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Abstract Background Children and young adults needing surgery for a primary malignant bone tumour around the knee face a difficult, life-changing decision. A previous study showed that this population wants to be involved more in the decision-making process and that more involvement leads to less decisional stress and regret. Therefore, a well-designed and standardized decision-making process based on the principles of shared decision-making needs to be designed, implemented, and evaluated. Methods We developed a shared decision-making (SDM) model for this patient population, including an online decision aid (DA). This model has been implemented in the standard care of patients with a primary malignant bone tumour around the knee. Following implementation, we will analyse its effect on the decision-making process and the impact on patient experiences using questionnaires and interviews. Moreover, potential areas for improvement will be identified. Discussion Given the importance of involving patients and parents in surgical decision-making, particularly in life-changing surgery such as malignant bone tumour surgery, and given the lack of SDM models applicable for this purpose, we want to share our model with the international community, including our study protocol for evaluating and optimising the model. This study will generate valuable knowledge to facilitate the optimisation of current patient care for local treatment. The sharing of our implementation and study protocol can serve as an example for other centres interested in implementing SDM methods in an era characterized by more empowered patients and parents who desire autonomy and reliable and realistic information.

Abstract Ossification of the posterior longitudinal ligament of the cervical spine (C-OPLL) is a degenerative disorder that leads to the narrowing of the spinal canal and compression of both the spinal cord and nerve roots. This condition is more prevalent in East Asian populations, with marked regional variations in incidence. Symptoms include neck pain, restricted movement, limb numbness, and motor impairment. In severe cases, surgery may be required. Surgical strategies for C-OPLL can be divided into anterior and posterior approaches, each offering distinct advantages and limitations. Anterior approaches, such as anterior cervical corpectomy and fusion (ACCF), anterior cervical discectomy and fusion (ACDF), anterior floating method and vertebral body sliding osteotomy (VBSO), provide the benefit of direct decompression but are technically demanding and carry a higher risk of complications. In contrast, posterior approaches, including laminectomy (with or without instrumented fusion) and laminoplasty (LAMP), offer indirect decompression but may increase the risk of cervical kyphosis. In recent years, innovative techniques like anterior cervical ossified posterior longitudinal ligament en bloc resection (ACOE), anterior controllable antedisplacement and fusion (ACAF), and minimally invasive endoscopic spine surgery have been developed to reduce complications and enhance surgical outcomes. Selecting the appropriate surgical technique requires a thorough assessment of factors such as the severity of the lesion, cervical alignment, and the surgeon’s experience. This narrative review examines the differences between these surgical options, discusses their respective advantages and disadvantages, and provides updated insights and recommendations.

Abstract Objective The aim was to investigate the relationship between metabolic indices and abnormal bone mass (ABM), analyse the association between osteoprotegerin (OPG) gene mutations and ABM, and explore the interaction effect of type 2 diabetes mellitus (T2DM) and OPG gene mutations on bone mineral density (BMD) in postmenopausal women to provide a new supplementary index and a reliable basis for the early identification of osteoporosis (OP) in postmenopausal women in the clinical setting. Methods Postmenopausal women hospitalized within the Department of Endocrinology of the First Affiliated Sanatorium of Shihezi University from June 2021 to March 2023 were retrospectively analysed, and the bone mineral density of lumbar vertebrae 1–4 (BMD (L1-4)) of the studied subjects was measured once via twin-energy X-ray absorptiometry. The studied subjects were divided into a normal bone mass (NBM) group and an ABM group according to their bone mineral density, and the general data of the studied subjects were recorded once. Blood biochemical indices were determined, and genotyping of the rs4355801 locus of the OPG gene was performed. Differences in the overall data and biochemical indices of the two groups were evaluated via the rank-sum test, and the relationship between blood glucose levels and mutations of the rs4355801 locus of the OPG gene and ABM or BMD (L1-4) was evaluated via binary logistic regression analysis or linear regression analysis. A bootstrap test was performed to test whether uric acid (UA) levels mediate the association between blood glucose levels and BMD (L1-4). Simple effect analysis was performed to analyse the interaction between T2DM and mutations at the rs4355801 locus of the OPG gene on BMD (L1-4). Results ① After adjusting for confounding factors, the risk of ABM increased by 50% (95% CI 21–85%) for each unit increase in fasting plasma glucose (FPG) levels and 31% (95% CI 2–69%) for each unit increase in glycosylated haemoglobin (HbA1c) levels (both P

Abstract Introduction Vitamin c can relieve the pain after other diseases, but there are no studies on whether vitamin C can relieve the pain after hip replacement. The purpose of this paper is to study whether vitamin C can relieve the pain after total hip replacement. Purpose In this prospective, double-blind, placebo-controlled, randomized trial, 100 patients receiving THA at our hospital were randomly assigned to vitamin c or control groups. During the operation, the vitamin C group will receive intravenous injection of 3 g vitamin C, and the control group will receive 3 g placebo. If the patient has postoperative pain, 10 ml subcutaneous injection of morphine will be required as a rescue analgesic. The primary outcome was the amount of postoperative injection of morphine as a rescue analgesic and expression of inflammatory factors, and the secondary outcome was postoperative pain and hip recovery as assessed by visual analog scale (VAS). Results The dosage of subcutaneous injection of morphine was significantly reduced in vitamin C group. VAS pain scores at rest and exercise were lower in the vitamin C group 24 h after surgery, and hip motion was better 24 h after surgery, but there was no significant difference between the two groups 24 h after surgery.Nonetheless, the overall changes in morphine usage and VAS scores did not surpass the established minimal clinically important differences (10 mg for morphine consumption; 1.5 at rest and 1.8 during movement for VAS scores). Conclusion Adding intravenous vitamin c to multimodal analgesia significantly improved morphine consumption, VAS pain score, and functional recovery. However, it is recommended that single intravenous administration of vitamin C during the perioperative period may achieve better pain relief for patients after THA.

Abstract Objective This study aimed to identify risk factors contributing to the early onset of patellofemoral osteoarthritis (PFOA) within the first two years following anterior cruciate ligament reconstruction (ACLR) using a hamstring tendon autograft. Methods Participants aged 18 to 40 who had undergone ACLR within the past two years were included in this study, along with a control group of healthy volunteers. Magnetic resonance imaging (MRI) data were obtained preoperatively, at two years postoperatively, and from the control group. T-tests were used to assess differences in patellofemoral alignment (PA) and trochlear morphology (TM) between the pre- and post-ACLR patients and healthy controls. The incidence of PFOA was recorded, and associations between PA, TM, and clinical parameters were evaluated in patients with and without PFOA. Logistic regression analysis was conducted to identify potential risk factors for PFOA development. Results A total of 177 patients, with a mean follow-up period of 22.17 ± 5.09 months and a mean age of 26.4 ± 5.6 years, were included in the study. Following ACL injury, significant alterations in patellar tilt angle (PTA), tuberositas tibae-trochlear groove distance (TT-TG), Insall-Salvati ratio (ISR), and static anterior tibial translation (SATT) were observed compared to the control group. Postoperatively, deviations in PTA and SATT remained significant when compared to healthy controls. Of the 177 patients, 68 (38.42%) developed early-onset PFOA. Factors associated with the early onset of PFOA included age at the time of surgery, the interval between injury and surgery, PTA, bisect offset (BO), sulcus angle (SA), thigh circumference, SATT, and partial meniscectomy. Conclusion Significant differences in PTA, TT-TG, ISR, and SATT were identified between patients who underwent ACLR and healthy controls. Postoperatively, there was no correction in PTA or SATT, which remained significantly altered. Factors such as age at the time of surgery, PTA, BO, SA, ISR, SATT, thigh circumference, partial meniscectomy, and the time interval between injury and surgery were associated with the early onset of PFOA within two years post-ACLR. These findings may aid in the prevention of PFOA by identifying individuals at higher risk for early development.

Abstract Objective Bone incision leads to interrupted and sluggish blood flow in the process of distraction osteogenesis (DO), creating a hypoxia (0–2% oxygen tension) at the center of the bone callus. This hypoxia is critical in the coupling of osteogenesis and angiogenesis during DO. This study aimed to investigate the effect of Uniaxial Static Strain (USS) on osteogenesis in osteoblasts under hypoxic conditions, with a focus on the expression of osteogenic markers and angiogenic factors. Methods The USS was made by a multi-unit tension compression device.Osteoblasts were subjected to 10% USS made under hypoxic conditions to mimic the process of DO in vitro. The cell proliferation, alkaline phosphatase (ALP) activity, mineralized nodule formation, and expression of osteogenic and angiogenic markers were evaluated by using a CCK-8 assay, alkaline phosphatase (ALP) staining, ALP activity assay, alizarin red S staining, qRT-PCR, Western blotting and ELISA. Results Hypoxia inhibited osteoblast cell proliferation, ALP activity, mineralized nodule formation, and the expression of runt-related transcription factor 2 (Runx- 2), osteopontin(OPN), osteocalcin (OCN), collagen type I (Col1a1). Conversely, hypoxia upregulated the expression of hypoxia-inducible factor 1-alpha (HIF-1α) and vascular endothelial growth factor (VEGF), which are associated with angiogenesis. However, the application of USS enhanced osteoblasts’ osteogenic capacity and upregulated angiogenic factors under hypoxic conditions. Conclusion USS can enhance osteogenesis in osteoblasts under hypoxic conditions. Moreover, it may stimulate angiogenesis by promoting the expression of VEGF, which further contributes to bone formation. This finding provides important implications for understanding the mechanisms involved in bone regeneration and may have clinical applications in optimizing the effectiveness of DO techniques.

