Background: Reliable scientific information is crucial for assessing hip function and evaluating the success of hip surgery. The Harris Hip Score (HHS) is the most widely used tool for measuring hip function and, in particular, the outcomes of hip surgery. The aim of this study was to conduct a systematic review of the literature to identify randomized controlled trials (RCTs) that reported the HHS for hip replacement treatment groups and to test whether there was a substantial difference between reporting only the postoperative HHS or the HHS difference (HHSdiff).

Methods: PubMed, CNKI, and Epistemonikos were searched until March 1, 2024. The risk of bias, level of evidence, and publication bias were assessed. As HHS is a continuous outcome, mean difference (MD) with 95% confidence intervals (CIs) was calculated using the Hartung–Knapp–Sidik–Jonkman method and a common-effect/random-effects model. The same approach was used for both postoperative HHS and HHSdiff. The effect of the two treatment groups studied (minimally invasive vs. conventional approach) on postoperative HHS was then compared with the effect of the two groups studied on the difference in HHS.

Results: A total of 41 RCTs, involving 3572 patients, with a low to high risk of bias and a low to moderate publication bias were included. The measured outcome parameters showed a low to moderate level of evidence. There was no relevant difference in the reporting of HHS only postoperatively or HHSdiff when comparing two hip replacement treatment groups in RCTs, measured at 0–0.5, 3, 6, and 12 months postoperatively.

Conclusion: The present study showed that there is no relevant difference between reporting of the HHS only postoperatively or HHSdiff when comparing two hip replacement treatment groups in RCTs. Both methods of HHS reporting produced comparable results in an identical cohort of 3765 patients undergoing hip replacement surgery.

Osteoarthritis (OA) is a prevalent degenerative disorder that severely impacts quality of life due to pain and disability. Although the pathophysiology of OA remains incompletely understood, recent research highlights the role of synovial inflammation in OA onset and progression, driven primarily by inflammatory infiltrates, especially macrophages, in the synovium. These macrophages respond to the local microenvironment, polarizing into either pro-inflammatory (M1) or anti-inflammatory (M2) subtypes. This review focuses on the role of macrophage polarization in OA pathogenesis and treatment, emphasizing how M1/M2 polarization is influenced by pathways such as STAT, NF-κB, caspase, and MAPK. These pathways induce low-grade inflammation within OA-affected joints, altering chondrocyte metabolism, inhibiting cartilage repair, and impairing mesenchymal stem cell chondrogenesis, thereby contributing to OA progression. Additionally, this review discusses potential therapies targeting macrophage polarization, encompassing compounds, proteins, cells, and microRNAs, to offer insights into novel treatment strategies for OA.

Objective: Plate fixation is the preferred method for treating forearm shaft fractures. However, it remains controversial regarding the necessity of implant removal after bone union. This review aims to assess refracture risk after plate removal.

Methods: We searched various data sources, including PubMed, Embase, Web of Science, and Cochrane Library. A total of 6749 papers were identified, of which 23 studies were eligible for final quantitative syntheses. Subgroup analyses and sensitivity analyses were conducted to reduce heterogeneity and make the results more reliable.

Results: The total risk difference (RD) was 0.06 (0.04–0.09), indicating that the difference was significant. In the “Reasons for Removal” subgroup analysis, the RD of the “No Symptom” subgroup was 0.07 (95% CI = 0.04–0.11), while the RD of the “Symptoms” subgroup was 0.04 (95% CI = –0.02 to 0.10). In the “Plate Type” subgroup analysis, the RD of the “LCP” subgroup was 0.07 (95% CI = 0.02–0.13), while the RD of the “DCP” subgroup was 0.07 (95% CI = 0.01–0.13). After omitting each study one by one, the RDs were all significant.

Conclusions: Plate retention is significantly associated with a lower rate of refracture than plate removal. Consequently, it is not recommended to remove implants, especially for patients without implant-related symptoms, but more reliable evidence is still needed.

Trial Registration: The review was registered on PROSPERO and the registration ID is CRD42023424743, and a protocol was not prepared

Objective: Ankylosing spondylitis (AS) is a debilitating rheumatic condition that significantly impairs mobility and quality of life through chronic inflammation and spinal fusion. The aim of this study is to investigate the optimal sequencing of spinal osteotomy and total hip replacement (THR) as treatment options, a topic that remains a subject of debate among medical professionals.

Methods: In a retrospective cohort study spanning from 2017 to 2021, we assessed adult patients with AS who underwent both spinal osteotomy and THR, outcome measures involved radiographic assessments like Global Cobb angle, thoracolumbar kyphosis (TLK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS), as well as clinical metrics such as the Harris hip score. For the same surgical group, paired t-tests were performed for pre- and postoperative data, while independent sample t-tests were used for comparing different surgical groups. The study aims to elucidate the optimal sequencing of these surgical procedures based on these comprehensive metrics.

Results: Among the 14 patients included, demographic and clinical variables were comparable between the two procedural groups. At the 3-month follow-up, all major metrics showed significant postoperative improvements. Specifically, the Global Cobb angle reduced from 98.88 ± 38.54 to 54.48 ± 18.14 (p = 0.018), and the Harris hip scores, evaluated at the 3-month follow-up, dramatically increased from 15.14 ± 10.12 to 72.57 ± 14.12 (p = 0.001). Furthermore, the Spine First Group exhibited more pronounced changes in pelvic parameters (p = 0.009), albeit at the expense of longer operation times and increased blood loss. No major complications were encountered.

Conclusions: Contrary to the prevalent belief that spinal osteotomy should precede THR, our study argues that under certain conditions, opting for hip surgery first can be both viable and advantageous. This approach may mitigate the risk of complications and even facilitate subsequent spinal surgery. Surgical decisions must be highly tailored, focusing on patient-specific needs and anatomical considerations. The ultimate goal remains consistent: to improve patients’ functional abilities in daily activities and thereby enhance their overall quality of life.

Purpose: The conjoined tendon-preserving posterior (CPP) approach is a modified posterior approach for total hip arthroplasty (THA) that preserves the short external rotator muscles and most ischiofemoral ligaments. The objective of the present study was to compare the short-term clinical outcomes, complications, and imaging evaluations of CPP and posterior approaches in THA.

Methods: This retrospective study included 83 patients from May 2018 to September 2021: 36 patients with 42 hips who underwent THA with the CPP approach (CPP group) and 47 patients with 60 hips who underwent THA with the standard posterior approach (PA group) with a minimum of 2 years of follow-up. Assessment tools included operative times, blood loss, preoperative and last follow-up Harris Hip Scores (HHS), postoperative complications, and implant placement angles between the groups. Statistical analysis was performed using chi-square tests and T-tests.

