ABSTRACT Objective When anatomical reduction cannot be safely achieved, the functional relevance of residual positive‐buttress displacement after FNS fixation remains uncertain. Few clinical studies have quantified how its magnitude relates to hip function. To determine whether hip function after femoral neck system fixation differs by postoperative reduction pattern and, within positive‐buttress reduction, by residual medial cortical displacement. Methods This retrospective cohort study included 180 adults with isolated acute femoral neck fractures treated with femoral neck system fixation between September 1, 2023, and April 30, 2024, and followed for at least 12 months. The overall analysis included Garden I–IV fractures; the exploratory five‐group displacement analysis was restricted to Garden I–III fractures. Postoperative reduction was classified as anatomical reduction, positive‐buttress reduction, or negative‐buttress reduction. Positive‐buttress displacement was measured on anteroposterior radiographs and categorized as PR‐2 (≤ 2 mm), PR‐4 (> 2–4 mm), or PR‐6 (> 4 mm). The primary outcome was 12‐month Harris Hip Score. Group comparisons used one‐way analysis of variance, Kruskal–Wallis tests, chi‐square or exact tests, and multivariable linear regression. Multivariable linear regression adjusted for age, sex, and Garden classification. Additional analyses evaluated continuous displacement, retained Garden IV fractures in the five‐group comparison, and incorporated the available clinical covariates. Results The cohort included 45 anatomical, 98 positive‐buttress, and 37 negative‐buttress reductions. Median 12‐month Harris Hip Score was 95.8, 86.0, and 69.5, respectively. Compared with anatomical reduction, adjusted Harris Hip Score was lower by 9.40 points in positive‐buttress reduction and 25.62 points in negative‐buttress reduction. In the exploratory analysis restricted to Garden I‐III fractures, median Harris Hip Score declined across anatomical reduction, PR‐2, PR‐4, PR‐6, and negative‐buttress reduction (95.8, 90.0, 80.0, 74.0, and 68.9). Among the 82 positive‐buttress cases in this restricted analysis, each additional millimeter of displacement was associated with a 3.89‐point lower score (95% confidence interval, 3.12–4.66 points lower). The additional five‐group analysis retaining Garden IV fractures showed the same direction of association. Conclusions In the overall cohort, reduction pattern was associated with 12‐month hip function. Garden IV fractures and open reduction were unevenly distributed across reduction patterns, and adjustment cannot eliminate residual confounding from fracture complexity, reduction difficulty, surgeon decisions, and unmeasured factors; these associations do not show that changing reduction pattern improves function. In the exploratory analysis restricted to Garden I‐III fractures, PR‐2 had the highest 12‐month Harris Hip Score among the nonanatomical groups. Larger residual displacement was associated with lower scores, but the findings do not establish a clinical 2‐mm threshold or a clinically important PR‐2 versus anatomical reduction difference. The additional all‐Garden analysis does not constitute separate validation in Garden IV fractures. PR‐2, PR‐4, and PR‐6 were exploratory categories rather than validated clinical thresholds or indications for additional reduction or open surgery.
ABSTRACT Background Robotic‐assisted unicompartmental knee arthroplasty (rUKA) aims to enhance the precision and reproducibility of implant positioning compared with manual UKA (mUKA). This systematic review and meta‐analysis compared radiographic, clinical, and patient‐reported outcomes between rUKA and mUKA. Methods A systematic search was conducted in PubMed, MEDLINE, EMBASE, Scopus and Web of Science (July 2025) for comparative studies of rUKA and mUKA, in line with the PRISMA statement. Data were pooled using random‐effects models, with effect sizes expressed as mean difference (MD), standardized mean change (SMC), or odds ratio (OR) with 95% confidence intervals (CIs). Results Thirty‐four studies encompassing 68,196 UKAs (22,585 robotic; 45,611 manual) were included. rUKA demonstrated significantly lower complication (OR 0.66, 95% CI 0.44–0.99; p = 0.045) and revision rates (OR 0.54, 95% CI 0.39–0.75; p < 0.001). Operative time was longer for rUKA (+16.1 min; 95% CI 10.8–21.4), while length of stay trended shorter (MD −0.2 days; p = 0.44). rUKA was associated with greater functional outcomes, including higher KSS Knee (MD 2.49; p = 0.007), KSS Function (MD 2.33; p = 0.008), and Oxford Knee Score (SMC 1.06; p = 0.049). Radiographically, rUKA yielded lower tibial slope deviation (MD −1.75°; p < 0.001) and reduced variability in tibial slope and hip‐knee‐ankle alignment. Conclusion rUKA may offer benefit compared to mUKA across radiographic precision, complications, revisions, and functional outcomes, though high heterogeneity in study design and the absence of UKA‐specific minimal clinically important difference thresholds limits the relevance of any rUKA benefit at present. Further large, multicenter, and methodologically robust studies are needed to confirm long‐term results and better define the role of rUKA in clinical practice.
