Far lateral lumbar disc herniation (FLLDH) is a subtype of lumbar disc herniation marked by severe radicular and lower back pain, often accompanied by sensory and motor dysfunction. Microscopic tubular discectomy (MTD) is a contemporary minimally invasive approach for treating FLLDH, yet its superiority over conventional discectomy remains inconclusive. The purpose of this systematic review was to assess the effectiveness of MTD in improving pain and mobility for FLLDH patients. A secondary aim was to assess the safety of MTD. Primary outcome measures were patient-reported pain, assessed using a visual analog scale (VAS), patient-reported mobility, assessed using the Oswestry Disability Index (ODI), and scores on the Modified MacNab criteria clinical assessment. Secondary outcome measures were mean blood loss, operation duration, hospital stay, reherniation rate, reoperation rate, and any peri- or postoperative complications. MEDLINE, Embase, and Scopus were searched for empirical studies on MTD for FLLDH, reporting pain or mobility outcomes. Data extracted included study design, participant characteristics, pre- and postmean scores for pain and mobility, blood loss, operation time, hospitalization duration, reherniation rate, and complications. Articles were quality appraised using Joanna Briggs Institute (JBI) quality appraisal tools. Of 271 articles identified, 15 were included. Preoperative leg pain scores ranged from 5.5 to 8.6, and postoperative scores ranged from 1.2 to 3.8. For lower back pain, preoperative scores ranged from 2.4 to 7.6, with postoperative scores from 1 to 4.8. Seven studies assessed mobility using the ODI, reporting significant improvements; pre-operative scores ranged from 30.6 to 56.7, and postoperative scores ranged from 5.5 to 30.3. Seven studies used the Modified MacNab criteria, reporting excellent outcomes in 18.2%–71% of patients, good in 23%–54.5%, fair in 0%–18.2%, and poor in 0%–18%. Mean blood loss ranged from 30 to 70 mL, mean operation times from 43 to 126 min, and average hospital stays were, on average, ≤ 4 days. Reherniation was minimal, and the reoperation rate was low. Complications were rare, primarily transient neuropraxic symptoms. This review comprehensively synthesized empirical research on the effectiveness and safety of MTD for treating FLLDH. Overall, the findings indicate that MTD can reduce pain and improve mobility in patients with FLLDH, but limited sample sizes, variable follow-up periods, and a lack of controlled studies constrain definitive conclusions about MTD's superiority over other discectomy techniques.

PROSPERO registration number: CRD42023443900

Thoracolumbar fractures are a prevalent clinical disease, with several surgical techniques, including traditional freehand pedicle screw fixation (TFPSF), conventional fluoroscopy (C-arm) percutaneous pedicle screw fixation (CPPSF), O-arm-assisted percutaneous pedicle screw fixation (OPPSF), and robot-assisted percutaneous pedicle screw fixation (RPPSF), being currently applied. However, a comprehensive comparison of their relative efficacy across multiple perioperative and functional outcomes is lacking, leading to uncertainty in optimal technique selection. This network meta-analysis (NMA) evaluates and compares the clinical efficacy of these four surgical techniques to identify the most effective intervention and guide clinical decision-making. Researchers independently searched PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science for studies published before September 20, 2024. Studies were selected based on stringent eligibility criteria. Randomized controlled trials (RCTs) were assessed using RoB 2.0, while cohort studies were evaluated with the Newcastle–Ottawa Scale (NOS). After data extraction, Bayesian network analysis was executed using R 4.2.2 and Stata 16.0. Nineteen studies were included, encompassing 1344 patients with thoracolumbar fractures. For screw accuracy, OPPSF ranked highest (SUCRA = 92.7%), significantly outperforming TFPSF (RR 1.12; 95% credible intervals [CrI] [1.04, 1.23]) and CPPSF (RR 1.12; 95% CrI [1.04, 1.22]), with RPPSF also surpassing both. OPPSF showed superior intraoperative blood loss reduction (SUCRA = 79.8%) while TFPSF had significantly more bleeding than others. For hospitalization, RPPSF ranked highest (SUCRA = 65.0%) but CPPSF significantly shortened stays versus TFPSF (MD −2.24; 95% CrI [−4.48, −0.03]). CPPSF also showed better pain control (SUCRA = 77.9%) with significantly lower VAS scores versus TFPSF (MD −1.02; 95% CrI [−1.71, −0.37]). RPPSF demonstrated the lowest complication risk (SUCRA = 94.9%), with both CPPSF and RPPSF showing significant reductions versus TFPSF. Additionally, although CPPSF ranked first in SUCRA for both operative time (SUCRA = 81.6%) and Cobb angle (SUCRA = 72.4%), the pairwise comparisons did not demonstrate statistical significance, necessitating cautious interpretation. In summary, OPPSF tends to demonstrate superior precision and blood loss control, CPPSF may optimize rehabilitation efficiency, while RPPSF appears to be the safest technique. Technique selection should balance clinical outcomes, economic feasibility, and patient-specific priorities.