Results: The CPP approach had a significantly longer operative time and greater blood loss compared to the PA group. Preoperative and postoperative HHS were not significantly different between groups. Considering complications, the PA group had one case each of dislocation and infection, and the CPP group had two cases of sciatic nerve palsy, but the difference was not significant. Cup anteversion, inclination and stem anteversion were not significantly different between groups.

Conclusion: Functional outcomes, complication rates, and implant placement angles were comparable with the posterior approach, and the CPP approach has the potential to reduce postoperative dislocations. However, careful attention should be paid to sciatic nerve palsy during early initiation of the CPP approach, and this study did not demonstrate that the CPP approach was clearly superior to the posterior approach.

Objective: An important reason for the poor recovery of anterior cruciate ligament (ACL) injuries is the poor recovery of muscle function. Therefore, we used surface electromyography (sEMG) and gait analysis to explore the muscle activation patterns and gait characteristics between lower limbs under different exercise states in patients, following anterior cruciate ligament reconstruction (ACLR).

Methods: Forty-one adults with unilateral ACL injuries in Binzhou Medical University Hospital from October 2022 to June 2023 were allocated to three groups according to the time after ACL reconstruction: group A (≤3 months, 16), group B (3 months–1 year, 13), and group C (>1 year, 12). Patients were tested by sEMG and gait, while straight leg raising (SLR), walking at normal speed, fast walking, and walking up and down the stairs. Two related sample tests were performed for the normalized root mean square (RMS) values and gait parameters.

Results: Muscle function changes varied in different training tasks. The RMS value of the involved side was more than the uninvolved side in biceps femoris and semitendinosus of group A (p < 0.010), and for the bilateral rectus femoris (RS), vastus medialis (VM), and vastus lateralis in group B, only the comparison of the RS was significant in group C during fast walking and going up and down the stairs. The ground impact (0.90 [0.63, 1.33] vs. 0.71 [0.43, 1.02], p = 0.035) of the uninvolved side was significantly decreased compared to those of the involved side in patients with ACLR when going down the stairs.

Conclusion: Different muscles need to be focused on at different stages of the postoperative period. sEMG and gait analysis can guide the development of a rehabilitation program.

Objective: Emerging scoliosis (ES) is a rare phenomenon after hemivertebra (HV) resection and short segmental fusion. Since the introduction of the ES, there have been rare in-depth studies. The aim of the present study was to further analyze the characteristics, risk factors, treatment, and prognosis of ES.

Methods: A retrospective study analyzed patients with congenital scoliosis due to a single HV who underwent posterior correction and short fusion from 2002 to 2022. ES was defined as a Cobb angle ≥20° from its initial value and an apical vertebra located ≥2 levels away from the fusion region. ES patients and non-ES patients were matched at a 1:2 ratio. Both demographics and radiological parameters were compared. Univariate analysis and multivariate logistic analysis were used to identify the risk factors of ES.

Results: Among 261 patients, 13 patients (5.0%) experienced ES. There were eight females and five males. The mean age of the ES patients at the time of primary surgery was 6.6 ± 3.7 years old (2.0–13.2 years old), with a mean follow-up of 64.2 ± 47.9 months (12–156 months). The ES could be further divided into three types: balance-related ES, complication-related ES, and separated ES. There were three balance-related ESs, six complication-related ESs, and four separated ESs. At the last follow-up, six patients were under observation, six patients underwent brace treatment, and one patient underwent revision surgery. Multivariate logistic analysis showed that the magnitude of postoperative compensatory curve (CC) was an independent risk factor for ES (OR = 1.172, p = 0.014).

Conclusions: ES is an extraordinary phenomenon after HV resection and short fusion, and it can be divided into three types. The magnitude of postoperative CC was an independent risk factor for ES. According to the severity of ES, observation, brace, or surgery can be chosen.

Objective: Percutaneous pedicle screw fixation (PPSF) technique requires a very precise entry point of the Jamshidi needle, which leads to repeated adjustments, damaging the pedicle and increasing radiation exposure. This study was designed to propose an improved percutaneous pedicle screw fixation technique-trajectory dynamic adjustment (TDA) technique, and evaluate its feasibility and assess the clinical outcomes.

Method: A total of 445 patients with lumbar spondylolisthesis or lumbar spinal stenosis associated with instability from June 2017 to May 2022 were included in the retrospective study. They were randomly separated into two groups. Two hundred thirty-one patients underwent TDA technique (TDA group). Two hundred fourteen patients underwent traditional PPSF technique (PPSF group). All patients underwent postoperative CT to assess the accuracy of screw placement, superior facet joint violation (FJV). The evaluated clinical outcomes were needle insertion time, radiation exposure, blood loss, hospital stay, the Japanese Orthopedic Association (JOA) score, the Visual Analogue Scale (VAS) scores for lower back pain (LBP), and leg pain, lumbar interbody fusion rate, and postoperative complications. The independent-sample t test and paired t-test were used for continuous data. The contingency table and Mann–Whitney U test were used for categorical data.

Results: The time of the insertion in TDA group was significantly lower than that in PPSF group (p < 0.05). Similarly, the fluoroscopy frequency in TDA group was significantly lower than that in PPSF group (p < 0.05). There was no difference in intraoperative blood loss and hospital stay between the two groups (p > 0.05). Overall, there was no significant difference in the proportion of clinically acceptable screws between the two groups (p > 0.05). In addition, the lateral screw misplacement in TDA group was higher. Moreover, FJV rate was significantly lower than that in PPSF group (p < 0.05). In both TDA group and PPSF group, postoperative back and leg pain and the JOA score were significantly improved (p < 0.05). However, there were no significant differences in the pre- and postoperative VAS score for back and leg pain and the JOA score, JOA recovery rate, intervertebral fusion rate, and complications rate between the two groups (p > 0.05).

Conclusion: Compared to traditional PPSF technique, TDA technique is a safer and more effective procedure which has shorter surgical time, lower radiation exposure, and lower facet joint violation rate.

Objective: The prevailing treatment for chronic periprosthetic joint infection (PJI) is a two-stage exchange, yet the optimal duration of antibiotic therapy following this procedure remains a topic of debate. This study aimed to determine whether a short course of postoperative antibiotic therapy can maintain infection control rates following a long interval two-stage exchange (LITE) for PJI.

