As a core minimally invasive technique for treating osteoporotic vertebral compression fracture (OVCF), percutaneous kyphoplasty (PKP) is widely employed clinically but continues to face significant technical challenges. These include uneven cement distribution, loss of vertebral height reduction, cement leakage, and adjacent vertebral re-fractures. To overcome these limitations, multi-dimensional technical refinements have emerged in recent years: innovations in surgical access and propping instruments (e.g., percutaneous curved kyphoplasty (PCKP), Sky system) optimize cement spatial distribution; intravertebral support implants (e.g., SpineJack, vertebral body stenting [VBS], stabilizing augmented Intervertebral Force [SAIF]) provide sustained mechanical support and mitigate loss of reduction height; and cement flow control techniques (e.g., Bone-filled bag systems, Kiva system), coupled with the use of high-viscosity bone cement, have significantly reduced leakage risks. This paper systematically reviews recent advancements in propping technology and intravertebral implants addressing these PKP challenges, aiming to provide an evidence-based foundation for optimizing the minimally invasive management of OVCF. Future development requires bioactive bone cements (e.g., magnesium/calcium phosphate-based composites) integrated with precise personalized design to advance PKP toward facilitating physiological bone remodeling.

Purpose: To compare the mobility and health-related quality of life (HRQoL) for femoral neck fractures (FNFs) in the elderly treated with either hemiarthroplasty (HA) or total hip arthroplasty (THA).

Methods: This study constitutes a post hoc analysis of a prospective cohort study. In this secondary analysis, we enrolled patients aged ≥ 65 years who underwent arthroplasty for FNFs at a tertiary hospital in Beijing, China, between 2018 and 2019. Patients were stratified into the HA group and THA group based on the surgical type. All patients were followed up via telephone at 30, 120, and 365 days postoperatively. The Fracture Mobility Score (FMS) was utilized to assess patients' mobility, while the EuroQol 5-Dimension (EQ-5D) instrument was adopted to evaluate their HRQoL. Intergroup comparisons, multivariate logistic regression models, and linear regression models were used to compare outcomes between the two groups and analyze the impact of surgical type on these outcomes.

Results: Among 416 eligible patients, 333 completed all three follow-up evaluations, including 250 patients in the HA group and 83 in the THA group. Multivariate logistic regression models adjusted for potential confounders indicated that patients in the THA group were significantly more likely to achieve unrestricted mobility at 120 and 365 days postoperatively compared with the HA group (OR [95% CI] = 2.407 [1.210–4.788], p.adj = 0.012; OR [95% CI] = 2.410 [1.120–5.183], p.adj = 0.024), with no significant difference observed at the 30-day follow-up. In addition, multivariate linear regression models adjusted for 12 covariates demonstrated that the THA group achieved significantly higher EQ-5D scores at 30 and 120 days postoperatively (p.adj = 0.003 and p.adj = 0.003, respectively). However, this advantage was not sustained at the 365-day follow-up (p.adj = 0.100).

Conclusion: THA may yield a higher probability of independent mobility recovery and better postoperative HRQoL than HA in elderly patients with FNFs.

Objectives: The distal radioulnar ligaments (DRULs) serve as primary stabilizers to the distal radioulnar joint (DRUJ). Existing cadaveric studies report heterogeneous morphometric data of the three-dimensional (3D) anatomy of the triangular fibrocartilage complex (TFCC) and the ulnar footprints of the DRULs due to methodological variations and small sample sizes, limiting the translation of precise anatomical knowledge to clinical practice. This study quantitatively evaluated the 3D anatomy of the TFCC and the insertions of both superficial and deep DRULs components using three different methods with subsequent interactive validation: (1) direct measurement, (2) 3D scan, and (3) artificial intelligence (AI) enhanced magnetic resonance imaging.

Methods: Eleven adult cadaveric upper limbs were included. All specimens underwent 3.0-Tesla MRI scans, which were then processed by AI algorithms for super-resolution enhancement and semi-automatic segmentation. The areas of deep and superficial limbs of DRUL ulnar footprint were measured in the super-resolution MRI images using the Slicer software. The specimens were then dissected and anatomical measurements of dorsal-volar maximal length and radial-ulnar maximum length of deep ulnar DRUL footprint were performed on the specimens' photographs. Anatomical measurements of ulna, radius, triangular fibrocartilage, and ulnar insertions footprint of both superficial and deep DRULs were conducted subsequently using a 3D scanner. Primary outcome measures included the area and morphological classification (irregular quadrilateral, ribbon, semilunar) of the deep and superficial ulnar DRUL footprints. Statistical analysis encompassed intraclass correlation coefficients (ICC) for agreement assessment and multiple linear regression to explore associations.

