Risk factors for perioperative blood transfusion in total hip arthroplasty: a meta-analysis

OBJECTIVE

The present study assessed and synthesized the potential risk factors for perioperative blood transfusion in total hip arthroplasty from various studies through Meta-analysis.

METHODS

We systematically searched for relevant studies in databases including Web of Science, PubMed, Embase, and Cochrane Library from the time of database creation to 1 February 2025 and included all observational studies exploring perioperative transfusion risk factors in patients undergoing total hip arthroplasty. All included studies were assessed for quality using the Newcastle-Ottawa Scale (NOS) scale. Data were analyzed using Stata 15 software.

RESULTS

A total of 18 articles (n = 424,158) were included, meta-analysis results suggest that increased intraoperative bleeding [OR = 1.13, 95%CI (1.02, 1.24)], increased postoperative drainage [OR = 2.24, 95%CI (1.24, 4.83)], body mass index ≤ 18.5 [OR = 1.10, 95%CI (1.02, 1.20)], preoperative anemia [OR = 1.82, 95%CI (1.62, 2.03)], age ≥ 80 [OR = 1.49 95%CI(1.21, 1.83)], female [OR = 1.92, 95%CI (1.71, 2.15)], ASA class ≥ 3 [OR = 2.06, 95%CI (1.63, 2.61)] in patients with total hip arthroplasty (THA) increases the incidence of perioperative blood transfusion.

CONCLUSION

The results of the current study suggest that increased intraoperative bleeding, increased postoperative drainage, low body mass index (≤ 18.5), preoperative anemia, advanced age (≥ 80 years), female gender, and high ASA classification (≥ 3) were significantly associated with the likelihood of needing blood transfusion. These findings highlight the importance of preoperative risk assessment and perioperative management strategies to reduce the need for blood transfusion and improve patient outcomes.

Comparison of a minimally invasive osteosynthesis technique with open surgical technique for transverse patellar fractures

This retrospective study aimed to compare the safety and efficacy of a new minimally invasive osteosynthesis technique with those of conventional open surgery for transverse patellar fractures. Between January 2016 and December 2022, a total of 138 patients with transverse patellar fractures who underwent osteosynthesis with either minimally invasive osteosynthesis technique (MIOT) or open reduction and internal fixation (ORIF) were enrolled and retrospectively analyzed. The outcomes were assessed for 67 patients in the MIOT group (mean age: 46.2 ± 15.8 years old, mean follow-up: 26.4 ± 5.1 months) and 51 patients in the ORIF group (mean age: 43.7 ± 13.4 years old, mean follow-up: 25.1 ± 4.8 months). Clinical outcomes, including surgical time, blood loss, bony union time, final range of motion involving knee extension and flexion, Bostman score, visual analogue scale (VAS), and complications, were measured over a minimum follow-up period of 24 months. The surgical time in the MIOT group was shorter than that in the ORIF group (P = .001). The blood loss in the MIOT group was significantly less than that in the ORIF group (P < .0001). At the 2-year follow-up, all fractures had healed. The mean union time in the MIOT group was shorter than that in the ORIF group (P = .002). The MIOT group also exhibited significantly better flexion (P = .001) and a higher Bostman score (P = .0065), compared with the ORIF group. The mean VAS was significantly lower in the MIOT group than that in the ORIF group (P < .0001). The MIOT group had a lower complication rate, including delayed wound healing and implant irritation, as well as an overall lower complication rate. The MIOT method proved to be a reproducibly reliable approach, offering lower surgical trauma, improved functional outcomes, and a lower incidence of complications compared with the conventional open surgical technique for transverse patellar fractures. It may be a prudent choice for treating transverse patellar fractures.

Reporting and incorporation of social risks in low back pain and exercise studies: A scoping review

BACKGROUND

Exercise is a common intervention for low back pain, but its effect sizes are small to modest. Social risk factors significantly influence health outcomes, yet their consideration in randomized controlled trials on exercise for low back pain is often neglected. Determining their relationship to outcomes may provide better insight into exercise effectiveness.

OBJECTIVES

To assess the reporting of social risk factors (SRFs) in randomized controlled trials (RCTs) of exercise interventions for low back pain (LBP) in adults and explore associations between SRFs and outcomes.

DESIGN

Scoping Review.

METHODS

The databases MEDLINE, CINAHL and Cochrane were searched for studies published between January 2014 to March 2025. RCTs were included if exercise was the primary intervention for LBP treatment and had a minimum follow-up of 12 weeks. A planned analysis of SRF and outcome associations was not conducted due to insufficient data.

RESULTS

A total of 10,292 studies were identified and 157 studies included. Fewer than half (47.1 %) reported any SRFs at baseline. Socioeconomic position (42.7 %) was most frequently reported, followed by social relationships (17.8 %), race/ethnicity/cultural context (8.3 %), residential/community context (1.3 %), and gender (0.6 %). Four studies incorporated SRFs in their outcome analyses; one examined associations with outcomes and found no significant association.

CONCLUSION

SRFs are underreported in RCTs of exercise interventions for LBP and are rarely analyzed in relation to primary outcomes, limiting our understanding of their impact. Future trials should prioritize collecting and reporting SRFs at baseline and incorporating them in outcome analyses to assess their influence on outcomes.

Safety and Efficacy of Tranexamic Acid in Total Ankle Arthroplasty

Tranexamic acid has been shown to significantly reduce blood loss in patients undergoing total knee arthroplasty and total hip arthroplasty. However, there is a paucity of data regarding its safety and efficacy in total ankle arthroplasty. The purpose of this study was to determine whether tranexamic acid use in patients with total ankle arthroplasty affects blood loss or overall complication rate. A retrospective chart review was conducted for 64 patients who underwent total ankle arthroplasty with (n = 32) and without (n = 32) intraoperative tranexamic acid from 2014 to 2023 at a single academic medical center. Recorded blood loss, pre-to-postoperative hemoglobin changes, hidden blood loss, and complication rates were recorded and compared. There was no statistically significant difference in recorded blood loss, total calculated blood loss, pre-to-postoperative hemoglobin difference, hidden blood loss, or overall complications between the groups (all, P > .05). A lower rate of wound complications was observed in the tranexamic acid group, but the difference between each group was not statistically significant (P > .05). Tranexamic acid did not decrease blood loss during total ankle arthroplasty, as measured in our study. Tranexamic acid was not associated with any increase in overall complications. Based on our findings, tranexamic acid may be a safe intervention in total ankle arthroplasty, but further studies are needed to better elucidate its clinical impact.Level of Evidence: Level 3.

Conversion Total Hip Arthroplasty after Sliding Hip Screw and Cephalomedullary Nail Failures: A Systematic Comparative Review and Meta-analysis

With the exception of revision osteosynthesis, conversion total hip arthroplasty (CTHA) following sliding hip screw (SHS) and cephalomedullary nail (CMN) failure in intertrochanteric fractures (ITF) is the most commonly used treatment option. This review determined the relative risk of medical and orthopedic complications, including periprosthetic femoral fractures (PFF), following CTHA in failed SHS and CMN fixation of ITF, as well as the Harris hip score (HHS). Major electronic databases were searched for studies and reports on CTHA after SHS and CMN fixation failures in ITF. To assess the risk of bias, the studies were analyzed using the Joanna Briggs Institute critical appraisal tool for cohort studies. Three studies pooled 327 cases and 353 cases of CTHA from failed CMN and SHS in ITF. The relative risk of medical and orthopedic complications and PFF in the SHS group as compared to the CMN group was 0.87 [0.39, 1.90], 1.64 [1.18, 2.29], and 1.92 [0.81, 4.56], respectively. The mean difference in HHS was -0.72 [-1.47, 0.02] between failed SHS and CMN groups. The included studies were of retrospective study design with a more than 20% loss of follow-up and a high risk of bias. There is 64% more risk of orthopedic complications with CTHA in SHS failures than CMN failures. There is no difference in relative risk of medical complications and PFF between CTHA in both SHS and CMN failure. After CTHA, the benefits in function are similar in both groups.

The Long-Term Effects of Radial Head Excision for Mason Type 3 Radial Head Fracture

Background: Radial head fractures with comminution and displacement present challenges in achieving optimal treatment outcomes in the long term. This study aims to evaluate the long-term effects of radial head excision (RHE) in patients with Mason type 3 fractures. Methods: We conducted a retrospective study of patients with a Mason type 3 radial head fracture who underwent primary RHE between January 2010 and January 2020. The primary outcome was the Mayo elbow performance score (MEPS). Additionally, joint stability and arthritis, and the carrying angle were recorded for each patient. Results: In total, 61 patients (21; 34% female) with a follow-up range of 3-13 years were examined. The mean (SD) total MEPS was 91.8 (9.2). The results were excellent for 46, good for 12 and fair for 3 patients. A model of total MEPS adjusted for sex, age and follow-up time showed a significant effect of patient age on treatment success (p < 0.001). Thirteen patients (21%) showed elbow instability. Six individuals had increased valgus laxity. The mean carrying angle was 19° (range: 11°-27°) on the injured side and 9° (4°-15°) on the uninjured side, t(120) = 12.608, p < 0.001. Overall, 37 patients had degenerative changes in the operative elbow. Conclusions: Benefits of RHE persist for a long time with predominantly excellent elbow function and minimal complications. An increase in the carrying angle, joint instability and degenerative changes are to be expected. Patient age at the time of the surgery can affect treatment outcomes. Level of Evidence: Level IV (Therapeutic).

