Osteology

Background/Objectives: Osteoporotic vertebral fractures (OVFs) are common in older adults. While surgery is generally reserved for unstable or painful fractures, some OVFs conceal underlying malignancies, including metastatic and hematologic cancers. This study aimed to determine the pooled prevalence of unsuspected malignancy in patients initially diagnosed with OVFs. Methods: A systematic search of PubMed and Scopus was conducted from inception to September 2025 in accordance with PRISMA guidelines. Eligible studies included adults with presumed OVFs who underwent vertebral biopsy and histopathological evaluation. Prevalence estimates were pooled using a random-effects model, and study quality was assessed with the Newcastle–Ottawa Scale. Results: Thirteen studies involving 3513 patients were included. The pooled prevalence of malignancy was 8.0% (95% CI: 5.4–10.6), comprising metastatic solid tumors (4.9%; 95% CI: 2.3–7.4) and multiple myeloma (2.6%; 95% CI: 1.3–3.9). Malignancy was detected in 2.7% (95% CI: 1.8–4.1) of routine biopsy cohorts versus 36.8% (95% CI: 22.1–54.4) of clinically suspected cases. Diagnostic yield exceeded 45% in patients selected by combined history, imaging, or known malignancy. No biopsy-related complications or procedure-related mortality were reported. Moderate heterogeneity was observed, mainly in suspected cohorts. Conclusions: Vertebral biopsy is a safe and diagnostically valuable procedure in vertebral compression fractures. Its yield ranges from about one in 30 patients in routine settings to nearly one in two in high-risk groups, underscoring the importance of structured patient selection to facilitate timely cancer detection and referral. Full article

Background/Objectives: Metallic surgical implants are commonly used in Orthopaedic surgery. There is a paucity of the literature on patient perspectives and awareness regarding their use. This study aims to investigate patients’ self-perceived awareness, knowledge and concerns toward metallic implant usage in Orthopaedic surgery, in order to provide a tailored and efficient means of pre-operative counselling. Methods: A single-centred, cross-sectional questionnaire-based study was performed in a single tertiary centre in Singapore. Patients between 21 and 75 years who were on follow-up with an Orthopaedic surgeon were recruited from the Orthopaedic specialist outpatient clinic. This questionnaire consisted of three main parts. Firstly, patients were asked to grade their self-perceived knowledge on metallic implants on a Likert scale of 1 to 5. The second part included questions designed to determine the level of knowledge of patients on metallic implants. For the third part, patients were asked to grade how comfortable they were with having metal implants in their bodies on a Likert scale of 0 (Strongly Disagree) to 4 (Strongly Agree). Results: A total of 100 patients were recruited, with 56 males and 44 females. The majority of the patients were Chinese (59%), and 32% had tertiary education. The self-perceived awareness regarding metallic implants was low with a median score of 3 (IQR 1–9) (1—unaware, 10—fully aware). There was no significant difference between younger and older patients (>50 years) or between patients of different educational levels. In total, 17% of the participants stated that they preferred to use non-metallic implants. The most significant concerns were surgical costs (51%), post-operation discomfort (50%) and potential rejection of metallic implants (50%). Conclusions: There is a poor level of self-reported awareness on metallic implants and a lack of knowledge regarding the use of metallic implants in Orthopaedic procedures among patients in our local population. The top concerns regarding the usage of metallic implants were cost, adverse reaction to metal and persistent discomfort. A significant percentage of patients prefer to use non-metallic implant options if available. This highlights the need for tailored pre-operative counselling for the provision of information and to address patients’ concerns accurately. Full article