Abstract Background Osteoporotic fractures (OPF) are fractures that occur with low-energy injuries or during daily activities, representing a serious consequence of osteoporosis (OP). With the worsening of population aging, the number of OPF patients continues to expand, causing a significant burden on families and society. Consequently, it is significant to diagnose and analyze OPF at the molecular level. Objective The aim of this research was to explore the diagnostic value of miR-32-3p in OPF patients and to exploit new biomarkers for clinical applications. Methods The miR-32-3p expression level of patients was detected by RT-qPCR. Diagnostic accuracy of miR-32-3p analyzed adopting ROC curve. Additionally, the risk factors correlation with the occurrence of OPF were assessed by logistic analysis. The effect of miR-32-3p on BMSCs was verified by in vitro transfection experiments. Results miR-32-3p expression was lower in OPF patients than in OP patients. ROC curve implied that miR-32-3p exhibits commendable sensitivity (88.9%) and specificity (75.6%) to differentiate between OP and OPF patients (AUC = 0.905, P

Abstract Background It has been reported that 43.6% of ankle fractures are accompanied by posterior malleolus fractures. The aim of this study is to define a safe zone for posterior malleolus fractures by determining the locations of the important anatomical structures in this region. Additionally, it aims to identify the trans-Achilles passage line for Kirschner wire insertion through a posteroanterior approach for posterior malleolus fragments. Methods Six below-knee amputee fresh-frozen leg cadavers were used in this study. A trans-Achilles Kirschner wire was applied to the cadavers in the posteroanterior direction under the guidance of fluoroscopy. The areas where the Kirschner wire passed were dissected, and their proximity to vital anatomical structures was measured. Results In all cadavers, the transverse thickness of the Achilles tendon at the level of the trans-Achilles Kirschner wire was 15.5 mm and the trans-Achilles Kirschner wire application was 18.6 mm from the sural nerve, 16 mm from the posterior tibial tendon, and 12.16 mm from the flexor digitorum longus muscle. It was performed 15.16 and 14.6 mm from the posterior tibial artery and vein, 12.3 mm from the tibial nerve, 13.6 mm from the tibiofibular joint, and 55.5 mm from the insertion site of the Achilles tendon to the calcaneus and at a sufficient distance from vital anatomical structures. Conclusions The proposed trans-Achilles percutaneous surgical technique is safe from neurovascular structures for fixing posterior malleolar fractures. However, the long-term clinical outcomes of this technique need to be explored. Level of evidence Level III, A cadaveric study.

Abstract Objective This study aims to evaluate the clinical management and effectiveness of metagenomic next-generation sequencing (mNGS) in patients with pyogenic spinal infections. Methods We conducted a retrospective review of 17 patients diagnosed with pyogenic spinal infections and treated at our institution between October 2022 and February 2024. The cohort included 8 males and 9 females, with a mean age of 63.59 ± 10.18 years (range: 41–71 years). The infections comprised 9 epidural abscesses, 6 intervertebral space infections, and 2 deep abscesses. All patients underwent open surgical procedures and mNGS-based bacterial identification using intraoperative pus or tissue specimens, in addition to conventional blood bacterial cultures. Clinical outcomes were assessed using CRP, PCT, WBC inflammatory markers, and VAS scores postoperatively. Results All 17 patients with pyogenic spinal infections underwent open surgery and mNGS bacterial detection at our institution. Among the 17 patients, mNGS yielded positive results in 14 cases (82.4%), significantly higher than the 5.9% positivity rate of conventional bacterial cultures (p

Abstract Background The aim of this study was to identify the most responsive foot position for detection of isolated unstable syndesmotic injury. Methods Fourteen paired human cadaveric lower legs were positioned in a pressure-controlled radiolucent frame and loaded under 700 N. Computed tomography scans were performed in neutral position, 15° internal / external rotation, and 20° dorsal / plantar flexion of the foot before and after cutting all syndesmotic ligaments. For each position, generated 3D models of the intact and injured distal tibiofibular joints were matched and analyzed by calculating three parameters: diastasis, anteroposterior displacement, and shortening of the fibula. Results Transection of syndesmotic ligaments resulted in significant posterior translation of the fibula (4.34°, SD 1.63°, p

Abstract Aim This study aims to assess the effectiveness of therapy of human synovial membrane-derived MSCs (SM-MSC) from OA grade IV patients in treating knee OA. Methods SM-MSC were isolated from patients undergoing total knee replacement surgery, cultured to the fourth passage, and characterized using flow cytometry. Differentiation potential was assessed through lineage-specific staining. Osteoarthritis was induced in 24 Wistar rats via monosodium iodoacetate (MIA). The rats were divided into three groups: negative control, OA control, and OA treated with SM-MSC. Radiological, histopathological, and molecular analyses were conducted to evaluate cartilage repair and gene expression. Results Flow cytometry confirmed the MSC phenotype of SM-MSC, and successful differentiation was observed. Radiological and histopathological analyses showed significant improvement in the SM-MSC treated group, with reduced cartilage damage and higher Safranin O staining compared to the OA control group. Gene expression analysis indicated increased type-2 collagen (COL-2) expression in the SM-MSC treated group, although MMP-13 levels remained unchanged across all groups. Conclusion Human SM-MSCs from OA grade IV patients significantly improved cartilage repair in an OA rat model, demonstrating their potential as a therapeutic option for OA. To enhance long-term efficacy and anti-inflammatory effects, further studies are needed to optimize treatment protocols, including injection frequency and dosage.

Abstract Background This study evaluates the clinical evidence for performing total knee arthroplasty (TKA) without a tourniquet, a shift from the near-universal use in 2009 to current trends towards tourniquet-less TKA in Norway and Sweden. This change is set against a backdrop of conflicting evidence regarding the positive and negative effects of tourniquet use. Questions/purposes The aims were to determine if the tourniquet has an impact on [1] Forgotten Joint Score-12 (FJS-12) at 8 weeks after surgery; [2] postoperative strength and function; [3] postoperative pain and opioid analgesic use; and [4] operative time, bleeding, and length of stay (LOS). Methods Eighty-one patients were randomised to TKA with or without a tourniquet. The outcome measures, FJS-12, muscle strength, functional test, pain, estimated blood loss, haemoglobin (Hb) loss, knee circumference, opioid consumption, and LOS were assessed preoperatively and at 1 day, 8 weeks, and 1 year after surgery. Results No significant difference in FJS-12 scores was found between the two groups at postoperative 8 weeks. However, the tourniquet group showed statistically significant better knee extension strength at 8 weeks (p = 0.045). There were no differences in other outcomes, except for a greater decrease in haemoglobin levels (p = 0.02) and higher estimated perioperative blood loss (p

Abstract Introduction Artificial cervical disc replacement (ACDR) is a widely accepted surgical procedure in the treatment of cervical radiculopathy and myelopathy. However, some research suggests that ACDR may redistribute more load onto the facet joints, potentially leading to postoperative axial pain in certain patients. Earlier studies have indicated that facet tropism is prevalent in the lower cervical spine and can significantly increase facet joint pressure. The present study aims to investigate the changes in the biomechanical environment of the cervical spine after ACDR using different prosthese when facet tropism is present. Methods A C2-C7 cervical spine finite element model was created. Symmetrical, moderate asymmetrical (7 degrees tropism), and severe asymmetrical (14 degrees tropism) models were created at the C5/C6 level by adjusting the left-side facet. C5/C6 ACDR with Prestige LP, Prodisc-C vivo, and Mobi-C were simulated in all models. A 75 N follower load and 1 N⋅m moment was applied to initiate flexion, extension, lateral bending, and axial rotation, and the range of motions (ROMs), facet contact forces(FCFs), and facet capsule stress were recorded. Results In the presence of facet tropism, all ACDR models exhibited significantly higher FCFs and facet capsule stress compared to the intact model. In the asymmetric model, FCFs on the right side were significantly increased in neutral position, extension, left bending and right rotation, and on both sides in right bending and left rotation compared to the symmetric model. All ACDR model in the presence of facet tropism, exhibited significantly higher facet capsule stresses at all positions compared to the symmetric model. The stress distribution on the facet surface and the capsule ligament in the asymmetrical models was different from that in the symmetrical model. Conclusions The existence of facet tropism could considerably increase FCFs and facet capsule stress after ACDR with Prestige-LP, Prodisc-C Vivo, and Mobi-C. None of the three different designs of implants were able to effectively protect the facet joints in the presence of facet tropism. Research into designing new implants may be needed to improve this situation. Clinical trials are needed to validate the impact of facet tropism.