Risk factors for infection in patients undergoing hip replacement: a systematic review and meta-analysis

A meta-analysis was conducted to determine the risk of infection following hip replacement and risk factors were identified for surgical site infection. PubMed/Medline, Embase and Cochrane Library databases were systematically searched, as well as the reference lists of previous systematic reviews and meta-analyses. The pooled odds ratio (OR) was estimated using a random effects model for each investigated factor. The evidence of observational studies was classified as high quality (class I), moderate quality (class II or III) or low quality (class IV) based on the GRADE system. A total of 25,383 potential articles met the inclusion criteria in the database search. After reviewing the titles, abstracts, and full texts, 27 articles were included in the final analysis, encompassing 699,473 patients who underwent hip arthroplasty. High-quality evidence shows that BMI (≥30 kg/m2) (OR 2.16; 95% CI 1.72-2.70), male sex (OR 1.39; 95% CI 1.26-1.53), operation time (≥120 min) (OR 1.72; 95% CI 1.39-2.14), American Society of Anesthesiologists (ASA) class ≥3 (OR 2.05; 95% CI 1.49-2.83), diabetes (OR 1.33; 95% CI 1.23-1.43), and heart disease (OR 1.99; 95% CI 1.48-2.68) are associated with a greater risk of infection. The meta-analysis revealed that age and renal disease were not associated with infection. In conclusion, this meta-analysis identified significant risk factors for infection after hip-replacement surgery, including BMI, male sex, operation time, heart disease, diabetes, and ASA class.

Comparative Proteomic Analysis of Osteoarthritis and Rheumatoid Arthritis: Identifying Potential Biomarkers

This study investigates proteomic differences between knee osteoarthritis (OA) and rheumatoid arthritis (RA) to identify protein signatures with potential diagnostic and therapeutic relevance. Using SWATH mass spectrometry, synovial fluid proteome from OA patients across Kellgren-Lawrence OA grades 2, 3, and 4 was analyzed and compared with RA patients. Out of 333 quantified proteins, 45 were differentially expressed, including aggrecan, versican, and inflammation-related proteins (e.g., CRP, APCS, S100A8, and SAA2). ELISA validation confirmed aggrecan, versican, and cartilage oligomeric matrix protein (COMP) as significantly altered proteins in OA compared to RA, along with distinct trends with OA progression and mirrored patterns in paired serum samples. ROC curve analysis highlighted COMP's strong diagnostic potential, with an AUC of 96%, 87.2%, and 85.2% for OA grades 2, 3, and 4 versus RA, respectively. COMP differentiated OA from RA at a synovial fluid concentration of < 3136 ng/mL, AUC of 92.1%, 89% sensitivity, and 82% specificity. Versican also demonstrated diagnostic utility, particularly in later OA stages. Gender-specific analysis revealed no differences for aggrecan and versican, while COMP levels were significantly higher in males. Simultaneously, a lower aggrecan, versican, and COMP levels were observed in OA (females) as compared to RA, potentially linked to estrogen decline with age and cartilage degradation. However, gender variability underscores the need for a larger, sex-balanced cohort study. Future studies could aim to account for validating COMP's diagnostic potential with healthy controls, demonstrating its reliability to characterize different OA grades.

Perioperative and Follow-Up Analyses of Primary Posterior Stabilized and Cruciate Retaining Knee Arthroplasty

Background: Total knee arthroplasty (TKA) is a widely performed procedure to alleviate pain and restore function in patients with advanced knee osteoarthritis. Two common implant designs are cruciate-retaining (CR) and posterior-stabilized (PS) knees. Despite extensive research, the superiority of one design over the other remains inconclusive. Methods: A prospective analysis was conducted on 123 patients who underwent total knee arthroplasty (TKA) between June 2022 and June 2023 at a university hospital. Demographic data, mobility, the use of walking aids, pre- and postoperative range of motion and leg axis as well as surgical and systemic complications were collected and compared between CR and PS-TKA. Results: The mean age of the patients was 67.94 ± 10.14 years and 65.9% were women. The time of operation was significantly different between PS- and CR-TKA (PS: 83.31 ± 25.65 min; CR: 95.26 ± 24.61 min; p = 0.011). The pre- to postoperative leg axis after six months was significantly different in both groups (PS: 7.06° ± 4.76°; CR: 6.25° ± 3.13°; p = 0.001). The range of motion (ROM) (PS: 105.19° ± 15.56°; CR: 93.29° ± 15.09°; p = 0.001) as well as the deficit after six months (PS: 23.56° ± 19.73°; CR: 37.57° ± 23.33°; p = 0.003) between patients with PS and CR-TKA were significantly different. Gender (male vs. female PS/CR) and age (<75 years vs. >75 years PS/CR) differences were shown for the ROM and flexion deficit after six months (p = 0.003; p = 0.005). For age, a significant difference was shown for the quality of life (mean ranks: <75 y: 47.96; >75 y: 31.03; p = 0.009) and WOMAC score (mean ranks: <75 y: 38.27; >75 y: 61.75; p = 0.001) after six months. Conclusions: This study shows the different outcomes for posterior-stabilized versus cruciate-retaining TKA with regard to time of surgery, range of motion, and flexion deficit after 6 months with PS-TKA yielding better results. The gender analyses revealed similar outcomes after six months between both arthroplasty groups, whereas the age analyses revealed significant differences. The standardized use of PS-TKA for the elderly is recommended.

Use of a Conical Fluted Femoral Stem Eliminates the Need for Fixation in Patients Who Have Crowe Type 3 or 4 Coxarthrosis Undergoing Subtrochanteric Osteotomy

BACKGROUND

This study aimed to analyze the clinical, functional, and radiographic outcomes of patients who had Crowe type 3 or 4 developmental dysplasia of the hip (DDH) undergoing cementless total hip arthroplasty (THA) using a conical fluted femoral stem in combination with a transverse subtrochanteric femoral shortening osteotomy without internal fixation.

METHODS

This retrospective study included the records and radiological data of 114 patients who had Crowe type 3 or 4 DDH who underwent subtrochanteric femoral osteotomy and cementless THA at our institution between 2015 and 2022. The mean age was 46 years (range, 28 to 80), comprising 76 women and 38 men. The mean follow-up duration was 55 months (range, 25 to 85). Patients underwent clinical and radiological evaluations at two, four, eight, 12, and 24 weeks postoperatively and were called for a final evaluation. Radiographic bone union, Harris Hip Score (HHS), true limb-length discrepancy, and Trendelenburg sign were assessed.

RESULTS

A total of 112 hips (98.2%) achieved union at the osteotomy site, with a mean healing time of 5.4 months. The mean preoperative HHS was 50 (range, 42 to 61), which improved significantly to 86 (range, 75 to 98) postoperatively (P < 0.001). The mean preoperative limb-length discrepancy was 3.8 cm (range, two to 5.2), which was reduced to 1.1 cm (range, zero to 1.9) postoperatively (P < 0.001). There were no revisions or component exchanges that were required during the follow-up period, and no patients experienced severe limping postoperatively.

CONCLUSION

The use of a conical fluted femoral stem in patients who had Crowe type 3 or 4 DDH undergoing subtrochanteric femoral osteotomy provides stable fixation and excellent functional outcomes while eliminating the need for additional internal fixation.

Risk Factor Analysis for Proximal Junctional Kyphosis in Neuromuscular Scoliosis: A Single-Center Study

Background/Objectives: Proximal junctional kyphosis (PJK) is one of the most frequently discussed complications following corrective surgery in patients with neuromuscular scoliosis (NMS). Despite its clinical relevance, the etiology of PJK remains incompletely understood and appears to be multifactorial. Biomechanical and limited clinical studies suggest that preoperative hyperkyphosis, resection of the spinous processes with consequent disruption of posterior ligamentous structures, and rod contouring parameters may contribute as risk factors. Methods: To validate these findings, we retrospectively analyzed 99 NMS patients who underwent posterior spinal fusion using a standardized screw-rod system between 2009 and 2017. Radiographic assessments were conducted at three time points: preoperatively (preOP), postoperatively (postOP), and at a mean follow-up (FU) of 29 months. Clinical variables collected included patient age, weight, height, sex, and Risser sign. Radiographic evaluations encompassed Cobb angles, thoracic kyphosis (TK), lumbar lordosis, the levels of the upper (UIV) and lower (LIV) instrumented vertebrae, the total number of fused segments, parameters of sagittal alignment, the rod contour angle (RCA), and the postoperative mismatch between RCA and the proximal junctional angle (PJA). Based on the development of proximal junctional kyphosis, patients were categorized into PJK and non-PJK groups. Results: The overall incidence of PJK was 23.2%. In line with previous biomechanical findings, spinous process resection was significantly associated with PJK development. Furthermore, the PJK group demonstrated significantly higher preoperative TK (59.3° ± 29.04° vs. 34.5° ± 26.76°, p < 0.001), greater RCA (10.2° ± 4.01° vs. 7.7° ± 4.34°, p = 0.021), and a larger postoperative mismatch between PJA and RCA (PJA-RCA: 3.8° ± 6.76° vs. -1.8° ± 6.55°, p < 0.001) compared to the non-PJK group. Conclusions: Spinous process resection, a pronounced mismatch between postoperative PJA and RCA (odds ratio [OR] = 1.19, p = 0.002), excessive rod bending (i.e., high RCA), and severe preoperative thoracic hyperkyphosis with an expected increase in the risk of PJK of approximately 6.5% per degree of increase in preoperative TK are significant risk factors for PJK. These variables should be carefully considered during the surgical planning and execution of deformity correction in NMS patients.

Diagnostic model for distinguishing fresh or old osteoporotic vertebral compression fractures based on modified computed tomography window: a retrospective cohort study

PURPOSE

To develop and validate a Computed Tomography (CT) -based nomogram for distinguishing fresh from old osteoporotic vertebral compression fractures (OVCFs), with magnetic resonance imaging (MRI) as the reference standard.