Background/Objectives: Comparison between the 10-year probability of major osteoporotic fracture (MOF) calculated with FRAX (pFRAX) and the actual MOF rate was conducted, and the availability of pFRAX was evaluated with a one-center cohort study. Methods: Eligible patients were followed up for 10 years. Risk factors listed as items in the FRAX, and presence of lifestyle-related diseases (LS-RDs), escalated ability to fall (Fall-ability), cognitive impairment (CI), etc., were evaluated concerning MOF. The 10-year probability and actual MOF rate were compared. Risk factors contributing to the discrepancy between the probability and the actual rate were evaluated after dividing subgroups. Results: The study included 931 patients. Factors that contributed to the significantly higher ratio for incident MOF besides items in the FRAX were LS-RD, Fall-ability, CI, and anti-osteoporotic drug intervention. The higher the number of factors presented, the higher the actual MOF prevalence compared to the probability rise. Presenting LS-RD, Fall-ability, and CI are independent of the items in the FRAX. pFRAX was overestimated in the low-risk groups and underestimated in the high-risk group compared to the actual MOF rate. These phenomena are caused by the lack of consideration of these three comorbidity risks. Conclusions: A discrepancy between pFRAX and the actual MOF rate exists. LS-RD, Fall-ability, and CI should be listed in the items of the FRAX for more concision. Full article

Background/Objectives: Periprosthetic joint infection (PJI) is a challenging problem in orthopedic surgery and is often associated with high morbidity. The treatment becomes even more challenging whenever the microorganism is virulent and/or not widely known as a causative organism on these occasions. This study aims to report on the clinical outcomes of hip hemiarthroplasty prosthetic hip joint infection by an atypical, rare microorganism, Morganella morganii (M. morganii), focusing on morbidity, revisions, and mortality. Methods: This is a retrospective series of four cases of prosthetic joint infections with Morganella morganii, a rare Gram-negative opportunistic facultative anaerobic pathogen, in four patients who received hip hemiarthroplasty for displaced femoral neck fractures at a level 1 trauma center. Clinical notes, laboratory findings, and radiographs were reviewed to extract relevant information regarding the history and outcomes. Results: The patients were four females, with a mean age of 84.27 years at the time of surgery. Two cases (50%) underwent surgical debridement and implant retention, followed by lifelong antibiotic suppression for symptomatic control of persistent wound drainage, and the other two underwent implant removal and resection arthroplasty (one patient) or received an antibiotic spacer (one patient), followed by chronic antibiotic therapy until wound closure. Conclusions: Periprosthetic hemiarthroplasty infection secondary to M. morganii was associated with overall poor outcomes. Antibiotic suppression could be a reasonable option after the surgical debridement or implant removal in M. morganii PJI to control the symptoms. Full article

Background/Objectives: To prevent potential complications for patients with metal hypersensitivity requiring total knee arthroplasty (TKA), implant coatings have been developed. Thermal nitriding of the titanium surface creates a TiN layer that increases hardness and wear resistance while preventing release of cobalt and chromium ions. The aim of this study was to evaluate the clinical safety and performance of an anatomic implant system comprised of thermally nitrided Ti-6Al-4V. Methods: This is an ongoing prospective, multicenter observational cohort study of primary and revision TKA patients. Patient-reported outcome measures including the Oxford Knee Score (OKS), Knee Society Score (KSS) Expectations subscale, EQ-5D-5L, physical exams, and radiographic assessments to document abnormalities were investigated in 94 patients who provided at least two years of follow-up data. The primary endpoint was improvement in the Oxford Knee Score (OKS), defined as the minimal clinically important difference (MCID, 7.0 points). Results: All outcome measures including patient-reported function (OKS) demonstrated significant improvements (19.4–22.6 points) exceeding the MCID with no between-group differences by bearing types utilized. Health-related quality of life as measured by EQ-5D-5L improved over the cohort and was maintained at 2-years post-operative. In total, three (1.4%) radiographic abnormalities were observed, all of which resolved at two-year follow-up. 12 (5.3%) serious complications were reported, none of which were related to the device. Two revisions have occurred, one due to infection and one due to a fall, in the ultracongruent bearing cohort (survivorship 98.1%, 95%CI 87.4–99.7). Implant survivorship was 100% in all other bearing cohorts. Conclusions: This anatomically designed, thermally nitrided titanium alloy implant demonstrated clinically significant improvements in function, PROMs, and quality of life in patients undergoing TKA regardless of bearing type. Excellent two-year implant survivorship between 98.1% and 100% across cohorts were observed, with no radiographic abnormalities at 2 years. Full article

