Periprosthetic fractures of the tibial shaft following long-stemmed total knee arthroplasty: A case report

BACKGROUND

Periprosthetic fractures of the tibia are uncommon complications after total knee arthroplasty (TKA). Therefore, there is still clinical debate regarding the appropriate treatment method. This study presents the case of a patient with two successive periprosthetic fractures of the tibial shaft treated with revision TKA (rTKA) and intramedullary fixation.

CASE SUMMARY

A 65-year-old woman was treated for tibial shaft pseudarthrosis after a periprosthetic fracture. The patient underwent rTKA with a tibial component exchange to a long-stemmed implant. At her 1.5-year follow-up visit, partial asymptomatic bone union was noted with no prosthesis loosening. The patient achieved 0° to 120° range of motion and a stable knee, and reported high satisfaction. Improvements were observed in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) from 74 to 17, and in the knee society scores (KSS) from 56 to 91 (clinical) and 10 to 80 (functional). After 2.5 years, the patient sustained a second fracture below the original site due to low-energy trauma. The rTKA with intramedullary stabilization was performed. One year later, WOMAC and clinical and functional KSS were 15, 81, and 80, respectively. Despite tibial shortening and lower limb inequality, the patient remains very satisfied and does not experience any issues with daily activities nor weight-bearing.

CONCLUSION

There is little consensus in the literature on the management of tibial shaft periprosthetic fractures. Intramedullary stabilization may yield excellent outcomes, but individual case discussion is necessary for rTKA indications.

Fundamentals of intervertebral disc degeneration and related discogenic pain

Lumbar intervertebral disc degeneration is thought to be the main cause of low back pain, although the mechanisms by which it occurs and leads to pain remain unclear. In healthy adult discs, vessels and nerves are present only in the outer layer of the annulus fibrosus and in the bony endplate. Animal models, and histological and biomechanical studies have shown that annulus tear or endplate injury is the initiating factor for painful disc degeneration. Injury to the disc triggers a local inflammatory repair response that activates nociceptors and promotes the synthesis of neuropeptides such as substance P and calcitonin gene-related peptide, by dorsal root ganglion neurons. These neuropeptides are transported to injured discs and act as pro-inflammatory molecules, promoting the production of an "inflammatory soup" by inducing vasodilatation and plasma extravasation as well as by promoting the release of chemical mediators from disc cells and infiltrating immune cells, causing neurogenic inflammation that leads to progressive disc degeneration and discogenic pain.

Current status of nanofat in the management of knee osteoarthritis: A systematic review

BACKGROUND

Osteoarthritis (OA) is a prevalent joint disorder requiring innovative treatment approaches.

AIM

To evaluate the use of nanofat, a specialized form of adipose tissue-derived cells, in the treatment of OA, by examining its efficacy, safety profile, mechanisms of action, comparative effectiveness, and long-term outcomes.

METHODS

A comprehensive review of preclinical studies, clinical trials, and in vitro investigations was conducted. The included studies provided insights into the potential role of nanofat in OA treatment, addressing its efficacy, safety profile, mechanisms of action, comparative effectiveness, and long-term outcomes.

RESULTS

Clinical studies consistently reported the efficacy of nanofat in providing pain relief and functional improvement in patients with OA. Local adverse events were limited to the injection site, such as localized pain and inflammation, and resolved within a few days to weeks. Systemic adverse events were rare, and no significant long-term complications were observed. Mechanistically, nanofat was found to enhance chondrocyte proliferation, reduce inflammation, and promote angiogenesis, thereby contributing to its therapeutic effects.

CONCLUSION

Nanofat therapy holds promise as a therapeutic option for managing OA, providing pain relief, functional improvement, and potential tissue regeneration. The safety profile of nanofat treatment appears favorable, but long-term data are still limited. Standardized protocols, larger randomized controlled trials, longer follow-up periods, and cost-effectiveness evaluations are warranted to establish optimal protocols, comparative effectiveness, and long-term outcomes. Despite current limitations, nanofat therapy demonstrates translational potential and should be considered in clinical practice for OA treatment, with careful patient selection and monitoring.