METHODS

In this retrospective study, OVCF patients from The First Affiliated Hospital of Chongqing Medical University (August 2022-December 2023) were analyzed. Modified CT window parameters (width: 400; level: 200) were applied to quantify vertebral features, including CT values, height reduction, endplate integrity, trabecular sparsity, Schmorl's nodes, and high-density shadows. Predictive variables were selected via univariate and multivariate logistic regression, followed by nomogram construction. Model performance was assessed using receiver operating characteristic (ROC) curves (area under the curve, AUC), calibration plots, Hosmer-Lemeshow testing, and decision curve analysis (DCA). 10-fold cross-validation was used to evaluate the generalization performance of the model.

RESULTS

The nomogram incorporated seven imaging biomarkers, achieving AUCs of 0.941 (training cohort) and 0.974 (validation cohort). The calibration accuracy was assessed using the Hosmer-Lemeshow test (χ²=3.30, P = 0.95). DCA demonstrating significant clinical utility across probability thresholds. In cross-validation, the mean AUC on the validation sets was 0.911 ± 0.080 (mean ± standard deviation).

CONCLUSION

The proposed CT-based nomogram achieved adequate performance in identifying fresh and old OVCFs.

Third fragment femoral shaft fracture: A retrospective analysis of complications and predictive factors for non-union and delayed union

INTRODUCTION

Diaphyseal femur fractures are relatively common, and up to 39% of these cases involve a third fragment. These types of fractures present a unique challenge due to their high risk of non-union, reported in up to 14% of cases. Despite their frequency, there is still no consensus on the optimal management of the third fragment in these fractures. The purpose of this retrospective study was to compare the clinical and radiological outcomes of patients who underwent reduction of the third fragment with those who did not, to determine the characteristics of the third fragment that warrant reduction, and to suggest the best approach. The hypothesis is that an open reduction of the third fragment is to be avoided as it increases the risk of non-union.

MATERIAL AND METHODS

This retrospective monocentric study analysed clinical data from patients diagnosed with diaphyseal femur fractures at our Unit between 2010 and 2022. Radiological data encompassed the length and width of the third fragment, the fracture gap, its proximity to the proximal and distal cortex, the greatest cortex-to-cortex distance, and the orientation of the third fragment. Other factors considered included patient age, BMI, sex, type of surgery performed, fracture fixation method, occurrence of complications, specific complication types, incidence of mortality, and duration of follow-up.

RESULTS

Seventy patients were included in the study; 24 patients underwent osteosynthesis with plates and screws, while 46 patients were treated with intramedullary nailing. Descriptive analysis revealed no statistically significant difference in the characteristics of the third fragment between patients who experienced complications and those who did not. Surgical technique for osteosynthesis (plates and screws Vs intramedullary nailing) also showed no statistically significant differences, conversely the open reduction and synthesis of the third fragment is a statistically significant complication predictor.

CONCLUSION

The management of the third fragment remains a challenge. In our series of patients third fragment characteristics and type of osteosynthesis did not influence the risk of complications. However, the determining factor was found to be the open reduction of the third fragment.

LEVEL OF EVIDENCE

IV.

Total knee arthroplasty after anterior cruciate ligament reconstruction with the use of image-based robotic technology and functional alignment

BACKGROUND

Total knee arthroplasty (TKA) in patients with prior anterior cruciate ligament reconstruction (ACLR) presents unique challenges due to altered knee kinematics, residual instability, and fixation implants that may interfere with implant positioning. Image-based robotic-assisted TKA enables the functional alignment (FA) strategy that accounts for individual bony anatomy, ligamentous laxities, and anterior compartment characteristics.

SURGICAL TECHNIQUE

This technique involves a CT-based robotic workflow where femoral and tibial components are planned based on patient-specific alignment and soft tissue balance. Intraoperative assessment with a digital tensioning device guides fine-tuning of flexion and extension gaps, ensuring balanced implant positioning while minimizing soft tissue releases. Fixation implants from prior ACLR are identified using robotic navigation, allowing for targeted adjustments such as selective removal or controlled elevation of components to avoid excessive bone loss. Patellar tracking is dynamically evaluated with a probe, facilitating real-time adjustments to optimize mediolateral tracking and anterior offset.

DISCUSSION

Given the altered biomechanics in post-ACLR knees, FA may provide a physiological alignment by accommodating native laxities and reducing the risk of residual instability. Additionally, robotic guidance allows for precise management of fixation implants, ensuring optimal implant positioning and bone preservation. While further studies are needed, robotic-assisted FA represents a promising approach for enhancing outcomes in TKA for post-ACLR patients.

Human-Derived Proteome Characterization of Tongue Coating in Colorectal Cancer

Most colorectal cancer (CRC) patients experience changes in tongue coating morphology, but the underlying mechanisms remain unclear. While the human-derived proteome of tongue coatings in gastric cancer and healthy individuals has been characterized, research on CRC patients remains lacking. The tongue coating collection process is painless and noninvasive, providing a more favorable examination experience. This study aims to preliminarily explore the composition and changes in the human-derived proteome of tongue coatings in CRC patients, providing insights into abnormal morphology and potential new CRC screening methods. Utilizing a "bottom-up" strategy and data-independent acquisition (DIA) mode, the human-derived proteome of tongue coating in healthy controls, colorectal hyperplastic polyps patients, and CRC patients was detected using the EASY-nLC 1200 chromatograph coupled with the Orbitrap Fusion Lumos Tribrid mass spectrometer. Differentially expressed proteins were validated by Western blot, and the diagnostic efficacy of tongue coating proteins compared with CRC serum markers was assessed. Our results indicate that the human tongue coating proteome undergoes significant changes in CRC, with upregulated proteins potentially involved in remodeling the tongue coating morphology. Hemopexin (HPX), fibrinogen β chain (FGB), and cystatin C (CST3) in the tongue coating are promising indicators for CRC screening.

Treatment of Interprosthetic Femoral Fracture Nonunion: A Systematic Review

BACKGROUND

Interprosthetic fractures (IFs) of the femur present complex injuries associated with increased morbidity and mortality. Limited bone stock between the proximal and distal prostheses makes fracture reduction and stabilization challenging. Nonunion is a common and severe complication of IFs, often requiring multiple interventions. This systematic review aimed to identify the most successful treatment for femoral IFs and determine the overall incidence and best management strategies for IF nonunion.

METHODS

There were five electronic databases (Medline/PubMed, Scopus, Web of Science, Cochrane and EMBASE) searched for relevant studies published until July 2024. There were 35 studies that fulfilled the inclusion criteria.

RESULTS

A total of 503 patients who had 506 IFs were analyzed. The mean age was 79 years (range, 30 to 98), and 83.6% were women. The one-year mortality was 9.9% (range, 0 to 66.7). In terms of fixation options, increased frequency of nonunion was found after nonoperative treatment (50%) and retrograde intramedullary nailing (RIN) (11.1%), while after the combination of open reduction and internal fixation (ORIF) with RIN, nonunion was not observed. In the subgroup analysis of patients treated with ORIF, dynamic condylar screws (33.3%) and conventional plates (27.3%) were related to increased frequency of nonunion compared to locking compression plates (9.1%), while double plating was the most successful method (nonunion was not reported). The overall nonunion rate was 9.5%. Depending on treatment modality, the incidence of nonunion was 8.7% after ORIF and 5.5% after revision arthroplasty combined with ORIF. For the treatment of nonunion, no secondary nonunion was reported after ORIF + RIN and double plating.

CONCLUSION

For the treatment of IFs, non-locking plating and RIN were associated with higher nonunion rates, whereas double plating and ORIF + RIN were the most successful treatment options. Interprosthetic fracture nonunion was reported in 9.5% of cases, but further research is warranted to determine the most successful management approach.

Mayo conservative hip stem for proximal femoral bone preservation in developmental dysplasia of the hip in young patients: a median follow-up of more than 10 years

PURPOSE

Studies on short-stem total hip arthroplasty (THA) in young patients with developmental dysplasia of the hip (DDH) are limited, with no studies on long-term outcomes. Our study aimed to investigate whether the Mayo conservative hip stem demonstrates favourable mid- to long-term outcomes in these patients.

METHODS

This retrospective study included 42 patients (50 joints) with DDH aged <55 years who underwent THA using the Mayo conservative hip stem and excluded those with a follow-up period <5 years. Radiographic evaluation involved comparison of the immediate postoperative anteroposterior images with those at the final follow-up. Clinical evaluations utilised the Japanese Orthopaedic Association (JOA) hip score and major postoperative complications, including revision surgery.

RESULTS

The mean age of the patients was 48.8 years, with a median follow-up of 11 years. According to the Crowe classification, 35, 11, and 4 cases were classified as Types I, II, and III, respectively. According to the Dorr classification, 29 and 21 cases were classified as Types A and B, respectively. Radiographically, spot welds were observed in 98% of joints in zones 2 or 6, whereas stress shielding was evident in 94% (zone 1) and 54% (zone 7) of the joints. Stem sinking ⩾3 mm was observed in 2 joints. No periprosthetic femoral fractures, dislocations, or infections were observed.

CONCLUSIONS

The Mayo conservative stem in young patients with DDH resulted in favourable mid- to long-term outcomes, including stability and bone preservation. The stem is an effective treatment strategy for these patients.