Background/Objectives: Mechanical, physiological, and biochemical changes contribute to post-traumatic osteoarthritis (PTOA). Specific mouse models that are highly reproducible, less invasive, and easy to use are lacking. This limitation hinders the progress of PTOA-related studies on therapeutic applications. The goal of the study was to establish a methodologically innovative, efficient, and less technically challenging surgical model for PTOA. Methods: We developed a modified medial meniscectomy (MMM) model demonstrating high reproducibility and applicability. The MMM model features distinct differences in the execution of transection of the medial meniscus on the lateral side and includes a smaller incision, which enhances reproducibility and is beneficial for studying pain, structure, and function. Results: One month after the MMM surgery, the mice showed increased sensitivity to pain and decreased biomechanical abilities, such as shorter running times and distances. This was further supported by higher Osteoarthritis Research Society International (OARSI) histology scores, a standardized system for determining the severity and extent of OA in cartilage. Additionally, transcriptomic analysis showed an elevated enrichment of immune activity and bone tissue formation gene sets in the knee joint. Conclusions: Overall, functional studies and transcriptomic analyses suggested that the MMM model can be utilized for future biomechanistic and therapeutic applications and could serve as a new resource for studying PTOA. Full article

Background: The long-term success of total knee arthroplasty (TKA) is often compromised by stress shielding, which can lead to bone resorption and even implant loosening. This study employs finite element analysis (FEA) to compare the stress-shielding effects of a knee prosthesis made from polyether ether ketone (PEEK) with a traditional titanium Ti6Al4V implant on an osteoporotic tibial bone model. Methods: Stress distribution and the stress-shielding factor (SSF) were evaluated at seven critical points in the proximal tibia under physiological loading conditions. Results: Results indicate that the PEEK prosthesis yields a more uniform stress transmission, with von Mises stress levels within the optimal 2–3 MPa range for bone maintenance and consistently negative or near-zero SSF values, implying minimal stress shielding. Conversely, titanium implants exhibited significant stress shielding with high positive SSF values across all points. Additionally, stress concentrations on the polyethylene liner were lower and more evenly distributed in the PEEK model, suggesting reduced wear potential. Conclusions: These findings highlight the biomechanical advantages of PEEK in reducing stress shielding and preserving bone integrity, supporting its potential use to improve implant longevity in TKA. Further experimental and clinical validation are warranted. Full article

Background/Objectives: Knee osteoarthritis is one of the most significant diseases globally and in Portugal. Despite the availability of international guidelines, there is a lack of tailored, evidence-based recommendations specifically for Portuguese physiotherapists to manage their knee osteoarthritis patients with non-pharmacological and non-surgical interventions. This study aimed to develop a clinical practice guideline that integrates the latest international evidence with local clinical practice data to enhance patient outcomes. Methods: To achieve the objective, a comprehensive search was conducted in November 2024 across major health-related databases, to identify robust and recent evidence regarding the efficacy of non-pharmacological and non-surgical interventions, as well as their usage in the national context. Two key sources were identified: An umbrella and a mixed-methods study. Data from both sources were independently reviewed and integrated through a comparative analysis to identify interventions with robust scientific support and high local acceptability. Recommendations were then formulated and categorized into gold (strong), silver (moderate), and bronze (weak) levels based on evidence quality and clinical relevance. A decision-making flowchart was developed to support guideline implementation and clinical usage. Results: The integrated analysis identified three gold-level interventions, namely Nutrition/Weight Loss, Resistance Exercise, and Self-care/Education. Five silver-level recommendations were Aerobic Exercise, Balneology/Spa, Extracorporeal Shockwave Therapy, Electrical Stimulation, and Manual Therapy. Similarly, five bronze-level recommendations comprised Kinesio Taping, Stretching, Ultrasound Therapy, Thermal Agents, and Walking Aids. Conclusions: This clinical practice guideline provides a context-specific, evidence-based framework for Portuguese physiotherapists managing knee osteoarthritis. By bridging international evidence with local clinical practice, the guideline aims to facilitate optimal patient care and inform future research and guideline updates. Full article

