Pain is the main symptom of knee osteoarthritis (KOA) and the main cause for patients to seek medical treatment. Despite the development of various therapies to address pain, its efficacy often remains uncertain. According to the new classification of the International Association for the Study of Pain, pain is classified as nociceptive pain, neuropathic pain and nociplastic pain. This review sought to outline potential mechanisms and clinical manifestations within this new classification framework and provided tailored treatment recommendations for each type of pain. Moreover, we further divided nociceptive pain into three subgroups including Inflammatory Pain, Mechanical Pain, and BMLs-related Pain. We suggest: (1) For inflammatory pain, the use of anti-inflammatory medications such as NSAIDs and corticosteroids is recommended. (2) For mechanical pain, weight loss, adjustments to mechanical alignment of the lower limb, and rehabilitation training may significantly alleviate symptoms. (3) For BMLs-related pain, patients might benefit from treatment, such as reducing weight-bearing and implementing antiosteoporosis drugs. (4) For neuropathic pain, management may involve tricyclic antidepressants or anticonvulsants. (5) For nociplastic pain, we give priority to nonpharmacological therapies, with an emphasis on the biopsychosocial model, and encourage patients to adopt positive lifestyle changes, including physical activity, weight management, sleep hygiene, and self-management, as well as involvement in psychotherapy and intervention. In clinical practice, it is essential to recognize that many patients may present with a combination of these pain types. Thus, it becomes imperative to identify the primary pain type and craft precise and individual treatment strategies tailored to their specific needs.

To manage anterior cruciate ligament (ACL) injury, both remnant-preserving anterior cruciate ligament reconstruction (ACLR) and standard ACLR without remnant preservation are applied. This study aims to systematically evaluate clinical outcomes of remnant-preserving versus standard ACLR techniques by analyzing randomized controlled trials (RCTs). The PubMed, Embase, and Cochrane Library databases were used to identify studies published from January 2000 to November 2024. Based on the PICOS framework, we systematically reviewed RCTs in which patients with ACL injuries compared ACLR with remnant preservation versus standard ACLR in terms of International Knee Documentation Committee (IKDC) score, Lysholm score, Lachman test, pivot shift test, KT1000/2000 arthrometer side-to-side difference (SSD), synovial coverage, proprioception evaluation, cyclops lesion, and range of motion (ROM). Data were pooled using the random-effects model or fixed-effects model, based on the heterogeneity. The quality of the included literature was assessed based on the Cochrane Risk of Bias tool (ROB 2.0), and the GRADE criteria were applied to rate evidence quality for key outcomes. Review Manager 5.4 and Stata 15 were used for the statistical analyses. The relative risk (RR) was used for dichotomous data, and the mean difference (MD) was used for continuous variable data. Both types of indicators were expressed as 95% confidence intervals (CIs). The minimal clinically important difference (MCID) was adopted to determine whether patients improved enough clinically to notice a difference. Subgroup analyses were conducted for outcomes failing to reach MCID thresholds in order to examine potential modifiers of different follow-up durations and remnant preservation techniques. A total of 10 studies were included in the qualitative review and meta-analysis. Although there were statistically significant differences between the remnant preservation group and the standard technique group in favor of the remnant preservation technique with respect to postoperative Lysholm score (MD 1.44; 95% CI, 0.60–2.29; I² = 23%; p < 0.01) (GRADE: Moderate), SSD (MD −0.57; 95% CI, −0.98 to −0.15; I² = 86%; p < 0.01) (GRADE: Low) and proprioception recovery (MD −0.57; 95% CI, −0.83 to −0.31; I² = 0%; p < 0.01) (GRADE: Low), these observed differences are so small that they are unlikely to be clinically relevant. No differences were found in other clinical outcomes between the two groups. The follow-up duration and remnant preservation techniques were not identified as the key factors influencing the differences between remnant preservation ACLR and standard ACLR. No clinically meaningful benefit in postoperative knee stability or function; remnant preservation may be considered primarily when technical feasibility is high and remnant quality is optimal. This is achieved without increasing the risk of cyclops lesions and deficiency of ROM.

Osteogenesis imperfecta (OI) is a hereditary connective tissue disorder characterized by increased bone fragility and a propensity for multiple fractures, often leading to various skeletal deformities. Spinal involvement, particularly the development of scoliosis, is one of the most serious clinical manifestations of OI, significantly impacting patients' quality of life. Scoliosis in OI is characterized by early onset and rapid progression, complicating its treatment and necessitating special attention. This review article consolidates the results of contemporary molecular-genetic studies on spinal deformities in children with OI and examines the risk factors for their progression. It provides an overview of existing methods for treating scoliotic deformities in OI, including surgical and conservative approaches, and discusses prospects for the implementation of new therapeutic strategies. The aim of the review is to enhance the understanding of the pathogenesis of spinal deformities in OI and to contribute to the development of more effective methods for their diagnosis and treatment.

Objective: Rotator cuff calcific tendinopathy is a leading cause of nontraumatic shoulder pain, frequently leading to articular and functional impairments, depicting an adhesive capsulitis-like clinical presentation. To date, there is a lack of evidence on the impact of conservative approaches, and no gold standard has been established for managing rotator cuff calcific tendinopathy. This systematic review aimed to identify the most effective conservative approach for reducing pain and improving function in rotator cuff calcific tendinopathy patients.

Methods: PubMed, Scopus, and Cochrane Library databases were systematically searched from their inception until January 2, 2025, for English-language randomized clinical trials including adults affected by rotator cuff calcific tendinopathy undergoing conservative treatment. Data extraction was performed independently by two reviewers using a customized data extraction form, with consensus reached by a third reviewer. A network meta-analysis was subsequently carried out to compare the efficacy of different interventions. The risk of bias within the included randomized clinical trials was assessed using Version 2 of the Cochrane risk-of-bias tool for randomized trials. The study has been registered with PROSPERO, registration number CRD420250650833.

Results: Nineteen articles were included. This study identified 1160 subjects affected by rotator cuff calcific tendinopathy. A pairwise comparison through a network meta-analysis indicated that platelet-rich plasma exhibited the highest probability (85%) of improving shoulder function, followed by disodium ethylenediamine tetra-acetic acid at 75%, aspiration techniques at 65%, and extracorporeal shockwave therapy at 57%. Regarding pain reduction, disodium ethylenediamine tetra-acetic acid showed the highest probability (66%), followed by kinesiotaping and needle aspiration, both at 61%.

Conclusion: This systematic review and network meta-analysis identified several interventional techniques, including platelet-rich plasma and disodium ethylenediamine tetra-acetic acid injections, extracorporeal shockwave therapy, and needle aspiration, as more effective strategies for reducing pain and improving function in subjects affected by rotator cuff calcific tendinopathy.

Level of Evidence: I (systematic review of Level-I randomized controlled studies).