Whole Span Plating Prevents Subsequent Ipsilateral Femoral Fractures After Peri-Implant Fixation: A Preliminary Report

Background: Peri-implant femoral fractures are increasingly prevalent among the elderly, often leading to re-fractures due to osteoporosis and implant stress. Whole span plating (WSP) has been proposed as a surgical approach to mitigate this risk. Methods: A retrospective study was conducted on 10 patients (mean age: 79.5 years) who underwent WSP for peri-implant femoral fractures between April 2020 and March 2023. Fractures were classified using the Vancouver, NPPIF, and Lewis and Rorabeck systems. Surgical indication required meeting at least two of the following criteria: age ≥ 70 years, history of fragility fracture(s), high fall risk, severe osteoporosis, extensive fracture pattern, or no implant loosening. Results: No re-fractures were observed during a mean follow-up period of 14.5 months. Although 90% of patients required red blood cell transfusions (mean volume: 3.8 units), early weight-bearing was achieved in most cases. Four patients had received osteoporosis treatment, highlighting the need for integrated bone health management. Conclusions: WSP appears to be a feasible and safe surgical option for high-risk patients with peri-implant femoral fractures, potentially reducing the incidence of subsequent fractures. Further studies with larger cohorts and longer follow-up are warranted.

A Comprehensive Literature Review of Total Hip Arthroplasty (THA): Part 1-Biomaterials

The rapid advancement of materials science has revolutionized total hip arthroplasty (THA), a critical orthopedic procedure aimed at restoring mobility and improving patient quality of life. This review investigates the evolution of biomaterials used in THA, analyzing their mechanical, biological, and chemical properties. The study outlines the transition from early natural materials to modern metals, polymers, and ceramics, highlighting their benefits and limitations in clinical applications. Particular emphasis is placed on the development of advanced materials such as highly cross-linked polyethylene (HXLPE), zirconia-toughened alumina (ZTA), and tantalum alloys (Ta), which demonstrate enhanced biocompatibility, wear resistance, and longevity. By examining emerging trends, including bioactive coatings and nanotechnology, this paper aims to provide a comprehensive understanding of current challenges and future directions in material selection for hip prostheses, ultimately aiming to minimize annual revision rates and improve long-term outcomes.

Mechanical study of the safe distance between humerus shaft fracture and distal locking screws in antegrade nailing

BACKGROUND

Optimal positioning of distal locking screws in intramedullary humeral nailing remains uncertain, particularly the influence of the distance between the fracture plane and the proximal distal locking screw on construct stability. This study aims to evaluate the mechanical stability of humeral nailing under different fracture-to-screw distances and numbers of distal locking screws using finite element analysis and mechanical testing on bone models.

METHODS

A finite element model and mechanical testing on six sawbones models were performed under traction (500 N), compression (500 N), and torsion (3 Nm). Models were tested with two osteotomy distances from the proximal distal locking screw (2 cm and 5 cm) and with either one or two distal locking screws. Axial and torsional stiffness and fracture displacement were recorded and analyzed statistically.

RESULTS

Finite element analysis showed higher stress concentrations near the distal fracture fragment. Mechanical testing demonstrated that traction and torsional stability were significantly affected by fracture-to-screw distance (p = 0.006 and p = 0.015), while compression stability was influenced by the number of distal screws (p = 0.035).

CONCLUSION

A fracture-to-screw distance of 5 cm was associated with improved axial and torsional stability, while double distal screws enhanced compressive stiffness. These biomechanical results, although very promising, should be confirmed with clinical studies.

Comparison of the effects of microdiscectomy and interlaminar endoscopic lumbar discectomy on sexual activity

PURPOSE

The aim of this study was to compare the clinical outcomes and sexual function of male and female patients who underwent IELD and MD due to LDH.

METHODS

The retrospective study included 72 sexually active patients aged 24-50 years. Patients were divided into four groups based on genders and surgical techniques. Visual Analogue Scale (VAS) (leg pain/LBP) and Oswestry Disability Index (ODI) tests were performed. International Index of Erectile Function-5 (IIEF-5) to evaluate the sexual functions of male patients; Female sexual function tests (FSFI) were used to evaluate the sexual functions of female patients, and the Hospital Anxiety Depression Score (HADS) test was used to evaluate the hospital anxiety and depression levels of all patients.

RESULTS

Mean age of the patients 39.8 ± 5.6. In all patients, a statistically significant improvement in three parameters (VAS-Leg, VAS-LBP, ODI) was observed in the post-operative period. However of note, the MD group had a statistically higher post-operative VAS-LBP pain score when compared with the IELD group (p = 0.001; p < 0.01). Both surgical interventions proved effective in increasing IIEF-5 scores, with the IELD group having statistically higher scores in the postoperative period. However, there was no such difference in FSFI scores in female patients with either procedure.

CONCLUSION

The results showed that both IELD and MD improved sexual function in patients with LDH, but IELD had a greater positive effect in male patients compared to MD. It was also found that IELD caused less LBP and more improvement in anxiety levels compared to MD.

Application of artificial intelligence-based three dimensional digital reconstruction technology in precision treatment of complex total hip arthroplasty

PURPOSE

To evaluate the predictive ability of AI HIP in determining the size and position of prostheses during complex total hip arthroplasty (THA). Additionally, it investigates the factors influencing the accuracy of preoperative planning predictions.

METHODS

From April 2021 to December 2023, patients with complex hip joint diseases were divided into the AI preoperative planning group (n = 29) and the X-ray preoperative planning group (n = 27). Postoperative X-rays were used to measure acetabular anteversion angle, abduction angle, tip-to-sternum distance, intraoperative duration, blood loss, planning time, postoperative Harris Hip Scores (at 2 weeks, 3 months, and 6 months), and visual analogue scale (VAS) pain scores (at 2 weeks and at final follow-up) to analyze clinical outcomes.

RESULTS

On the acetabular side, the accuracy of AI preoperative planning was higher compared to X-ray preoperative planning (75.9% vs. 44.4%, P = 0.016). On the femoral side, AI preoperative planning also showed higher accuracy compared to X-ray preoperative planning (85.2% vs. 59.3%, P = 0.033). The AI preoperative planning group showed superior outcomes in terms of reducing bilateral leg length discrepancy (LLD), decreasing operative time and intraoperative blood loss, early postoperative recovery, and pain control compared to the X-ray preoperative planning group (P < 0.05). No significant differences were observed between the groups regarding bilateral femoral offset (FO) differences, bilateral combined offset (CO) differences, abduction angle, anteversion angle, or tip-to-sternum distance. Factors such as gender, age, affected side, comorbidities, body mass index (BMI) classification, bone mineral density did not affect the prediction accuracy of AI HIP preoperative planning.

CONCLUSION

Artificial intelligence-based 3D planning can be effectively utilized for preoperative planning in complex THA. Compared to X-ray templating, AI demonstrates superior accuracy in prosthesis measurement and provides significant clinical benefits, particularly in early postoperative recovery.

Electrocardiogram and respiration recordings show a reduction in the physical burden on professional caregivers when performing care tasks with a transfer support robot

In this study, we assessed the physical burden on professional caregivers when using a transfer support robot, "Hug," to transfer and move a care recipient. We compared heart rate (HR), heart rate variability (HRV), and the time-series synchronization between HRV and respiration in caregivers using the robot or a normal wheelchair as control. Under both conditions, a commercial wearable device was used to simultaneously obtain electrocardiogram and respiration signals while performing care tasks, which comprised transfer from a bed to a wheelchair or to the robot, movement to a remote location, and transfer to a chair. We found that HR was significantly higher and HRV and wavelet coherence were significantly lower in the control than with Hug during at least the first 30 seconds of rest after the task (p < 0.05). This suggests that Hug could reduce the increase in HR and thereby maintain a more constant rhythm between HRV and respiration during care tasks. A post-task questionnaire also revealed that caregivers felt the physical burden of the tasks was reduced using Hug. Our results suggest that the introduction of transfer support robots can reduce the physical burden for caregivers of daily transfer assistance tasks.

Recent advances in omics and the integration of multi-omics in osteoarthritis research

Osteoarthritis (OA) is a complex disorder driven by the combination of environmental and genetic factors. Given its high global prevalence and heterogeneity, developing effective and personalized treatment methods is crucial. This requires identifying new disease mechanisms, drug targets, and biomarkers. Various omics approaches have been applied to identify OA-related genes, pathways, and biomarkers, including genomics, epigenomics, transcriptomics, proteomics, and metabolomics. These omics studies have generated vast datasets that are shaping the field of OA research. The emergence of high-resolution methodologies, such as single-cell and spatial omics techniques, further enhances our ability to dissect molecular complexities within the OA microenvironment. By integrating these multi-layered datasets, researchers can uncover central signaling hubs and disease mechanisms, ultimately facilitating the development of targeted therapies and precision medicine approaches for OA treatment.

Exploring the Relationship Between Low Back Pain, Physical Activity, Posture, and Body Composition in Older Women

BACKGROUND

Low back pain (LBP) is a widespread and disabling condition affecting many older adults.

METHODS

This study aimed to establish correlations between LBP, physical activity, body composition, and posture in 114 women (mean age: 67.6 ± 5.68 years). Using a cross-sectional study design, LBP was assessed using the Oswestry Disability Index (ODI). Physical activity (PA) was measured using a pedometer to count the steps taken. Spinal curvatures in the sagittal plane were examined with a Rippstein Plurimeter.

RESULTS

Significant correlations were found between ODI and waist circumference (WC) (F(1, 113) = 7.574, p = 0.007), body mass index (BMI) (F(1, 113) = 11.660, p = 0.001), total fat (TF) (F(1, 113) = 8.806, p = 0.004, R2 = 0.072), and total steps (F(1, 113) = 4.446, p = 0.037). No associations were found between ODI and hip circumference (HC) (F(1, 113) = 6.257, p = 0.014, R2 = 0.52), waist-to-hip ratio (WHR) (F(1, 113) = 6.342, p = 0.013, R2 = 0.053), thoracic kyphosis (THK) (F(1, 113) = 0.290, p = 0.591, R2 = 0.003), or lumbar lordosis angle (LLA) (F(1, 113) = 0.290, p = 0.591, R2 = 0.003).

