Abstract Background Robotic-assisted total joint arthroplasty (rTJA) has witnessed rapid adoption across the Asia-Pacific region. However, practice heterogeneity and conflicting evidence regarding its clinical value necessitate standardized guidance. Therefore, this expert consensus aims to establish consensus-based recommendations to guide and standardize the clinical application of rTJA. Methods The Arthroplasty Society in Asia (ASIA) convened a panel of 45 experts. A modified Delphi technique was employed across three rounds. A systematic literature review informed the generation of consensus statements, which were finalized through anonymous voting. Consensus was defined as ≥ 75% agreement. Results The panel reached consensus on 18 critical clinical questions spanning general principles, total hip arthroplasty, and total knee arthroplasty. Key consensus points include: (1) rTJA demonstrates superior accuracy in implant positioning and alignment restoration compared to manual techniques (98%); (2) current evidence does not yet support a definitive superiority in long-term survivorship or PROMs (77%); (3) robotic platforms are enabling technologies that make personalized alignment philosophies technically reproducible (100%); and (4) soft-tissue balancing should take precedence over rigid mechanical alignment targets in rTKA when conflicts arise(91%). Conclusion This consensus statement provides a comprehensive framework for the application of robotic technology in hip and knee arthroplasty, emphasizing safety, precision, and the need for rigorous training.

Background: Periprosthetic joint infection (PJI) is a devastating complication of arthroplasty and is difficult to diagnose accurately. This study aims to explore the value of neutrophil extracellular traps in synovial fluid (SF-NETs, web-like structures released by neutrophils as a critical innate immune response) for diagnosing PJI. Methods: A retrospective cohort study was conducted, enrolling post-arthroplasty subjects from January 2018 to December 2023. Three components of SF-NETs (cell-free double-strand DNA, SF-dsDNA; citrullinated histone H3, SF-CitH3; SF-Nucleosome) and SF-NETs1+ (positive with one out of the three NET components), SF-NETs2+ (positive with two out of the three NET components), white blood cell count (SF-WBC), polymorphonuclear cell percentage (SF-PMN %), neutrophil count in SF (SF-PMN), microbiological examinations (Culture) and infection-related systemic indices were evaluated. Results: A total of 64 of 153 included subjects were diagnosed as PJI. SF-dsDNA and SF-CitH3 had significantly higher levels in the PJI group compared to the non-PJI group ( P < 0.001) and showed positive correlations with SF-WBC, SF-PMN % and SF-PMN (0.4 < ρ < 0.7), while SF-Nucleosome had no significant difference. Sensitivity and specificity of SF-NETs1+, SF-NETs2+ and Culture were 82.2 % and 78.7 %, 59.4 % and 95.5 %, and 54.1 % and 86.8 %, respectively. The NET related index (NETRI) was defined as 10.529 × SF-NETs 1 + + 28.114 × SF-PMN % + 8.210 × Culture-1.452, with the area under the receiver operating characteristic curve of 0.922, making it a novel indicator. Conclusions: SF-NETs1+ and SF-NETs2+ may serve respectively in the screening and exclusion of PJI. NETRI represented a new discriminator for PJI diagnosis.

Abstract Background This study compared the learning curves and clinical outcomes of osteotomy guide robot and guide plate-based robot-assisted total knee arthroplasty (TKA). Patients and methods From January to May 2023, 100 patients were prospectively enrolled to receive either a guide plate-based robot or an osteotomy guide robot-assisted total knee arthroplasty. The thickness of the osteotomy planned by the robot and the actual thickness were recorded in real time during the operation, as was the time taken for each step in the operation, including bone registration and osteotomy. The SF-12, HSS score, and FJS of the patients before surgery and 6 weeks and 24 months after surgery were also collected. Results For surgeon 1, the average operating time with the guide plate-based robot and osteotomy guide robot was 98.16 ± 9.68 and 118.52 ± 15.95 min, respectively; the difference was significant. The average time of the last 10 cases was shorter than that of the first 10 cases. The inflection points of the osteotomy learning curve of surgeon 1 with two robotic systems were at case 5 and case 9. The average operative times for Surgeon 2’s two robotic surgery groups were 104.52 ± 12.65 min and 105.76 ± 33.03 min, respectively. The inflection points of the osteotomy learning curves using the two robotic systems occurred at case 13, respectively. Patients who underwent guide plate-based robot or osteotomy guide robot-assisted TKA had similarly improved knee recovery, reflected in the SF-12, HSS score, and FJS. Conclusions There was no significant difference in the osteotomy learning curve between the two robotic systems. The improvement in knee functional recovery was similar after the guide plate-based robot and the osteotomy guide robot-assisted TKA. Level of evidence Level II.

