Purpose:Pain perception following staged bilateral total knee arthroplasty (TKA) remains controversial, with previous studies suggesting increased pain after the second knee attributed to central sensitization. This retrospective observational study aimed to compare postoperative pain between first- and second-stage TKA using a linear mixed-effects model adjusted for opioid consumption and peripheral nerve block type. Patients and Methods:This retrospective observational study included 155 patients who underwent staged bilateral TKA under spinal anesthesia between 2015 and 2020 at Prince of Songkla University Hospital, Hat Yai, Thailand. Pain was assessed using a verbal numerical rating scale (VNRS) every 4 hours for 72 hours postoperatively. A linear mixed-effects model with a random intercept for each patient was used for the primary analysis, with last observation carried forward (LOCF) as sensitivity analysis. Results:Among the 155 patients included, no significant difference in pain was found between the first and second TKAs (β = -0.027; 95% CI, -0.139 to 0.085; P = 0.638). Pain decreased significantly over time (β = -0.073 per 4-hour interval; 95% CI, -0.083 to -0.063; P < 0.001). Femoral nerve block was associated with reduced pain (β = -0.321; 95% CI, -0.509 to -0.133; P = 0.001). Higher opioid consumption was associated with increased pain (β = 0.018; 95% CI, 0.014 to 0.022; P < 0.001). The LOCF sensitivity analysis confirmed no significant difference between stages (β = -0.051; 95% CI, -0.147 to 0.045; P = 0.300). Conclusion:Within the first 72 hours, pain following second-stage TKA was not significantly different from that following first-stage TKA. These findings do not support central sensitization as an inevitable cause of increased second-knee pain and suggest that previously reported increases may have been confounded by uncontrolled opioid exposure. As an observational analysis, these results cannot establish causation.
Ruihuan Du,1,2 Juan Zhao,3 Zixuan Xiong,1,4 Bo Wang21Department of Emergency Surgery, Hohhot First Hospital, Hohhot, Inner Mongolia, People’s Republic of China; 2Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People’s Republic of China; 3Department of Medical and Health Sciences, Hohhot Vocational and Technical University, Hohhot, Inner Mongolia, People’s Republic of China; 4The Fifth Clinical College, Inner Mongolia Medical University, Hohhot, Inner Mongolia, People’s Republic of ChinaCorrespondence: Bo Wang, Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, No. 222 Zhongshan Road, Xigang District, Dalian, Liaoning, 116011, People’s Republic of China, Tel +86-18098876058, Fax +86-411-83635963, Email wangbobest@163.comObjective: To evaluate global and China-specific spinal pain burden and trends among women aged 15– 49 years from 1990 to 2023 and to examine regional and Socio‑demographic Index (SDI) variations.Methods: Using the Global Burden of Disease (GBD) 2023 data, we retrieved data on the incidence and years lived with disability (YLDs) of low back pain (LBP) and neck pain among women aged 15– 49 years in 204 countries and territories from 1990 to 2023. Estimated annual percentage changes (EAPC) in the age‑standardized incidence and YLDs rates were calculated to quantify the temporal trends. Spearman correlation analysis was used to examine the relationship between age‑standardized rates and the SDI. Bayesian age‑period‑cohort models with integrated nested Laplace approximations were applied to project incidence trajectories through 2040.Results: From 1990 to 2023, the absolute burden of LBP and neck pain increased globally, with divergent trends across regions. Globally, the age‑standardized incidence rate declined for LBP [EAPC – 6.0% (95% CI, – 8.1 to – 3.3)] but increased for neck pain [EAPC 6.2% (95% CI, 0.5 to 13.9)]. The age‑standardized YLDs rate followed a similar directional pattern for each condition. In 2023, the age‑standardized incidence of LBP was highest in high‑SDI regions, while the age‑standardized incidence of neck pain was most pronounced in the Middle East and North Africa. Correlation analyses revealed a significant positive association between LBP and SDI at both the regional (incidence: r=0.673, p< 0.0001; YLDs: r=0.678, p< 0.0001) and national levels (incidence: r=0.664, p< 0.0001; YLDs: r=0.653, p< 0.0001). In contrast, no such correlation was observed for neck pain. China showed a distinct pattern: it achieved the steepest global decline in both LBP incidence [EAPC – 20.9% (95% CI, – 26.4 to – 15.0)] and YLDs [EAPC – 21.7% (95% CI, – 26.6 to – 16.0)], yet its neck pain YLDs rate rose sharply [EAPC 17.6% (95% CI, 2.5 to 37.1)]. Projections to 2040 suggest that while age‑standardized rates for both conditions will continue to decline globally and in China, the absolute number of cases and YLDs will remain substantial.Conclusion: This study reveals divergent global trends in spinal pain among women of reproductive age—LBP declining, neck pain rising—with striking geographical heterogeneity. Australasia recorded the highest LBP rates alongside the lowest neck pain rates worldwide, while China achieved one of the steepest global declines in LBP but experienced one of the sharpest rises in neck pain‑related disability. These divergent patterns underscore substantial regional health inequalities in spinal pain burden and highlight the need for tailored, population‑specific prevention strategies, with implementation research urgently needed to evaluate context‑specific effectiveness, particularly in resource‑limited settings.Keywords: low back pain, neck pain, incidence, GBD database
