Effect of Prior Bariatric Surgery on the Outcomes of Joint Arthroplasty: A Systematic Review and Meta-Analysis

OBJECTIVE

Obesity is a risk factor for joint arthroplasty complications. With this systematic review and meta-analysis, we assessed whether a positive history of bariatric surgery influences postoperative outcomes in patients undergoing various types of joint arthroplasty.

METHODS

We conducted a comprehensive search database such as Scopus, PubMed, Medline Ovid, CNKI, and CENTRAL for studies comparing outcomes between patients undergoing arthroplasty with and without a history of bariatric surgery. We extracted data on short-term medical complications, venous thromboembolism (VTE), periprosthetic infections, superficial wound infections, hospital stay length, and operative time. We used the data to conduct meta-analyses using random-effects models and subgroup analyses based on the type of arthroplasty.

RESULTS

Overall, 15 studies with nearly 150,000 participants were included. The analysis showed that prior bariatric surgery did not significantly affect overall medical complications post-arthroplasty, with OR of 0.968 (95%CI, 0.706-1.327). For VTE, the results similarly indicated no substantial difference, with an OR of 0.912 (95%CI, 0.644-1.291). In assessing periprosthetic infections, the OR was 0.754 (95%CI, 0.535-1.064), showing comparable rates between patients with and without a history of bariatric surgery.Regarding superficial wound infections, the analysis produced an OR of 2.390 (95%CI, 0.723-7.897), indicating variability but not statistical significance. Hospital stay length was reduced in patients with a history of bariatric surgery, reflected by SMD of -0.113 (95%CI, -0.221 to -0.005). Lastly, operative time also showed a significant reduction, with an SMD of -0.462 (95%CI, -0.865 to -0.059).

CONCLUSIONS

Prior bariatric surgery does not reduce the risk of short-term complications post-arthroplasty, but it seems to reduce the hospital stay length and operative time. The effects vary significantly across different types of joint arthroplasty, suggesting a need for tailored preoperative assessments and care protocols.

PROTOCOL REGISTRATION

This systematic review and meta-analysis was registered at PROSPERO, with the number: CRD42024539052.

Human induced pluripotent stem cell-derived therapies for regeneration after central nervous system injury

In recent years, the progression of stem cell therapies has shown great promise in advancing the nascent field of regenerative medicine. Considering the non-regenerative nature of the mature central nervous system, the concept that "blank" cells could be reprogrammed and functionally integrated into host neural networks remained intriguing. Previous work has also demonstrated the ability of such cells to stimulate intrinsic growth programs in post-mitotic cells, such as neurons. While embryonic stem cells demonstrated great potential in treating central nervous system pathologies, ethical and technical concerns remained. These barriers, along with the clear necessity for this type of treatment, ultimately prompted the advent of induced pluripotent stem cells. The advantage of pluripotent cells in central nervous system regeneration is multifaceted, permitting differentiation into neural stem cells, neural progenitor cells, glia, and various neuronal subpopulations. The precise spatiotemporal application of extrinsic growth factors in vitro, in addition to microenvironmental signaling in vivo, influences the efficiency of this directed differentiation. While the pluri- or multipotency of these cells is appealing, it also poses the risk of unregulated differentiation and teratoma formation. Cells of the neuroectodermal lineage, such as neuronal subpopulations and glia, have been explored with varying degrees of success. Although the risk of cancer or teratoma formation is greatly reduced, each subpopulation varies in effectiveness and is influenced by a myriad of factors, such as the timing of the transplant, pathology type, and the ratio of accompanying progenitor cells. Furthermore, successful transplantation requires innovative approaches to develop delivery vectors that can mitigate cell death and support integration. Lastly, host immune responses to allogeneic grafts must be thoroughly characterized and further developed to reduce the need for immunosuppression. Translation to a clinical setting will involve careful consideration when assessing both physiologic and functional outcomes. This review will highlight both successes and challenges faced when using human induced pluripotent stem cell-derived cell transplantation therapies to promote endogenous regeneration.

Concomitant hip arthroscopy and periacetabular osteotomy: Systematic review and meta-analysis of contemporary outcomes, survivorship, and complications with comparison to isolated periacetabular osteotomy

Objective

To evaluate outcomes, survivorship, and complication rates among patients who underwent concomitant periacetabular osteotomy (PAO) and hip arthroscopy and compare them to patients undergoing isolated PAO.

Design

Systematic review and meta-analysis.

Setting

Medline, EBSCO host, and Google Scholar databases were searched to identify all studies describing concomitant PAO and HA through May 9, 2023 (PROSPERO study protocol registration: CRD42023426191).

Patients

Patients who underwent concomitant PAO and hip arthroscopy compared to patients who underwent isolated PAO.

Interventions

Randomized controlled trials and cohort studies reporting clinical outcomes after concomitant PAO and hip arthroscopy.

Main outcome measures

Patient-reported outcome measures (PROMs), radiographic outcomes, range of motion scores, complications, re-operations, and survivorship.

Results

Thirteen studies reporting on a total of 697 patients (726 hips) were included. Significant improvements in PROMs and radiographic measures were demonstrated for most included studies. Pooled analyses demonstrated significant improvements in post-operative modified Harris Hip Score (mHHS) (mean difference (MD): 26.97, 95%CI: 30.19 to -23.75; p < 0.00001) and lateral-center edge angle (LCEA; MD: 13.94, 95%CI: 16.95 to -10.93; p < 0.0001) values. Patients undergoing combined procedures experienced 136 complications for 690 hips (19.71 %) with 29 (21.32 %) classified as major. There were 27 re-operations for 614 hips (4.40 %), and post-operative survivorship estimated at minimum 85 % after 3.5 years follow-up. However, for most outcome measures, there were no differences between concomitant procedures and isolated PAO.

Conclusions

Based on the available literature, patients undergoing concomitant PAO and hip arthroscopy experience excellent outcomes. However, there is limited evidence to indicate that performing both procedures result in different outcomes compared to PAO alone.

Osteotomy across arcuate line in ilium needs prudence in curved periacetabular osteotomy

Background

This study aimed to measure the optimal osteotomy angle and length, as well as the available width of the osteotomy site in the posterior column for the safe performance of periacetabular osteotomy.

Methods

Fifty-six hips in 41 patients who underwent curved periacetabular osteotomy were evaluated. Computed tomography data were subjected to multiplanar reconstruction to measure parameters in two reference planes: the functional pelvic plane and the anterior pelvic plane. The optimal osteotomy angle, osteotomy length, and available width of the posterior column were defined. We assessed the possible factors affecting the optimal osteotomy angle.

Results

The functional pelvic plane showed an average and maximum anterior pelvic tilt of 7.8° and 16.4°, respectively, from the anterior pelvic plane. The optimal osteotomy angles had comparable dispersions in the functional pelvic plane and anterior pelvic plane reference planes. Furthermore, as the rotation angle of the reconstructed axial views increased, i.e., the osteotomy site became closer to the arcuate line of the pelvis, the available width of the osteotomy site narrowed, and the length of the osteotomy site increased. We found significant correlations between the optimal osteotomy angle and sex, height, weight, body mass index, head lateralization index, and acetabular anteversion in all planes. The multiple regression analysis revealed that acetabular anteversion was significantly correlated with the optimal osteotomy angle in all planes, while height, weight, BMI, center edge angle, acetabular roof obliquity, and head lateralization index were correlated in some planes.

Conclusions

Osteotomies near the arcuate line of the pelvis are considered particularly risky because long-distance osteotomies must be performed within a narrow width. The optimal osteotomy angle is affected by many factors, including acetabular anteversion, which varies from case to case.

The top 50 cited publications relating to femoral shaft fractures - A bibliometric analysis of the literature

Background

Femoral shaft fractures (FSF's) represent common orthopaedic injuries, traditionally resulting from high-energy trauma in younger patients. Effective treatment is crucial for functional recovery, with significant social and economic implications. Despite extensive literature relating to FSF's, the quality of evidence and research trends remain unclear.

Methods

A bibliometric analysis was conducted using Web of Science (August 2024) to identify the top 50 most-cited publications related to FSF's. Publications were screened using specific inclusion and exclusion criteria, focusing on primary FSF-related research. Data including authorship, publishing institution, level of evidence (LOE), and study focus were analysed using VOSviewer software to explore bibliometric coupling, co-citation relationships and keyword co-occurrences.

Results

The 50 most-cited publications collectively received 9796 citations, with the highest cited paper accumulating 508 citations. Treatment outcomes (50 %) and epidemiology (32 %) were the predominant study focuses, while only 4 % addressed surgical techniques. Retrospective cohort and case-control studies constituted 84 % of the included papers, predominantly of level III evidence. The mean patient age was 37.96 years, with a majority being female (65.2 %). Hannover Medical School emerged as the most prolific institution, and the Journal of Bone and Joint Surgery published the highest number of articles. Co-occurrence analyses highlighted trends in osteoporosis and bisphosphonate-related FSFs.

