World Journal of Orthopedics最新文献

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.

Background: Aneurysmal bone cysts (ABCs) are usually treated with curettage or various minimally invasive percutaneous procedures. Patient refractory to these treatments, as well as those with locally advanced or unresectable tumors, present a challenge for orthopedic surgeons and require new treatment approaches. Anti-resorptive drugs inhibit osteoclastic resorption and increase intralesional osteogenesis. Denosumab induces tumor ossification, but this effect may disappear after drug withdrawal due to limited impact on neoplastic cells. Bisphosphonates (BPs) may induce apoptosis of tumor cells and allow for long-term local control. We hypothesized that after denosumab treatment, BPs would better accumulate in the tumor and exert an irreversible antitumor effect.

Aim: To test the hypothesis that the sequential use of BPs after denosumab induction improves treatment outcomes in surgically unsalvageable ABCs.

Methods: Using data from five electronic databases (Scopus, MEDLINE, EMBASE, PubMed, Web of Science), we aimed to identify all patients who received denosumab therapy (DT) for unresectable ABCs. Among published case reports and case series, we identified patients who discontinued denosumab for various reasons and divided them into two groups: Group 1 included 31 patients without further anti-resorptive therapy and Group 2 included 12 patients who received BPs in the context of rebound hypercalcemia. Local control rates in both groups were analyzed.

Results: As of December 2024, 43 patients have been reported in the literature who received DT for locally advanced/unresectable ABCs. There were 27 males and 16 females with a mean age of 15.8 years. At a median follow-up time of 15.5 months, there were 10 confirmed and two pathologically unconfirmed relapses after denosumab discontinuation. All 10 relapses occurred in patients in Group 1 at a median time of 13.5 months. Among patients in Group 2, with a median follow-up time of 12.5 months after completion of therapy, no local relapses were observed. The difference between local recurrence rates (32% vs 0%) is statistically significant (P value = 0.02). Kaplan-Meier estimates show the same trend with marginal statistical significance (P value = 0.085). Here we put forward a novel treatment algorithm.

Conclusion: BPs used in post-denosumab ossifying ABCs appear to improve treatment outcomes, presumably by targeting residual tumor cells. Prospective clinical studies are warranted to validate this promising two-stage conceptual strategy in difficult-to-treat ABC.

Intertrochanteric fractures, prevalent among older adults, pose significant clinical challenges due to high morbidity, mortality, and complication rates. Despite advancements in surgical methods and implant technology, one-year mortality remains between 20% and 30%, with up to 20% of survivors requiring revision surgery due to mechanical complications. Accurate fracture reduction and precise implant positioning are critical determinants of successful outcomes. This review synthesizes current literature on key radiographic parameters essential for evaluating fracture reduction quality and implant placement in intertrochanteric fracture fixation. Standardized intraoperative imaging techniques, such as correct anteroposterior and lateral fluoroscopic views, are fundamental for identifying malalignment. Important radiographic measures include the neck shaft angle, greater trochanter orthogonal line, anterior cortical line, and calcar displacement assessment. Reduction quality indices, notably the Baumgaertner and Chang Reduction Quality Criteria, provide reliable frameworks for predicting mechanical complications. Additionally, implant positioning parameters-including tip-apex distance, Calcar-referenced tip-apex distance, Cleveland zones, and Parker's ratio index-are discussed as predictors of mechanical complications. Enhanced understanding and application of these radiographic criteria can improve surgical precision, reduce complications, and ultimately optimize patient outcomes in intertrochanteric fracture management.

Bone defects caused by trauma, infection, or congenital anomalies remain a significant challenge in orthopedic and dental practice, necessitating innovative strategies to enhance healing and functional restoration. This systematic review by Pagani et al synthesizes evidence on the synergistic role of synthetic biomaterials, such as hydroxyapatite (HA) and β-tricalcium phosphate (β-TCP), combined with fibrin derivatives in bone regeneration. Analyzing 21 studies, the authors demonstrate that HA and β-TCP composites exhibit superior osteoconductivity and biocompatibility when integrated with fibrin sealants or platelet-rich fibrin, promoting cellular adhesion, osteogenic differentiation, and accelerated healing. While these studies underscore the potential of these biomaterial-fibrin hybrids, limitations such as variability in fibrin preparation, lack of long-term data, and insufficient standardization hinder clinical translation. This editorial contextualizes these findings within the evolving landscape of regenerative medicine, emphasizing the need for optimized formulations, interdisciplinary collaboration, and robust clinical trials to bridge laboratory innovation to bedside application.

