Functional outcomes of peroneus longus tendon autograft for posterior cruciate ligament reconstruction: A meta-analysis

BACKGROUND

The posterior cruciate ligament (PCL) is vital for regulating posterior tibial translation in relation to the femur, which is critical for knee stability. PCL tears are infrequently isolated in knee injuries; however, the absence of the PCL results in abnormal knee kinematics, which may cause injuries to other ligaments. The ideal tendon source for PCL reconstruction is still a subject of debate.

AIM

To evaluate the results of employing the peroneus longus tendon (PLT) in PCL reconstruction.

METHODS

A comprehensive search was conducted to identify relevant randomized controlled trials and retrospective observational studies discussing the outcomes of using the PLT for PCL reconstruction. Studies published up to August 2024 were searched across multiple databases, including PubMed, EMBASE, Scopus, Web of Science, Cochrane Library, and Google Scholar. Full texts of the selected articles were retrieved, reviewed, and independently assessed by the investigators. Discrepancies were resolved by consensus, with any remaining disagreements being arbitrated by a third author.

RESULTS

This meta-analysis included five studies on PLT use for PCL reconstruction: (1) Four prospective studies with 104 patients; and (2) One retrospective study with 18 patients. Most studies followed up participants for 24 months, while one had a shorter follow-up of 18 months. Lysholm and modified cincinnati scores improved by pooled means of 32.2 (95%CI: 29.3-35.1, I 2 = 0%) and 31.1 (95%CI: 27.98-34.22, I 2 = 0%), respectively. Postoperative American Orthopaedic Foot and Ankle Society and Foot and Ankle Disability Index scores were 94.5 (I 2 = 61.5%) and 94.5 (I 2 = 80.09%), respectively. Single-hop and triple-hop test scores averaged 95.5 (95%CI: 94.5-96.5) and 92.4 (95%CI: 91.9-92.9) respectively. No significant differences were observed in thigh circumference at 10 cm and 20 cm between the injured and healthy sides.

CONCLUSION

Evidence supports PLT autografts for PCL reconstruction, improving knee function and patient outcomes. Larger randomized trials are needed to confirm efficacy and compare graft options.

Investigation on the quality of life after anterior minimally invasive total hip arthroplasty: Commentary on recent findings

This editorial critically evaluated the recent study by Ishikura et al, which examined the impact of anterior minimally invasive total hip arthroplasty (MIS-THA) on postoperative quality of life, with a specific focus on the timeline and influencing factors for return to work and resumption of driving. Ishikura et al's research demonstrated that anterior MIS-THA could shorten recovery time, reduce postoperative pain, and significantly enhance patients' quality of life and productivity. Their findings identified occupational type and work intensity as key determinants of postoperative recovery. By synthesizing evidence from multiple studies, this analysis systematically evaluated the clinical advantages of anterior MIS-THA-including reduced soft tissue trauma and accelerated functional recovery-while acknowledging its limitations, such as a steep surgical learning curve and early postoperative complication risks. The discussion emphasized the necessity of designing personalized rehabilitation protocols that accounted for patients' occupational demands. Notably, while current findings primarily derived from retrospective analyses, the article highlighted the need for prospective cohort studies to validate these observations. The commentary also addressed ongoing debates in the field, particularly the elevated complication rates associated with the direct anterior approach compared to posterior techniques, thereby underscoring the critical role of surgeon expertise in optimizing procedural safety. Collectively, this evaluation advanced our understanding of postoperative recovery dynamics in anterior MIS-THA and provides evidence-based insights to refine clinical rehabilitation frameworks.

Denosumab regimens in the treatment of giant cell tumor of bone: A systematic review with meta-analysis

BACKGROUND

Giant cell tumor of bone (GCTB) is a rare, locally aggressive neoplasm that should be treated surgically, whenever possible. This treatment approach may be linked with greater morbidity besides functional impairment. Denosumab is a human monoclonal antibody. Its administration inhibits bone resorption and has become part of the therapeutic armamentarium against GCTB, as it allows local control with a view to downstaging for a more conservative surgical procedure. However, there is no consensus in the literature regarding the optimal denosumab regimen for GCTB. Therefore, a wide discussion of denosumab regimen is necessary.

AIM

To assess the effectiveness of various therapy protocols employing denosumab in individuals with GCTB.

METHODS

A broad and systematic literature search was carried out using the PRISMA guidelines. We analyzed studies that reported skeletally mature patients with GCTB regardless of sex or ethnicity treated with denosumab. Articles with fewer than five patients and in languages except Spanish, Portuguese and English were excluded. Statistical analysis with proportion meta-analysis was performed due to the dichotomous nature of the data.