Conclusions

FSF literature has expanded, focusing primarily on treatment outcomes and epidemiological risk factors. However, a significant proportion of studies are of low evidence, with limited prospective research and an underrepresentation of topics such as FSF complications and paediatric fractures. Future studies should aim to maximise research quality and address emerging themes, including gender-specific analyses and the management of atypical fractures in elderly male populations.

Strategies for preventing anterior cruciate ligament injuries in athletes: Insights from a scoping review

Background and aims

Anterior cruciate ligament (ACL) injuries significantly impact young athletes, leading to long-term physical, psychological, and socioeconomic consequences. There is an urgent need to develop effective preventive strategies. This scoping review aims to evaluate modifiable and non-modifiable risk factors for ACL injuries and assess existing preventive strategies.

Methods

A comprehensive literature search was performed on November 20, 2024, across databases including Embase, PubMed, Web of Science, Google Scholar, and Cochrane Library. Articles published between 2000 and 2024 focusing on ACL injury prevention were included, while editorial content, non-clinical studies, and non-English publications were excluded.

Results

The search yielded 322 articles, narrowing down to 94 after deduplication. After title screening, 46 studies progressed to full review, ultimately leading to the inclusion of 14 relevant manuscripts. Key findings indicate that ACL injuries result from various factors, with female athletes being 2.2 times more susceptible. Genetic predispositions linked to collagen-related SNPs and biomechanical patterns, such as landing techniques and knee positioning, were identified as significant contributors. Effective preventive programs integrated strength training, neuromuscular training, and advanced technology, including wearable devices and video analysis.

Conclusion

The study reinforces the importance of a personalized, multifaceted approach to ACL injury prevention, focusing on risk stratification and optimizing training strategies alongside technological advancements. Implementing these strategies can significantly mitigate the risk of ACL injuries in high-risk populations.

A Di-aptamer-functionalized scaffold promotes bone regeneration by facilitating the selective retention of MSCs and EPCs and then promoting crosstalk between osteogenesis and angiogenesis

The crosstalk between osteogenesis and angiogenesis plays an important role in promoting the formation of a microenvironment that supports bone regeneration. This suggests that the retention of endogenous osteogenic and angiogenic cells in the bone defect area can promote tissue-engineered bone (TEB) osteogenesis and cell-cell interactions. In this study, a Di-Aptamer-functionalized HA/β-TCP (Di-Aptamer-H/T) scaffold was prepared by sequential modification of APTES and sulfo-SMCC and connected with aptamer HM69 and EPC1. We confirmed that aptamers HM69 and EPC1 can specifically identify mesenchymal stem cells (MSCs) and endothelial progenitor cells (EPCs), respectively. This process triggers the expression of adhesion-related genes in these cells and allows these cells to selectively stay coupled to Di-Aptamer-H/T. The osteogenic differentiation ability of MSCs treated with Di-Aptamer-H/T in vitro was significantly increased. Similarly, the ability of Di-Aptamer-H/T-treated EPCs to form blood vessels was also enhanced. Notably, the osteogenic and angiogenic abilities of cocultured MSCs and EPCs treated with the Di-Aptamer-H/T scaffold were significantly better than those of cells cultured individually. In vivo, the results of micro-CT angiography, H&E staining, Masson's staining and histochemical staining further confirmed that Di-Aptamer-H/T formed new bones and vessels more readily than those treated with a single aptamer linked to HA/β-TCP or with HA/β-TCP alone. In brief, our study demonstrated that crosstalk between osteogenesis and angiogenesis is promoted by the Di-Aptamer-H/T scaffold, which serves as a potential treatment strategy for bone defects and can improve outcomes.

The use of exoskeleton robotic training on lower extremity function in spinal cord injuries: A systematic review

Objective

To perform a systematic review of the utility of exoskeleton robotic therapy on lower extremity recovery in Spinal Cord Injury (SCI) patients.

Methods

We used the Embase, Cochrane, and PubMed databases and searched from January 2012 to December 2023 for studies on exoskeleton robotic assist devices used in working with SCI patients. Only articles published in English were evaluated, and the retrieved articles were screened via our inclusion/exclusion criteria. We conducted our meta-analysis with the Cochrane Review Manager 5.4 (RevMan) software. Robotic assisted gait training and conventional gait training methodology were compared using Walking Index for Spinal Cord Injury II (WISCII), Spinal Cord Independence Measure III (SCIM III), and 6 Minute Walk Test (6MWT) as reported outcome measures.

Results

Eleven randomized clinical trials (RCTs) involving 552 total participants were included in the meta-analysis. The results of the meta-analysis indicated statistically significant improvement in SCIM III [MD 5.14, 95 % CI = (4.47, 5.810), P < 0.00001], WISCII [MD 2.31, 95 % CI = (2.13, 2.49), P < 0.00001] and 6MWT [MD 37.04, 95 % CI = (32.35, 41.74), P < 0.00001] in patients with SCI as compared to conventional gait training (CGT) therapy. Conclusion: Robotic Therapy could improve ambulation/quality of life in patients with spinal cord injuries compared to the standard treatment only, but future studies should include additional measures addressing quality of life and patient satisfaction.

Surgical site soft tissue thickness as a predictor of complications following arthroplasty

Appreciation of soft-tissue thickness (STT) at surgical sites is an increasingly recognized aspect of arthroplasty procedures as it may potentially impacting postoperative outcomes. Recent research has focused on the predictive value of preoperative STT measurements for complications following various forms of arthroplasty, particularly infections, across procedures such as total knee, hip, shoulder, and ankle replacements. Several studies have indicated that increased STT is associated with a higher risk of complications, including infection and wound healing issues. The assessment of STT before surgery could play a crucial role in identifying patients at a higher risk of complications and may be instrumental in guiding preoperative planning to optimize outcomes in arthroplasty procedures. Standardized measurement techniques and further research are essential to enhance the reliability and clinical utility of STT assessment for arthroplasty surgery.

Demographic and training descriptive analysis of National and American Hockey League team physicians

Aims/objective

Assess the demographic/education backgrounds of team physicians (TPs) in the National Hockey League (NHL) and American Hockey League (AHL).

Materials/methods

Orthopedic Surgeon (O) and Primary Care (PC) TPs for each NHL and AHL team were recorded based on an internet search. Age, sex, and race were collected. Education and practice information were collected and included programs attended, program region, degree, fellowship completion, fellowship subspeciality, practice setting, and H-indices.

Results

Thirty-nine NHL O, 38 NHL PC, 39 AHL O, and 33 AHL PC TPs were identified. 100 % of O-NHL and -AHL TPs were male while 94.7 % and 87.9 % of NHL and AHL PC TPs were male, respectively. NHL TPs were 53.2 years old on average while AHL TPs were 50.8 years old (p = 0.11). Most TPs were Caucasian. More NHL O TPs were MDs (100 %) compared to NHL PC TPs (84.2 %; p = 0.011); similar trends were seen in the AHL. 66.7 % of NHL O TPs practice in academic settings, compared to 33.3 % of AHL O TPs (p = 0.030). NHL O TPs had the highest H-indices. The most represented residency/fellowship programs were Hospital for Special Surgery and Kerlan-Jobe.

Conclusion

NHL O TPs were more likely to have an MD, be fellowship trained, practice in an academic setting, and had higher H-indices compared to their NHL PC counterparts; similar trends were observed in the AHL. There was an overall lack of diversity amongst TPs in both leagues.

Risk factors for diabetic foot ulcer in diabetic patients at the Tehran diabetes clinic: a case-control study

Background and objective

: Diabetic foot ulcer (DFU) is one of the main health challenges of diabetes complications worldwide. A wide range of factors may increase the risk of DFU. This study aimed to investigate the risk factors of DFU among diabetic patients.

Methods

This case-control study was conducted on 800 diabetic patients at the Tehran diabetes clinic of the Endocrinology and Metabolism Research Institute in Iran. The case group included 400 diabetic patients diagnosed with DFU, while the control group included 400 diabetic patients without DFU. Data were collected through medical records, validated questionnaires, and clinical examinations. The association between factors and the risk of DFU was analyzed using both crude and adjusted logistic regression models, adjusting for confounders based on a directed acyclic graphs.

Results

The final adjusted model demonstrated significant direct associations between the risk of DFU with a longer duration of diabetes, a history of previous DFU, peripheral neuropathy, retinopathy, high blood pressure, severe kidney function loss, and good foot self-care. However, there were significant inverse associations between DFU risk with female gender, higher education levels, being married, use of oral diabetes drugs, higher hemoglobin levels, and high physical activity.

Conclusions

The risk of DFU was significantly associated with the following factors: diabetes duration, previous DFU history, peripheral neuropathy, retinopathy, blood pressure, kidney function, foot self-care, gender, education levels, marital status, diabetes drugs, hemoglobin levels, and physical activity. Further studies, especially ones in multicenter cohorts with a special focus on novel risk factors, are warranted to expand on our findings.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-025-01582-z.