Results: The mean area of the deep foveal fibers of DRUL was 43.39 ± 13.49 mm² and the superficial footprint was 20.11 ± 10.49 mm² as measured with the 3D scanner. The morphologic features of the deep footprint shapes varied, with the most common shape being a ribbon (7/11, 64%). The intraclass correlation coefficients (ICCs) for the measurement of dorsal-volar maximal length and radial-ulnar maximum length of the DRUL between direct measurement and the 3D scan were excellent (ICC = 0.97 and 0.98, respectively). The ICCs between the AI-enhanced analysis and the 3D scan for measuring the ulnar deep and superficial DRUL insertion areas were excellent (ICC = 0.95 and 0.96, respectively). Multiple linear regression explained 72.4% of the variance in deep DRUL footprint area (R² = 0.724, p = 0.147), with the superficial footprint area showing the strongest association (β = 0.639, p = 0.196).

Conclusions: Compared to direct measurement and 3D scan, the AI algorithms developed and validated for wrist MRI image enhancement demonstrated high accuracy and reliability in anatomical measurements of DRULs.

Background: Total knee arthroplasty (TKA) offers significant relief for advanced knee osteoarthritis. With an aging population, TKA procedures are increasing, leading to a higher demand for revision surgeries. Rotating-hinge knee (RHK) prostheses have emerged as a solution for complex revisions, but the long-term durability of RHK prostheses and their effectiveness in infection-related revisions remain controversial. Therefore, this study aimed to evaluate the mid- to long-term clinical and survivorship outcomes of a single-design rotating hinge knee (SDRHK) system in revision TKA, comparing patients revised for infection with those revised for noninfectious causes.

Methods: This retrospective study analyzed 110 patients who underwent revision total knee arthroplasty (rTKA) with a SDRHK system from 2004 to 2023, with an average follow-up of 11.3 years. Patients were divided into an infection group (n = 51) and a noninfection group (n = 59) for comparative analysis. Preoperative diagnostic arthrocentesis was performed to evaluate synovial cell count, leukocyte differential, and microorganisms. Functional outcomes were assessed using Hospital for Special Surgery (HSS) knee score, range of motion (ROM), and Knee Society Score (KSS). Study outcomes included prosthesis survival, mechanical failure, and complications. Data were analyzed using Kaplan–Meier survival analysis, t test, and χ² test, with statistical significance set at p ≤ 0.05.

Result: The infection group experienced symptom onset significantly earlier than the noninfection group (18.8 vs. 50 months, p = 0.003), had a shorter initial prosthesis lifespan (32.7 vs. 66.8 months, p = 0.001), and underwent more surgeries before revision (2.6 vs. 1.6, p = 0.004). Microbiological analysis indicated that coagulase-negative staphylococci and Staphylococcus aureus were the most commonly isolated pathogens. The 5- and 10-year prosthesis survival rates in the infection group were 78.4% and 71%, respectively, while those in the noninfection group were 83.1% and 74.6%. At the latest follow-up, survival rates for the two groups were 68.6% and 71.2%, showing similar outcomes. Functional scores in both groups improved postoperatively, with no significant differences in HSS, ROM, or KSS scores between the groups.

Conclusion: This study highlights the important value of RHK prostheses in the treatment of prosthetic joint infection (PJI) after TKA. Despite challenges such as earlier symptom onset, shorter prosthesis lifespan, and higher complication rates in the infection group, their functional outcomes and prosthesis survival rates were comparable to those of the noninfection group, further validating the effectiveness of RHK prostheses. These findings provide useful references for clinical management of PJI and underscore the importance of continued innovation in revision techniques.

