搜索结果：Journal of orthopaedic surgery (Hong Kong)

Generative artificial intelligence (AI) is a powerful class of machine learning that moves beyond simply analysing data to actually creating new and original content, such as medical images or clinical text. The use of generative AI is varied in orthopaedic surgery. Generative AI moves us from one-size-fits-all surgical planning to highly personalised surgical blueprints for each patient's unique anatomy and condition. While generative AI in surgery is new, it can provide real-time intelligent help to a surgeon's skill and decision-making. Most practitioners see the use of AI as a tool to improve diagnosis and treatment, with some expressing their concern that it will conversely worsen diagnosis and treatment. With its use and potential, the use of generative AI currently should be supervised and validated, as it has been shown that sometimes the generated content does not reference to any actual source. Policies and economic values are also detrimental to the integration of AI technologies in clinical orthopaedics. Ethical issues, practitioners view and perspective, and the high overall cost of AI technology use, are among the barriers that may emerge. This comprehensive review addresses the opportunities, challenges, and future direction of integrating generative AI in orthopaedic surgery.

Breast cancer is a leading cause of mortality and morbidity among females worldwide. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, we provided an updated comprehensive assessment of the epidemiological trends, disease burden, and risk factors associated with breast cancer globally, regionally, and nationally from 1990 to 2023. Breast cancer incidence, mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) were estimated by age and sex for 204 countries and territories from 1990 to 2023. Mortality estimates were generated using GBD Cause of Death Ensemble models, leveraging data from population-based cancer registration systems, vital registration systems, and verbal autopsies. Mortality-to-incidence ratios were calculated to derive both mortality and incidence estimates. Prevalence was calculated by combining incidence and modelled survival estimates. YLLs were established by multiplying age-specific deaths with the GBD standard life expectancy at the age of death. YLDs were estimated by applying disability weights to prevalence estimates. The sum of YLLs and YLDs equalled the number of DALYs. Breast cancer burden attributable to seven risk factors was examined through the comparative risk assessment framework. The GBD forecasting framework was used to forecast breast cancer incidence and mortality from 2024 to 2050. Age-standardised rates were calculated for each metric using the GBD 2023 world standard population. In 2023, there were an estimated 2·30 million (95% uncertainty interval [UI] 2·01 to 2·61) breast cancer incident cases, 764 000 deaths (672 000 to 854 000), and 24·1 million (21·3 to 27·5) DALYs among females globally. In the World Bank low-income group, where a low age-standardised incidence rate (ASIR) was estimated (44·2 per 100 000 person-years [31·2 to 58·4]), the age-standardised mortality rate (ASMR) was the highest (24·1 per 100 000 [16·8 to 31·9]). The highest ASIR was in the high-income group (75·7 per 100 000 [67·1 to 84·0]), and the lowest ASMR was in the upper-middle-income group (11·2 per 100 000 [10·2 to 12·3]). Between 1990 and 2023, the ASIR in the low-income group increased by 147·2% (38·1 to 271·7), compared with a 1·2% (-11·5 to 17·2) change in the high-income group. The ASMR decreased in the high-income group, changing by -29·9% (-33·6 to -25·9), but increased by 99·3% (12·5 to 202·9) in the low-income group. The increase in age-standardised DALY rates followed that of ASMRs. Risk factors such as dietary risks, tobacco use, and high fasting plasma glucose contributed to 28·3% (16·6 to 38·9) of breast cancer DALYs in 2023. The risk factors with a decrease in attributable DALYs between 1990 and 2023 were high alcohol use and tobacco. By 2050, the global incident cases of breast cancer among females were forecast to reach 3·56 million (2·29 to 4·83), with 1·37 million (0·841 to 2·02) deaths. The stable incidence and declining mortality rates of female breast cancer in high-income nations reflect success in screening, diagnosis, and treatment. In contrast, the concurrent rise in incidence and mortality in other regions signals health system deficits. Without effective interventions, many countries will fall short of the WHO Global Breast Cancer Initiative's ambitious target of achieving an annual reduction of 2·5% in age-standardised mortality rates by 2040. The mounting breast cancer burden, disproportionately affecting some of the world's most vulnerable populations, will further exacerbate health inequalities across the globe without decisive immediate action. Gates Foundation, St Jude Children's Research Hospital.