Abstract Background Medial tibial stress syndrome (MTSS) is a prevalent running-related injury that could impact athletic performance and quality of life. The purpose of the study was to investigate the effectiveness of functional hip abductor strength training on reducing contralateral pelvic drop angle (hip frontal plane projection angle), and dynamic knee valgus (knee frontal plane projection angle) in runners with medial tibial stress syndrome (MTSS). Methods Forty male and female recreational runners were diagnosed with MTSS for at least one month. The age ranged from 25 to 35 years old, and the body mass index (BMI) ranged between (18.5 and 25 kg/m2) participated in this study. This was a single-blind, randomized controlled trial. Participants were randomized into two groups: a control group (Group A, n = 20) received a selected physical therapy exercise program, and an experimental group (Group B, n = 20) received the same program plus functional hip abductor strength training. Dynamic knee valgus (frontal plane projection angle) and contralateral pelvic drop angle were measured using 2D video and analyzed by Kinovea software at baseline and after 8 weeks. Mixed-effect multifactor analysis of variance (MANOVA) was conducted to compare within and between groups effects on FPPA and pelvic drop angle. Results After 8 weeks, Group B exhibited a significantly decreased frontal plane projection and pelvic drop angles compared to Group A (p

Abstract Purpose Tibial tubercle osteotomy (TTO) is often employed for certain patellofemoral instability (PFI) cases, though its indications and effectiveness are not widely accepted. This systematic review gathers recent studies comparing isolated medial patellofemoral ligament reconstruction (iMPFLR) to MPFLR combined with TTO in managing PFI and to offer recommendations for clinicians when selecting TTO. This review proposes that MPFLR combined with TTO is superior to iMPFLR and that the combined procedure does not increase the incidence of postoperative complications. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 (PRISMA 2020), extensive searches were performed on August 20, 2024, across PubMed/Medline, Embase, and Cochrane databases to locate relevant studies. Data on research protocols, participant characteristics (including epidemiological and radiographic features), functional scores, and complications were collected and examined. A meta-analysis was conducted to compare the outcomes between the two surgical techniques. Results This systematic review analyzed 10 studies involving 715 participants, divided into a control group (which underwent iMPFLR) and an experimental group (which underwent MPFLR combined with TTO). In the control group, the incidence of severe trochlear dysplasia before surgery was 68.3% (95% CI [67.3-69.3%]), and the mean preoperative tibial tubercle to trochlear groove distance (TT-TG) was 16.1 mm (95% CI [15.8–16.3]). In the experimental group, both were respectively 79.1% (95% CI [77.5–80.7]) and 20.2 mm (95% CI [20.0-20.4]). Eight studies (80%) reported postoperative Kujala scores, with an average score of 85.1 (95% CI [84.4–85.9]) for the control group and 85.4 (95% CI [84.9–85.9]) for the experimental group (I²=22.7%). Four studies (40%) reported postoperative Lysholm scores, with an average score of 89.4 (95% CI [88.9–89.9]) for the control group and 89.1 (95% CI [89.0-89.3]) for the experimental group (I²=0%). The mean surgical failure rate for the control group was 5.1% (95% CI [4.7-5.6%]), compared to 3.2% (95% CI [3.0-3.4%]) for the experimental group, with an odds ratio (OR) of 2.18 (95% CI [1.05–4.53], I²=0%, p = 0.738). The rate of secondary surgeries in the control group was 1.9% (95% CI [1.6–2.2]), while in the experimental group it was 10.7% (95% CI [9.4–12.1]), with an OR of 0.12 (95% CI [0.03–0.54], I²=63.1%, p = 0.028). Conclusion The combination of MPFLR and TTO for treating PFI yields knee joint function comparable to that achieved with MPFLR alone. The approach does not elevate the failure rate of the surgery or the incidence of other adverse events. However, the combined approach may prolong the postoperative rehabilitation process and typically requires removal of internal fixation devices, resulting in a higher rate of secondary surgeries.

Abstract Background Platelet-rich plasma (PRP) is a promising treatment for knee osteoarthritis (OA). However, exercise therapy and activities of daily living (ADL) guidance are recommended as core treatments in the Osteoarthritis Research Society International (OARSI) guidelines. However, the effects of PRP combined with exercise therapy are not fully understood. This study aimed to clarify the effectiveness of this treatment. Methods We assigned patients diagnosed with knee OA and treated between January 2021 and December 2022 to groups who underwent PRP + exercise (PE), PRP (P), or exercise (E) therapy. Outcomes were evaluated using Knee Injury and Osteoarthritis Outcome Scores (KOOS) before, and 1, 3, and 12 months after treatment. Within-group comparisons according to the time of each score were statistically assessed using a one-way analysis of variance, then differences were analyzed using Bonferroni multiple comparisons p

Abstract Background Introduction: Robotic surgery in total hip arthroplasty (THA) has emerged as a promising approach for improving precision and reducing errors. This meta-analysis aimed to compare the efficacy and safety of robot-assisted MAKO total hip arthroplasty. Methods Studies were searched using four databases. Meta-analysis was performed using Review Manager 5.4. Efficacy was assessed radiologically, and functional scores and complications were recorded. Results Twelve studies (1224 hips) were analyzed. The MAKO group achieved greater cup anteversion (MD 1.53, 95%CI 1.04–2.03) and a higher percentage of components within safe inclination and anteversion ranges (p > 0.05). Harris Hip Scores did not differ significantly (MD 0.61, 95%CI -0.22–1.45) but the forgotten joint scores favored MAKO (MD 5.99, 95% CI 4.10–7.88), although not exceeding the minimally clinically significant difference. No differences in intraoperative complications emerged (OR 0.96, 95%CI 0.51–1.79) but preoperative plans significantly mismatched the final cup placement after MAKO (p

Abstract Background Motor-sparing local infiltration analgesia (LIA) enhances recovery after total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, LIA can induce local anesthetic systemic toxicity (LAST), sometimes necessitating rescue lipid emulsion therapy. Our institute initiated a pilot study to pretreat patients with lipid emulsion (SMOFlipid®) to test its efficacy in mitigating LIA-induced LAST events. Methods This retrospective study enrolled 1,621 adult patients who received LIA with bupivacaine (2–3 mg/kg, maximum 300 mg) for unilateral primary THA or TKA under general anesthesia between January 2020 and April 2022. A total of 439 patients received lipid pretreatment, while 1,182 did not. Demographics, surgical and anesthesia profiles, along with LAST events affecting the neurological, cardiovascular, and respiratory systems, were compared after propensity score matching for age, sex, body mass index (BMI), and surgery type. Results The incidence of severe LAST events requiring rescue lipid emulsion slightly decreased after lipid pretreatment (from 2.54 to 2.28 per 1000). Lipid pretreatment significantly reduced the incidence of bradycardia and new-onset arrhythmia (odds ratio: 0.13, adjusted p-value: 0.024) but increased postoperative opioid requirement (odds ratio: 1.71, adjusted p-value: 0.032) after Benjamini-Hochberg correction for multiplicity. Conclusions The efficacy of lipid pretreatment (SMOFlipid® 1.5 ml/kg, maximum 100 ml) in mitigating LIA-induced LAST remains controversial. While lipid pretreatment reduced the incidence of new-onset arrhythmia, it showed no clear benefits for neurologic and respiratory outcomes. Additionally, lipid pretreatment might hinder postoperative recovery by increasing the need for rescue opioid analgesia. Further prospective pharmacokinetic studies are required to assess plasma bupivacaine concentrations following LIA and lipid pretreatment, examine their relationship to LAST events, and establish the efficacy and safety of lipid pretreatment.

