Background:Hip resurfacing arthroplasty (HRA) is needed for certain patients, such as those with in situ metal work and abnormal anatomy, and/or other needs that are not well-served by total hip replacement (THR). Over the last 20 years, almost all HRAs have been performed using Metal-on-Metal (MoM) bearings, but metal wear debris generated over time has now ended their continued use. Cemented highly cross-linked polyethylene (XLPE) acetabular bearings have shown excellent survivorship for use in THR and the aim of this study is to determine if this also applied to HRA. Methods:This prospective cohort study evaluated extending the use of cemented XLPE acetabular bearings to HRA. There were 122 HRA patients who received a cemented XLPE acetabular component. They were followed for a mean 15 years (range, 10-20 years). There were 65 women (53%) and 57 men (47%). The mean age at surgery was 49.2 years (range, 21-68 years) the mean body mass index (BMI) was 26 kg/m2. Clinical outcomes and survivorship were determined. Analyses of implants retrieved during revision or postmortem were performed to evaluate consequences of wear debris. Results:The 10-year survival rate for 122 hips was 93.5% [95% confidence interval (CI): 91.7-98.1%] for all-cause revision. Six acetabular bearings failed, requiring revision for: loosening [2], polyethylene wear [2], and dislocation [2]. Four additional well-functioning XLPE bearings were retrieved postmortem. Two well-functioning cemented acetabular bearings were also retrieved; one was an explant for an infection after 9 years and the other was retrieved during revision to THR because of femoral head avascular necrosis at 6 years. Analysis of the 12 retrievals found signs of limited anterior/superior wear in all bearings along with minimal wear in the dome of 10 bearings. Only two retrieved bearings had more than 50% of the anterior/superior area worn and these were after 15 and 20 years of use. Two of the retrieved implants had no signs of wear. Conclusions:Cemented all XLPE acetabular bearings produced successful clinical outcomes initially in all patients. Six (4.9%) patients required revision for acetabular failure. Anterior/superior wear was found in the retrievals, but dome wear was limited. Cementing an XLPE acetabular component is a reasonable approach in HRA, but since it does not allow adjunct screw fixation that a metal-backed two-piece component can offer, it is not a solution for every HRA.
Reliable lateral decubitus positioning is critical for safe and effective lateral lumbar interbody fusion (LLIF); however, traditional patient stabilization with adhesive taping can be time-consuming, inconsistent, and associated with skin shear or breakdown, particularly in high body mass index (BMI) or elderly patients. In this technical report, we describe the use of a mechanical patient positioning system as a tape-free method of stabilization designed to provide counter-pressure at the iliac crest, thoracic cage, and/or greater trochanter while allowing for fine adjustments in alignment. The system is mounted directly to the operating table and uses adjustable support arms with anatomically contoured pads to improve control of pelvic tilt, trunk rotation, and coronal balance during positioning Conceptually, this approach enables controlled, reproducible support at fixed bony landmarks and may facilitate positioning optimization during fluoroscopic imaging. Compared with traditional taping techniques, this system is intended to reduce reliance on variable manually applied tension and instead provide adjustable mechanical support. Potential advantages include improved positioning consistency, decreased dependence on skin-based traction, and the ability to make intraoperative adjustments after draping. In addition, the technique may streamline operating room (OR) workflow by reducing repeated repositioning maneuvers and minimizing setup variability between surgical teams. The ability to fine-tune patient alignment after preparation may be particularly useful in multilevel LLIF procedures and in patients with increased soft-tissue mobility. This report aims to: (I) outline the rationale for mechanical positioning in LLIF; (II) describe the technical application of a table-mounted positioning system; and (III) discuss its potential advantages and limitations relative to conventional taping methods. No quantitative outcome data are presented, and further study is required to evaluate clinical impact.