Rita Saad,1 Johnny Saadeh,1 Fouad Assaf,1 Antoine Saber,1 Saadeddine Abouzahr,1 Elyssa Kiwan,1 Wendy Ghanem,1 Mohamad Badra,1,2 Ramzi Moucharafieh1– 31Department of Orthopaedics and Traumatology, University of Balamand, Koura, Lebanon; 2Department of Orthopaedic Surgery, Clemenceau Medical Center, Beirut, Lebanon; 3Department of Medicine, European University Cyprus, Nicosia, CyprusCorrespondence: Rita Saad, Email ritahsaad@hotmail.comAbstract: Segmental bone loss and chronic nonunion of the forearm present major reconstructive challenges due to the forearm’s unique functional anatomy and the frequent coexistence of biological compromise, infection, and soft-tissue deficiency. The purpose of this review is to analyze the pathophysiology of forearm nonunion and to compare the Masquelet induced membrane technique (IMT) and free vascularized bone grafting (VBG) as contemporary reconstructive strategies, focusing on indications, biological rationale, outcomes, and complications. A narrative review of the English-language literature was conducted using PubMed, Embase, and the Cochrane Library, with searches performed through December to February 2026. Search terms included combinations of: forearm nonunion, segmental bone defect, Masquelet technique, induced membrane, vascularized bone graft, free fibular graft, upper extremity reconstruction, and forearm fracture. Clinical and experimental studies addressing forearm nonunion or segmental defects treated with IMT or VBG were included; non-English publications and studies not reporting union or functional outcomes were excluded. Emphasis was placed on biological principles, surgical techniques, union rates, functional outcomes, complication profiles, and factors influencing technique selection. Based on predominantly retrospective, single-center series with heterogeneous defect characteristics, both IMT and VBG appear to demonstrate favorable union rates when applied in appropriately selected patients; however, direct forearm-specific comparative evidence remains limited and largely low-level. IMT provides a staged, biologically favorable environment for graft incorporation and is particularly effective in infected or moderate-sized defects, while avoiding microsurgical complexity. VBGs, especially free vascularized fibular grafts, offer intrinsic vascularity and structural stability, making them advantageous for large defects, compromised local biology, or salvage after failed reconstruction, though with increased technical demands and donor-site morbidity. IMT and VBG are complementary rather than competing strategies in forearm reconstruction. Given the scarcity of high-quality comparative data, outcome optimization relies on individualized decision-making informed by defect size, biological environment, soft-tissue status, patient factors, and surgical expertise, pending more robust prospective evidence.Keywords: forearm nonunion, segmental bone defect, masquelet technique, vascularized bone graft, upper extremity reconstruction
Hip osteoarthritis (OA) is a chronic, progressive degenerative joint disorder associated with significant morbidity and limited non-surgical treatment options. Over the past 20 years, Platelet-rich plasma (PRP) has garnered increasing interest as a conservative intervention in the setting of OA; however, its clinical efficacy in hip OA remains inconclusive due to substantial heterogeneity in preparation protocols and administration methods. This systematic review aims to examine randomized controlled trials (RCTs) published between 2019 and 2024 that evaluated the efficacy of PRP in the management of hip OA, with specific criteria including the use of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and/or the Visual Analog Scale (VAS) for outcome measurement. Three RCTs met the eligibility criteria. While short-term improvements in pain and function were observed in patients with mild to moderate OA, long-term benefits were inconsistent. Considerable variability in PRP composition (leukocyte-rich versus leukocyte-poor), activation techniques, injection schedules, and follow-up durations was evident across studies. Particularly, one trial demonstrated no significant advantage of PRP over placebo. Methodological limitations, including lack of blinding, underreporting of PRP characteristics, and protocol heterogeneity, impeded the ability to draw definitive conclusions. Although PRP may provide short-term symptomatic relief in early-stage hip OA, the absence of standardized protocols highlights the need for rigorous, long-term randomized controlled trials that employ consistent classification systems (eg, PAW or MARSPILL) and stratified patient populations to inform evidence-based clinical guidelines.