CONCLUSION

These results of the study findings reveal the multifactorial nature of LBP syndrome and highlight the connection between LBP and ODI, BMI, WC, and TF in older women. Additionally, we emphasize the importance of implementing further prevention and intervention strategies to manage the clinical manifestation of LBP in the geriatric population. Healthcare providers can better support this population's well-being by focusing on targeted interventions.

Efficacy of Polydeoxyribonucleic Acid (PDRN) in periodontal regeneration: A systematic review of clinical outcomes

Background

Periodontal disease is a major dental health concern due to its impact on the supporting structures of teeth, including the alveolar bone and periodontal ligament. Polydeoxyribonucleic Acid (PDRN) has shown promise in promoting tissue regeneration through anti-inflammatory effects and angiogenesis, crucial for periodontal healing.

Objective

To evaluate the clinical effectiveness of Polydeoxyribonucleic Acid (PDRN) in periodontal regeneration through a systematic analysis of available studies.

Methods

This review followed PRISMA guidelines and included randomized controlled trials (RCTs), cohort, and case-control studies assessing PDRN's effects on periodontal regeneration. A comprehensive search in PubMed, Scopus, Web of Science, and Embase was conducted using keywords related to PDRN and periodontal regeneration. Primary outcomes included clinical attachment level (CAL) gain, probing depth reduction, and bone fill. Two reviewers independently assessed study eligibility and extracted data on PDRN application methods, dosages, and observed outcomes.

Results

Among the four studies that met the inclusion criteria, significant improvements in CAL, bone fill, and probing depth reduction were consistently observed in PDRN-treated sites compared to controls. Animal studies also demonstrated enhanced bone quality, reduced inflammation, and a conducive environment for cell proliferation. Clinical trials indicated that PDRN, as an adjunct to conventional therapy, produced more favorable outcomes in periodontal healing. PDRN's activation of adenosine A2A receptors and VEGF expression promoted angiogenesis and modulated inflammatory responses, aiding regeneration.

Conclusion

PDRN appears to offer substantial benefits in periodontal regeneration by enhancing bone and tissue healing and reducing inflammatory responses. While promising, further clinical trials are necessary to determine optimal dosing and long-term effectiveness. This systematic review provides evidence supporting PDRN as a potential adjunctive treatment for periodontitis, with implications for enhancing clinical outcomes in periodontal therapy.

Radiographic outcomes of flexible and rigid fixation techniques of syndesmotic injuries across various body mass indices: A retrospective analysis

In the setting of ankle trauma, surgical management of syndesmosis injury involves screw fixation and suture button technique. The efficacy of flexible (suture button) versus rigid (screw) fixation in the management of syndesmotic injury has been investigated extensively in current literature. There is sparse data comparing these two techniques across different body mass indices (BMI). In this study, two fellowship-trained foot and ankle surgeons at urban level-1 trauma centers reviewed blinded post-operative ankle radiographs of BMI-stratified patients undergoing syndesmotic fixation. A total of 79 patients were included for analysis based on inclusion and exclusion criteria. There were 42 patients in the screw fixation group and 37 patients in the suture button group. The average follow-up period was 5.5 months. No significant difference was found in the average radiographic measurements when comparing the two fixation types, regardless of BMI parameters. This was consistent when analyzing individual fixation types stratified by BMI, as well as when comparing BMI groups stratified by fixation type. Additionally, the distribution of body mass index was even across both fixation types. Our study demonstrates that both fixation groups achieved comparable anatomic ankle reduction regardless of body mass index. The authors suggest expanding the indication of suture button fixation to include the higher body mass index patients.

Which Lenke type curve is most appropriate for vertebral body tethering in adolescent idiopathic scoliosis?

PURPOSE

Clinical trials have studied the effects of curve magnitude and flexibility, age, and skeletal immaturity on the outcomes of VBT. No studies have assessed the effect of Lenke curve type on the outcomes of VBT. This study compares outcomes in patients who underwent VBT with Lenke type 1, 3, 5, and 6 curves.

METHODS

Single center retrospective review of patients undergoing mini-open thoracoscopic-assisted two row vertebral body tethering (2RVBT) for the correction of AIS with a minimum 2-year follow-up were included. Patients were grouped by Lenke type, which yielded 4 groups; types 1, 3, 5, or 6. Analysis included preoperative demographic parameters, as well as radiographic and clinical outcome measures.

RESULTS

156 2RVBT (Lenke 1, N = 61; Lenke 3, N = 35; Lenke 5, N = 37; Lenke 6, N = 23) patients met inclusion criteria. The mean preoperative apex Cobb angle in the Lenke type 1, 3, 5, and 6 groups were 50.2 ± 9.1, 50.5 ± 10.1, 45.0 ± 8.6, and 49.0 ± 10.8, respectively. This corrected to 21.2 ± 10.2, 19.2 ± 8.5, 13.6 ± 7.2, 18.5 ± 8.3 in Lenke type 1, 3, 5, and 6 groups, respectively, demonstrating that Lenke type 5 saw greatest correction following 2RVBT. With regards to revision recommendation following tether breakage, Lenke type 3 curves were most frequently indicated for fusion, whereas Lenke type 1 curves were most frequently not indicated for revision surgery.

CONCLUSION

Lenke type 5 curves are the most amenable to correction via 2RVBT, as evident by their lower post-operative apex Cobb angles and lowest rate of recommendation for revision to posterior spinal fusion.

Radiological and Functional Outcomes of Joshi External Stabilization System (JESS) in Proximal Humerus Fractures: A Retrospective Review

Introduction

There has been an increased interest in the external and percutaneous fixation of proximal humerus fractures. Numerous advantages of external fixation like less blood loss, ease of application, and rigid fixation provide a promising new avenue for the management of humeral fractures. This retrospective case series aims to assess the radiological and functional outcome of proximal humerus fractures treated with the Joshi External Stabilization system (JESS).

Materials and Methods

A retrospective review of records was performed using hospital records from January 2020 to January 2024. The records of patients more than 18 years of age with proximal humerus fractures who were operated with the JESS fixator were reviewed and a proforma based on each follow-up was filled by the investigators.

Results

A total of 28 patients met the inclusion criteria with an average age of 65.17 ± 13.1 years. Neers type 3 injuries were most common (38.3%, n = 11). All fractures united on 6-week follow-up. 75% (n = 21) reported good 25% (n = 7) excellent Constant scores at 24 weeks. The overall complication rate was 28.6%. Common complications were superficial pin tract infections and fixator loosening.

Conclusion

The JESS is an acceptable treatment option for orthopaedic surgeons for the fixation of proximal humeral fractures, especially in geriatric patients. Like other external fixation devices, pin tract infection and pin loosening are inherent to the system.

Customized Metal 3D Printed Total Wrist Prosthesis in the Treatment of Severely Destroyed Wrist: Design Rationale and Clinical Applications

OBJECTIVE

Severe destruction of the wrist joint after trauma, disease, or iatrogenic causes can lead to significant bone defects and deformities, limiting the options for surgeries. Bespoke 3D-printed metal prostheses were designed and used for four patients. This study aimed to describe the design rationale and report the clinical outcomes.

METHODS

Between 2022 and August 2024, we followed up on four patients with significant bone defects and deformities caused by various factors, who opted against arthrodesis. These patients were treated with customized 3D-printed prostheses replacements. All cases underwent assessment through clinical and radiological examinations, evaluating parameters including passive range of motion (ROM) of the wrist, grip strength, VAS of pain, and functional scales such as the Mayo score, Patient-Rated Wrist Evaluation (PRWE), and Quick Disabilities of the Arm, Shoulder, and Hand (quick DASH) score. A paired t-test was conducted to compare pre- and postoperative outcomes.

RESULT

The mean follow-up period lasted 11.9 ± 6.7 months (range 6-18 months). All patients reported satisfying pain relief and enhanced function. The average ROM was 23.3° ± 5.7° of extension and 27.0° ± 18.6° of flexion. The average VAS score of pain was 1.5. The mean Mayo score, PRWE, and Quick DASH were 60.0, 31.5, and 28.3, respectively. No complications such as loosening, dislocation, or infection were observed during the follow-up period.

CONCLUSIONS

Customized 3D-printed prosthetic replacements for severely destroyed wrists can provide good functional outcomes with a higher satisfaction rate.

LEVEL OF EVIDENCE

IV.

Measurement of the femoral neck anteversion angle using a three-dimensional reconstruction in the fixed coordinate system based on the basal anterior cortex of the femoral neck: an observational study

PURPOSE

This study investigated the accessibility of 3D reconstruction in the fixed coordinate system(3D-R-FCS) based on the basal anterior cortex of the femoral neck in measuring the femoral neck anteversion angle (FNAA).

METHODS

CT and EOS examinations were performed on 40 femoral samples synthesized by Sawbone. Two evaluators were responsible for measurement of the FNAA based on four different methods, including EOS 3D reconstruction, 3D-R-FCS, Reikerås, and Murphy methods.

