World Journal of Orthopedics最新文献

Background: Tibial plateau fractures often require structural support for metaphyseal defects created during articular reduction. While autologous bone grafting has been utilized as the gold standard, bone substitutes offer advantages including reduced donor site morbidity. Our meta-analysis evaluated the comparative efficacy of these approaches across clinical and operative outcomes.

Aim: To conduct a systematic review and meta-analysis of randomized controlled trials comparing autologous bone grafts with bone substitutes for tibial plateau fractures.

Methods: We conducted a systematic review and meta-analysis of randomized controlled trials comparing autologous bone grafts with bone substitutes for tibial plateau fractures. Primary outcomes included joint depression, secondary collapse rate, operative time, blood loss, and infection rate. Subgroup analyses were performed by fracture complexity, geographic region, and methodological factors. In addition to that, we also developed a combined outcome score integrating structural, procedural, and complication domains.

Results: Seven randomized controlled trials with 424 patients (296 bone substitute, 128 autograft) were included. No significant differences in joint depression or secondary collapse were observed across fracture complexity categories. Geographic variations were evident, with Western studies showing significantly higher risk of secondary collapse with autografts (risk ratio = 1.45, P value = 0.02). Both Western and Asian studies have demonstrated significantly reduced blood loss with bone substitutes (70-90 mL less), while operative time reduction was more significant in the Asian studies (23.65 vs 8.00 minutes, P value = 0.04 for subgroup difference). The combined outcome score (standardized effect size -0.2481) favored bone substitutes, primarily due to procedural advantages.

Conclusion: Bone substitutes provide similar structural outcomes to autologous bone grafts while having better procedural advantages in tibial plateau fracture management. These findings support bone substitutes as a viable option across fracture patterns. Future studies should focus on specific bone substitute formulations and cost-effectiveness analyses.

Inflammatory bone diseases constitute a category of chronic inflammatory disorders, with the primary pathological characteristic being the impact of chronic inflammation on bone metabolism and remodeling. It leads to pain, spinal joint deformities, and functional impairments. Common clinical types of inflammatory bone diseases include rheumatoid arthritis, ankylosing spondylitis, and osteoarthritis. However, there is a paucity of effective clinical treatments for inflammatory bone diseases, and pharmacological interventions are frequently associated with intolerable side effects. Traditional Chinese medicine (TCM) has a long-standing history and proven efficacy in managing inflammatory bone diseases. In recent years, an increasing number of studies have highlighted the potential of TCM in this context. This article systematically evaluates the application of TCM in treating inflammatory bone diseases, emphasizing the underlying molecular mechanisms of its anti-inflammatory effects. By elucidating the specific targets of TCM in the treatment of rheumatoid arthritis, ankylosing spondylitis, and osteoarthritis, we aim to provide novel insights into the further exploration of TCM's role in clinical application for inflammatory bone diseases.

Lumbar interbody fusion is essential for treating degenerative lumbar diseases. The disadvantages of open surgery have led to the evolution of minimally invasive spine surgery, including endoscopic techniques such as unilateral biportal endoscopy (UBE). Leveraging arthroscopic principles, UBE offers superior visualization and flexibility and expands from decompression to fusion (UBE fusion). However, achieving robust UBE fusion presents challenges, such as suboptimal arthrodesis rates and implant-related complications, requiring more than surgical skill alone. Optimizing UBE fusion critically depends on the effective integration of advanced biomaterials with the surgical technique. This minireview assessed recent advances in UBE, focusing on the development of novel biomaterials, such as functionalized porous, expandable, or double-cage designs, to improve bone regeneration outcomes. These advancements address challenges, like washout of bone graft material and biologics, and utilize growth factors, such as recombinant human bone morphogenetic proteins, while exploring pathway modulation to improve outcomes. We also evaluated clinical optimization strategies involving technical refinements, fluid and hemostasis control, key complication mitigation especially concerning dural tears and hematomas, and technologies such as navigation and robotics. While UBE shows promise particularly for early recovery, its long-term success hinges on these biotechnological advancements. High-quality evidence, especially from randomized controlled trials and long-term studies, is needed to validate integrated strategies and define the optimal role of UBE fusion.