Artificial intelligence (AI) has become pervasive in biomedicine and is transforming orthopaedic research from bench to bedside. Beyond its established roles in robotic surgery and diagnostics, AI now supports advances in biomechanics, imaging, tissue engineering, drug discovery, genomics, and prosthetic control. In biomechanics, AI enables faster finite-element simulations, markerless gait analysis, and data augmentation using synthetic signals. Imaging applications include automated segmentation of the spine and hip, opportunistic screening for osteoporosis, bone metastasis detection, and three-dimensional analysis of knee osteoarthritis. In regenerative medicine, AI assists in scaffold optimization, bioprinting, and personalized cell therapies, while integration with genomic and proteomic data enhances precision orthopaedics. Machine learning-based control systems also improve the usability of prosthetics and exoskeletons, reducing cognitive burden for patients. Despite challenges such as data scarcity, validation, and ethical considerations, AI is emerging as a powerful complement to traditional research methods. By accelerating workflows, improving accuracy, and enabling individualized care, AI holds strong potential to bridge laboratory discoveries with clinical applications in orthopaedics. This review highlights the application of AI in orthopaedic research and assesses how it could integrate into clinical practice in the future.

IntroductionTotal Hip Arthroplasty (THA) is a widely performed orthopaedic surgery, essential for treating severe pain and mobility issues arising from various conditions. The anticipated rise in Total Hip Arthroplasty (THA) procedures underscores the critical importance of their success, which is heavily dependent on the accurate positioning of prosthetic components. Various approaches like the Direct Anterior Approach with Fluoroscopy (DAA-F THA) and Robotic-assisted THA (RA THA) have their limitations. Computer-Navigated THA (CN THA) has emerged as a promising alternative, offering real-time feedback and potentially enhanced accuracy in component placement. This study evaluates the precision of CN THA in correcting leg length discrepancies and accurately positioning the acetabular component.MethodsThe study involved 122 consecutive patients undergoing direct anterior CN THA by the senior author. Exclusions were based on different surgical approaches, need for revision surgery, and infections. The study focused on the precise placement of acetabular components and leg length restoration. CN THA was used for intra-operative measurements, while post-operative radiographs were analyzed with TraumaCad® for comparison. Statistical analyses included Pearson correlation coefficients and descriptive analyses.ResultsCN THA showed high accuracy in leg length restoration with 85.25% of cases showing less than 5 mm discrepancy. Similarly, acetabular component positioning was precise, with 90.98% of inclination and 74.59% of anteversion measurements within acceptable ranges. The correlation between intra-operative and post-operative measurements was strong, indicating the reliability of CN THA measurements.ConclusionCN THA was shown to be highly accurate in correcting leg length discrepancies and achieving proper acetabular component positioning. The strong correlation between intra- and post-operative measurements underscores the reliability of CN THA. The study, however, is limited by its single-surgeon, single-approach design, and lack of a control group. Despite these limitations, CN THA shows considerable potential in improving THA precision, enhancing surgical outcomes, and customizing patient care.

BackgroundPatients with type 2 diabetes (T2DM) undergoing ankle fracture open reduction and internal fixation (ORIF) face high risks of surgical site infection (SSI) and implant failure. This study evaluated whether preoperative use of sodium-glucose cotransporter-2 inhibitors (SGLT2is) or glucagon-like peptide-1 receptor agonists (GLP-1 RAs) improves these postoperative outcomes.MethodsUsing the TriNetX global database (2005-2025), we identified T2DM patients undergoing ankle fracture ORIF. Users of SGLT2is or GLP-1 RAs within 180 days before surgery were compared with non-users using 1:1 propensity score matching (PSM). The primary outcome was a 90-day composite of SSI or infection-related implant removal. Secondary outcomes included the 1-year composite and all-cause mortality.ResultsAfter PSM, 1289 users were compared with 1289 non-users. At 90 days, the composite infection-related outcome occurred in 1.45% of users versus 6.26% of non-users (HR 0.34, 95% CI 0.19-0.62; p < 0.001). At 1 year, the risk remained significantly lower in users (1.79% vs 11.92%; HR 0.42, 95% CI 0.25-0.72; p < 0.001). While 1-year mortality showed a downward trend in the primary cohort (HR 0.61, p = 0.1393), sensitivity analyses excluding dual-therapy users demonstrated a statistically significant survival advantage for single-agent users (HR 0.41, 95% CI 0.21-0.80; p = 0.007). Further analysis restricted to active users (30-day exposure) showed no observed instances of mortality or 1-year infection-related complications (both p < 0.001), although these findings should be interpreted cautiously given the small number of events.ConclusionsPreoperative use of SGLT2is or GLP-1 RAs was associated with a substantial reduction in infection-related implant failure and a lower risk of mortality, particularly when used as monotherapy or in closer proximity to surgery. These findings suggest that modern cardiometabolic agents may represent valuable components of preoperative optimization strategies in high-risk diabetic patients, although confirmation in prospective studies is warranted.