Abstract Objective To analyze the clinical efficacy of autologous platelet rich plasma (PRP) injection in the treatment of knee osteoarthritis (KOA) and its influence on related biomarkers such as interleukin-1 beta (IL-1β), tumor necrosis factor-alpha (TNF-α), and high-sensitivity C-reactive protein (hs-CRP). Method 150 study subjects are randomly selected from KOA patients received treatment in the Third Hospital of Bethune Hospital from January 2022 to January 2023. After enrollment, patients are randomly numbered 1–100. 75 patients with odd and even numbers are included in the control group and the observation group, respectively. The former is cured with etocoxib, while the latter is treated with autologous PRP injection based on this. The clinical efficacy, relevant biomarkers (IL-1β, TNF-α, hs-CRP), and Lysholm knee score scale and Fugl Meyer assessment (FMA) scores are compared and analyzed. Results The total effective rate of 94.67% (71/75) in the observation group was higher than 84.00% (63/75) in the other one group (P 0.05. When the treatment period is at 1 and 2 months, the IL-1β, TNF-α, hs-CRP levels within the group were lower than before treatment, while the Lysholm knee joint score and FMA scale score were higher than before treatment (P

Abstract Background The failure of disease-modifying osteoarthritis drugs (DMOADs) trials lies mainly in the heterogeneity of the disease, which calls for a more precise population with specific progression and outcomes. This study aimed to determine whether and which MRI-based structural phenotype of knee osteoarthritis (KOA) is associated with short-term structural progression and subsequent total knee replacement (TKR). Methods A longitudinal study was conducted among participants with baseline Kellgren-Lawrence grade (KLG) ≥ 2 from the Osteoarthritis Initiative (OAI). The structural phenotypes at baseline were defined as subchondral bone, meniscus/cartilage and inflammatory phenotypes according to the MRI Osteoarthritis Knee Score (MOAKS). The primary outcome was the progression of structural abnormalities within 24 months and multivariable logistic regressions were applied to evaluate the associations. The secondary outcome was the incidence of TKR during 108 months. Cox regressions and Kaplan–Meier survival curves were used for the analysis. Results A total of 733 participants with KOA were finally included in our study, with 493 (67.3%) having the three main structural phenotypes. For the primary outcome, the subchondral bone phenotype (OR [95% CI]:1.71 [1.02, 2.83], 1.52 [1.06, 2.18], 1.65 [1.11, 2.42], respectively) and the inflammatory phenotype (OR [95% CI]: 1.69 [1.05, 2.74], 1.82 [1.31, 2.52], 2.15 [1.48, 3.14], respectively) were both associated with the short-term progression of joint space narrowing, osteophytes and sclerosis in 24 months, whereas the meniscus/cartilage phenotype was only associated with the progression of osteophytes and sclerosis. For the secondary outcome, the subchondral bone phenotype (HR [95% CI]: 1.71 [1.06–2.78]) and inflammatory phenotype (HR [95%CI]: 2.00 [1.02–2.67]) were associated with shorter time to subsequent TKR, but not the meniscus/cartilage phenotype. Besides, the cumulative effect when the structural phenotype overlapped was confirmed in both outcomes. Conclusions The subchondral bone phenotype and inflammatory phenotype were associated with the progression of joint space narrowing, osteophytes and sclerosis in 24 months, along with subsequent TKR in 108 months. Besides, additive effects of overlapped phenotypes were further determined. These phenotypes could serve as valuable screening tools for future clinical trials and provide guidance for risk evaluation.

Abstract Objective To investigate the risk factors influencing 1-year mortality after intramedullary nail fixation for fragile intertrochanteric fracture in elderly individuals. Methods The medical records of 622 consecutive elderly patients (aged ≥ 65 years) with fragile intertrochanteric fractures treated with proximal femoral nail anti-rotation (PFNA) and followed-up were retrospectively analyzed. The patients were divided into death and survival groups according to their survival status within 1 year after surgery, and the differences in age, sex, region of residence, tobacco use, alcohol use, body mass index (BMI), comorbidities (hypertension, diabetes mellitus, coronary heart disease, stroke, dementia, chronic obstructive pulmonary disease, pneumonia), preoperative hemoglobin, preoperative albumin, deep vein thrombosis, fracture type (AO classification), injury-to-surgery time, American Society of Anesthesiologists (ASA) score, anesthesia modality, duration of surgery, intraoperative blood loss, and blood transfusion were compared. The Kaplan–Meier method was used for univariate analysis to screen for statistically significant differences between the two groups, and the data were entered into the Cox proportional hazards model for multivariate analysis to determine independent risk factors affecting 1-year postoperative mortality. For subgroup analysis, we explored the varying effects of hypoproteinemia and being underweight in patients of different genders, as well as the effects of different age ranges, different injury-to-surgery times, and different blood transfusion volumes on 1-year postoperative mortality. Results The mortality rates at 1, 3, and 6 months, and 1 year after surgery were 3.9%, 7.2%, 10.1%, and 15.3%, respectively. Univariate analysis showed that advanced age, male sex, tobacco use, underweight (BMI

Abstract Background Knee osteoarthritis (OA) is a common and serious joint disease and patients mainly suffer from knee pain and dysfunction, significantly impacting their quality of life and daily activities. Non-pharmacological treatments and total knee arthroplasty (TKA) are the two major treatments for knee OA. TKA is the primary treatment for severe knee OA patients, however, the postoperative rehabilitation results are not entirely satisfactory. To enhance postoperative rehabilitation outcomes, preoperative lower-limb muscle strengthening has aroused attention and demonstrated significant results on functional recovery after TKA. Specifically, isokinetic muscle strengthening (IMS) has been highly anticipated as an efficient training method. Nevertheless, its effects in perioperative and long-term periods of TKA require further investigation. This study aims to evaluate the impact of preoperative lower-limb IMS during the 4 weeks before TKA on the perioperative and postoperative outcomes, with particular attention on knee function, pain, and inflammatory response. Methods In this study, 104 patients awaiting TKA will be randomized to 2 groups: the IMS and health education groups. All patients will be evaluated at baseline, post-intervention, discharge day, and postoperative day 14, with follow-up assessments at 6 weeks, 3, 6, and 12 months after discharge. The primary outcome will be the Knee Injury and Osteoarthritis Outcome Score 3 months after TKA and the medial-to-lateral knee contact force ratio. The secondary outcomes will be changes in lower-limb muscle strength, knee pain, inflammation response, active range of motion, performance-based function (5-times Sit-to-Stand Test, Time Up-and-Go Test, 3 m walking speed), Berg Balance Scale, and surgical need. Discussion Lower-limb IMS can improve muscle strength, pain, and function for early knee OA patients. However, the effects of different doses of IMS on perioperative and postoperative knee pain, inflammation response, and function after TKA are inconclusive. This study will provide high-quality evidence to assess the efficacy of IMS in end-stage patients who will undergo TKA. Understanding IMS in end-stage knee OA patients will help guide future surgical management for this population. Trial Registration Chinese Clinical Trial Registry ChiCTR2400088136.

Abstract Background This study aimed to investigate the impact of three-dimensional (3D)-printed guide plate-assisted percutaneous pedicle screw implantation on minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) surgery. Methods Overall, 162 patients who underwent MIS-TLIF at Tai’an City Central Hospital were retrospectively reviewed. The studied variables included operative time, volume of intraoperative blood loss, fluoroscopy time, postoperative drainage volume, visual analogue scale (VAS) score, Oswestry disability Index (ODI) score (preoperatively and at 2 weeks, 3 months, 6 months, and 12 months after surgery), and intervertebral fusion rate at 6 months after surgery. Results The conventional group included 99 patients who underwent a conventional procedure, while the 3D printing group included 63 patients who underwent 3D-printed guide plate-assisted percutaneous pedicle screw implantation. The conventional group required more times of positioning needle punctures than the 3D printing group (22.2 ± 5.9 vs. 16.1 ± 4.9). The operation and fluoroscopy time were also longer in the former group (183.5 ± 51.1 min vs. 148.8 ± 40.3 min and 30.2 ± 5.9 s vs. 24.1 ± 4.9 s, respectively). In 3D printing group, lower back pain VAS scores and ODI scores at 2 weeks and 3 months after surgery were observed. There were no significant differences in terms of the volumes of intraoperative blood loss; postoperative lower limb pain VAS scores; and interbody fusion rate (P > 0.05). Conclusion The novel 3D-printed guide plate-assisted percutaneous pedicle screw implantation can achieve better amelioration of back pain and recovery of function. It also reduced the times of positioning needle puncture and fluoroscopy time during percutaneous screw placement surgery and reduced the duration of surgery.

Abstract Purpose This study aimed to (1) analyze the Coronal Plane Alignment of the Knee (CPAK) classification in patients undergoing unicompartmental knee arthroplasty (UKA), (2) assess whether UKA can restore pre-arthritic coronal alignment by utilizing the arithmetic hip-knee-ankle angle (aHKA), and (3) evaluate the relationship between patient-reported outcome measures (PROMs) and postoperative alignment following UKA. Methods We retrospectively analyzed 152 consecutive patients who underwent fixed-bearing medial UKA. A radiological analysis was conducted using an EOS imaging system. Postoperative alignment was classified as neutral (varus ≤ 3°), mild varus (3° < varus ≤ 7°), or marked varus (varus > 7°) based on the mechanical hip-knee-ankle angle (mHKA). The aHKA was calculated and the CPAK classification was used to categorize knee phenotypes. The PROMs were obtained both before and after the surgery. Results A total of 152 knees from 113 patients were included with a mean two-year follow-up. The mean difference between the postoperative mHKA and the estimated aHKA was 0.80° (90% CI 0.35 to 1.24; P = 0.003). Postoperatively, 63 (41.45%) of the 152 knees were in neutral group, 54 (35.53%) mild varus, and 35 (23.03%) marked varus. The neutrally aligned cohort did not exhibit significantly higher scores in range of motion, VAS, HSS, WOMAC, or FJS-12 scores compared to the mild or marked varus cohort (P = 0.205, 0.118, 0.076, 0.140, and 0.788, respectively) during the short-term follow-up. Conclusion Non-robotically assisted, fixed-bearing medial UKA can restore pre-arthritic coronal alignment and achieve satisfactory PROMs. Fixed-bearing medial UKA aims to restore the pre-arthritic alignment rather than achieving neutral mechanical alignment.