This scoping review summarizes the evidence regarding sociodemographic disparities in long-term (≥ 6 months postoperative) functional outcomes after total hip and knee arthroplasty (THA/TKA). Five databases were searched by a librarian. US-based original research articles that reported on long-term functional outcomes after THA/TKA by sex, race, ethnicity, socioeconomic status, and/or geography were included. Seventy-nine articles met inclusion criteria. Fifty-four articles reported on sex disparities, with 60% of post-THA and 51% of post-TKA outcomes finding that men had a better long-term functional outcome than women. Across the 34 articles and 72 outcomes that examined the variable of race or ethnicity, 63% of post-THA outcomes and 69% of post-TKA outcomes found White patients had better long-term function compared to minoritized patients. In the 24 articles and 47 outcomes that examined socioeconomic status (SES) in relation to long-term function, 63% of post-THA and 71% of post-TKA outcomes indicated higher SES was associated with better long-term function. Only 3 of the 79 studies looked at geography. None found significant disparities. The evidence from our sample shows that disparities in long-term functional outcomes post-THA/TKA likely exist for different racial, ethnic, and socioeconomic groups. There is a lack of data on smaller racial and ethnic minority populations, rural communities, and the way sociodemographic variables may interact with one another. Comparisons across studies were limited due to variation in the outcome measures used and length of follow-up. Additional research should identify patients at risk of decreased long-term function after THA/TKA and protocols to enhance their functional recovery.

Objective: The etiology of adjacent segment diseases and proximal junctional kyphosis has been related to biomechanical alterations after spinal operation. This study investigated the variation in pre- and postoperative range of motion in adjacent segments in patients with degenerative lumbar scoliosis (DLS) following posterior lumbar interbody fusion.

Patients and Methods: Eight patients with symptomatic DLS were analyzed using a biplane radiographic imaging system while adopting different postures. Synchronized biplane radiographs from L1 to S1 and the motions of each vertebra were acquired pre- and postoperatively. Six degrees of freedom (DOF) of kinematic data were compared between different postoperative pelvic incidence-lumbar lordosis (PI-LL) groups (group A: PI-LL = −10°–~10°; group B: PI-LL = 10°–~20°).

Results: After surgery, the axial rotational movement (primary rotation) during flexion–extension, bending, and torsion in the first adjacent segment at L3-4 decreased significantly in three patients (8.14 ± 2.78 vs. 15.13 ± 6.71; 8.36 ± 5.59 vs. 9.08 ± 3.57; 5.07 ± 0.56 vs. 9.25 ± 5.06). At this level, the torsion around the crania-caudal (CC) axis during bending (1.48 ± 1.01 vs. 7.05 ± 5.84, p < 0.05) and flexion around the mediolateral (ML) axis and bending rotation around the anterioposterior (AP) axis during torsion decreased postoperatively (6.37 ± 6.01 vs. 13.83 ± 8.12, 4.53 ± 1.97 vs. 13.06 ± 6.65; p < 0.05, p < 0.05). After surgery, in the L1-2 segment, translation along the ML direction decreased during bending (3.69 ± 2.12 vs. 14.76 ± 7.99, p < 0.05). In the adjacent L5-S1 segment, primary flexed rotation around the ML axis increased in group B postoperatively during flexion–extension, but decreased in group A (6.08 ± 1.17 vs. −13.41 ± 2.99, p < 0.05). Coupled flexed rotation around the ML axis decreased and showed the opposite trend during bending (−10.76 ± 5.51 vs. 18.12 ± 39.83, p < 0.05).

Conclusions: Postoperative coupled motion at the adjacent segment decreased, which indicates an improved balance of the spinal order compared to before the surgery. However, primary motion changed according to the location of the upper instrumented vertebrae. Our results indicate that postoperative PI-LL values between 10° and 20° were associated with lower coupled motion and higher primary motion at L5-S1.

Objectives: The prevertebral fascia (PVF), which constitutes part of the deep layer of the deep cervical fascia, is routinely incised during anterior cervical discectomy and fusion (ACDF) surgery. Suturing the PVF could serve as an optimal barrier between the surface of the fusion device and the posterior esophagus and may alleviate postoperative dysphagia. Thus, this retrospective study was aimed to (1) evaluate the impact of prevertebral fascia (PVF) suturing and (2) perform a multivariate analysis of relevant risk factors for postoperative dysphagia following anterior cervical discectomy and fusion (ACDF).

Methods: A total of 197 patients who underwent ACDF and had at least 1 year of follow-up between June 2020 and February 2024 were retrospectively reviewed. To compare baseline data and incidence of dysphagia, the patients were divided into two groups on the basis of whether they had undergone PVF suturing during the operation (suture group, N = 83; nonsuture group, N = 114). The incidence and severity of dysphagia were evaluated using the Bazaz grading system. The patients were further categorized into a dysphagia group (N = 56) and a nondysphagia group (N = 141) to conduct a multivariate analysis of dysphagia.