Background/Objectives: Overhead athletes, including swimmers, are prone to shoulder adaptations and pathologies, such as scapular dyskinesis (SD) and glenohumeral internal rotation deficit (GIRD). While SD has been extensively studied in various overhead sports, its prevalence and clinical implications in swimmers remain unclear. This study aims to evaluate static scapular asymmetries (SAs), defined as differences in the observed position of the scapulae at rest or in a fixed position, in young elite swimmers and compare these findings with functional scapular dyskinesis (SD) tests, which assess alterations in scapular motion patterns during arm movement. It also assesses potential relationships between SA and SD. Methods: A cohort of 661 young elite swimmers (344 males, 317 females) was assessed during the National Young Swimming Championships. Scapular asymmetries were measured in two positions: at rest and at 90° abduction with internal rotation. The measurements included the following: (1) dHeight: Difference in superomedial scapular angle height from the C7 spinal process; (2) dDistance: Difference in the distance of the superomedial scapular angle from the body midline; (3) dAngle: Angular deviation of the medial scapular border from the plumb line, assessed using a goniometer. The presence of scapular dyskinesis (SD) was determined using a functional test, and SA findings were compared with SD results. Statistical analyses included ANOVA and chi-square tests, with significance set at p < 0.05. Results: Scapular asymmetries were observed in 3.63% to 15.43% of swimmers, with no significant associations with age, gender, BMI, training years, or swimming characteristics (p > 0.05). A significant difference was observed between dominant limb and scapular height in abduction (p < 0.05). In position 1 (resting position), SA was significantly more prevalent in swimmers without SD (p < 0.001 for dHeight, p = 0.016 for dDistance). In position 2 (abduction), SA was significantly associated with SD-negative subjects in dAngle (p = 0.014) and dDistance (p = 0.02), while dHeight was not significant (p > 0.05). These findings suggest that static scapular asymmetries do not necessarily correlate with dynamic scapular dysfunction (SD), and, indeed, a negative correlation was observed where SA was significantly more prevalent in swimmers without SD in several measures (position 1, p < 0.001 for dHeight and p = 0.016 for dDistance; position 2, p = 0.014 for dAngle and p = 0.02 for dDistance). Conclusions: Young elite swimmers exhibit a relatively symmetrical scapular positioning, with scapular asymmetries potentially representing normal adaptations rather than pathological findings. The lack of positive correlation between SA and SD, and the higher prevalence of SA in SD-negative subjects, suggests the need for caution when interpreting static scapular assessments in swimmers as SA may reflect sport-specific adaptations rather than pathology. Full article