Abstract Background Lateral lumbar interbody fusion (LLIF) via a retroperitoneum approach has gained popularity due to minimal invasiveness, which avoids resection of the spinous process and laminae. However, as challenges in grafting autogenous bone persist, artificial bone has been tested in Japan to fill the spinal cage. Platelet-rich plasma (PRP) contains growth factors and anti-inflammatory cytokines to promote cellular proliferation and repair damaged tissues. While the effects of PRP on tendon and ligament repair are widely known, any effects on bone healing are scarcely reported. However, PRP-loaded artificial bone carries potential to improve intervertebral bone fusion. Objective This study assessed whether PRP enhances intervertebral bone fusion in LLIF surgery using β-tricalcium phosphate artificial bone. Methods The current study was a prospective, randomized, controlled trial. We evaluated 13 consecutive patients undergoing LLIF surgery in our hospital. Patients received artificial bone impregnated with PRP or without PRP within the same fusion cage. The primary outcome was the intervertebral bone fusion rate at 6 and 12 months postoperatively, evaluated using CT imaging. The intervertebral bone fusion rates with and without PRP loading and with and without contact part between the endplate and the artificial bone were compared. Secondary outcomes included clinical evaluations using visual analog scale scores for low back pain, buttock-leg pain, and leg numbness from the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOA-BPEQ) and the Oswestry Disability Index (ODI), plus adverse events information. Results Of the 13 patients (29 vertebral segments) included, bone fusion was observed in 43.4% of the PRP group and 26.1% of the non-PRP group at 6 months (p = 0.216). At 12 months, fusion rates were 60.9% with PRP and 34.8% without PRP (p = 0.074). The fusion rate was significantly higher in cases with good contact between the vertebral endplate and the artificial bone (p = 0.0004). Clinical scores improved postoperatively. Adverse events were in accordance with expectations from LLIF surgery and no PRP-specific events occurred. Conclusion PRP did not significantly improve intervertebral bone fusion rates in LLIF surgeries, particularly in cases with poor contact between the vertebral endplate and artificial bone. While PRP may have a limited role in enhancing bone fusion, maintaining good contact between the vertebral endplate and artificial bone is crucial for successful outcomes. Further research is needed to explore optimal uses of PRP in spinal fusion surgeries.

Abstract Introduction Symptomatic hip osteoarthritis (OA) causes significant morbidity and functional limitations. While corticosteroid injections (CSI) are commonly offered and administered for OA pain relief, it is unknown if they offer any clinically meaningful long-term benefit or reduce the overall need for surgical intervention. Methods A cross-sectional retrospective cohort study was performed on primary hip osteoarthritis patients from a single academic tertiary-care center arthroplasty clinic from 2014 to 2019. Patients were divided into three groups. CSI + THA: hip CSI patients who underwent subsequent ipsilateral THA. CSI-noTHA: hip CSI who have not had ipsilateral THA to date. THA-noCSI: a control group of consecutive hip OA patients who underwent primary THA without prior CSI. Demographic variables, injection relief duration, and radiographic arthritis severity were recorded. Time from clinic presentation to injection and/or THA were compared. Results 357 patients met inclusion criteria and underwent guided, arthroplasty provider-ordered CSI. Mean duration of relief was 6.7 weeks (SD 8.7). 244 injection patients (67.2%) subsequently underwent THA (CSI + THA). 150 of 390 patients have not undergone THA at mean of 25.5 months follow-up. Mean time from clinic presentation to THA was 8.6 months longer after CSI (16.3, SD 17.8) months in CSI patients compared to 7.7 (SD 10.6) months for patients without CSI (p

Abstract Background We aimed to investigate the compression and ischemic effects of two different tourniquet pressures on tissues during surgery show a clinical difference. Methods Patients aged 18–65 years who underwent foot and ankle surgery and applied a tourniquet in a single center between September 2022 and November 2023 were included in this prospective randomized study. Accordingly, tourniquet pressures were applied as limb occlusion pressure (LOP) + 50 mmHg in group 1 (12 patients) and LOP + 100 mmHg in group 2 (12 patients). The time point at which the femoral nerve motor evoked potential (MEP) decreased by 50%, the time point at which the MEP decreased by 100% for all nerves (femoral, tibial, and deep peroneal), and the time point at which all responses returned after the tourniquet was deflated were identified as the time points for analysis. Results There were no differences in demographic data (age, body mass index, and sex) between the two groups. The mean tourniquet pressure was 191 ± 16 mmHg in Group 1 and 247 ± 21 mmHg in Group 2 (p

Abstract Background Closed suction drainage is typically used in orthopaedic surgery to reduce the occurrence of incision complications. However, whether drainage tubes should be routinely placed in iliac crest bone graft surgeries is still unclear. This study aimed to evaluate the effect of closed suction drainage at iliac crest bone donor site on clinical prognosis. Materials and methods G.Power was used for a prior analysis to estimate the required sample size. 91 patients with tibial plateau fractures who underwent iliac crest harvesting and grafting between January 2019 and January 2022 were enrolled in the study. All surgeries were performed by the same experienced surgeon team. Patients were divided into close suction drainage (CSD) group and no-CSD group according to the use of drainage tube. The demographic and perioperative data of the patients were collected and analyzed. Results There were no significant differences in demographic characteristics between the two groups except that the CSD group had more people with diabetes. The use of closed suction drainage in patients undergoing iliac crest harvest can significantly reduce the incidence of incision complications without increasing pain level and extending hospital stay. However, the closed suction drainage obviously caused the increase of blood loss. More drainage tubes would cause more drainage fluid to flow out. And drainage tube placement may impose a higher financial burden on patients. Conclusion The closed suction drainage should not be recommended routinely for iliac crest bone graft patients. Only when the patient is at high risk for infection and without severe blood loss, placing a single drainage tube is recommended. Trial registration This study was registered at (NCT04807062) and approved by the Ethics Committee of the participating institution (Theoretical No. 2015-003-1).

Abstract Background Displaced femoral neck fractures frequently result in considerable patient morbidity, with complications such as postoperative femoral neck shortening occurring in up to 39.1% of cases. This shortening is associated with reduced hip function and mobility. The Femoral Neck System (FNS), which allows for controlled sliding to facilitate fracture reduction and healing, may mitigate these issues. However, the ideal sliding distance to balance fracture healing and minimize complications is not well defined. Methods We performed a retrospective cohort study of 179 patients who underwent FNS fixation for displaced femoral neck fractures at our institution from September 2019 to September 2023. Patients were categorized into three groups based on the intraoperative sliding distance allowed by the FNS: the Minimal Slide group (≤ 5 mm), the Moderate Slide group (> 5 to ≤ 10 mm), and the Extensive Slide group (> 10 to 20 mm). Primary outcomes included postoperative femoral neck shortening, the incidence of moderate to severe shortening, time to fracture union, and hip joint function as assessed by the Harris Hip Score (HHS) and the Parker Mobility Score. Secondary outcomes included complication rates such as implant cut-out, nonunion, avascular necrosis of the femoral head, and the need for secondary surgery. Results The Extensive Slide group of moderate to severe shortening at 32.31%, which was 1.59-fold and 8.88-fold that of the Moderate Slide (20.34%) and Minimal Slide group’s (3.64%), respectively (P

Abstract Repair of the damaged meniscus is a scientific challenge owing to the poor self-healing potential of the white area of the meniscus. Tissue engineering provides a new method for the repair of meniscus injuries. In this study, we explored the superiority of 2% hyaluronic acid chitin hydrogel in temperature sensitivity, in vitro degradation, biocompatibility, cell adhesion, and other biological characteristics, and investigated the advantages of hyaluronic acid (HA) and Transforming Growth Factor β1 (TGF-β1) in promoting cell proliferation and a matrix formation phenotype. The hydrogel loaded with HA and TGF-β1 promoted cell proliferation. The HA + TGF-β1 mixed group showed the highest glycosaminoglycan (GAG) content and promoted cell migration. Hydroxypropyl chitin (HPCH), HA, and TGF-β1 were combined to form a composite hydrogel with a concentration of 2% after physical cross-linking, and this was injected into a rabbit model of a meniscus full-thickness tear. After 12 weeks of implantation, the TGF-β1 + HA/HPCH composite hydrogel was significantly better than HPCH, HA/HPCH, TGF-β1 + HPCH, and the control group in promoting meniscus repair. In addition, the new meniscus tissue of the TGF-β1 + HA/HPCH composite hydrogel had a tissue structure and biochemical content similar to that of the normal meniscus tissue.