Results: Compared with the nonsuture group, the suture group presented a significantly lower incidence and severity of dysphagia at 1 week, 1 month, and 3 months postoperatively (p < 0.05). A binary logistic regression analysis revealed that advanced age (odds ratio [OR], 1.034; 95% confidence interval [95% CI, 1.006–1.063]), greater ΔC_2-7A (OR, 1.141; 95% CI, 1.056–1.232), minor ΔTS-CL (OR, 0.890; 95% CI, 0.842–0.941), and nonsutured PVF (OR, 0.329; 95% CI, 0.146–0.740) were significantly associated with higher rates of dysphagia (p  < 0.05).

Conclusion: Suturing of the PVF during ACDF can significantly decrease the incidence and severity of transient postoperative dysphagia in patients. The incidence of postoperative dysphagia is also significantly associated with advanced age, greater ΔC_2-7A, and minor ΔTS-CL.

Introduction: Patients with chronic obstructive pulmonary disease (COPD) and femoral neck fractures are at high risk for postoperative complications and mortality. One consideration to reduce risk is the type of anesthesia, although this has not been investigated. The purpose of this study was to compare 30-day complications between use of general and spinal anesthetic in patients with COPD and femoral neck fractures who underwent hip arthroplasty.

Methods: Patients with COPD treated with hip arthroplasty for femoral neck fractures were identified on the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) database between January 1, 2015 and December 31, 2020. Demographics, patient variables, and surgical variables were recorded. Patients were divided into cohorts based on general or spinal anesthetic. Propensity score matching was used to match the two groups. Thirty-day outcome measures were compared between groups using chi-squared test. Logistic regression was used to assess for risk factors for 30-day complications.

Results: Five thousand and forty patients with COPD were identified who underwent arthroplasty for femoral neck fracture—3800 with general anesthesia and 1240 patients with spinal anesthesia. The general anesthesia cohort had higher rates of diabetes (18.4% vs. 15.1%, p = 0.007), congestive heart failure (10.7% vs. 6.7%, p < 0.001), and chronic kidney disease requiring dialysis (2.6% vs. 1.5%. p = 0.019). After matching, the general anesthesia cohort had higher rates of mortality (8.4% vs. 5.8%, p = 0.042), nonhome discharge (85.5% vs. 79.2%, p < 0.001), and unplanned intubation (1.9% vs. 0.7%, p = 0.048). Logistic regression identified general anesthesia to be an independent risk factor for 30-day mortality (RR 1.514 [1.022–2.245]), nonhome discharge (1.626 [1.237–2.138]), and unplanned intubation (RR 1.488 [1.012–2.187]).

Conclusions: General anesthesia is an independent risk factor for 30-day mortality, nonhome discharge, and unplanned intubation in patients with COPD undergoing arthroplasty procedures for femoral neck fractures. If possible, spinal anesthetic should be considered as it may reduce the risk of complications in this patient population.

Objectives: Total hip arthroplasty (THA) with Ceramic-on-Ceramic (CoC) components achieved excellent outcomes. However, the long-term outcomes of anatomic and tapered stems are controversial in clinical practice, and the difference in the survival rates between the tapered stems and anatomical stems over the long term remains unknown.

Methods: A retrospective cohort study was performed to evaluate the 11-year follow-up outcomes of anatomic and tapered femoral stems. Between January 2009 and December 2011, a total of 1438 patients with COC were included in this study initially. Among these hips, 30 patients (30 hips) experienced death, and 254 hips (17.6%) were lost to follow-up. Finally, a total of 591 hips with Corail stem and a total of 334 hips with Ribbed stems were included in this study. The outcomes were evaluated by the modified Harris hip score (mHHS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and a questionnaire assessing articular noises.

Results: For the Corail stem, the survival rate with aseptic loosening or revision of any component for any reason as the endpoint was 99.1% at 11 years. The survival rate with reoperation for any reason as the endpoint was 98.8% at 11 years. For the Ribbed stem, the survival rate with aseptic loosening or revision of any component for any reason as the endpoint was 98.8% at 11 years. In patients with the Corail stem, the preoperative modified Harris hip score (mHHS) score, with a mean of 43.8 points, significantly improved to a mean of 93.5 points at the final follow-up assessment (p < 0.001). In patients with the ribbed stem, the preoperative mHHS score, with a mean of 40.9 points, significantly improved to a mean of 92.8 points at the final follow-up assessment (p < 0.001) during the follow-up period. The incidence of squeaking and squaking in the Corail group was significantly higher than that in the ribbed group (squeaking: 22.7% vs. 6.9%; squaking: 17.4% vs. 4.2%). The incidence of postoperative thigh pain was 4% in patients with the Corail stem, significantly lower than that in patients with the ribbed stem (17.4% vs. 4%; p < 0.001).