Background:Malignant neoplasm of bone and articular cartilage (MNBAC) is a rare malignancy associated with substantial premature mortality and disability, particularly among younger populations. Comprehensive, region‑specific assessments in East Asia remain limited despite evolving demographic and epidemiologic patterns. Therefore, this study provides the first East Asia-specific epidemiological assessment of MNBAC with future projections. Methods:Utilizing estimates from the Global Burden of Disease (GBD) 2023 study, we quantified incidence, prevalence, deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) attributable to MNBAC in five East Asian countries and territories from 1990 to 2023, with projections extending to 2050 under multiple foresight scenarios. Data are presented as absolute counts and age-standardized rates with 95% uncertainty intervals. Results:Between 1990 and 2023, in East Asia, the number of incident cases increased from 9,054 to 29,877. DALYs rose from 256,249 to 615,434. Over the same period, age-standardized incidence rates per 100,000 population increased modestly, death rates declined from 3.60 to 3.09, and DALY rates decreased from 138.61 to 112.04. Projections indicate that continued increases in absolute deaths (38,467 by 2050 under the reference scenario) and DALYs (804,272), with similar or higher estimates under alternative scenarios. In contrast, age‑standardized death and DALY rates are projected to remain broadly stable or decline slightly across scenarios. Conclusion:The burden of MNBAC in East Asia was increasing, with projections indicating a continuing upward trend through 2050. While declines in age-standardized death and DALYrates suggest improved health outcomes, these metrics do not necessarily reflect substantive changes in healthcare systems. Overall, advancements in population health are unlikely to fully counterbalance the rising MNBAC burden. Targeted treatment strategies focusing on MNBAC, as well as enhancements to registries and data collection, are essential for mitigating future health losses.
Emily Awdish,1 Marlena Muszynska,1 Konrad Lautenschlager,2 Ali Hamade,3 Matthew Caid31Department of Biomedical Sciences, Noorda College of Osteopathic Medicine, Provo, UT, USA; 2Covenant HealthCare College of Medicine, Central Michigan University, Mount Pleasant, MI, USA; 3Orthopedic Surgery, Corewell Health, Farmington Hills, MI, USACorrespondence: Emily Awdish, Department of Biomedical Sciences, Noorda College of Osteopathic Medicine, Provo, UT, USA, Email Do28.ejawdish@noordacom.orgAbstract: Hip osteoarthritis (OA) is a chronic, progressive degenerative joint disorder associated with significant morbidity and limited non-surgical treatment options. Over the past 20 years, Platelet-rich plasma (PRP) has garnered increasing interest as a conservative intervention in the setting of OA; however, its clinical efficacy in hip OA remains inconclusive due to substantial heterogeneity in preparation protocols and administration methods. This systematic review aims to examine randomized controlled trials (RCTs) published between 2019 and 2024 that evaluated the efficacy of PRP in the management of hip OA, with specific criteria including the use of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and/or the Visual Analog Scale (VAS) for outcome measurement. Three RCTs met the eligibility criteria. While short-term improvements in pain and function were observed in patients with mild to moderate OA, long-term benefits were inconsistent. Considerable variability in PRP composition (leukocyte-rich versus leukocyte-poor), activation techniques, injection schedules, and follow-up durations was evident across studies. Particularly, one trial demonstrated no significant advantage of PRP over placebo. Methodological limitations, including lack of blinding, underreporting of PRP characteristics, and protocol heterogeneity, impeded the ability to draw definitive conclusions. Although PRP may provide short-term symptomatic relief in early-stage hip OA, the absence of standardized protocols highlights the need for rigorous, long-term randomized controlled trials that employ consistent classification systems (eg, PAW or MARSPILL) and stratified patient populations to inform evidence-based clinical guidelines.Keywords: hip replacement, regenerative medicine, tissue repair, growth factors/healing enhancement, inflammation modulation
Khanin Iamthanaporn, Arnan Wiwatboworn, Pawin Wanasitchaiwat, Peeranut Purngpiputtrakul, Varah YuenyongviwatDepartment of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, ThailandCorrespondence: Varah Yuenyongviwat, Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, Songkhla, 90110, Thailand, Tel +6674451601, Email varahortho@gmail.comPurpose: Pain perception following staged bilateral total knee arthroplasty (TKA) remains controversial, with previous studies suggesting increased pain after the second knee attributed to central sensitization. This retrospective observational study aimed to compare postoperative pain between first- and second-stage TKA using a linear mixed-effects model adjusted for opioid consumption and peripheral nerve block type.Patients and Methods: This retrospective observational study included 155 patients who underwent staged bilateral TKA under spinal anesthesia between 2015 and 2020 at Prince of Songkla University Hospital, Hat Yai, Thailand. Pain was assessed using a verbal numerical rating scale (VNRS) every 4 hours for 72 hours postoperatively. A linear mixed-effects model with a random intercept for each patient was used for the primary analysis, with last observation carried forward (LOCF) as sensitivity analysis.Results: Among the 155 patients included, no significant difference in pain was found between the first and second TKAs (β = − 0.027; 95% CI, − 0.139 to 0.085; P = 0.638). Pain decreased significantly over time (β = − 0.073 per 4-hour interval; 95% CI, − 0.083 