RESULTS

1005 articles were screened, of which 26 articles met the inclusion criteria and were selected, totaling 1742 patients, 51.8% women and 48.2% men, with an average of 35 years of age. Treatment with denosumab was associated with high rates of clinical benefit (CB) and imaging response (IR), without changing local recurrence rates when compared to patients treated without denosumab, regardless of the therapeutic regimen adopted and the number of doses applied. The adverse events (AE) presented were mostly mild, with the exception of a malignant transformation to osteosarcoma.

CONCLUSION

Treatment of GCTB with denosumab is effective, showing high rates of CB and IR. The AE that occurred were mostly mild. We found no differences between the articles considering the researched outcomes regardless of the therapeutic regimen adopted.

Factors affecting outcomes of indirect decompression after oblique and lateral lumbar interbody fusions

In this editorial, the authors of this paper comment on the article by Bokov et al published in the recent issue of World Journal of Orthopedics. We reviewed a general overview of oblique lumbar interbody fusions (OLIF) and lateral lumbar interbody fusions (LLIF), their indications and complications as an increasingly popular minimally invasive technique to address several lumbar pathologies. This editorial thoroughly discusses and reviews the literature regarding factors affecting outcomes of indirect decompression utilized through OLIF and LLIF procedures. Several parameters play a critical role in patient outcomes including restoration of disc height, foraminal height, central canal squared, and foraminal area. The indirect decompression allows for unbuckling of the ligamentum flavum which can significantly decompress the neural elements as well as aid in reduction of spondylolisthesis. However, the authors further highlight the limitations of indirect decompression and factors that may predict unsuccessful outcomes including bony foraminal stenosis, severe central canal stenosis, and osteoporosis. As a result, failure of indirect decompression can lead to persistent pain, radiculopathy and unsatisfied patients. Spinal surgeons may be left to reimage patients and consider additional procedures with direct decompression.

Intraoperative imaging adequacy and its impact on unplanned return-to-theatre rates in pedicle screw instrumentation

BACKGROUND

Pedicle screw instrumentation is a critical technique in spinal surgery, offering effective stabilization for various spinal conditions. However, the impact of intraoperative imaging quality-specifically the use of both anteroposterior (AP) and lateral views-on surgical outcomes remains insufficiently studied. Evaluating whether the adequacy of these imaging modalities affects the risk of unplanned returns to theatre (URTT) within 90 days due to screw malplacement is essential for refining surgical practices and improving patient care.

AIM

To evaluate how intraoperative imaging adequacy influences unplanned return-to-theatre rates, focusing on AP and lateral fluoroscopic views.

METHODS

This retrospective cohort study analyzed 1335 patients who underwent thoracolumbar and sacral pedicle screw instrumentation between January 2013 and December 2022. Data on intraoperative imaging adequacy, screw placement, and URTT events were collected and statistically analyzed using IBM SPSS v23. Imaging adequacy was assessed based on the presence of both AP and lateral views, and outcomes were compared between imaging groups.

RESULTS

A total of 9016 pedicle screws were inserted, with 82 screws identified as malplaced in 52 patients. Of these, 46 patients required URTT due to screw malplacement, with 37 returning within 90 days (URTT90). Patients with both AP and lateral imaging saved intraoperatively had significantly lower URTT90 rates compared to those with only lateral imaging saved, demonstrating the critical role of imaging adequacy in improving surgical outcomes.

CONCLUSION

This study underscores that comprehensive intraoperative imaging with both AP and lateral views reduces unplanned returns, improves outcomes, enhances precision, and offers a cost-effective approach for better spinal surgery results.

Osteosarcopenia and geriatric hip fractures: Current concepts

According to World Health Organization, one in six people will be older than 60 by 2030. The rising life expectancy is anticipated to contribute to a subsequent increase of geriatric fractures worldwide. Osteosarcopenia, which is the coexistence of osteoporosis and sarcopenia, greatly affects older people. Recent studies have tried to identify the prevalence of osteosarcopenia in older populations as well as its correlation with fragility fractures such as hip fractures. The latter pose a major burden on both health loss and costs worldwide. Increasing amount of evidence suggests that osteosarcopenia in patients with hip fractures contributes to higher rates of mortality and complications. At the same time, research focuses on the molecular basis of the interplay between osteoporosis and sarcopenia by utilizing genomic or proteomic approaches. These promising studies could reveal potential preventive or diagnostic biomarkers to optimize the management of osteosarcopenia in hip fractures patients. The fact that bones and muscle can also function as endocrine organs further highlights the complex relationship between osteoporosis and sarcopenia, underscoring the need for a better understanding of the role of myokines and osteokines in osteosarcopenia. Finally, the impact of osteosarcopenia on pain management and rehabilitation after hip fracture surgery, requires further assessment.