Background:Complex hip-spine syndrome combined with hip ankylosis is clinically challenging to manage. Traditional surgeries are associated with insufficient precision and significant trauma, which easily lead to poor lumbar-pelvic-hip alignment and affect prognosis. With the development of digitalized and intelligentized surgical techniques, the integration of artificial intelligence (AI), computer navigation, and minimally invasive techniques has provided a new solution for such complex cases, enabling optimized surgical outcomes through precise planning and operation in line with the damage-control philosophy. Case Description:A young male patient with severe hip-spine deformity and hip ankylosis underwent treatment. The first-stage hip surgery was performed using AI, computer navigation and minimally invasive total hip arthroplasty. The second-stage scoliosis correction was conducted based on simulation planning with a three dimensional (3D) printed model. At the 30-month postoperative follow-up, the Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 36-Item Short-Form Health Survey (SF-36) scores increased by 75, 143, and 350 points, respectively. The patient's overall quality of life was significantly improved. Spinal function parameters including cervical balance vertical axis (CBVA), Scoliosis Research Society-22 questionnaire (SRS-22), and Oswestry Disability Index (ODI) were also significantly enhanced. Radiological examinations (anteroposterior pelvic and standing full-length X-rays) showed that the inclination and anteversion of the acetabular component were consistent with AI's preoperative predictions, reflecting favorable lumbar-pelvic-hip adaptation. Conclusions:In the treatment of hip ankylosis in complex hip-spine syndrome, the application of AI combined with navigation technology can significantly improve surgical precision, reduce trauma, promote coordinated lumbar-pelvic-hip alignment, and effectively enhance patients' joint/spinal function and quality of life. It provides a new digitalized and intelligentized solution for the surgical management of such complex cases.
Background:Glucagon-like peptide-1 receptor agonists (GLP-1As) are increasingly being used for managing obesity and type 2 diabetes mellitus (T2DM). As obesity is a risk factor for both osteoarthritis (OA) and total joint arthroplasty (TJA), GLP-1As are commonly prescribed to surgical candidates. However, the trends, outcomes, and complications associated with perioperative GLP-1A use in patients undergoing TJA are not yet fully understood. The aim of this review is to summarize the current evidence surrounding their perioperative use. Methods:Four databases (EMBASE, MEDLINE, Scopus, and CINAHL) were searched to identify studies that investigated perioperative GLP-1As use in patients undergoing TJA. Relevant data was extracted and findings were described qualitatively in a concept map and table. Results:A total of eleven studies were included in this review. Eight studies investigated the impact of perioperative GLP-1A use on outcomes following TJA, while three investigated the long-term conversion rate to TJA and development of OA associated with GLP-1A use. Two studies reported the impact on hemoglobin A1c (HbA1c) and/or body mass index (BMI), and ten studies reported complication rates associated with GLP-1A use. Mixed treatment effects and complication rates were found across all above outcome measures. Three studies reported the perioperative GLP-1A withholding period, all of which reported to withhold GLP-1A use 7 days prior to surgery. Conclusions:This review provides a comprehensive overview of the literature investigating perioperative GLP-1A use in patients undergoing TJA. Based on available data, perioperative GLP-1A use may be associated with improved surgical outcomes following arthroplasty. However, there is uncertainty regarding postoperative complications associated with their use. Given the paucity of evidence, high-quality prospective studies with standardized protocols are needed to better assess their clinical impact.
Lateral extra-articular tenodesis (LET) has re-emerged as a significant adjunct to anterior cruciate ligament reconstruction (ACLR), particularly in high-level athletes who are at a heightened risk for re-injury and graft failure. This review synthesizes recent literature examining the biomechanical and clinical outcomes associated with LET in the context of ACLR in high-level athletes. Biomechanical studies indicate that LET can enhance knee stability by providing additional restraint against anterior tibial translation and rotatory instability, thereby reducing rotational laxity and offloading stress on the intra-articular graft. Cadaveric and in vivo studies suggest that LET can reduce forces applied to the graft and improve knee kinematics, particularly in the setting of concomitant injury to the anterolateral complex. Furthermore, recent clinical research has shown that incorporating LET during ACLR surgery is associated with lower rates of graft failure and improved functional outcomes, including high rates of return to pre-injury level of sport among high-level athletes. However, the literature also highlights the need for careful patient selection and consideration of potential implant-related complications, as well as the risk of lateral knee pain. Recent evidence indicates that LET does not increase the risk of lateral compartment osteoarthritis when modern surgical techniques and appropriate graft tensioning are employed. Overall, while LET shows promise in improving the outcomes of ACLR surgery in high-level athletes, further high-quality research is warranted to establish standardized protocols and long-term efficacy.