Methods: We conducted a prospective study enrolling patients with chronic PJI who underwent the LITE procedure at our institution from April 2018 to November 2021. Patients were randomly assigned to receive either a long course (12 weeks) or short course (2 weeks) of postoperative antibiotics. The pathogens, antibiotics, inflammatory markers, antibiotic-related complications, cases of reinfection, or re-operation were recorded. Continuous variables were analyzed using the two-sample t-test or Mann–Whitney U test, and categorical variables were analyzed using Fisher’s exact tests. Kaplan–Meier survival analysis was used to compare infection control rates.

Results: A total of 60 patients with chronic PJI who completed the LITE procedure were included in the study (30 patients per group). All patients were followed for a minimum of 24 months (mean 39.2 ± 13.0 months). We observed that the infection control rate in the short-course group was not inferior to that in the long-course group (96.7% vs. 96.7%, p = 1.000).

Conclusions: For patients with chronic PJI undergoing the LITE procedure, a 2-week course of postoperative antibiotics suffices to maintain infection control rates.

Trial Registration: Chinese Clinical Trial Registry: ChiCTR1900027089

Objective: There has been no definitive conclusion on the selection of the lowest instrumented vertebra (LIV) in Lenke 5C adolescent idiopathic scoliosis (AIS) patients. The purpose of this study was to evaluate whether it is enough to stop distal fusion at L3 in mild to moderate Lenke 5C AIS patients with posterior selective lumbar fusion, Ponte osteotomies and segmental direct vertebra rotation and to analyze the risk factors for postoperative complications in patients selecting L3 as the LIV.

Methods: A retrospective review was conducted on 106 Lenke 5C AIS patients who underwent corrective surgery in our institution from 2010 to 2021, with a minimum 2-year follow-up. The LIV was L3 or L4. According to the LIV, patients were initially divided into Group I (the LIV was L3) and Group II (the LIV was L4). Then, Group I was further divided into a complication group and a non-complication group. Demographics, radiological parameters, postoperative complications, and clinical outcomes were recorded. Univariate analysis and multivariate logistic analysis were used to identify the risk factors for postoperative complications in patients with L3 as the LIV.

Results: There were no significant differences in the demographics, radiological parameters, postoperative complications, or clinical outcomes between Group I and Group II (p > 0.05), and the outcomes were satisfactory in both groups. The main postoperative complications were distal adding-on (11 cases), coronal imbalance (16 cases), proximal junctional kyphosis (2 cases), and internal fixation failure (4 cases). Logistic regression analysis revealed that age and postoperative C7-CSVL were independent predictors of postoperative complications when selecting L3 as the LIV.

Conclusion: Terminating the distal fusion level at L3 was practical for mild to moderate Lenke 5C AIS patients. For patients selecting L3 as the LIV, younger patients should be cautious, and maintaining postoperative coronal balance is necessary for avoiding postoperative complications.

Objective: The clinical management of partial bone defects in lower limbs, particularly those resulting from osteomyelitis, remains a significant challenge. This study aimed to systematically evaluate the effectiveness of 3D-printed porous Ti6Al4V prostheses in addressing osteomyelitis-induced partial bone defects.

Methods: We established a comprehensive protocol for utilizing 3D-printed prostheses for bone defect repair, encompassing 3D simulation of prosthesis implantation and internal fixation, finite element analysis (FEA), and clinical implementation. Mimics software facilitated simulation of fixation patterns and screw lengths. FEA modeled bone defects in the distal metaphyseal femur and distal diaphyseal tibia to assess changes in stress conduction pre- and post-prosthesis implantation. The clinical study involved eight patients (average age: 56.3 years) with an average defect length of 14.9 cm. Postoperative outcomes were evaluated using X-rays and the Lower Extremity Functional Scale (LEFS).

Results: FEA demonstrated that the implanted prostheses effectively shared stress and reduced the load on residual bone in both models, thus lowering the risk of fractures under external forces. The average follow-up period was 24.5 months, with patients initiating weight-bearing activities on average 7.8 days post-surgery. Serial postoperative X-rays demonstrated long-term stability of the prostheses, with progressive bone regeneration around and integration with the prostheses. While two patients experienced infection recurrence requiring prosthesis removal and debridement, the remaining six showed significant improvement in LEFS scores, increasing from 31.5 preoperatively to 61.0 at the last follow-up.

Conclusions: 3D-printed porous Ti6Al4V prostheses effectively restore anatomical integrity and optimize stress conduction in lower limbs, resulting in substantial functional recovery. This innovative approach shows promise for wider clinical adoption and warrants further investigation in medical practice.

Objective: Although percutaneous kyphoplasty (PKP) under C-arm guidance is an effective treatment for osteoporotic vertebral compression fractures (OVCF), obtaining high-definition images in patients with OVCF and spinal deformities can be challenging or insufficient using traditional C-arm guidance, prompting our institution to adopt the O-arm navigation system—which offers comprehensive 3D imaging and precise navigation—and this study compares its safety and efficacy with conventional C-arm-assisted PKP.

Methods: This was a retrospective study. From February 2019 to February 2022, we enrolled 28 patients with OVCF (44 vertebrae) with spinal deformity treated with O-arm navigation-assisted PKP and 30 patients with OVCF (42 vertebrae) with spinal deformity treated with C-arm-guided PKP. We recorded puncture times, single-segment operation time, number of cases with bone cement leakage, and length of stay. The visual analog scales (VASs), Oswestry disability indexes (ODIs), recovery of Cobbs angle, and vertebral height were used to assess treatment effect before the operation, on the first day postoperation, the first month postoperation, and at the final follow-up. The chi-squared test was utilized for comparing discrete variables, an independent samples t-test was used for continuous variables, and Pearson’s chi-squared test and Fisher’s exact test were applied for categorical data.

Results: Demographic features were comparable between the groups. The O-arm navigation group showed a significant reduction in puncture adjustment per vertebrae, single-segment operation time, and the rate of trocar needle malposition compared to the C-arm guidance group. The rate of cement leakage was decreased in the O-arm-guided PKP group, and other complications did not differ between the two groups. Intragroup comparisons revealed significant improvements in VAS scores and ODI on the first day, first month, and final follow-up after the operation (p < 0.05). The VAS score was significantly lower in the O-arm navigation-assisted PKP group than in the C-arm-guided PKP group on the first day postoperatively (p = 0.049). However, no significant differences in VAS scores were observed between the groups at the first month postoperatively or at the final follow-up. In each follow-up period, there was no significant difference in ODI, Cobb angle, and the percent of anterior vertebral height (AVH %) between the groups.

Conclusion: O-arm navigation-assisted PKP demonstrates better clinical safety and efficacy than C-arm-guided PKP, marking it as a minimally invasive, safe, and effective procedure for treating patients with OVCF with spinal deformity.