Cross-talks between osteoporosis and gut microbiome

The gut microbiome comprises a vast community of microbes inhabiting the human alimentary canal, playing a crucial role in various physiological functions. These microbes generally live in harmony with the host; however, when dysbiosis occurs, it can contribute to the pathogenesis of diseases, including osteoporosis. Osteoporosis, a systemic skeletal disease characterized by reduced bone mass and increased fracture risk, has attracted significant research attention concerning the role of gut microbes in its development. Advances in molecular biology have highlighted the influence of gut microbiota on osteoporosis through mechanisms involving immunoregulation, modulation of the gut-brain axis, and regulation of the intestinal barrier and nutrient absorption. These microbes can enhance bone mass by inhibiting osteoclast differentiation, inducing apoptosis, reducing bone resorption, and promoting osteoblast proliferation and maturation. Despite these promising findings, the therapeutic effectiveness of targeting gut microbes in osteoporosis requires further investigation. Notably, gut microbiota has been increasingly studied for their potential in early diagnosis, intervention, and as an adjunct therapy for osteoporosis, suggesting a growing utility in improving bone health. Further research is essential to fully elucidate the therapeutic potential and clinical application of gut microbiome modulation in the management of osteoporosis.

Optimization and advances in negative pressure wound therapy for the management of necrotizing fasciitis in the upper limb

Necrotizing fasciitis (NF) is a rapidly progressing, life-threatening soft tissue infection, with upper limb NF posing a particularly serious threat to patient survival and quality of life. Negative pressure wound therapy (NPWT) has shown considerable advantages in accelerating wound healing and mitigating functional impairment. A retrospective study by Lipatov et al. demonstrated that NPWT significantly reduced the time needed for wound closure preparation while enhancing the success rate of local repair. Despite its benefits, certain limitations highlight the need for further optimization. This paper investigates the potential for personalized dynamic regulation of NPWT, its integration with adjunctive therapies, and the role of multidisciplinary collaboration. Furthermore, it explores the incorporation of advanced technologies such as artificial intelligence, imaging modalities, and biomaterials, presenting novel pathways for the personalized management and global standardization of NF treatment.

Role of WARP sequence magnetic resonance imaging with the removal of metal artifacts in the evaluation of lumbar adjacent

BACKGROUND

Posterior lumbar interbody fusion has good clinical results, but adjacent segment disease (ASD) affects its long-term efficacy. In patients with L4-5 fusion who were followed up for more than 10 years, the ASD incidence was 33.3%. Magnetic resonance imaging (MRI) is key for ASD diagnosis, but metal artifacts from internal fixation limit its use; therefore, removing the artifacts is crucial for ASD diagnosis and treatment.

AIM

To evaluate the value of WARP MRI for patients with lumbar ASD.

METHODS

In our hospital, the lumbar spines of patients with ASD were assessed via lumbar MRI, including conventional sequences and sequences for artifacts. A PACS workstation was used for image measurement, analysis, and assessment, which mainly included measurement of the internal fixation implant artifact area, evaluation of the visibility of the anatomical structures surrounding the implant, and diagnostic assessment of ASD in the section. Conventional MRI data sequences and artifacts to sequence the contrast analysis of the MRI data.

RESULTS

A total of 30 patients with ASD after lumbar fusion and internal fixation were included in the study; the patients included 13 male and 17 female patients and were aged 66.03 ± 5.83 years. The metal artifact area of the WARP T2-tirm sequence was significantly smaller than that of the conventional STIR sequence [(20.85 ± 6.27) cm² vs (50.56 ± 8.55) cm², P < 0.01]. The WARP T2-tirm sequence was observed around the implants, pedicles, intervertebral foramen, and vertebral bodies, and the conventional STIR sequence clearly displayed nerve roots within the intervertebral foramen. In all 30 patients, all adjacent segments of the WARP T2-tirm sequence could be clearly observed (above Grade 4), whereas it was difficult to observe these segments in the conventional STIR sequence due to the presence of more severe metal artifacts.

CONCLUSION

WARP sequences can significantly reduce the artifact area in the sagittal and cross-sectional images of titanium alloy spinal fixation, providing a good imaging reference for the diagnosis of ASD.