Platelet rich plasma and anterior cruciate ligament repair: A new frontier, or a short term adjunct

Platelet rich plasma (PRP) is an autologous blood product rich in platelets, showing promise in reducing inflammation and accelerating healing. While extensively utilized in plastic surgery, dermatology, and osteoarthritis treatment, its application in anterior cruciate ligament (ACL) injuries is limited. This article examines PRP's potential in ACL reconstruction (ACLR), exploring its history, current usage, controversies and future directions. PRP has demonstrated significant early benefits in ligamentisation and vascularisation post-ACLR, though its long-term efficacy is inconsistent. Studies suggest that PRP may serve as both an adjunct therapy in ACLR to enhance initial healing and reduce postoperative complications, and as a non-surgical alternative for small ACL tears. Despite these promising findings, outcome variability necessitates further high-quality research to optimize PRP formulations and determine its most effective applications. The exploration of PRP as a treatment modality in ACLR offers promising but varied outcomes. PRP holds considerable promise as both an adjunct and alternative to traditional ACLR. This article underscores the need for targeted research to fully realize PRP's therapeutic potential in ACL treatment, aiming to inform future studies and clinical practices. By understanding PRP's mechanisms of efficacy and identifying the most beneficial patient populations, PRP could significantly impact orthopaedics and sports medicine, improving recovery pathways and patient outcomes.

Long-term follow-up result of short metaphyseal femoral stem in primary total hip arthroplasty: A retrospective study

BACKGROUND

Total hip arthroplasty (THA) has increased along with an increasing demand for improved quality of life. Combined with prolonged life expectancy, the number of revision surgeries is expected to increase. Stress shielding is a significant issue with traditional femoral stems used in THA, making revision surgeries particularly challenging in younger patients. This has sparked renewed interest in studying safety and functional outcomes of short metaphyseal femoral stems, which have the potential to alleviate these challenges and simplify revision surgeries.

AIM

To evaluate the long-term outcomes of short-stem THA.

METHODS

A total of 124 hips that underwent THA using the short femoral stem (TRILOCK® Depuy) between May 2006 and November 2008 were included in this study. Patients were followed for a period of 15 years. Outcomes were assessed in terms of pain relief, hip joint range of motion, improvement in mobility, and functional outcomes using the modified Harris Hip Score, Oxford hip score, and Western Ontario and McMaster Universities Osteoarthritis index score.

RESULTS

A total of 124 hips in 98 patients were evaluated. Significant improvements in functional outcomes were observed over the 15-year follow-up period, with no cases of subsidence, implant loosening, or complications necessitating revision surgery. The only complication reported was heterotopic ossification in 1 patient.

CONCLUSION

Short metaphyseal stems provide better functional outcomes with early mobilization, and its long-term follow-up without subsidence, implant loosening, or proximal femoral bone loss simplifies revision surgery in younger patients.

Assessment of the hip-spine relationship in total hip arthroplasty for childhood hip disorders sequelae

In this article, we comment on the article by Oommen et al. Oommen et al provided a comprehensive overview of the management of hip centre restoration in total hip arthroplasty (THA) for childhood hip disorder sequelae. Given the developmental disparity in this population, specific preoperative planning is an essential prerequisite for the success of THA procedures. In the review by Oommen et al, assessments of acetabular and femoral anatomic variations were fully described. However, spinal malalignment and stiffness are common in physical and radiological examinations and should be taken into careful consideration when planning surgical procedures. Poor outcomes of THA for patients with comorbid hip and spinopelvic pathologies have been widely reported, especially for hips with childhood disorder sequelae. Therefore, in this editorial, we would like to emphasize the need for a thorough hip-spine evaluation of patients with childhood hip disorder sequelae before THA.

Integrating finite element analysis in total hip arthroplasty for childhood hip disorders: Enhancing precision and outcomes

Total hip arthroplasty for adults with sequelae from childhood hip disorders poses significant challenges due to altered anatomy. The paper published by Oommen et al reviews the essential management strategies for these complex cases. This article explores the integration of finite element analysis (FEA) to enhance surgical precision and outcomes. FEA provides detailed biomechanical insights, aiding in preoperative planning, implant design, and surgical technique optimization. By simulating implant configurations and assessing bone quality, FEA helps in customizing implants and evaluating surgical techniques like subtrochanteric shortening osteotomy. Advanced imaging techniques, such as 3D printing, virtual reality, and augmented reality, further enhance total hip arthroplasty precision. Future research should focus on validating FEA models, developing patient-specific simulations, and promoting multidisciplinary collaboration. Integrating FEA and advanced technologies in total hip arthroplasty can improve functional outcomes, reduce complications, and enhance quality of life for patients with childhood hip disorder sequelae.