Objectives: Pelvic reconstruction with conventional 3D-printed prostheses faces a critical trade-off, where achieving sufficient porosity for optimal bone ingrowth often compromises essential mechanical stability. To address this challenge, this study evaluates the clinical outcomes of 3D-printed hemipelvic prostheses incorporating re-entrant chiral structure (RCS), a novel negative Poisson's ratio design, in patients undergoing pelvic reconstruction following tumor resection.

Methods: A retrospective analysis was conducted on 15 patients (eight females and seven males; mean age: 39.3 ± 11.7 years) with pelvic malignancies who underwent reconstruction using 3D-printed hemipelvic prostheses incorporating RCS between March 2018 and June 2023. The diagnoses included osteosarcoma (n = 8), Ewing's sarcoma (n = 3), chondrosarcoma (n = 2), and high-grade soft tissue sarcoma (n = 2). All patients were staged as IIB according to the Enneking system, except for one case of Ewing's sarcoma (stage III). Neoadjuvant chemotherapy (four cycles) was administered to six osteosarcoma patients, and one Ewing's sarcoma patient received six cycles, while other patients proceeded directly to surgery. Patient outcomes were systematically evaluated through oncological status, functional performance (MSTS-93 score), pain assessment (VAS score), surgical parameters, complications, and radiographic analysis using Tomosynthesis Shimadzu Metal Artifact Reduction Technology (T-SMART).

Results: At the latest follow-up (44.5 ± 9.4 months), 13 patients (86.7%) remained disease-free; one patient (6.7%) experienced local recurrence requiring revision surgery, and one patient (6.7%) died of metastatic complications at 32 months post-surgery. Functional outcomes showed significant improvement, with mean MSTS-93 scores increasing from 14.5 ± 1.1 preoperatively to 25.8 ± 1.3 at final follow-up (p < 0.001). Pain control was satisfactory, with VAS scores decreasing from 5.5 ± 0.6 to 1.5 ± 0.5 (p < 0.001). The mean surgical duration was 289.3 ± 30.4 min, with an average intraoperative blood loss of 3540 ± 621.5 mL. Early complications included delayed wound healing in three cases (20%), successfully managed with wound care protocols and VAC therapy. One patient (6.7%) developed deep prosthetic infection at 14 months post-surgery, necessitating a two-stage revision procedure. No mechanical failures, aseptic loosening, or prosthesis fractures were observed during the follow-up period. Radiographic analysis demonstrated progressive bone ingrowth into the RCS porous regions in all cases, with no signs of osteolysis or implant migration in the remaining prostheses.

Conclusion: D-printed custom hemipelvic prostheses with RCS offer an effective solution for pelvic reconstruction by achieving an optimal balance between mechanical stability and biological integration, leading to promising clinical outcomes.

Background: Anteromedial cortex reduction and accurate placement of the cephalomedullary nail is the key point to confront implant failure of intertrochanteric fractures. Existing intramedullary nails cannot compensate for femoral neck-shaft offset (FNSO), potentially undermining surgical outcome. This study aimed to investigate the effect of FNSO on anteromedial cortex reduction and accurate placement of the cephalomedullary nail for intertrochanteric fractures.

Methods: This retrospective study included patients with intertrochanteric fractures treated with short intramedullary nails at our institution from January 2014 to December 2016, who were divided into acceptable and unacceptable groups according to the anteromedial cortex reduction quality. We measured the femoral neck-shaft offset (FNSO) and offset angle (FNSOA) on the uninjured femur CT. Postoperative CT of the fractured femur was used to measure the offset between the femoral neck axis and the cephalic nail axis (FNCO) and the corresponding angular offset (FNCOA). Cephalic nail insertion alignment was classified into three types (oblique-forward/rear, coincident, and oblique-backward/front) based on FNCO/FNCOA values. Group differences were analyzed, and logistic regression identified predictors of poor reduction.

Results: Fifty-seven patients (mean age 78.10 ± 13.47  years; 74% women) were included. The median FNSO and FNSOA of unaffected femurs were 4.31 (IQR 1.50) mm and 4.85° (IQR 2.01). 42.1% of cases had acceptable anteromedial reduction, while 57.9% were unacceptable. Cephalic nail insertion types were: 43.9% oblique-backward/front, 28.1% coincident, and 28.1% oblique-forward/rear. The unacceptable reduction group had significantly different FNCO (−2.32 vs. 2.14 mm) and FNCOA (−3.5° vs. 0°) compared to the acceptable group (both p < 0.001), despite similar fracture types and devices. Cephalic nail insertion type differed between groups (p < 0.001): oblique-backward/front and coincident insertions were more common in poor reductions. Logistic regression showed that oblique-backward/front insertion (OR = 51.33, 95% CI 7.60–346.85) and coincident insertion (OR = 9.00, 95% CI 1.52–53.40) were strong independent predictors of unacceptable reduction (both p < 0.001). Among insertion types, oblique-forward/rear had the lowest median FNCO (3.59 mm) and FNCOA (0.69°) and only 12.5% unacceptable reductions, versus coincident (0 mm, 0°, 56.3%) and oblique-backward/front (−3.06 mm, −5.84°, 88.0%) (p < 0.001).

Conclusions: It is difficult for existing intramedullary nails to achieve both the reduction of the anterior medial cortex and the accurate implantation of intramedullary nails due to the presence of FNSO. Optimizing intramedullary nailing design and surgical strategy according to FNSO may improve the treatment outcome of intertrochanteric fractures.

Objective: Intertrochanteric fractures (IF) in the elderly are often complicated by osteoporosis and high rates of fixation failure. Current treatment options have limitations in providing both stable fixation and early mobilization in this fragile population. This study aimed to introduce and evaluate a novel approach, the periprosthetic femoral fracture treatment concept (PFFtc), as a surgical strategy to guide hip arthroplasty in elderly IF patients.

Methods: A retrospective analysis was conducted on 209 elderly patients (mean age: 81.6 years; range: 70–93) with IF who underwent hip arthroplasty using the PFFtc protocol between March 2014 and August 2021, comprising 133 females and 76 males. All patients underwent treatment with the “PFFtc” and were subsequently followed up at intervals of 1 month, 3 months, 6 months, 1 year, 2 years, and annually thereafter. Clinical parameters such as ASA anesthesia grading, Visual Analogue Scale (VAS) scores, Harris Hip Scores (HHS), and Short-Form 36 (SF-36) outcomes were meticulously recorded. The subsidence of the femoral stem was assessed using Pelligrini's method, while mortality rates, postoperative complications, and patient's survival status post-discharge were systematically documented. Multivariate logistic regression analysis was performed to identify independent risk factors for postoperative complications.