Purpose: Long-segment spinal fusions are associated with lumbosacral complications (LSC), but the associated risk factors are not known. This study aimed to identify the risk factors for LSC after long-segment instrumented fusion with distal fixation to the L5 vertebral body in adult degenerative scoliosis (ADS).

Methods: We retrospectively evaluated 294 patients with ADS who underwent long-segment floating fusion between January 2014 and March 2022, with follow-up for at least 2 years. Patients were matched to the baseline data using fusion level > 5 as a grouping variable. Patients who completed matching were divided into two groups according to the presence or absence of LSC. Univariate logistic regression was applied to identify potential risk factors for LSC, and multivariate logistic regression was used to identify independent risk factors for postoperative LSC.

Results: The overall incidence of LSC was 21.77% in the 294 patients, with disc degeneration in 28 (9.52%) and radiographic ASD in 44 (14.97%) patients. The mean time to LSC development after surgery was 26.91 ± 8.43 months. A total of 54 pairs of patients were matched and grouped, and the complication group had higher Oswestry Disability Index (ODI) and visual analog scale (VAS) scores at the last follow-up. Multivariate analysis showed that gender (OR = 0.274, p = 0.026 [0.087, 0.859]); levels of fusion > 5 (OR = 3.127, p = 0.029 [1.120, 8.730]), main curve correction rate (OR = 0.009, p = 0.005 [0.000, 0.330]), and postoperative pelvic incidence minus lumbar lordosis (PI-LL) > 15° (OR = 3.346, p = 0.022 [1.195, 9.373]) were independent risk factors for postoperative LSC. The area under the curve value of the prediction model was 0.804, with a 95% confidence interval of 0.715–0.892, indicating that the model had a high prediction accuracy. Collinearity statistics showed no collinearity between variables.

Conclusion: Sex, level of fusion > 5, main curve correction rate, and postoperative PI-LL > 15° were independent risk factors for the development of LSC after long-segment floating fusion. These results will improve our ability to predict personal risk conditions and provide better medical optimisation for surgery.

Objective: Total hip arthroplasty (THA) is currently one of the most effective treatment methods for end-stage hip joint disease, and its long-term effectiveness largely depends on the accurate placement of the acetabular prosthesis. In conventional surgery, the placement of the acetabular prosthesis mainly relies on the surgeon’s clinical experience and surgical techniques. To further improve the accuracy of prosthesis placement, a new robotic system for THA is designed. The purpose of this study is to verify the effectiveness and safety of THA assisted by this robotic system.

Method: A multicenter, prospective, randomized controlled, superiority study design was adopted with statistical methods of t test and Chi-squared test. Participants undergoing primary THA have been enrolled in three centers of joint surgery in China since July 17, 2023. Robotic THA was operated in the experimental group, and conventional instruments were used in the control group. The primary outcome is the proportion of anteversion and inclination angles in the safe zone. The secondary outcomes include operation time, WOMAC score, Harris score, SF-36 health questionnaire, dislocation rate of hip joint, and rates of adverse events and serious adverse events.

Results: A total of 138 patients were included in this study. The proportion of both anteversion and inclination angles in the safe zone was 92.2% in the experimental group and 50.8% in the control group, with significant difference (p < 0.01). The average operation time in the experimental group and control group was 116.4 and 80.5 min respectively, with significant difference (p < 0.01). There was no significant difference in WOMAC score, Harris score, and SF-36 between the two groups (6 ± 2) weeks after operation (p > 0.05). The dislocation rate of hip joint in the experimental group and control group were 3.0% and 1.5%, respectively, without significant difference (p > 0.05). The rate of adverse events and severe adverse events in the experimental group and control group also showed no significant difference (p > 0.05). No adverse events or serious adverse events were judged to be “definitely related” to the experimental instruments.

Conclusion: Robotic THA could prolong the operation time within an acceptable range, but more precise acetabular prosthesis positioning could be obtained when compared with conventional surgery. Besides, no significant difference was found in function scores, dislocation rate or other adverse events, which indicates that this new robot system shows both good effectiveness and safety in THA.

Trial Registration: Clinical Trials: NCT05947734

Purpose: Infection after fracture fixation (IAFF) is a severe complication. There are few multicenter studies targeting IAFF. This paper identifies independent risk factors associated with IAFF by analyzing multicenter clinical data. Appropriate interventions should be implemented to reduce the risk of IAFF.

Methods: This is a multicenter retrospective cohort study. This study screened medical records of patients who underwent internal fixation for fractures at participating medical institutions from January 1, 2011, to December 31, 2020. Data extraction included demographic characteristics, disease features, surgical variables, and laboratory indicators. Logistic regression analysis was employed to identify the relationship between relevant risk factors and IAFF. Research data were sourced from the hospital’s electronic medical record system and self-constructed databases.

Results: In our study, 202 patients who underwent internal fixation for fractures experienced postoperative infections, which corresponds to an overall incidence rate of approximately 1.7%. The predominant pathogen identified in these infections was Staphylococcus aureus. A multifactorial analysis indicated that several factors were independently associated with the occurrence of IAFF. These factors included BMI ranges of 24.0–27.9 and 28.0–31.9, smoking, a high ASA score, high-energy trauma, diabetes, open fracture, seasonal timing of the surgery (summer), bone grafting, drainage duration, surgical duration ≥ 180 min, and A/G ratio < 1.2.

Conclusions: We strongly recommend that orthopedic surgeons perform comprehensive preoperative assessments on fracture patients to identify factors that may increase the risk of infection. Through the implementation of targeted interventions and beneficial modifications to these modifiable risk factors, it is possible to lower the incidence of IAFF. Additionally, proactive screening, risk stratification, and thorough patient education should be prioritized for patients with high risk but nonmodifiable factors.

Objective: The type of atlantodental space tissue in patients with atlantoaxial dislocation (AAD) can help doctors understand the possibility of reduction before surgery. However, relevant research on this topic is lacking. This study aimed to summarize cases of AAD, classified based on the atlantodental space using magnetic resonance imaging (MRI), and preliminarily explore its impact on the degree of reduction.

Methods: Preoperative T2-weighted MRIs and dynamic digital radiographs of patients who underwent posterior reduction and fixation surgery for congenital AAD between September 2012 and February 2023 were collected. The patients were classified into flexible and inflexible tissue sign groups based on T2-weighted imaging. Patients with an atlantodental interval < 3 mm on extension digital radiography were considered radiographically reducible. Three radiologists read and recorded the MRI results using standard protocols. Kappa and Fleiss kappa values were used to evaluate intra- and inter-observer agreements for MRI signs and dynamic digital radiography findings. Multivariate logistic regression and receiver operating characteristic curves were used to analyze the relationships between imaging parameters and the reduction degree.