Background: Leg length discrepancy (LLD) following total hip arthroplasty (THA) is a common complaint, leading to decreased patient satisfaction. However, the effect of LLD before THA on outcomes and complications is not well defined.

Aim: To assess the effect of prior LLD on rates of falls, implant-related complications, stay length, readmissions, and implant survival following THA.

Methods: A retrospective review of a nationwide insurance database was conducted from 2010 to 2021. All cases of THA and those with a prior diagnosis of LLD were identified. THA patients with LLD were matched to control patients 1:5 based on demographic and comorbidity profiles. Two-year fall rates and implant complications, lengths of stay, 90-day readmissions, and time to revision were compared between cohorts.

Results: A total of 2038 patients with LLD were matched to 10165 control patients. The LLD group showed significantly greater rates of falls [odds ratio (OR) = 1.58; 95% confidence interval (95%CI): 1.24-2.01], dislocation (OR = 2.61; 95%CI: 2.10-3.24), mechanical loosening (OR = 4.58; 95%CI: 3.28-6.29), and periprosthetic fracture (OR = 2.70; 95%CI: 1.96-3.72) compared to the control group (all P < 0.001). Mean length of stay (LOS) was also significantly higher in the LLD group (3.1 days vs 2.8 days, P = 0.034). No significant difference in 90-day readmission rates (7.75% vs 7.02%, P = 0.244) was observed between the groups (P = 0.244). Time to revision was significantly less in the LLD group (225 days vs 544 days, P < 0.001).

Conclusion: LLD in patients having THA is related with significantly higher fall risk, rates of implant-related complications, LOS, and quicker time to revision. Identifying patients with LLD before their THA may help in identifying risks, better patient counselling, and more effective preoperative planning. However, the study have important limitations: Its design lacks information on the degree and cause of LLD, the time between diagnosis and surgery, and which leg with the discrepancy underwent the operation. Future well-designed studies should confirm the findings of this study.

Routine postoperative radiographs after surgical fixation of pediatric distal-radius fractures have long been part of standard care. Yet growing evidence shows that these images rarely change management in stable cases, adding unnecessary cost, radiation exposure, and clinical burden. A recent study highlights this issue and questions whether routine imaging truly benefits patient outcomes. As orthopedic care shifts toward more patient-centered and value-driven models, there is increasing support for the judicious use of radiographs, reserving imaging for cases where clinical examination or patient symptoms suggest a potential problem. This shift would reflect a broader movement within orthopedic practice: Aligning tradition with necessity, and optimizing care based on evidence rather than habit.

Background: This is a retrospective study on endoscopic treatment of cervical spinal radiculopathy (CSR) conducted at a single academic institution. Conventional full-spine endoscopy is performed in a single portal which has certain limitations of high technical requirements, steep learning curve, and narrow indications. Although unilateral biportal endoscopy (UBE) technique has a gentle learning curve and is gradually applied to treat CSR, all procedures were performed in the uniportal working channel that potentially increase the surgical risk and time in the treatment of complex cases. It is worthy to delve novel technique for more working channels in the treatment of complex CSR.

Aim: To propose a hybrid technique (HT) that utilizes spine endoscopy in UBE to treatment of CSR.

Methods: A total of 81 patients with single-segment CSR who underwent uniportal endoscopic surgery (UES), UBE, or HT at a single institution between September 2019 and August 2021 were retrospectively studied. Perioperative patient data were compared between the groups. The pre-operative and post-operative images were compared to confirm adequate decompression of the nerve root canal. Patients' visual analogue scale (VAS) scores and neck disability index (NDI) were recorded before surgery, and three days, three months and six months after surgery.

Results: The UBE and HT groups had a significantly shorter operation duration than the UES group. Data for bleeding and length of hospital stay were significantly higher in the UBE group than in the UES and HT groups. The hospitalization cost was lowest in the UES group and highest in the HT group. Soft tissue edema reaction bands on post-operative day 3 were larger in the UBE and HT groups than in the UES group. Post-operative VAS and NDI scores were significantly lower in all three groups than the pre-operative levels. On post-operative day 3, the VAS score for neck pain was significantly higher in the UBE and HT groups than that in the UES group. However, there were no significant differences in the VAS scores for arm pain or NDI between the three groups. The post-operative 3-month and 6-month neck pain VAS, arm pain VAS, NDI, and modified Macnab success rates did not differ statistically between the three groups.

Conclusion: The HT for CSR treatment has the advantage of double working channels to facilitate decompression and hemostasis, improving the surgical efficiency and clinical outcomes of CSR.