Teriparatide as a non-surgical salvage therapy for prolonged humerus fracture nonunion: A case report and literature review

BACKGROUND

Fracture nonunion represents a challenging complication during fracture repair, often necessitating surgical intervention. Teriparatide, a recombinant human parathyroid hormone, has demonstrated promise in enhancing fracture healing, although its efficacy in treating established nonunion remains under investigation.

CASE SUMMARY

We report a case of a 27-year-old male who presented with a right humerus fracture following a traffic accident. Despite undergoing open reduction and internal fixation, the fracture resulted in a delayed union and subsequent nonunion. After 4 years of conservative management, teriparatide treatment was initiated due to persistent nonunion. Teriparatide injections were administered daily for 6 months, resulting in complete fracture healing and resolution of pain.

CONCLUSION

Our case demonstrates the successful use of teriparatide in treating a prolonged nonunion of a humerus fracture. Teriparatide may provide a valuable therapeutic option for established bone nonunion, even in cases that have not responded to conservative treatments.

Comparative study of a rabbit model of spinal tuberculosis using different concentrations of Mycobacterium tuberculosis

BACKGROUND

Tuberculosis is among the most devastating infectious diseases worldwide. Spinal tuberculosis is not easy to detect at an early stage, which without effective treatment often leads to spinal deformity and spinal cord damage which in turn cause complications such as paraplegia and quadriplegia. In this study, we established a model using three concentrations of bacteria and carried out a comprehensive evaluation of the model by imaging, general observations, and histopathological and bacteriological studies.

AIM

To establish a rabbit model of spinal tuberculosis and examine the effect on the model's efficacy using different concentrations of Mycobacterium tuberculosis (M. tuberculosis) inoculum.

METHODS

New Zealand rabbits were randomly divided into experimental, control and blank groups. The experimental and control animals were sensitized with complete Freund's adjuvant, a hole was drilled beneath the upper endplate of the L6 vertebral body and filled with gelfoam sponge. The experimental group was divided into three subgroups (experimental 1, experimental 2, experimental 3) and infused with M. tuberculosis suspension at various concentrations. The control group was inoculated with saline and the blank group received no treatment. The 12-week post-operative survival rates were 100%, 80% and 30% in the experimental groups inoculated with concentrations of 106, 107 and 108 CFU/mL bacteria, respectively.

RESULTS

The survival rate of the control and blank groups was 100%. Vertebral body destruction at 8 weeks in the three experimental groups as determined by X-ray analysis was 33.3%, 62.5% and 66.7%, and by computed tomography (CT) and 3-dimensional CT 44.4%, 75% and 100%, respectively. At 12 weeks, the figures were 44.4%, 75% and 100% by X-ray analysis and 44.4%, 100% and 100% by CT and 3-dimensional CT, respectively. All surviving rabbits of the experimental groups had vertebral destruction. The positive bacterial culture rates were 22.2%, 75% and 66.7%, respectively, in the experimental groups. After being sensitized with complete Freund's adjuvant, large differences were observed in the extent of spinal tuberculosis after inoculation of the rabbits with different concentrations of H37RV standard M. tuberculosis.

CONCLUSION

The experimental 1 had a low success rate at establishing an infection. The experimental 3 resulted in high mortality and complication rates. The experimental 2 was optimum for establishing a spinal tuberculosis model based on the high level of symptoms observed and the low rabbit mortality.

Advances in 3D correction of adolescent scoliosis: The superiority of scoliocorrector fatma-UI in rotational realignment

This letter compares the clinical efficacy and economic feasibility of the scoliocorrector fatma-UI (SCFUI) with direct vertebral rotation (DVR) in treating adolescent idiopathic scoliosis (AIS). SCFUI has shown promising results in three-dimensional spinal correction, providing superior rotational alignment compared to DVR and achieving significant improvements in coronal and sagittal planes. Additionally, SCFUI's advanced design reduces risks associated with AIS surgeries and enhances overall patient outcomes. Economic analysis reveals SCFUI as a cost-effective option, potentially lowering long-term healthcare costs by minimizing complications and revisions. Our findings suggest that SCFUI is a viable, innovative approach in AIS treatment, meeting clinical and economic demands in orthopedic care.

Limited evidence to support demineralized bone matrix in foot and ankle surgical procedures: A systematic review

BACKGROUND

Demineralized bone matrix (DBM) is a commonly utilized allogenic bone graft substitute to promote osseous union. However, little is known regarding outcomes following DBM utilization in foot and ankle surgical procedures.

AIM

To evaluate the clinical and radiographic outcomes following DBM as a biological adjunct in foot and ankle surgical procedures.