High rates of return to sport following suture button fixation for ligamentous Lisfranc injuries: A systematic review

BACKGROUND

The purpose of this systematic review was to evaluate the clinical and radiological outcomes at short-term follow-up following suture button fixation for the management of ligamentous Lisfranc injuries.

AIM

To assess the effectiveness of suture button fixation in managing ligamentous Lisfranc injuries through a systematic evaluation of short-term clinical and radiological outcomes.

METHODS

During March 2024, the PubMed, EMBASE, and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following suture button fixation for the management of ligamentous Lisfranc injuries. Data regarding patient demographics, pathological characteristics, subjective clinical outcomes, radiological outcomes, complications, and failure rates were extracted and analyzed.

RESULTS

Eight studies were included. In total, 94 patients (94 feet) underwent suture button fixation for the management of ligamentous Lisfranc injuries at a weighted mean follow-up of 27.2 ± 10.2 months. The American Orthopaedic Foot and Ankle Society score improved from a weighted mean pre-operative score of 39.2 ± 11.8 preoperatively to a post-operative score of 82.8 ± 5.4. The weighted mean visual analogue scale score improved from a weighted mean pre-operative score of 7.7 ± 0.6 preoperatively to a post-operative score of 2.0 ± 0.4. In total, 100% of patients returned to sport at a mean time of 16.8 weeks. The complication rate was 5%, the most common complication of which was residual midfoot stiffness (3.0%). No failures nor secondary surgical procedures were recorded.

CONCLUSION

This systematic review demonstrated that suture button fixation for ligamentous Lisfranc injuries produced improved clinical outcomes at short-term follow-up. In addition, there was an excellent return-to-sport rate (100%) at a weighted mean time of 16.8 weeks. This review highlights that suture button fixation is a potent surgical treatment strategy for ligamentous Lisfranc injuries; however, caution should be taken when evaluating this data in light of the lack of high quality, comparative studies, and short-term follow-up.

Retrieval analysis in total knee arthroplasty

Retrieval analysis in total knee arthroplasty (TKA) has been little studied in the literature. A narrative review of the literature to understand the current importance of retrieval analysis in TKA has been conducted. On August 27, 2024, a literature search was performed in PubMed using "TKA retrieval analysis" as keywords. A total of 160 articles were found, of which only 19 were analyzed because they were directly related to the subject of this article. Rotating-platform (mobile-bearing) TKA has no surface damage advantage over fixed-bearing TKA. TKAs with central locking mechanisms are more prone to debond from the cement mantle. No major wear of the polyethylene (PE) component in TKA using oxidized zirconium components occurs. Femoral components of cobalt-chromium roughen more than oxidized zirconium femoral components. The use of a polished tibial tray over an unpolished design is advised. At short-run assessment (15 months on average), antioxidant-stabilized highly crosslinked PE components are not clinically different in surface damage, density of crosslinking, or oxidation compared to standard remelted highly crosslinked PE components. A correlation between implant position and PE component surface damage has been reported. It shows the importance of optimizing component position to reduce PE component damage. Contemporary knee tumor megaendoprostheses show notable volumetric metal wear originated at the rotating hinge. Retrieval analysis in TKA renders relevant data on how different prosthetic designs described in the literature perform. Such information can help to improve future prosthetic designs to increase prosthetic survival.

Treatment of refractory thoracolumbar spine infection by thirteen times of vacuum sealing drainage: A case report

BACKGROUND

A case study of multiple distinct levels of skipped thoracolumbar spine infection was reported in which 13 successful vacuum sealing drainage (VSD) surgeries were treated.

CASE SUMMARY

The patient underwent a total of 13 procedures within our medical facility, including five performed under local anesthesia and eight performed under general anesthesia. The source of the ailment was ultimately identified as Enterobacter cloacae. After the last procedure, the patient's symptoms were alleviated, and the recovery process was satisfactory. Three months post-operation, the Japanese Orthopaedic Association scores had improved to 100%. Imageological examination revealed a satisfactory position of internal fixation, and the abnormal signals in the vertebral body and intervertebral space had been eliminated when compared to the pre-operative results.

CONCLUSION

The study demonstrates that the extreme lateral approach debridement combined with multiple VSD operations is a secure and successful method of treatment for recurrent spinal infection, providing an alternative to traditional surgery.