To introduce a medial femoral condyle restoration (MFCR) technique for total knee arthroplasty (TKA) and compare its clinical outcomes with conventional mechanical alignment (MA) in varus osteoarthritis. In this prospective randomized trial, 126 consecutive patients with varus osteoarthritis undergoing TKA (January 2021–January 2023) were assigned to MFCR or MA. MFCR surgical key points were medially focused quantitative compensation of cartilage loss by reducing distal/posterior medial femoral resections using thickness-specific shims (0.5–2.0 mm, 0.5-mm steps) guided by Outerbridge grading and calibrated probing. Participants were randomized to receive either the MFCR technique or the conventional MA technique. Intraoperative outcomes (blood loss, operative time, hospital stay, and medial release) and postoperative ROM were recorded; functional outcomes included WOMAC and walking VAS pain. Continuous variables were expressed as mean ± standard deviation and analyzed using one-way analysis of variance. The mean age of the MFCR group and control group was 68.3 ± 7.4 years and 67.9 ± 8.7 years, respectively (P = 0.4236). Preoperatively, the mean WOMAC score of the groups was 67.2 ± 9.8 and 62.3 ± 16.4, respectively (P = 0.2524). The mean varus knee angle was 18.2° ± 7.2° and 17.3° ± 8.9°, respectively (P = 0.6735). The mean time for soft tissue balancing was 5.1 ± 2.6 min and 12.1 ± 4.3 min in the MFCR and control group, respectively (P = 0.017). The mean operative time was 50.6 ± 12.1 min and 58.9 ± 13.8 min in the MFCR and control group, respectively (P = 0.011). The mean hospital stay time was 1.8 ± 0.7 days and 3.2 ± 0.9 days in the MFCR and control group, respectively (P = 0.028). At 2 years postoperatively, the WOMAC scores were 29.9 ± 17.9 and 43.6 ± 13.7, respectively (P = 0.0325). Postoperative nausea/vomiting occurred less frequently in the MFCR group (P = 0.0391), with no other complications observed during follow-up. MFCR restored the anatomy of the medial femoral condyle by quantitatively preserving medial femoral bone to compensate for cartilage loss within a bony-first, minimal-release workflow. Compared with MA, MFCR reduced perioperative burden and improved early function, and can be implemented using a simple, reproducible technique without advanced imaging or robotics.

Robotic-assisted total knee arthroplasty (TKA) requires pin trackers fixed to the femur and tibia. The influence of femoral pin tracker placement (intra-incisional or extra-incisional) on fracture risk remains controversial, with limited clinical and biomechanical evidence. A retrospective cohort study included 688 patients who underwent robotic-assisted TKA (505 in intra-incisional group, 183 in extra-incisional group). The incidence of femoral periprosthetic fractures was compared between the two groups within three months postoperatively. Finite-element analysis (FEA) simulated femoral biomechanical behaviour under compression, torsion, and bending loads in three models: control, intra-incisional, and extra-incisional groups. One fracture occurred in the extra-incisional group (1/183, 0.55

This study reports the mid-term outcomes of primary total hip arthroplasty (THA) and investigates the effect of bony ankylosis on postoperative hip function in patients with ankylosing spondylitis (AS). We identified 544 primary THAs performed in 319 consecutive patients with AS (median age, 33 years) from 2012 to 2017. Survivorship of the implants, complications, and patient satisfaction were investigated. Functional outcomes were assessed by the measurement of hip flexion–extension range of motion (ROM), the Harris hip score (HHS), and the Western Ontario and McMaster Universities Arthritis Index (WOMAC). The hips undergoing THA were divided into a bony ankylosis group and a hip stiffness group based on the severity of hip involvement. The postoperative functional results of the two groups at the most recent follow-up were compared. Survivorship was 99.8