Rotator cuff tears are highly prevalent, and there is an urgent need to understand their healing mechanisms to improve treatment outcomes for patients. This editorial aims to summarize the roles and limitations of common animal models (including rodents, rabbits, sheep, dogs, and primates) and second-look arthroscopy in rotator cuff healing research. Different animal models offer distinct advantages and disadvantages. For example, rodent models are cost-effective and suitable for genetic studies but have anatomical differences from humans. Rabbit models are favored for their relatively large tendon size and ease of surgical manipulation, yet they still deviate from human shoulder anatomy in some aspects. Larger animals like sheep and dogs have more similar shoulder structures to humans but come with high costs and challenges in maintaining consistent experimental conditions. Second-look arthroscopic studies have provided evidence for the effectiveness of current surgical techniques. Animal models will continue to play a crucial role in further exploring the local microenvironment of the rotator cuff, which is expected to help develop more effective strategies to promote healing.

Total hip arthroplasty (THA) effectively treats advanced hip disorders, yet outcomes vary among patients. Frailty has become a crucial factor influencing these results. Several studies explored multiple preoperative factors affecting THA outcomes, highlighting the significance of age, Western Ontario and McMaster Universities Osteoarthritis Index, Center for Epidemiologic Studies Depression Scale, and central sensitization index scores in predicting post-operative recovery, emphasizing comprehensive preoperative assessments. Subsequent research has shown that frailty, measured by tools like the hospital frailty risk score and frailty deficit index, is significantly associated with adverse outcomes such as higher 30-day readmission rates, longer hospital stays, increased costs, and elevated mortality and complication risks in both primary and revision THA. Additionally, frailty related to short-term adverse events but stressed the need for standardized frailty measurement. Currently, there is no unified standard for assessing frailty before THA, which hinders cross-study comparison and evidence-based guideline development. Future research should focus on establishing a universal frailty assessment standard considering physical function, comorbidities, cognitive and psychological status. Prospective studies are also needed to clarify the causal relationship between frailty and long-term THA outcomes and identify modifiable factors for preoperative interventions. Overall, understanding the impact of frailty on THA outcomes is essential for improving patient care and resource utilization, especially in an aging population with a rising prevalence of hip disorders.

Background: Proximal humerus fractures (PHFs) are common, especially in the elderly, and optimal surgical management remains debated. This study compares clinical, functional, and radiographic outcomes of deltoid split (DS) vs deltopectoral (DP) approaches in PHFs treated with locking plates.

Aim: To evaluate and compare the clinical, functional, and radiographic outcomes-as well as postoperative complication rates-associated with the DS vs the DP surgical approach in the open reduction and internal fixation (ORIF) of PHFs using locking plate constructs.

Methods: A multicenter retrospective study of 120 patients undergoing ORIF for closed Neer type II-IV PHFs between January 2023 and December 2023. Patients were grouped by surgical approach [DS (n = 70), DP (n = 50)]. Outcome measures included Numeric Rating Scale (NRS) for pain, Quick-Disabilities in Arm, Shoulder, and Hand questionnaire (QuickDASH), Constant-Murley score, Short Form Health Survey-12v2, and radiographic alignment. Complication rates were recorded. Statistical significance was defined as P < 0.05.

Results: Early outcomes favored the DS group: (1) Lower NRS (3.1 vs 5.9); (2) Higher Constant-Murley (68.2 vs 50.5); and (3) Better QuickDASH (25.4 vs 37.1). Complication rate was lower in the DS group (1.66% vs 5.81%). Radiographic outcomes were comparable. Long-term results were similar between groups.

Conclusion: While both approaches yield satisfactory long-term outcomes, the DS approach is associated with faster early recovery and fewer complications, supporting its use in selected cases.

Crush syndrome demands an integrated multidisciplinary approach that spans acute surgical decisions and long-term functional recovery. In response to Khan et al's recent systematic review, we propose complementary perspectives that address two underrepresented dimensions: Vascular surgical decision-making and psychiatric rehabilitation. We emphasize the use of intraoperative technologies such as indocyanine green fluorescence angiography and compartment pressure monitoring to guide limb salvage strategies and reperfusion management. Additionally, we advocate for the systematic integration of mental health screening and trauma-informed psychiatric care to address the high prevalence of psychological distress in survivors. Embedding these domains into standardized protocols could enhance both short- and long-term outcomes, particularly in high-impact trauma and disaster settings.