Conclusion: In conclusion, CoC THA with Corail and Ribbed stems exhibits excellent clinical outcomes at the long-term follow-up. However, the incidence of postoperative thigh pain in the Ribbed group is significantly higher than that in the Corail group, while the incidence of squeaking was lower.

Objective: Intraoperative femoral condylar avulsion fractures during total knee arthroplasty (TKA) are rare but potentially lead to joint instability and poor outcomes if not properly managed. However, the necessity of using condylar-constrained prostheses in these cases remains controversial. This retrospective study examines the incidence, management approaches, and radiological outcomes of these fractures.

Methods: A total of 47 patients (11 males, 36 females; mean age 67.1 ± 7.0 years) with femoral condylar avulsion fractures were identified from 4290 TKAs performed between January 2008 and December 2022, matched with nonfracture patients at a 1:1 ratio by age, gender, and BMI. Intraoperative fractures were treated using cancellous bone screws or nonabsorbable sutures based on the size of the fracture fragment, without the insertion of condylar constrained prostheses. All patients underwent outpatient follow-up, with data collected on preoperative diagnosis, body mass index (BMI), knee range of motion (ROM), and type of prosthesis used. Key radiological indicators assessed included proximal tibia varus angle (PTVA), distal femoral valgus angle (DFVA), joint line congruence angle (JLCA), hip-knee-ankle angle (HKA), and preoperative subluxation status.

Results: The incidence of femoral condylar avulsion fracture in primary TKA was found to be 1.1%. Over a follow-up period of 1.5–3 years, no instability was noted in any patients. Significant differences were observed between fracture and nonfracture groups in PTVA (82.02 ± 3.39 vs. 85.32 ± 1.87, p = 0.01), DFVA (85.53 ± 2.73 vs. 87.51 ± 5.29, p = 0.02), and HKA (8.81 ± 3.30 vs. 6.53 ± 2.21, p = 0.01). However, the Knee Society Score (KSS) at last follow-up showed no statistical difference (p = 0.05).

Conclusion: Femoral condylar avulsion fractures during primary TKA may be linked to joint deformities. Fixation methods using cancellous bone screws or nonabsorbable sutures, combined with a hinged knee brace, resulted in favorable clinical and radiological outcomes, with no need for prosthesis modification.

Objectives: Femoral component rotation affects knee function and component survival in total knee arthroplasty (TKA). However, the presence of posterior femoral condylar cartilage leads to discrepancies in the femoral posterior condylar axis (PCA) between robotic-assisted TKA and manual TKA. The purpose of this study was to investigate the relationship between the discrepancy in thickness of the medial and lateral posterior femoral condylar cartilage and the discrepancy between robotic-assisted and manual rotation of the femoral component.

Methods: In the computed tomography (CT) modeling simulation section, we retrospectively reviewed a total of 18 preoperative knee CT scans of patients who underwent robotic-assisted TKA with different femoral prosthesis sizes between January 2022 and January 2023 to measure the mean posterior femoral condylar distance between femurs of different sizes. In the prospective clinical study section, we prospectively measured the cartilage thickness of the medial and lateral posterior condyles in 60 patients who underwent Mako-assisted TKA between October 2023 and December 2024.

Results: According to our mathematical model of the difference between robotic and manual femoral component rotation in the presence of different femoral sizes and differences in medial and lateral posterior condyle cartilage thicknesses, the maximum value of angular discrepancy of PCA was 4.02° and the minimum value was 1.13°. The average cartilage thickness difference between the medial and lateral posterior femoral condyles was 0.29 ± 0.97 mm (−2.00 to 2.10 mm). The mean difference in femoral component rotation between robotic and manual TKA was 0.35° ± 1.21° (−2.61° to 2.82°).

Conclusion: For most patients with posterior femoral condylar cartilage, the PCA determined by robotic-assisted surgery was greater than that determined manually. Therefore, when surgeons perform TKA with robotic assistance, it is important to be aware of this discrepancy in femoral component rotation to avoid complications such as poor component survival due to inadequate rotation of the femoral component.

Objective: To evaluate the surgical efficacy of repeated vertebral column resection (Re-VCR) after instrumentation removal in congenital scoliosis (CS) patients previously undergoing primary posterior spinal correction with VCR, and to analyze complications pertinent to revision surgery.

Methods: In this retrospective cross-sectional study, a total of 16 CS patients who underwent Re-VCR following instrumentation removal between February 2013 and February 2022 were reviewed. Radiographic parameters were assessed pre- and post-primary operation, pre-removal, pre- and post-revision and at the last follow-up. Clinical data were also analyzed and recorded for each patient.