METHODS

During May 2023, the PubMed, EMBASE and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following DBM for the management of various foot and ankle pathologies. Data regarding study characteristics, patient demographics, subjective clinical outcomes, radiological outcomes, complications, and failure rates were extracted and analyzed. In addition, the level of evidence (LOE) and quality of evidence (QOE) for each individual study was also assessed. Thirteen studies were included in this review.

RESULTS

In total, 363 patients (397 ankles and feet) received DBM as part of their surgical procedure at a weighted mean follow-up time of 20.8 ± 9.2 months. The most common procedure performed was ankle arthrodesis in 94 patients (25.9%). Other procedures performed included hindfoot fusion, 1st metatarsophalangeal joint arthrodesis, 5th metatarsal intramedullary screw fixation, hallux valgus correction, osteochondral lesion of the talus repair and unicameral talar cyst resection. The osseous union rate in the ankle and hindfoot arthrodesis cohort, base of the 5th metatarsal cohort, and calcaneal fracture cohort was 85.6%, 100%, and 100%, respectively. The weighted mean visual analog scale in the osteochondral lesions of the talus cohort improved from a pre-operative score of 7.6 ± 0.1 to a post-operative score of 0.4 ± 0.1. The overall complication rate was 27.2%, the most common of which was non-union (8.8%). There were 43 failures (10.8%) all of which warranted a further surgical procedure.

CONCLUSION

This current systematic review demonstrated that the utilization of DBM in foot and ankle surgical procedures led to satisfactory osseous union rates with favorable wound complication rates. Excellent outcomes were observed in patients undergoing fracture fixation augmented with DBM, with mixed evidence supporting the routine use of DBM in fusion procedures of the ankle and hindfoot. However, the low LOE together with the low QOE and significant heterogeneity between the included studies reinforces the need for randomized control trials to be conducted to identify the optimal role of DBM in the setting of foot and ankle surgical procedures.

Role of neurogenic inflammation in intervertebral disc degeneration

In healthy intervertebral discs (IVDs), nerves and blood vessels are present only in the outer annulus fibrosus, while in degenerative IVDs, a large amount of nerve and blood vessel tissue grows inward. Evidence supports that neurogenic inflammation produced by neuropeptides such as substance P and calcitonin gene related peptide released by the nociceptive nerve fibers innervating the IVDs plays a crucial role in the process of IVD degeneration. Recently, non-neuronal cells, including IVD cells and infiltrating immune cells, have emerged as important players in neurogenic inflammation. IVD cells and infiltrating immune cells express functional receptors for neuropeptides through which they receive signals from the nervous system. In return, IVD cells and immune cells produce neuropeptides and nerve growth factor, which stimulate nerve fibers. This communication generates a positive bidirectional feedback loop that can enhance the inflammatory response of the IVD. Recently emerging transient receptor potential channels have been recognized as contributors to neurogenic inflammation in the degenerative IVDs. These findings suggest that neurogenic inflammation involves complex pathophysiological interactions between sensory nerves and multiple cell types in the degenerative IVDs. Clarifying the mechanism of neurogenic inflammation in IVD degeneration may provide in-depth understanding of the pathology of discogenic low back pain.

Utilization of artificial intelligence in the diagnosis of pes planus and pes cavus with a smartphone camera

BACKGROUND

Pes planus (flatfoot) and pes cavus (high arch foot) are common foot deformities, often requiring clinical and radiographic assessment for diagnosis and potential subsequent management. Traditional diagnostic methods, while effective, pose limitations such as cost, radiation exposure, and accessibility, particularly in underserved areas.

AIM

To develop deep learning algorithms that detect and classify such deformities using smartphone cameras.

METHODS

An algorithm that integrated a deep convolutional neural network (CNN) into a smartphone camera was utilized to detect pes planus and pes cavus deformities. This case control study was conducted at a tertiary hospital with participants recruited from two orthopaedic foot and ankle clinics. The CNN was trained and tested using photographs of the medial aspect of participants’ feet, taken under standardized conditions. Participants included subjects with standard foot alignment, pes planus, or pes cavus determined by an expert clinician using the foot posture index. The model’s performance was assessed in comparison to clinical assessment and radiographic measurements, specifically lateral tarsal-first metatarsal angle and calcaneal inclination angle.