Results: In total, 118 patients with AAD were included in the analysis. Inter-observer agreement among the three readers was higher for MRI than for dynamic digital radiography (0.816 vs. 0.668). The intra-observer consistency for MRI signs was also better than that of dynamic digital radiography. Both the flexible tissue sign and radiographically reducible groups showed a higher rate of satisfactory reduction. However, only the flexible tissue sign showed positive results in the multivariate regression. The receiver operating characteristic curve for MRI signs as a predictor of satisfactory reduction yielded an area under the curve of 0.776 (95% confidence interval, 0.667–0.875, p < 0.0001).

Conclusions: Novel MRI signs of the atlantodental space exhibited high inter- and intra-observer agreement. Patients with flexible tissue signs were more likely to achieve satisfactory reduction after direct posterior surgery.

Objective: The impact of preoperative consultations on mortality and morbidity rates, and their association with delays and hospital stays for surgery, remains a topic of discussion. This study aims to elucidate the necessity of consultations for those undergoing femoral neck fracture surgery, examining their influence on delays, hospital durations, and their correlation with mortality rates.

Methods: The study examined data from 320 emergency department patients with femoral neck fractures undergoing hip arthroplasty surgery at our hospital between 2011 and 2021, using digital medical records. Patients were consulted in relevant departments for risk optimization. They were categorized into two groups based on the time of surgery: Group 1 (operated within 48 h) and Group 2 (delayed surgery). The analysis included days from admission to surgery, total hospital stay, and time from surgery to discharge. Mortality rates, with a minimum 2-year follow-up, were assessed using digital records, patient contact, or a death notification system. Statistical analyses involved Mann–Whitney U, Kruskal–Wallis, post hoc analysis, Pearson’s chi-squared, and Fisher–Freeman–Halton tests (α = 0.05). SPSS v25.0 software was used.

Results: Patients with consultation requests experience significantly delayed surgery compared to those without (p < 0.001). Statistically significant differences were observed between consulted and nonconsulted groups in time until surgery (p < 0.001), time from surgery to discharge (p < 0.001), and overall length of hospital stay (p < 0.001). However, there is no statistically significant difference in 30-day and 1-year mortality between consulted and nonconsulted patients, both departmentally and overall.

Conclusion: This study found that advanced age and high ASA scores were the main factors causing surgical delays in hip fracture patients. While modifiable comorbidities could reduce hospital stays, they did not significantly affect postoperative mortality. Streamlining elective consultations and reducing organizational delays could help prevent delayed surgeries and improve outcomes.

Background: Flatfoot is a common foot disorder involving progressive foot deformity of the three-dimensional structures of the forefoot, midfoot, and hindfoot. Currently, Chinese surgeons and patients favor subtalar arthroereisis (SA) due to its minimally invasive and low-damage characteristics. HyProCure device is widely used. However, there is limited analysis of large sample sizes. This study utilized statistical evaluation with a large sample size to analyze clinical characteristics trends of SA for flatfoot, including baseline indicators, selection of HyProCure size and surgical strategy, complications, and implant removal. This study will enhance the understanding of SA in China.

Methods: A retrospective analysis of 732 patients (1008 ft) who underwent SA from June 2015 to June 2023, with 509 pediatric and adolescent patients (772 ft) and 223 adult patients (236 ft). Based on the patient’s age, patients aged ≤ 18 were included in the children and adolescent group, while adult acquired flatfoot deformity (AAFD) patients aged > 18 were included in the adult group. General data was collected, including patient sex, age, side, body mass index (BMI), surgery date, HyproCure size, and surgical data, and trends were analyzed. Postoperative complications and HyProCure removal were collected as outcome measures during follow-up.

Results: The age of patients treated with SA was gradually getting younger, with male patients predominating, mainly concentrated in the 11–14 age group. HyProCure 7 has the highest usage rate. In the children and adolescent group, 288 ft (37.31%) only underwent SA. In the adult group, 18 ft (7.63%) only underwent SA. Complications include sinus tarsi pain, peroneal spasms, achilles tendon tension, and muscle strength decline. The complication rate in the children and adolescent group was 5.05%, while in the adult group it was 28.81%. Overall, it was 10.62%. The removal rate of HyProCure in the children and adolescent group is 1.04%, in the adult group is 15.25%, and overall is 4.37%.

Conclusions: The trend in flatfoot treated with SA was towards children and adolescent male patients, and sinus tarsi pain was the most common complication after SA. The complication rate and removal rate in the children and adolescent group were lower than those in the adult group. HyProCure can be removed without additional adverse effects.

Background: Currently, traditional UBE surgery, which is based on arthroscope, has been increasingly employed for complex lumbar degenerative diseases. However, this approach is associated with complications such as intraoperative dural sac tears, nerve root injuries, and postoperative epidural hematomas. In response to these challenges, we propose a novel technique utilizing uniaxial spinal endoscope to replace arthroscope—Unilateral Bi/Multi-Portal Endoscopy (UME). This new method has successfully treated complex lumbar disc herniation and spinal stenosis, resulting in improved postoperative outcomes and a reduction in complications. Based on the previous findings, we utilized uniaxial spinal endoscopy as the primary operating method, with the assistance of multi-portal endoscopic techniques (UME-TLIF), to perform transforaminal lumbar interbody fusion. The feasibility and preliminary clinical results have been presented in this paper.

Methods: A total of 18 patients (8 men and 10 women, aged 52.6 ± 15.29 years) diagnosed with lumbar degenerative diseases, such as giant lumbar disc herniation, severe lumbar spinal stenosis, or lumbar spondylolisthesis, were included in this study from January 2022 to March 2023. Various parameters including operation time, ambulatory time, intraoperative fluoroscopy times, hospitalization days, and complications were recorded during the perioperative period. Clinically relevant symptoms were evaluated and documented 1, 3, 6, and 12 months postoperatively. Visual analogue scale (VAS) scores for lower back pain and leg pain, as well as the Oswestry disability index (ODI), were measured. The extent of lumbar interbody fusion was assessed using lumbar X-ray and CT scans at the 12-months follow-up. MRI was performed to assess the degree of nerve decompression in patients at the same time points. The paired t-test or Wilcoxon signed-rank test were used as statistical methods.

Results: The single-segment UME-TLIF procedure had an average operation time of 211 ± 53.3 min, and the average number of X-rays taken during the operation was 11.78 ± 5.32. Patients were able to walk and perform functional exercises approximately 35.11 ± 8.41 h post-surgery, and the average duration of hospital stay was 8.5 ± 2.27 days. The VAS and ODI values at each time point post-surgery were significantly lower than the respective pre-surgery values (p < 0.05). Two patients developed postoperative sensory disturbances which significantly improved with conservative treatment. Furthermore, a follow-up CT scan conducted 12 months post-surgery showed 100% fusion rate of the surgical segments in all patients.