Background:Although complication rates following primary total knee arthroplasty (TKA) are low, prosthetic joint infection can be catastrophic. To mitigate this risk, various postoperative wound dressings are utilized. Anecdotal clinical observations at The Bone and Joint Center suggested increased rates of postoperative skin irritation with a topical skin adhesive dressing compared with a silver hydrofiber dressing. The aim of this study was to compare postoperative skin irritation and infection outcomes between these two dressing types following primary TKA. Methods:A retrospective review was performed of 837 patients who underwent primary TKA between January 1, 2020, and April 30, 2023. Patients received either a silver hydrofiber dressing (Aquacel®, ConvaTec, Bridgewater, NJ, USA) or a topical skin adhesive dressing (LiquiBand®, Advanced Medical Solutions, Plymouth, Devon, UK). A manual chart review was conducted to collect demographic information, perioperative variables, and number of postoperative skin irritations, superficial skin infections, and deep periprosthetic joint infections. Results:A total of 837 patients were included, 303 of whom received the silver hydrofiber dressing, and 534 received the topical skin adhesive dressing. Thirty-eight patients developed postoperative infections. There was no statistically significant difference between dressing groups in total infection rates (P=0.14), superficial skin infections (P=0.08), nor deep periprosthetic joint infections (P=0.27). Skin irritation occurred less frequently in the silver hydrofiber group (n=1; 0.33%) compared with the topical skin adhesive group (n=26; 4.87%) (P<0.001). Conclusions:Following primary TKA, there were no significant differences in total, superficial or deep periprosthetic joint infection rates between a silver hydrofiber dressing and a topical skin adhesive dressing. However, the topical skin adhesive dressing was associated with a significantly higher rate of postoperative skin irritation.
Chronic lateral ankle instability (CLAI) is a frequent sequela of acute lateral ligament injury, causing recurrent sprains, persistent pain, and functional limitations, particularly among athletes and active individuals. While most acute ankle sprains respond well to conservative treatment, approximately 20-30% of patients experience persistent mechanical or functional instability requiring surgical intervention. In recent years, arthroscopic techniques have grown in popularity due to their minimally invasive nature, ability to address concomitant intra-articular pathology, and favorable recovery profiles compared to open surgery. This clinical practice review integrates recent evidence from randomized controlled trials, comparative cohort studies, and technical reports with expert clinical experience to provide practical guidance on the arthroscopic management of CLAI. For patients with adequate ligament tissue quality, arthroscopic Broström repair remains the preferred first-line option, offering high return to sport (RTS) rates and low complication rates. For cases involving revision, poor-quality tissue, or generalized ligamentous laxity, arthroscopic ligament reconstruction using autografts or allografts is recommended. Concomitant procedures such as synovectomy, loose body removal, and cartilage debridement or microfracture can be performed during the same operation. A structured postoperative rehabilitation program is essential for achieving optimal outcomes. Early protected mobilization is followed by progressive range of motion (ROM) and strengthening phases, with sport-specific training typically initiated at about 3 months postoperatively. Current evidence suggests that arthroscopic management yields comparable clinical results to open procedures, while enabling the simultaneous treatment of associated joint pathologies and potentially facilitating faster recovery. Arthroscopic management of CLAI should be regarded not merely as a surgical alternative, but as a comprehensive clinical approach that integrates diagnosis, surgical decision-making, and rehabilitation for optimized patient outcomes. This review aims to provide an evidence-informed framework to guide orthopedic surgeons and sports medicine clinicians in the individualized, evidence-based management of CLAI.