ABSTRACT Objectives The clinical significance of a single unexpected positive intraoperative culture (UPC) during aseptic revision arthroplasty remains unclear. This study primarily aimed to evaluate the association between postoperative antibiotic duration and treatment failure in patients with a single UPC after aseptic revision total hip or knee arthroplasty. A secondary aim was to compare failure‐free survival between patients with a single UPC and those with multiple UPCs. Methods We retrospectively reviewed 51 presumed aseptic revision hip or knee arthroplasties with UPCs performed between January 1999 and December 2023. Cases meeting the 2018 ICM criteria for periprosthetic joint infection were excluded. Postoperative antibiotic duration was the exposure of interest. Treatment failure, defined as infection‐related re‐revision, was the primary outcome; failure‐free survival was the secondary outcome. Continuous variables were compared using the Mann–Whitney U test, and categorical variables were compared using chi‐square or Fisher's exact tests. Factors associated with failure were examined using univariate logistic regression, and failure‐free survival was assessed using Kaplan–Meier analysis with the log‐rank test. Results Among 39 patients with one UPC, treatment failure occurred in 18%. Antibiotic courses longer than 21 days were associated with failure (OR 28.1). In the small subgroup with available data ( n = 13), synovial biomarkers did not show a statistically significant difference between success and failure groups. Patients with one UPC had better failure‐free survival than those with ≥ 2 UPCs. Conclusion The observed association between prolonged antibiotic therapy and treatment failure may reflect underlying infection severity rather than a causal effect of antibiotic duration. Individualized management is recommended for UPCs in aseptic revision arthroplasty.
ABSTRACT Background The causative tumor for tumor‐induced osteomalacia (TIO) locating in the long bone is hidden and has diverse locations, resulting in great challenges to orthopedists. This study aimed to investigate and summarize the clinical features and surgical outcomes of TIO patients with culprit tumors involving the long bones to enhance clinical understanding and improve orthopedic surgical management of this rare disease. Methods A retrospective analysis was performed on the clinical data of TIO patients with causative tumors located in the long bones who underwent surgery by the Orthopedic Bone and Soft Tissue Tumor Sub‐specialty Group at our hospital between January 2013 and January 2023. This article described the clinical symptoms, location of causative tumors, tumor sizes, and other clinical features of TIO patients, and analyzed the trend of changes in blood phosphorus levels before and after surgery and pathological results. At the same time, clinical surgical experience and strategies for TIO patients with culprit tumors located in long bones were summarized. Results All 49 patients included in the study had been pathologically confirmed and met clinical diagnostic criteria for TIO. All patients experienced bone pain (49/49), often accompanied by limited mobility, fatigue, difficulty turning over, and difficulty sitting up or walking. Importantly, 65.3% (32/49) experienced height loss during disease progression. A total of 65 operations were performed on these 49 patients, with culprit tumors located in the humerus (five cases), femur (33 cases), tibia (seven cases), fibula (three cases), and foot (one case). Twenty‐nine cases involved skeletal lesions, seven cases affecting the periosteum (outside‐in), while 13 showed both bone and soft tissue involvement. Following the final orthopedic procedure, serum phosphorus levels increased in 45 patients, and the median follow‐up duration was 45 months (interquartile range, 28–61 months; range, 2–215 months). Nine patients showed no remission after the first orthopedic surgery, and five experienced recurrence. One patient was diagnosed with a malignant culprit tumor. Conclusion Surgical planning for TIO with long bone involvement should account for the anatomical location and extent of the causative tumor. Currently, no standardized surgical strategy exists for this rare condition. Recurrence, non‐remission, or malignant transformation remains possible due to incomplete resection or local relapse. Based on the single center experience of this case series, we summarized the surgical classification and feasible surgical strategies for TIO's orthopedic surgery with causative tumors located in the long bones. The actual clinical application effect of this classification system needs further clinical data verification.
ABSTRACT Objective This study aims to compare the clinical and radiographic outcomes of interlaminar and transforaminal endoscopic lumbar discectomy (IELD and TELD) in the treatment of lumbar disc herniation (LDH) with sciatic scoliosis. Methods Patients with sciatic scoliosis secondary to LDH who had undergone IELD or TELD between January 2022 to June 2024 were reviewed. Radiographic parameters, including Cobb angle, apical vertebral translation (AVT), and coronal balance distance (CBD), were measured preoperatively and postoperatively to assess curve evolution. Clinical outcomes were evaluated using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). Meanwhile, perioperative data were also collected. Comparisons between the groups were made by independent t ‐tests and χ 2 tests. Results A total of 134 patients in the IELD group and 103 patients in the TELD group were included in this study. There was no significant difference in intraoperative blood loss (13.4 ± 7.8 mL vs. 11.5 ± 7.1 mL, p = 0.067) and postoperative length of stay (2.5 ± 0.6 days vs. 2.5 ± 0.8 days, p = 0.378) between the two groups; however, the IELD group demonstrated shorter operation time (87.2 ± 17.4 min vs. 96.1 ± 23.3 min, p = 0.001) and fewer intraoperative fluoroscopy times (4.9 ± 0.7 vs. 10.3 ± 2.7, p < 0.001) compared to the TELD group. Both groups showed significant improvements in VAS and ODI scores ( p < 0.05), with no significant differences between the groups. Before surgery, 86.9% (206/237) patients had a disc herniation at the convex side of the lumbosacral curve and 86.5% (205/237) patients showed a trunk shift toward the opposite side of disc herniation. After surgery, 91.8% (123/134) of the IELD group and 90.3% (93/103) of the TELD group achieved resolution of scoliosis (AVT ≤ 10 mm) within 12 months. At the final follow‐up, the AVT, Cobb angle, CBD, and SVA in the IELD group were 2.7 ± 2.0 mm, 1.0° ± 0.8°, 1.2 ± 0.9 mm, and 3.4 ± 3.1 mm, respectively, with no significant differences compared to the 2.8 ± 2.7 mm, 1.1° ± 0.8°, 1.2 ± 0.8 mm, and 3.7 ± 3.5 mm in the TELD group. Conclusions Both IELD and TELD are effective and safe for LDH with sciatic scoliosis, with comparable radiographic and clinical outcomes in terms of scoliosis correction. IELD is associated with shorter operation time and fewer intraoperative fluoroscopy times in this cohort.