to − 0.063; P < 0.001). Femoral nerve block was associated with reduced pain (β = − 0.321; 95% CI, − 0.509 to − 0.133; P = 0.001). Higher opioid consumption was associated with increased pain (β = 0.018; 95% CI, 0.014 to 0.022; P < 0.001). The LOCF sensitivity analysis confirmed no significant difference between stages (β = − 0.051; 95% CI, − 0.147 to 0.045; P = 0.300).Conclusion: Within the first 72 hours, pain following second-stage TKA was not significantly different from that following first-stage TKA. These findings do not support central sensitization as an inevitable cause of increased second-knee pain and suggest that previously reported increases may have been confounded by uncontrolled opioid exposure. As an observational analysis, these results cannot establish causation.Keywords: total knee arthroplasty, staged bilateral TKA, postoperative pain, central sensitization, linear mixed-effects model
Karlen Ka Pui Law,1 Alex Kwan Ho Yau,2 Henry Chung Ngai Chan,3 Angela On Kei Lai,4 Agnes King Yan Lam,5 Kenney Ki Lee Lau61Department of Occupational Therapy, Duchess of Kent Children’s Hospital, Hong Kong, People’s Republic of China; 2Department of Physiotherapy, Pamela Youde Nethersole Eastern Hospital, Hong Kong, People’s Republic of China; 3Department of Physiotherapy, Shatin Hospital, Hong Kong, People’s Republic of China; 4SEN Technology, Hong Kong, People’s Republic of China; 5Department of Physiotherapy, North District Hospital, Hong Kong, People’s Republic of China; 6Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, People’s Republic of ChinaCorrespondence: Kenney Ki Lee Lau, Email kenney.kl.lau@link.cuhk.edu.hkBackground: Malignant neoplasm of bone and articular cartilage (MNBAC) is a rare malignancy associated with substantial premature mortality and disability, particularly among younger populations. Comprehensive, region‑specific assessments in East Asia remain limited despite evolving demographic and epidemiologic patterns. Therefore, this study provides the first East Asia-specific epidemiological assessment of MNBAC with future projections.Methods: Utilizing estimates from the Global Burden of Disease (GBD) 2023 study, we quantified incidence, prevalence, deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) attributable to MNBAC in five East Asian countries and territories from 1990 to 2023, with projections extending to 2050 under multiple foresight scenarios. Data are presented as absolute counts and age-standardized rates with 95% uncertainty intervals.Results: Between 1990 and 2023, in East Asia, the number of incident cases increased from 9,054 to 29,877. DALYs rose from 256,249 to 615,434. Over the same period, age-standardized incidence rates per 100,000 population increased modestly, death rates declined from 3.60 to 3.09, and DALY rates decreased from 138.61 to 112.04. Projections indicate that continued increases in absolute deaths (38,467 by 2050 under the reference scenario) and DALYs (804,272), with similar or higher estimates under alternative scenarios. In contrast, age‑standardized death and DALY rates are projected to remain broadly stable or decline slightly across scenarios.Conclusion: The burden of MNBAC in East Asia was increasing, with projections indicating a continuing upward trend through 2050. While declines in age-standardized death and DALYrates suggest improved health outcomes, these metrics do not necessarily reflect substantive changes in healthcare systems. Overall, advancements in population health are unlikely to fully counterbalance the rising MNBAC burden. Targeted treatment strategies focusing on MNBAC, as well as enhancements to registries and data collection, are essential for mitigating future health losses.Keywords: malignant neoplasm of bone and articular cartilage, global burden of disease, East Asia, epidemiology
Objective:To develop and validate a clinical prediction model integrating lumbar spine bone mineral density (LS-BMD) and fall risk assessment for identifying secondary osteoporosis in community-dwelling elderly men. Methods:This retrospective cross-sectional study enrolled men aged 65 years or older from community health centers and geriatric outpatient clinics (June 2023-December 2025). Secondary osteoporosis was defined as T-score ≤ -2.5 at any site (lumbar spine, femoral neck, or total hip) with at least one confirmed major secondary etiology (hypogonadism, glucocorticoid use, vitamin D deficiency, etc). Controls were men with normal BMD or osteopenia without secondary etiology. Participants were randomly assigned to training (70%) and validation (30%) sets. LASSO regression and multivariate logistic regression were used for variable selection and model construction. Bootstrap resampling provided optimism-corrected performance estimates. Results:Among 843 eligible participants (mean age 73.12±5.27 years), 187 (22.18%) were diagnosed with secondary osteoporosis. Six independent predictors were identified: age, LS-BMD T-score, history of fall, testosterone, glucocorticoid use, and vitamin D level. The apparent AUC was 0.846 (95% CI: 0.815-0.878) in the training set and 0.798 (95% CI: 0.741-0.854) in the validation set; the optimism-corrected AUC was 0.731, indicating moderate discrimination. Calibration was satisfactory. Decision curve analysis confirmed clinical net benefit. Of note, three predictors (testosterone, vitamin D, glucocorticoid use) overlap with the diagnostic criteria for secondary osteoporosis, and the AUC values should be interpreted with this caveat in mind. Conclusion:This study developed a preliminary clinical prediction model for identifying secondary osteoporosis in elderly men using internal validation. The model integrates LS-BMD T-score, fall risk, Vitamin D, testosterone, and glucocorticoid use, but external validation is required before clinical application. The overlap between several predictors and the diagnostic criteria represents an important limitation.