Results: Over a mean follow-up of 38.5 ± 6.0 months, prosthesis subsidence averaged 2.2 mm and stabilized. No deaths occurred within 30 days postoperatively. The 1- and 2-year cumulative mortality rates were 4.3% and 11%, respectively. The most common complications included DVT and urinary tract infections. Logistic regression identified hypoproteinemia (OR = 2.38, p = 0.032) and heart disease (OR = 2.74, p = 0.012) as independent risk factors for postoperative complications. At final follow-up, the mean VAS was 1.1 ± 1.0, HHS was 89.4 ± 3.9, PCS was 53.2 ± 8.5, and MCS was 50.5 ± 6.7. Among surviving patients, 63.0% lived independently at home.

Conclusion: The PFFtc-guided arthroplasty approach appears to be a safe and effective option for managing IF in elderly patients. It provides stable fixation and functional recovery of prostheses and muscles and offers a promising alternative to traditional fixation strategies.

Objective: Habitual patellar dislocation (HDP) in children and adolescents is divided into dislocation in flexion and dislocation in extension, but their pathogenesis remains unclear. Our purpose is to focus on investigating the anatomical difference between the extended dislocation and the flexed dislocation of HDP.

Methods: We retrospectively observed all patients diagnosed as HDP who underwent surgery at our institution from May 2016 to August 2023. Patients were categorized into two subgroups according to “J sign”: the extension group and the flexion group. We measured and compared the various anatomical parameters on CT images, including patellar dysplasia, trochlear dysplasia, alignment of the patellofemoral joint, and torsional deformity of the knee joint. Continuous data were analyzed using the t-test, while categorical data were analyzed using Fisher exact test and Mann–Whitney U test.

Results: We enrolled 20 patients (average age of 9 years old, ranging from 6 to 15; 14 patients in the extension group and 6 patients in the flexion group) with 30 knees. The extension group exhibited significantly greater Wiberg index (0.62 ± 0.09 vs. 0.56 ± 0.05, p = 0.030), lateral patellar angle (17.83 ± 4.5 vs. 12.24 ± 5.7, p = 0.009), PT/FT ratio (1.45 ± 0.1 vs. 1.31 ± 0.1, p = 0.005), and Caton–Deschamps index (1.46 ± 0.3 vs. 1.17 ± 0.1, p = 0.015) than those in the flexion group. Meanwhile, the flexion group demonstrated greater patellar lateralization distance (24.03 ± 11.5 vs. 16.26 ± 7.3, p = 0.036), patellar inclination angle (50.75 ± 13.1 vs. 29.98 ± 14.5, p = 0.001), lateral patellofemoral angle (38.49 ± 13.5 vs. 18.32 ± 8.2, p = 0.000) and congruence angle (57.57 ± 23.3 vs. 28.15 ± 16.7, p = 0.001) when knees were extending but a smaller lateral trochlear inclination angle (18.84 ± 6.9 vs. 12.49 ± 5.2, p = 0.026) than those in the extension group. Additionally, the knees in the flexion group predominated the femoral trochlea of Dejour type C and D (100%) while only half of the extension group had Dejour type C and D (51%). The duration of symptoms before surgery was significantly longer in the extension group compared to the flexion group (25.93 ± 25.8 months vs. 9.33 ± 4.18 months, p = 0.034). Parameters related to torsional abnormality of the lower extremity showed no significant difference between the two groups.

Conclusions: Patients with HDP in extension had patella alta, more severe patellar dysplasia, while those with HDP in flexion had a more inclined patella, laterally positioned patella when knees extended, and a more dysplastic femoral trochlea. These differences provide reasonable references for doctors to better understand the mechanisms of dislocation and the design of optimal surgical strategies.

Clinical Relevance: Improved understanding of anatomical features of HDP is critical to informing clinical treatment decisions.

Objective: This study compared the intraoperative neurophysiological monitoring (IONM) data between patients with Marfan syndrome (MFS) scoliosis undergoing posterior spinal correction surgery and those with idiopathic scoliosis (IS).

Methods: Patients diagnosed with MFS who underwent posterior spinal correction surgery between January 2018 and December 2023 were reviewed. Patients with IS who underwent posterior spinal correction surgery were randomly selected as the control group. Motor-evoked potentials (MEPs) and somatosensory-evoked potentials (SEPs) were measured separately on the convex and concave sides of the main curve. We recorded IONM failure and asymmetrical SEPs waveforms. For each patient, we assessed the apical vertebral translation, Cobb angle of the main curve, curve pattern, deformity angular ratio (DAR), and global kyphosis. Independent-sample t-test and chi-square tests were conducted to compare differences between the IS and MFS groups.

Results: We included 238 girls with IS and 118 patients with MFS scoliosis (45 men and 73 women). The rates of MEPs and SEPs were 95.4% and 93.7% in girls with IS, and 92.4% and 89.8% in patients with MFS scoliosis, respectively. In the MFS group, the average N45 latency, P37 latency, and amplitude of SEPs were 49.5 ± 3.9 ms, 39.9 ± 3.5 ms, and 2.5 ± 1.4 μV on the convex side and 50.1 ± 4.0 ms, 39.9 ± 3.5 ms, and 2.4 ± 1.3 μV on the concave side, respectively. The MEP amplitude was 731.7 ± 734.3 μV on the concave side and 854.3 ± 778.2 μV on the convex side. Patients in the IS group had lower SEP-N45 and SEP-P37 latencies than the patients in the MFS group (p < 0.001). Asymmetrical SEPs were observed in 102 patients in the IS group and 52 patients in the MFS group, respectively (p = 0.879). IONM waveform failure was identified in 21 patients in the IS group and 17 patients in the MFS group, respectively (p = 0.108). IONM failure was more likely in patients with a larger C-DAR, S-DAR, T-DAR, and Cobb angle of the main curve preoperatively (p = 0.017, 0.005, 0.001, and 0.001, respectively).

Conclusions: In patients with MFS scoliosis, the success rates of MEPs and SEPs during posterior spinal fusion were 92.4% and 89.8%. Compared to MFS patients, those with IS demonstrated shorter SEP latencies, with similar MEP and SEP amplitudes. MFS patients with higher DAR values and larger Cobb angles of the main curve preoperatively were at a higher risk of IONM failure.

Purpose: Bone void fillers are essential for successful outcomes in opening-wedge high tibial osteotomy (OWHTO), a procedure that corrects varus knee misalignment and alleviates medial compartment pain. However, the best filler for OWHTO is still uncertain. This study compared the clinical and radiographic results of using three-dimensional-printed (3DP) porous tantalum wedges versus allogeneic chip bone as fillers in OWHTO, aiming to provide a reference for clinical decision-making.