RESULTS

Measurement of the FNAA based on EOS, 3D-R-FCS based on the basal anterior cortex of the femoral neck, and the Reikerås and Murphy methods were 6.53°±4.28°, 7.08°±4.58°, 3.03°±4.44°, and 11.9°±4.91°, respectively. No statistical difference was detected for the FNAA measurements between EOS and the 3D-R-FCS based on the basal anterior cortex of the femoral neck (P > 0.05). However, a statistical difference was detected between the Reikerås and Murphy methods and EOS (P < 0.05). The value of the ‌intraclass correlation coefficients (ICCs) for the 4 methods measured by evaluator A were 0.89, 0.99, 0.75, and 0.81, respectively, while the ICCs measured by evaluator B were 0.91, 0.98, 0.71, and 0.79, respectively. The correlation coefficients between the two evaluators were 0.89, 0.99, 0.75, and 0.83, respectively.

CONCLUSION

The consistency of the scores for the FNAA measurement based on the 3D-R-FCS within and between the evaluators was the highest among the four methods and correlated well with the EOS measurement, which may potentially provide a more stable method for the measurement in clinical practice.

CLINICAL TRIAL NUMBER

Not applicable.

Heat Therapy for Musculoskeletal Pain Conditions: Actionable Suggestions for Pharmacists from a Panel of Experts

Musculoskeletal disorders represent one of the most pervasive health concerns that drive frequent medical consultations and pharmacy encounters. Community pharmacies are well placed to help address this demand as they are accessible settings for healthcare advice and support for patients with musculoskeletal disorders complaining of pain. Heat therapy stands as a valuable component of a multimodal approach to the management of musculoskeletal pain by virtue of multiple effects: pain relief, reduction of muscle spasms and stiffness, and enhanced muscle flexibility and range of motion. However, there is limited guidance on heat therapy use in routine practice, particularly on indications and contraindications, mode of application, and precautions. Such an educational gap has been documented among pharmacists. Therefore, it is paramount that pharmacists gain knowledge about when and how to effectively integrate superficial heat therapy with both pharmacological and physical therapy, to provide patients with a comprehensive, multimodal approach to alleviating musculoskeletal pain. A multidisciplinary panel of experts gathered to develop practical guidance on heat therapy-appropriate application in patients with musculoskeletal pain. In this work, we provide actionable suggestions to build pharmacists' competency in managing musculoskeletal pain and empower them in effectively using heat therapy as a single therapeutic option or in combination with over-the-counter analgesics.

Empathy heals: patients' perception after an upper limb fracture and their experiences during and after the treatment discharge: a qualitative study

PURPOSE

To explore patients' experiences, identify barriers and facilitators to recovery, and analyze their perceptions of treatment following upper limb fractures.

MATERIALS AND METHODS

A qualitative study using semi-structured interviews was conducted with 25 patients (10 men, 15 women) at a tertiary referral hospital. A purposive sampling approach was used, and data analysis followed Braun and Clarke's thematic analysis method.

RESULTS

Four key themes emerged: the need for information to engage in treatment; the impact of physical and mental health on fracture patients; the role of physiotherapy in recovery; and the relationship with the healthcare team and treatment perception.

CONCLUSION

Although patients felt supported by the healthcare team, they expressed a need for a deeper understanding of the recovery process. Empathy and the patient-physiotherapist bond were crucial for treatment adherence and successful rehabilitation.

Elucidating the Role and Mechanism of Alpha-Enolase in Senescent Amelioration via Metabolic Reprogramming

Senescent cells are characterised by increased glycolysis dependence. Normalisation of glycolysis metabolism is essential for senescence amelioration. However, the mechanism of proteins involved in cellular glycolysis metabolism has not been fully elucidated. Here, we identified a candidate compound, an oxazole analogue (KB2764), that can improve senescence. To elucidate the mechanism of the KB2764, we investigated the interacting proteins. KB2764 interacted with alpha-enolase (ENO1) and pyruvate kinase M (PKM), ultimately allowing PKM to phosphorylate ENO1. KB2764 consequently increased mitochondrial ATP production and reduced reliance on glycolysis. Knockdown of the ENO1 experiment in senescent cells demonstrates that regulation of ENO1 activity is a prerequisite for recovery of mitochondrial function. Furthermore, the action of KB2764 extends its application to extend the lifespan of Caenorhabditis elegans. Taken together, our findings reveal a novel mechanism by which senescence is ameliorated through metabolic reprogramming and mitochondrial functional recovery via KB2764-mediated regulation of ENO1 protein activity.

Mitochondrial complex I deficiency occurs in skeletal muscle of a subgroup of individuals with Parkinson's disease

BACKGROUND

Widespread neuronal mitochondrial complex I (CI) deficiency was recently reported to be a characteristic in a subgroup of individuals with idiopathic Parkinson's disease (PD). Here, we sought to determine whether a CI-deficient subgroup could be discerned using clinically accessible muscle biopsies. We further hypothesized that the inconsistency of previous findings of mitochondrial respiratory impairment in PD muscle may be due to interindividual variation, with respiratory deficiency only occurring in a subgroup of cases.

METHODS

Using a cross-sectional design, vastus lateralis needle biopsies were collected from 83 individuals with PD and 29 neurologically healthy controls and analyzed by immunohistochemistry for CI and complex IV (CIV), cytochrome c oxidase/succinate dehydrogenase (COX/SDH) histochemistry, and spectrophotometric activity assays of complexes I-IV. Mitochondrial DNA (mtDNA) copy number, deletions, and point variation were analyzed in single muscle fibers and bulk biopsy samples.

RESULTS

We show that PD muscle exhibits reduced CI activity at the group level, with 9% of cases falling below two standard deviations of the control group. In contrast, the activities of CII-CIV are not significantly different between the PD and control groups. No quantitative change of CI or CIV is detected, and the observed functional CI deficiency is not associated with mtDNA abnormalities.

CONCLUSIONS

Our findings support the existence of a PD subpopulation characterized by CI pathology in skeletal muscle and suggest that stratification by extra-neural mitochondrial dysfunction may be informative for selecting individuals for clinical trials.

Global, regional, and national burden of low back pain in working-age population from 1990 to 2021 and projections for 2050

Background

Low back pain (LBP) is a leading cause of disability worldwide, especially among working-age group. This study evaluates the global, regional, and national burden of LBP among individuals aged 15-64 utilizing data from the Global Burden of Disease (GBD) 2021 study.

Methods

We assessed trends in incidence, prevalence, and disability-adjusted life years (DALYs) for LBP from 1900 to 2021. Age-standardized rates (ASRs) were calculated, and joinpoint regression and decomposition analyses were used to identify key drivers. Future trends were projected through 2050.

Results

The prevalence of LBP in working-age group has risen to 452.8 million cases globally, a 52.66% increase since 1990. South Asia reported the highest absolute number of cases, while Central and Eastern Europe showed the highest ASRs. Across all regions, women consistently exhibited higher incidence, prevalence, and DALYs than men. Decomposition analysis revealed that population growth was the main factor contributing to the rising burden. Projections indicate that LBP cases will continue increasing through 2050, particularly among women, although ASRs are expected to decline.

Conclusion

The burden of LBP among working-age group is growing due to population expansion. Despite declining ASRs, substantial regional and gender disparities remain, highlighting the need for targeted public health strategies.

The Effects of Joint Mobilization and Myofascial Release on Muscle Thickness in Non-Specific Low Back Pain: A Randomized Clinical Trial

Background: Non-specific low back pain is a discomfort that affects individuals at any point in their lives. This study's aim was to determine the effects of myofascial release and joint mobilization on muscle thickness via ultrasonography in individuals experiencing non-specific low back pain. Methods: This double-blinded randomized clinical trial was conducted on 84 participants in three groups: joint mobilization, myofascial release, and a combination of joint mobilization and myofascial release. Data were collected during a two-week treatment regimen (days 1, 4, 8, and 12) and at a one-month follow-up. Ultrasound evaluations were used to measure the thickness of deep lumbar muscles at rest and contraction, i.e., the transverse abdominis (rTrA and cTrA) and lumbar multifidus (rLM and cLM). Repeated-measures ANOVA was utilized to analyze the follow-ups within the groups and among the groups, with post hoc tests conducted to identify specific differences. Results: Significant increases in muscle thickness were observed over time in the transverse abdominis, with improvements in both rTrA (right, p = 0.001; left, p = 0.001) and cTrA (right, p = 0.001; left, p = 0.008). The lumbar multifidus also demonstrated significant changes, with increases in the rLM (right, p = 0.001; left, p = 0.047) and cLM (right, p = 0.004; left, p = 0.037). However, the main effects showed no significant differences in muscle thickness among the groups. Conclusions: Joint mobilization demonstrated increased effectiveness in improving muscle thickness relative to myofascial release and a combination of both treatments for individuals with non-specific low back pain.

Comparison of clinical efficacy between proximal femoral locking plate and cannulated compression screws for femoral neck fracture

Objective

The objective of this study is to investigate the clinical efficacy of proximal femoral locking plates in comparison to cannulated compression screws for the treatment of femoral neck fractures.

Methods

A retrospective analysis of clinical data from 50 patients with femoral neck fractures treated at the Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from September 2018 to June 2023. Patients were divided into 25 in the PFLP group and 25 in the CCS group. A comparison was made between the two groups in terms of the following variables: basic characteristics, perioperative information, and information during follow-up visits.

Results

The basic characteristics of the two groups were found to exhibit no statistically significant differences (P > 0.05). The PFLP group had significantly longer surgical times and greater Intraoperative hemorrhage loss compared to the CCS group (P < 0.05). The statistical analysis revealed that there were no significant differences in intraoperative fluoroscopy times and Garden index between the two groups (P > 0.05). The PFLP group exhibited a markedly superior fracture healing time, femoral neck shortening, and Harris hip scores in comparison to the CCS group (P < 0.05). The postoperative complication rates were 12% in the PFLP group and 20% in the CCS group, with no statistically significant difference (P > 0.05).