Conclusion: UME-TLIF is an endoscopy-assisted fusion procedure that minimizes muscle damage in patients and allows early rehabilitation. This technique broadens the surgical applications of uniaxial spinal endoscope as a surgical tool, particularly benefitingpatients diagnosed with severe lumbar disc herniation and lumbar instability.

Objective: Lamina-implantation is gradually becoming the main surgical method for the treatment of intraspinal tumors. Traditional titanium (Ti) internal fixation not only produces artifacts, which affects the observation of tumors and dural sac closure, but also faces the problem of secondary surgical removal. In this study, absorbable material were used in lamina replantation for the first time and was evaluated for its efficacy and safety.

Methods: We retrospectively enrolled patients who underwent short-segment lamina replantation for intraspinal tumors in our center from February 2020 to November 2022. After condition matching of the number of fixation segment and fixation position, the baseline information, complications, neurological function, quality of life, spinal mobility and bone healing rate of the absorbable group and the Ti group were compared. Fisher exact, Chi-square, or rank sum test were used for categorical variables, and t-test was used for continuous variables to distinguish differences between groups.

Results: Cerebrospinal fluid leak was the most common complication, with no difference between the two groups (12.9% vs. 19.4%, p = 0.366). The bone healing rates of the two groups at 3 months after surgery were 77.4% and 87.1%, respectively, and there was no significant difference (p = 0.508). At 1 year after surgery, the resorbable group showedlower levels of anxiety/depression (1.20 ± 0.41 vs. 1.61 ± 0.61, p = 0.050), however, it did not affect the overall quality of life of the patients at 1 year.

Conclusion: Both titanium and absorbable internal fixation have shown good clinical results in the treatment of intraspinal tumors by laminareplantation. Regardless of cost, absorbable screws and plates are also suitable options for patients undergoing lamina replantation, because it has no stress shielding effect and does not require secondary removal. In addition, there are no artifacts in the image, which is more conducive to observing the recurrence of the tumor and the closure of the dural sac.

Objective: Pseudo-patella baja (PPB) was one of the complications after total knee arthroplasty (TKA). This complication may be closely related to the occurrence of knee joint movement limitation and pain after TKA. This study aimed to investigate whether PPB affects clinical outcomes after TKA and to study the biomechanical effects of PPB after TKA.

Methods: This study was a retrospective case series of 462 eligible patients (563 knees). Clinical evaluation was performed using the visual analogue scale (VAS), the Hospital for Special Surgery (HSS), the Western Ontario McMaster University Osteoarthritis Index (WOMAC) scoring systems, the 5-Level EuroQol Generic Health Index (EQ-5D-5L), the Forgotten Joint Score-12 (FJS-12), and patient satisfaction. CT and MRI scans of two healthy left knees and TKA prostheses were taken; 3D models including PPB, True patella baja (TPB), normal patella, and patella alta (PA) were created in FEA and applied load along the direction of quadriceps femoris. T-test, Mann–Whitney U-test, chi-squared (χ ²) test, and analysis of variance (ANOVA) were performed using GraphPad Prism (Version 8, GraphPad Software, USA). A statistically significant difference was considered at p < 0.05 with bilateral α.

Results: The VAS, HSS, WOMAC, EQ-5D-5L, FJS-12, and patient satisfaction scores in the PPB and TPB groups were significantly worse than those in the patella normal (PN) group (p < 0.05). The PPB group found a positive correlation between Blackburne–Peel index (BPI) and FJS-12 score. PPB showed lower contact stress of patellofemoral joint compared to TPB when knee flexion was less than < 90° (p < 0.01), but no significant difference when flexion was more than > 90° (p > 0.05) in the finite element model with Patella baja (PB). The contact area of the patellofemoral joint tended to increase with the deepening of knee flexion, and decreased after reaching the peak value. The contact area of the patellofemoral joint tended to decrease with the increase in patellar height. There was no significant difference in the contact area of the patellofemoral joint among different patellar heights and different degrees of knee flexion (p > 0.05).

Conclusion: PPB after TKA may increase patellofemoral joint stress and postoperative complications like anterior knee pain.

Objectives: Proximal humeral fractures (PHFs) show a high incidence in aged patients. While nondisplaced fractures achieve good results by conservative treatment, surgical procedures are discussed controversially. Next to open reduction and internal fixation (ORIF), the primary use of reverse shoulder arthroplasty (RSA) has become increasingly important. The aim of this study was to investigate the clinical function, activities of daily living (ADL), as well as pain assessment in patients with PHFs, treated by ORIF or RSA.

Methods: A retrospective comparison study was assessed. From November 2011 to March 2016, 34 patients (17 matched pairs) that had undergone either ORIF or RSA of the proximal humerus, were included in this study. Pain was measured by numeric rating scale (NRS). ADL were obtained by Katz-Index and SF-12. Moreover, shoulder function was assessed using the Oxford Shoulder Score (OSS). The maximum range of motion (ROM) was also recorded. From November 2011 to March 2016, 34 patients (17 matched pairs) that had undergone either ORIF (Figure or RSA of the proximal humerus) were included in this study. For statistical analyses, Student’s t-test, Wilcoxon test, and Chi-Quadrat test were used. Statistical significance was indicated with p < 0.05.

Results: Totally 34 patients with an average age of 76.6 years were included. Surgical treatment was performed on average 5.2 days after diagnosis, differing significantly between the two groups (RSA/ORIF: 6.9/3.5 days) The operation time of RSA (97 min) was significantly longer than for ORIF (78 min). Pain assessment, as well as the Katz-Index and the SF-12, showed no significant differences. Moreover, clinical shoulder function showed no significant discrepancies between the two surgical techniques.

Conclusions: Aged patients with PHFs treated with RSA display similar results regarding clinical function, ADL as well as pain perception compared with ORIF. However, revision surgery rate was lower in patients who underwent RSA. Thus, the surgical treatment of PHFs by RSA represents an excellent alternative, especially with regard to an aging patient population.

Objective: Modic changes (MCs) classification system is the most widely used method in magnetic resonance imaging (MRI) for characterizing subchondral vertebral marrow changes. However, it shows a high degree of sensitivity to variations in MRI because of its semiquantitative nature. In 2021, the authors of this classification system further proposed a quantitative and reliable MC grading method. However, automated tools to grade MCs are lacking. This study developed and investigated the performance of convolutional neural network (CNN) in detecting and grading MCs based on their maximum vertical extent. In order to verify performance, we tested CNNs’ generalization performance, the performance of CNN with that of junior doctors, and the consistency of junior doctors after AI assistance.