Background and Objective:Knee osteoarthritis (KOA) is the most common degenerative joint disease, causing significant social and economic burden globally. KOA management typically follows stepped-care approaches, including lifestyle changes, pharmacological treatments, and surgery. Driven by recent translational breakthroughs in KOA research, clinical management paradigms are increasingly characterized by high degrees of personalization and diagnostic precision. This review aimed to summarize key therapeutic research on KOA over the past year. Methods:This narrative review was conducted using the PubMed database, focusing on English-language studies involving human participants published between January and December in 2025. Eligible studies mainly included observational longitudinal studies, systematic reviews, meta-analyses, and randomized controlled trials (RCTs) examining KOA treatment. Priority was given to studies with the potential to influence current treatment paradigms. Key Content and Findings:The management of KOA is evolving toward a stepwise and individualized paradigm. In early disease stages, patient education, exercise, and weight control constitute the foundation of treatment. In addition to standard pharmacotherapies such as non-steroidal anti-inflammatory drugs (NSAIDs), some drugs originally used for other conditions are increasingly applied in KOA management. Metabolic agents and intra-articular injections have shown promising therapeutic potential. In terms of surgery, partial knee arthroplasty and high tibial osteotomy (HTO) techniques continue to be optimized. Total knee arthroplasty (TKA), as a definitive intervention for advanced KOA, has benefited from advances in personalized alignment, robotic assistance, novel prosthetic materials, and enhanced recovery after surgery (ERAS) protocols. These innovations collectively contribute to improved surgical precision, prosthesis durability, and perioperative safety. Conclusions:The management of KOA is shifting toward increasingly personalized and precision-driven paradigms, grounded in conservative care, emphasizing knee preserving for early intervention, and leveraging enabling technologies in TKA to enhance long-term outcomes. Although integrated enhanced recovery pathways demonstrably optimize perioperative outcomes, the enduring clinical utility of these disruptive technologies necessitates rigorous validation through high-certainty evidence.
Background and Objective:Anterior cruciate ligament (ACL) injury remains a career-defining event for high-level athletes, and current return to sport (RTS) criteria often fail to detect residual neuromuscular deficits that drive graft failure and contralateral tears. Three-dimensional (3D) markerless motion capture has emerged as a scalable technology that may address these gaps by quantifying movement quality during sport-specific tasks. The objective of this narrative review is to summarize the current evidence on markerless 3D motion capture in ACL rehabilitation and RTS decision-making, with a specific focus on clinical implementation pathways for high-level athletes. Methods:A comprehensive literature search was conducted across PubMed/MEDLINE, Embase, and the Cochrane Library from January 2005 through May 2025 using terms related to markerless motion capture, biomechanical analysis, ACL reconstruction, and RTS. English-language original research, systematic reviews, validation studies, and clinical commentaries were considered. Reference lists of included articles were hand-searched to identify additional relevant publications. Key Content and Findings:Traditional biomechanical tools, including dual fluoroscopy, marker-based motion capture, and inertial measurement units, have advanced understanding of ACL injury mechanisms but face practical barriers limiting routine clinical use. Markerless systems use computer vision and machine learning to generate joint kinematics and, when integrated with force plates or pressure insoles, kinetics during sport-specific tasks. Platforms such as OpenCap expand access for research and large-scale field testing, whereas clinical systems such as Theia3D demonstrate the strongest current evidence for clinical integration, with validation studies showing acceptable sagittal-plane accuracy but less mature evidence for dynamic, multiplanar RTS movements. A structured RTS pathway incorporating serial biomechanical testing, parameter-specific clearance thresholds, and longitudinal monitoring is proposed. Remaining challenges include limited validation samples, incomplete evidence for sport-specific multiplanar tasks, and sparse prospective data linking markerless-derived metrics with clinically meaningful outcomes. Conclusions:Markerless motion capture is positioned to become a valuable component of RTS decision-making by providing scalable, objective, and ecologically valid assessment of movement quality. Future work should prioritize standardized capture protocols, multicenter normative datasets stratified by sport and sex, and prospective studies connecting markerless-derived metrics with reinjury and performance outcomes.
Osteoarthritis (OA) is the most prevalent degenerative joint disease worldwide and a leading cause of pain, disability, and reduced quality of life, with pronounced sex-specific differences in incidence and clinical presentation. Epidemiological evidence shows a sharp increase in OA prevalence in women after menopause, whereas in men, the elevated risk at older age is more closely associated with declines in bone mass, muscle strength, and biomechanical stability. Increasing experimental and clinical studies indicate that sex hormones-including estrogen, androgens, and progesterone-and their respective receptors [estrogen receptor (ER), androgen receptor (AR), and progesterone receptor (PR)] play essential roles in maintaining joint homeostasis and modulating OA pathogenesis. At the molecular level, these hormones regulate chondrocyte proliferation, differentiation, apoptosis, extracellular matrix (ECM) metabolism, synovial inflammation, and subchondral bone remodeling through diverse genomic and non-genomic signaling pathways. Dysregulation of hormone signaling, particularly estrogen deficiency or receptor imbalance, contributes to cartilage degeneration, aberrant bone remodeling, and inflammatory activation, thereby promoting OA progression. Notably, hormone-related effects appear to be tissue-specific, receptor subtype-dependent, and stage-dependent, underscoring the complexity of endocrine regulation in joint diseases. This review summarizes recent advances in the roles of sex hormones and their receptors in OA, integrating evidence from molecular mechanisms, experimental studies, and clinical research. It aims to provide a comprehensive framework for understanding sex differences in OA and to support the development of sex-specific and mechanism-based therapeutic strategies.