Musculoskeletal diseases, such as osteoarthritis and joint trauma, significantly impact patient mobility, independence, and quality of life. With the rising demand for effective and accessible rehabilitation strategies, artificial intelligence (AI) has emerged as a powerful tool to support diagnosis, surgical planning, and personalized rehabilitation. This narrative review summarizes recent advances in the application of AI in musculoskeletal disease management, with a particular emphasis on postoperative and conservative rehabilitation. We outline the foundational concepts of AI, including machine learning, deep learning, computer vision, and natural language processing, and discuss their roles in clinical decision-making and recovery monitoring. Furthermore, we examine emerging AI-assisted rehabilitation tools, including mobile applications, robotic exoskeletons, gamified platforms, and markerless motion tracking systems, which collectively enhance treatment precision, patient adherence, and remote care capabilities. Despite promising outcomes, current limitations include insufficient personalization, limited multimodal data integration, and inadequate clinical validation. Future developments should focus on improving model interpretability, integrating real-time biosensing, and optimizing user interface design to support clinically feasible and patient-centered musculoskeletal rehabilitation.
Background:Acute inability to flex the knee following a sudden extension event is commonly attributed to structural pathology. However, some patients present with non-mechanical flexion limitation that resolves without invasive intervention, suggesting potentially reversible functional mechanisms. Purpose:To synthesize current concepts and integrate them into a clinically applicable framework that distinguishes effusion-related inhibition from transient alignment-dependent restriction in acute knee flexion limitation. Methods:Narrative review and conceptual synthesis of published literature addressing arthrogenic muscle inhibition, knee effusion, and rotational knee biomechanics, integrated with clinical observations to develop an interpretive framework for bedside assessment. Results:A four-component interpretive framework is described comprising: (1) identification and aspiration of knee effusion to reduce capsular distension; (2) gravity-assisted passive flexion assessment; (3) pain-limited, alignment-facilitated motion involving medial compression, controlled external rotation, posterior translation, and oscillatory flexion; and (4) validation through restoration of symmetric gravity-assisted motion. Conclusion:Acute knee flexion limitation following sudden extension may not always reflect fixed mechanical obstruction. The proposed framework integrates established concepts of arthrogenic muscle inhibition with observations from rotational knee biomechanics to support clinical reasoning in selected cases. As a conceptual and hypothesis-generating model, it has not undergone prospective clinical, imaging, or biomechanical validation, and further investigation is required to determine its validity, safety, reproducibility, and clinical utility.
Background:Corticosteroids may cause glaucoma by increasing intraocular pressure (IOP) due to their systemic side effects. Few studies have investigated the effect of intraarticular corticosteroids (IACS) on IOP. This study aimed to evaluate the effects of IACS preparations (betamethasone and triamcinolone hexacetonide) on IOP. Methods:In this single-center randomized study, patients receiving IACS were randomized into two groups: Group 1 received betamethasone (Diprospan®, betamethasone dipropionate 6.43 mg + betamethasone sodium phosphate 2.63 mg, equivalent to 7.0 mg betamethasone) and Group 2 received triamcinolone hexacetonide (Artropan®,20 mg triamcinolone hexacetonide). IOP was measured before injection and at 1 week after injection. The change in IOP (ΔIOP) was calculated using the following formula: IOP (after injection) - IOP (before injection). Results:A total of 80 patients and 160 eyes were included in the study, with 40 patients in each group. No significant change was found in ΔIOP in Group 1 (p > 0.05). A statistically significant increase in ΔIOP was observed in both eyes and in the left eye in Group 2; (both eyes: p = 0.002; left eye: p = 0.012; right eye:p = 0.060). ΔIOP was significantly higher in Group 2 than in Group 1 (p = 0.043). Conclusion:Triamcinolone hexacetonide may increase IOP after IACS more than betamethasone; caution is warranted in patients with risk factors for glaucoma. Trial Registration:The trial was registered at ClinicalTrials.gov retrospectively (No: NCT07242846, Date: 17.11.2025).