OBJECTIVE:The purpose of this study is to validate the efficacy of the Deep Convolutional Neural Network (DCNN) model to automatically detect Leukocyte Esterase (LE) strips in the diagnosis of Periprosthesis Joint Infection (PJI). METHODS:This study is a prospective diagnostic trial. We constructed an automatic detection system for LE strips based on the AlexNet deep convolutional model to diagnose PJI.LE strip images and white blood cell counts from 46 patients were used to train the DCNN model.96 patients were prospectively enrolled in this single-center study and underwent joint aspiratio. Based on inclusion and exclusion criteria, 18 patients were excluded; 78 patients were included for analysis, and they all agreed to participate. The ICM2018 standard was used as the gold standard to classify the included patients. One drop of synovial fluid (100 μL) from patients was applied to LE strips before and after centrifugation. The DCNN Model automatically captures the images of the strips and outputs the results. The framework of the DCNN Model includes LE strip image acquisition, preprocessing, and intelligent detection. Three observers performed LE strip colorimetric test, and the majority result was considered the final result. The clinical laboratory provided results for WBC count, PMN%, serological tests, histopathology, and microbial cultures. The diagnostic performance of the DCNN Model was analyzed using sensitivity, specificity, PPV, NPV, ROC curve, and AUC. The reliability of the DCNN Model in diagnosing PJI was assessed through a consistency test (Kappa value) with traditional PJI diagnostic methods. RESULTS:The AUC of the DCNN Model was 0.92 before centrifugation and 0.91 after centrifugation. Before centrifugation, the sensitivity, specificity, PPV, and NPV of the model were 0.83, 0.97, 0.98 and 0.79, respectively. After centrifugation, they were 0.79, 1.00,1.00 and 0.76, respectively. The Kappa value for diagnosing PJI using the model before and after centrifugation was 0.82 (P<0.05). The Kappa values of the model results for PJI diagnosis compared to WBC count, PMN%, LE strip colorimetric test, ESR, CRP, and microbial culture before centrifugation were 0.82, 0.72, 0.59, 0.69, 0.64 and 0.4. After centrifugation, the Kappa values were 0.90, 0.75, 0.69, 0.67, 0.62 and 0.48. CONCLUSION:The DCNN Model demonstrates excellent performance and high reliability in diagnosing PJI. Utilizing this model improves the objectivity of LE strip test for diagnosing PJI and mitigates the influence of external factors on the test results. Large-scale, multicenter clinical studies are necessary to further enhance the diagnostic performance of the model.

BACKGROUND:Intraosseous regional administration (IORA) of vancomycin for preventing infection in total knee arthroplasty (TKA) achieves high local tissue concentrations and enhances efficacy when combined with intravenous (IV) cephalosporins. This study evaluated the safety and efficacy of standalone intraosseous (IO) cefuroxime for TKA infection prophylaxis and determined its optimal dose. METHODS:There were 30 primary TKA patients divided into three groups: IO administration of 750 mg cefuroxime (C750IO group), IO administration of 1,500 mg cefuroxime (C1500IO group), and IV administration of 1,500 mg cefuroxime (C1500IV group). All groups received no other IV antibiotics preoperatively. During surgery, nine tissue samples were collected: bone samples were collected from the femur or tibia, synovial and fat samples were collected from the surgical area, and systemic blood samples were collected twice to detect cefuroxime levels. Intraoperative vital signs, inflammatory markers, and liver/kidney function on days one and three, and postoperative and complications within three months were recorded. RESULTS:The C750IO and C1500IO groups showed higher tissue cefuroxime concentrations than the C1500IV group (P < 0.05). Except for the proximal tibial bone sample, there were no significant differences in cefuroxime concentrations between the C750IO and C1500IO groups (P > 0.05). Intraoperative blood concentrations were lower in the IO groups compared to C1500IV (P < 0.05), but post-tourniquet-release levels in C1500IO exceeded other groups. There were no intergroup differences in vital signs that occurred (P > 0.05). Postoperative inflammatory marker levels were higher in the C1500IV group than in the C750IO and C1500IO groups, with significantly lower erythrocyte sedimentation rate levels in the C750IO group on postoperative day three compared to the C1500IV group (P = 0.017). No infections or adverse drug events occurred within three months postoperatively. CONCLUSIONS:Intraosseous cefuroxime (750 or 1500 mg) achieved higher local tissue concentrations than IV 1,500 mg in TKA. Preoperative IO 750 mg cefuroxime alone minimized systemic exposure while maintaining effective concentrations, suggesting its safety and potential as a preferred prophylactic strategy.