Meniscus and ligament injuries of the knee can have significant implications on both short-term activity level as well as long-term knee health. While great advancements in technique and treatment strategy for these injuries have been made in recent years, clinical failure and progressive joint deterioration remain significant concerns. At the same time, technical advancements are being made throughout orthopedics, especially in the field of sports medicine. Many of these developing technologies focus on augmenting stability in the early postoperative period while optimizing biology, with the end goal of a well-integrated repair or reconstruction of the injured structure. Although these technologies are rapidly expanding, with many similar ideas developing in parallel, a basic understanding of the current landscape will be necessary to incorporate them into practice moving forward. Four main augmentation strategies pertaining to meniscoligamentous injuries involve suture, scaffolds, allograft, and biologics. Although the literature is in its infancy for some of these techniques, short- and mid-term outcomes have been promising for many of them. Direct comparison between techniques is often limited by heterogeneity in their application and study design. Ultimately, further study and appropriate incorporation of these augmentation strategies will help to improve current surgical technique with the goal of improving short-term recovery and long-term joint health for patients with meniscoligamentous injuries. This article provides an overview of the current landscape of strategies and technologies in augmentation of meniscus and ligament surgery.
Background:Knee osteoarthritis (KOA) is a major cause of disability among middle-aged and older adults worldwide. Emerging evidence suggests that muscle strength may be more relevant than muscle mass for functional outcomes, yet the combined impact of dynapenia and abdominal obesity remains insufficiently explored. The aim of this study was to investigate the association between dynapenic abdominal obesity (DAO) and symptomatic KOA in Chinese adults. Methods:This cross-sectional study analyzed data from 7,418 participants aged 45 years and older from the 2015 China Health and Retirement Longitudinal Study (CHARLS). Symptomatic KOA was defined based on physician-diagnosed osteoarthritis accompanied by self-reported knee pain. Participants were categorized into four phenotypes according to grip strength and waist circumference: non-dynapenic/non-abdominal obesity, dynapenic/non-abdominal obesity, non-dynapenic/abdominal obesity, and DAO. Results:The overall prevalence of symptomatic KOA was 9.75% and differed significantly across phenotypes. After adjustment for potential confounders, individuals with DAO showed the strongest association with symptomatic KOA, whereas abdominal obesity alone was not independently associated. Higher grip strength was consistently associated with a lower likelihood of symptomatic KOA. Age-stratified analyses revealed a stronger association of DAO with symptomatic KOA in individuals younger than 60 years, while no significant association was observed in older participants. Conclusions:DAO is associated with an increased likelihood of symptomatic KOA, with dynapenia playing a more prominent role than abdominal obesity alone. The age-related heterogeneity observed suggests that maintaining muscle strength may be particularly important for KOA prevention in midlife.