Hilal Yağar,1 Kadir Eren Biçer,1 Gamze Yıldırım Biçer21Department of Orthopedics and Traumatology, Niğde Ömer Halisdemir University, Faculty of Medicine, Niğde, Türkiye; 2Department of Ophthalmology, Niğde Ömer Halisdemir University, Faculty of Medicine, Niğde, TürkiyeCorrespondence: Hilal Yağar, Department of Orthopedics and Traumatology, Niğde Ömer Halisdemir University Medical School Niğde, 51200, Turkey, Tel +905058968028, Email hilalyagar1989@gmail.comBackground: Corticosteroids may cause glaucoma by increasing intraocular pressure (IOP) due to their systemic side effects. Few studies have investigated the effect of intraarticular corticosteroids (IACS) on IOP. This study aimed to evaluate the effects of IACS preparations (betamethasone and triamcinolone hexacetonide) on IOP.Methods: In this single-center randomized study, patients receiving IACS were randomized into two groups: Group 1 received betamethasone (Diprospan®, betamethasone dipropionate 6.43 mg + betamethasone sodium phosphate 2.63 mg, equivalent to 7.0 mg betamethasone) and Group 2 received triamcinolone hexacetonide (Artropan®,20 mg triamcinolone hexacetonide). IOP was measured before injection and at 1 week after injection. The change in IOP (ΔIOP) was calculated using the following formula: IOP (after injection) – IOP (before injection).Results: A total of 80 patients and 160 eyes were included in the study, with 40 patients in each group. No significant change was found in ΔIOP in Group 1 (p > 0.05). A statistically significant increase in ΔIOP was observed in both eyes and in the left eye in Group 2; (both eyes: p = 0.002; left eye: p = 0.012; right eye:p = 0.060). ΔIOP was significantly higher in Group 2 than in Group 1 (p = 0.043).Conclusion: Triamcinolone hexacetonide may increase IOP after IACS more than betamethasone; caution is warranted in patients with risk factors for glaucoma.Trial Registration: The trial was registered at ClinicalTrials.gov retrospectively (No: NCT07242846, Date: 17.11.2025).Keywords: adverse reactions, betamethasone, drug-related side effects, injections, intra-articular, intraocular pressure, triamcinolone
Cervical collars have traditionally been applied routinely in adult trauma to reduce the risk of secondary cervical spinal cord injury. Increasing evidence, however, supports selective spinal motion restriction and earlier collar removal when instability has been adequately excluded. This narrative review evaluates current evidence on collar application, avoidance, clearance, and continued use after confirmed cervical fracture. A structured literature search was conducted across major biomedical databases and guideline sources, with the synthesis guided by the Scale for the Assessment of Narrative Review Articles. In blunt trauma, collar use should be based on clinical risk, examination reliability, mechanism of injury, and phase of care. Routine collaring is generally unsupported in isolated penetrating trauma and may delay time-critical management. In evaluable patients, validated decision rules and high-quality computed tomography (CT) support early clearance when appropriate. In adults with impaired consciousness, collar removal after a negative high-quality CT should be individualized according to neurological findings, clinical context, examination reliability, institutional protocols, and the presence or absence of radio-clinical discrepancy. After fracture confirmation, continued collar use should be individualized according to stability, frailty, treatment goals, and tolerance. Collar-related harms should be incorporated into repeated reassessment. The proposed Four-Domain Trauma Collar Framework organizes these decisions across application, clearance, continuation, and de-escalation but remains a conceptual, unvalidated model.
