Accurate measurement of acetabular cup orientation after total hip arthroplasty is essential, but postoperative CT relies on subjective, error-prone manual measurement. Robot-assisted surgery provides intraoperative cup-orientation measurements but is costly and not widely available. We aimed to develop and evaluate a deep-learning model measuring cup orientation on postoperative CT, using robotic navigation values as reference standard. This secondary analysis of a randomized trial (ChiCTR2200060115) analyzed 94 hips with robotic intraoperative angle measurements and postoperative CT (May 2023 to May 2024). A VGG16-based U-Net segmented key anatomical structures into three-dimensional point clouds. Three measurement pathways were compared: manual annotation, machine learning, and deep learning. The optimal model was integrated into a graphical user interface. Ninety-four hips (mean age, 57.0 years ± 9.5 [standard deviation]; 62 men) were evaluated using 27,821 CT images. The best model (PointNet++) achieved mean absolute errors of 4.48° (anteversion) and 3.89° (inclination), compared with 4.08°/ 5.52° for machine learning and 8.91°/ 8.70° for manual measurement, significantly outperforming manual measurement (both p < 0.05). Exploratory full-cohort Lewinnek classification was correct in 81/94 hips versus 57/94 with manual measurement; in internal validation, 71

Robot-assisted total hip arthroplasty (THA) improves component-placement accuracy but lengthens the operative time, an established risk factor for perioperative complications. Whether this additional operative time increases perioperative trauma has not been formally tested, particularly where the robot-assisted THA procedure is substantially longer. This was a post hoc analysis of a prospective, multicenter randomized controlled trial comparing seven-axis robot-assisted and conventional THA at 3 centers. The modified intention-to-treat population comprised 99 operated patients (47 in the robot-assisted THA group and 52 in the conventional THA group). We compared operative time, blood loss, intraoperative transfusion, postoperative day-7 C-reactive protein and composite cellular-immune ratios, and adverse events, with all comparisons adjusted for study center. Exploratory mediation estimated the model-based indirect association between treatment assignment and blood loss through operative time. Robot-assisted THA took substantially longer than the conventional procedure (median 150 vs. 106 min; center-adjusted difference 34.8 min; P < 0.001), yet no statistically significant between-group differences were detected in blood loss, intraoperative transfusion, postoperative day-7 inflammatory markers, or adverse events. Exploratory mediation identified an indirect association through operative time (+ 97.8 mL, bootstrap 95

ABSTRACT Background Cardiometabolic Multimorbidity (CMM) is defined as the co‐occurrence of two or more conditions among heart disease, diabetes mellitus, stroke, and hypertension. Previous studies have shown associations between cardiometabolic diseases and fragility fractures; however, the relationship between CMM and hip fractures remains unclear in the Chinese population. This study therefore aims to investigate this association in a Chinese cohort to inform fracture prevention strategies. Methods This prospective cohort study used data from the China Health and Retirement Longitudinal Study (CHARLS) collected from 2011 to 2020. Participants from the 2011 baseline survey cohort were initially included. Subsequently, individuals were sequentially excluded if they were under 45 years of age, had incomplete baseline CMM information, had a history of hip fracture, lost to follow‐up, or had missing data on confounders. Kaplan–Meier survival analysis, Cox proportional hazards regression, subgroup analyses, and sensitivity analyses were performed to evaluate the association between CMM and the risk of hip fracture. Results A total of 6314 participants aged 45 years and older were included, of whom 544 had CMM. Over a 9‐year follow‐up period, 287 incident hip fractures (4.55%) were identified. Among these, 36 participants had been diagnosed with CMM at baseline, whereas 251 had not. The incidence of hip fracture was significantly higher in participants with CMM than in those without CMM (13% vs. 8%, p = 0.015). After full adjustment for confounders, multivariable Cox regression showed that CMM was associated with a 70% increased risk of hip fracture (HR = 1.70, 95% CI: 1.318–2.47; p = 0.005). Subgroup analyses indicated that age and history of falls were significant effect modifiers. The association between CMM and hip fracture was more pronounced in participants under 60 years old (P for interaction = 0.048) and those with a history of falls (P for interaction = 0.014). Conclusion These findings suggest that CMM increases the risk of hip fracture, particularly among relatively younger individuals and those with a history of falls.