Background/Objectives: Congenital clubfoot (CC) is one of the most common congenital deformities of the lower limbs, typically presenting as a complex skeletal malformation. It is frequently associated with other congenital anomalies, although the co-occurrence with agenesis of the toes is rare. This case report describes a unique presentation of congenital clubfoot associated with agenesis of the 4th and 5th toes, focusing on clinical management and reviewing the literature on skeletal malformations linked to CC. Methods: A comprehensive literature review was conducted, focusing on studies published in the last decade regarding congenital clubfoot and its association with other skeletal malformations. A clinical analysis of a patient with congenital clubfoot and digital agenesis was performed, including diagnostic methods, treatment approach, and follow-up results. The patient was treated with the Ponseti method, followed by percutaneous Achilles tendon tenotomy due to insufficient correction. Due to persistent equinus deformity, a second intervention involving Achilles tendon lengthening and syndesmotic capsulotomy was performed. Results: The patient presented with unilateral congenital clubfoot and agenesis of the 4th and 5th toes, a rare combination. Initial correction was achieved with the Ponseti method, but further surgical intervention was needed. Follow-up at 2 years showed excellent results, with the patient able to walk without difficulty. The literature review revealed limited cases involving digital agenesis associated with clubfoot. Conclusions: This case report highlights the rare association between congenital clubfoot and agenesis of the 4th and 5th toes. While satisfactory outcomes were achieved, further studies are needed to explore potential worse outcomes in cases with associated malformations and the genetic factors involved. Full article

Background/Objectives: Complete rupture of the Achilles tendon is a common and challenging injury, specifically for individuals engaged in high-demand activities such as sports. Surgical repair is often required, but conventional methods, including direct suture repair, may fail to address the biological limitations associated with tendon healing, especially in cases involving chronic degeneration or extensive tissue damage. Methods: This case report explains how bioinductive implants, such as the Regeneten collagen-based scaffold, have gained attention as an innovative approach to augment tendon repair. Results: These implants not only provide mechanical stabilization but also promote the regeneration of tendon-like tissue by enhancing the biological healing environment. Conclusions: The use of bioinductive implants, such as the Regeneten scaffold, improves outcomes in tendon repair by augmenting both mechanical stabilization and biological healing. This approach represents a valuable alternative to improve clinical outcomes, particularly in patients with poor prognostic factors. Full article

Background/Objectives: Semiquantitative grading of the vertebral body (SQ) is an easy screening method for vertebral body deformation. The validity of SQ as a risk factor and screening tool for incident osteoporotic fractures in the vertebral body (OF) was investigated using retrospective case-control data. Methods: Outpatients with osteoporosis who were followed up for ≥2 years as patients with osteoporosis were recruited. All of them were tested using X-ray images of the lateral thoracolumbar view and other tests at baseline. Patients were classified according to the SQ grade, and potential risk factors were compared for each SQ group. Cox regression analyses were conducted on the incident OFs. Statistical differences in the possible risk factors among the groups and the likelihood of incident OFs in the variables were examined. After propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) for confounding factors, the possibility of incident OFs was compared between the SQ grade groups. Results: In the crude dataset, the probability of incident OF in SQ Grade 3 was significantly higher than in other grade groups. Using a Cox regression analysis in multivariate mode, SQ grade was the only statistically significant factor for incident OF. However, no significant differences were observed between PSM and IPTW. Conclusions: These results suggest that the SQ classification was inappropriate for predicting incident OFs. However, the grading showed a significantly higher risk than that available for screening. Full article

Background/Objectives: This retrospective study assessed the accuracy of implant positioning with dynamic computer-aided implant surgery (dCAIS) for Toronto Bridge fabrication, using a conometric prosthetic concept and a new intraoral splinting technique (CLIKSS). It compared discrepancies across various anatomical regions, bone qualities, and implant sites. Methods: This study involved 52 patients undergoing full-arch rehabilitation (17 in the mandible, 30 in the maxilla, and 5 in both), with 366 implants placed (125 in the mandible, 241 in the maxilla; 128 in post-extraction sites, and the remainder in healed sites). All implants were immediately loaded. Precision was assessed by measuring linear and three-dimensional (3D) angular deviations between planned and actual implant positions. Results: Measurement errors for apical linear and 3D deviations at the apex and entry point ranged from 0.24 ± 0.10 to 0.55 ± 0.57 mm, and angular deviations varied from 0.32 ± 0.65° to 0.35 ± 0.71°. Maxillary measurements were significantly higher at the entry, apical, and vertical levels, even when comparing anterior and posterior regions with the corresponding mandibular areas, while no differences were found in the angular deviation. Significant discrepancies were observed among different mandibular bone types. Maxillary post-extraction sites exhibited significantly greater deviations than mandibular sites in all parameters except angular deviation. No significant differences were found between healed and post-extraction sites within the same jaw. Conclusions: dCAIS improved implant placement accuracy, leading to predictable prosthetic outcomes, especially during parallel multi-implant insertions. This report introduced dCAIS for conometric/biconometric implant placement combined with the innovative CLIKSS technique as an effective intraoral split method for this prosthesis connection. Full article