Objective: Severe scoliosis is often accompanied by moderate-to-severe pulmonary dysfunction. Numerous surgical methods are available for the treatment of severe scoliosis, but the effect of each method on postoperative pulmonary function (PF) remains controversial. Apical region correction and global balance (ACGB) is an effective surgical strategy to treat severe scoliosis, using Schwab I–II osteotomies and simple one-stage surgery. Herein, we explore the effect of the ACGB surgical strategy on postoperative PF values in patients with severe scoliosis at 2-year follow-up.

Methods: Patients who underwent ACGB for scoliosis between 2015 and 2020 were enrolled, PF and radiological outcomes were evaluated preoperatively and at 2-year follow-up. PF values included forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and percent-predicted values (FVC% and FEV1%). Paired t-test, Pearson and Spearman correlation analyses, and multiple linear regression were used to analyze changes in PF values and associated factors.

Results: In total, 36 patients (12 male and 24 female; mean age, 20.1 years) who underwent ACGB surgery were enrolled. Preoperative PF values showed restrictive ventilatory dysfunction. At 2-year follow-up, the PF values showed significant improvements. FVC, FEV1, FVC%, and FEV1% showed mean increases of 0.72, 0.68 L, 10.3%, and 9.8%, respectively. Changes in PF values were significantly correlated with age, thoracic height, preoperative FVC%, and preoperative FEV1%.

Conclusion: ACGB significantly improves PF in patients with severe scoliosis at 2-year follow-up. The increased thoracic height may be crucial for improving PF values, while patients with poorer preoperative PF may show greater postoperative improvement.

Objective: To evaluate the clinical efficacy, safety profile, and clinical outcomes of AUSS versus PELD in single-level LSS treatment.

Methods: This retrospective comparative study included 68 consecutive LSS patients treated between January 2023 and January 2024: 35 underwent AUSS and 33 underwent PELD. Primary outcomes included total operative time, extracanal working time, intracanal decompression duration, incision length, fluoroscopy exposure time, intraoperative blood loss, preoperative/postoperative day 3 hemoglobin levels, hospitalization duration, total treatment costs, and postoperative complications. Clinical assessments utilized the visual analog scale (VAS) for axial back/leg pain evaluation, Oswestry Disability Index (ODI) for functional assessment, and modified MacNab criteria for clinical success. Minimum follow-up was 12 months.

Results: All 68 patients completed 12-month follow-up with no demographic disparities between groups. AUSS exhibited superior operative efficiency with significantly shorter total operating time (45.6 ± 3.14 vs. 54.6 ± 5.54 min, p < 0.01) and intracanal decompression time (21.25 ± 2.38 vs. 35.4 ± 3.36 min, p < 0.01), although with marginally prolonged extracanal operating time (27.35 ± 3.28 vs. 18.6 ± 3.54 min, p < 0.01). Fluoroscopy duration was significantly reduced in AUSS (7.45 ± 2.39 vs. 38.38 ± 7.62 s, p < 0.01). AUSS required larger incisions (19.74 ± 2.13 vs. 7.83 ± 1.08 mm, p < 0.01) and resulted in higher estimated blood loss (17.18 ± 6.43 vs. 9.53 ± 1.38 mL, p < 0.05), and higher total costs (21937.44 ± 579.36 vs. 17459.44 ± 589.26 ¥, p < 0.05), though without clinically significant changes in hemoglobin levels (130.24 ± 7.02 vs. 130.31 ± 6.25, p > 0.05) and postoperative hospital stay (6.48 ± 2.72 vs. 6.84 ± 1.93 days, p > 0.05). AUSS had lower postoperative VAS-leg pain scores at early postoperative periods (3 days and 1 month) (p < 0.01) and higher patient satisfaction rates (94.29% vs. 84.85% excellent/good outcomes, p < 0.05). One PELD case required secondary surgical interventions within 12 months for persistent radiculopathy, whereas no AUSS patients required reoperations. Overall complication rates were comparable between groups.

Conclusion: Both techniques showed similar safety. AUSS offers superior operative efficiency, reduced radiation exposure, and better early clinical outcomes compared to PELD for LSS treatment. Despite slightly larger incisions and increased blood loss, AUSS demonstrates enhanced decompression completeness with lower revision rates, suggesting AUSS as a valuable alternative to PELD, particularly for cases requiring comprehensive neural decompression.

Study Design: Retrospective cohort study.