Postoperative complications and cost implications in sickle cell disease patients undergoing total hip arthroplasty: A national inpatient sample study

Background

Sickle cell disease (SCD) is a genetic condition affecting approximately 5 % of the global population, with significant prevalence in sub-Saharan Africa and an estimated 89,079 cases in the United States. Osteonecrosis, particularly of the femoral head (ONFH), is a common orthopaedic complication in SCD, often requiring total hip arthroplasty (THA) when conservative treatments fail. While THA can improve pain and function, it carries significant perioperative risks, with complication rates in patients with SCD as high as 67 %. This study aims to compare postoperative outcomes, medical costs, and the impact of different THA implant designs in patients with SCD versus a matched non-SCD cohort.

Methods

The study utilized the National Inpatient Sample (NIS) database. Postoperative outcomes in patients with and without SCD undergoing total hip arthroplasty between the fourth quarter of 2015 and 2020 were analyzed using propensity score matching and multivariable logistic regression modeling. Additionally, a subgroup analysis examined outcomes based on the use of cemented versus non-cemented implants.

Results

The study analyzed 2,830,040 hip arthroplasty patients, including 2535 with sickle cell disease (SCD), and after propensity score matching, found that patients with SCD had significantly higher rates of postoperative complications such as periprosthetic fractures, dislocations, infections, and acute kidney injury. Multivariate analysis confirmed SCD as an independent risk factor for these complications, along with increased hospital stays and higher charges. Additionally, patients with SCD receiving cemented implants experienced worse outcomes, including higher risks of periprosthetic fractures and infections, compared to those with non-cemented implants.

Conclusion

This study found that patients with sickle cell disease (SCD) undergoing total hip arthroplasty had significantly higher complication rates, increased healthcare costs, and longer hospital stays, with cemented implants posing greater risks compared to press-fit implants.

Conditioned medium derived from mesenchymal stem cells and spinal cord injury: A review of the current therapeutic capacities

Spinal cord injury (SCI) is a debilitating condition of the nervous system that imposes considerable challenges for subjects, such as bladder and bowel incontinence and infections. The standard therapeutic strategy is methylprednisolone utilization accompanied by surgical decompression. However, achieving an effective therapy with the minimum side effects for SCI is still a puzzle. Nowadays, mesenchymal stem cell (MSC) therapy has received much consideration in scientific communities in light of its pharmacological and therapeutic properties, for instance, anti-inflammatory, regenerative, analgesic, and immunomodulatory influences. Despite the mentioned advantages for MSCs, their tumorigenic potential is a limiting agent for its wide therapeutic application. Recent documents show that the use of conditioned medium (CM) derived from MSCs can largely solve these problems. CM encompasses neuroprotective growth factors and cytokines, such as stem cell factor (SCF), vascular endothelial growth factor (VEGF), and glial cell line-derived neurotrophic factor (GDNF). The persuasive evidence from experimental studies revealed that CM originating from MSCs can have a considerable role in the amelioration of SCI. Hence, in the current papers, we will review and summarize evidence indicating the anti-SCI mechanisms of MSC-derived CM by relying the current experimental data.

Antibiofilm capacity of PMMA surfaces: A review of current knowledge

The emergence of microorganisms resistant to antimicrobial therapies, associated with the decline in the development of new drugs, including antibiotics, antifungals, and antivirals, highlights the need for alternative strategies to combat microorganisms that cause infections, especially multidrug-resistant bacteria. Polymethylmethacrylate (PMMA) is a material widely used in the biomedical field, with uses ranging from surgical implants, bone cements, and dental devices, to laboratory equipment and three-dimensional models for surgical planning. Despite its multiple applications, PMMA has the disadvantage of favoring microbial adhesion, due to the porous nature of the material, associated with poor bond strength, thermal instability and water sorption in the oral environment, which can contribute to infection development. To mitigate this problem, the scientific community is looking to modify PMMA to give it antimicrobial properties. This review presents possible approaches that include changes to the topography of PMMA, creating textured or nanostructured surfaces, and chemical modifications, such as incorporating antimicrobial agents into the PMMA matrix or surface treatments. Both strategies aim to hinder the adhesion and growth of microorganisms. In addition, combining these approaches seeks a synergistic effect and could become a promising mechanism for preventing infections.

The effects and optimal dosage of traditional Chinese exercises on patients with chronic ankle instability: A systematic review and meta-analysis

BACKGROUND

The effectiveness of Traditional Chinese exercises in promoting functional recovery in patients with chronic ankle instability, as well as the potential impact of variables such as intervention type, duration, frequency, and cycle on treatment outcomes, still requires further investigation.

METHODS

Literature searches were conducted in multiple databases including China National Knowledge Infrastructure (CNKI), VIP, Wanfang, China Biomedical Literature Database (CBM), PubMed, EBSCO(Medline、CINAHL、SPORTDiscus), Embase, Cochrane Library, ProQuest, and Web of Science for randomized controlled trials assessing the effects of Traditional Chinese Exercises interventions on patients with Chronic Ankle Instability. The publication timeframe spanned from the inception of each database until January 20, 2025. Meta-analysis was performed using STATA 15 software on the included studies.

RESULTS

Twelve randomized controlled trials (RCTs) involving 323 patients were included in this analysis. Compared with the control group, Traditional Chinese exercises showed the following improvements: CAIT: WMD = 4.02, 95 % CI [3.22, 4.81], z = 9.90, P < 0.001.Balance: ANT: SMD = 0.38, 95 % CI [0.18, 0.59], z = 3.71, P = 0.003.PM: SMD = 0.49, 95 % CI [0.26, 0.70], z = 4.73, P < 0.001.PL: SMD = 0.67, 95 % CI [0.46, 0.88], z = 6.35, P < 0.001.C: SMD = 0.80, 95 % CI [0.35, 1.25], z = 3.51, P < 0.001.JPS:Plantarflexion: SMD = -0.58, 95 % CI [-0.94, -0.21], z = 3.09, P = 0.002.Inversion: SMD = -0.46, 95 % CI [-0.86, -0.06], z = 2.23, P = 0.025.Muscle Strength: Plantarflexion: SMD = 0.81, 95 % CI [0.43, 1.18], z = 4.25, P < 0.001.Inversion: SMD = 0.66, 95 % CI [0.25, 1.07], z = 3.16, P = 0.002.Eversion: SMD = 1.04, 95 % CI [0.62, 1.46], z = 4.82, P < 0.001.Subgroup Analysis: Tai Chi training conducted twice weekly for a 12-week intervention period, with 60-minute sessions, demonstrated the most effective improvements.

LEVEL OF EVIDENCE

The evidence level for the effects of Traditional Chinese exercises on Balance-ANT, Balance-PM, and Balance-PL balance directions in CAI patients is rated as "moderate."

CONCLUSION

Traditional Chinese exercise has been shown to significantly improve balance, muscle strength, and joint position sense in CAI patients. Based on the current findings, Tai Chi training appears to provide greater benefits for CAI patients. It is recommended that CAI patients participate in Tai Chi training twice a week, with each session lasting 60 minutes, over a 12-week period.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO database, CRD42024613359.

Total knee arthroplasty reimbursement is declining overall and at a marginally faster rate amongst female orthopaedic surgeons: A Medicare analysis

Background

While the prevalence of total knee arthroplasty (TKA) is increasing, reimbursement is declining. The purpose of this study was to determine how surgeon gender influences procedure volume, reimbursement, practice style, and patient demographics for TKAs nationally and regionally between 2013 and 2021.

Methods

The Medicare Physician and Other Practitioners database was queried from 2013 to 2021 for procedure volume, TKA reimbursement, surgeon characteristics, and patient demographics for any surgeon who performed at least ten primary TKAs per year. Statistical tests were conducted to analyze differences based on surgeon gender, geography, and year.

Results

Of the 2,415,802 TKAs performed between 2013 and 2021, 1.5 % were billed by female surgeons. The number of TKAs performed annually increased by 29.1 % for female surgeons and decreased by 2.6 % for male surgeons. Between 2013 and 2021, reimbursement for TKAs decreased by 23.9 % for male surgeons and 26.2 % for female surgeons. In 2021, male surgeons were reimbursed $1017 per TKA while female surgeons were reimbursed $964 (p = 0.049). Male surgeons performed more TKAs annually in 2021 (Male: 39.3, Female: 30.9, p < 0.001), more total billable services (Male: 4148.0, Female: 2719.3, p < 0.001), and more unique billable services (Male: 70.7, Female: 55.3, p < 0.001) than female surgeons.

Conclusions

Female representation among surgeons who perform TKAs is increasing nationally. However, male surgeons treat more patients, perform more total billable services, and perform more unique billable services than female surgeons. TKA reimbursement is decreasing at a faster rate for female surgeons than male surgeons, although this is likely due to geographical differences.

Effects of external ankle braces on kinematics and kinetics of the lower limb during the cutting maneuver in healthy females

BACKGROUND

To explore if lace-up ankle brace and hinged ankle brace affect the kinematics and kinetics of the lower limbs during a cutting maneuver.

METHODS

Twenty healthy females performed a 45° cutting maneuver with different ankle braces. Ground reaction force, lower-limb joint angles and moments were compared among different ankle braces.