Abstract Background Acute compartment syndrome(ACS) is a perilous consequence of trauma. Acute compartment syndrome’s precise cause is yet unknown. We performed studies to confirm that acute compartment syndrome can be relieved by suppressing ferroptosis and activating the Nrf2/Hmox1 pathway. Methods We generated an ACS rat model and we conducted next-generation sequencing(NGS) of skeletal muscle tissue and identified differentially expressed target genes. Ultimately, we performed in vivo experiments to validate the presence of ferroptosis and the Nrf2/Hmox1 pathway in ACS rats. After the minocycline intervention, the drug was evaluated for its effects on ACS by examining changes associated with ferroptosis. Results The bioinformatics analysis identified that the genetic changes in the disease were mostly focused on ferroptosis, with noticeable modifications in Nrf2/Hmox1. Based on the in vivo results, it was observed that ACS rats exhibited significantly elevated levels of ferroptosis compared to the control rats. The suppression of the Nrf2/Hmox1 pathway mediated by minocycline improves outcomes in ACS and reduces tissue damage after intervention. Conclusion Minocycline hinders ferroptosis via stimulating the Nrf2/Hmox1 pathway, which slows down the advancement of acute compartment syndrome.

Abstract Purpose The aim of this study was to characterize the biomechanical properties of a novel side-to-side tenorrhaphy (SST), this tenorrhaphy is designed to achieve reliable strength utilizing fewer knots and greater operationalization. This is compared with a well-established tendon reconstruction technique called the Pulvertaft weave technique (PWT). Methods Twenty fresh porcine hindfoot flexor tendons were collected, and 10 novel SST and 10 PWT were performed in each group. The repaired tendons were tested cyclically by applying a force of 35 N using an electric tensile testing machine. Tendons were loaded until they ruptured and failed. The cyclic elongation, ultimate elongation, ultimate failure load, stiffness, and operation time were recorded and analyzed for both groups, and the failure patterns of the tendons were observed. Results The mean operation time were 1.86 in the SST group and 3.25 min for the PWT group, respectively. The ultimate failure load was 179.93 N ± 12.05 for the SST group and 113.46 N ± 7.89 for the PWT group. The ultimate elongation was 17.79 mm ± 0.51 for the SST group and 26.83 mm ± 0.64 for the PWT group. The stiffness of the SST group was 35.27 N/mm ± 0.90 in the SST group and 20.11 N/mm ± 0.84 in the PWT group. There was no statistically significant difference in cyclic elongation. Conclusion The SST group performed better than the PWT group in terms of the ultimate elongation, ultimate failure load, and stiffness. It is clear that the novel SST is a reliable alternative to PWT for tendon repair. The operation time of the SST group was significantly shorter than that of the PWT group.

Abstract Background The risk factors for contralateral hip refracture after primary hip fracture are not fully understood; therefore, this study compared the clinical characteristics of patients with first and second hip fractures and explored and analyzed the risk factors for contralateral refracture after hip fracture in elderly individuals to provide a reference for the clinical prevention of postoperative refracture of hip fracture in elderly individuals. Methods A retrospective study was conducted on 458 elderly patients with hip fractures who underwent surgical treatment and were discharged from our hospital from March 2016 to March 2019. The clinical data of the patients were analyzed retrospectively. Patients were divided into a case group (postoperative refracture) and a control group (no postoperative refracture) based on whether they experienced refracture within five years after surgery. The clinical data of the two groups were compared and analyzed via univariate and multivariate logistic regression analyses and receiver operating characteristic (ROC) regression analysis to identify the risk factors for refractures after hip fracture surgery in elderly patients. Results Sixty-one patients experienced refracture, with an incidence rate of 13.3%. Age ≥ 80.5 years, female sex, poor knee joint function, FRAX score ≥ 15.5, anemia, visual impairment, osteoporosis, and Alzheimer’s disease (AD) were identified as risk factors for refracture after hip fracture surgery in elderly individuals (P

Abstract Background Adjacent segment disease (ASD) is a common and serious complication that can develop in the mid- to long-term after lumbar fusion surgery. However, the underlying mechanisms of ASD are not yet fully understood. This study aimed to develop and validate a risk prediction model for ASD in patients who underwent transforaminal lumbar interbody fusion (TLIF) for lumbar degenerative diseases. Methods Patients with lumbar degenerative disease who underwent TLIF between January 2015 and December 2016 were included in the retrospective study. The participants were divided into two groups: ASD and non-ASD. Univariate and multivariate logistic regression analyses were performed to identify factors influencing ASD after TLIF surgery. The receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) were used to evaluate the model’s discrimination, calibration and clinical value, respectively. Results A total of 11.5% (59/513) of patients developed ASD. Higher BMI, lower BMD, higher disc grade, and reduced disc height were identified as independent risk factors for ASD after TLIF. The model demonstrated good discrimination in both the training and validation sets, with calibration and Hosmer-Lemeshow tests confirming accuracy, and DCA demonstrating clinical applicability. Conclusions The nomogram model demonstrated promise in predicting ASD in patients who underwent TLIF, aiding clinicians in selecting the most suitable surgical approach and optimizing surgical decisions.

Abstract Background Knee osteoarthritis (KOA) is a common musculoskeletal disorder. Therapeutic ultrasound (US) is a safe and effective treatment for KOA. It relieves knee pain and enhances function. Metformin (MF) regulates chondrocytes, hence providing chondroprotection. Furthermore, it efficiently reduces knee articular cartilage degeneration and retards the progression of osteoarthritis. However, the localized administration of MF by phonophoresis for KOA has yet to be studied. Purpose To assess the possible effects of metformin phonophoresis (MFPH) plus exercise therapy (EX) compared to MFPH alone or the US on knee pain, function, and range of motion (ROM) in chronic KOA patients. Methods Seventy-eight patients with unilateral mild to moderate chronic KOA were included. Patients were randomly assigned to three groups: group A (MFPH + EX), group B (MFPH alone), and group C (US). The US group used an acoustic-neutral gel, while the MFPH group used a gel containing 1.2% MF. The exercises included hamstring stretches, calf stretches, and knee strengthening exercises. Treatment in the three groups continued for four weeks (three sessions per week). The Visual Analog Scale (VAS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the goniometer were used to assess knee pain, function disability, and ROM, respectively. All measures were recorded before, 2 weeks, and 4 weeks after the intervention in all groups. Multivariate Analysis of Variance (MNOVA) was performed to compare the effects within and between groups for knee ROM and function disability. The Kruskal-Wallis test and the Friedman test analyzed the pain intensity. Results When the baseline patient characteristics were compared, there were no significant differences in means of age, gender, body mass index (BMI), or lower limb dominance across the three groups (p > 0.05). After 4 weeks of intervention, clinical outcomes significantly improved in all three groups (p

Abstract Background Osteoarthritis (OA) is marked by the progressive degradation of joint cartilage and subchondral bone. The precise molecular mechanisms driving meniscus deterioration in OA, especially at the single-cell level, remain poorly understood. Method We analyzed two datasets from the GEO database, GSE220243 and GSE98918, focusing on meniscus tissue sequencing data from OA and non-OA patients. The standard Seurat procedure was employed to process single-cell data and identify differentially expressed genes (DEGs). Immune cell infiltration was assessed using the Microenvironment Cell Populations (MCP) counter and CIBERSORT algorithms. For the microarray data, DEGs were identified with the limma package, and Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were performed using ClusterProfiler. The overlapping DEGs from both datasets were imported into Cytoscape to generate protein-protein interaction (PPI) networks and identify hub genes. Transcription factor (TF) and miRNA interaction networks were analyzed using NetworkAnalyst, and gene-related predictive drugs were enriched through the DSigDB platform. Result After quality control, 34,763 cells from the OA patients and 34,145 cells from the healthy controls were analyzed. UMAP identified and SingleR annotated 14 cell clusters. The 10 largest cell clusters were selected for further analysis. The OA group exhibited a notable increase in macrophages and a reduction in cytotoxic lymphocytes and endothelial cells in the meniscus. In GSE98918, 220 DEGs were identified, and the MCODE plug-in in Cytoscape pinpointed a key module containing 12 candidate genes. The MCC methodfiltered the top 20 DEGs in each GSE220243 cluster. Overlapping DEGs from GSE220243 and GSE98918 identified COL1A1, COL3A1, COL5A2, COL6A3, LOX, and VEGFA as significantly decreased in OA, with COL3A1, COL5A2, LOX, and VEGFA upregulated in meniscal chondrocytes. The interaction network highlighted 3 key miRNAs and 13 shared TFs. Ten gene-related predictive drug molecules were identified. Conclusion This research highlights crucial genes in the OA meniscus and uncovers their differing regulatory patterns between chondrocytes and non-chondrocytes. These findings enhance our understanding of the molecular mechanisms driving OA pathogenesis and aid in identifying potential drug targets.