Objective: Mono-segmental thoracic and lumbar nonfusion (MTLN) can occur during spinal fusion in patients with ankylosing spondylitis (AS). This study aimed to summarize the clinical characteristics of AS-MTLNs, identify correlative variables for their occurrence, and propose a new classification system.

Methods: We retrospectively reviewed the clinical materials of patients with AS diagnosed between 2008 and 2023 in our institution, and 803 patients were included. The patients were divided into an AS-MTLN group (n = 155, 19.3%) and a non-AS-MTLN group (n = 648, 80.7%). Fifteen variables were collected, and the differences between groups were compared. The proposed new classification system included three main types and seven subtypes, including noninflammatory nonfusion (Type 1), inflammatory nonfusion without intervertebral destruction (Type 2), and inflammatory nonfusion with intervertebral destruction (Type 3).

Results: The prevalence of AS-MTLNs in descending order was lower thoracic spine (n = 84, 54.2%), lumbar spine (n = 62, 40.0%), and upper thoracic spine (n = 9, 5.8%). The computed tomography (CT) Hounsfield unit (HU) of the L1 vertebra was the only variable that showed a significant difference between two groups (p = 0.007), and the binary logistic regression model further confirmed its correlation with the occurrence of AS-MTLN (p = 0.005, odds ratio = 0.993, 95%). Regarding the new classification system, the AS-MTLN numbers of three types were (1) Type 1: 53 cases, 34.2%; (2) Type 2: 31 cases, 20%; (3) Type 3: 71, 45.8%. Type 1 was more common in lumbar spine (33 cases, 62.3%), Type 2 was more common in lower thoracic spine (20 cases, 64.5%), and Type 3 was also more common in lower thoracic spine (52 cases, 73.2%).

Conclusion: This study systematically described the clinical characteristics of AS-MTLNs and recognized that the CT HU of the L1 vertebra was correlated with the occurrence of AS-MTLN. The newly proposed classification system includes all types of AS-MTLNs, with value for clinical applications and popularization.

Objective: Open tibial shaft fractures (OTSFs) pose significant therapeutic challenges due to high-energy trauma, extensive soft tissue damage, and contamination risks, complicating fracture stabilization and increasing infection rates. Conventional freehand closed reduction often requires multiple attempts, exacerbating soft tissue injury and radiation exposure. To address these limitations, this study evaluates a double reverse traction-assisted technique, hypothesizing that it could improve reduction accuracy and reduce complications in OTSFs managed with hexapod external fixators (HEFs).

Methods: This retrospective cohort study analyzed the records of 55 hospitalized patients with AO/OTA type 42-A or 42-B OTSFs treated with HEF between March 2020 and March 2023. Double reverse traction-assisted closed reduction was performed on 28 patients (DRTA group), while traditional freehand closed reduction was performed on 27 patients (Freehand group). We documented fracture reduction time, fluoroscopy time, external fixation time, radiographic results, electronic prescription count, and complications. Final clinical outcomes were assessed using the Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria at a mean follow-up of 15.3 months. Statistical analysis was performed using independent samples t-tests or the chi-square test.

Results: DRTA group demonstrated significantly shorter fracture reduction time (12.13 ± 2.12 vs. 17.14 ± 3.43 min; p < 0.001) and fluoroscopy time (8.12 ± 1.78 vs. 13.75 ± 2.62; p < 0.001) compared to the Freehand group. External fixation time showed no significant difference (p > 0.05). DRTA group exhibited superior radiographic alignment, with significantly reduced residual translation and angulation on AP/lateral views (all p < 0.05). The electronic prescription count for postoperative correction was significantly lower in the DRTA group (0.9 ± 0.7 vs. 1.4 ± 1.0; p < 0.05). The complication rate was lower in the DRTA group (32.1%) than in the Freehand group (48.1%), but this difference was not statistically significant (p > 0.05). ASAMI scores were similar between both groups (p > 0.05). ASAMI bone and functional scores were similar between groups.

Conclusion: In this retrospective study, both reduction techniques achieved favorable therapeutic outcomes. However, the double reverse traction-assisted technique was associated with greater efficiency in fracture reduction, more accurate radiographic alignment, and a nonsignificant trend toward lower complications compared to traditional freehand reduction. These results indicate that the double reverse traction-assisted technique is a feasible and promising alternative, but its definitive advantages need to be confirmed by larger, prospective, randomized controlled trials.