Methods: This exploratory-retrospective matched-cohort consecutively enrolled study included 20 patients (10 per group) who were treated between January 2020 and December 2022, with Group A (3DP porous tantalum) selected from a large trial and Group B (allogeneic chip bone) matched by age, gender, and varus severity. Inclusion criteria: young, active patients with tibial varus and complete follow-up; exclusions: knee infection, instability, contracture, dislocation, or pan-compartmental osteoarthritis. Postoperatively, early full-weight-bearing rehabilitation was applied, with follow-ups at 6 weeks, 3 months, 6 months, 12 months, and annually. Primary outcome: bone healing (modified van Hemert score, standing radiographs). Secondary outcomes: hospital for special surgery knee score (HSS), visual analogue scale (VAS), time to full-weight-bearing walking, and radiographic parameters (joint line convergence angle [JLCA], femur-tibia angle [FTA], hip–knee–ankle angle [HKA], mechanical medial proximal tibial angle [mMPTA], mechanical axis deviation [MAD], weight-bearing line [WBL] ratio, posterior tibial slope [PTS]). Postoperative complications were recorded and compared between both groups. Statistical analyses used the Mann–Whitney U test for continuous data and the chi-square test for categorical data.

Results: Mean age was 48.7 ± 3.9 years, with a mean follow-up of 50.0 ± 7.0 months (range: 29.4–59.0). Group A had significantly higher bone healing scores at 6 weeks, 3 and 6 months (3.0 ± 0.8 vs. 1.6 ± 1.0, 3.4 ± 0.5 vs. 2.0 ± 0.9, 4.3 ± 0.5 vs. 2.9 ± 0.9, respectively, all p < 0.01), with no difference at 1 year (4.8 ± 0.4 vs. 4.4 ± 0.5, p = 0.075). Time to full-weight-bearing walking was significantly shorter in Group A (18.7 ± 3.2 vs. 54.4 ± 15.3 days; p < 0.001). Both groups showed significant postoperative improvements in VAS, HSS scores, and radiographic parameters (MAD, WBL ratio, mMPTA, HKA; all p < 0.01 vs. preoperative values), with no intergroup differences in these metrics (preoperative or postoperative). Overall complication rates were similar (20% vs. 60%; p = 0.074), but Group A had a lower incidence of delayed union (0% vs. 40%; p = 0.011). The statistical power for 1-year bone union grades was 0.65 (G*Power, effect size = 0.883).

Conclusion: 3DP porous tantalum wedges in OWHTO accelerate bone healing (up to 6 months), reduce time to full-weight-bearing walking, and lower delayed union rates compared to allogeneic chip bone, thereby establishing them as a promising option for future surgical interventions. Further large-scale, long-term trials are needed to confirm these benefits.

Objectives: Cage retropulsion (CR) is a common complication following posterior lumbar interbody fusion (PLIF). Symptomatic patients with CR often require revision surgery. However, there is a lack of literature supporting the effectiveness of conservative treatment for CR. This study compares clinical and radiographic outcomes between conservative treatment and revision surgery in patients with CR after PLIF.

Methods: A total of 55 patients with CR after PLIF treated at our institution between 2016 and 2023 were retrospectively reviewed; postoperative radiographic data of follow-up were used to diagnose CR. Clinical outcomes were assessed before therapy and at the final follow-up using the visual analog scale (VAS) for lower back pain and leg pain, Oswestry Disability Index (ODI) scores, and Japanese Orthopedic Association 29 (JOA-29) scores. The treatment effectiveness was evaluated based on whether the score change reached the minimally clinically important difference (MCID). Radiographic indicators included the fusion rates, the extent of CR into the spinal canal, and the total displacement distance. Continuous variables were compared using independent samples t-tests or Mann–Whitney U tests, while categorical variables were analyzed using Chi-square or Fisher's exact tests, as appropriate. A p-value < 0.05 was considered statistically significant.

Results: The fusion rates at the final follow-up for the conservative treatment group and the revision surgery group were 87.5% and 84.6%, respectively. There were no significant differences in final follow-up fusion rates, lower back pain VAS scores, leg pain VAS scores, JOA scores, or ODI scores between the two groups (all p > 0.05). Additionally, there was no difference in the proportion of patients whose lower back pain VAS, ODI, and JOA scores achieved MCID between groups (all p > 0.05). However, in the revision surgery group, the proportion of patients whose leg VAS scores reached MCID was significantly higher than in the conservative group (p = 0.001). In the revision surgery subgroup analysis, patients who did not achieve leg VAS MCID demonstrated significantly more severe cage retropulsion distance compared to MCID achievers (p = 0.03).

Conclusions: Conservative treatment yields satisfactory outcomes in mild, symptomatic CR patients, particularly for low back pain. For patients with a CR distance less than 8.8 mm, conservative treatment and revision surgery showed comparable outcomes, whereas when the CR distance is ≥ 8.8 mm, revision surgery was recommended to improve clinical results. Both conservative treatment and revision surgery can yield favorable outcomes when appropriately indicated.

Objective: Since the 1960s, although open reduction and internal fixation for ankle fractures has been widely used, it is associated with complications such as wound dehiscence, infection, prominent hardware, and failure. Closed reduction and internal fixation, on the other hand, offers greater biomechanical strength, requires minimal incisions, and features low-profile hardware. Our study compares the efficacy of elastic locking intramedullary nails (ELIN) fixation featuring minimally invasive microenvironmental protection microstress shielding versus rigid internal fixation (RIF) for trimalleolar fractures.

Methods: This retrospective study included a total of 39 patients (2020–2024), comprising 10 men and 29 women (mean age, 55.9 years), who were assigned to the ELIN group or the RIF group. Comparing the different variables between the two groups, including surgical incision length, intraoperative blood loss, operative time, time until union, time to device removal, AOFAS scores, ankle dorsiflexion, and plantar flexion, postoperative complications, and patient satisfaction. The surgical incision length, intraoperative blood loss, and operative time conformed to a normal distribution, so the independent t-tests were used for statistical analysis. Time until union, time to device removal, AOFAS scores, ankle dorsiflexion, and plantar flexion, and patient satisfaction did not conform to a normal distribution; thus, the Mann–Whitney U test was adopted.

Results: All 39 patients were completed the surgery successfully. ELIN fixation is superior to RIF in surgical incision length (p < 0.001), intraoperative blood loss (p = 0.047), operative time (p < 0.001), time until union (p = 0.003), and time to device removal (p < 0.001), with significant differences in the above parameters between the two groups. The AOFAS scores (p = 0.553), ankle dorsiflexion (p = 0.904), and plantar flexion (p = 0.799) were not significantly different between the two groups. One case of ankle pain was reported in each group at the sixth month postoperatively. By the end of the follow-up, the pain in these two cases had lessened or even disappeared after the patients reduced weight bearing on the injured ankle joint and took non-steroidal anti-inflammatory drugs under medical guidance. There was a surgical incision infection case in the RIF group, which healed after 3 weeks following daily wound dressing and use of sensitive antibiotics.