ObjectiveThis study examined the associations of visceral adiposity index (VAI), body roundness index (BRI), and lipid accumulation product (LAP) with the risk, severity, and prognosis of knee osteoarthritis (KOA). The aim was to evaluate the clinical utility of these novel adiposity indices for early screening and prognostic assessment of KOA.MethodsA total of 124 patients with clinically and radiographically confirmed KOA and 120 healthy individuals who underwent routine physical examinations during the same period were enrolled as the KOA and control groups, respectively. Baseline data were collected retrospectively from electronic medical records. KOA patients were further classified into mild, moderate, and severe subgroups based on K-L grading and were followed for 12&#xa0;months.ResultsCompared with controls, the KOA group had significantly higher BMI, TG, TC, LDL-C, VAI, BRI, and LAP, and lower HDL-C (p < 0.05). VAI, BRI, and LAP increased progressively with KOA severity (p < 0.05), showing positive correlations (r = 0.608, 0.489, 0.551, p < 0.001), and were confirmed as independent risk factors (p < 0.05). ROC analysis yielded AUCs of 0.775 (95% CI: 0.718-0.833; cutoff: 2.91) for VAI, 0.752 (95% CI: 0.692-0.813; cutoff: 5.21) for BRI, and 0.779 (95% CI: 0.722-0.836; cutoff: 48.58) for LAP, with a combined AUC of 0.880 (95% CI: 0.839-0.922). Survival time differed significantly across groups stratified by these cutoffs (VAI: &#x3c7;2 = 4.238; BRI: &#x3c7;2 = 3.956; LAP: &#x3c7;2 = 6.043; all p < 0.05).ConclusionThis study concludes that VAI, BRI, and LAP are closely linked to KOA. Firstly, their levels are significantly raised in patients and show a positive correlation with disease severity, marking them as useful clinical indicators. Secondly, the combined detection of these indices provides superior predictive value for KOA and is associated with an unfavorable prognosis, suggesting their utility in comprehensive risk assessment.

ObjectiveIn revision total knee arthroplasty (rTKA), metaphyseal sleeves represent an effective modality for managing metaphyseal bone defects. The purpose of this study was to clearly stratify patients with different grades of metaphyseal bone defects while evaluating the mid-term clinical outcomes and survival rate of metaphyseal sleeves.MethodsA retrospective study was conducted on 58 patients who underwent revision total knee arthroplasty (rTKA) with metaphyseal sleeves between May 2018 and September 2022. Bone defects were classified using the Anderson Orthopaedic Research Institute (AORI) classification system: patients with AORI type I and IIA defects were categorized as having mild bone defects, while those with AORI type IIB and III defects were defined as severe bone defects. Clinical outcomes, including the visual analog scale (VAS) for pain, range of motion (ROM), Hospital for Special Surgery (HSS) score, Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Short Form-12 (SF-12) health survey, were recorded preoperatively and during the entire follow-up period. Linear mixed-effects models were employed to analyze repeated-measure outcomes, and Kaplan-Meier analysis was utilized to estimate the survivorship of metaphyseal sleeves.ResultsThe mean duration of follow-up was 66.6&#xa0;months, with a range of 30 to 85&#xa0;months. All clinical outcome metrics exhibited a statistically significant improvement compared with preoperative values (p < 0.001), and both the mild and severe defect groups demonstrated analogous postoperative recovery trajectories. No sleeve-related complications or failures were observed, including aseptic loosening, periprosthetic fracture, or deep periprosthetic infection. Kaplan-Meier analysis yielded an estimated 5-years metaphyseal sleeve survivorship of 100%.ConclusionThese findings demonstrate that metaphyseal sleeves provide reliable midterm fixation and significant functional improvements in patients undergoing revision total knee arthroplasty (rTKA), irrespective of the severity of metaphyseal bone defects.