Background/Objectives: The achievement of primary stability in low-density bone represents a critical endpoint in clinical practice. The aim of the present investigation was to evaluate the effectiveness of different drilling osteotomy techniques on polyurethane bone substitutes in vitro. Methods: A total of 320 osteotomies have been conducted on 10 pound per cubic feet (PCF) and 20PCF, respectively, with and without cortical layer. The simultaneous and progressive drilling protocol has been conducted at two different rotational speeds considering two different implant profiles (TAC conical vs. NT cylindrical implants). The study variables were insertion torque, removal torque, and resonance frequency analysis (RFA). Results: A significantly higher insertion torque, removal torque, and resonance frequency analysis RFA was detected at low speed with simultaneous drilling protocol (RPM) (p < 0.05). A TAC implant produced an increased implant stability compared to NT implants in all conditions tested (p < 0.05). Conclusions: The conical TAC implant showed higher implant stability in low-density polyurethane, and it is strongly recommended in critical bone quality. Simultaneous drilling osteotomy at low speed could further improve torquing positioning and significantly achieve primary stability in this condition. Full article

Background/Objectives: Ochronosis is an uncommon metabolic condition caused by a deficiency of homogentisate 1,2-dioxygenase, leading to the accumulation of homogentisic acid (HGA) in connective tissues. This deposition of HGA in the joints can result in cartilage degeneration and advanced ochronotic arthritis. Although this condition is usually asymptomatic, it can demonstrate devastating articular destruction characterized by dark pigmentation of the tissues. Methods: A 64-year-old female with a medical history consisting of diabetes mellitus type 2, hypertension, and thoracic aortic aneurysm, with no personal or family history of ochronosis or related symptoms, has been diagnosed with progressive knee osteoarthritis, Kellgren and Lawrence grade III, unresponsive to conservative treatment. Results: The patient underwent staged bilateral, bicompartmental, cemented total knee arthroplasty (TKA), during which several pathological changes were incidentally discovered: black-pigmented, weakened articular cartilage and darkened synovial fluid, as well as brittle metaphyseal bone necessitating increased cement application to ensure prosthetic stability. Postoperative recovery was significant for anemia requiring a blood transfusion. Improved knee function was observed in the first month follow-up visit, and the patient was referred for diagnostic confirmation of her condition. Conclusions: This case underscores the importance of recognizing ochronosis as a potential cause of advanced joint degeneration in patients undergoing arthroplasty. Furthermore, the diagnosis might be of clinical relevance, since this case demonstrated postoperative anemia which required blood transfusion. This, combined with the brittleness of bone, highlights the need for meticulous surgical planning and tailored approaches by the unaware surgeon who might encounter such not-so-pleasant findings. Full article

Background/Objectives: Obliterates such as autologous bone dust (BD) or the synthetic bioactive glass S53P4 (BA) are frequently used for the obliteration of non-critical size defects (NCSDs), especially in otosurgery. Both obliterates have advantages and disadvantages, so that the combination of both for the obliteration of NCSDs is analysed. Methods: As part of a large animal project with sheep, four NCSDs were created in the calotte of thirteen animals using a drill. These were filled with BD, BD and BA, or BA, and the reference defect remained empty. After three weeks, the explanted calottes were examined with regard to their newly formed bone using digital volume tomography, bone density measurement, fluorochrome sequence labelling, and histological analysis. In addition, human cell culture analyses were carried out on the quality of the BD. Results: BD collected at 7.000 and 15.000 rpm shows a higher activity of new bone formation. In combination with BA, bone is formed centripetally and centrifugally. Defect filling with BA and BD shows a higher bone density and compactness than BD alone. Conclusions: BD should be harvested at a speed of less than 15.000 rpm. Using this BD in combination with BA to obliterate NCSDs enables the defect to be obliterated quickly and completely, with more newly formed bone, creating a bone network with incorporated BA. Further studies are needed to investigate the long-term stability of this obliteration and to determine which other parameters of the extraction can increase the amount of vital BD. Full article