Objective: The selection of the lowest instrumented vertebra (LIV) is crucial in the surgical treatment of adolescent idiopathic scoliosis (AIS), particularly for thoracolumbar/lumbar curves. While traditional LIV selection strategies primarily rely on weight-bearing radiographs, the utility of supine imaging remains unclear. This study aimed to evaluate the feasibility of using the last touched vertebra identified in the supine position (LTV-supine) as the LIV for Lenke-5 AIS.

Methods: We conducted a retrospective review of Lenke-5 AIS patients who underwent posterior spinal fusion at Peking Union Medical College Hospital from 2010 to 2017, with a minimum 5-year follow-up. All patients underwent distal fusion to the LTV-supine. Radiographic parameters, including coronal and sagittal alignments and LIV-related measurements (LIV tilt, translation, rotation, and the subjacent disc angle), as well as the Scoliosis Research Society-22 (SRS-22) scores were compared across preoperative, postoperative, and final follow-up time points using the paired t-tests. Based on the positional relationship between the LTV-supine (the selected LIV) and the LTV-upright, patients were categorized into two groups: the short-fusion group (LIV at the first vertebra proximal to the LTV-upright) and the non-short-fusion group (LIV at LTV-upright). Radiographic parameters, SRS-22 scores, and the incidence of radiographic complications were compared between groups using independent t-test.

Results: Forty-five consecutive patients were included. Radiographic outcomes demonstrated significant improvements: the thoracolumbar/lumbar curve Cobb angle was corrected from 49.2° ± 10.8° preoperatively to 8.3° ± 5.6° at final follow-up (correction rate: 83.4% ± 10.9%; p < 0.05), and the coronal balance decreased from 20.3 ± 10.0 mm to 11.2 ± 6.9 mm (p < 0.05). All LIV-related parameters showed significant improvement at the final follow-up compared to preoperative values (p < 0.05). SRS-22 scores showed notable enhancements in self-image/appearance and mental health domains at final follow-up (p < 0.05). Fusion to LTV-supine saved 0.3 ± 0.5 distal vertebrae compared to the LTV-upright strategy (p < 0.05), resulting in shorter fusions in one-third of the patients (15/45). No significant differences were observed between the short-fusion (n = 15) and non-short-fusion (n = 30) groups in the final follow-up Cobb angle, correction rate, SRS-22 domain scores, nor in the incidence of adverse radiographic outcomes, such as sloped LIV, subjacent disc wedging, or coronal imbalance.

Conclusions: Supine imaging serves as a valuable adjunct for LIV selection in AIS. For Lenke-5 AIS, adopting the LTV-supine can yield comparable radiographic outcomes while potentially sparing additional distal segments in a subset of patients compared to the conventional upright radiograph-based approach.

Introduction: There are many instruments and facilities designed to facilitate the procedure of minimally invasive spine surgery. However, those current instrumentation systems may increase the complexity to accomplish the procedure. Our department developed a specific two small incision surgery for MI-TLIF, and the benefits of this technique could control only one unilateral surgical incision for two-screw insertion, which the length of each wound was as small as 3.0–4.0 cm. In this retrospective study, we compared the intraoperative and postoperative results of novel two incisions technique and traditional four surgical incisions for patients with 1-level MI-TLIF treatment.

Methods: We retrospective recruited 80 consecutive patients who had degenerative spinal stenosis or spondylolisthesis and received primary 1-level MI-TLIF in single hospital from September 10, 2020, to October 19, 2023. The Wiltse approach for interbody fusion and a single-plane fluoroscopy-guided method to insert the pedicle screws were used. Patients were divided into two groups depending on different surgical techniques. Patient demographics, intraoperative and postoperative data were assessed. The Mann–Whitney U test or Fisher exact test were used to evaluate the data and a p value < 0.05 was considered significant in this study.

Results: A total of 71 patients met the inclusion criteria in this study. The baseline data were similar between novel technique (n = 41, two incisions) and traditional MI-TLIF group (n = 30, four incisions). Among all intraoperative, postoperative and complication categories, the instrumentation time was the only item that showed significant difference, which is shorter in novel technique group (p = 0.034). The difference became more apparent in the obese group (BMI ≥ 27 kg/m², p = 0.01).