Requirements for standardizing the assessment of mesenchymal stem cell therapy and its effects on osteoarthritis

Publications of Soufan et al and Kristjánsson et al in the World Journal of Orthopedics on mesenchymal stem cell (MSC) therapy for osteoarthritis (OA) represent a significant exploration of regenerative medicine's potential in OA treatment. In their research, it is highlighted that MSCs can alleviate OA symptoms and even regenerate cartilage, potentially reversing the disease. They also compared the efficacy of three MSC subtypes, emphasizing the therapeutic advantages of adipose-derived MSCs. MSC injections, a novel and less invasive alternative to traditional treatments such as chondrocyte transplantation or arthroplasty, have a low cost, low risks, and favorable outcomes, presenting a promising approach for OA patients. Additionally, we stressed that the efficacy evaluation criteria, heterogeneity, safety, and other factors must be carefully considered to further advance the clinical translation of MSC therapy for OA.

Patellar resurfacing in knee arthroplasty: A comprehensive review and meta-analysis

BACKGROUND

Patellar resurfacing in knee arthroplasty remains a contentious issue, with various strategies including routine, selective, and non-resurfacing approaches. This review and meta-analysis aim to assess the incidence of patellar resurfacing, revision rates, patient satisfaction, and relevant knee scores associated with each method.

AIM

To determine the comparative effectiveness of routine, selective, and non-resurfacing strategies in patellar resurfacing within knee arthroplasty by evaluating incidence rates, revision rates, patient satisfaction, and knee function scores.

METHODS

A systematic review spanning from 1990 to 2024 was conducted using PubMed, Embase, and Cochrane Library databases. Studies reporting on the incidence of patellar resurfacing, revision rates, patient satisfaction, and relevant knee scores were included. Data from esteemed world registries such as the Australian Orthopaedic Association National Joint Replacement Registry, the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man and Danish Knee Arthroplasty Registry among others, were meticulously examined. Meta-analysis was employed to derive pooled estimates and 95% confidence intervals.

RESULTS

Analysis of data sourced from diverse world registries and literature sources unveiled significant disparities in the incidence of patellar resurfacing across different geographic regions and healthcare institutions. For instance, the incidence of routine patellar resurfacing ranged from 60% to 90% in some regions, while in others, it was as low as 30% to 50%. The meta-analysis indicated that routine resurfacing was associated with a lower revision rate of 3.5% (95%CI: 2.8%-4.2%) compared to non-resurfacing approaches, which exhibited a higher revision rate of 6.8% (95%CI: 5.5%-8.1%). Patient satisfaction outcomes showed variability, with routine resurfacing demonstrating higher mean satisfaction scores in functionality, pain relief, and stability categories.

CONCLUSION

The findings underscore the complexity of patellar resurfacing in knee arthroplasty and highlight the need for continued research to refine clinical practice. Future studies should prioritize prospective randomized controlled trials comparing different patellar resurfacing techniques using standardized outcome measures. Longitudinal studies with extended follow-up periods are necessary to evaluate the long-term outcomes and durability of various patellar resurfacing strategies. Collaborative efforts among multidisciplinary teams will be essential to conduct high-quality research that can provide actionable insights and improve patient outcomes.

Trabecular titanium acetabular cup in patients with medial femoral neck fracture: Survivorship analysis and clinical and radiological outcomes

BACKGROUND

Clinical studies using Trabecular Titanium™ acetabular cups have shown promising short and medium-term results. This material, due to its macro and micro surface roughness, provides a substrate for osseointegration and enhances implant stability. However, there is a lack of evidence in the literature on the use of this material in patients with femoral neck fracture.

AIM

To evaluate the short-term clinical-functional and radiographic outcomes in patients with femoral neck fractures undergoing total hip arthroplasty (THA) with Trabecular Titanium™ acetabular cup implants.

METHODS

The study included 104 patients with medial femoral neck fractures who underwent THA between January 2020 and December 2020 with the Delta TT acetabular cup (Lima Corporate, Villanova di San Daniele del Friuli, Italy). The mean age of the patients was 69.57 ± 10.16 years (range: 36-85 years). The follow-up period ranged from a minimum of 3 to a maximum of 4 years. Three questionnaires (Harris Hip Score, Oxford Hip Score, and EQ5D) were administered along with radiographic evaluations. Statistical methods included the Student's t-test and one-way analysis of variance for comparisons (with significance set at 0.05), and the Kaplan-Meier curve for prosthetic implant survival.