PurposeDespite systemic antibiotics and topical vancomycin powder, deep surgical-site infections (SSIs) remain a devastating complication of major posterior spine surgery, driving morbidity, costs, and antimicrobial resistance. In this study, we aimed to compare deep surgical-site infection (SSI) incidence following major posterior spine surgery between patients receiving intraoperative hypochlorous acid (HOCl) lavage and a historical control group receiving intrawound vancomycin powder.MethodsIn this retrospective comparative study, 161 patients undergoing major posterior spinal surgery received &#x2265;2L of topical HOCl lavage, while 88 historical controls received intra-wound vancomycin powder. The primary endpoint was deep SSI incidence within 12&#xa0;months. Demographics, operative variables, and microbiological data were analyzed with rigorous statistical methods.ResultsDeep SSI rates were nearly identical: 3.1% (5/161) with HOCl versus 3.4% (3/88) with vancomycin (p = 0.999), with no HOCl-related adverse effects. Pathogen profiles (including MRSA, S. epidermidis, and E. coli) were comparable between groups, underscoring HOCl's broad-spectrum efficacy.ConclusionHOCl lavage showed similar deep SSI rates to intrawound vancomycin powder in this retrospective cohort; prospective multicenter studies are warranted to validate these findings and define optimal protocols.

Study designNetwork Meta-Analysis.ObjectiveTo comprehensively compare the clinical efficacy and safety of anterior controllable antedisplacement and fusion (ACAF), anterior cervical corpectomy and fusion (ACCF), and laminoplasty (LP) for treating multilevel cervical ossification of the posterior longitudinal ligament (OPLL).MethodsPubMed, Cochrane Library, Embase, and Web of Science were systematically searched (inception to April 1, 2025) for clinical studies comparing at least two of ACAF, ACCF, or LP for multilevel (&#x2265;2 segments) cervical OPLL. Data on surgical parameters, neurological function (Japanese Orthopaedic Association [JOA] score, JOA recovery rate, Visual Analog Scale [VAS]), biomechanics (cervical curvature, Cobb angle, Range of Motion [ROM], Neck Disability Index [NDI]), and complications were extracted. A frequentist network meta-analysis using a multivariate random-effects model was performed. Treatments were ranked using the surface under the cumulative ranking curve (SUCRA).ResultsThirty-one non-randomized studies involving 2616 patients were included (ACAF: 585; ACCF: 875; LP: 1156). NMA showed ACAF and ACCF achieved significantly better postoperative JOA scores and recovery rates than LP (p < 0.05). ACAF showed the highest probability of being the most effective treatment for postoperative VAS score (vs ACCF & LP, p < 0.05) and maintenance of cervical curvature/Cobb angle (vs ACCF & LP, p < 0.05). LP had the shortest operative time (p < 0.05). Regarding safety, ACAF was associated with the lowest probability of total complications (SUCRA 99.7%), with significantly lower risks of cerebrospinal fluid (CSF) leakage versus ACCF (p < 0.05), and C5 palsy and axial pain versus LP (p < 0.05). LP had the lowest risk of dysphagia (p < 0.05). Subgroup analysis suggested ACAF's benefits, particularly in neurological outcome, are more pronounced in patients with severe stenosis (occupying ratio &#x2265;60%).ConclusionBased on current observational evidence, ACAF appears to be a promising option for multilevel cervical OPLL, particularly for patients with severe stenosis. ACCF provides effective neurological decompression but carries a higher CSF leak risk than ACAF. LP, while having shorter operative times, results in inferior neurological and biomechanical outcomes compared to anterior approaches. Surgical decisions require individualized assessment based on patient and OPLL characteristics.However, these findings should be interpreted with caution due to the predominance of non-randomized studies and potential selection bias.

BackgroundOrthopaedic infections are difficult to eradicate because biofilm and poor local vascularity limit antibiotic exposure. Continuous local antibiotic perfusion (CLAP) delivers sustained, titratable antibiotics directly into infected compartments. We used harmonised individual participant data (IPD) to quantify early effectiveness, longer-term control, safety, and patient-level modifiers.MethodsWe performed an IPD review of observational reports using CLAP as primary or adjunctive therapy (January-May 2025). The primary outcome was 30-days early response (C-reactive protein &#x2264;3&#xa0;mg/L or earliest sustained clinical/wound improvement). Secondary outcomes were durable infection control at &#x2265;6 and &#x2265;12&#xa0;months using evaluable denominators with best-worst bounds, infection-free days) and safety. One-stage analyses used mixed-effects logistic regression; Restricted Mean Survival Time (RMST) was preferred when proportional hazards were violated. Multiple imputation supported inferences.ResultsEighty-one studies (n = 256) were included; 164 patients had observed time-to-response. Fifty-nine percent achieved a 30-days response; median time-to-response was 26&#xa0;days. Implant involvement was associated with lower odds of 30-days response; trajectories were slower with implants and higher organism burden (polymicrobial &#x2265;3), while osteomyelitis responded faster than fracture-related infection. RMST (30) showed delays with implants (+4.43&#xa0;days) and polymicrobial infection (+6.74&#xa0;days), and faster response for osteomyelitis versus fracture-related infection (-9.06&#xa0;days). Durable control among evaluable patients was 88.4% at &#x2265;6&#xa0;months and 90.2% at &#x2265;12&#xa0;months, with best-worst bounds of 89.2-82.2% and 90.9-83.5%, respectively. Infection-free-day RMST supported substantial time free of recurrent infection within the first year. Adverse events were uncommon; renal events were generally reversible.ConclusionsCLAP achieved encouraging early response and high durability among evaluable patients, with slower trajectories when implants were retained or pathogen burden was high and faster responses in osteomyelitis. Safety appeared acceptable with monitoring. Prospective comparative studies using standardised endpoints, with RMST for non-proportional hazards, are warranted.