PURPOSE:This study evaluated the therapeutic potential of 5-aminolevulinic acid combined with sodium ferrous citrate (5-ALA/SFC) for rheumatoid arthritis (RA), focusing on its dual anti-inflammatory and immunomodulatory properties. METHODS:Collagen-induced arthritis (CIA) murine models were administered either low (100/157 mg/kg) or high (500/157 mg/kg) doses of 5-ALA/SFC. Disease progression was evaluated using clinical scoring, a histopathological analysis, and micro-computed tomography to assess bone morphology. Synovial inflammation and oxidative stress markers, including tumor necrosis factor-alpha (TNF-α), interleukin (IL)-1β, inducible nitric oxide synthase (iNOS), heme oxygenase-1 (HO-1), and indoleamine 2,3-dioxygenase (IDO), were quantified in fibroblast-like synoviocytes (FLSs) using flow cytometry and quantitative reverse transcription polymerase chain reaction. B cell subpopulations, specifically plasmablasts and regulatory B cells (Bregs) in the draining lymph nodes (dLNs), were analyzed by flow cytometry. Human MH7A synovial cells were used to corroborate the FLS-mediated immunoregulatory effects. RESULTS:5-ALA/SFC demonstrated significant dose-dependent amelioration of joint swelling, synovial hyperplasia, cartilage, and bone degradation in CIA mice. This treatment significantly attenuated the expression of pro-inflammatory mediators (TNF-α, IL-1β, and iNOS) in FLSs while upregulating the expression of HO-1, IDO, and TNF-stimulated gene-6 (TSG-6). In the dLNs, 5-ALA/SFC reduced the proportion of plasmablasts and increased the percentage of Bregs. In vitro experiments using MH7A cells confirmed that 5-ALA/SFC downregulates B cell-activating factor (BAFF) and vascular cell adhesion molecule-1 (VCAM-1), both of which are critical for B cell maturation, and enhances HO-1 and TSG-6 expression under pro-inflammatory cytokine stimulation. CONCLUSION:5-ALA/SFC exerted its therapeutic effects in RA by suppressing synovial inflammation via HO-1/IDO-mediated antioxidant pathways and restoring B cell homeostasis by modulating FLS-derived signals, including BAFF and VCAM-1 in mice. Potential translational limitations include inherent differences between murine CIA models and human RA pathophysiology, as well as the use of immortalized human synovial cell lines instead of primary patient-derived FLSs. These findings underscore the potential of 5-ALA/SFC as a multitarget therapeutic strategy, offering promising prospects for the development of novel RA treatments though clinical translation requires further investigation of long-term safety, optimal dosing, and side effects in humans.

BACKGROUND:Evidence has noted associations of osteoarthritis (OA) with obesity and C-reactive protein (CRP). However, little is clarified about the link between cardiometabolic index (CMI) and OA and the mediating role of CRP. METHODS:Participants from NHANES 2001-2010 were enrolled. CMI was computed based on anthropometric and biochemical indexes, covering height, waist circumference, triglyceride, and high-density lipoprotein cholesterol. OA diagnosis data were derived from the Medical Conditions questionnaires. Multivariate logistic regressions, restricted cubic spline (RCS) analysis, subgroup analyses, and interaction tests were implemented to investigate the association. A mediation analysis was employed to verify the mediating role of CRP. RESULTS:After controlling for all covariates, CMI was significantly linked with OA (OR: 1.07, 95% CI (1.01, 1.13), P = 0.038). RCS analyses elicited a non-linear link between CMI and OA (P - non - linear = 0.0012). The inflection point was 0.54. Threshold effect analysis was conducted through two-segment linear regression, including the left side ( < = 0.54) (OR: 2.06, 95% CI: 1.03, 6.58) and the right side of the inflection point (> 0.54) (OR: 0.40, 95% CI: 0.15, 1.03). CRP partially mediated the link between CMI and OA, around 7.59% of the total effect. CONCLUSION:CMI is positively linked with OA, with CRP mediating the link. This paper unveils novel perspectives on the mechanism that links CMI to OA. Managing CMI and monitoring CRP levels may alleviate OA.