RESULTS

The CNN model demonstrated high accuracy in diagnosing both pes planus and pes cavus, with an optimized area under the curve of 0.90 for pes planus and 0.90 for pes cavus. It showed a specificity and sensitivity of 84% and 87% for pes planus detection, respectively; and 97% and 70% for pes cavus, respectively. The model’s prediction correlated moderately with radiographic lateral Meary’s angle measurements, indicating the model’s excellent reliability in assessing food arch deformity (P < 0.05).

CONCLUSION

This study highlights the potential of using a smartphone-based CNN model as a screening tool that is reliable and accessible for the detection of pes planus and pes cavus deformities, which is especially beneficial for underserved communities and patients with pain generated by subtle foot arch deformities.

Femoral nerve palsy following Girdlestone resection arthroplasty: An observational cadaveric study

BACKGROUND

When patients with a failed hip arthroplasty are unsuitable for reimplantation, Girdlestone resection arthroplasty (GRA) is a viable treatment option. We report on a patient who was treated with a GRA due to a periprosthetic infection. We discovered partial paralysis of the quadriceps muscle in this patient. We investigated the femoral nerve anatomy, particularly the nerve entry points, to better understand this phenomenon.

AIM

To reveal the femoral nerve anatomy with respect to severe proximal migration after GRA.

METHODS

Eight cadaveric hemipelves were investigated. The branches of the femoral nerve were dissected and traced distally. The GRA was performed by the direct anterior approach. Axial stress to the lower extremity was applied, and the relative movement of the femur was recorded. The femoral nerve and its entry points were assessed.

RESULTS

GRA led to a 3.8 cm shift of the femur in vertical direction, a 1.8 cm shift in the dorsal direction, and a 2.3 cm shift in the lateral direction. A 36.5° external shift was observed. This caused stress to the lateral division of the femoral nerve. We observed migration of the femoral nerve entry point at the following locations: (1) Vastus medialis (5.3 mm); (2) The medial part of the vastus intermedius (5.4 mm); (3) The lateral part of the vastus intermedius (16.3 mm); (4) Rectus femoris (23.1 mm); (5) Tensor vastus intermedius (30.8 mm); and (6) Vastus lateralis (28.8 mm).

CONCLUSION

Migration of the femur after GRA altered the anatomy of the femoral nerve. Stress occurred at the lateral nerve division leading to poor functional results.

Construction and validation of a risk prediction model for depressive symptoms in a middle-aged and elderly arthritis population

BACKGROUND

Arthritis is a prevalent and debilitating condition that affects a significant proportion of middle-aged and older adults worldwide. Characterized by chronic pain, inflammation, and joint dysfunction, arthritis can severely impact physical function, quality of life, and mental health. The overall burden of arthritis is further compounded in this population due to its frequent association with depression. As the global population both the prevalence and severity of arthritis are anticipated to increase.

AIM

To investigate depressive symptoms in the middle-aged and elderly arthritic population in China, a risk prediction model was constructed, and its effectiveness was validated.

METHODS

Using the China Health and Retirement Longitudinal Study 2018 data on middle-aged and elderly arthritic individuals, the population was randomly divided into a training set (n = 4349) and a validation set (n = 1862) at a 7:3 ratio. Based on 10-fold cross-validation, least absolute shrinkage and selection regression was used to screen the model for the best predictor variables. Logistic regression was used to construct the nomogram model. Subject receiver operating characteristic and calibration curves were used to determine model differentiation and accuracy. Decision curve analysis was used to assess the net clinical benefit.

RESULTS

The prevalence of depressive symptoms in the middle-aged and elderly arthritis population in China was 47.1%, multifactorial logistic regression analyses revealed that gender, age, number of chronic diseases, number of pain sites, nighttime sleep time, education, audiological status, health status, and place of residence were all predictors of depressive symptoms. The area under the curve values for the training and validation sets were 0.740 (95% confidence interval: 0.726-0.755) and 0.731 (95% confidence interval: 0.709-0.754), respectively, indicating good model differentiation. The calibration curves demonstrated good prediction accuracy, and the decision curve analysis curves demonstrated good clinical utility.

CONCLUSION

The risk prediction model developed in this study has strong predictive performance and is useful for screening and assessing depression symptoms in middle-aged and elderly arthritis patients.