Jiayue Hao,1,* Shibo Sun,2,* Tianxu Dou,3,* Jin Deng,1 Wen Li,1 Chicheng Ma,1 Yejia Zhang,4 Lutian Yao11Department of Orthopaedics, The First Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China; 2Shu Dong Yun Yi (Beijing) Technology Co., Ltd, Beijing, People’s Republic of China; 3Department of Sports Medicine, Shenyang Orthopedic Hospital, Shenyang, Liaoning, People’s Republic of China; 4Department of Physical Medicine & Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA*These authors contributed equally to this workCorrespondence: Lutian Yao, Email ltyao@cmu.edu.cn Yejia Zhang, Email Zhang@pennmedicine.upenn.eduAbstract: Musculoskeletal diseases, such as osteoarthritis and joint trauma, significantly impact patient mobility, independence, and quality of life. With the rising demand for effective and accessible rehabilitation strategies, artificial intelligence (AI) has emerged as a powerful tool to support diagnosis, surgical planning, and personalized rehabilitation. This narrative review summarizes recent advances in the application of AI in musculoskeletal disease management, with a particular emphasis on postoperative and conservative rehabilitation. We outline the foundational concepts of AI, including machine learning, deep learning, computer vision, and natural language processing, and discuss their roles in clinical decision-making and recovery monitoring. Furthermore, we examine emerging AI-assisted rehabilitation tools, including mobile applications, robotic exoskeletons, gamified platforms, and markerless motion tracking systems, which collectively enhance treatment precision, patient adherence, and remote care capabilities. Despite promising outcomes, current limitations include insufficient personalization, limited multimodal data integration, and inadequate clinical validation. Future developments should focus on improving model interpretability, integrating real-time biosensing, and optimizing user interface design to support clinically feasible and patient-centered musculoskeletal rehabilitation.Keywords: artificial intelligence, musculoskeletal rehabilitation, computer vision, wearable devices, tele-rehabilitation
Purpose:To assess whether the implementation of a novel hospital-based bundled-payment program affects access to platelet rich plasma (PRP) injections for the treatment of osteoarthritis (OA) for patients representing different population subgroups. Patients and Methods:This was a retrospective observational study, which included patients receiving PRP injections between January 2021 and October 2024, at three outpatient orthopaedic clinics of a single hospital-based institution. Patients were excluded if they did not undergo knee, hip, or shoulder (glenohumeral) PRP injections or had insurance coverage for PRP injections. The main outcome measured was the utilization of the bundled-payment program for PRP injections and treatment failure, defined as need for additional treatment within 9 months. Results:Among 220 patients who received PRP injections, women were more likely to use the bundled-payment program than men (37.76% women vs 18.18% men, p = 0.003). Younger patients more frequently utilized the program (53.26 ± 9.55 years vs 62.02 ± 12.75 years, p < 0.001). Non-white patients were significantly more likely to use the bundled-payment program than white patients (51.61% vs 29.14%, p = 0.014). There were no significant differences in program utilization by ethnicity, DCI, or OA severity. There was no significant difference in odds for requiring additional treatments within 9 months between patients of different racial subgroups. Conclusion:The bundled-payment program was associated with increased access to PRP for non-white patients and women. There was no significant difference between racial subgroups in terms of requiring additional treatments within 9 months after initial PRP treatments.
Saied Besharaty,1 Shahab Sheikhalishahi,2 Hesameddin Jafarinasab21Department of Orthopedic Surgery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; 2Student Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd, IranCorrespondence: Shahab Sheikhalishahi, Email s.shahab.sheikhalishahi@gmail.comAbstract: Cervical collars have traditionally been applied routinely in adult trauma to reduce the risk of secondary cervical spinal cord injury. Increasing evidence, however, supports selective spinal motion restriction and earlier collar removal when instability has been adequately excluded. This narrative review evaluates current evidence on collar application, avoidance, clearance, and continued use after confirmed cervical fracture. A structured literature search was conducted across major biomedical databases and guideline sources, with the synthesis guided by the Scale for the Assessment of Narrative Review Articles. In blunt trauma, collar use should be based on clinical risk, examination reliability, mechanism of injury, and phase of care. Routine collaring is generally unsupported in isolated penetrating trauma and may delay time-critical management. In evaluable patients, validated decision rules and high-quality computed tomography (CT) support early clearance when appropriate. In adults with impaired consciousness, collar removal after a negative high-quality CT should be individualized according to neurological findings, clinical context, examination reliability, institutional protocols, and the presence or absence of radio-clinical discrepancy. After fracture confirmation, continued collar use should be individualized according to stability, frailty, treatment goals, and tolerance. Collar-related harms should be incorporated into repeated reassessment. The proposed Four-Domain Trauma Collar Framework organizes these decisions across application, clearance, continuation, and de-escalation but remains a conceptual, unvalidated model.Keywords: cervical collar, spinal motion restriction, cervical spine trauma, cervical spine clearance, odontoid fracture, adult trauma
Objective:The objective of this study was to evaluate the influence of cage anteroposterior position and angulation, as well as plate and screw trajectory, in oblique lumbar interbody fusion with lateral plate fixation, on clinical and radiographic outcomes along with associated perioperative complications. Methods:A total of 47 patients undergoing OLIF-LP surgery were enrolled. Cases were divided into the anterior position group (APG) or the posterior position group (PPG) based on whether the cage was positioned anterior or posterior to the midline. Data were collected preoperatively and at 3 days, 3 months, and 12 months postoperatively. Radiographic parameters measured included LL, FSL, DH, and FH. Implant-related measurements comprised cage-device angle (CDA), superior screw to endplate angle (SSEA), and inferior screw to endplate angle (ISEA). Clinical outcomes included Back-VAS, Leg-VAS, ODI scores, and perioperative complications, to evaluate the impact of cage position on radiographic and clinical outcomes at different time points. Results:No significant differences were found in clinical outcomes between the groups at any point. Radiographically, the APG showed greater improvement in FSL than the PPG (4.37±3.56° vs. 1.75±3.16°, p=0.012). The APG also had greater loss of FH during follow-up (p=0.024). Thigh/inguinal numbness was the most common complication (38.3%), and was more frequent in the PPG. SSEA positively correlated with FSL at final follow-up (r=0.408, p=0.004). Conclusion:When employing a lateral plate for fixation in OLIF, an anteriorly positioned cage yields superior improvement in FSL, whereas posterior placement more effectively maintains FH, albeit with an increased risk of perioperative neurological complications. Moreover, a larger SSEA was positively associated with improvement in long-term FSL.