Conclusion: Although the novel technique could reduce the number of surgical incisions compared to traditional MI-TLIF, the intraoperative and postoperative results were similar to the traditional MI-TLIF. Hence the reduction in wound number and the total length of surgical wound does not have obvious benefits in 1-level MI-TLIF patients. However, the less surgical exposure may offer less surgical wounds complications for specific groups, which were immune-compromised, such as diabetics, chronic renal disease, or cancer patients, and the clinical follow-up of specific groups will be planned to perform in the future.

Introduction: Pelvic reconstruction following bone sarcoma resection presents significant challenges. This study evaluates the outcomes of using 3D-printed custom-made prostheses and cutting guides to improve surgical precision and functional results in periacetabular reconstructions. Therefore, in this study, we asked: (1) What is the cumulative incidence of reoperation for any reason following pelvic resection and reconstruction with a custom-made 3D-printed prosthesis involving the acetabulum in patients with primary bone sarcoma, and what factors contribute to an increased risk of reconstruction failure? (2) Does the use of 3D custom-made cutting guides, combined with a 3D custom-made hemipelvis prosthesis, ensure the attainment of safe resection margins and allow for anatomical reconstruction with optimal fit at the bone-prosthesis interface? (3) What were the observed outcome scores as measured by the Musculoskeletal Tumor Society (MSTS) Score? Additionally, how do the type of resection and the volume of the primary bone sarcoma affect the outcomes in relation to the type of reconstruction?

Materials and Methods: We conducted a retrospective review of 24 patients treated for primary bone sarcomas at our institution from January 2013 to December 2023. Each patient received a 3D-printed cutting guide and a 3D-printed custom-made prosthesis tailored to their specific anatomical needs, based on high-resolution imaging and computer-aided design.

Results: The use of custom-made 3D prostheses resulted in a reoperation rate of 46%, primarily due to complications such as infection and mechanical failures. Specific complications included an 8% rate of deep infections and mechanical issues like aseptic loosening. Local recurrence was observed in 5 patients (21%) at a median time of 5 months post-surgery. Despite these challenges, the average MSTS score was 83.7%, indicating a high level of functional recovery post-surgery.

Conclusions: The integration of 3D printing in pelvic reconstructions for bone sarcomas significantly enhances anatomical and functional outcomes. However, the technology demands further refinement to reduce complication rates. Continued advancements in 3D-printing materials and techniques are crucial to maximizing the benefits of this innovative approach in orthopedic oncology.

Objective: This study aims to investigate the role of Denosumab and its downstream target ST18 in wear particle-induced macrophage inflammation and osteolysis, and to explore the underlying mechanisms involved in aseptic loosening (AL) of prosthetic joints.

Methods: Macrophages were stimulated with titanium particles (TiPs), and inflammatory responses were assessed using qRT-PCR, western blot, flow cytometry, and immunohistochemistry. Denosumab's effects on inflammation and osteolysis were evaluated with the same approaches. Potential targets of Denosumab were screened via online databases and validated by qRT-PCR and western blot. ST18 was modulated in macrophages using lentiviral overexpression and knockdown systems. A mouse calvarial model of TiPs-induced osteolysis was established, and the roles of Denosumab and ST18 were examined in vivo using micro-CT, H&E staining, and tartrate-resistant acid phosphatase (TRACP) staining.

Results: Denosumab suppressed TiPs-induced macrophage inflammation by inhibiting NF-κB signaling and M1 polarization. We identified ST18 as a direct target of Denosumab, whose expression was upregulated by TiPs but downregulated by Denosumab. Lentivirus-mediated ST18 knockdown markedly attenuated TiPs-induced inflammation, whereas ST18 overexpression exacerbated it. Further analysis revealed that ST18 interacts with PARP1. In vivo, Denosumab significantly alleviated TiPs-induced osteolysis in mouse calvaria, an effect that was reversed by ST18 overexpression.

Conclusion: Denosumab attenuates TiPs-induced macrophage activation and osteolysis through suppression of the NF-κB pathway and M1 polarization, with ST18 serving as a key mediator. These findings highlight Denosumab as a promising therapeutic candidate for the prevention of prosthesis-related aseptic loosening.