RESULTS

Wearing hinged ankle brace significantly increased maximal knee valgus angle than lace-up and no brace conditions (0.7° [p = 0.011] and 0.6° [p = 0.029], respectively). Wearing hinged and lace-up ankle braces significantly increased maximal knee internal rotation angle (1.58° [p ≤ 0.001] and 1.30° [p = 0.020], respectively) and decreased maximal ankle inversion angle (3.04° [p ≤ 0.001] and 1.76° [p = 0.013], respectively). A considerable difference in kinetics was observed only in the maximal ankle eversion moment, which was higher in the hinged condition than the lace-up (p = 0.010) or no brace (p = 0.023) condition.

CONCLUSION

Wearing an hinged or lace-up ankle brace may reduce the risk of ankle sprain in females during cutting maneuvers. Ankle brace appears to have upstream effects on the knee, which may have injury implication.

Causal associations between scapular morphology and shoulder condition estimated with Bayesian statistics

BACKGROUND AND OBJECTIVE

While there is a reported correlation between shoulder condition and scapular morphology, the precise impact of typical anatomical variables remains a subject of ongoing debate. This study aimed to evaluate this causal association, by emphasizing the importance of scientific modeling before statistical analysis.

METHODS

We examined the effect of scapular anatomy on shoulder condition, and conditioning on sex, age, height, and weight. We considered the two most common pathologies: primary osteoarthritis (OA) and cuff tear arthropathy (CTA). We combined the other pathologies into a single category (OTH) and included a control category (CTRL) of adult subjects without pathology. We represented acromion and glenoid morphology by acromion angle (AA), acromion posterior angle (APA), acromion tilt angle (ATA), glenoid inclination angle (GIA), and glenoid version angle (GVA). GVA was negative for posterior orientation. These variables were automatically calculated from CT scans of 396 subjects in the 4 shoulder condition groups by a deep learning model. We applied do-calculus to assess the identifiability of the causal associations and used a multinomial logistic regression Bayesian model to estimate them. To isolate the effect of each anatomical variable on each shoulder condition, we increased it from -2 to 2 z-score while constraining all other variables to their average value, and reported the effect on shoulder condition probability as percentage points (pp) for females and males.

RESULTS

Increasing AA reduced the probability of OA by 44 pp for females and 17 pp for males while increasing the probability of CTA by 36 pp for females and 33 pp for males. Increasing APA raised the probability of OA by 15 pp for females and 4 pp for males and increased the probability of CTA by 12 pp for females and 4 pp for males. Increasing ATA increased the probability of OA by 15 pp for females but decreased it by 25 pp for males, while also raising the probability of CTA by 11 pp for females and 21 pp for males. Increasing GIA decreased the probability of OA by 55 pp for females and 23 pp for males while increasing the probability of CTA by 45 pp for females and 31 pp for males. GVA (more anterior), decreased the probability of OA by 33 pp for females and 63 pp for males. The effects of APA and ATA were less important compared to the other variables. Overall, morphological effects were more pronounced for females than for males, except for GVA's impact on OA.

CONCLUSIONS

We developed a Bayesian causal model to answer interventional questions about the scapular anatomy's effect on shoulder condition. Our results, consistent with clinical knowledge, hold promise for aiding in early pathology detection and optimizing surgical planning within clinical settings.

Hospital and Patient Factors Associated With Length of Hospitalization in Patients Who Have Osteoarthritis Undergoing Primary Total Knee Arthroplasty: An Analysis of National Data

BACKGROUND

By 2040, an estimated 3.5 million primary total knee arthroplasties (TKAs) are expected to be performed annually in the United States. Osteoarthritis (OA) is the most common indication for primary TKA. We examined the association of hospital, regional, and patient-level factors with extended lengths of hospital stay (eLOS).

METHODS

We studied patients who have OA who underwent primary TKA from 2016 to 2019 using a national inpatient database. We used the International Classification of Diseases codes to identify diagnoses and procedures. There were 2,592,469 patients who had OA who underwent primary TKA from 2016 to 2019. We used univariate and multivariable-adjusted logistic regression analyses to assess whether patient, payer, hospital, and geographic factors were associated with an eLOS. Predictive probabilities from multivariable analyses were used to estimate the area under the curve.

RESULTS

Patient race and ethnicity, Medicaid or Medicare payer status, income, age/sex, and nearly all regional and hospital characteristics were independently associated with eLOS (>3 days; receiver-operating characteristic C-statistic = 0.74). Sensitivity analyses that used the most recent years of data from 2020 to 2021 (COVID-19 pandemic years) or adjusted for individual organ system complications reproduced the main results without much attenuation.

CONCLUSIONS

Age, sex, race, ethnicity, hospital location and teaching status, elective procedure designation, perioperative complications, and insurance payer status significantly influenced the LOS for primary TKA hospitalizations in the United States. Recognized disparities were linked to longer hospital stays after primary TKA in patients who had OA. Implementing policies and interventions that target these factors could help shorten hospital stays for high-risk patients after primary TKA.

Hand in hand with healthcare: A nationwide analysis of emergency department encounters for hand ailments

Background

Hand ailments are frequent reasons for emergency department (ED) visits in the United States. This study analyzed the incidence, causes, outcomes, predictors of hospitalization, and healthcare utilization patterns nationwide.

Methods

This retrospective cohort study utilized data from the Nationwide Emergency Department Sample and National Readmission Database from 2016 to 2021. It included patients with a principal diagnosis of hand or wrist complaints.

Results

The study included 29,109,534 ED visits for hand ailments. The mean patient age was 36 years. Most patients were Caucasian (61 %), healthy (89 % Charlson Comorbidity score of 0), male (57 %), and from lower income brackets (60 %). Most injuries were unintentional (71 %), with hand lacerations being the most common reason for presentation, followed by closed distal radius fractures. Most patients were discharged home (96 %). Predictors of admission included older age (adjusted odds ratio (aOR) per decade: 1.03; 95 % Confidence Interval (CI): 1.02-1.03; p < 0.01), higher Charlson index (aOR:1.69; CI:1.65-1.73; p < 0.01), Medicaid insurance or uninsured (aOR:1.26; CI:1.18-1.36, aOR:1.25; CI:1.16-1.36; p < 0.01, respectively), and presentation at level I metropolitan trauma teaching hospitals (aOR:3.48; CI:2.98-4.07; p < 0.01). Admission rates increased by 21 % in 2020 compared to 2016. Healthcare expenditure was a staggering $105 billion in total ED and inpatient hospitalization charges. Expenditure increased significantly, surpassing inflation-adjusted rates.

Conclusions

Our analysis of 29 million patients highlights the healthcare burden posed by hand ailments, with lacerations being the most prevalent concern in emergency settings. Admission and readmission rates were influenced by age, comorbidities, socioeconomic status, insurance type, and hospital characteristics. This study provides a basis for targeted interventions in patient outcome enhancement and resource allocation. Limitations include the reliance on ICD-10-CM coding in the absence of clinical data, which may impact the accuracy of case identification and classification.

Local antibiotic delivery: Recent basic and translational science insights in orthopedics

BACKGROUND

Infections remain a significant challenge in orthopedic settings despite advancements in preventive measures. Antibiotics are the primary defense against infections, but optimal delivery methods to the infection site are still being investigated. This review aims to examine existing approaches for local drug delivery from a basic science perspective.

RECENT FINDINGS

Achieving adequate antibiotic concentration at the infection site is challenging due to compromised vasculature in ischemic conditions. Local administration methods, including antibiotic-loaded carriers such as impregnated bone grafts and various bone substitutes, are being explored as alternatives to systemic antibiotic use.

SUMMARY

Various materials, including polymethyl methacrylate (PMMA), hydroxyapatite, calcium phosphate/sulfate, bone glass, and hydrogel, are being investigated for local antibiotic delivery. Some of these materials possess inherent antibacterial properties due to their chemical interactions. The selection of appropriate antibiotics, their dosage, release kinetics from the carrier material, physical behavior of the material/graft, and biocompatibility are key areas for further investigation in basic science research.

One Size Does Not Fit All: Women Experience More Pain Than Men After Total Knee Arthroplasty

BACKGROUND

Multimodal pain regimens are universally applied to all patients, despite known differences in pain and responses to medication between patients of different sexes, ethnicities, and races. The purpose of this study was to understand the influence of patient sex on postoperative total knee arthroplasty pain perception as well as the efficacy of perioperative pregabalin for pain control.

METHODS

Visual analog Scales (VASs) and Knee Injury and Osteoarthritis Outcome Junior (KOOS Jr.) scores were prospectively collected for 150 patients (64 men and 86 women). Mean pain scores, delta pain scores, time to achieve minimal clinically important differences, influence of pregabalin, and opioid consumption were recorded at baseline, day of surgery, 24 hours, 48 hours, and 72 hours postoperatively, as well as postoperatively weeks 1, 2, 6, 12, and 26, and compared between women and men cohorts. This study was registered on ClinicalTrials.gov (NCT04471233).