BackgroundRotational alignment of the tibial component is critical for successful total knee arthroplasty (TKA). Akagi's line is a reliable anteroposterior reference, but its intraoperative applicability may be limited when the posterior cruciate ligament (PCL) is not visible after tibial resection. The extensor hallucis longus (EHL) tendon, as an extra-articular and consistently identifiable structure, may represent a practical distal landmark. This study evaluates the anatomical relationship between Akagi's line and the EHL tendon on computed tomography (CT) and analyzes its association with tibial morphometric parameters.MethodsA descriptive correlational study was conducted on CT scans of 100 anatomically normal tibiae. Akagi's line was defined as the line connecting the center of the PCL to the medial border of the patellar tendon. Its distal projection at the tibial plafond was compared with the center of the EHL tendon. Tibial length, morphology, posterior slope, sagittal distance, and the angle of Akagi's line relative to the femoral transepicondylar axis (TEA) were measured. Two independent observers performed all measurements. Associations were analyzed using Spearman's correlation coefficients with 95% confidence intervals.ResultsAkagi's line projected through the center of the EHL tendon in 60% of cases and medially in 40%, with no lateral deviations. The Akagi-EHL distance correlated strongly with tibial length (&#x3c1; = 0.71; p < 0.001) and sagittal distance (&#x3c1; = 0.70; p < 0.001), but showed no association with tibial slope. No significant correlation was observed between the Akagi-femoral TEA angle and morphometric parameters.ConclusionThe distal projection of Akagi's line consistently aligns with, or lies slightly medial to, the center of the EHL tendon. This predictable relationship supports the EHL as a reliable, extra-articular distal landmark for tibial rotational alignment in TKA when intra-articular references are obscured.Level of evidenceIV (Descriptive study).

BackgroundWhile obesity is an established risk factor for osteoarthritis (OA), the differential impacts of regional body composition is not well understood. This study aimed to examine the associations of whole-body and region-specific (arms, legs, and trunk) fat-to-muscle mass ratio (FMR) with OA prevalence, as well as the mediating effects of systemic inflammation in this relationship.MethodsData from adults aged &#x2265;40&#xa0;years were collected from the 1999-2006 & 2011-2018 cycles of National Health and Nutrition Examination Survey. Total and region-specific FMR was assessed using dual-energy X-ray absorptiometry, with OA status determined by self-report. Logistic regression was used to analyze the associations between total or regional FMR and OA prevalence. Mediation analysis was conducted to determine the mediating effect of the systemic immune-inflammation index (SII).ResultsAmong the 9,504 participants included, 953 (10.63%) had OA. The odds ratio (95% confidence intervals) for OA by arm, leg, trunk and total FMR were 1.122 (1.082-1.163), 1.156 (1.101-1.213), 1.142 (1.094-1.192), and 1.194 (1.131-1.260), respectively. Compared to the lowest quartile, the highest quartile of arm, leg, trunk, and total FMR had 75.4%, 115.7%, 113.6%, and 161.3% increased risk of OA, respectively. Restricted cubic spline curves indicated a linear relationship between leg, trunk and total FMR with OA. The discriminatory performances of FMR measures were modest (area under the curve 0.635-0.656). SII mediated 2.4%-2.6% of the association between FMR and OA.ConclusionA higher FMR in all body regions is associated with a higher risk of OA, which is partially mediated by systemic inflammation.