Background The patellar height index is important; however, the measurement procedures are time-consuming and prone to significant variability among and within observers. We developed a deep learning-based automatic measurement system for the patellar height and evaluated its performance and generalization ability to accurately measure the patellar height index.Methods We developed a dataset containing 3,923 lateral knee X-ray images. Notably, all X-ray images were from three tertiary level A hospitals, and 2,341 cases were included in the analysis after screening. By manually labeling key points, the model was trained using the residual network (ResNet) and high-resolution network (HRNet) for human pose estimation architectures to measure the patellar height index. Various data enhancement techniques were used to enhance the robustness of the model. The root mean square error (RMSE), object keypoint similarity (OKS), and percentage of correct keypoint (PCK) metrics were used to evaluate the training results. In addition, we used the intraclass correlation coefficient (ICC) to assess the consistency between manual and automatic measurements.Results The HRNet model performed excellently in keypoint detection tasks by comparing different deep learning models. Furthermore, the pose_hrnet_w48 model was particularly outstanding in the RMSE, OKS, and PCK metrics, and the Insall-Salvati index (ISI) automatically calculated by this model was also highly consistent with the manual measurements (intraclass correlation coefficient [ICC], 0.809-0.885). This evidence demonstrates the accuracy and generalizability of this deep learning system in practical applications.Conclusion We successfully developed a deep learning-based automatic measurement system for the patellar height. The system demonstrated accuracy comparable to that of experienced radiologists and a strong generalizability across different datasets. It provides an essential tool for assessing and treating knee diseases early and monitoring and rehabilitation after knee surgery. Due to the potential bias in the selection of datasets in this study, different datasets should be examined in the future to optimize the model so that it can be reliably applied in clinical practice.Trial registration The study was registered at the Medical Research Registration and Filing Information System (medicalresearch.org.cn) MR-61-23-013065. Date of registration: May 04, 2023 (retrospectively registered).

After robotic-assisted total knee arthroplasty (RA-TKA) surgery, some patients still experience joint discomfort. We aimed to establish an effective machine learning model that integrates radiomic features extracted from computed tomography (CT) scans and relevant clinical information to predict patient satisfaction three months postoperatively following RA-TKA. After careful selection, data from 142 patients were randomly divided into a training set (n = 99) and a test set (n = 43), approximately in a 7:3 ratio. A total of 1329 radiomic features were extracted from the regions of interest delineated in CT scans. The features were standardized using normalization algorithms, and the least absolute shrinkage and selection operator regression model was employed to select radiomic features with ICC > 0.75 and P < 0.05, generating the Rad-score as feature markers. Univariate and multivariate logistic regression was then used to screen clinical information (age, body mass index, operation time, gender, surgical side, comorbidities, preoperative KSS score, preoperative range of motion (ROM), preoperative and postoperative HKA angle, preoperative and postoperative VAS score) as potential predictive factors. The satisfaction scale ≥ 20 indicates patient satisfaction. Finally, three prediction models were established, focusing on radiomic features, clinical features, and their fusion. Model performance was evaluated using Receiver Operating Characteristic curves and decision curve analysis. In the training set, the area under the curve (AUC) of the clinical model was 0.793 (95

Osteoarthritis (OA), a degenerative joint disorder, has an unclear immune infiltration mechanism in subchondral bone (SCB). Thus, this study aims to discern immune infiltration variations in SCB between early- and late-stages of OA and identify pertinent biomarkers. Utilizing the GSE515188 bulk-seq profile from the Gene Expression Omnibus database, we performed single-sample gene-set enrichment analysis alongside weighted gene co-expression network analysis to identify key cells and immune-related genes (IRGs) involved in SCB at both stages. At the meanwhile, differentially expressed genes (DEGs) were identified in the same dataset and intersected with IRGs to find IR-DEGs. Protein-protein interaction network and enrichment analyses and further gene filtering using LASSO regression led to the discovery of potential biomarkers, which were then validated by ROC curve analysis, single-cell RNA sequencing, qRT-PCR, western blot and immunofluorescence. ScRNA-seq analysis using GSE196678, qRT-PCR, western blot and immunofluorescence results confirmed the upregulation of their expression levels in early-stage OA SCB samples. Our comprehensive analysis revealed lymphocytes infiltration as a major feature in early OA SCB. A total of 13 IR-DEGs were identified, showing significant enrichment in T- or B-cell activation pathways. Three of them (CD247, POU2AF1, and TNFRSF13B) were selected via the LASSO regression analysis, and results from the ROC curve analyses indicated the diagnostic efficacy of these 3 genes as biomarkers. These findings may aid in investigating the mechanisms of SCB immune infiltration in OA, stratifying OA progression, and identifying relevant therapeutic targets.