RESULTS

The mean follow-up was 41.5 months. The Harris Hip Score (HHS) showed a mean increase of 2.74 points (mean HHS 88.52 at 6 months postoperatively and mean HHS 91.26 at the last follow-up) with statistical significance. Similarly, the Oxford Hip Score demonstrated a statistically significant difference between follow-up groups. However, the EQ5D did not show statistically significant differences among the three groups (preoperative, 6-month follow-up, and last follow-up). Revision surgery was required in 6 patients. According to Moore's criteria, 96% of the acetabular components were radiographically stable and well-integrated at the last follow-up. The Kaplan-Meier curve showed a 96% survival rate.

CONCLUSION

The clinical and radiographic results obtained in the short to medium term confirm the excellent performance of the Delta TT acetabular cup in terms of osseointegration, providing an optimal solution both for young patients with high functional recovery demands and for fragile patients requiring optimal stability of the acetabular component to reduce the risk of implant failure.

Some artificial intelligence tools may currently be useful in orthopedic surgery and traumatology

Artificial intelligence (AI) can help in diagnosing fractures and demonstrating effusions, dislocations, and focal bone lesions in both adult and pediatric aged individuals and also aid in early tumor discovery (bone osteosarcoma) and in robot-assisted surgery. A recent AI model [Mask R-CNN (region-based convolutional neural network)] has shown to be dependable for detecting surgical target zones in pediatric hip and periarticular infections, offering a more convenient and quicker alternative to conventional methods. It can help inexperienced physicians in pre-treatment evaluations, diminishing the risk of missed diagnosis and misdiagnosis. AI has some very interesting applications in orthopedic surgery, which orthopedic surgeons should be aware of and if possible use. Although some interesting advances have been made recently on AI in orthopedic surgery, its usefulness in clinical practice is still very limited. Ethical concerns, such as transparency in AI decision-making, data privacy, and the potential loss of human intuition cannot be forgotten. Besides, it is paramount to explore how to gain trust from both healthcare professionals and patients in the utilization of AI.

Effectiveness of sub-acromial injections in rotator cuff injuries: A systematic review and meta-analysis

BACKGROUND

Sub-acromial injections are a therapeutic option for rotator cuff injuries; however, evidence regarding the most effective drug in this context is unclear, which needs to be investigated.

AIM

To evaluate the effectiveness of various sub-acromial injections for rotator cuff injuries.

METHODS

We conducted a systematic review and pair-wise and network meta-analyses of randomized clinical trials (RCTs) comparing sub-acromial injections for rotator cuff injuries. The interventions evaluated were hyaluronic acid (HA), platelet-rich plasma (PRP), prolotherapy, and corticosteroids. The outcomes of interest were pain and functional improvement, which were evaluated with standardized scores. The Risk of Bias 2 tool and the Grading of Recommendations, Assessment, Development and Evaluation methodology were used to assess data quality.

RESULTS

Twenty RCTs, comprising 1479 participants, were included. In the short term, HA achieved the best outcomes [pain mean difference (MD) = -1.48, 95% confidence interval (CI) -2.37 to -0.59; function MD = 10.18, 95%CI: 4.96-15.41]. In the medium term, HA, PRP, HA + PRP, and corticosteroids were not superior to placebo in improving pain. Based on function, HA + PRP was superior to placebo, corticosteroids, and PRP (MD = 26.72; 95%CI: 8.02-45.41). In the long term, HA, PRP, and corticosteroids were not superior to placebo in reducing pain. However, based on function, HA + PRP, PRP, and HA were superior to placebo, and HA + PRP had the best result (MD = 36.64; 95%CI: 31.66-33.62).

CONCLUSION

HA provides satisfactory short-term results, while HA with PRP demonstrates functional improvement in the medium and long terms. However, no intervention maintained the pain-relief effect on > 3-month follow-up.

Percutaneous transforaminal endoscopic treatment of gas-containing pseudocyst compressing the L5 nerve root: A case report

BACKGROUND

Gas-containing pseudocysts rarely cause of lumbar radiculopathy. This report describes successful treatment of a gas-containing pseudocyst using percutaneous transforaminal endoscopy.

CASE SUMMARY

A 48-year-old man presented with severe pain and numbness in his right leg, which worsened upon walking or weight bearing. Computed tomography and magnetic resonance imaging revealed a gas-containing cyst compressing the left L5 nerve root at the L4-5 level. The pseudocyst was successfully removed using a percutaneous transforaminal endoscopic discectomy. Vivid and clear endoscopic imaging of the pseudocysts was performed intraoperatively. The patient experienced immediate pain relief and was discharged one day after the operation. The patient returned to work. Moreover, numbness in the right leg returned to normal within 6 months. At the one-year follow-up, there was no symptoms recurrence.