Background: Patients can obtain medical web information instantly, but there is no guarantee of its accuracy, reliability, or quality. The goal of this study is to critically analyze and provide a comprehensive assessment of the current state of online accessible patient information about robotic-assisted hip arthroplasty (RAHA). Methods: The top 50 search results for 'robotic hip arthroplasty' on Google, Bing, and Yahoo were screened. After excluding from the analysis duplicate entries, advertisements, non-English websites, video platforms, and unrelated websites, 27 patient-oriented websites were included and assessed by three independent reviewers with the DISCERN instrument, Flesch-Kincaid Reading Ease (FRE), Flesch-Kincaid Grade Level (FGL), and Journal of the American Medical Association (JAMA) benchmarks to evaluate the quality and readability of the selected websites. Results: The average DISCERN score was 45.2/80, indicating a fair level of information quality. The mean FRE score was 41.9/100, corresponding to difficult-to-read text, while the mean FGL score was 11.6, indicating that comprehension requires at least a high school education level. The average JAMA benchmark score was 0.96/4, reflecting poor adherence to established credibility and transparency criteria. Conclusions: Web-based reporting on academic, private hospital, and general websites needs to be significantly improved, as evidenced by the poor quality and readability of online patient information. Due to its potential benefits over traditional hip replacement surgeries, RAHA is a novel surgery that has recently attracted a lot of attention. However, there is a chance of generating erroneous expectations, unhappy patients, and dissatisfied healthcare providers if efforts are not put forward to create consistent guidelines and collaborate on patient education strategies.
Articular cartilage lesions of the knee pose a significant clinical challenge due to the limited regenerative capacity of hyaline cartilage and the wide variability in patient presentation and lesion characteristics. Surface-based cartilage restoration techniques have evolved substantially, shifting from isolated marrow stimulation toward biologically enhanced strategies designed to improve repair tissue quality, durability, and clinical outcomes while preserving native joint anatomy. These techniques are primarily indicated for contained chondral defects without substantial subchondral bone compromise and include scaffold-augmented microfracture, particulated cartilage techniques using juvenile or adult allograft tissue, and matrix-associated autologous chondrocyte implantation (ACI). Selection among these options is driven by patient age, activity level, and expectations, as well as lesion-specific factors such as size, anatomic location, containment, and subchondral bone integrity. Single-stage approaches, including micronized cartilage extracellular matrix augmentation and particulated cartilage allografts, offer reduced procedural burden and avoidance of cell expansion, with favorable short- to mid-term outcomes for small to moderate lesions. In contrast, matrix-induced autologous chondrocyte implantation (MACI) is supported by randomized controlled trials and long-term cohort studies demonstrating sustained improvements in patientreported outcomes (PROs) beyond 10 years, particularly in younger, active patients with larger isolated defects. Despite these advances, variability in imaging findings, complication profiles, and performance in the patellofemoral joint underscores the importance of appropriate patient selection, meticulous surgical technique, and structured postoperative rehabilitation. This review synthesizes current evidence regarding indications, surgical techniques, outcomes, and limitations of contemporary surface-based cartilage restoration options for the knee, providing a practical framework to guide clinical decision-making in joint preservation surgery.
Osteoarthritis (OA) of the knee, particularly in the medial compartment, is driven by chronic synovial inflammation, immune dysregulation, and progressive cartilage degeneration. Increasing evidence indicates that modifying the complete inflammatory microenvironment of the joint, rather than focusing solely on cartilage, is essential for achieving true disease-modifying outcomes. This review provides an integrated bench-to-bedside overview of emerging immunomodulatory cell and cell-derived therapies for knee OA, summarizing mechanistic foundations, preclinical findings, and early clinical progress. We first outline the pathological features of the OA joint, emphasizing macrophage polarization, T-cell subsets, and cytokine-driven pathways that sustain synovitis and extracellular matrix breakdown. The review then highlights three major therapeutic strategies: (I) immunomodulatory cell therapies, including cartilage-activated T cells (CATs), which aim to restore immune homeostasis; (II) extracellular vesicle (EV) and miRNA-based therapies that modulate inflammation, enhance chondrocyte survival, and promote matrix synthesis; and (III) peripheral blood stem cell (PBSC)-assisted regenerative approaches used in combination with arthroscopic procedures. Preclinical studies consistently demonstrate reduced inflammation, improved chondrogenesis, and enhanced structural repair across these modalities. We further summarize recent phase I/II clinical trials, which report favorable safety profiles and early clinical benefits, particularly for MSC-derived EVs and PBSC-based interventions. Nonetheless, long-term efficacy, manufacturing scalability, product heterogeneity, and regulatory complexity remain significant obstacles to widespread clinical translation. In conclusion, immunomodulatory cell and cell-derived therapies represent promising disease-modifying strategies for knee OA. Future progress will rely on standardized potency assays, optimized GMP manufacturing, robust clinical trial designs, and precision medicine approaches for targeted patient selection.