Methods: A retrospective analysis of 139 patients’ MRIs with MCs was conducted and annotated by a spine surgeon. Of the 139 patients, MRIs from 109 patients were acquired using Philips scanners from June 2020 to June 2021, constituting Dataset 1. The remaining 30 patients had MRIs obtained from both Philips and United Imaging scanners from June 2022 to March 2023, forming Dataset 2. YOLOv8 and YOLOv5 were developed in PyCharm using the Python language and based on the PyTorch deep learning framework, data enhancement and transfer learning were applied to enhance model generalization. The model’s performance was compared with precision, recall, F1 score, and mAP50. It also tested generalizability and compared it with the junior doctor’s performance on the second data set (Dataset 2). Post hoc, the junior doctor graded Dataset 2 with CNN assistance. In addition, the region of interest was displayed using the class activation mapping heat map.

Results: On the unseen test set, the YOLOv8 and YOLOv5 models achieved precision of 81.60% and 61.59%, recall of 80.90% and 67.16%, mAP50 of 84.40% and 68.88%, and F1 of 0.81 and 0.60 respectively. On Dataset 2, YOLOv8 and junior doctor achieved precision of 95.1% and 72.5%, recall of 68.3% and 60.6%. In the AI-assisted experiment, agreement between the junior doctor and the senior spine surgeon significantly improved from Cohen’s kappa of 0.368–0.681.

Conclusions: YOLOv8 in detecting and grading MCs was significantly superior to that of YOLOv5. The performance of YOLOv8 is superior to that of junior doctors, and it can enhance the capabilities of junior doctors and improve the reliability of diagnoses.

Objectives: Currently, there are various surgical options for the treatment of lateral ankle sprains, and deciding which surgical option to use is a question worth considering. Furthermore, there is a relative scarcity of mechanical research comparing suture anchor repair (SAR) and suture tape augmentation (STA) internal brace for the repair of the anterior talofibular ligament (ATFL). Therefore, this study aimed to compare the efficacy of arthroscopically all-inside ATFL SAR and STA for reconstruction to treat lateral ankle sprains through biomechanical testing.

Methods: Eighteen fresh-frozen cadaver ankles were used for the study and divided into one of three groups: (1) intact ATFL group, (2) arthroscopically reconstructed with suture tape augmentation internal brace of the ATFL (STA group), and (3) arthroscopically repaired ATFL with suture anchors (SAR group). We used custom fixtures to test the specimens for loading to ultimate failure and stiffness.

Results: The mean load to failure of the STA group (311.20 ± 52.56 N) was significantly higher than that of the intact ATFL group (157.37 ± 63.87 N; p = 0.0016) and the SAR group (165.27 ± 66.81 N; p = 0.0025). The mean stiffness of the STA group (30.10 ± 5.10 N/mm) was significantly higher than that of the intact ATFL (14.17 ± 6.35 N/mm; p = 0.0012) and the SAR group (15.15 ± 6.89 N/mm; p = 0.0021). The suture anchor repair withstood failure loads and stiffness similar to the intact ATFL.

Conclusions: In terms of failure load and stiffness, the reconstructive outcome of ATFL reconstruction with STA is markedly superior to that of SAR reconstruction of the ATFL and the intact ATFL. Additionally, the novel technique of the SAR was a reliable technique that offered biomechanical properties similar to intact ATFL.

Purpose: Hip fractures in the elderly, especially those discharged to a rehab facility, have historically been associated with poor outcomes. There has yet to be identified which patients have a higher likelihood of a rehab discharge after isolated hip fracture fixation. The purpose of this study was to identify factors that predispose patients to require short or long-term rehab after surgical intervention of traumatic, isolated hip fractures.

Methods: Patients undergoing operative management of hip fractures (n = 71,849) from 2017 to 2019 at institutions that submitted data to a nationwide database were analyzed retrospectively. Various factors were compared between patients discharged to inpatient rehab (n = 56,178) versus home (n = 15,671).

Results: The rehab discharge group was significantly older and predominantly female. This cohort had a longer average hospital stay, higher incidence of diabetes, congestive heart failure, chronic renal failure, history of cerebrovascular accident, functionally dependent health status, hypertension, chronic obstructive pulmonary disease, dementia, baseline anticoagulation therapy, and history of myocardial infarction. DVT during hospitalization was encountered more often in patients discharged to rehab. Patients with femoral neck fractures and those undergoing total hip arthroplasty were more often discharged home. Patients with intertrochanteric hip fractures and those undergoing fracture fixation were more often discharged to rehab.

Conclusions: Multiple risk factors associated with a significantly higher likelihood of a rehab discharge after isolated hip fracture surgery were identified. Early identification of these patients may provide an opportunity to optimize patients for home discharge and better outcomes.

Level of Evidence: Level III, Case-Control Study.

Objective: Type III hemipelvectomy and reconstruction are challenging. Several reconstruction options, including autologous soft tissue, prosthesis patch, autologous, or allograft, were reported, but a variety of shortcomings limited their application. Three-dimensional (3D)-printed prosthesis was designed to reconstruct the unilateral Type III pelvic defect and had favorable clinical outcomes. However, the reconstruction method for bilateral Type III pelvic defect was few reported. This study aims to design a bilateral pubis prosthesis and evaluate the early clinical outcomes and complications.

Methods: We retrospectively collected patients receiving 3D-printed bilateral pubis prosthesis reconstruction after malignant tumor resection between 2017 and 2021. Demographics, anatomic data, operation time, blood loss, and clinical outcomes of patients were analyzed. The Musculoskeletal Tumor Society-93 (MSTS-93) score was performed to evaluate the function and complications were recorded.

Results: Four patients, including three for females and one for males, were enrolled in this study. Prosthesis was designed according to the pelvic anatomical data. The mean operation time and blood loss were 308.8 min (range, 240–400 min) and 655 mL (range, 400–1100 mL), respectively. The average follow-up was 15.5 months (range, 12–16 months). The mean MSTS was 28.5 (28–29). One patient had incision necrosis postoperatively. No hernia, prosthesis displacement, or implant failure occurred during follow-up. Four patients with 15 interfaces showed good osteointegration.

Conclusions: 3D-printed bilateral pubis prosthesis could restore the integrity and stability of pelvic ring and improve limb function. Meanwhile, this reconstruction option provided a rigid bony-soft support to prevent the development of hernia. In all, 3D-printed bilateral pubis prosthesis is recommended to be a favorable selection for Type III pelvic defect reconstruction.