Conclusion: Compared with RIF, ELIN offers advantages including minimally invasive procedures, faster fracture union, shorter time to device removal, a more aesthetically pleasing appearance of the wound, and high patient satisfaction in treating trimalleolar fractures. These advantages well embody the concept of enhanced recovery after surgery. In contrast to traditional intramedullary fixation, ELIN realized locking fixation, reducing the risk of nail backing out and even nail fracture; however, it is more difficult to remove the nail.

Objective: Lateral lumbar interbody fusion technology may have a protective effect on the paravertebral and spinal ligaments during surgery, resulting in positive effects on bone mineral density (BMD). However, evidence is lacking on the change in vertebral bone density of patients. The changes in bone density in patients after lumbar fusion surgery are closely related to the occurrence of mechanical complications such as proximal border kyphosis, screw extraction, and adjacent vertebral fractures. Therefore, the aim is to investigate the changes in the volumetric bone mineral density (vBMD) of the adjacent vertebral cancellous bone and endplate at the fusion level in patients undergoing lateral lumbar interbody fusion (LLIF).

Methods: The medical records of patients with lumbar degenerative diseases who underwent LLIF surgery in our hospital from March 2018 to October 2021 were retrospectively examined. The volumetric BMD of the cancellous bone and endplate adjacent to the lumbar fusion segment was measured before the operation and during postoperative follow-up. The measured volumetric BMD included the level of the upper/lower instrumented vertebra and the endplate (UIV + 1; LIV + 1; UIV + 1e; and LIV + 1e). Shapiro–Wilk test, one-way ANOVA, Mann–Whitney test, Fisher exact test, univariable, and receiver operating characteristic (ROC) curve analysis were executed in this study.

Results: A total of 32 patients were included in the study, including 27 women and 5 men, with a mean age of 60.1 ± 7.1 years. The preoperative vBMD values in the UIV + 1, LIV + 1, UIV + 1e, and LIV + 1e groups were greater than those at the postoperative follow-up (131.9 ± 34.8 vs. 115.8 ± 30.8; 134.8 ± 37.0 vs. 117.2 ± 32.1, p < 0.001; 312.9 ± 79.3 vs. 287.7 ± 85.2, p = 0.007; 314.7 ± 71.4 vs. 296.1 ± 59.8, p = 0.042). The vBMD changes and rates of change in the cancellous and endplate regions were 16.1% ± 17.7% (11.4% ± 13.0%), 12.2% ± 12.1% (17.3% ± 17.5%), 11.4% ± 18.3% (−25.2% ± 49.2%), and 7.2% ± 18.5% (−18.6% ± 49.8%) in the UIV + 1, LIV + 1, UIV + 1e, and LIV + 1e groups, respectively. There was no significant difference in the preoperative vBMD, postoperative vBMD, or percent vBMD change between UIV + 1 and LIV + 1. However, there was a significant difference in the endplate vBMD at follow-up (p = 0.035).

Conclusion: We evaluated the changes of vBMD of the cancellous bone and endplates adjacent to the vertebral body, cephalad or caudal to the fused level in LLIF patients through QCT, and can provide a new approach for reducing the occurrence of mechanically related complications after vertebral fusion surgery.

Objectives: The treatment of extensive acetabular bone defects presents significant challenges in revision total hip arthroplasty (rTHA). Custom-made implants, tailored to patient-specific anatomy via 3D printing, offer potential advantages regarding implant stability and alignment. Precise positioning of these large-volume implants is crucial for primary stability and long-term fixation, but can be surgically demanding, especially when intramedullary iliac press-fit stems are used. In contrast to triflange custom-made implants, data on the implantation accuracy of custom-made acetabular components with iliac stem fixation remain limited. This study aimed to assess the accuracy of implant positioning by comparing preoperatively planned component positions with postoperative radiographic outcomes, focusing on anteversion (AV), inclination (INCL), and the center of rotation (CoR).

Methods: In this retrospective cohort study, 24 patients with large acetabular defects (Paprosky ≥ 3A) underwent rTHA with custom-made acetabular components with intramedullary press-fit iliac stem fixation between November 2022 and April 2024. Implantation accuracy was evaluated by comparing the planned positions on preoperative CT scans with the actual implant positions observed on 6-week postoperative radiographs using a previously validated methodology. Discrepancies in AV, INCL, and the CoR were analyzed.

Results: A high degree of alignment with preoperative plans was observed. The mean postoperative AV was 9.96° ± 6.4° (planned: 10.2°), and the mean INCL was 46.3° ± 3.2° (planned: 44.6°). The deviations were minor (Δ AV: −0.25°, Δ INCL: 1.7°), confirming the precision of implant placement. Four implants had CoR deviations exceeding 5 mm cranially (mean cranial shift: 1.77 ± 3.97 mm), and five exceeded 5 mm laterally. Most deviations were within clinically acceptable ranges.

Conclusions: Our findings demonstrate that custom-made acetabular components with iliac stem fixation can be implanted with high accuracy. Moreover, our results support the use of standard radiographs for the postoperative assessment of implant positioning precision. This study provides valuable insights into the accuracy of implant placement in complex rTHA cases, highlighting the role of patient-specific implant technologies in enhancing surgical outcomes.

Objective: Knee osteoarthritis (KOA) is a prevalent condition characterized by cartilage degeneration, tissue destruction, and bone hyperplasia, with pain being the primary symptom. High tibial osteotomy (HTO) has emerged as an effective treatment for symptomatic unicompartmental KOA, focusing on realigning force vectors to redistribute mechanical stress and alleviate pain. This study aims to address the question of whether two-dimensional (2D) and three-dimensional (3D) preoperative planning methods yield different correction angles and distraction distances in open-wedge high tibial osteotomy (OWHTO). By comparing these methodologies, we seek to evaluate their impact on surgical outcomes and patient prognosis.

Methods: A retrospective analysis was conducted involving patients diagnosed with unicompartmental medial knee osteoarthritis (KOA) who exhibited deviations in the mechanical axis of the lower limbs. These patients underwent OWHTO between January 2021 and August 2022. Both 3D and 2D preoperative planning procedures for OWHTO were employed, targeting an ideal alignment with the weight-bearing line (%WBL) set at 62.5%. The study quantitatively assessed the differences in correction angles and distraction distances associated with the two surgical planning methods using paired t-tests and non-parametric Wilcoxon signed-rank tests.

Results: The study comprised a total of 102 patients. It was observed that the mean correction angle in the 2D approach was significantly greater than that recorded in the 3D approach (p < 0.001), with an average difference of 1.49° ± 1.70°. The medial opening gap differences for OWHTO between the two approaches measured 2.1 ± 2.06 mm.

Conclusions: To summarize, the 2D preoperative planning method for OWHTO necessitates a larger correction angle and a wider medial opening gap relative to the 3D planning approach when aiming for the same WBL. Therefore, it is crucial for surgeons to take into account the variances between 2D and 3D planning and to evaluate potential correction errors during the surgical procedure while strategizing for OWHTO.