Results: The indications for instrumentation removal were infection, implant failure, patient and family request, and persistent pain. The Cobb angle of the main curve, global kyphosis (GK), coronal balance (CB) and sagittal vertical axis (SVA) significantly progressed after instrumentation removal. The average progression rates of scoliosis and kyphosis were 5.3° ± 4.0°/year and 10.0° ± 7.2°/year. Following revision surgery, the Cobb angle of the main curve, GK, CB showed significant improvement (t = 10.694, p < 0.001; Z = −3.516, p < 0.001; Z = −2.664, p = 0.008). For Re-VCR, the average extension of the fusion level was 2.9 ± 1.4 vertebrae proximally, 3.0 (2.0, 3.0) vertebrae distally and 5.4 ± 1.6 vertebrae in total. The average correction rates of the Cobb angle of the main curve and GK were 59.5% ± 23.4% and 53.7% ± 18.3% with no significant correction loss during follow-up (p > 0.05). Compared with pre-revision, the mean scores of pain, satisfaction, mental health and self-image on the Scoliosis Research Society-22 (SRS-22) questionnaire improved at different levels. Intra-revision complications included alert of neurophysiological monitoring and dural tear, while breakage of the distal L5 pedicle screw occurred in 1 (6.3%) patient 2 years after revision.

Conclusions: Severe progression of deformity and trunk imbalance was frequently observed following instrumentation removal. The removal of instrumentation is not routinely recommended, and revision surgery employing Re-VCR frequently necessitates an extension of the fusion level. Satisfactory radiographic and clinical outcomes following Re-VCR were effectively maintained throughout the follow-up period, but great caution should be exercised during Re-VCR.

Objective: Surgical management of cervical spinal fractures accompanying ankylosing spondylitis (ASCSF) is intractable in clinical practice. There is still debate about whether surgery by a single-anterior approach is enough for treating ASCSF. The purpose of this study is to summarize and share relevant experience and lessons from both our team and the literature.

Methods: Patients referred to our center for ASCSF following single-anterior surgery (from January 2008 to December 2020) were distinguished and enrolled. In addition, literature published from 2000 to 2021 on PubMed and Web of Science databases was systematically reviewed.

Results: A total of 63 patients (7 from our center and 56 from the literature) who underwent single-anterior surgery for treating ASCSF were brought into this study. The average follow-up time of patients in our center is 44 months. The average age of all patients was 58.6. C6/7 was the most commonly injured level (22 patients, 34.9%), and 44 patients (69.8%) experienced neurological impairment at admission. Most ASCSF patients have lordotic cervical alignment and minimal displacement of the fracture. A total of 8 patients died at an early stage after surgery. Apart from these 8 cases, the incidence rates of general complications and surgical complications were relatively 10.9% and 20.0% respectively. The incidence analysis revealed pneumonia (5.45%) as the predominant general complication, contrasting with implant failure (14.55%), which emerged as the most common surgical complication. Among the 8 cases (14.55%) demonstrating implant failure, radiographic analysis revealed preserved cervical lordosis in 4 patients (50%), kyphotic deformity in 1 patient (12.5%), while cervical alignment data were unavailable for the remaining 3 cases (37.5%). Moreover, 29 patients (52.7%) achieved improvement, and 18 patients (37.5%) maintained stable neurological function.

Conclusions: For most ASCSF patients with preserved lordotic alignment and minimal displacement, a single anterior surgery can achieve significant neurological improvement and result in a relatively lower incidence of complications. This provides a good basis for orthopedic physicians to handle cervical spine trauma patients with ankylosing spondylitis.

Objectives: Multiple imaging criteria are available for assessing fusion following anterior cervical discectomy and fusion (ACDF). In clinical trials, the 3-month postoperative follow-up serves as a critical timepoint for evaluating the efficacy of interventions on accelerating the fusion process. This study aims to determine how applying different fusion criteria influences the conclusions of a comparative analysis.

Methods: Patients aged 18 or older who underwent ACDF with allograft or beta-tricalcium phosphate artificial bone between C3 and C7 were reviewed from 1 April 2023 to 30 September 2023. Fusion rates between the two grafts at three-month follow-up were compared under different criteria. Fusion status was judged by CT or dynamic radiographs, or their combinations. Cut-offs of dynamic indicators included angle changes of 4°, 3°, and 2°, and interspinous motion of 3, 2, and 1 mm. Criteria were applied singly, combined in pairs, or combined in groups of three, leading to a total of 31 criteria. Student's t-test and Chi-squared test were employed, and Cohen's kappa coefficient and phi coefficient were calculated.

Results: Ninety-eight segments were included. Twenty-five criteria yielded higher fusion rates for artificial bone, with 7 out of 25 reaching statistical significance (p < 0.05). The remaining six criteria led to a reversed result, but none reached significance (p > 0.05). The agreement and correlation between CT and dynamic criteria were poor (kappa and phi < 0.200). In contrast, the agreement and correlation between two dynamic indicators were better, and even being close to moderate (kappa = 0.398, phi = 0.398) between 3° and 2 mm.