Objective:To observe the effect of the domestic orthopedic robot-assisted core decompression and bone grafting surgery for early necrosis of the femoral head.Methods:A retrospective analysis was performed on 36 cases underwent core decompression and bone grafting for early necrosis of the femoral head treated at Department of Bone and Joint Surgery, the Second Affiliated Hospital of Xi ′an Jiaotong University from June 2020 to May 2021. 15 cases underwent robot-assisted surgery, and 21 cases underwent conventional surgery. All the patients were in Association research circulation osseous (ARCO)stageⅡ. The operating times, the number of guidewire attempts and total number of intraoperative radiation exposure were recorded. The preoperative and postoperative Harris scores and VAS scores in three and six months were compared. The repeated measurements analysis of variances and t test of two independent samples were used for statistical analysis.Results:All the patients were successfully followed up, and the operation time of the robot-assisted group (57.3±18.9) min was significantly shorter than that of the traditional group (71.6±18.2) min (t=2.292, P<0.05); compared with the traditional group, the number of guidewire attempts, the total number of intraoperative radiation exposure, and the number of radiation exposure during insertion of guidewire were significantly reduced in the robot-assisted group (t=6.818, 4.871, 4.546, all P<0.05), and there were no significant differences between the two groups in Harris score and VAS score at three and six months postoperatively (F=0.080, 0.069, both P>0.05).Conclusion:It is safe and effective to use the domestic robot-assisted core decompression and bone grafting for the treatment of early femoral head necrosis, which can save the operation time and reduce the radiation exposure.

Osteoarthritis (OA) is mainly characterized by articular cartilage degeneration, synovial fibrosis, and inflammation. LncRNA CRNDE (colorectal neoplasia differentially expressed) has been reported to be down-regulated in age-related OA, but its role in injury-induced OA needs to be further explored. In this study, an OA rat model was established using anterior cruciate ligament transection, and the adenovirus-mediated CRNDE overexpression (Ad-CRNDE) or DACT1 (dapper antagonist of catenin-1) interference (sh-DACT1) vectors were administered by intraarticular injection. Moreover, chondrocyte‑like ATDC5 cells were treated with IL-1β (10 ng/mL) to simulate OA conditions in vitro. We found that overexpression of CRNDE alleviated cartilage damage and synovitis in OA rats, and suppressed IL-1β-induced apoptosis, inflammation, and extracellular matrix (ECM) degradation in chondrocyte‑like ATDC5 cells, while silencing DACT1 effectively antagonized the protective effect of CRNDE both in vivo and in vitro. Mechanism studies revealed that DACT1 could act as a downstream target of CRNDE. By recruiting p300, CRNDE promoted the enrichment of H3K27ac in the DACT1 promoter, thus promoting DACT1 transcription. In addition, CRNDE hindered the activation of the Wnt/β-catenin pathway in IL-1β-stimulated cells by inducing DACT1 expression. In conclusion, CRNDE promoted DACT1 expression through epigenetic modification and restrained the activation of Wnt/β-catenin signaling to impede the progression of OA.

目的:探讨应用携带阔筋膜的股前外侧穿支皮瓣（ALTPF）移植修复头皮及硬脑膜缺损的临床疗效。方法:2017年3月至2021年10月,大连医科大学附属大连市中心医院手足外二科收治8例头皮及硬脑膜缺损的患者,男5例,女3例；年龄28~63岁。头皮缺损面积6.0 cm×4.0 cm~8.0 cm×6.5 cm,所切取ALTPF面积8.0 cm×5.5 cm~10.0 cm×8.5 cm,阔筋膜面积10.0 cm×8.0 cm~13.0 cm×11.5 cm。患者均为开放性颅脑外伤,入院后,积极抢救,维持生命体征平稳,同时急诊行头皮清创术,待患者一般状态稳定且创面感染控制后,行双下肢血管DSA,并行ALTPF穿支血管超声定位,确保血管条件良好后,行ALTPF移植,并携带阔筋膜,阔筋膜用于修复硬脑膜缺损,ALTPF用于修复头皮缺损,将颞浅动脉及颞浅静脉分别与皮瓣供血血管旋股外侧动脉降支及其中1条伴行静脉吻合。皮瓣供区处理情况：6例患者供区直接缝合,2例患者供区部分缝合,剩余创面行游离植皮术。随访方式包括门诊复诊、微信联系或电话询问等。结果:所移植8例ALTPF全部成活,随访3个月~3年,所移植皮瓣血运良好,感觉恢复良好,质地柔软,弹性好,其中2例皮瓣略显臃肿,经皮瓣整形后均得以改善。供区直接缝合6例,外形及功能均恢复良好；行游离植皮2例,移植皮肤轻度色素沉着,瘢痕轻度增生。结论:应用携带阔筋膜的ALTPF移植修复头皮及硬脑膜缺损具有良好的临床疗效。