RESULTS

The VAS pain scores for women were higher than for men at all study time points (P < 0.05). The change in VAS walking and mean KOOS Jr. scores from baseline to final follow-up at 26 weeks were not significantly different between cohorts. Both cohorts achieved VAS minimal clinically important difference by 2 weeks postoperatively. No significant differences in opioid consumption between men and women were noted during the study time periods. Women were also noted to have significantly higher raw KOOS Jr. scores than men at all-time points, except for at 26 weeks postoperatively. Interim analysis revealed no significant influence of pregabalin on VAS scores, so this arm of the study was discontinued.

CONCLUSIONS

Patient sex plays a role in perceived postoperative total knee arthroplasty pain, as women reported higher pain scores than men. We recommend not overly relying on standardized protocols, but rather instituting patient-specific pain management strategies.

Knee Injuries in Baseball

While knee injuries account for just 7% of injuries in professional and collegiate baseball, they are the fourth most common cause of missed professional games. The 3 most common knee-related issues in baseball are patellar tendinopathy, meniscus tears, and medial collateral ligament sprains. While injuries such as anterior cruciate ligament tears and patellar dislocations are less common, they are notable due to their potentially significant effect on time missed. Treatment considerations of all these pathologies are multifactorial and should include skeletal maturity, level of play, timing of season/recruiting, and long-term goals.

Autologous Peripheral Blood-Derived Orthobiologics for the Management of Elbow Disorders: A Review of Current Clinical Evidence

INTRODUCTION

Elbow ailments are common, but conventional treatment modalities have shortcomings, offering only interim pain relief rather than targeting the underlying pathophysiology. The last two decades have seen a marked increase in the use of autologous peripheral blood-derived orthobiologics (APBOs), such as platelet-rich plasma (PRP), to manage elbow disorders. Platelet-rich plasma (PRP) is the most widely used APBO, but its efficacy remains debatable. Consequently, other APBOs, such as platelet lysate (PL), autologous conditioned serum (ACS), gold-induced cytokine (GOLDIC), plasma rich in growth factors (PRGF), autologous protein solution (APS), and hyperacute serum (HS), have been considered. Only a few reviews summarize the results of clinical studies investigating the efficacy of these APBOs in elbow disorders. This review documents the results of clinical studies involving APBOs in managing elbow disorders and summarizes the ongoing clinical studies on different clinical trial protocol repositories comprising these APBOs to manage elbow disorders.

METHODS

This systematic review adhered to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. In December 2024, PubMed, Embase, and Web of Science were accessed with no additional filters or time constraints. All available clinical studies published in English, French, Spanish, German, or Italian concerning the management of elbow disorders by means of APBOs were considered.

RESULTS

Only three clinical studies met our predefined search and inclusion criteria. In particular, two and one studies involving the use of PL and ACS, respectively, were included in this review. Data from 99 patients were obtained. Of them, 57.6% (57 of 99 patients) were women. The mean length of follow-up was 11.9 ± 0.6 months, and the mean age was 42.0 ± 3.5 years. No complications were reported in any of the studies included. The included studies have low to medium risk of bias, and a very low score on methodological quality. Finally, no clinical studies involving the use of GOLDIC, PRGF, APS or HS were identified, and only one ongoing clinical study involving the use of PL was registered.

CONCLUSIONS

The current peer-reviewed published studies demonstrated that administering APBOs, including PL and ACS, might be safe and effective in reducing pain and improving function in patients with elbow disorders. Further, high-quality studies are required.

The efficacy of tranexamic acid in perioperative bleeding following total hip arthroplasty through different surgical approaches: Systematic review and meta-analysis

Introduction

Tranexamic acid (TXA) has been documented to reduce perioperative blood loss following orthopedic surgeries, such as total hip arthroplasty (THA). Previous studies focused on the best applicable dose and administration method to minimize blood loss. Although the surgical approach is another factor that may influence perioperative bleeding, no previous research has examined its concurrent impact alongside TXA. This meta-analysis investigated the effect of intravenous TXA on perioperative bleeding in primary THA, focusing on the surgical approach used.

Method

The authors searched PubMed, Web of Science, Scopus, Embase, and the Cochrane Library through November 2022. Fourteen studies, comprising 1358 patients, were identified as suitable for inclusion in this meta-analysis. To assess perioperative bleeding, hemoglobin (Hb) decline, transfused blood products, total blood loss (TBL), and intraoperative blood loss (IOBL) were recorded.

Results

The study showed that the lateral approach (LA) maintains the postoperative Hb level more effectively (WMD = 1.081, 95 % CI: 0.620-1.541). Significantly less IOBL was observed with the posterolateral approach (PLA; WMD = -70.578, 95 % CI: [-130.389] - [-10.766]). The posterior approach (PA) was associated with a reduction in TBL (WMD = -392, 95 % CI: [-474.439] - [-310.231], P-value <0.0001).

Conclusion

The surgical approach plays a significant role in blood management during surgery. Overall, the PLA resulted in the least IOBL, while the LA was associated with the least blood transfusion and a decline in Hb level. Additionally, the PA was linked to the lowest TBL.

Fourth-generation Ceramic Head Fracture in Total Hip Arthroplasty: A Case Report and Literature Review

Ceramics are used in total hip arthroplasty due to inherent wettability and low wear rates, but fracture risk is a known complication. Rates as high as 13.4% were reported in the past, yet as low as 0.02% in newer generations. Howard et al. reported a fracture rate of 0.009% for fourth-generation ceramic heads. We present a case report of a 69-year-old male with a BMI of 40.01 kg/m2 who suffered a fracture of a 36-mm ceramic femoral head with pseudoacetabular involvement of the polyethylene liner. This occurred 2 years and 3 months after his primary surgery after a 4-foot fall off of a ladder. The patient underwent revision of his total hip arthroplasty with arthroplasty of the polyethylene liner and femoral head component without stem explantation.

Advancements in 3D printing technologies for personalized treatment of osteonecrosis of the femoral head

Three-dimensional (3D) printing technology has shown significant promise in the medical field, particularly in orthopedics, prosthetics, tissue engineering, and pharmaceutical preparations. This review focuses on the innovative application of 3D printing in addressing the challenges of osteonecrosis of the femoral head (ONFH). Unlike traditional hip replacement surgery, which is often suboptimal for younger patients, 3D printing offers precise localization of necrotic areas and the ability to create personalized implants. By integrating advanced biomaterials, this technology offers a promising strategy approach for early hip-preserving treatments. Additionally, 3D-printed bone tissue engineering scaffolds can mimic the natural bone environment, promoting bone regeneration and vascularization. In the future, the potential of 3D printing extends to combining with artificial intelligence for optimizing treatment plans, developing materials with enhanced bioactivity and compatibility, and translating these innovations from the laboratory to clinical practice. This review demonstrates how 3D printing technology uniquely addresses critical challenges in ONFH treatment, including insufficient vascularization, poor mechanical stability, and limited long-term success of conventional therapies. By introducing gradient porous scaffolds, bioactive material coatings, and AI-assisted design, this work outlines novel strategies to improve bone regeneration and personalized hip-preserving interventions. These advancements not only enhance treatment efficacy but also pave the way for translating laboratory findings into clinical applications.

Non-Medial Ulnar Collateral Ligament Elbow Pathology in the Thrower: Valgus Extension Overload, Osteochondritis Dissecans, Olecranon Stress Fracture, and Ulnar Nerve

Injury rates in baseball players reach as high as 5.8 per 1000 at the professional level. Recent data have singled out the elbow as the leading cause of injured list necessitating injuries and the costliest injury location in professional baseball. While the medial ulnar collateral ligament (MUCL) has gained the largest notoriety in this population, elbow injury in the thrower occurs as a spectrum of pathologies. These pathologies may encompass other injuries often resulting from or occurring in conjunction with MUCL insufficiency. These conditions include valgus extension overload syndrome, osteochondritis dissecans, olecranon stress fractures, and ulnar nerve pathology.

Infection following mini-open rotator cuff repair: a single surgeon experience

BACKGROUND

Surgical technique has been shown to influence risk of surgical site infection following rotator cuff repair (RCR). Few studies have reported the rate of infection associated with mini-open RCR. The goal of this study was to report the postoperative infection rate and risk factors for infection among patients undergoing RCR performed by a single surgeon using a modified mini-open technique. Our hypothesis was that the rate of infection after mini-open RCR would be lower than previously reported for this surgical approach.

METHODS

We retrospectively reviewed an institutional shoulder surgery database to identify patients who underwent mini-open RCR performed by 1 surgeon at an academic tertiary care institution between 2003 and 2020. Patient records were reviewed to determine which individuals returned within 3 months postoperatively with a superficial or deep surgical site infection requiring operative management. Patient demographics, preoperative clinical characteristics, intraoperative variables, microbiological findings, infection management, and clinical course after infection were recorded. Backward elimination multivariate regression was used to assess for significant risk factors for infection.