Conclusion

The results of this retrospective study suggest that the PFLP group demonstrated superior outcomes compared to the CCS group in several key areas, including fracture healing time, preservation of femoral neck length, recovery of hip function, and incidence of postoperative complications.

A novel classification for aseptic femoral shaft nonunion after intramedullary nailing: a retrospective study

BACKGROUND

Although intramedullary nailing has been established as the gold standard for treating femoral shaft fractures, nonunion following intramedullary nailing remains a major concern for clinicians, severely affecting patients' walking ability and quality of life. Presently, there are certain controversies and deficiencies in nonunion classification and treatment. Herein, we propose a novel classification system for aseptic femoral shaft nonunion after intramedullary nailing based on X-ray-assessed nailing morphology and stability. Furthermore, we sought to explore the new classification's clinical significance and management implications.

METHODS

This retrospective study involved the analysis of clinical data collected from 82 patients with aseptic bone nonunion after intramedullary nailing of femoral shaft fractures between 2010 and 2022. The patients were classified into four groups based on intramedullary nailing stability and bone defect existence, as revealed in X-ray images. The four classifications were as follows: Type I (intramedullary nailing is stable without bone defect), Type II (intramedullary nailing is stable with bone defect), Type III (intramedullary nailing is not stable without bone defect), and Type IV (intramedullary nailing is not stable with bone defect). Based on the novel classifications, we introduced individualized treatment methods. Type I patients underwent dynamization, and Type II patients received bone grafting and plate fixation. Type III patients underwent larger intramedullary nail exchange or plate fixation, and Type IV patients received larger intramedullary nail exchange and plate fixation with bone graft or double plate fixation with bone graft. Data on relevant indicators were collected.

RESULTS

All patients recovered well with no complications. The average surgery times for Types I-IV were 0.4 ± 0.1, 0.8 ± 0.2, 1.1 ± 0.4, and 1.6 ± 0.4 h, respectively. Furthermore, the mean blood loss volumes for Types I-IV were 23.4 ± 4.8, 53.3 ± 8.4, 56.3 ± 7.9, and 125.2 ± 10.8 ml, respectively. The average bone healing time of all 82 patients was 5.1 ± 1.5 months. On the other hand, the mean bone healing times for Types I-IV were 4.6 ± 1.1, 4.7 ± 1.1, 5.1 ± 1.5, and 5.7 ± 1.8 months, respectively. Furthermore, the LEFS scores for Types I-IV were 68.7 ± 3.5, 69.8 ± 3.1, 66.8 ± 3.8, and 68.6 ± 2.9 points, respectively. The mean surgery time and bleeding volume increased gradually from Types I to IV (p < 0.05) but with no significant difference between Types II and III. Moreover, there were no statistical differences in fracture healing times, LEFS scores, age, and nonunion durations across the four classifications.

CONCLUSIONS

The proposed novel classification system could achieve accurate diagnosis and guidance for clinical management of aseptic femoral shaft nonunion after intramedullary nailing. The corresponding individualized treatment approaches could improve prognostic outcomes and healing rates and alleviate postoperative complications.

CLINICAL TRIAL NUMBER

Not applicable.

Review of Preclinical and Clinical Studies Supporting the Role of Polydeoxyribonucleotide in the Treatment of Tendon Disorders

Tendon disorders are among the most common musculoskeletal conditions, accounting for 30% to 50% of all sports-related injuries. Injured tendons heal slowly and often fail to regain their original structural integrity and mechanical strength, creating significant challenges for physicians. Recently, investigations have reported that polydeoxyribonucleotide (PDRN) plays a key role in promoting tendon healing. For example, preclinical studies indicate that PDRN can enhance tendon repair by inhibiting inflammation and cell apoptosis while promoting collagen production. In clinical studies, the effectiveness and safety of PDRN were also confirmed for managing several conditions, including plantar fasciitis, epicondylitis, Achilles tendinopathy, pes anserine tendinopathy, and chronic rotator cuff disease. In light of these findings, this article aims to review the preclinical and clinical studies that support the role of PDRN in the treatment of tendon disorders. A search was conducted in Medline and PubMed from January 1994 to October 2024 to find relevant research. Ultimately, the review included 3 preclinical studies and 8 clinical studies, involving a total of 318 patients. In conclusion, PDRN is a promising therapeutic option for treating tendon disorders. However, further preclinical and clinical studies are needed to better understand its effects on tendon disorders and to support future clinical applications.

Use of controlled nail dynamization technique for femoral shaft hypertrophic nonunion

Background

Femoral nonunion after intramedullary nailing (IMN) of a diaphyseal long bone fracture is a severe complication that requires effective management. The IMN dynamization has been used to treat hypertrophic nonunions previously. However, routine nail dynamization has only a low success rate and the risk of limb shortening.

Methods

Two patients with femoral shaft fracture hypertrophic nonunion at 4 or 5 months after intramedullary nailing were treated with the therapeutic paradigm named "controlled nail dynamization". In this paradigm, the interlocking nails are removed but the dynamic hole nails are retained. At the same time, four Poller screws were used to limit the movement of the intramedullary nail in the coronal and sagittal planes. The intramedullary nail can only generate compressive stress along the axial direction of the femoral shaft, thereby promoting fracture healing. So this technique was named "controlled nail dynamization".

Results

Here, we describe two cases of delayed healing of the femoral diaphysis, which were successfully treated through controlled nail dynamization. Followed up for more than 12 months. Bone union was achieved in both patients, and there were no complications such as nonunion and internal fixation failure.

Conclusion

The controlled nail dynamization is feasible for safe and effective treatment for femoral shaft hypertrophic nonunion.

A Comprehensive Review of Medial Thighplasty: The Role of Liposuction in Reducing Complications and Optimizing Patient Outcomes

Background/Objectives: Medial thighplasty is a widely performed body contouring procedure, particularly in patients with massive weight loss. Despite advancements in surgical techniques, complications remain a significant concern. The integration of liposuction into thigh lift procedures has shown promise in improving both aesthetic and functional outcomes while reducing risks. This review aims to assess the role of liposuction in medial thighplasty by evaluating its impact on surgical outcomes and complications. Methods: This systematic review was conducted following PRISMA guidelines. A comprehensive search was performed in the MEDLINE/PubMed database using predefined keywords. A total of 52 records were identified, of which 19 studies met the inclusion criteria, encompassing 1113 patients who underwent liposuction-assisted medial thighplasty. Two independent reviewers screened and selected the studies, resolving discrepancies through discussion or consultation with a third reviewer. Data on surgical techniques, complications, and outcomes were extracted and analyzed. Statistical comparisons were performed using the Chi-square test, with significance set at p < 0.05. Results: The incorporation of liposuction significantly reduced the overall complication rate (36.75% vs. 70.68%, p < 0.001). Specific complications, including infections (1.77% vs. 9.02%), hematomas (1.30% vs. 6.77%), and seromas (8.95% vs. 24.81%), were markedly lower in the liposuction group. Conclusions: Liposuction appears to reduce complication rates and improve surgical outcomes in medial thighplasty. Further standardization of techniques and additional research on advanced liposuction technologies are necessary to refine this surgical approach and optimize patient outcomes.

Comparison of the surgical efficacy of total hip replacement versus hemiarthroplasty in the treatment of femoral neck fractures in elderly patients with sarcopenia

BACKGROUND

Total hip arthroplasty (THA) and hemiarthroplasty (HA) are common surgical procedures for femoral neck fracture (FNF) in elderly patients; however, optimal treatment options remain controversial. Currently, limited research has compared the effectiveness of THA versus HA, specifically in patients with FNF and sarcopenia.

METHODS

This retrospective study included data from 109 patients who fulfilled the inclusion criteria for the period between January 2015 and December 2017. Among these, 48 underwent THA, and 61 underwent hip arthroplasty (HA). The cross-sectional area (cm2) of muscle tissue at the pedicle level of the 12th thoracic vertebra (T12) was measured using chest computed tomography. The skeletal muscle index (SMI) was calculated by dividing the cross-sectional area of the muscle at the T12 pedicle by height squared. Sarcopenia was diagnosed when grip strength and SMI values were below the diagnostic cut-off value. Various factors were compared, including age, sex, SMI, body mass index (BMI), perioperative surgery-related indicators, postoperative 5-year survival, satisfaction, complication, and re-revision surgery rates between the 2 groups.

RESULTS

There were no statistically significant differences between the THA and HA groups in terms of age (P =  0.227), sex (P =  0.870), SMI (P =  0.946), BMI (P =  0.310), postoperative time to ambulation (P =  0.803), length of hospitalization (P =  0.777), postoperative visual analog scale score (P =  0.933), and postoperative Harris score (P =  0.379). At the 5-year follow-up, there were no statistical differences in patient survival rate (P =  0.896), satisfaction (P =  0.945), incidence of complications (P =  0.796), or re-revision rate (P =  0.807). Patients who underwent THA had significantly longer operative times (P =  0.000) and larger surgical incisions (P =  0.000). They also experienced greater blood loss (P =  0.000) and blood transfusion volumes (P =  0.017), as well as increased hemoglobin (P =  0.000) and albumin (P =  0.000) loss. Furthermore, patients who underwent THA incurred higher surgical costs (P =  0.000).

CONCLUSION

THA and HA demonstrated comparable effectiveness and outcomes in patients with FNF and sarcopenia. HA was a less invasive and more cost-effective surgical option, making it the preferred choice.

Presoaking hamstring autograft with vancomycin does not jeopardize its biomechanical properties, including graft elongation, after cyclic loading

PURPOSE

Presoaking the graft with vancomycin before implantation has been shown to reduce the risk of postoperative infection after anterior cruciate ligament reconstruction (ACLR). However, the effects of presoaking on the graft biomechanical properties remain unclear. This study aimed to determine whether presoaking the graft with vancomycin affects the graft biomechanical properties and length after cyclic loading.