BACKGROUND:The hip joint is one of the peripheral joints most commonly affected by ankylosing spondylitis (AS). Previous research showed that compared to manual total hip arthroplasty (THA), robot-assisted THA significantly improves the likelihood of achieving cup positioning within the target zone. METHODS:In this study, we investigated robot-assisted THA for arthrodesed hips, including fused hip joints and fibrously fused hip joints. We retrospectively analyzed patients who had AS who underwent THA in our hospital from January 2021 to October 2023. There were 60 patients who underwent robot-assisted THA, and 60 patients received manual THA. There was no significant difference in demographic characteristics between the two groups. The patients were followed up at one year after surgery. We collected the patient's sex, age, body mass index, operative time, postoperative anteroposterior pelvic X-ray, postoperative Harris hip score, intraoperative and postoperative complications. RESULTS:The operation time of the two groups was 105.5 ± 8.8 versus 104.2 ± 7.1 minutes, with no statistically significant difference. In addition, the frequency of fluoroscopy was lower in the robot group than in the manual group (0 versus 0.8 ± 0.8). The proportion of acetabular prosthesis in the safety zone in the robot-assisted group was higher than that in the control group (93.3 and 55.0%). The dislocation rate of the robot-assisted group was significantly less than that of the manual group (1.7 versus 5.0%). The complication rate of the robot-assisted group was 3.3%, and that of the manual surgery group was 8.3%. At one year after surgery, the Harris hip score of patients in the robot-assisted group was higher than that in the manual group (77.9 ± 4.9 versus 70.4 ± 4.8), with a statistical difference. CONCLUSIONS:We demonstrate that robot-assisted THA in AS patients significantly reduces dislocation rates and improves patient satisfaction.

Purpose Obesity is widely recognized as a risk factor for osteoarthritis. This study aimed to explore the association between BMI and periarticular soft tissue readmission complications in patients who previously underwent joint replacement through the study of clinical and imaging data. Methods This retrospective study included 625 patients who underwent total knee arthroplasty. Imaging data included several measurable soft tissue values and ratios on the anteroposterior side. The associations between BMI and imaging soft tissue measurements and complications leading to readmission during follow-up were explored. Results A total of 761 preoperative imaging measurements and postoperative follow-up data were analyzed, and a significant correlation (P < 0.05) emerged between postoperative readmission complications and the soft tissue thickness around the joint. A 1:4 paired test confirmed the independent predictive power (P < 0.1) of the selected soft tissue data for readmission complications. Conclusion BMI was insufficient for evaluating obesity-related complications after total knee arthroplasty. Preoperative imaging soft tissue data exhibited superior predictive capability for predicting readmission complications after arthroplasty.