CONCLUSION

Transforaminal endoscopy offers excellent surgical visualization and facilitates meticulous operative manipulation, making it a minimally invasive approach for treating gas-containing pseudocysts in the intervertebral foramen.

Discussion of the public interest in arthroscopy based on the Baidu index and its implications for nursing care

BACKGROUND

Despite the widespread application of big data in topic analysis, the public's attention and nursing requirements for arthroscopy remain inadequate.

AIM

To understand netizens' concerns and spatial distributions regarding arthroscopy and to provide customized nursing strategies.

METHODS

The Baidu index was employed to gather and analyze the search index, demand graph, keyword popularity, and regional distribution data for the keywords "arthroscopy," "knee arthroscopy," and "arthroscopy surgery" from 2018 to 2023.

RESULTS

A total of 254692 items of information were searched for these keywords, with 59.86% from mobile terminals. Netizens' interest in arthroscopy showed a fluctuating pattern, which was consistent with fluctuations in the elasticity coefficient, and was primarily concentrated in the provinces of Guangdong, Jiangsu, and Shandong.

CONCLUSION

The Baidu index provides new avenues for exploring public demand for arthroscopy. Nursing personnel can utilize these data to develop more precise health education plans and guidance, enhancing the quality and satisfaction of patient care.

Atlantoaxial dislocation with vertebral artery anomaly: A case report

BACKGROUND

Surgical intervention is a critical treatment approach for symptomatic atlantoaxial dislocation. However, vertebral artery injury remains a significant challenge during such procedures. We present a case of successful treatment of atlantoaxial dislocation with concurrent vertebral artery injury using interlaminar screw technology, and review the relevant literature.

CASE SUMMARY

A 69-year-old female patient, with no history of trauma, was diagnosed with atlantoaxial dislocation based on X-ray, computed tomography (CT), and magnetic resonance imaging. Preoperative CT angiography (CTA) revealed vertebral artery developmental anomalies, and she underwent posterior cervical surgery. Postoperative follow-up showed improvement in the patient's clinical symptoms such as unstable walking and dizziness, as well as functional scores compared to pre-surgery. Intraoperative vertebral artery injury was successfully managed, and postoperative CTA review revealed no complications related to vascular damage.

CONCLUSION

Thorough preoperative evaluation, such as CTA imaging, and the surgeon's expertise in various spinal screw placement techniques are crucial for improving the success rate of atlantoaxial dislocation surgeries.

Return to work and resumption of driving after anterior minimally invasive total hip arthroplasty

BACKGROUND

Return to work (RTW) and resumption of driving (ROD) are critical factors that influence postoperative quality of life in patients undergoing total hip arthroplasty (THA). However, few studies have focused on the minimally invasive (MIS) approach and its effect on these outcomes.

AIM

To investigate RTW and ROD's timelines and influencing factors following anterior MIS-THA.

METHODS

A retrospective analysis was conducted on 124 patients who underwent anterior MIS-THA. Data on the demographics, occupational physical demands, and RTW/ROD timelines were also collected. Clinical outcomes were measured using standardised scoring systems. Statistical analyses were performed to evaluate the differences between the groups based on employment status and physical workload.

RESULTS

Among employed patients, the RTW rate was 94.7%, with an average return time of five weeks. The average ROD time was 3.5 weeks across all patients. Despite similar postoperative clinical scores, RTW time was significantly influenced by occupations' physical workload, with heavier physical demands associated with delayed RTW.

CONCLUSION

Anterior MIS-THA facilitates early RTW and ROD, particularly in occupations with lower physical demands. These findings highlight the importance of considering occupational and physical workload in postoperative care planning to optimize recovery outcomes.

Novel association between chronic obstructive pulmonary disease and osteoporosis: A prospective cross-sectional study

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition often associated with a high incidence of osteoporosis. Studies indicate that patients with COPD present with a significant decrease in bone mineral density (BMD), potentially related to inflammation and corticosteroid use.

AIM

To investigate the relationship between BMD and lung function, mainly the forced expiratory volume in the forced expiratory volume in 1 second (FEV1)/ forced vital capacity percentage (FVC%), in patients with COPD using quantitative computed tomography (QCT).

METHODS

This prospective cross-sectional study included 85 patients with COPD treated at Gansu Provincial People's Hospital. Exposure variables included lung function parameter (FEV1/FVC%), age, sex, body mass index, smoking status, tea-drinking habits, and physical activity. BMD was measured using QCT. Linear regression and generalized additive models were employed to analyze the relationship between exposure variables and BMD.