Objective: Percutaneous vertebroplasty (PVP) is a widely used minimally invasive procedure for the treatment of osteoporotic vertebral compression fracture (OVCF), yet accelerating postoperative recovery and reducing complications remain critical clinical challenges that require urgent resolution. This study aimed to evaluate the clinical effectiveness of an optimized perioperative management strategy based on the Enhanced Recovery After Surgery (ERAS) concept in patients undergoing PVP.

Methods: From May 2022 to April 2024, a total of 301 patients with OVCF who underwent PVP were retrospectively enrolled in the retrospective cohort study. Using May 2023 as the implementation time point for the optimized perioperative management strategy in our department, all subjects were divided into the traditional group (155 cases) and the optimized strategy (ERAS) group (146 cases). The two groups were analyzed for visual analog scale (VAS) scores for low back pain at various time points before and after surgery, Oswestry Disability Index (ODI) at preoperative and 3 months postoperatively, postoperative first ambulation time, total length of hospital stay (LOS), postoperative LOS, postoperative rehydration volume, and postoperative complications. Group comparisons of continuous variables were performed using independent samples t-tests or Mann–Whitney U tests, while categorical variables were compared using χ² tests or Fisher's exact tests. p-value < 0.05 was considered statistically significant.

Results: Compared to the traditional group, patients in the ERAS group exhibited significantly lower VAS pain scores at 2 and 4 h postoperatively, earlier postoperative first ambulation time, shorter total and postoperative LOS, and reduced postoperative intravenous rehydration volume (p < 0.05). However, no statistically significant differences were observed between the two groups in preoperative VAS scores, VAS scores at 24 h postoperatively and on the day of discharge, as well as in ODI scores both preoperatively and at 3 months postoperatively (p > 0.05). Additionally, the complication rates were similar between the two groups (p > 0.05).

Conclusion: For patients with OVCF, performing PVP under the optimized perioperative management strategy facilitates early pain relief, reduces the average LOS, shortens the postoperative first ambulation time, and significantly improves perioperative clinical outcomes.

Objective: Modic changes (MC) are pathological signal alterations occurring in the vertebral endplates and adjacent bone marrow. These changes are frequently linked to degenerative disc diseases and are associated with low back pain symptoms. However, despite increasing research interest, existing studies are fragmented, mostly descriptive, and lack a comprehensive, quantitative assessment of research patterns, hotspots, and collaboration networks in this field. This study aims to evaluate the current research landscape and global trends regarding spinal MC using bibliometric analysis.

Methods: We retrieved relevant publications on spinal MC from the Web of Science Core Collection database, spanning January 2004 to August 2024. Using CiteSpace, we conducted a comprehensive analysis of keywords, co-authors, institutions, countries, research domains, cited literature, cited authors, and cited journals.

Results: This study analyzed 603 articles published in 168 journals from 193 countries. China emerged as the leading contributor in terms of publication volume, while the University of Oulu in Finland demonstrated the most significant institutional impact. J. Karppinen was identified as the most prolific author, whereas M. Modic was the most frequently cited. Among journals, Spine accounted for the highest number of publications and citations. Key research hotspots identified through keyword analysis include “degenerative disease,” “bone marrow changes,” “abnormalities,” “type II changes,” “lower back,” “protrusion,” “discectomy,” “paraspinal muscles,” “obesity,” and “overweight”.

Conclusion: This study represents the first known bibliometric analysis and visualization of MC, offering clinicians valuable insights into research priorities and directions. Future investigations should prioritize the classification, pathophysiological mechanisms, and clinical significance of different types of MC, especially their roles in pain and functional impairment. Research should also explore the impact of obesity and paraspinal muscles on the progression of MC. Moreover, studies should examine the potential benefits of weight loss and muscle strengthening in alleviating symptoms. Finally, researchers should focus on leveraging artificial intelligence to improve the identification and understanding of MC.

Background: Lumbar spondylolisthesis (LS) is a spinal disorder that often necessitates surgical intervention. However, evidence on the comparative clinical value of robot-assisted full-endoscopic transforaminal lumbar interbody fusion (RA FE-TLIF) versus conventional FE-TLIF in early-grade (Grades I and II) LS remains limited, leaving uncertainty about its true clinical value in this patient population. This study aims to compare the clinical efficacy and safety of FE-TLIF with RA FE-TLIF in patients with Grade I and II LS.

Methods: A retrospective analysis was conducted on 47 patients who underwent surgical treatment for LS between April 2022 and April 2023 at our hospital. Patients were divided into two groups: 22 underwent RA FE-TLIF, and 25 underwent FE-TLIF. Key outcomes measured included operative time, intraoperative blood loss, postoperative recovery time, fusion rate, screw placement accuracy, Visual Analogue Scale (VAS), the Japanese Orthopaedic Association (JOA) scores, and the incidence of postoperative complications. Statistical analyses were performed using the independent-sample t test for continuous variables and the chi-square test for categorical variables, with a significance threshold of p < 0.05.

Results: The RA FE-TLIF group exhibited significantly shorter operative times and lower intraoperative blood loss compared to the FE-TLIF group (p < 0.05). Postoperative recovery, as measured by hospital stay, was also shorter in the RA FE-TLIF group (p = 0.001). VAS and JOA scores indicated greater pain relief and functional improvement in the RA FE-TLIF group, with statistically significant differences observed at both 1 month and final follow-up (p < 0.05). The incidence of postoperative complications was lower in the RA FE-TLIF group, though this difference was not statistically significant (p = 0.144). Complete fusion rates were 95.45% in the RA FE-TLIF group and 88.00% in the FE-TLIF group, with no significant difference (p > 0.05). Screw placement accuracy was higher in the RA FE-TLIF group (97.73%) than in the FE-TLIF group (89.00%), with a significant difference (p < 0.05).

Conclusion: RA FE-TLIF demonstrates superior clinical outcomes compared to FE-TLIF in the treatment of LS. These findings support the broader adoption of RA FE-TLIF as a preferred surgical technique for this condition.

Objective: If the appropriate internal fixation surgical method is not adopted for femoral neck fractures in young people, it may lead to serious consequences such as poor fracture healing and femoral head necrosis, affecting the quality of life and working ability of young people. Therefore, it is crucial to conduct in-depth research on the internal fixation surgical methods. This study compared the therapeutic effects of triple cannulated screws combined with a bone graft sleeve for parallel implantation of DBM Crunch internal fixation (CCSBGS) and cannulated compression screws (CCS).