BACKGROUND:Good wound healing is critical to infection prophylaxis and satisfactory rehabilitation in Total Knee Arthroplasty (TKA). Currently, two techniques, i.e., barbed continuous subcuticular suture without skin adhesive or combined use skin adhesive (n-butyl-2) are being used for superficial wound closure of TKA. While a new skin adhesive (2-octyl) with self-adhesive mesh has been employed as an alternative to conventional surgical skin closure in TKA, its superiority, especially in reducing wound complications and improving wound cosmetic outcomes has not been investigated. This study aimed to compare 2-octyl, n-butyl-2, and no skin adhesive in terms of safety and efficacy in TKA superficial wound closure. METHODS:We conducted a multicenter, prospective, randomized controlled study in 105 patients undergoing primary TKA between May 2022 and October 2023. Each patient's knee was randomized to receive 2-octyl, n-butyl-2, or no skin adhesive skin closure with all using barbed continuous sutures in deep tissue. Wounds were followed 1, 3, 5 days, 2, 6 weeks, and 3 months after surgery. Wound discharge, complications, cosmetic outcomes, patient satisfaction, and wound-related costs were compared among these three methods. RESULTS:Wound discharge was less in 2-octyl group and n-butyl-2 group than in non-adhesive group at 1 day, with the discharge only being less in 2-octyl group than in the non-adhesive group at day 3 and day 5 days (P < 0.05). There was no statistical difference in the incidence of other wound complications among the groups (P > 0.05). The 2-octyl group achieved better cosmetic effects than the other two groups in 6 weeks and 3 months (P < 0.05). Compared to the non-adhesive group, 2-octyl group scored higher in overall patient satisfaction score in 2 weeks and incurred lower costs (P < 0.05). CONCLUSIONS:Skin closure in TKA using 2-octyl adhesive material showed superiority when compared to no skin adhesive or n-butyl-2, in reducing wound discharge, improving the cosmetic outcomes, without increasing wound complications. In addition, the use of 2-octyl yielded better patient satisfaction and also was less costly compared to no skin adhesive. Our study exhibited that 2-octyl was a safe and effective wound closure technique for patients undergoing TKA. TRIAL REGISTRATION:This study has been registered at Clinical Trials. Gov (No. ChiCTR210046442).

Objective Osteonecrosis of the femoral head (ONFH) is a severe disease that primarily affects the middle-aged population, imposing a significant economic and social burden. Recent research has linked the progression of non-traumatic osteonecrosis of the femoral head (NONFH) to the composition of the gut microbiota. Steroids and alcohol are considered major contributing factors. However, the relationship between NONFH caused by two etiologies and the microbiota remains unclear. In this study, we examined the gut microbiota and fecal metabolic phenotypes of two groups of patients, and analyzed potential differences in the pathogenic mechanisms from both the microbial and metabolic perspectives.Methods Utilizing fecal samples from 68 NONFH patients (32 steroid-induced, 36 alcohol-induced), high-throughput 16 S rDNA sequencing and liquid chromatography with tandem mass spectrometry (LC-MS/MS) metabolomics analyses were conducted. Univariate and multivariate analyses were applied to the omics data, employing linear discriminant analysis effect size to identify potential biomarkers. Additionally, functional annotation of differential metabolites and associated pathways was performed using the Kyoto Encyclopedia of Genes and Genomes (KEGG) database. Subsequently, Spearman correlation analysis was employed to assess the potential correlations between differential gut microbiota and metabolites.Results High-throughput 16 S rDNA sequencing revealed significant gut microbial differences. At the genus level, the alcohol group had higher Lactobacillus and Roseburia, while the steroid group had more Megasphaera and Akkermansia. LC-MS/MS metabolomic analysis indicates significant differences in fecal metabolites between steroid- and alcohol-induced ONFH patients. Alcohol-induced ONFH (AONFH) showed elevated levels of L-Lysine and Oxoglutaric acid, while steroid-induced ONFH(SONFH) had increased Gluconic acid and Phosphoric acid. KEGG annotation revealed 10 pathways with metabolite differences between AONFH and SONFH patients. Correlation analysis revealed the association between differential gut flora and differential metabolites.Conclusions Our results suggest that hormones and alcohol can induce changes in the gut microbiota, leading to alterations in fecal metabolites. These changes, driven by different pathways, contribute to the progression of the disease. The study opens new research directions for understanding the pathogenic mechanisms of hormone- or alcohol-induced NONFH, suggesting that differentiated preventive and therapeutic approaches may be needed for NONFH caused by different triggers.

Periprosthetic joint infection (PJI) is a severe complication after joint replacement surgery that demands precise diagnosis for effective treatment. We enhanced PJI diagnostic accuracy through three steps: (1) developing a self-supervised PJI model with DINO v2 to create a large dataset; (2) comparing multiple intelligent models to identify the best one; and (3) using the optimal model for visual analysis to refine diagnostic practices. The self-supervised model generated 27,724 training samples and achieved a perfect AUC of 1, indicating flawless case differentiation. EfficientNet v2-S outperformed CAMEL2 at the image level, while CAMEL2 was superior at the patient level. By using the weakly supervised PJI model to adjust diagnostic criteria, we reduced the required high-power field diagnoses per slide from five to three. These findings demonstrate AI’s potential to improve the accuracy and standardization of PJI pathology and have significant implications for infectious disease diagnostics.