Abstract Antibacterial bone cements (ABCs), such as antibiotic-loaded bone cements (ALBCs), have been widely utilized in clinical treatments. Currently, bone cements loaded with vancomycin, gentamicin, tobramycin, or clindamycin are approved by the US Food and Drug Administration. However, traditional ALBCs exhibit drawbacks like burst release and bacterial resistance. Therefore, there is a demand for the development of antibacterial bone cements containing novel agents to address these defects. In this review, we provide an overview and prospect of the new antibacterial agents that can be used or have the potential to be applied in bone cement, including metallic antibacterial agents, pH-switchable antibacterial agents, cationic polymers, N-halamines, non-leaching acrylic monomers, antimicrobial peptides and enzymes. Additionally, we have conducted a preliminary assessment of the feasibility of bone cement containing N-halamine, which has demonstrated good antibacterial activities. The conclusion of this review is that the research and utilization of bone cement containing novel antibacterial agents contribute to addressing the limitations of ALBCs. Therefore, it is necessary to continue expanding the research and use of bone cement incorporating novel antibacterial agents. This review offers a novel perspectives for designing ABCs and treating bone infections. Graphical abstract

Abstract Objective Our study focused on the effects and molecular mechanisms of kaempferol, a major active component of Eucommia ulmoides Oliver (EUO), on the osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs). Methods Target molecules for EUO, osteoarthritis, and osteogenic differentiation were identified through network pharmacology analysis. BMSCs were isolated and treated with various concentrations of kaempferol. Optimal concentration was determined through MTT assays. Osteogenic differentiation was assessed using alkaline phosphatase (ALP) and Alizarin Red S staining, while osteogenic markers (Collagen I, RUNX2, and OPN) and CAV-1 expression were analyzed using RT-qPCR and Western blot. The effects of combined treatment with kaempferol and an overexpression vector for CAV-1 (oe-CAV-1) on osteogenic differentiation were also observed. Results Network pharmacology analysis identified kaempferol as the primary active component influencing CAV-1 targeted in subsequent experiments. It was found that 10 µM kaempferol was optimal for treating BMSCs. Post-treatment, significant increases in ALP activity and calcium deposition were observed, along with elevated expression of osteogenic markers, and decreased CAV-1. Overexpression of CAV-1 significantly reversed the promotive effects of kaempferol on BMSC osteogenic differentiation, effectively inhibiting the process. Conclusion Collectively, kaempferol promotes osteogenic differentiation in BMSCs by inhibiting CAV-1 expression.

Abstract Background Total knee arthroplasty (TKA) is an effective treatment for knee osteoarthritis; however, early readmissions due to complications are common. This study assessed the ability of the hemoglobin-to-red cell distribution width ratio (HRR), hemoglobin-to-monocyte ratio (HMR), and hemoglobin-to-leukocyte ratio (HLR) to predict readmission within 14 days after TKA. Methods Data from the Chang Gung Medical Research Database (CGRD) from 2014 to 2022 were retrospectively analyzed. Patients ≥ 20 years old who underwent primary TKA were eligible for inclusion. Patients with incomplete data on the indices of interest or follow-up

Abstract Background Patients with chronic ankle instability (CAI) often experience recurrent swelling and pain, which hinder their ability to walk long distances. Emerging evidence suggests that joint mobilization can enhance ankle function in patients with CAI. Objective The aim of this study is to investigate the effects of subtalar joint mobilization on enhancing ankle stability, alleviating ankle pain, and improving the walking ability of patients diagnosed with CAI. Methods A retrospective analysis was conducted on 46 patients who were treated between April 2022 and October 2023. They were randomly divided into two groups: a treatment group with 23 cases receiving conventional treatment along with subtalar joint mobilization treatment, and a control group with 23 cases receiving only conventional treatment. The treatment duration was eight weeks. Pain levels and walking ability were assessed before and after the treatment period. Results After eight weeks of treatment, the treatment group showed significant increases in the number of heel raises on the affected leg (NLHSL), improvements in the star excursion balance test (SEBT), and higher American Orthopedic Foot and Ankle Society (AOFAS) scores compared to the control group. Additionally, resting pain (RVAS) and walking pain (WVAS) scores were significantly lower in the treatment group. However, there was no statistically significant difference in single-leg standing time (SLT) between the two groups. Within the control group, post-treatment assessments indicated significant improvements in dynamic balance and control measures (SLT, NLHSL, SEBT), but no significant changes were observed in pain levels (RVAS, WVAS) or rear foot function (AOFAS). In contrast, the treatment group showed significant improvements across all measured parameters (RVAS, WVAS, SLT, NLHSL, SEBT, and AOFAS) following treatment. Conclusion Subtalar joint mobilization effectively reduces ankle pain and enhances walking ability among patients with CAI by improving ankle stability. The observed improvements in walking ability may stem from mitigating compensatory mechanisms associated with varus of the calcaneus and ankle instability.

Abstract Background Strong research capacity and culture (RCC) within professional groups predict engagement in high-quality research and the integration of evidence into practice. However, factors affecting RCC participation and development are currently unknown in Australian Orthopaedic Surgeons. Study design Cross-sectional survey. Methods All Australian Orthopaedic Association members were invited to complete the individual domain of the validated Research Capacity and Culture tool. Results One hundred and sixty-three Australian Orthopaedic Association members (9%) provided survey answers. Survey findings indicated that AOA members scored moderate or high for most RCC domains (14 out of 15). Barriers to the completion of research included a lack of time, other work roles taking priority, and a lack of funds for research. Conclusion The Australian Orthopaedic Association members surveyed in this study demonstrated adequate research skills and experience, although reported they could benefit from additional support securing funding and navigating specific research tasks. Increasing future collaboration with academic institutions and clinician-researcher roles may enhance the output of high-quality orthopaedic research in Australia.

Abstract Background High tibial osteotomy (HTO) is an effective treatment option for deformity correction after fracture. However, performing precise corrective osteotomy for cases with a severe varus deformity and a significant posterior slope poses a significant challenge. Three-dimensional (3D) bone model construction and patient-specific instrumentation (PSI) created from preoperative Computed tomography (CT) may be useful tools in achieving successful outcome for such cases. The present technique describes a hybrid closing-wedge distal tuberosity tibial osteotomy (Hybrid CWDTO) using two PSIs. Methods Preoperative planning was performed in 3D with reference to the contralateral normal lower extremity CT taken preoperatively, which was then mirrored for analysis. A full-scale bone model and two PSIs were constructed based on this plan to allow for complex correction. During surgery, osteotomy was performed using these sterilized PSIs as guides. Results Radiographic imaging showed that medial proximal tibial angle (MPTA) improved from 68 to 84 degrees and posterior tibial slope (PTS) improved from 19 to 6 degrees. The standing leg radiograph showed a mechanical varus alignment improvement from 12 to 3 degrees. The 2011 Knee Society Scoring system (2011 KSS) improved from 31 to 95 in objective knee indicators, from 10 to 24 in symptoms, from 14 to 40 in patient satisfaction and from 51 to 95 in activities. Conclusion Hybrid CWDTO using PSIs is a useful surgical technique for alignment correction post-malunion while also achieving high patient satisfaction. This can assist surgeons in treating complex deformities that are otherwise difficult to treat.

Abstract Amentoflavone (AF), a plant biflavone isolated from Selaginella sinensis ethanol extract, is characterized by anti-inflammatory and anti-oxidant properties. According to previous studies, inflammation and oxidative stress are closely related to the pathophysiology of osteoarthritis (OA). However, the effects and mechanisms of AF on OA have not been elucidated.To investigate the inhibitory effects and its molecular mechanism of AF on extracellular matrix (ECM) degradation stimulated by IL-1β as well as subchondral bone loss induced by RANKL in mice chondrocytes. Quantitative PCR was used to detect the mRNA expression of genes related to inflammation, ECM, and osteoclast differentiation. Protein expression level of iNOS, COX-2, MMP13, ADAMTS5, COL2A1, SOX9, NFATc1, c-fos, JNK, ERK, P65, IκBα was measured by western blotting. The levels of TNF-α and IL-6 in the supernatants were measured by ELISA. The amount of ECM in chondrocytes was measured using toluidine blue staining. The levels of Aggrecan and Col2a1 in chondrocytes were measured using immunofluorescence. Tartrate-resistant acid phosphatase (TRAP) staining, F-actin staining and immunofluorescence were used to detect the effect of AF on osteoclast differentiation and bone resorption. The effect of AF on destabilization of the medial meniscus (DMM)-induced OA mice can be detected in hematoxylin–eosin (H&E) staining, Safranin O green staining and immunohistochemistry.AF might drastically attenuated IL-1β-stimulated inflammation and reduction of ECM formation by blocking ERK and NF-κB signaling pathways in chondrocytes. Meanwhile, AF suppressed the formation of osteoclasts and the resorption of bone function induced by RANKL. In vivo, AF played a protective role by stabilizing cartilage ECM and inhibiting subchondral bone loss in destabilization of the medial meniscus (DMM)-induced OA mice, further proving its protective effect in the development of OA. Our study show that AF alleviated OA by suppressing ERK, JNK and NF-κB signaling pathways in OA models in vitro and DMM-induced OA mice, suggesting that AF might be a potential therapeutic agent in the treatment of OA.