RESULTS

Linear regression analysis revealed a significant positive relationship between BMD and FEV1/FVC% (β = 0.1, 95% confidence interval [CI]: 0.1-0.1; P < 0.0001). Non-linear analysis identified a unique BMD breakpoint of 128.08 mg/cm³. Before the breakpoint, BMD was significantly positively correlated with FEV1/FVC% (β = 0.245; P = 0.0019); while after the breakpoint, the relationship was negative and showed no statistical significance (β = -0.136; P = 0.0753). This finding underscores the critical role of BMD in COPD management and highlights the importance of individualized clinical interventions in improvement of lung function and overall health status in patients.

CONCLUSION

There is a complex non-linear relationship between BMD and lung function in patients with COPD, highlighting the importance of monitoring change in bone density during the management of COPD.

Hidden dangers of pelvic fracture: A meta-analysis on urinary tract injury incidence and risk factors

BACKGROUND

Pelvic fractures are often associated with significant morbidity, including injuries to the urinary tract. Understanding the incidence and risk factors for urinary tract injury in these patients is crucial for prompt diagnosis and management. This meta-analysis aims to synthesize existing evidence to determine the overall incidence and identify specific risk factors associated with urinary tract injuries in patients with pelvic fractures.

AIM

To determine the incidence and risk factors for urinary tract injuries in patients with pelvic fractures.

METHODS

A systematic search of PubMed, EMBASE, Scopus, and the Cochrane Library was conducted without date restrictions. Studies examining the incidence and risk factors of urinary tract injuries in patients with pelvic fractures were included. Data extracted included demographics, injury mechanism, pelvic fracture type, urinary tract injury incidence, mortality, and discharge disposition. Review Manager 5.4 was used for data analysis.

RESULTS

Ten studies comprising 22700 patients were included. The pooled incidence of urinary tract injury associated with pelvic fracture was 6.88% (95%CI: 6.20%-7.55%). Vehicle, motorcycle, and pedestrian accidents were identified as risk factors for urinary tract injury, with relative risks (RR) of 1.08 (95%CI: 1.06-1.11), 1.89 (95%CI: 1.78-2.00), and 1.53 (95%CI: 1.20-1.95), respectively. Pubic fracture and pelvic ring disruption were significantly associated with urinary tract injury [odds ratio (OR) 1.94, 95%CI: 1.09-3.44 and OR 5.53, 95%CI: 4.67-6.54, respectively)]. Patients without urinary tract injury were more likely to be discharged home (RR 0.79, 95%CI: 0.67-0.92). Mortality was higher in patients with urinary tract injury (OR 1.92, 95%CI: 1.77-2.09).

CONCLUSION

Urinary tract injury occurs in nearly 7% of patients with pelvic fractures. Motorcycle accidents, pubic fractures, and pelvic ring disruptions are significant risk factors. Urinary tract injury following pelvic fracture is associated with increased mortality.

Pre-injection local anesthesia does not affect experienced pain in intra-articular hip injections

BACKGROUND

Intra-articular hip injections (IAHIs) are commonly used for diagnostic and therapeutic purposes but are often associated with patient anxiety and fear. The disparity between anticipated and experienced pain during IAHIs and the role of pre-injection local anesthesia in pain modulation remains unclear.

AIM

To investigate the difference between anticipated and experienced pain during IAHIs and the impact of pre-injection local anesthesia.

METHODS

This prospective study enrolled 60 patients undergoing IAHI, 30 receiving pre-injection superficial local anesthesia and 30 serving as a control group without pre-injection local anesthesia. Pain levels were assessed using numeric rating scales.

RESULTS

Patients significantly overestimated anticipated pain compared to experienced pain (6.43 ± 2.48 vs 3.68 ± 2.37, P < 0.001). Pre-injection local anesthesia did not significantly reduce experienced pain (3.19 ± 2.38 vs 4.20 ± 2.29, P = 0.130).

CONCLUSION

Patients overestimate anticipated pain during IAHIs. Pre-injection local anesthesia does not reduce experienced pain.

Individual and population differences affect the pain management in acute musculoskeletal injury

In this editorial, we comment on the article published in a recent issue of the World Journal of Orthopedics. Although substantial literature regarding pain management of acute musculoskeletal injury has been published over the last three decades, there is still a lack of evidence-based protocol for individual and population disparities. This systematic review gives us a comprehensive view of the evidence-based use of opioid vs opioid-free analgesia. Nevertheless, there is still a need for further investigation at a high level regarding this topic.