Objective:To compare the mid- and long-term effectiveness of patellar resurfacing versus non-resurfacing in primary total knee arthroplasty (TKA). Methods:Twenty-six patients who underwent bilateral TKA between March 2013 and September 2015 were selected as the study subjects. One side was randomly chosen for patellar resurfacing (resurfacing group), and the other side was not (control group). There were 4 males and 22 females, the age ranged from 51 to 65 years, with an average of 59 years. According to Kellgren-Lawrence classification, there were 21 cases of grade Ⅳ and 5 cases of grade Ⅲ in both knees. There was no significant difference in the surgical side, and preoperative clinical and functional scores of the Knee Society Score (KSS), visual analogue scale (VAS) score, and the composition ratio of anterior knee pain localization points between the two groups ( P>0.05). The operation time, intraoperative blood loss, postoperative abnormal signs such as patellar clunk, feeling of constraint, patellar tendon weakness, crepitus, or snow-on-glass sensation, and the occurrence of complications were recorded and compared. Patient subjective evaluations included Forgotten Joint Score (FJS) and the degree of difficulty in high-level knee activities (including flexion with load bearing, going upstairs, going downstairs, squatting and standing up, kneeling, knee extension, and crossing legs for 7 items); KSS clinical/functional scores and VAS scores were used to evaluate the recovery of knee joint function, and the location of anterior knee pain was determined by a localization diagram. Results:The operation time of the resurfacing group was significantly longer than that of the control group ( P<0.05), and there was no significant difference in intraoperative blood loss between the two groups ( P>0.05). All patients' incisions healed by first intention; the hospital stay ranged from 8 to 23 days, with an average of 12.6 days. All patients were followed up 9-11 years, with an average of 9.7 years. Except for 1 case who died of multiple organ failure due to internal diseases at 9 years after operation and 5 cases with incomplete radiological data, the rest 20 patients were assessed radiologically and found that 1 side of the knee joint in the control group had patellar dislocation; the remaining patients had no prosthetic failure (fracture, loosening, displacement, etc.), patellar fracture, patellar necrosis, patellar instability, patellar tendon rupture, prosthetic revision, etc. No patients had reoperations due to patellar-related complications or anterior knee pain in both knee joints. At 2 years postoperatively and at last follow-up, there was no significant difference in the incidence of abnormal signs such as patellar clunk, feeling of constraint, patellar tendon weakness, crepitus, or snow-on-glass sensation, the incidence of high-level knee activity difficulty, and the composition ratio of anterior knee pain localization between the two groups ( P>0.05). The KSS clinical scores, functional scores, and VAS scores of both groups significantly improved compared to preoperative ones ( P<0.05); there was no significant difference in the comparison between the two groups at the two time points postoperatively ( P>0.05). At 2 years postoperatively and at last follow-up, there was no significant difference in FJS scores between the two groups ( P>0.05). Conclusion:Patellar resurfacing or not has similar mid- and long-term effectiveness in primary TKA.

This study aimed to report the mid-term functional outcomes of total hip arthroplasty (THA) for the treatment of advanced hip involvement in ankylosing spondylitis (AS) and identify the factors associated with poor hip flexion range of motion (ROM) after THA in patients with AS. We retrospectively investigated the mid-term functional outcomes in 313 AS patients (538 hips) who underwent primary THA from 2012 to 2017, with a mean follow-up of 7 years (range, 4–9 years). Postoperative functional outcomes were assessed by hip flexion ROM, Harris hip score (HHS), and the Western Ontario and McMaster Universities Arthritis Index (WOMAC). The hips were divided into poor (≤ 90°) and good hip flexion ROM (> 90°) groups based on the degree of hip flexion ROM recorded at the most recent follow-up. We grouped factors related to postoperative hip flexion ROM into three categories: preoperative (or patient-related), intraoperative (or surgery-related), and postoperative factors. Multivariate logistic regression was performed to identify the independent factors associated with postoperative poor hip flexion ROM. The overall flexion-extension ROM improved significantly with a median from 0° (0 120°) to 100° (30 130°) after THA (P < 0.001), and the mean HHS increased from 37 to 90 (P < 0.001). There were 102 hips (19