Objective: Current surgical strategies for thoracic ossification of the ligamentum flavum (TOLF) are denounced by thoracic kyphosis, loss of spinal motion range, etc. A new surgical technique, laminoplasty and in-site regrafting (LPIR), was modified to address the problems. This study aimed to report the safety and feasibility of LPIR for TOLF treatment.

Methods: This retrospective study reported the outcome of eight consecutive patients (3 males and 5 females, mean age 52.87 years) with TOLF who underwent LPIR surgery from January 2019 to March 2024. Pre- and post-operative data including x-ray, computerized tomography (CT), magnetic resonance imaging (MRI), the modified Japanese Orthopedic Association score (mJOA), the visual analog scale (VAS), and complications were collected to evaluate the outcome.

Results: All surgeries were performed successfully, significantly alleviating symptoms postoperatively. During an average follow-up period of 28.63 months, the VAS score reduced from 4.50 ± 1.00 pre-operatively to 1.63 ± 0.48 on the third post-operative day and further reduced to 0.50 ± 0.70 during the last follow-up. The mJOA score increased from 3.63 ± 0.70 pre-operatively to 6.13 ± 0.78 on the third postoperative day and further increased to 8.88 ± 1.27 during the last follow-up. No severe complications were observed.

Conclusions: LPIR exhibited significant safety and feasibility for treating TOLF, offering a novel strategy for managing this problem.

Objective: Osteosarcoma at the first metacarpal is extremely rare. Reconstructing the metacarpal after tumor resection is essential, as the thumb accounts for approximately 40%–50% of hand function. Although autografts, arthroplasty, and transposition have been reported as reconstruction options, their use is limited by complications such as secondary injury, nonunion, and displacement. In this study, we present a case of a patient with first metacarpal osteosarcoma who underwent tumor resection followed by reconstruction with a 3D-printed metacarpal prosthesis. We tend to introduce a novel strategy to reconstruct the first metacarpal and restore the hand function.

Methods: A 30-year-old male with 5-month history of first metacarpal swelling in the left hand was admitted to our center. Imaging examinations and incision biopsy confirmed a diagnosis of intramedullary well-differentiated osteosarcoma. A 3D-printed metacarpal prosthesis was then designed to achieve carpometacarpal (CMC) joint fusion and thumb metacarpophalangeal (MCP) joint reconstruction. Postoperative evaluations included X-ray and tomosynthesis-shimadzu metal artifact reduction technology (T-SMART) imaging to assess bone-prosthesis integration. Hand function was measured using the Musculoskeletal Tumor Society (MSTS) score and the Disabilities of the Arm, Shoulder, and Hand (DASH) score.

Results: The tumor was completely resected, and a 3D-printed metacarpal prosthesis was performed to reconstruct the tumor defect. Postoperative imaging showed that the interface between bone and prosthesis was integrated and that there was no loose, displacement, or fracture of the implant. At the last follow-up, the patient had an MSTS score of 25/30 and a DASH score of 8/100. The range of motion on thumb MCP joint was 30° of flexion and 0° of extension. The Kapandji thumb opposition score was 4 points. The grip strength was 9 kg (compared to 30 kg on the contralateral side) and the key-pinch strength was 3 kg (compared to 8 kg on the contralateral side).

Conclusion: 3D-printed metacarpal prosthesis could be an effective reconstruction option for patients with low-grade malignant tumors. Themulti-planar fixation achieved through 3D surgical planning helps maintain thumb function and restore overall hand function.

Background: Malignant tumors originating in the talus are rare and present significant challenges in reconstruction. Traditional treatments, such as below-knee amputation or tbiocalcaneal fusion, often result in significant loss of ankle function. After tumor resection, reconstruction of the talus and calcaneus is necessary to preserve ankle function. However, the intricate anatomical structure and unique location of the talus and calcaneus present significant challenges for prosthetic reconstruction.

Case Presentation: Here, we present the case of an 11-year-old adolescent patient diagnosed with Ewing’s sarcoma of the talus, accompanied by suspected involvement of the calcaneus. Following a comprehensive evaluation, a 3D-printed talus-calcaneus prosthesis, which is composed of a ultrahigh-molecular weight polyethylene (UHMWPE) part and a titanium alloy part, was designed for talus and calcaneus reconstruction. In addition, a porous structure was designed to promote the integration of bone–prosthesis interface. The lesion was completely resected and the prosthesis was precisely installed. After 12 months follow-up, patients demonstrated favorable function results with the Musculoskeletal Tumor Society (MSTS) score was 27/30, and the American Orthopedic Foot and Ankle Society (AOFAS) score was 92/100. The range of motion for dorsiflexion, plantarflexion, inversion, and eversion of the right ankle joint was measured as 10° and 35°, 15°, and 10°, respectively. The postoperative radiograph showed a good position of the prosthesis. No narrowed joint space was observed. Tomosynthesis shimadzu metal artifact reduction technology (T-SMART) revealed that integration between bone and prosthesis was good.

Conclusion: In this case, we present a case of 3D-printed talus-calcaneal prosthesis reconstructing talus and calcaneus. Favorable postoperative function outcome and good integration of the interface were observed. Therefore, this case provides an alternative therapeutic option for the treatment invasive talus tumor accompanied by suspicious contamination of the calcaneus. Nevertheless, a larger cohort study and with longer follow-up is needed to evaluate the effectiveness and potential complications of this novel prosthesis.

Background: Chondroblastoma is a rare bone tumor that originates from the epiphysis, constitutes around 1% of all primary bone tumors and is recognized for its tendency to exhibit local invasiveness, as well as the possibility of metastasis and recurrence in nearby areas. Currently, the main surgical treatment for chondroblastoma is open surgery, involving excision of the lesion. There are relatively few reports on arthroscopic surgery for the treatment of chondroblastoma. However, open surgical curettage is associated with operation-related trauma and potential for damage to the osteoepiphysis resulting in growth disturbances.

Case Presentation: This case study presents the application of an arthroscopic technique in a 14-year-old male patient with chondroblastoma affecting the proximal tibia and tibial eminence. The procedure involved thorough removal of the lesion using direct visualization with the management of the cavity utilizing a substitute for autologous bone graft. After 1 year of follow-up, the patient remains free from symptoms, exhibits normal knee functionality, and radiographic analysis reveals a good autologous bone graft fusion without any signs of recurrence.

Conclusions: Based on the existing cases of arthroscopic treatment for chondroblastoma and the report of this case, arthroscopic treatment for chondroblastoma can be considered as a specific treatment option for certain patients. In some cases, this technique could be an effective alternative to open surgery.