Conclusion: Changes in fusion criteria affected result significance but did not produce conflicting conclusions. There was a significant disagreement between the results under CT and dynamic radiographs criteria. Thresholds of 3° or 2 mm can be optimal choices for dynamic criteria.

Objective: Tumor-induced osteomalacia with the culprit tumor located in the knee joint is rare in clinical practice, and previous literature has only been seen in case reports, which pose great challenges to the clinical diagnosis and treatment of such patients. The purpose is to elucidate clinical characteristics and orthopedic surgical treatment experience of tumor-induced osteomalacia (TIO) with causative tumor located in the knee joint region.

Methods: Clinical data of all consecutive TIO patients with culprit tumors located in the knee joint region was retrospectively analyzed. All patients were surgically treated by an orthopedic bone and soft tissue tumor sub-professional team at Peking Union Medical College Hospital from January 2015 to January 2025. The clinical distribution feature and surgical effects were analyzed, and clinical practice experience was presented.

Results: All nine patients were included in this study. All patients exhibited varying degrees of bone pain and 100% (9/9) of the patients had limited mobility, often accompanied by difficulties in sitting up, walking, and weakness or fatigue. Approximately 44.4% (4/9) of the patients had significantly shorter height after initial symptoms appeared. All patients underwent a total of 10 operations to control the causative tumors in the knee joint region. Culprit tumors were located in the patella (one case), infrapatellar fat pad (three cases), suprapatellar capsule (one case), popliteal fossa (three cases), and the entire knee joint (one case), respectively. There was only one case of skeletal involvement, one case with involvement of bones and soft tissues, and seven cases with soft tissue causative tumors. All the patients had a gradual increase in blood phosphorus levels in the short term after the first orthopedic surgery, after a follow-up of 12 months to 10 years. During the follow-up, no patients experienced recurrence.

Conclusion: The causative tumor for TIO in the knee joint region is hidden and has diverse locations; however, there is no established orthopedic surgical intervention strategy for these rare entities in clinical practice. Due to the unique anatomical location and complex structure of the knee joint, orthopedic surgeons can adopt different surgical approaches to completely remove the causative tumor. For these patients, the prognosis is satisfactory after complete tumor resection, and the condition can be effectively improved. These findings may help to improve the clinical diagnosis and treatment level of orthopedic physicians for this rare entity.

Objective: Glucocorticoid-induced osteonecrosis of the femoral head (GC-ONFH) represents a devastating complication of steroid therapy, primarily driven by osteoblast apoptosis and impaired osteogenesis. Although selenium (Se) is renowned for its potent bone-protective properties, its therapeutic potential, and specific mechanisms in GC-ONFH remain largely unexplored and thus require further investigation.

Methods: To assess the therapeutic effectiveness of oral selenium supplementation in GC-ONFH, a rat model of GC-ONFH was utilized. The rats were randomly allocated into three groups (n = 6 per group): (1) Control group, (2) Methylprednisolone sodium succinate (MPS) group, and (3) Se group. The intervention was carried out for 4 weeks. In vitro experiments utilized primary rat osteoblasts and MC3T3-E1 cells to elucidate the mechanisms through which selenium mitigates dexamethasone (DEX)-induced alterations in cell proliferation, apoptosis, and osteogenic differentiation. The assessments were conducted using micro-CT and histomorphometry, CCK-8 assays and flow cytometry, as well as RT–qPCR, Western blotting, and immunofluorescence.

Results: Selenium supplementation effectively prevented trabecular collapse and significantly reduced the number of empty lacunae in rats with GC-ONFH. Specifically, an optimal dose of 10 μmol Se successfully reversed the damage induced by DEX, including the restoration of cell proliferation, suppression of apoptosis, and rescue of osteogenic activity. Mechanistically, Se counteracts the DEX-induced suppression of phosphorylated phosphatidylinositol 3-kinase (p-PI3K), phosphorylated protein kinase B (p-AKT), and phosphorylated glycogen synthase kinase 3β (GSK3β) (p-GSK3β), thereby activating the PI3K/AKT/GSK3β signaling pathway, which promotes cell proliferation, inhibits apoptosis, and enhances osteogenesis in osteoblasts.

Conclusion: Selenium can activate the PI3K/AKT/GSK3β pathway, reverse DEX-induced hypoproliferation and apoptosis, restore osteogenic capacity, prevent trabecular collapse, and attenuate GC-ONFH in rat models. Our findings demonstrate that selenium supplementation can be regarded as a clinically applicable strategy for impeding the progression of GC-ONFH in at-risk patients.