Artificial intelligence (AI) and machine learning (ML) are transforming spine care by addressing diagnostics, treatment planning, and rehabilitation challenges. This study highlights advancements in precision medicine for spinal pathologies, leveraging AI and ML to enhance diagnostic accuracy through deep learning algorithms, enabling faster and more accurate detection of abnormalities. AI-powered robotics and surgical navigation systems improve implant placement precision and reduce complications in complex spine surgeries. Wearable devices and virtual platforms, designed with AI, offer personalized, adaptive therapies that improve treatment adherence and recovery outcomes. AI also enables preventive interventions by assessing spine condition risks early. Despite progress, challenges remain, including limited healthcare datasets, algorithmic biases, ethical concerns, and integration into existing systems. Interdisciplinary collaboration and explainable AI frameworks are essential to unlock AI's full potential in spine care. Future developments include multimodal AI systems integrating imaging, clinical, and genetic data for holistic treatment approaches. AI and ML promise significant improvements in diagnostic accuracy, treatment personalization, service accessibility, and cost efficiency, paving the way for more streamlined and effective spine care, ultimately enhancing patient outcomes.

Background: Bilateral hip disorder is a common finding that can occur in approximately 42% of the population with osteoarthritis. It is estimated that 25% individuals with osteoarthritis requiring total hip replacement (THR) may require a bilateral replacement. This has resulted in the test of the greatest strategy to run single staged bilateral hip replacement while addressing the outcomes to achieve swift and cost-effective patient recovery.

Aim: To assess the outcomes and cost effectiveness of bilateral THR (B/L THR) at our tertiary care hospital.

Methods: Retrospective observational cross- sectional study was undertaken from Jan 2018 to July 2023 to assess the clinical outcomes of patients who underwent single stage B/L THR.

Results: Data of 75 patients were analysed. The mean age was 36 years. Our complication rate was 4.0% including acute coronary syndrome, intra-operative acetabular fracture and paralytic ileus. The re-admission rate was 4%.

Conclusion: The choice of sequential or bilateral hip replacement is controversial. While, our study showed that bilateral hip replacement is safe and cost effective. As surgeons, we were careful in patient selection (low American Society of Anesthesiologist score). Though more than 50% of our B/L THR patients were obese [body mass index (BMI) > 25], our outcomes were equivalent to normal BMI patients with lower risk of complication as well as early ambulation. Systemic complication deep vein thrombosis and pulmonary embolism were handled prophylactively by close monitoring, use of mechanical and pharmacological agents along with anticoagulants. Patients who require THR, often require them bilaterally and single stage replacement thus offers early restoration of an individual into their activities of daily living with minimal complications. Our findings support the use of single-stage B/L THR as a viable option for bilateral hip disorders, having favourable outcomes.

Skeletal stem cells (SSCs) are tissue-specific stem cells characterized by their capacity for self-renewal and their position at the apex of the differentiation hierarchy. They can generate mature bone cell types essential for bone development, maintenance, and repair. Lineage tracing experiments have demonstrated that SSCs reside in the bone marrow, periosteum, and the resting zone of the growth plate. These findings not only enhance our understanding of bone growth and development mechanisms but also offer novel therapeutic strategies for conditions such as epiphyseal injuries, fractures, osteoarthritis (OA), and other orthopedic diseases. Recent advancements in biological scaffold technology, combined with 3D printing techniques, have facilitated bone tissue regeneration using bone stem cells. In OA, SSCs antagonize inflammatory factors, such as tumor necrosis factor-alpha and interleukin-1 beta, via paracrine secretion of insulin-like growth factor 1 and transforming growth factor-beta. Simultaneously, SSCs secrete matrix metalloproteinase inhibitors to maintain cartilage matrix homeostasis. In femoral head necrosis, SSCs promote angiogenesis by secreting vascular endothelial growth factor and optimize the repair microenvironment through immune regulation, such as by inhibiting the nuclear factor-kappa B pathway. Additionally, bone stem cells have shown promise in cartilage regeneration therapy, particularly in treating degenerative diseases like OA and articular cartilage damage, thereby improving joint function. This review summarizes the latest research progress on the role of skeletal stem cells in bone and joint injury regeneration and provides new insights into potential therapeutic approaches.