKP, but they show variable outcomes and several limitations.

Aim: To assess the incidence and severity of AKP following BPTB ACL reconstruction using an autologous bone grafting technique.

Methods: We conducted a retrospective observational study of 24 patients aged 20-45 years, who had primary ACL reconstruction with BPTB grafts. During surgery, autologous cancellous bone generated from tunnel drilling was used to fill the patellar and tibial donor site voids after graft fixation. All patients were followed up for at least twelve months. Using the Kujala Anterior Knee Pain Score, clinical outcomes were evaluated, including the pain-specific subcomponent.

Results: With scores ranging from 86 to 100, the average overall Kujala score was 95.67 ± 4.01. No patient scored below 85. There was no complication such as patellar fracture, tibial tuberosity fracture, or infection. Grouped data showed 20.8% of patients scored 100, whereas 54.2% scored between 95 and 99, and 25% scored between 86 and 94. One patient (4.2%) had an 8/10 pain subcomponent, whereas 23 patients (95.8%) had a 10/10.

Conclusion: This procedure is easy to incorporate into routine surgical practice, cost-effective and reproducible without requiring extra incisions or raising the patient's surgical expenses. Excellent short-term results back up this technique.

Background: Humeral shaft fractures are common and vary by age, with high-energy trauma observed in younger adults and low-impact injuries in older adults. Radial nerve palsy is a frequent complication. Treatment ranges from nonoperative methods to surgical interventions such as intramedullary K-wires, which promote faster rehabilitation and improved elbow mobility.

Aim: To evaluate the outcomes of managing humeral shaft fractures using closed reduction and internal fixation with flexible intramedullary K-wires.

Methods: This was a retrospective cohort study analyzing the medical records of patients with humeral shaft fractures managed with flexible intramedullary K-wires at King Abdulaziz Medical City, using non-random sampling and descriptive analysis for outcome evaluation.

Results: This study assessed the clinical outcomes of 20 patients treated for humeral shaft fractures with intramedullary K-wires. Patients were predominantly male (n = 16, 80%), had an average age of 39.2 years, and a mean body mass index of 29.5 kg/m². The fractures most frequently occurred in the middle third of the humerus (n = 14, 70%), with oblique fractures being the most common type (n = 7, 35%). All surgeries used general anesthesia and a posterior approach, with no intraoperative complications reported. Postoperatively, all patients achieved clinical and radiological union (n = 20, 100%), and the majority (n = 13, 65%) reached an elbow range of motion from 0 to 150 degrees.

Conclusion: These results suggest that intramedullary K-wire fixation may be an effective option for treating humeral shaft fractures, with favorable outcomes in range of motion recovery, fracture union, and a low rate of intraoperative complications.

Bone regeneration for non-load-bearing defects remains a significant clinical challenge requiring advanced biomaterials and cellular strategies. Adipose-derived mesenchymal stem cells (AD-MSCs) have garnered significant interest in bone tissue engineering (BTE) because of their abundant availability, minimally invasive harvesting procedures, and robust differentiation potential into osteogenic lineages. Unlike bone marrow-derived mesenchymal stem cells, AD-MSCs can be easily obtained in large quantities, making them appealing alternatives for therapeutic applications. This review explores hydrogels containing polymers, such as chitosan, collagen, gelatin, and hyaluronic acid, and their composites, tailored for BTE, and emphasizes the importance of these hydrogels as scaffolds for the delivery of AD-MSCs. Various hydrogel fabrication techniques and biocompatibility assessments are discussed, along with innovative modifications to enhance osteogenesis. This review also briefly outlines AD-MSC isolation methods and advanced embedding techniques for precise cell placement, such as direct encapsulation and three-dimensional bioprinting. We discuss the mechanisms of bone regeneration in the AD-MSC-laden hydrogels, including osteoinduction, vascularization, and extracellular matrix remodeling. We also review the preclinical and clinical applications of AD-MSC-hydrogel systems, emphasizing their success and limitations. In this review, we provide a comprehensive overview of AD-MSC-based hydrogel systems to guide the development of effective therapies for bone regeneration.

Background: Medial dished (MD) liner designs for cruciate-retaining (CR) total knee arthroplasty (TKA) are a relatively novel development. MD tibial inserts have a more constraining medial side, which allows for more similar kinematics and function to a native knee.

Aim: To evaluate the clinical results and patient-reported outcomes after CR TKA procedures utilizing a kinematically designed medial dish system.

Methods: A multicenter, retrospective cohort review of 139 primary elective TKAs utilizing a kinematically designed CR Knee System (JOURNEY™ II CR MD; Smith and Nephew, Memphis, TN, United States) at three different institutions with a minimum of two years of follow-up. Demographic information, clinical outcomes, and patient-reported outcome measures were collected and analyzed.

Results: With up to 3.7 years from surgery, overall implant survivorship was 98.6%. There were significant postoperative increases in the average Knee Injury and Osteoarthritis Outcome Score for Joint Replacement scores (17.4 at 6 months, 26.1 points at two years or more, P < 0.001).

Conclusion: The combination of high implant survivorship and substantial improvements in patient-reported outcome measures suggests that the medial dish tibial insert represents a safe and effective option within TKA. Additional investigation is necessary to evaluate the long-term survivorship of this design.