目的 分析全膝关节置换术后基于膝关节评分量表的远程随访的可行性和效果.方法 回顾性分析2021年7月至2022年9月于中国人民解放军总医院第一医学中心骨科接受全膝关节置换的71例膝关节骨关节炎患者,共12例完成随访,男6例、女6例,年龄(72.83±4.22)岁(范围68～78岁),远程随访组采用线上方式进行随访.按照1∶2的比例选择同期接受门诊随访的24例患者作为对照(门诊随访组),男12例、女12例,年龄(72.16±4.50)岁(范围65～80岁).采用西安大略和麦克马斯特大学(Western Ontario and McMaster University,WOMAC)骨关节炎指数、牛津大学膝关节评分(Oxford Knee Score,OKS)及2011版膝关节协会评分(Knee Society Score,KSS)评估术后疗效.结果 远程随访组随访完成率为17％(12/71).两组手术前后WOMAC评分的差异均有统计学意义(F=106.18,P＜0.001;F=34.33,P＜0.001);远程随访组末次随访时的WOMAC评分为(11.21±5.64)分,小于术前的(43.83±8.52)分和术后2～4周的(33.96±9.19)分,差异有统计学意义(P＜0.001,P＜0.001);门诊访组末次随访时的WOMAC评分为(13.33±5.36)分,小于术前的(42.00±7.21)分和术后2～4周的(32.83±11.00)分,差异有统计学意义(P＜0.001,P＜0.001).两组患者手术前后OKS的差异均有统计学意义(F=168.65,P＜0.001;F=66.18,P＜0.001).远程随访组末次随访时的OKS为(15.13±4.92)分,小于术前的(44.50±5.84)分和术后2～4周的(36.83±6.31)分,差异有统计学意义(P＜0.001,P＜0.001);门诊访组末次随访时的OKS为(16.58±3.63)分,小于术前的(41.42±5.05)分和术后2～4周的(33.33±6.60)分,差异有统计学意义(P＜0.001,P＜0.001).两组患者手术前后2011版KSS的差异均有统计学意义(F=164.21,P＜0.001;F=51.78,P＜0.001));远程随访组末次随访时为(83.67±6.27)分,大于术前的(41.33±10.33)分和术后2～4周的(50.42±11.07)分,差异有统计学意义(P＜0.001,P＜0.001);门诊随访组末次随访时为(83.17±6.28)分,大于术前的(40.08±8.91)分和术后2～4周的(44.37±9.04)分,差异有统计学意义(P＜0.001,P＜0.001).术前、术后2～4周、术后6周、术后2～3个月和术后4个月及以上三种评分的组间比较差异均无统计学意义(P＞0.05).结论 膝关节置换术后基于膝关节评分量表的远程随访可获得与门诊随访相似的效果,但失访率均较高.应对评分量表进行优化以提高患者的依从性.

Abstract Objective This study described a minimally invasive approach for the management of early-stage avascular necrosis of the femoral head, which integrated arthroscopic intra-articular decompression and core decompression by drilling multiple small holes. Method A total of 126 patients with 185 hip avascular necrosis were included between March 2005 and January 2008, and the hips were classified, based on the Association Research Circulation Osseous staging system, into stage I (n = 43), stage II (n = 114), and stage III (n = 28). Arthroscopic intra-articular inspection and debridement, along with drilling of multiple small holes for core decompression, were performed. The Modified Harris hip score system and radiographs were used to assess the pre- and post-surgery outcomes. Results One hundred and three patients (involving 153 hips) were followed up successfully for an average of 10.7 ± 3.4 years (range: 9–12 years). After surgery, the overall survival rate was 51.6% (79 hips), and the clinical survival rates were 79%, 72%, 52%, 32%, and 10% for patients with stage I, IIa, IIb, IIc, and III, respectively. The outcomes of patients with Association Research Circulation Osseous Stages I or IIA were better than those of other stages, while hips with a large necrotic area had poor results. This approach preserved the original biomechanical strength of the femoral head after core decompression and eliminated arthritis factors in the hip joint. Conclusion The core decompression with multiple small-size holes is an effective method for treating early-stage avascular necrosis of the femoral head, particularly in those with pathological changes in the hip joint. Level of evidence Therapeutic study, Level IV.