目的:探讨游离双侧股前外侧穿支皮瓣串联移植修复手部大面积皮肤缺损的临床效果。方法:自2015年7月至2020年7月我科收治手部大面积皮肤缺损患者15例，男8例，女7例；年龄19~48岁，平均37.5岁。所有患者的皮肤缺损位置都在手背及手掌，累及近指间关节，创面合并内固定物外露、肌腱外露和骨外露。皮肤缺损面积27 cm×16 cm~34 cm×19 cm。选择游离双侧股前外侧穿支皮瓣串联修复。术前应用DSA造影或者超声定位确定双侧皮瓣穿支血管位置，以确定的位置为点，按照创面形态以及面积大小，在双侧股前外侧区域分别设计皮瓣，一侧皮瓣和另一侧穿支皮瓣分别命名为近侧串联皮瓣和远侧串联皮瓣。两处皮瓣总面积为30 cm×18 cm~37 cm×22 cm。术后定期随访修复部位的功能恢复及皮瓣存活情况。结果:所有患者术后均未出现血管危象，皮瓣存活良好。术后随访8~30个月，平均21.5个月，皮瓣弹性好、质地佳，7例皮瓣比较臃肿，整形后有效改善。按照中华医学会手外科学会上肢功能评定试用标准评价：优13例(80~100分)，良2例(60~79分)，15例平均分值为96.8分。结论:游离双侧股前外侧穿支皮瓣串联移植修复手部大面积皮肤缺损临床效果良好。

The renin-angiotensin-aldosterone system (RAAS) is locally expressed in skeletal tissue and is known to affect bone health. This study investigated the therapeutic effects and potential mechanisms of the angiotensin-converting enzyme inhibitor (ACEI) captopril (CAP) in a rat model of glucocorticoid-induced femoral head necrosis (GIONFH). Bone marrow mesenchymal stem cells (mBMSC) from mice treated with dexamethasone (DEX) in vitro and methylprednisolone (MPS)-induced rats in vivo were used to explore the effects and mechanisms of CAP, respectively. Cell proliferation was detected in vitro by the CCK-8 assay, apoptosis by Annexin V-FITC-PI and Western blotting, and reactive oxygen species (ROS) by the DCFH-DA probe. Osteogenic ability was assessed by alkaline phosphatase and alizarin red staining. In vivo hematoxylin and eosin staining, terminal deoxynucleotidyl transferase dUTP nick end labeling, immunohistochemistry, enzyme-linked immunosorbent assay, micro-computed tomography, RT-PCR, and Western blotting were also performed. The in vitro data showed that CAP promotes DEX-induced mBMSC proliferation, reduces apoptosis and ROS accumulation, and promotes osteogenesis. However, these protective effects were partially counteracted by A-779, a specific Mas-receptor antagonist. In vivo experiments showed that CAP prevented MPS-induced osteonecrosis, attenuated inflammation levels, and corrected bone metabolism and bone loss while reversing MPS-induced upregulation of ACE1, AT1-receptor, and RANKL expression and downregulation of ACE2, Mas-receptor, and osteoprotegerin expression. Taken together, these findings demonstrate for the first time that CAP exerts anti-inflammatory, antioxidant, anti-apoptotic, and osteoprotective effects against GIONFH by activating the ACE2/Ang-(1-7)/Mas receptor signaling pathway, which expands a new strategy for the treatment of orthopedic diseases.