Meningitis remains the leading infectious cause of neurological disabilities globally, disproportionately affecting children younger than 5 years and populations in the African meningitis belt. Whereas previous global estimates focused on ten pathogen categories, this study presents the most comprehensive analysis to date, assessing the meningitis burden attributable to 17 causative pathogens based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 framework. GBD is a systematic, scientific effort aimed at quantifying the comparative magnitude of health loss caused by diseases, injuries, and risk factors across age groups, sexes, and geographical locations over time. We estimated meningitis mortality using the Cause of Death Ensemble model (CODEm) and morbidity using DisMod-MR 2.1, incorporating data from vital registration, verbal autopsy, surveillance, hospital data, and systematic reviews. Aetiology-specific estimates were generated with pathogen-linked case-fatality ratios and splined binomial regression models. Risk factor attribution was based on established risk-outcome pairs and population attributable fractions. In 2023, there were 259&#x2009;000 (95% uncertainty interval 202&#x2009;000-335&#x2009;000) global deaths and 2&#xb7;54 million (2&#xb7;20-2&#xb7;93) incident cases of meningitis. Children younger than 5 years accounted for more than a third of deaths (86&#x2009;600 [53&#x2009;300-149&#x2009;000]). Streptococcus pneumoniae, Neisseria meningitidis, non-polio enteroviruses, and other viruses were the leading causes of death, while non-polio enteroviruses caused the most cases. The four WHO-defined preventable meningitis pathogens of interest (S pneumoniae, N meningitidis, Haemophilus influenzae, and Group B streptococcus) contributed to 98&#x2009;700 deaths (77&#x2009;000-127&#x2009;000) and 594&#x2009;000 cases (514&#x2009;000-686&#x2009;000). Low birthweight, short gestation, and household air pollution were the top risk factors for meningitis-related mortality. Although mortality and incidence have declined significantly since 1990, progress is insufficient to meet WHO 2030 targets. Despite marked progress in reducing bacterial meningitis via global vaccination campaigns, a substantial meningitis burden persists, attributable both to common pathogens such as S pneumoniae and N meningitidis and to emerging non-bacterial pathogens such as Candida spp and drug-resistant fungi. Achieving WHO goals will require sustained investment in surveillance, vaccination, maternal screening, and health-system strengthening, especially in high-burden settings. Gates Foundation, Wellcome Trust, and UK Department of Health and Social Care.

This study aims to evaluate the global burden of adverse effects of medical treatment (AEMT) using data from the Global Burden of Disease Study (GBD) 2021. Data were extracted from the GBD 2021, covering 204 countries/territories from 1990 to 2021. AEMT was defined using ICD-9 and ICD-10 codes, encompassing complications from medical procedures, treatments, or healthcare exposures. Estimates were categorized into fatal and non-fatal outcomes and stratified by age, sex, year, and covariates, including the Socio-demographic Index (SDI). Mortality-incidence ratios (MIRs), defined as the ratio of mortality calculated by dividing the number of deaths by the total incident cases, were analyzed. In 2021, the global age-standardized prevalence, incidence, disability-adjusted life years (DALYs), and mortality rates of AEMT were 11.48 (95% uncertainty interval [UI], 8.86-14.13), 150.44 (131.19-171.81), 64.19 (51.06-73.11), and 1.53 (1.29-1.68) per 100,000 population, respectively. DALY rates were highest in the early neonatal group (4,789.47 per 100,000 population [95% UI, 3,682.00-5,963.30]), while mortality rates followed a U-shaped pattern across age groups. In 2021, MIRs were highest at both ends of the age range: the early neonatal group (0.58 [95% UI, 0.55-0.58]) and the 95+ age group (0.05 [0.04-0.06]). This pattern was consistent across all SDI quintiles, with higher MIRs observed in lower SDI quintiles. The significantly higher prevalence and incidence rates of AEMT among the older population in high SDI quintiles, compared to lower SDI quintiles, could be attributed to the healthcare overutilization, highlighting the need for policy adjustments.