Methods: Medical records on the young and middle-aged patients with femoral neck fracture treated with two different internal fixation methods from January 2020 to June 2023 were collected and retrospectively analyzed in the Trauma Emergency Center of the Third Hospital of Hebei Medical University. Two internal fixation groups are: CCSBGS group with 50 patients, 35 males and 15 females, aged (42.44 ± 14.07) years; CCS group with 80 males and 39 females, aged (41.5 ± 13.48) years. This study compared the outcome measures of two groups of patients, including Garden alignment index, Operation duration time, Intraoperative blood loss, Length of hospital stay, Postoperative complications, Femoral neck shortening, Postoperative ambulation time, Walking with sticks, Barthel score, and Harris score.

Results: There was a statistically significant difference in blood loss between the CCS group and the CCSBGS group; at the same time, the amount of bleeding in the CCS group was lower than that in the CCSBGS group (p < 0.01). During the follow-up period, there was a statistically significant difference in the incidence of osteonecrosis of the femoral head among the two groups (p < 0.05), 20 patients in the CCS group and 2 patients in the CCSBGS group developed osteonecrosis of the femoral head. At the last follow-up, the average degree of femoral neck shortening in the CCSBGS group [(0.49 ± 0.28) cm] was significantly lower than that in the CCS group [(0.87 ± 0.35) cm] (p < 0.05). Meanwhile, the postoperative ambulation time of the CCSBGS group is earlier than that of the CCS group (p < 0.05). In addition, the CCSBGS group had the highest Barthel scores [(95.50 ± 2.90)] (p < 0.05). The average Harris score in the CCSBGS group [(92.52 ± 2.41)] was higher than that in the CCS group [(90.47 ± 2.88)] (p < 0.05).

Conclusions: Compared with CCSBGS and CCS, CCSBGS shows better efficacy in terms of quicker return to weight-bearing activities, preservation of femoral neck length, reduction of the rate of osteonecrosis of the femoral head, and overall enhancement of hip function.

Objective: Incorporating the sagittal stable vertebra (SSV) in posterior spinal fusion (PSF) may reduce postoperative distal junctional kyphosis (DJK) in adolescent idiopathic scoliosis (AIS), but its determination varies across reference methods and may be affected by patient posture. This study aims to investigate the SSV determined by different sagittal reference lines in predicting the risk of DJK after PSF in AIS patients.

Methods: This retrospective cohort study evaluated AIS patients with Lenke Type 1 or 2 curves treated with PSF between January 2009 and July 2017. The inclusion or exclusion of SSV in PSF based on SSV determined by different reference lines was assessed for its association with the postoperative DJK. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and odds ratio were calculated.

Results: One hundred twenty-two patients (mean age at surgery: 15.1 ± 3.2 years) were included with the incidence of postoperative DJK 6.6%. PSF with the exclusion of SSV, defined by the vertebral level at which 50% of the vertebral body was anterior to the posterior sacral vertical line (PSVL), the midline between PSVL and the C7 plumb line (PSVL-C7PL Midline), and the line connecting the center point of the C7 vertebral body and the posterior superior corner of the sacrum (C7PSL), was significantly associated with the occurrence of postoperative DJK. Among the evaluated reference lines, PSVL demonstrated numerically higher sensitivity, NPV, odds ratio, and area under the curve (AUC), although these differences in AUC did not reach statistical significance.

Conclusions: Although there are concerns about whether standing posture affects the SSV determined by a specific reference line, this study demonstrates that PSVL might be an effective and convenient reference line for identifying SSV.

Purpose: Curved intertrochanteric varus osteotomy (CVO) is a joint-preserving option for young patients with osteonecrosis of the femoral head (ONFH), but postoperative leg length discrepancy (LLD) remains a concern. This study investigated factors associated with leg shortening in both the early postoperative phase (P1) and the healing phase until bone union (P2).

Methods: This retrospective study included 48 patients (51 hips) with non-traumatic ONFH who underwent CVO. Radiographic evaluations were performed preoperatively, immediately postoperatively, and at bone union. Pearson's correlation coefficient was used to correlations between radiographic parameters and leg shortening in P1 and P2. Patients were divided into groups based on whether leg shortening ≥ 5 mm was observed in each phase, and statistical comparisons were conducted. Multivariate logistic regression analyses were performed to identify independent risk factors for leg shortening ≥ 5 mm.

Results: Leg shortening ≥ 5 mm occurred in 17.6% of hips in P1 and 47.1% in P2. Lateral shift of the osteotomy arc center correlated with leg shortening in P1 (r = 0.689, p < 0.0001). Varus angle and changes in femoral anteversion were also correlated in both P1 and P2 (P1: r = 0.362/0.322; P2: r = 0.404/0.754, all p < 0.05). Greater varus angle and lateral/distal shift of the osteotomy center were significantly associated with P1 shortening. In P2, greater changes in femoral anteversion, increased osteotomy distance from the midpoint of the lesser trochanter, and larger varus angle were significant factors. Multivariate analysis identified lateral shift of the osteotomy center as an independent predictor in P1 (OR, 1.30; 95% CI, 1.06–1.81; p = 0.004). In P2, change in femoral anteversion was an independent predictor of leg shortening ≥ 5 mm (OR: 1.24, 95% CI: 1.07–1.51; p = 0.003).

Conclusion: Leg shortening post-CVO progresses during surgery and bone healing. Careful surgical planning and postoperative management, particularly in cases requiring extensive varus correction or anteversion changes, is essential for minimizing LLD and optimizing outcomes.

Objective: Adult thoracolumbar kyphosis secondary to osteoporotic vertebral fractures (OVF) impairs the quality of life. Traditional 3CO provides correction but carries a high risk of complications, especially in the elderly. Minimally invasive anterior approaches may be safer. This study aims to compare the radiographic and clinical outcomes of septuagenarians with thoracolumbar kyphosis treated with single-position navigated lateral column realignment with anterior longitudinal ligament release (LCR-A) plus posterior column osteotomy (PCO) and posterior spinal fusion (PSF), or percutaneous pedicle screws (PPS) versus three-column osteotomy (3CO).

Materials and Methods: This retrospective study included 21 patients with LCR-A and 54 with 3CO prospectively treated between March 2020 and April 2024. Radiographic parameters, the Oswestry Disability Index (ODI), SRS-22 scores, complications, and perioperative data were analyzed over a 2-year follow-up period.

Results: Although LCR-A patients were older, they had significantly reduced blood loss, shorter operative times, and fewer fused levels than 3CO patients. LCR-A achieved comparable deformity correction, with fewer complications, lower postoperative ODI, and better SRS-22 scores. The LCR-A group maintained radiographic correction, with fewer new neurological deficits and lower rates of infection, ileus, and delirium.

Conclusions: Single-position navigated LCR-A is a safer and less invasive alternative to 3CO in elderly patients with thoracolumbar kyphosis, offering effective deformity correction, fewer complications, improved functional outcomes, and enhanced recovery.

Level of Evidence: IV.