Objective: In total hip arthroplasty, the femoral component design requires a trade-off between initial stability and stress shielding. We designed the new bionic hip arthroplasty (BHA) prosthesis with compression and tension screws to mimic compression and tension trabeculae for bionic reconstruction. This prosthesis is designed to reduce stress shielding by mimicking physiological load transfer while ensuring sufficient initial stability for successful bone integration. This study aimed to biomechanically evaluate the initial stability and migration pattern of the BHA prosthesis under dynamic and static loading conditions.

Methods: The BHA prostheses were implanted into ten Sawbones fourth-generation composite non-osteoporotic femurs. In dynamic fatigue testing, the irreversible displacements and migration patterns in vertical and rotational directions were analyzed after 1,000,000 loading cycles. In static failure testing, the failure load of the BHA implanted model was analyzed.

Results: In dynamic fatigue testing, the irreversible subsidence displacement of the BHA prosthesis was (0.3683 ± 0.1046) mm and the irreversible retroversion displacement was (0.0328 ± 0.0157)°. The irreversible displacements in both vertical and rotational directions stabilized at 100,000 loading cycles. In static failure testing, the failure load of the BHA implanted model was (4485 ± 702) N.

Conclusions: The irreversible subsidence displacement of the BHA prosthesis was below the interface failure threshold of 1.5 mm, and secondary fixation was accomplished at 100,000 loading cycles. The average failure load was approximately 6.4 times body weight, much higher than the daily load range of hip joints. The BHA prosthesis suggests potential for adequate axial initial stability to facilitate bone ingrowth, which is expected to reduce revision rates in patients.

Objective: Hyperuricemia, characterized by elevated serum uric acid levels without acute gout symptoms, may influence postoperative outcomes after total knee arthroplasty (TKA). This study aimed to evaluate the impact of hyperuricemia on postoperative inflammatory responses, complications, and mid-term functional outcomes in patients undergoing primary TKA.

Methods: This was a retrospective cohort study. We identified all patients who had undergone primary TKA from April 1, 2015, to March 30, 2016. Patients were grouped by uric acid level. The knee society score (KSS) and hospital for special surgery knee score (HSS) before the surgery and 6 years after the surgery were recorded. Statistical analyses included t-tests, chi-square tests, and regression analyses to assess the influences of uric acid levels on C-reactive protein (CRP) levels, body temperature, functional scores, and local inflammatory response. The influence of the uric acid level on the local inflammatory response was also analyzed.

Results: Of the 614 patients, 140 had hyperuricemia, and 474 had normal uric acid levels. The hyperuricemia group had a higher unplanned readmission rate (11.4% vs. 5.7%, p < 0.05) and longer hospital stay (10.75 vs. 9.54 days, p = 0.002). CRP levels were significantly greater in the hyperuricemia group (OR = 34.64, 95% CI: 27.99–41.30, p < 0.001), and the incidence of the local inflammatory response was greater (42.1% vs. 9.5%, p < 0.01). The diagnostic accuracy for uric acid in the local inflammatory response was 0.742 (AUC). Improvements in the KSS clinical score (p < 0.01), KSS functional score (p < 0.01), and HSS score (p < 0.01) were lower in the hyperuricemia group.

Conclusions: Hyperuricemia is associated with significantly elevated postoperative CRP levels, a higher unplanned readmission rate, and substantially poorer mid-term functional outcomes after TKA. These patients also demonstrate increased inflammatory complications. These findings support preoperative uric acid screening to identify high-risk patients for targeted management.

Clinical Relevance: Level III.Trial Registration: ClinicalTrials.gov identifier: NCT05476367.

Objective: Chronic exertional compartment syndrome (CECS) of the forearm is a rare and underdiagnosed condition that mainly affects young athletes. Minimally invasive endoscopic surgical treatment has been shown to reduce complication rates and allow for an expedited return to activity. Evidence on the outcomes of single-portal endoscopic fasciotomy for forearm CECS remains limited. The aim of this study was to describe the results of single-portal endoscopic-assisted fasciotomy in treating forearm CECS.

Methods: A total of 17 patients (21 forearms) diagnosed with forearm CECS and treated with single-portal endoscopic-assisted fasciotomy were included in this study. Intracompartmental pressure was preoperatively measured at rest, on exertion, and at 5 min postexertion. Additionally, pain intensity and physical function were evaluated using the visual analog scale (VAS) and the Disability of Arm, Shoulder, and Hand (DASH) questionnaire, respectively, before surgery and 4 weeks after surgery.

Results: Preoperative assessments revealed a mean intracompartmental pressure of 15.7 ± 1.5 mmHg at rest, 77.7 ± 3.8 mmHg on exertion, and 22.9 ± 2.3 mmHg at 5 min postexertion. The mean preoperative VAS score was 7.6 ± 1.1, which dropped to 0.1 ± 0.35 after surgery. The mean DASH score was 29.8 ± 3.0 preoperatively and 4.6 ± 2.4 postoperatively. Both VAS and DASH scores were significantly lower after surgery (paired t test, p < 0.001). No major adverse effects were reported. Patients returned to light cycling at an average of 10 ± 3.8 days and resumed usual daily activities within 18.2 ± 1.9 days on average.