BackgroundThe optimal positioning range for the femoral component in unicompartmental knee arthroplasty (UKA) performed in osteoporotic bone remains undefined. Most existing biomechanical studies have been established using normal bone quality models, whereas limited evidence addresses abnormal bone conditions. Complications involving the operative-side compartment are closely associated with the high revision rates after UKA.MethodsCT and MRI scans of the right knee of a volunteer without pathological changes were used to construct a three-dimensional finite element model. A normal bone quality UKA model (NB group) was created, and an osteoporotic model (OP group) was generated by reducing the elastic modulus of bone tissue proportionally. Femoral component alignment was set at 0&#xb0;, as well as 3&#xb0;, 6&#xb0;, and 9&#xb0; of varus and valgus. Stress changes within operative-side structures were quantified and compared between the two models.Results(1) In both models, peak stress on the femoral component increased progressively with greater varus alignment, with the OP group consistently demonstrating higher stress values than the NB group. Compared to their respective 0&#xb0; neutral position, the peak von Mises stress on the femoral component surface increased by 71.8% and 70.8% at 9&#xb0; of varus in the NB and OP groups, respectively. (2) Peak stresses on the PE insert and on the cortical bone beneath the tibial component increased with both varus and valgus malalignment; the increase was more pronounced under varus. The OP group exhibited higher peak stresses and greater incremental changes than the NB group. Compared to their respective 0&#xb0; neutral position, the peak von Mises stress on the cortical bone surface beneath the tibial component increased by 50.0% in the NB group and 40.8% in the OP group at 9&#xb0; varus, and by 14.2% and 27.0%, respectively, at 9&#xb0; valgus.ConclusionEven small coronal-plane deviations (&#xb1;3&#xb0;) in femoral component positioning during medial UKA may substantially elevate stresses within the operative-side compartment. Strict control of coronal alignment is essential to avoid varus or valgus and prevent abnormal stress concentrations around the implant. Additionally, the impact of osteoporosis on postoperative biomechanical stability warrants careful consideration to optimize implant design and surgical technique, thereby reducing the risks of aseptic loosening, periprosthetic fracture, and improving long-term outcomes.

ObjectiveThis study aimed to evaluate the clinical efficacy of different rotational alignment techniques for the tibial component in total knee arthroplasty (TKA) using a Medial Pivot (MP) knee system, providing improved strategies for tibial prosthesis positioning.MethodsA retrospective analysis included 115 patients with end-stage osteoarthritis who underwent MP-TKA at our hospital from January 2022 to June 2025. Patients were grouped based on tibial alignment reference points: the medial one-third of the tibial tubercle (medial 1/3 group) and the midpoint of the tibial tubercle (midpoint group). Intraoperative variables-operation time, incision length, blood loss-were recorded. Postoperative knee function was assessed using the Hospital for Special Surgery (HSS) score, Visual Analogue Scale (VAS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Tibial posterior slope angles evaluated prosthesis positioning accuracy, and postoperative complications (infection, anterior knee pain, deep vein thrombosis) were documented.ResultsThe average follow-up was 15.87 &#xb1; 3.87&#xa0;months. Baseline and intraoperative data showed no significant differences between groups (p > 0.05). The medial 1/3 group reported one incision infection and four cases of anterior knee pain; the midpoint group had no infections and two cases of anterior knee pain, all resolved with treatment. At 1 and 6&#xa0;months postoperatively, the midpoint group had significantly higher HSS scores and lower VAS and WOMAC scores compared to the medial 1/3 group (p < 0.05). Tibial posterior slope <1&#xb0; was more frequent in the midpoint group (75.86% vs 59.65%), indicating more accurate alignment.ConclusionUsing the tibial tubercle midpoint for tibial component alignment in MP-TKA results in better prosthesis fit, improved knee function, and reduced anterior knee pain compared to the medial one-third reference, offering a preferable clinical approach.

BackgroundIntervertebral disc degeneration (IVDD) is a prevalent musculoskeletal condition that affects the spine, particularly in the lumbar region and induces low back pain. Tuina therapy has been widely utilized to alleviate low back pain for a long time. However, the specific mechanism underlying this effect of Tuina therapy on IVDD remains unclear.MethodsThe rat IVDD model was established by puncturing caudal vertebrae. Magnetic resonance imaging, Hematoxylin and eosin staining, and Safranin O staining were operated to assess histological changes. RT-qPCR and Western blot were carried out to measure mRNA and protein levels, respectively. Prussian Blue Staining and an iron assay kit were utilized to measure iron content in NP tissues.ResultsThe chaotic fibrous tissues, loss of NP tissues and cartilaginous components were observed in IVDD rats, and these pathological changes were alleviated by Tuina therapy. Besides, the mRNA and protein levels of inflammatory factors (TNF-alpha, IL-1beta, and IL-6) were significantly upregulated in IVDD group compared to sham group, and Tuina therapy reduced the release of these inflammatory factors. Moreover, the increased content of iron ion in IVDD rats was also reduced by Tuina therapy. Furthermore, the upregulation of ACSL4 protein, the downregulation of GPX and FTH proteins in IVDD groups were reversed by Tuina therapy.ConclusionsTuina therapy prevented IVDD aggravation by suppressing inflammatory response and ferroptosis in rat model.