目的 探究跟骨孤立性骨囊肿(solitary bone cyst,SBC)病灶范围与病理性骨折的关系,为SBC治疗提供参考.方法 基于CT图像建立足踝三维有限元模型,在病灶好发区构建4种梯度球型骨缺损模型,模拟不同的SBC病灶范围,分析步态周期不同时相跟骨的生物力学特征.结果 在步态周期下,随着SBC范围增加,跟骨位移无明显变化,但峰值应力逐渐增大.当SBC直径超过跟骨宽度的75％时,跟骨沟和病灶下方皮质区域应力增加到正常跟骨的1.48倍和7.74倍.结论 当SBC直径超过跟骨宽度的75％时,应力性骨折风险增大,可早期手术干预.跟骨沟和SBC下方骨皮质是应力集中区,可作为评估应力性骨折的重点区域.

Objective: To explore the learning curve of SkyWalker robot-assisted total knee arthroplasty（TKA）. Methods: The operative data of SkyWalker robot-assisted TKA from January 2022 to April 2022 were collected. During the operation, fixed personnel recorded the total operation time, tripod installation time, reference frame installation time, bone registration time, and the number of registered red dots, osteotomy time, soft tissue and bone preparation time after osteotomy, installation and test time and prosthesis implantation time in real time. Results: Operative data from 50 cases of 7 surgeons were collected in this study including 28 cases of SkyWalker-assisted TKA and 22 cases of manual TKA. The total operation time of robot-assisted TKA and manual TKA was（123.3±22.0）min and（103.6±22.9）min, and the difference was statistically significant（P=0.003）. Surgeon 1 completed the TKA of 13 cases with the help of SkyWalker robot, with the accumulation of experience his spending time on the operation decreased significantly, and his peak number of CUSUM curve was seven. The time of robotic osteotomy decreased significantly and its peak number of CUSUM curve was also seven, and the other operation steps like bone registration did not change significantly. The proportion of accurate preoperative planning of prosthesis size among the 7 surgeons increased significantly from the initial 38% to 85%. Conclusions: In SkyWalker robot-assisted TKA, after the operator is familiar with the SkyWalker robot, the operation time is significantly reduced mainly on the osteotomy, and the critical value of the learning curve is in the 7th case.

Abstract Background Dislocation is a common complication after total hip arthroplasty (THA). This study aimed to compare the outcomes of mesh reconstruction versus conventional capsular repair in maintaining capsular integrity and preventing dislocation after THA. Methods This was a prospective, randomized controlled study of consecutive patients. A total of 124 high-dislocation-risk THAs were identified and randomized into two groups, one using mesh reconstruction and the other using the conventional capsular repair method. Perioperative data and radiological data were collected. Patients were followed up regularly. The main indices were the capsular integrity assessed by magnetic resonance imaging (MRI) and hip dislocation rate. The secondary indices included the Harris hip score (HHS), complications, and satisfaction. Results A total of 106 patients completed the follow-up and the average follow-up times were 19 ± 3.1 and 18 ± 3.3 months. The operation time of the mesh group was longer than that of the conventional group (P < 0.001). There were minor differences in acetabular anteversion and abduction angle, and the other data showed no differences. MRI results indicated that the success rate of capsular repair was higher in the mesh group (50 hips, 98%) than in the conventional group (37 hips, 67%) (P < 0.001), and the others failed the repair. Three dislocations occurred in the conventional group, while none occurred in the mesh group. The preoperative HHS (30 points) and postoperative HHS (82 points) of the mesh group were similar to those (35 points, 83 points) of the conventional group (P = 0.164, P = 0.328). Satisfaction had no difference (P = 0.532). Conclusions Compared to conventional repair, mesh reconstruction can effectively maintain capsular integrity and decrease dislocation risk after THA without increasing complications. Level of evidence: Therapeutic study, Level IA.