RESULTS

Of the 925 patients identified, 823 (89%) had at least 3 months of follow-up and were included for further analysis. A majority of the patients undergoing RCR were men (57%). The mean age was 58.4 ± 9.9 years, and the mean body mass index was 29.3 ± 5.9 kg/m2. Fourteen cases (1.7%) of postoperative surgical site infection were identified in 13 patients. Ten infections (1.2%) were superficial and 4 (0.49%) were deep. The most commonly identified organisms were Staphylococcus aureus and Cutibacterium acnes. Male sex (odds ratio [OR] 4.3, 95% CI 1.2-15.3) and diabetes mellitus (OR 3.9, 95% CI 1.2-12.6) were found to be associated with greater odds of infection. The RCR construct was found to be intact in all 10 patients with superficial infections and 2 of the 4 patients with deep infections. All infections were successfully treated with 1 round of surgical débridement and wound irrigation, and with 6 or fewer weeks of intravenous antibiotic therapy. All patients with postoperative infections recovered with no sequelae at a median final follow-up of 63.5 months (range, 3-215 months).

CONCLUSIONS

This single-surgeon series of a large patient cohort undergoing mini-open RCR over an 18-year period demonstrated a low overall infection rate of 1.7%. Only 4 infections were deep, which suggests that deep infection after mini-open RCR is uncommon and approximates infection rates seen with arthroscopic techniques.

Exploring Outcomes of Tibial Rigid Intramedullary Nailing in Adolescent Patients

OBJECTIVES

To explore outcomes after tibial rigid intramedullary nailing (RIMN) in skeletally immature patients, with a focus on postoperative complications and iatrogenic changes in tibial slope due to anterior physeal arrest.

METHODS

DESIGN

Retrospective case series.

SETTING

A large, tertiary care health system in the rural Mid-Atlantic United States, including two Level 1 trauma centers and one Level 2 trauma center.

PATIENT SELECTION CRITERIA

Included were skeletally immature patients within 2 years of skeletal maturity undergoing tibial RIMN for Orthopaedic Trauma Association/Arbeitsgemeinschaft fur Osteosynthesefragen 42 A to C fractures between March 2009 and January 2024 with postoperative follow-up more than 1-year.

OUTCOME MEASURES AND COMPARISONS

The primary outcome was change in tibial slope after RIMN. Secondary outcomes included postoperative weight-bearing status and complications.

RESULTS

Thirty-seven skeletally immature patients were included (mean age 15.2 ± 1.3 years, 76% male). For 22 patients with minimum 6-month postoperative radiographs (mean 18.4 ± 12.7 months), there was no significant change from preoperative to postoperative tibial slope (80.0 ± 1.9 vs. 80.1 ± 1.6 degrees, P = 0.86). Time to achievement of full weight-bearing across the series averaged 45.4 ± 35.6 days. Five patients (14%) underwent hardware removal, and 89% of patients reported that they had returned to "normal" activity at the latest follow-up (mean 56.2 ± 42.5 months).

CONCLUSIONS

This study demonstrated that RIMN for tibial shaft fractures in skeletally immature pediatric patients within 2 years of maturity was not associated with iatrogenic physeal injury and resultant changes in tibial slope. Additional favorable clinical outcomes, the potential for early weight-bearing, and few associated postoperative complications indicate that RIMN is a safe option for skeletally immature patients with tibial shaft fractures. Caution should be exercised when extrapolating these results to younger pediatric patients with >2 years of skeletal growth remaining.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Lateral column midfoot injury: Do they all need fixation?

Introduction/purpose

Research on midfoot injuries have primarily concentrated on the central column and the Lisfranc ligament without amassing evidence on lateral column injuries. Classically lateral column injuries were treated with Kirschner wire fixation. Our aim was to analyse midfoot lateral column injuries and their methods of treatment.

Methods

Multicentre observational study. Data was retrospectively collected from three centres on surgically treated midfoot fracture dislocations between 2011 and 2021. Radiographs were analysed using departmental PACS. All statistics was performed using SPSS 26.

Results

A total of 409 surgically treated midfoot injuries were identified for further investigation. Following analysis, a total of 235 cases were diagnosed as having a lateral column injury, and 222 had data available for further analysis. All but 1 case (234, 99.6 %) of lateral column injury was associated with central column injury and 166 cases (70.6 %) were associated with medial column injuries.There were 44 cases where the lateral column underwent Kirschner wire fixation, 23 lateral column plate fixations and 3 lateral column screw fixations. Most patients (147, 63 %) had no fixation for their lateral column injury with only 2.84 % losing alignment at subsequent follow up. The patients undergoing K wire fixation had a greater loss of alignment rate (5.88 %). The use of a bridge plate to fix the central column appears protective and purely ligamentous injury was a higher risk than an injury that included the bone.

Conclusion

Lateral column injury occur in over half of midfoot fractures in this study. It rarely occurs alone and is most commonly related to three column injuries. Nevertheless, following stabilisation of the central column, additional fixation of injuries to the lateral unlikely to be required in the majority of cases. In cases where lateral column stabilisation is required, plates and screws may be preferable to K wires.

Elastic stable intramedullary nailing versus submuscular plating in length unstable pediatric diaphyseal femur fractures: A prospective comparative study

Objective

This study aims to compare the effectiveness of ESIN versus SMPs in both length-stable and unstable fractures of the femoral diaphysis in children above five years of age.

Methods

A Prospective Comparative Study was done including 40 children aged 5-13 years with a displaced shaft of femur fracture. Patients were randomized with either elastic nailing or submuscular plating as one of the operating options and were operated on according to their unique hospital identification number. The mean blood loss, operative time, fluoroscopy time, duration of analgesic use, and complications in both groups were noted. At end of 12 months, the primary outcome as per Flynn's criteria, was evaluated. Minimum 2 year follow up was done to evaluate for any complications.

Results

40 patients were available for the study, 22 in ESIN (group1) and 18 in SMP (group2). In the ESIN (group1), 16 patients (72.72 %) had excellent grade, 4 patients (18.18 %) had satisfactory grade, and 2 patients (9.09 %) had a poor grade. In the SMP group, 17patients (94.44 %) had excellent grade, and 1 patient (5.55 %) had a poor outcome. Surgical parameters such as the mean operative time, incision length, blood loss, mean fluoroscopy time was significantly shorter in ESIN group compared to the SMP group (<0.001).

Conclusions

The outcome of fractures, irrespective of length stability managed by ESIN are comparable to SMP. Based on our findings, ESIN can safely be employed for management of length unstable fractures. The choice of implant should be based on surgeon's discretion, comfort level, patient decision and overall cost of the procedure, rather than on length stability of fracture.

Mechanisms and Therapeutic Prospects of Microglia-Astrocyte Interactions in Neuropathic Pain Following Spinal Cord Injury

Neuropathic pain is a prevalent and debilitating condition experienced by the majority of individuals with spinal cord injury (SCI). The complex pathophysiology of neuropathic pain, involving continuous activation of microglia and astrocytes, reactive gliosis, and altered neuronal plasticity, poses significant challenges for effective treatment. This review focuses on the pivotal roles of microglia and astrocytes, the two major glial cell types in the central nervous system, in the development and maintenance of neuropathic pain after SCI. We highlight the extensive bidirectional interactions between these cells, mediated by the release of inflammatory mediators, neurotransmitters, and neurotrophic factors, which contribute to the amplification of pain signaling. Understanding the microglia-astrocyte crosstalk and its impact on neuronal function is crucial for developing novel therapeutic strategies targeting neuropathic pain. In addition, this review discusses the fundamental biology, post-injury pain roles, and therapeutic prospects of microglia and astrocytes in neuropathic pain after SCI and elucidates the specific signaling pathways involved. We also speculated that the extracellular matrix (ECM) can affect the glial cells as well. Furthermore, we also mentioned potential targeted therapies, challenges, and progress in clinical trials, as well as new biomarkers and therapeutic targets. Finally, other relevant cell interactions in neuropathic pain and the role of glial cells in other neuropathic pain conditions have been discussed. This review serves as a comprehensive resource for further investigations into the microglia-astrocyte interaction and the detailed mechanisms of neuropathic pain after SCI, with the aim of improving therapeutic efficacy.

Association of Knee Osteoarthritis Treatment Types, Patient Characteristics, and Medical History With Subsequent Risk for Total Knee Arthroplasty: Data From a New Real-World Registry

Background

This article examines predictors of subsequent total knee arthroplasty (TKA) within 6 months of nonoperative intervention based on (1) patient demographics; (2) knee osteoarthritis (OA) severity; and (3) various nonoperative treatments (cryoneurolysis with superficial or deep genicular nerve block, intra-articular [IA] hyaluronic acid injections, nonsteroidal inflammatory drug injections, IA-corticosteroids injections, or IA-triamcinolone extended-release [IA-TA-ER] injections).

Methods

Patients who had unilateral knee OA and received nonoperative intervention were identified in the Innovations in Genicular Outcomes Research registry between September 2021 and February 2024, identifying 505 patients. Baseline patient demographics were tabulated by knee OA severity as graded by Kellgren-Lawrence (KL) and nonoperative treatment, identifying patients who underwent TKA within 6 months. Predictors of TKA were identified using 20 potential demographic/clinical variables and calculating individual hazard ratios.