Regulatory gaps in India’s medical device framework: The case of Johnson and Johnson’s faulty hip implants

The Johnson and Johnson faulty hip implant case represents one of the most significant crises in medical device history, impacting nearly 93000 patients worldwide. In response to alarming failure rates and a global recall in August 2010, countries such as Australia, the United States, and the United Kingdom quickly implemented revision surgeries and reimbursement programs to protect patient safety. In stark contrast, India's response was alarmingly delayed; defective implants continued to be sold even after the global recall. By the time the import license was revoked, and the Central Drugs Standard Control Organization issued a recall notice, these implants had already been involved in 4700 surgeries across India. This paper explores the systemic weaknesses in India’s medical device regulatory framework that contributed to this delayed action, resulting in many patients suffering from serious health complications. It highlights deficiencies in monitoring and reporting mechanisms, inadequate regulatory oversight, and insufficient approval processes. Furthermore, the inability to trace affected patients and provide necessary compensation underscores significant gaps in regulation. Although subsequent legislative reforms were introduced, this paper argues that substantial loopholes remain, posing risks for future incidents. Thus, urgent, comprehensive, and enforceable regulatory measures are needed to increase patient safety.

Prognostic factors in patients with bone metastasis of lung cancer after immune checkpoint inhibitors: A retrospective study

BACKGROUND

Accurate data on the prognosis of bone metastases are necessary for appropriate treatment. Immune checkpoint inhibitors (ICIs) are widely used in the treatment of gene mutation-negative non-small cell lung cancer (GMN-NSCLC).

AIM

To investigate the prognostic factors in patients with bone metastases from GMN-NSCLC following ICI use.

METHODS

This retrospective cohort study included 45 patients with GMN-NSCLC who were treated for bone metastases from 2017 to 2022 and received chemotherapy after diagnosis. Using Kaplan–Meier curves and Cox proportional hazards models, we evaluated the association between overall survival (OS) and clinical parameters, including serum biochemical concentrations and blood cell count.

RESULTS

Univariate analysis showed that Eastern Cooperative Oncology Group performance status ≤ 1 and the use of ICIs and bone-modifying agents after bone metastasis diagnosis were significantly associated with a favorable OS. Multivariate analysis revealed that ICI use after bone metastasis diagnosis was significantly associated with a favorable OS.

CONCLUSION

ICI use after bone metastasis diagnosis may be a favorable prognostic factor in patients with bone metastases of GMN-NSCLC. Consideration of ICI treatment for bone metastasis and GMN-NSCLC is warranted to establish a more accurate predictive nomogram for patients with bone metastasis.

Cervical spine infection arising from chronic paronychia: A case report and review of literature

BACKGROUND

Cervical spine pyogenic infection (CSPI) is a rare and challenging form of spinal infection that is typically caused by pyogenic bacteria and primarily affects the cervical vertebral bodies and surrounding tissues. Given its nonspecific symptoms, such as fever and neck pain, early diagnosis is crucial to prevent severe complications, including spinal cord injury. We report a previously unreported case of acute CSPI arising from chronic paronychia, exploring its diagnostic and therapeutic challenges through a review of the current literature.

CASE SUMMARY

The presented case involved a 15-year-old man with CSPI caused by Staphylococcus aureus, which led to complications including bacteremia and a paronychia-associated abscess. Acute pyogenic infection was initially diagnosed by typical symptoms and blood culture. Fever improved after antibiotic treatment while developing progressive limbs dysfunction. Six days after admission, the patient underwent anterior cervical debridement + autogenous iliac bone graft fusion + plate internal fixation and received 12 weeks of antibiotic treatment after the operation. Re-examination 3 years postoperatively showed that the patient had stable cervical fixation, no significant neck pain or upper limb abnormalities, and normal urinary function.

CONCLUSION

Early imaging findings, laboratory markers, and timely antibiotic treatment are crucial for CSPI management, preventing complications and facilitating recovery.

Gut microbiome and orthopaedic health: Bridging the divide between digestion and bone integrity

The gut microbiome, a complex ecosystem of microorganisms in the digestive tract, has emerged as a critical factor in human health, influencing metabolic, immune, and neurological functions. This review explores the connection between the gut microbiome and orthopedic health, examining how gut microbes impact bone density, joint integrity, and skeletal health. It highlights mechanisms linking gut dysbiosis to inflammation in conditions such as rheumatoid arthritis and osteoarthritis, suggesting microbiome modulation as a potential therapeutic strategy. Key findings include the microbiome’s role in bone metabolism through hormone regulation and production of short-chain fatty acids, crucial for mineral absorption. The review also considers the effects of diet, probiotics, and fecal microbiota transplantation on gut microbiome composition and their implications for orthopedic health. While promising, challenges in translating microbiome research into clinical practice persist, necessitating further exploration and ethical consideration of microbiome-based therapies. This interdisciplinary research aims to link digestive health with musculoskeletal integrity, offering new insights into the prevention and management of bone and joint diseases.