Background/Objectives: Osteoporosis is a skeletal disorder characterized by reduced bone mineral density (BMD) and increased fracture risk. Chronic inflammation is implicated in osteoporosis pathogenesis, with inflammatory mediators promoting bone resorption. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are markers of systemic inflammation and have emerged as potential indicators of bone health. This study’s aim was to highlight the potential role of the NLR and PLR as markers of bone health in postmenopausal women affected by osteoporosis or osteopenia and to evaluate the possible influence of autoimmune disease in this context. Methods: This cross-sectional study included 124 postmenopausal women diagnosed with osteopenia or osteoporosis at the Orthopedic Unit of the Policlinico G. Rodolico in Catania, Italy. Demographic, clinical, laboratory, and diagnostic imaging data were collected. The NLR and PLR were calculated from complete blood counts, and BMD was measured using dual-energy X-ray absorptiometry (DEXA). Statistical analyses included correlations, group comparisons, and multiple and logistic regressions. Results: The NLR and PLR did not directly correlate with BMD or fracture incidence. However, the PLR weakly correlated with vitamin D levels. Notably, women without Hashimoto’s thyroiditis exhibited higher NLR values than those with the condition. Hypertensive women had a lower PLR than non-hypertensive women, while euthyroid women had a higher PLR than hyperthyroid or hypothyroid women. Multiple regression analysis revealed that age, BMI, CKD stage, vitamin D levels, NLR, PLR, diabetes, and autoimmune diseases significantly predicted BMD at the femur neck, with the PLR contributing significantly. Logistic regression confirmed these predictors for osteoporosis or osteopenia, with an increased PLR being associated with a higher likelihood of osteoporosis. Conclusions: While the NLR and PLR may not independently predict bone health, their inclusion in a multifactorial assessment considering age, BMI, vitamin D, and comorbidities could enhance osteoporosis management. Full article

This perspective work focuses on the transformative role of robotics in orthopedic surgery, enhancing precision and efficiency. It details the evolution of robotic systems such as ROBODOC, Mako, and Da Vinci, outlining their contributions to procedures such as total knee and hip replacements. It also discusses future trends, including the integration of AI, augmented reality, personalized implants, and the potential for telesurgery. Challenges such as high costs, the learning curve, and regulatory concerns are noted, but the field is poised for significant growth and innovation in orthopedic care. Full article

Background/Objectives: Rotator cuff tears are a prevalent cause of shoulder pain and functional impairment. Full-thickness tears often require surgical intervention, but managing such injuries can be challenging, particularly when complete anatomical repair is unattainable. Bioinductive implants have emerged as an innovative adjunct to enhance tendon healing and regeneration. Methods: This case report details the partial repair of a full-thickness rotator cuff tear in a 66-year-old woman, augmented with a bioinductive implant. Postoperative recovery was monitored through clinical examinations, MRI, and kinematic analysis at 3 and 6 months. Results: The findings suggest that bioinductive implants may offer a promising strategy for managing complex rotator cuff tears, particularly when complete repair is not feasible. The patient reported improvement in function and pain reduction. Conclusions: The use of bioinductive implants showed promising results, promoting tendon regeneration and improving functional outcomes. Future research should explore patient selection criteria and the long-term effectiveness of this strategy. Full article