Background:Osteoporotic vertebral compression fractures (OVCFs) are common in the elderly, severely impacting health and quality of life. Percutaneous vertebroplasty (PVP) is a primary treatment, with bone cement distribution being a key factor influencing its efficacy. Objective:This study aimed to evaluate the impact of bone cement distribution patterns on clinical outcomes in unilateral PVP for OVCFs. Methods:A total of 145 patients undergoing first-time unilateral PVP were retrospectively analyzed. Based on postoperative anteroposterior X-rays, patients were divided into three groups according to cement coverage: Group A (uniform distribution across three vertebral regions, n=57), Group B (covering >1/2 to ≤2/3, n=51), and Group C (covering >1/3 to ≤1/2, n=37). Primary outcomes (VAS, ODI, vertebral height recovery, refracture rate) and secondary outcomes were compared. Results:At one-year follow-up, VAS scores were significantly lower in Groups A (2.12±0.54) and B (2.16±0.54) than in Group C (2.43±0.50, P<0.05). Vertebral height recovery was superior in Groups A and B compared to Group C (P<0.05). The overall refracture rate was significantly lower in Group A (3.6%) than in Group C (18.9%, P<0.05), with no significant difference from Group B (3.9%). Group A received a higher cement volume (4.95±0.43 mL) than Groups B and C (P<0.05). Conclusion:Bone cement distribution crossing the vertebral midline is associated with better pain relief, improved vertebral height restoration, and a lower refracture rate after unilateral PVP. However, exceeding two-thirds vertebral coverage does not appear to be a critical factor for surgical efficacy.
Purpose:Shoulder arthroplasty has evolved substantially in surgical technique, implant design, and indications. Careful coordination across the patient care pathway remains central to optimizing outcomes. Concurrently, rapid advances in digital health, wearable technologies, smart implants, and intraoperative innovations are being explored across orthopedics, with emerging applications in shoulder arthroplasty. Objective:This narrative review synthesizes current evidence on digital technologies relevant to shoulder arthroplasty, with particular attention to the strength and origin of the available data. Patients and Methods:A structured review of recent literature was performed, including primary studies in shoulder arthroplasty as well as relevant evidence extrapolated from hip and knee arthroplasty. Areas examined included CT-based 3D planning, navigation, patient-specific instrumentation, robotics, augmented/mixed reality, mobile health (mHealth) platforms, wearable devices, tele-rehabilitation, sensor-enabled implants, and artificial intelligence (AI). Results:In shoulder arthroplasty, digital planning tools, navigation systems, and patient-specific instrumentation have demonstrated improvements in implant positioning accuracy in selected studies; however, evidence linking these technologies to superior long-term clinical outcomes remains limited. Robotic systems and augmented reality applications are in early investigational phases. Postoperative digital health tools, including tele-rehabilitation and wearable monitoring, have shown non-inferior functional outcomes compared with conventional care in hip and knee arthroplasty, with only preliminary and pilot data currently available in shoulder populations. Sensor-enabled implants and AI-based predictive models represent emerging areas of research, but external validation, workflow integration, and cost-effectiveness analyses remain insufficient. Conclusion:Digital and smart health technologies in shoulder arthroplasty are evolving and largely investigational. While early findings and extrapolated evidence from other arthroplasty domains suggest potential benefits in planning accuracy, patient engagement, and outcome monitoring, robust shoulder-specific clinical validation is limited. Further prospective studies are required before widespread clinical adoption can be recommended. This narrative review synthesizes emerging evidence in this field, which is currently dominated by feasibility studies, technical reports, and early-phase clinical investigations, with limited high-level outcome data specific to shoulder arthroplasty.