Objectives: Wide surgical resection is the standard for primary malignant soft tissue and bone tumors, especially when the knee's intra-articular space is involved. Extraarticular Knee Joint Resection (EKJR) aims to remove the knee joint while preserving function. Considering the lack of literature present on these aspects, the purpose of this study is to analyze the data of a series of 30 patients affected by benign aggressive or malignant bone and soft tissue tumors who underwent EKJR with two different resection techniques.

Methods: The study involved all patients treated with EKJR for tumors between October 2006 and March 2023. Two EKJR techniques were analyzed: Type-A (complete extensor mechanism excision) and Type-B (patellar coronal osteotomy sparing the extensor mechanism). Clinical outcomes, tumor characteristics, and complications were compared between the two techniques. For statistical analyses, the Mann–Whitney test or Kruskal–Wallis test was employed to explore differences between continuous variables. Relationships between categorical variables were assessed using Pearson's Chi-square test or Fisher's exact test. Correlations were evaluated using Spearman's correlation coefficient. Survival analyses were conducted using the Kaplan–Meier method.

Results: The cohort included 13 males and 17 females (16 Type-A, 14 Type-B resections). Histologically confirmed intra-articular involvement was found in 26.7% of cases. Late complications included infections and amputations, more frequently in Type-A resections. The 5-year Local Recurrence-Free Survival was 91.5%, Metastasis-Free Survival was 39.5%, and Overall Survival was 47.9%. Type-A resections lead to higher complication rates, including amputation, due to extensive vascular and tissue disruption. Type-B resections, preserving the extensor mechanism, result in better functional outcomes and faster recovery despite some residual weakness.

Conclusion: EKJR is oncologically effective but carries significant functional and complication considerations. Type-B resection balances oncological safety and functional preservation, especially for benign aggressive tumors.

Background: Despite technical and material improvements in rotator cuff repair, clinical and radiological failure remains common. Following suture fixation, tension and footprint compression decrease from time zero. A novel suture has been designed to shorten when submerged in liquid to maintain tension and increase repair construct security. The aim of this study was to assess the safety and clinical outcomes (IDEAL 2a assessment) in patients receiving rotator cuff repair with the self-tensioning suture with a minimum of 12 months follow up. Clinical registries allow early identification of outlier or poorly performing prosthesis with prevention of avoidable complications.

Methods: A cohort analysis was performed utilizing patients from the PRULO (Patient Reported Outcomes in Upper Limb Surgery) registry. All patients with the suture of interest who underwent a rotator cuff repair with 12 months follow up were included. Results included patient reported outcome scores: Quick Disability of the Arm, Shoulder and Hand (QuickDASH), and the Western Ontario Rotator Cuff Index (WORC) and complications. Patient reported outcome measures (PROMs) were analyzed using multiple imputation and a linear model to assess changes over 12 months follow up.

Results: A cohort of 255 patients was included for analysis. At 12 months follow up, median scores for QuickDASH decreased by 36 and WORC increased by 41, both of which surpass the minimum clinically important difference. Our observed rates of complications included: Infection 2.4%, stiffness/capsulitis 13%, and retear 12%. Complication rates and functional improvements were similar to other studies. These results suggest the suture is safe and adequately effective for ongoing clinical use and further study.

Conclusion: The novel suture demonstrated comparable safety and efficacy profiles, with outcomes similar to those published in the literature. This study suggests this novel suture is safe and does not seem to produce unique complications. Further research is warranted to specifically investigate clinical efficacy in the longer term.

Trial Registration: ACTRN12619000770167

Objective: Vertebroplasty with non-degradable polymethyl methacrylate bone cement is a common procedure in spine surgery. However, this bone cement reinforcement of the vertebral body could affect subsequent spinal surgeries, especially for pedicle screw insertion. This study proposes a novel method of inserting pedicle screws into bone cement-reinforced vertebral bodies through thermal softening via Kirschner wires (K-wires) drilling, and conducts preliminary in vitro experiments to assess its feasibility and safety.