Conclusions: Endoscopic compartment decompression through a single port proved to be an effective and safe surgical treatment technique in patients with forearm CECS, thus deserving serious consideration as a replacement for classic fasciotomy.

Level of Evidence: III.

Objectives: Obesity has an important impact on the future of total joint arthroplasty (TKA). We aimed to determine whether waist-to-hip ratio (WHR) is a useful measurement in predicting postoperative outcomes associated with obesity in patients undergoing primary TKA and compared the predictive value of WHR to that of body mass index (BMI).

Methods: Prospective data from patients undergoing unilateral primary TKA from February to May 2024 were analyzed, including BMI and WHR. Outcomes included complications, hospitalization details, and 12-month patient-reported function (University of California, Los Angeles [UCLA] activity scale, the Hospital for Special Surgery [HSS] score). Multivariable regression models were used to identify significant obesity-related predictors of outcomes.

Results: A total of 195 patients were included, with the mean BMI of 28.2 ± 5.2 kg/m² (range: 17.6–40.8) and the mean WHR of 1.03 ± 0.08 (range: 0.83–1.27). WHR was a significant predictor of wound complication (OR: 1.087, p = 0.016). Both WHR (OR: 1.153, p = 0.004) and BMI (OR: 1.058, p = 0.021) independently predicted systemic complications, with WHR explaining greater variance (R² = 0.241 vs. 0.107 for BMI). For functional outcomes, higher WHR was associated with poorer UCLA activity scores (RR: 0.877, p = 0.012) and HSS function scores (RR: 0.921, p < 0.001), whereas BMI only showed significance for HSS function scores (RR: 0.960, p = 0.002). WHR again explained more variance in HSS function scores (R² = 0.233 vs. 0.124). In contrast, neither WHR nor BMI correlated with surgical records, hospitalization days, or HSS pain scores (all p > 0.05).

Conclusions: The WHR demonstrates superior predictive value over BMI for perioperative complications and 12-month patient-reported functional outcomes following primary TKA. Preoperative WHR assessment may help surgeons improve risk stratification and better educate obese patients regarding postoperative expectations prior to elective TKA.

Objective: It is unclear whether a hip with a developmental dysplasia deformity can remain functional and free of osteoarthritis (OA) throughout life. This study aims to determine the percentage of Chinese older adults without severe OA who meet the diagnostic criteria for DDH and BDDH. Additionally, this study seeks to explore hip morphology in this population.

Methods: Data from 808 consecutive patients with recent unilateral femoral neck fractures, collected between January 2022 and October 2024, were retrospectively analyzed. A total of 493 patients (493 hips) were included in the analysis. For imaging evaluation, the following parameters of the contralateral (unfractured) hip were measured: LCEA, Tönnis angle, Sharp's angle, femoral head eminence index (FHEI), and femoral head lateralization. Categorical variables were expressed as numbers and percentages. Continuous variables were presented as mean ± SD if normally distributed; otherwise, they were reported as median (Q1, Q3). The Pearson chi-square test, likelihood ratio chi-square test, or Fisher's exact test was used to compare categorical variables. An independent-samples t-test or Mann–Whitney U test was used to compare continuous variables in the group analysis. For parameter comparisons between multiple groups, use ANOVA with post hoc analysis.

Results: In this study, 7.1% of individuals aged over 60 years with unilateral femoral neck fractures exhibited imaging results consistent with DDH, while 13.2% had results consistent with BDDH. Patients with DDH and BDDH were at a higher risk of developing mild OA compared to individuals with normal acetabular coverage. However, not all individuals with DDH or BDDH develop OA. Only the Tönnis angle was significantly associated with mild OA, indicating a 7.8% increase in OA risk for each 1° increase in the Tönnis angle. Significant differences were observed in the Tönnis angle (5.0 ± 3.9 vs. 11.5 ± 4.1 vs. 17.5 ± 4.1, p < 0.001), Sharp's angle (38.2 ± 2.9 vs. 41.7 ± 2.5 vs. 44.0 ± 2.5, p < 0.001), femoral head lateralization (7.8 ± 2.7 vs. 9.3 ± 2.6 vs. 10.3 ± 2.8, p < 0.001), and FHEI (17 ± 4 vs. 25 ± 3 vs. 30 ± 4, p < 0.001) between the normal group and both the DDH and BDDH groups.

Conclusion: The prevalence of DDH imaging abnormalities is notable among Chinese older adults without severe OA. Individuals with DDH and BDDH are more likely to exhibit mild OA symptoms, although not all develop OA. Using multiple imaging parameters in addition to LCEA facilitates characterizing hip morphology in asymptomatic individuals with DDH.