Specific approach to total hip arthroplasty in patients with childhood hip disorders sequelae

Hip arthroplasty in patients with a history of paediatric hip disorders presents a significant challenge for orthopaedic surgeons. These patients are typically younger and have greater functional demands. Therefore, achieving optimal biomechanical conditions is crucial, involving placement of the acetabulum at the ideal centre of rotation and securing a stable femoral component with good offset to preserve abductor muscle function and restore leg length. The altered anatomy in these cases makes total hip arthroplasty more complex, necessitating thorough preoperative imaging and an individualised surgical approach. Various techniques may be employed to optimise biomechanical outcomes. We propose a modified lateral hip approach, offering exceptional visualisation of the acetabulum and femur while preserving the continuity of the abductor muscles without requiring trochanteric osteotomy. To achieve the most biomechanically advantageous acetabular position, cotyloplasty is our preferred method.

Enhanced recovery after surgery protocols for minimally invasive treatment of Achilles tendon rupture: Prospective single-center randomized study

BACKGROUND

Achilles tendon rupture is a common orthopedic injury, with an annual incidence of 11-37 per 100000 people, significantly impacting daily life. Minimally invasive surgery, increasingly favored for its reduced risks and comparable fixation strength to open surgery, addresses these challenges. Despite advantages like accelerated recovery, perioperative care poses emotional support, pain management, and rehabilitation challenges, impacting treatment efficacy and patient experience. To address these gaps, this study investigated the efficacy of a rapid rehabilitation protocol in enhancing recovery outcomes for minimally invasive Achilles tendon surgery, aiming to develop personalized, standardized care guidelines for broader implementation.

AIM

To evaluate a nursing-led rapid rehabilitation program for minimally invasive Achilles tendon repair surgery, providing evidence-based early recovery indicators.

METHODS

This study enrolled 160 patients undergoing channel-assisted minimally invasive Achilles tendon repair randomized into experimental and control groups. The experimental group received perioperative rapid rehabilitation nursing care, while the control group received standard care. The primary outcome measure was the Oswestry disability index score, with secondary outcomes including quality of life, Barthel index, patient satisfaction with nursing, incidence of complications, and rehabilitation adherence. Statistical analysis included appropriate methods to compare outcomes between groups. The study was conducted in a specific setting, utilizing a randomized controlled trial design.

RESULTS

All 160 patients completed the follow-up. The experimental group showed significantly greater improvements in key efficacy indicators: Postoperative Oswestry disability index score (8.688 vs 18.88, P < 0.0001), quality of life score (53.25 vs 38.99, P < 0.0001), and Barthel index (70.44 vs 51.63, P < 0.0001). The experimental group had a lower incidence of deep vein thrombosis (1.25% vs 10.00%, P = 0.0339) with a relative risk of 0.1250 (95% confidence interval: 0.02050-0.7421). Infection rates were lower in the experimental group (2.50% vs 11.25%, P = 0.0564). Hospital stay (5.40 days vs 7.26 days, P < 0.0001) and postoperative bed rest (3.34 days vs 5.42 days, P < 0.0001) were significantly shorter. Patient satisfaction was 100% in the experimental group vs 87.50% in the control group (P = 0.0031).

CONCLUSION

The rapid rehabilitation intervention significantly reduced pain, shortened hospital stays, and lowered complication rates, improving joint function and patient satisfaction.

Ipsilateral Rockwood type V acromioclavicular joint dislocation and midshaft clavicle fracture: A case report

BACKGROUND

Clavicle fractures are among the most common fractures seen in the emergency department. While acromioclavicular (AC) joint injuries are much less common. However, ipsilateral combinations of these injuries are quite rare with only a few cases reported in the literature.

CASE SUMMARY

A 29-year-old man who sustained a combination of ipsilateral AC joint dislocation and midshaft clavicle fracture. He underwent open reduction and plate fixation of the clavicle fracture, as well as semi-rigid surgical implants used to restore both the AC ligaments and the coracoclavicular joint. one year follow-up revealed that the patient had a complete range of motion and excellent shoulder scores. This case presents a rare presentation of such combination of injuries, contributing valuable insights to the literature on such rare injuries.