BackgroundOsteoarthritis (OA) is a leading cause of chronic pain and disability worldwide, particularly among aging populations. Early identification of structural alterations may enable timely intervention and reduce irreversible joint damage. The posterior tibial slope (PTS) and metaphysio-diaphyseal angle (MDA) have been proposed as radiographic biomarkers of knee OA; however, population-specific data from South India are limited.ObjectivesTo evaluate PTS and MDA as radiological markers of knee osteoarthritis in South Indian adults, compare these parameters between osteoarthritic and non-osteoarthritic knees, assess their interrelationship, and determine their diagnostic performance in predicting OA.MethodsA hospital-based cross-sectional comparative study was conducted among 384 adults aged &#x2265;30 years attending the Orthopaedics Department at Chettinad Hospital & Research Institute, Chennai, between June 2022 and January 2024. Equal numbers of osteoarthritic knees (n = 192) and non-OA controls (n = 192) underwent standardized anteroposterior and lateral knee radiography. PTS and MDA were measured digitally using validated techniques.ResultsMean PTS was significantly higher in osteoarthritic knees compared with controls (15.98 &#xb1; 2.18&#xb0; vs 9.78 &#xb1; 2.73&#xb0;, p < 0.001). Similarly, MDA was significantly elevated in the OA group (24.86 &#xb1; 4.13&#xb0; vs 21.44 &#xb1; 4.30&#xb0;, p < 0.001). A moderate positive correlation was observed between PTS and MDA (r = 0.275, p < 0.001; R2 = 0.075). ROC analysis demonstrated excellent discriminative ability for PTS (AUC = 0.963) and moderate discriminative ability for MDA (AUC = 0.717). Female participants constituted 52.5% of the OA group, consistent with established sex-related prevalence patterns.ConclusionPosterior tibial slope and metaphysio-diaphyseal angle are significantly increased in osteoarthritic knees among South Indian adults, with PTS showing superior diagnostic accuracy. These parameters may serve as useful adjunctive radiographic markers for early OA detection and risk stratification. Further longitudinal studies are warranted to establish population-specific predictive thresholds.

PurposeThis study aimed to evaluate the clinical and radiological outcomes of lunate excision scaphocapitate fusion (LESCF) using a single headless cannulated compression screw in patients with advanced Kienb&#xf6;ck disease (Lichtman IIIb-IV). The hypothesis was that this technique would provide significant pain relief, functional improvement, and comparable union rates to multi-screw methods while reducing implant-related morbidity.MethodsA retrospective single-center case series included 24 patients (8 males, 16 females; mean age 37.3 &#xb1; 8.5 years) who underwent LESCF between June 2021 and June 2023. Minimum follow-up was 24 months (mean 33.6 &#xb1; 4.1). Clinical evaluation included pain (VAS), wrist function (Modified Mayo Wrist Score), grip strength, and range of motion. Radiological assessment involved union rate and time, radioscaphoid angle (RSA), carpal height ratio (CHR), Modified Carpal Ulnar Distance Ratio (modified-CUDR) and ulnar variance.ResultsRadiographic union was achieved in all cases (100%) at a mean of 3.5 &#xb1; 1.2 months. Mean VAS score decreased from 7.2 &#xb1; 1.1 to 2.1 &#xb1; 1.0 (p < 0.001), and Modified Mayo Wrist Score improved from 47 &#xb1; 12 to 74 &#xb1; 10 (p < 0.001). Grip strength increased from 55 &#xb1; 15% to 75 &#xb1; 18% of the contralateral hand (p < 0.01). Flexion-extension arc slightly decreased (81&#xb0; &#xb1; 10 to 76&#xb0; &#xb1; 9; p < 0.05), while radioulnar deviation changes were minimal. RSA improved from 48&#xb0; &#xb1; 7 to 41&#xb0; &#xb1; 6 (p < 0.01), with no significant change in CHR or ulnar variance. Modified CUDR values were found to be 0.834 &#xb1; 0.104 in the preoperative period and 0.804 &#xb1; 0.116 in the postoperative period. One patient (4.2%) reported mild screw irritation without surgical intervention; no other complications occurred.ConclusionSingle-screw scapho-capitate fusion and lunate excision can be considered a suitable treatment option for advanced Kienb&#xf6;ck's disease, offering pain reduction, positive effects on functional recovery, acceptable healing rates, and a low risk of complications. However, larger, prospective studies are needed to demonstrate the long-term results of this method and its comparative effectiveness with other surgical techniques.