Objective:To retrospectively analyze the treatment of 25 cases of lower necrotizing fasciitis.Methods:A total of 25 patients with lower limb necrotizing fasciitis (13 males and 12 females), with mean age 63 years old (48-75 years old) in Dalian Municipal Central Hospital from September 2016 to December 2020. After admission, the patient′s general physical condition was strictly evaluated, the relevant preoperative examination was improved, and the necrotizing fasciitis laboratory risk index (LRINEC) score was performed. In the absence of surgical contraindication, multiple debridement was performed, leaving the necrotic tissue removed for general bacterial culture and drug sensitivity test in parallel. After debridement, eight patients showed a large area of skin necrosis, and amputation was selected. The other 17 patients chose limb protection treatment after debridement, and adopted debridement and free skin grafting. After surgery, patients were encouraged to strengthen rehabilitation exercise to restore limb function to the maximum extent.Results:With followed up 0.6 to 3.0 years, with an average of 1.8 years. Methods include outpatient return visit, WeChat contact or telephone inquiry. The skin survived in 17 patients with mean healing time (27.5 ± 6.9) d. Eighteen patients were multiple bacterial infections and seven patients were single bacterial infections. All patients had no joint dysfunction caused by scar contracture, and reinfection in the skin grafting area.Conclusions:Necrotizing fasciitis requires early diagnosis and early treatment, with correct choice of treatment method is closely related to the patient′s prognosis.

目的:探讨应用ALTPF移植联合Ilizarov骨延长技术修复足踝部完全离断伤的临床疗效。方法:2016年9月至2020年12月,收治11例足踝部完全离断伤的患者,男9例,女2例；年龄21~47岁。入院后,急诊行断肢再植术,再植过程中,因吻合血管的需要,患肢需要短缩,而致患肢短于健侧肢体。部分患者术后出现足趾坏死及足背部皮肤坏死,创面行ALTPF移植术,大多采用单侧ALTPF移植；创面面积较大者采用双侧ALTPF串联移植。待皮瓣成活后,患肢接受Ilizarov骨延长术,以恢复患肢长度。随访方式包括门诊复诊、微信联系或电话询问等。结果:11例断肢再植术后均成活,所移植ALTPF均成活。随访0.6~3.0年,平均1.8年,所移植皮瓣血运良好,质地柔软,弹性好,其中6例皮瓣略显臃肿,经皮瓣整形后均得以改善。Ilizarov骨延长效果满意;术后患者足踝部功能AOFAS平均分为93.8分。结论:ALTPF移植联合Ilizarov骨延长技术修复足踝部完全离断伤,具有良好的临床疗效。

Previous studies have provided evidence linking the DPEP1 gene to the risk of osteoarthritis (OA) in Europeans. In this study, we aimed to examine the relationship between DPEP1 gene and the susceptibility and clinical severity of OA in a Chinese Han population.

目的:探讨应用第1趾蹼皮瓣游离移植修复拇、手指指蹼软组织缺损的临床疗效。方法:2016年7月至2019年7月,收治9例拇、手指指蹼软组织缺损患者,男5例,女4例,年龄20~49岁。软组织缺损位于指蹼,缺损面积1.9 cm×5.5 cm~3.3 cm×7.2 cm,创面合并骨外露；均采用第1趾蹼皮瓣游离移植修复,切取皮瓣面积2.3 cm×6.3 cm~4.1 cm×8.5 cm。术后通过门诊复诊、微信及电话沟通方式进行随访,观察皮瓣成活情况及修复部位的功能恢复情况,并根据中华医学会手外科学会上肢功能评定标准评价临床效果。结果:术后皮瓣全部成活,均无血管危象发生,随访6~28个月,平均13.5个月,皮瓣血运良好,质地柔软,弹性好,修复后拇、手指指蹼外形及肤色均接近正常,指骨间关节屈指活动度85°~90°,皮瓣感觉良好。结论:应用第1趾蹼皮瓣游离移植修复拇、手指指蹼软组织缺损临床疗效良好。