Abstract Background The investigation aimed to assess the impacts of magnesium sulphate (MgSO4) iontophoresis and high-power pain-threshold ultrasound (HPPT-US) on pain, range of motion (ROM), and functional activity in physical therapy students suffering from mechanical cervical pain. Methods Typically, 75 males aged 19 to 30 years suffering from mechanical neck pain were enrolled in this investigation. Participants were divided at random into three groups. Group A received iontophoresis plus conventional physical therapy program, Group B received HPPTUS along with conventional therapy, and Group C received conventional therapy only. The outcomes were pain evaluated by visual analog scale (VAS) and Digital Electronic Pressure Algometer, cervical range of motion measured by Myrin gravity reference goniometer, and Arabic Neck disability index (ANDI) evaluate neck function. Results The differences within and between groups were detected utilizing a mixed-design multivariate analysis of variance (MANOVA). The within- and between-group analysis of all outcome measures revealed that there were statistically significant differences at post-intervention between high-power ultrasound and conventional group at all variables and also between iontophoresis and conventional group, but there was no statistically significant variation between high-power ultrasound and iontophoresis. Conclusion MgSO4 iontophoresis and HPPT-US are effective in decreasing pain, improving neck function, and improving neck ROM in subjects with mechanical neck pain who have active myofascial trigger points (MTrPs) on the upper fibers of the trapezius with no superiority of one over the other. Trail registration The study was registered in the Clinical Trials Registry (registration no: NCT05474898) 26/7/2022.

Abstract Objective This study investigated the protective effects of low fluid shear stress (FSS ≤ 2 dyn/cm²) against interleukin-1β (IL-1β)-induced chondrocyte apoptosis and explored the underlying molecular mechanisms. Methods Chondrocytes were cultured under four conditions: control, IL-1β stimulation, low FSS, and combined low FSS + IL-1β stimulation. Apoptosis was assessed using Hoechst staining and flow cytometry. Western blotting determined the expression of caspase-3 (CASP3), caspase-8 (CASP8), and NF-κB p65. Quantitative real-time PCR measured miR-143-3p expression. The roles of miR-143-3p and the extracellular signal-regulated kinase 5 (ERK5)/Krüppel-like factor 4 (KLF4) signaling pathway were further investigated using miR-143-3p mimics and inhibitors, an ERK5 inhibitor, and a KLF4 overexpression vector. Results IL-1β induced significant chondrocyte apoptosis, which was markedly inhibited by low FSS. Mechanistically, low FSS suppressed miR-143-3p expression, thereby enhancing ERK5 signaling. This activated ERK5 subsequently upregulated KLF4 expression, further mitigating IL-1β-induced damage. Importantly, miR-143-3p overexpression under low FSS conditions exacerbated IL-1β-induced apoptosis, while miR-143-3p inhibition attenuated it. Consistent with this, ERK5 inhibition augmented IL-1β-induced apoptosis, whereas KLF4 overexpression suppressed it. Conclusion Low FSS protects chondrocytes from IL-1β-induced apoptosis by suppressing miR-143-3p and activating the ERK5/KLF4 signaling pathway. This study reveals a novel mechanism by which mechanical stimulation protects cartilage.

Abstract Objective The objective of this study is to assess and compare the clinical efficacy of “Figure-8” banding and double-row anchor suture-bridge fixation techniques in the arthroscopic management of tibial intercondylar eminence avulsion fractures. Method A retrospective analysis was conducted on the medical records of 42 patients who underwent arthroscopic surgery for tibial intercondylar eminence fractures at our institution from June 2017 to June 2022. This cohort included 20 cases treated with “Figure-8” banding and 22 cases managed using double-row anchor suture-bridge fixation. Comparative assessments were made regarding operative duration, duration of fracture consolidation, postoperative knee joint range of motion, joint stability as assessed by the Lachman test, Lysholm score, and International Knee Documentation Committee (IKDC) functional score for both treatment groups. Results The mean follow-up duration was 13.8 months. The analysis indicated that the double-row anchor suture-bridge group had a significantly longer operative duration compared to the “Figure-8” banding group (p 0.05). By the one-year postoperative mark, joint stability outcomes were comparable between the two treatment groups (p > 0.05). Conclusion Both “Figure-8” banding and double-row anchor suture-bridge fixation techniques in the arthroscopic management of tibial intercondylar eminence avulsion fractures can achieve precise reduction and stable fixation. In addition, the figure-8 suture group has the characteristics of shorter surgery time and less cost. Notably, early postoperative knee function appears to be superior with double-row anchor suture-bridge fixation compared to “Figure-8” banding.

Abstract Background Halo-pelvic traction (HPT) is acknowledged for enhancing pulmonary function and reducing neurological complications in severe and rigid scoliosis and kyphoscoliosis. While its role in improving coronal balance is established, its impact on sagittal kyphosis remains under-researched. This study aims to assess HPT’s effects on sagittal alignment in these conditions. Methods A retrospective review of 37 patients with severe and rigid scoliosis or kyphoscoliosis was conducted to evaluate HPT’s efficacy. The analysis focused on the impact of HPT on coronal and sagittal parameters, pulmonary function tests (PFTs) and complications. Radiographic assessments included main cobb angle in coronal, sagittal major kyphosis. Results HPT was applied for an average of 2.9 months, significantly reducing the primary coronal curve from 127.7°±30.3° to 74.9°±28.3° (P

Abstract Aims Following Failed Internal Fixation of Intertrochanteric Fractures (FIF-ITF), the choice of treatment remains a clinical challenge. This study introduces a novel classification system to guide the selection of femoral prostheses in hip arthroplasty (HA) and validates its clinical efficacy. Methods Retrospectively, we analyzed 108 cases from three university-affiliated hospitals between December 2012 and February 2023 involving patients who underwent hip arthroplasty due to Failed Internal Fixation of Intertrochanteric Fractures (FIF-ITF). Patients were classified into three categories based on fracture healing, proximal femoral support, and the severity of femoral cortical defects, with subtypes identified. Surgical outcomes and complication rates were compared between the Classification-based Decision Group and the Non-classification Decision Group. Results The Classification-based Decision Group did not differ significantly from the Non-classification Decision Group in operation time, blood loss, or the use of cemented stems. However, the classification system markedly reduced the risk of periprosthetic fractures intraoperatively from 22.5 to 4.4% and postoperatively from 10 to 1.4%. The Classification-based Decision Group also demonstrated higher postoperative Harris Hip Score (HHS) and Visual Analog Scale (VAS) scores. Conclusion The proposed classification system serves as an innovative clinical tool for femoral prosthesis selection in hip arthroplasty post-FIF-ITF, effectively reducing complications and enhancing hip function in the Classification-based Decision Group, underscoring its significant clinical utility.

Abstract Background Malnutrition is a state resulting from lack of intake or uptake of nutrition. Investigating the association between malnutrition and postoperative complications is essential for enhancing patient outcomes in total joint arthroplasty (TJA). This meta-analysis aimed to investigate the impact of malnutrition on the incidence of surgical site infections (SSIs) and periprosthetic joint infections (PJIs) following TJA. Methods The data were searched from databases including PubMed, Embase, Web of Science, and Cochrane Library inception through July 19 2023, without time restrictions. Inclusion criteria focused on studies examining malnutrition as a risk factor for SSIs and PJIs postarthroplasty, providing sufficient data for calculating odds ratios (ORs) and 95% confidence intervals (CIs). Methodological quality was assessed using the Newcastle‒Ottawa Scale, and statistical analyses were executed in Stata version 17. Results A total of 1,025 articles were screened, and 9 studies satisfying the predefined inclusion criteria were consequently selected for this meta-analysis. Studies indicated that malnutrition is significant factor to the heightened incidence of both SSIs and PJIs following TJA procedures. Our pooled results yielded aggregated ORs of 2.60 for SSIs and 3.44 for PJIs, with respective 95% CIs of 2.10–3.10 and 2.35–4.53. The heterogeneity of malnutrition as a risk factor for postoperative SSI was I2 = 0.0% (p = 0.592), and for PJI was I2 = 0.0% (p = 0.422). Egger’s linear regression test showed no significant publication bias (p > 0.05). Conclusions Malnutrition is a significant risk factor for SSIs and potentially PJIs in patients undergoing TJA. Preoperative optimization strategies targeted at malnourished patients are suggested to minimize postoperative complications clinically.