Methods: This study includes bone cement block experiments and in vitro goat bone experiments. The bone cement block experiment utilized a CNC machine to drill into bone cement blocks with varying K-wire diameters, rotational speeds, and feed rates, followed by the insertion of pedicle screws. The highest temperature during the procedure and the pull-out strength of the pedicle screws were recorded for different groups. A two-way ANOVA was used for comparative analysis. The goat bone experiment consisted of an experimental group and a control group. The control group had screws inserted along the pedicle after drilling. In the experimental group, screws were inserted after softening the old bone cement within the vertebral body using a 3.5 mm K-wire for drilling. The highest temperature during the procedure was recorded for the experimental group, and pull-out tests were conducted on the screws of both groups after the procedure. The pull-out results from the goat bone experiment were analyzed using Student's t-test.

Results: Bone cement block experiment: Drilling with K-wires caused a significant temperature increase in the bone cement blocks, with temperature rises at 4 mm ranging from 28.1°C to 75.9°C. The maximum pull-out loads across all groups ranged from 2455.053 to 15201.94 N. In the goat bone experiment, the experimental group showed temperature increases of 8.38°C ± 3.07°C beneath the pedicle, 11.18°C ± 1.42°C in the spinal canal, and 8.26°C ± 3.46°C anterior to the vertebral body during drilling. The average maximum loads for the experimental and control groups were 910.5504 ± 221.6544 N and 294.229 ± 40.3475 N, respectively, indicating a statistically significant difference between the two groups (p = 0.0001).

Conclusion: The experimental results demonstrate that screws can be inserted into bone cement after thermal softening via K-wire drilling, achieving good pull-out resistance. In the goat bone experiment, the average temperature increase around the vertebral body was measured to be below 10°C, indicating a low risk of thermal damage to the surrounding tissues.

Objective: Hip fracture causes significant morbidity and mortality, necessitating the identification of biomarkers for risk stratification. This study aimed to evaluate the association between N-terminal pro-B-type natriuretic peptide (NT-proBNP) and incidence of postoperative complications and the 2-year all-cause mortality among hip fracture patients.

Methods: This retrospective cohort study involved 2595 patients aged from 45 years who received surgery for hip fracture between 2000 and 2022. Preoperative NT-proBNP levels were used to divide patients into three groups: low (< 123.27 pg/mL), moderate (123.27–349.93 pg/mL), and high (> 349.93 pg/mL) NT-proBNP group. Multivariate logistic regression and Cox proportional hazards models were used to evaluate the odds ratio (OR) for postoperative complications and the hazard ratio (HR) for mortality, after adjusting for potential confounders.

Results: Post-operative complications were reported in 171 (6.59%) patients with mortality of 226 (8.71%) during the 2-year follow-up. Compared to patients with low NT-proBNP group, the adjusted odds ratio for postoperative complications was 1.21 (95% CI 0.69–2.15) for those in the moderate NT-proBNP group and 2.33 (95% CI 1.35–4.03) for those in the high NT-proBNP group. Similarly, the adjusted hazard ratio for 2-year all-cause mortality was 1.51 (95% CI 0.91–2.50) for those in the moderate NT-proBNP group and 2.66 (95% CI 1.63–4.32) for those in the high NT-proBNP group. Higher pre-operative NT-proBNP levels were associated with an increased risk for postoperative complications and 2-year all-cause mortality (both p for trend < 0.001) among hip fracture patients. The results were consistent across various subgroup and sensitivity analyses.

Conclusion: Preoperative NT-proBNP is strongly associated with both postoperative complications and 2-year all-cause mortality among patients received hip fracture surgery. Higher levels of NT-proBNP before surgery may serve as a useful biomarker for risk stratification and guiding treatment decisions for this patient subpopulation.

J. Zang, F. Wei, L. Shi, and S. Qin, “The Principle of Limb Reconstruction—“One Walking, Two Lines, and Three Balances”: A Retrospective Analysis of Post-Traumatic Lower Limb Deformity Correction,” Orthopaedic Surgery 16 (2024): 2252–2263, https://doi.org/10.1111/os.14215.

The affiliation of Dr. Jiancheng Zang and Fang yuan Wei were incorrect, it should be:

1. Department of Foot and Hand Surgery, Beijing University of Chinese Medicine Third Affiliated Hospital, The Engineering Research Center “Traditional Chinese Medicine Orthopedics and Intelligent Rehabilitation”, Ministry of Education.

We apologize for this error.