Objective: In spinal surgery, precise identification of high-speed bur milling states is crucial for patient safety. This study investigates whether integrating tactile and auditory perception can enhance the accuracy of milling state detection in robot-assisted cervical laminectomy.

Methods: Based on the mathematical and physical model of vibration and sound in high-speed bur milling bone, the feasibility of employing vibration and sound characteristics to identify the milling states of high-speed bur is studied systematically. Cervical laminectomy was performed on the cervical spine of the sheep. During the signal acquisition process, acceleration sensors and microphones were installed to collect vibration and sound signals, respectively. Seven milling states were set up in the experiment: (1) Milling depths of cortical bone (CTB): 0.5, 1.0, and 1.5 mm; (2) Milling depths of milling of cancellous bone (CCB): 0.5, 1.0, and 1.5 mm; (3) Boundary conditions: high-speed bur idling or complete penetration of bone (PT). The milling speed was set at 0.5 mm/s, the milling angle was 45°, and the bur diameter was 4 mm. The vibration or sound was extracted by Fast Fourier Transform (FFT) in the frequency domain of the first nine harmonics to generate the feature vector in 9 dimensions (9-D) space. These vibration and sound features were combined to form an 18-D multi-perception spatial vector for subsequent analysis, including five machine learning algorithms: Support Vector Machine (SVM), K Nearest Neighbors (KNN), Naive Bayes (NB), Linear Discriminant Analysis (LDA), and Decision Tree (DT), and deep learning models: Long Short-Term Memory networks (LSTM).

Results: Based on the 18-D features of tactile and auditory multisensory fusion, the LSTM model is trained using 6600 sets of high-speed bur milling data. In order to achieve the best performance, a layer-by-layer parameter optimization strategy was used to determine the optimal parameter configuration, and finally, a single-layer LSTM with 12 memory units was constructed. In terms of accuracy and stability, the model is significantly superior to the machine learning algorithms (SVM, KNN, NB, LDA, and DT), and the accuracy of LSTM is 99.32% in the milling states identification of cervical lamina milling with high-speed bur.

Conclusion: Through theoretical analysis and experimental verification, the study built a multi-perception fusion framework based on tactile and auditory perception and accurately identified the cervical vertebra milling states through the LSTM model, which can provide perception means for operational spinal surgery robots in the future.

Objective: Conversion to hip arthroplasty (cHA) is a widely utilized and effective surgical intervention for addressing the failure of internal fixation in intertrochanteric femoral fractures (FIF-INF). Although previous studies have confirmed that the failure rate of internal fixation is higher in unstable intertrochanteric femoral fractures, but whether the efficacy and complications of cHA after failure differ from those in stable fractures remains unclear. This study aimed to evaluate and compare the clinical and radiological outcomes, as well as the incidence of complications associated with hip arthroplasty over a minimum follow-up period of 3 years after the failure of internal fixation in both stable and unstable intertrochanteric femoral fractures.

Methods: This multicenter study retrospectively analyzed patients who underwent hip arthroplasty subsequent to the failure of FIF-INF from December 2012 to December 2020 at various participating research centers. Cases demonstrating excellent and acceptable quality fracture reduction, as defined by the criteria established by Chang et al., were included. According to AO/OTA classification criteria of intertrochanteric fractures, the fractures were classified into stable fractures (31-A1) and unstable fractures (31-A2, A3). There were 47 patients with stable fractures and 56 patients with unstable fractures. Clinical and radiological evaluations were conducted for all patients. This study employed independent samples t-tests, χ² tests or Fisher's exact test, and both univariate and multivariate logistic regression analyses.

Results: A total of 103 patients were analyzed. The HHS in the stable group improved from a preoperative mean of 47.08 ± 5.50 to 89.13 ± 4.75 at the final follow-up, whereas that in the unstable group increased from 45.43 ± 6.36 to 83.87 ± 4.67. The improvement scores for the stable and unstable groups were 42.05 ± 4.69 and 38.81 ± 3.06, respectively, with a statistically significant difference (p < 0.0001). VAS scores decreased from the preoperative levels of 7.13 ± 0.92 and 7.61 ± 0.82 to 2.36 ± 0.87 and 2.91 ± 0.79, respectively, indicating a significant reduction in pain in both groups; however, the unstable group reported more severe postoperative pain (p = 0.001). The incidence of postoperative complications following cHA was significantly greater in the unstable group (28.57%) than in the stable group (10.64%) (p = 0.047).

Conclusion: cHA is an effective treatment modality for the failure of internal fixation in intertrochanteric femoral fractures. Compared with stable fractures, patients with initial unstable fractures that have failed experience a greater incidence of postoperative complications, relatively poorer joint function, and more pronounced pain following cHA.

Objectives: Knee osteoarthritis (OA) is a common cause of pain and disability, and conventional conservative treatments often provide only limited and temporary relief. Platelet-rich plasma (PRP) injections have emerged as a promising biological therapy; however, patient response is highly variable, and biomechanical factors such as lower extremity malalignment may influence treatment outcomes. This study aimed to evaluate the effect of the lower extremity mechanical axis angle (MAA) on the clinical efficacy of PRP injection therapy in improving knee function and pain in patients with OA.

Methods: A total of 210 patients with knee OA who consented to PRP treatment between January 1, 2018, and January 1, 2023, were enrolled. Patients were stratified into three groups according to baseline varus angle: Group 1, 0°–5° (n = 70); Group 2, 6°–10° (n = 70); and Group 3, 11°–15° (n = 70). Clinical evaluations were performed at baseline and at 1, 3, 6, 12, and 24 months post-treatment using the Knee Injury and Osteoarthritis Outcome Score (KOOS), Kujala Patellofemoral Score, knee joint range of motion (ROM), MAA measurement, and a Visual Analogue Scale (VAS) for pain.

Results: All groups demonstrated significant improvements in pain and functional scores over the 24-month follow-up compared to baseline (p < 0.001), with the most notable gains observed at 3 and 6 months. At 3, 6, and 12 months, Group 1 achieved significantly better VAS and KOOS Pain subscale scores than Group 3 (p < 0.05). Both Groups 1 and 2 had higher KOOS Total scores than Group 3 at these time points (p < 0.05). Spearman correlation analysis revealed moderate negative associations between baseline MAA and changes from baseline to 6 months in VAS (ρ = −0.58), KOOS Total (ρ = −0.54), and Kujala scores (ρ = −0.53) (all p < 0.001). Statistical analyses were conducted using ANOVA or Kruskal–Wallis tests as appropriate, and effect sizes (Cohen's d) with 95% confidence intervals were calculated.

Conclusion: PRP injection therapy yields significant improvements in pain and functional outcomes in patients with knee OA. However, increased MAA is associated with reduced clinical benefit, indicating that baseline lower extremity alignment should be considered in treatment planning.