Background: To explore the clinical effect of robot-assisted core decompression combined with bone grafting in the treatment of femoral head necrosis involved in early stage.Methods: This study is a prospective cohort study. The study included 49 patients (78 hips) who attended the Department of Orthopedics and Joint Surgery of the Second Affiliated Hospital of Xi'an Jiaotong University from August 2019 to February 2021. All the patients suffering Association Research Circulation Osseous (ARCO) II stage of femoral head necrosis underwent core decompression and bone grafting. Among the patients undergoing surgery, 30 patients (54 hips) were treated with traditional surgical methods, and 19 patients (24 hips) were assisted by the made-in-China orthopedic robot system. All operations were performed by the same operator. The baseline data of the two groups of patients, the time of unilateral operation, the number of unilateral X-ray fluoroscopy, the Harris hip score (HHS) at the last follow-up after surgery, the visual analog score (VAS), and the collapse rate at the last follow-up were collected and compared. Results: A total of 41 patients (70 hips) were followed up, including 24 cases (42 hips) in the traditional surgery group and 17 cases in the robot-assisted group (28 hips). The average follow-up time of all cases was (13.9±3.4) months (range: 8-18 months). At the last follow-up, a total of 13 patients (13 hips) suffered femoral head surface collapse, including 11 patients in the traditional surgery group (11 hips) and 2 patients in the robot-assisted group (2 hips). The rate of femoral head collapse between the two groups had statistical difference. The average operation time of unilateral hip in the traditional operation group was (22.5±5.5) min, and (18.2±4.0) min in the robot-assisted group, with significant difference. The number of X-ray fluoroscopy of unilateral hip in the traditional operation group was (14.7±3.1) times, and (10.1±3.1) times in the robot-assisted group, with significant difference. The HHS before surgery in the traditional surgery group was (63.8±3.2) points, and (84.6±3.4) points at the last follow-up,while the preoperative HHS of the robot-assisted surgery group was (65.5±3.5) points, and (85.9±3.1) points at the last follow-up. The HHS at the last follow-up of the two groups were significantly different from those before the operation, but there was no difference between the two groups. The preoperative VAS of the traditional surgery group was (4.8±0.8) points, and (1.7±1.2) points at the last follow-up. The preoperative VAS of the robot-assisted surgery group was (5.0±0.7) points, and (0.9±0.7) points at the last follow-up. At the last follow-up of the two groups, there were significant differences in VAS, and significant difference between the two groups was also detected.Conclusion: Core decompression combined with bone grafting have a definite effect in the treatment of femoral head necrosis at early stage. Compared with traditional surgery, robot-assisted surgery can achieve better short-term results and head preservation rate. Trial registration: the research has been registered in China National Medical Research Registration and Filing System

Background Bone defects are often combined with the risk of infection in the clinic, and artificial bone substitutes are often implanted to repair the defective bone. However, the implant materials are carriers for bacterial growth, and biofilm can form on the implant surface, which is difficult to eliminate using antibiotics and the host immune system. Magnesium (Mg) was previously reported to possess antibacterial potential. Methods In this study, Mg was incorporated into poly(lactide- co -glycolic acid) (PLGA) to fabricate a PLGA/Mg scaffold using a low-temperature rapid-prototyping technique. All scaffolds were divided into three groups: PLGA (P), PLGA/10 wt% Mg with low Mg content (PM-L) and PLGA/20 wt% Mg with high Mg content (PM-H). The degradation test of the scaffolds was conducted by immersing them into the trihydroxymethyl aminomethane–hydrochloric acid (Tris–HCl) buffer solution and measuring the change of pH values and concentrations of Mg ions. The antibacterial activity of the scaffolds was investigated by the spread plate method, tissue culture plate method, scanning electron microscopy and confocal laser scanning microscopy. Additionally, the cell attachment and proliferation of the scaffolds were evaluated by the cell counting kit-8 (CCK-8) assay using MC3T3-E1 cells. Results The Mg-incorporated scaffolds degraded and released Mg ions and caused an increase in the pH value. Both PM-L and PM-H inhibited bacterial growth and biofilm formation, and PM-H exhibited higher antibacterial activity than PM-L after incubation for 24 and 48 h. Cell tests revealed that PM-H exerted a suppressive effect on cell attachment and proliferation. Conclusions These findings demonstrated that the PLGA/Mg scaffolds possessed favorable antibacterial activity, and a higher content of Mg (20%) exhibited higher antibacterial activity and inhibitory effects on cell attachment and proliferation than low Mg content (10%).