Results

Obesity and KL grade IV knees were significant predictors of TKA within 6 months of nonoperative treatment (P < .05). Age, sex, marital status, number of comorbidities, physical activity level, smoking status, insurance type, and baseline pain and functional scores were not associated with subsequent TKA. Overall, treatment type was also not linked to subsequent TKA, although pairwise comparison suggested use of IA-TA-ER was associated with a decreased conversion to subsequent TKA (P = .002).

Conclusions

Apart from obesity and KL grade IV knees, it remains challenging to identify which patients are at risk for conversion to subsequent TKA after nonoperative treatment. It appears IA hyaluronic acid and IA-TA-ER are most associated with decreased conversion to TKA within 6 months.

Maintaining Mobility and Balance in Multiple Sclerosis: A Systematic Review Examining Potential Impact of Symptomatic Pharmacotherapy

BACKGROUND

Mobility disability (MD) manifests as walking dysfunction and postural instability in more than 90% of people with multiple sclerosis (MS) within 10 years of disease onset. Disease-modifying pharmacotherapies reduce rates of relapses and new lesions and slow disease progression, but ongoing decline in MD can persist or result from secondary, symptomatic pharmacotherapies. This systematic review focuses on symptomatic pharmacotherapies that potentially impact markers of MD in MS.

METHODS

PubMed/Medline, Google Scholar, and Scopus were searched between January 1990 and December 2024. Eligible studies were included on the basis of the following criteria: (1) randomized, placebo-controlled trials (RCTs); (2) confirmed MS diagnosis; (3) one MD-related outcome; and (4) one symptomatic pharmacotherapy; OR (5) multiple doses of a symptomatic pharmacotherapy. Results were uploaded to Rayyan: Intelligent Systematic Review software and screened by two blinded reviewers for eligibility. Risk of bias was assessed using the PEDRo Scale for quality assessment.

RESULTS

This review included 23 RCTs (all RCTs scored good-to-excellent on PEDRo Scale); 13 RCTs examined fampridine (4-aminopyridine) for its direct effects on MD, and 10 RCTs assessed indirect effects of symptomatic pharmacotherapies, including cannabinoids (n = 9), and baclofen (n = 1) on MD. The MD outcomes included gait (25-foot walk [T25FW], kinetics, and kinematics), community mobility (12-item MS Walking Scale [MSWS-12]), endurance (6-min walk [6MW]), balance (Berg Balance Scale [BBS], Dynamic Gait Index [DGI], Six-Spot Step Test, posturography, and falls), and functional mobility (Timed Up and Go [TUG] and 5 Times Sit-to-Stand [5STS]). Fampridine significantly improved gait (T25FW, MSWS-12), endurance (6MW), and functional mobility (5STS, TUG), with the largest effect on gait speed; changes in balance were inconclusive. Indirect pharmacotherapies, specifically cannabinoids mainly reduced spasticity (Modified Ashworth Scale, nine out of nine studies), but rarely improved pain (Numerical Rating Scale, two out of nine studies) or MD outcomes (two out of nine studies). Both direct and indirect pharmacotherapies resulted in adverse effects, notably dizziness (n = 366), urinary tract infection (n = 216), and nausea (n = 150), potentially impacting MD in MS.

CONCLUSIONS

Fampridine may improve gait and functional mobility in MS, but its effect on balance requires further investigation in RCTs. Cannabinoids and baclofen may alleviate spasticity and pain, but seemingly have limited secondary effect on markers of MD, such as gait and postural stability. Clinicians should consider the impact of symptomatic pharmacotherapies on MD in MS, including potential side effects. Future research should explore integrating rehabilitation (e.g., balance training) with symptomatic pharmacotherapies, as this might enhance positive effects or combat deleterious effects on markers of MD.

Does Cruciate Ligament Substitution and Implant Asymmetry Make a Difference for Total Knee Arthroplasty Kinematics? A Multi-Implant Evaluation

BACKGROUND

The non-implanted knee differs in comparison to total knee arthroplasty (TKA) designs, with regard to asymmetry and functionality of the anterior cruciate ligament and the posterior cruciate ligament. While surgeons may choose to implant either posterior stabilized (PS) or bi-cruciate stabilized (BCS) TKAs, substituting for one or both cruciate ligaments, the effects of symmetry versus asymmetry in substituting TKA designs have not been widely analyzed to determine possible benefits. Therefore, the objective of this research study was to determine if either TKA asymmetry and/or anterior ligament stabilization can lead to more normal-like kinematics and clinical benefit for patients.

METHODS

In vivo, femoro-tibial kinematics for 64 subjects were evaluated in this retrospective study. Overall, 10 subjects had a normal, nonimplanted knee, 20 had a BCS TKA, and 34 had one of two different PS TKAs. All three TKAs had varying degrees of symmetry incorporated into the design, and all were implanted by the same surgeon and were analyzed using fluoroscopy during a deep knee bend.

RESULTS

At full extension, the BCS TKA subjects demonstrated a statistically more anterior position of both condyles compared to both PS TKAs. The BCS TKA subjects also experienced more posterior femoral rollback (PFR) and axial rotation in early flexion and from full extension to maximum knee flexion. Additionally, the TKAs in this study having asymmetry experienced greater amounts of PFR and weight-bearing knee flexion.

CONCLUSIONS

The results from this study indicated that in early flexion, the anterior cam/post mechanism does pull the femoral component more anterior, and all TKAs experienced PFR when the posterior cam engaged the post. The asymmetric designs also achieved greater rollback and axial rotation compared to the symmetric designs.

Platelet-rich plasma enhances remodeling of combined gastrocnemius muscle and Achilles tendon injuries in rat model: Reducing fibrosis, modulating gene (MMP9, Bax, HMGB1, and IGF) expression, and restoring histopathological and ultrastructural changes

Muscle and tendon injuries are prevalent occurrences during sports activities. Platelet-rich plasma (PRP) is known for its rich content of factors essential for wound healing, inflammation reduction, and tissue repair. Despite its recognized benefits, limited information is available regarding PRP's effectiveness in addressing combined surgical injuries to the gastrocnemius muscle and Achilles tendon. The effects of PRP on muscle and tendon injury in rats were assessed through a set of biochemical markers, histopathological examinations, and immunohistochemistry analyses of muscular myogenin, desmin, and tendinous type I collagen. Additionally, mRNA expression levels of Matrix metalloproteinase-9 (MMP-9), Pro-apoptotic Bcl-2 Associated-X-protein (BAX), Insulin-like growth factor (IGF), and High mobility group box 1 protein (HMGB1) genes were evaluated. Induction of muscle and tendon injuries was associated with elevated levels of serum biomarkers such as C-reactive protein (CRP), Aspartate aminotransferase (AST), Lactate dehydrogenase A (LDH), and Creatine Kinase MB (CK-MB), delayed collagen fiber remodeling, and structural abnormalities in myofibrils. Furthermore, there was overexpression of MMP9, Bax, and HMGB1 genes, along with decreased expression of the IGF gene in this group. Treatment with PRP resulted in significant improvement of these reported findings, including enhanced collagen fiber remodeling, elevated levels of desmin and myogenin in muscle tissues, and increased expression of collagen type I in tendons. Additionally, PRP treatment led to reduced expression levels of MMP9, Bax, and HMGB1 genes, while the expression of the IGF gene increased. Overall, PRP treatment demonstrated substantial enhancement of the healing process in both muscle and tendon tissues in a surgical model of gastrocnemius skeletal muscle and Achilles tendon-induced injury. These findings suggest that PRP therapy may offer advantages in the treatment of physical-related injuries.

MicroRNA dysregulation and target genes in common spinal tumors

Spinal tumors, although rare, pose significant challenges in diagnosis and treatment due to their complex biological behavior and the variety of tumor types involved. MicroRNAs (miRNAs), small non-coding RNA molecules, have emerged as critical regulators of gene expression and play dual roles as oncogenes or tumor suppressors, depending on their target genes. This review comprehensively examines the role of miRNAs in the pathogenesis and progression of common spinal tumors, including ependymoma, astrocytoma, meningioma, and metastasis, based on existing studies using both human and in vitro models. Several miRNAs have been identified as dysregulated in these tumor types, influencing key cellular processes such as proliferation, migration, and apoptosis. The potential of miRNAs as diagnostic, prognostic, and therapeutic biomarkers is explored, highlighting their value in guiding personalized treatment approaches. Although promising, these findings require further validation to fully understand miRNA-mediated mechanisms and translate these insights into clinical applications. MiRNA-targeted therapies offer a promising avenue for improving patient outcomes in spinal tumor management.

The Impact of Travel Distance on Patient-Reported Outcomes Following Primary Total Hip Arthroplasty

BACKGROUND

Total hip arthroplasties (THAs) are increasingly being performed at high-volume centers, causing some patients to travel further distances to receive care. Concerns remain that increased travel distance limits follow-up, which may impact outcomes and early return to the hospital. The purpose of this study is to evaluate the impact of travel distance on 90-day patient-reported outcomes (PROs) and 90-day complication rates.