CONCLUSION

Combined midshaft clavicle fractures and AC joint dislocations are considered quite rare. Timely diagnosis of such injuries leads to great functional outcomes. AC joint dislocation should be suspected with midshaft clavicle fractures and should be investigated radiologically and clinically in an appropriate manner. Still, there is no consensus on the optimal management of such injuries.

Assessing clinical and patient reported outcomes of Sironix suture anchors in rotator cuff and Bankart repair surgeries

BACKGROUND

Rotator cuff tears and Bankart lesions significantly affect shoulder function and quality of life. Arthroscopic rotator cuff repair and Bankart repair has become the standard treatment for restoring function and reducing pain. Recent advancements include new suture anchor technologies, such as the Sironix suture anchor known for its biomechanical strength and promising outcomes. However, there are limited real-world data on its effectiveness and safety, particularly in the Indian population.

AIM

To evaluate the effectiveness and safety of Sironix suture anchors in rotator cuff and Bankart repair surgeries.

METHODS

Sixty participants underwent surgery between January 2021 and December 2022, and demographic data and postoperative outcomes were collected through retrospective reviews and telephonic interviews. Validated scales, including the PENN Shoulder Score (PSS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, and Single Assessment Numeric Evaluation (SANE), were utilized for assessment.

RESULTS

Treatment with Sironix suture anchor devices, including Ceptre Knotted UHMWPE Suture Titanium Anchor, Spyke Knotted UHMWPE Suture Peek Anchor, Stativ Knotted UHMWPE Suture Anchor, and Viplok Knotless Peek Screw Anchor with Titanium Tip, revealed no repair failures. Participants demonstrated high satisfaction and functional improvement, as evidenced by the mean Quick DASH score (32.01) and PSS (71.65) and the satisfactory SANE scores for both injured joints (74.33) and non-injured (83.67) shoulder joints.

CONCLUSION

The study yielded favorable outcomes for rotator cuff tear repair and Bankart repair. No repair failures were observed, supporting the safety and efficacy of these devices in shoulder injury management.

Low back pain in China: Disease burden and bibliometric analysis

BACKGROUND

Low back pain has become a global problem. Since many traditional Chinese therapies are helpful for low back pain, the current status of low back pain in China may provide some insights to this issue.

AIM

To demonstrate the disease burden of low back pain in China and the response of Chinese scholars to this issue.

METHODS

The burden of low back pain in China was estimated using the Global Burden of Disease Study 2021 released by the American Institute for Health Metrics and Evaluation. The incidence, prevalence and disability-adjusted life years were analyzed. We also performed a bibliometric analysis to analyzed the publication trend, changes of cooperation models and research topics on low back pain.

RESULTS

Prevalence of low back pain increased from 69.61 million in 1990 to 102.96 million in 2021. New cases increased by a stunning 44.50 million in 2021. Low back pain led to an increase of 4.16 per 1000000 population in terms of disability-adjusted life years from 1990 to 2021. But the increase in China was slower than that of world average. As a response, publications of low back pain published by Chinese scholars were stably raised. From 1990 to 2023, domestic cooperation significantly increased, while international cooperation and no cooperation decreased. However, domestic cooperation decreased between 2021 and 2023. The number of studies on prevention and treatment of low back pain reduced from 1990 to 2023, while the mechanism, etiology and other aspects of low back pain augmented.

CONCLUSION

The burden of low back pain in China is heavy. Together with the government, Chinese institutions of medical science should do more in declining the impacts of low back pain.

Total hip arthroplasty preoperative planning for childhood hip disorders’ sequelae: Focus on developmental dysplasia of the hip

Developmental dysplasia of the hip (DDH) poses significant challenges in both childhood and adulthood, affecting up to 10 per 1000 live births in the United Kingdom and United States. While newborn screening aims to detect DDH early, missed diagnoses can lead to severe complications such as hip dysplasia and early onset osteoarthritis in adults. Treatment options range from less invasive procedures like hip-preserving surgery to more extensive interventions such as total hip arthroplasty (THA), depending on the severity of the condition. Preoperative planning plays a critical role in optimizing surgical outcomes for DDH patients undergoing THA. This includes accurate imaging modalities, precise measurement of acetabular bone stock, assessment of femoral head subluxation, and predicting prosthesis size and leg length discrepancy. Recent advancements artificial intelligence and machine learning offer promising tools to enhance preoperative planning accuracy. However, challenges remain in validating these technologies and integrating them into clinical practice. This editorial highlights the importance of ongoing research to refine preoperative strategies and improve outcomes in DDH management through evidence-based approaches and technological innovations.