METHODS

Ten paired (20 specimens) gracilis and semitendinous tendons were harvested from fresh-frozen human cadaveric specimens. Two tendons were folded in half to make four strands, and the grafts were randomized into the vancomycin and control groups. The graft was exposed to the antibiotic solution for 15 min (5 mg/mL) and prepared by mixing 1 g of vancomycin with 200 mL of normal saline (NaCl 0.9%). The control group was soaked in normal saline for 15 min. The prepared grafts were attached to the actuator of a dynamic tensile-testing machine. All grafts were tested with 3000 cycles of cyclic loading followed by a pull-to-failure. The cyclic loading protocol consisted of position and load control blocks to simulate the graft in vivo in the postoperative phase after ACLR.

RESULTS

Presoaking in vancomycin did not jeopardize the biomechanical properties of the graft. In addition, presoaking with vancomycin did not elongate the grafts. No significant differences were found in the mean Young's modulus and the mean total elongation of the graft of the specimen between the vancomycin group and the control group.

CONCLUSION

Presoaking the graft with vancomycin jeopardized neither its biomechanical properties nor elongation even after cyclic loading in this in vitro study. It is suggested that vancomycin presoaking could be considered a safe and effective preventive measure for postoperative infections after ACLR.

LEVEL OF EVIDENCE

Not applicable.

Youth soccer players: patterns of injury involving the primary growth plates of epiphyses

Youth soccer (football) is immensely popular internationally. Earlier participation, sport sub-specialization, and year-around practice have led to an increased incidence of injury from both acute trauma and repetitive overuse. The growth plates (physes) of the immature skeleton are particularly vulnerable to injury and delayed diagnosis can lead to future growth disturbance and long-term morbidity. Familiarity with the various components of the growth plate complex necessary for ensuring normal endochondral ossification is fundamental in understanding the various patterns of imaging findings following injury. This review discusses the zonal columnar arrangement of the growth plate proper and the contrasting function of the vasculature within the subjacent epiphysis and metaphysis. This is followed by an evidence-based discussion of the common patterns of injury involving the epiphyseal primary growth plate observed among youth soccer players: subcategorized into physeal fractures (direct injury) and physeal stress injuries (indirect insult to subjacent metaphysis). In this section, the role of imaging and characteristic imaging features will be discussed. While the normal physiologic and pathophysiologic mechanisms can be applied to other growth plates, such as primary growth plates underlying the apophyses and secondary growth plates surrounding the secondary ossificiation centers, which also undergo endochondral ossification, the current review is focused on injuries involving the primary growth plates underlying epiphyses.

Multiligament Knee Injuries: Updates of the Debates

Background

Multiligament knee injuries (MLKI) constitute a complex and challenging problem. They can have life-modifying consequences, such as the development of osteoarthritis, and an inability to return to work or sport. At present, there is insufficient high-level evidence or expert consensus to support one management strategy over another.

Purpose

The purpose of this article is to review the updates of the debates about multiligament knee injuries, diagnosis, treatment options, and rehabilitation protocols. This article also aimed to elucidate expert opinions on controversial issues in MLKI from scholars from Egypt and the Arab world.

Study Design

Comprehensive review; Level of evidence, 5.

Methods

Medline, Embase, PubMed, and Physiotherapy Evidence Database (PEDro) databases were searched between inception and February 2024. The terms: 'multi-ligament' OR 'multiligament' OR 'multi ligament' OR multiple ligaments' AND 'knee' were used to extract relevant studies.

Results

Overall, 1009 eligible studies were identified. After applying inclusion and exclusion criteria, there were 251 articles; of which there were 24 systematic reviews and 227 clinical studies.

Conclusion

The relative rarity of MLKI makes it difficult to perform good-powered prospective randomized studies evaluating these injuries. The debates are expected due to the diversity of presentations of MLKI with regard to types of injured ligaments, site of injury within the ligament, time of presentation, and the different management methods. Thorough knowledge and experience are mandatory to tailor a diagnostic workup and management plan for each case.

A Modified Wagner Stem Design Increases the Primary Stability in Cementless Revision Hip Arthroplasty

Background

Primary stability is of great importance for the longevity of the implant in cementless revision total hip arthroplasty, since instability is a major cause of rerevision. The purpose of this study was to evaluate the effect of an additional set of less prominent, wider splines added to an established conical stem design with sharp splines on axial stability in a model with significant proximal bone defects.

Methods

Twenty fresh-frozen human femurs were implanted with either the established or the additional spline design, dynamically loaded and tested in a load-to-failure configuration. Cortical contact in the femoral canal after implantation was evaluated by superimposing computed tomography scans and 3-dimensional laser scans. Stem subsidence and micromotion were evaluated to assess primary stability.

Results

Stems remained stable during cyclic loading of up to 200% body weight, except in bones with cortical bone mineral density below 1000 mgHA/mL. A significant reduction of more than 85% in stem subsidence (P = .040), axial micromotion (P = .007), and rotational micromotion (P = .010) was achieved with the new spline design. Load-to-failure testing exceeded 400% body weight.

Conclusions

The new spline design increased the cortical contact which resulted in increased axial primary stability in this in vitro experiment. Bone mineral density as a measure of bone quality proved to be a decisive factor for achieving immediate postoperative stability. Further variations of the established stem designs could further improve the longevity of artificial joint replacements.

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.

Outcomes after multiligament knee injury worsen over time: A systematic review and meta-analysis

PURPOSE

Multiligament knee injuries (MLKIs) are devastating injuries that can have life-long consequences. A management plan requires the decision to perform surgery or not, timing of surgery, consideration of repair versus reconstruction, reconstruction technique and reconstruction graft choice. The purpose of this study was to analyze development of clinical outcomes of MLKIs over time at a minimum of 2 years of follow-up.

METHODS

Four databases were queried for surgical outcome-based studies of MLKIs published from 01/2000 through 09/2022 with a minimum 2-year follow-up. Technique articles, nonoperative treatment, arthroplasty, pediatric and review articles were excluded. Study characteristics including design, number of patients, age, follow-up period, anatomical region and posterior-cruciate ligament (PCL)-based injury were collected. Primary outcomes were Lysholm, International Knee Documentation Committee (IKDC) outcome scores and Tegner activity score. Random-effects model analysis was performed.

RESULTS

After the application of inclusion and exclusion criteria, 3571 patients in 79 studies were included in the analysis. The mean age at surgery was 35.6 years. The mean follow-up was 4.06 years (range 2-12.7). The mean Lysholm score at 2-year follow-up was 86.09 [95% confidence interval [CI]: 82.90-89.28], with a yearly decrease of -0.80 [95% CI: -1.47 -0.13], (p = 0.0199). The mean IKDC at 2 years was 81.35 [95% CI: 76.56-86.14], with a yearly decrease of -1.99 [95% CI: -3.14 -0.84] (p < 0.001). Non-PCL-based injuries had a higher IKDC 83.69 [75.55-91.82] vs. 75.00 [70.75-79.26] (p = 0.03) and Lysholm score 90.84 [87.10-94.58] versus 84.35 [82.18-86.52] (p < 0.01) than PCL-based injuries, respectively.

CONCLUSION

According to the present systematic review and meta-analysis of MLKIs with minimum 2-year follow-ups, the patients who suffered an MLKI can expect to retain around 80-85% of knee function at 2 years and can expect a yearly deterioration of knee function, depending on the score used. Inferior outcomes can be expected for PCL-based injuries at 2 years postoperative.

LEVEL OF EVIDENCE

Level IV meta-analysis.

Quarter Century Outcomes of Alumina Ceramic-on-Ceramic Total Hip Arthroplasty

BACKGROUND

Alumina ceramic-on-ceramic (CoC) bearings were widely used in total hip arthroplasty (THA) due to their superior wear resistance and inert properties, making them ideal for young, active patients who require long-lasting implants. This study aimed to synthesize findings from previous reports, providing a comprehensive follow-up of at least 25 years on the clinical and radiologic outcomes, the prevalence of osteolysis, and implant survivorship in patients undergoing primary cementless CoC THA.

METHODS

We have previously reported 5- to 10-year outcomes following the implementation of third-generation alumina-on-alumina bearings in a consecutive series of 100 primary cementless THAs. This report updates those results with a minimum follow-up of 25 years. Of the original cohort, 58 patients who had 67 hips were available for the latest follow-up. Clinical assessments were performed using the Harris Hip Score and pain questionnaires. Radiographic evaluations were employed to assess implant fixation and osteolysis.

RESULTS

At the final follow-up, the implant survival rate was an impressive 96.3%, with revision of the implant as the end point. The mean Harris Hip Score improved significantly from preoperative values to 90.1, indicating excellent functional outcomes. The incidence of ceramic-related noise increased over time, with three cases of ceramic head fractures requiring a change of bearings. Notably, the extent of stem notching observed in earlier reports did not show further progression. Radiologically, all implants demonstrated bony ingrowth with no signs of aseptic loosening or major osteolysis.

CONCLUSIONS

The long-term (minimum 25-year) follow-up of alumina-on-alumina bearings in primary cementless THA demonstrates outstanding implant survivorship, excellent functional outcomes, and minimal adverse effects over 25 years. Despite some issues like ceramic-related noise and component fractures, the overall performance of CoC bearings remains highly encouraging, particularly suitable for young, active patients. Surgeons should provide appropriate education to both potential THA candidates and patients who already have THAs with CoC bearings.

LEVEL OF EVIDENCE

Therapeutic Level IV.