METHODS

Patients undergoing inpatient primary THA at a single center by one of three surgeons between 2017 and 2021 were retrospectively reviewed. Patients whose local and distant medical records were available were included. Patients who lived ≥ 40 miles from the location or follow-up were labeled as "travelers," and those < 40 miles were "locals." Primary outcomes included PROs as measured by Veterans Rand 12 Item Health Survey, Harris Hip Score, and Hip Dysfunction and Osteoarthritis Outcome Score for Joint Replacement. Secondary outcomes included rates of 90-day medical complications, emergency department visits, unplanned readmissions, and reoperations.

RESULTS

A total of 413 patients were analyzed at a mean of 897.1 days (range, 92 to 2,196) including 96 travelers. Travelers averaged 96.1 miles for follow-up (range, 40.1 to 678 miles), and locals averaged 14.1 miles for follow-up (range, 0.3 to 39.8 miles). There were no differences in the percentage of patients achieving minimal clinically important difference in PROs. There was no difference in the rate of 90-day medical complications, 90-day readmissions, and reoperations. Local patients were significantly more likely to have unplanned postoperative emergency department visits (travelers = 0%, locals = 7.4%, P = 0.003).

CONCLUSIONS

Travelers did not demonstrate any significant differences with respect to rates of achieving minimal clinically important difference in PROs or 90-day complication rates. These data suggest that increased travel distance to treatment centers does not impact outcomes following primary THA.

The use of three-dimensional printing and virtual reality technologies in orthopaedics-with a focus on orthopaedic trauma

Although the use of three-dimensional printing in orthopaedics is relatively new, many benefits of this technology to both patients and providers have already been observed. Printing models of fractured bone based upon segmented CT imaging allows for improved surgical planning as surgeons are able to view and physically manipulate accurate representations of fracture patterns prior to surgery, increasing both speed and accuracy of fixation in the operating room. The use of three-dimensional models by surgeons prior to surgery has been shown to reduce blood loss, intraoperative time, and fluoroscopy use. These models also have incredible potential in orthopaedic resident and patient education. Among residents, these models significantly improve recognition of fracture patterns, while patients benefit from the use of these models through increased trust and satisfaction with their surgeon's care, as well as decreased anxiety about their injury. Currently, the imaging segmentation and model generation process are prohibitively costly both in terms of time and money; however, in the future, three-dimensional printing may become a point-of-care technology in the orthopaedic field as technology improves and costs decrease. This article aims to illustrate the value of three-dimensional printing and virtual reality technologies in preoperative planning and intraoperative precision, resident education, and patient understanding and satisfaction. The benefits and challenges of the technologies are discussed, as well as current limitations.

The Evolution of Geriatric Ankle Fracture Management to Promote Mobility

Geriatric ankle fracture management requires a comprehensive approach that balances appropriate patient optimization, fracture reduction, stability, and early mobilization. Surgical and nonsurgical options should be cautiously considered based on patient and fracture characteristics. Early weight-bearing treatment options should be pursued when possible. There are a myriad of treatment options including fibular intramedullary devices or minimally invasive joint prep tibiotalocalcaneal nailing that minimize soft tissue disruption and can provide robust stability sufficient to allow early weight-bearing postoperatively when appropriate. It is essential for geriatric patient treatment teams to optimize outcomes and minimize complications in this often-challenging patient population.

Ultrasound imaging in professional soccer: when is it adequate?

Ultrasound imaging plays an important role in the diagnosis, monitoring and treatment of injuries in professional soccer players. With the rapid increase in the availability of hand-held portable ultrasound devices and the pressure to make timely and accurate diagnosis in professional soccer where return to play time is crucial, ultrasound imaging is an essential diagnostic tool. In this article, we discuss examples of injuries that can be adequately assessed by ultrasound imaging alone and injuries where ultrasound imaging provides a useful first step to guide further investigation and management.

Systemic trafficking of macrophages in implant wear debris-induced periprosthetic osteolysis

Periprosthetic osteolysis (PPOL) is a significant complication post-joint replacement, often instigated by implant wear debris, leading to chronic inflammation and bone resorption. Herein, this review summarizes the immune mechanisms of PPOL, specifically, the processes where macrophages are recruited by implant wear debris, the mechanisms by which macrophages trigger inflammatory cascades, and the role of chemokines that facilitate macrophage migration, including CCL2, CCL3, CCL4, CCL5, CXCL8, CX3CL1, and XCL1. This review highlights novel findings on these processes and suggests that illustrating these mechanisms offers promising avenues for future therapeutic strategies to prevent and treat PPOL, such as the potential use of anti-inflammatory drugs.

Collagen/polyvinyl alcohol scaffolds combined with platelet-rich plasma to enhance anterior cruciate ligament repair

In anterior cruciate ligament (ACL) repair methods, the continuous enzymatic erosion of synovial fluid can impede healing and potentially lead to repair failure, as well as exacerbate articular cartilage wear, resulting in joint degeneration. Inspired by the blood clot during medial collateral ligament healing, we developed a composite scaffold comprising collagen (1 %, w/v) and polyvinyl alcohol (5 %, w/v) combined with platelet-rich plasma (PRP). The composite scaffold provides a protective barrier against synovial erosion for the ruptured ACL, while simultaneously facilitating tissue repair, thereby enhancing the efficacy of ACL repair techniques. The composite scaffold is primarily formed through hydrogen bonding between molecular chains and physical cross-linking of microcrystalline regions using a simple cyclic freeze-thaw method, resulting in improved mechanical properties and an extended degradation period. The maximum tensile fracture load of the composite scaffold reached 5.99 ± 0.30 N. The incorporation of PRP facilitates cell migration, proliferation, and blood vessel growth by enabling slow release of various growth factors. In vivo results demonstrate that this composite scaffold promotes rabbit hindlimb rupture ACL healing by stimulating fibroblast proliferation, collagen deposition, microvascular formation, and proprioceptor generation. Furthermore, it effectively reduces meniscus and cartilage wear while mitigating bone arthritis and joint degenerative diseases. Overall, our proposed composite scaffold holds great promise as a candidate for ACL healing.

Reassessing Glycemic Control: A Novel Method for 90-Day Major Complication Stratification Based on Hemoglobin A1c and Same-Day Glucose Levels for Patients Undergoing Total Knee Arthroplasty

BACKGROUND

Glucose levels obtained on the day of surgery may be predictive of complications following total knee arthroplasty (TKA). Established glucose thresholds for TKA are either nonspecific or have low predictive power. Therefore, the purpose of this study was to create data-driven hemoglobin A1c (HbA1c) and same-day glucose thresholds associated with varying risks of 90-day major and surgical site infection (SSI) complications following TKA.

METHODS

Stratum-specific likelihood ratio analysis was conducted to determine data-driven HbA1c and glucose strata associated with varying risks of 90-day major and SSI complications. Each strata was then propensity score matched to the lowest strata based on age, sex, hypertension, heart failure, chronic obstructive pulmonary disorder, and obesity. The risk ratio (RR) for complications in each stratum with respect to the lowest matched stratum was analyzed.

RESULTS

Four data-driven HbA1c (%) strata (4.5 to 5.9, 6.0 to 6.4, 6.5 to 7.9, and 8.0+) and two same-day glucose (mg/dL) strata (60 to 189 and 190+) were identified that predicted 90-day major complications. When compared to the propensity-matched lowest strata (4.5 to 5.9%), the risk of 90-day major complications sequentially increased as the HbA1c (%) strata increased: 6.0 to 6.4 (RR: 1.23; P = 0.024), 6.5 to 7.9 (RR: 1.38; P < 0.001), and 8.0+ (RR: 2.0; P < 0.001). When compared to the propensity-matched lowest strata (60 to 189 mg/dL), the 190+ mg/dL strata had a higher risk of 90-day major complications (RR: 1.18; P = 0.016). No HbA1c or same-day glucose strata had significantly different risks of 90-day SSI.

CONCLUSIONS

The multiple strata identified for HbA1c demonstrate that a single HbA1c cutoff as identified in prior literature may be missing a larger picture for risk stratification. The threshold identified for same-day glucose can be utilized in day-of-surgery glycemic control guidelines to further reduce the risk of 90-day major complications.

Balancing postural control and motor inhibition during gait initiation

This study examines the relationship between stopping a planned gait initiation due to sudden environmental changes and maintaining body stability. Using a gait initiation version of the Stop Signal Task (SST), we studied changes in anticipatory postural adjustments (APAs) during gait initiation and suppression. We found that trial-level variables, such as the time to start or stop stepping, interacted with biomechanical factors like the center of mass displacement relative to the base of support affecting performance. A critical biomechanical threshold was identified, beyond which stopping movement was unlikely. These findings highlight the strong link between limb action control and body equilibrium, offering a framework within a motor control paradigm. By integrating biomechanical elements, the model effectively simulates real-life scenarios, identifying key variables for studying neural correlations between action and postural control, and aiding in the development of injury prevention and rehabilitation tools for individuals with movement and posture impairments.

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.

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.

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.