Search Results (546)

Background/Objectives: The prevalence of joint replacement surgeries has significantly increased over the last century, leading to a corresponding rise in complications, particularly periprosthetic joint infection (PJI). The management of a PJI involves various strategies, including debridement, antibiotic therapy, and staged revision procedures. A notable advancement in treatment is the use of calcium sulfate reabsorbable carriers, recognized for their biocompatibility, osteoconductivity, and localized antibiotic delivery. Recent reports indicate that when combined with conventional treatment regimens, calcium sulfate carriers can achieve infection eradication rates exceeding 90%. This study aims to evaluate the efficacy of calcium sulfate carriers in managing periprosthetic infections, specifically assessing their impact on healing rates in patients undergoing treatment. Study Design & Methods: A retrospective analysis was conducted at our institution, focusing on patients diagnosed with PJIs treated with 2-stage revision surgery with local application of calcium sulfate carriers with antibiotics at both stages, and systemic antibiotic therapy, and comparing results with different surgical procedures. Results: The study included 40 patients (24 males and 16 females), with a mean age of 68.7 (range 48–87) years. The affected joints included the hip (27.5%), shoulder (27.5%), and knee (45%). The findings revealed that 97% of patients achieved infection eradication at the end of the follow-up period. Conclusions: These results highlight the complexities of managing PJIs and the significant role of calcium sulfate carriers in improving outcomes, supporting their use as a standard practice in confirmed PJI cases. Full article

Walking (or gait) speed is recognised as a robust indicator of health status, functional capacity, and physiological reserve across the lifespan; however, its objective measurement remains underused in routine musculoskeletal physiotherapy practice. This commentary argues that gait speed is underutilised in musculoskeletal physiotherapy despite its strong prognostic and functional relevance, and proposes its cautious adoption as a functional vital sign to support more objective, standardised, and interpretable rehabilitation decision making. Evidence from an orthopaedic population undergoing total hip and knee arthroplasty illustrates the persistent gap between surgical success and functional recovery, as reflected in sustained deficits in walking speed relative to healthy benchmarks. Methodological issues in gait speed assessment are considered, and the potential future role of wearable sensors and digital health technologies in capturing real-world locomotor performance is highlighted. Overall, the evidence suggests that gait speed can provide an objective, low-cost, and scalable measure that integrates multiple domains of musculoskeletal function. Therefore, the routine integration of gait speed into physiotherapy assessment may help to quantify functional impairment, support personalised rehabilitation, reduce practice variation, and align musculoskeletal care with contemporary adaptive and digitally enabled healthcare models. Full article

Background and aim: Traditional marker-based optical motion capture systems are costly, time-consuming to operate, and constrained by laboratory environments, limiting their broader adoption in clinical practice and naturalistic settings. Markerless motion capture based on a sums-of-Gaussians (SoG) body model is a potential alternative; however, its metrological properties for kinematic assessment during walking and slow running remain insufficiently validated. Using a conventional marker-based Vicon system as the reference, this study evaluated the reliability and concurrent validity of an SoG-based markerless system (MocapGS) for bilateral lower-limb joint range of motion (ROM) during gait. Methods: Thirty-six healthy adults completed self-selected-pace speed walking and slow running tasks while both systems synchronously acquired bilateral lower-limb kinematics. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), SEM percentage (SEM%), minimal detectable change (MDC), MDC percentage (MDC%), and root mean square error (RMSE) were used to assess reliability. Concurrent validity was evaluated using the Pearson correlation coefficient, paired-sample t-tests, and the concordance correlation coefficient (CCC) to compare the ROM. Results: Vicon showed moderate-to-high reliability for ROM in most joints across both tasks. By contrast, the MocapGS achieved acceptable ICC values mainly for the sagittal-plane ROM at the hip and knee. The CCC analysis showed no significant agreement between the two systems. Bland–Altman plots showed systematic biases with spatially heterogeneous random errors. During walking, MocapGS systematically overestimated ROM relative to Vicon at several joint axes; the widest limits of agreement (LOA) occurred at the left knee X-axis and right hip Z-axis. During running, overestimation was consistent across all bilateral joints at the X-axis and the right hip at the Y-axis, while the widest LOA were found at the bilateral hip X-axes. These specific discrepancies highlighted the joint–axis combinations with the greatest measurement variance. In walking, the test–retest reliability of the knee flexion–extension ROM measured by the MocapGS approached that of Vicon; however, the SEM% and MDC% were generally larger for MocapGS than for Vicon. The RMSE exceeded 5 degrees for ROM in most joint planes, especially in the frontal and transverse planes and at distal joints; errors increased further during slow running. Conclusions: MocapGS may be used for coarse monitoring of large-magnitude changes in sagittal-plane kinematics during gait; however, it is currently unlikely to replace Vicon for clinical decision-making or detecting subtle gait changes, and its outputs should be interpreted with caution, particularly for ankle kinematics and non-sagittal-plane motion. Full article

Background: The use of augmented reality (AR) in orthopaedics is growing rapidly but is mainly limited to pre-operative planning and teaching. This study is one of the first to describe the intraoperative application within revision arthroplasty for the positioning of customised partial pelvic replacements. Methods: In a proof-of-concept study an AR environment was used during surgery in 11 cases to enhance implant positioning. Postoperatively, a voxel-based CT deviation analysis was carried out to determine the COR deviation and the cup plane deviation angle. Additionally, digital implant superimposition was conducted. Results: Implantation was possible in all cases with a mean COR deviation vector of 4.2 (SD 2.5; 1.2–9.3) mm and a cup plane deviation angle of 4.4 (SD 2.5; 0.7–8.1)°. The implant analysis showed a superimposition of 0.69 (SD 0.15; 0.38–0.88) (Dice-Score calculation). Conclusions: This study is able to report promising results for AR in orthopaedic surgery, showing improved intraoperative feedback in complex operations, resulting in increased accuracy. However, the integration of AR poses a new challenge to the surgical team, especially because the AR users are facing a significantly increased level of intraoperative stress. Further development of this auspicious tool, as well as a conceivable combination with navigation, is necessary to facilitate broader usage. Full article

Background/Objectives: Hip hemiarthroplasty (HHA) for femoral neck fractures (FNFs) can be performed via the posterolateral approach (PLA), straight lateral approach (SLA) or direct anterior approach (DAA). However, the optimal approach remains unclear. This study evaluated mortality and return-to-home rates following an institutional transition from SLA to DAA. Methods: This retrospective observational cohort study included patients who underwent primary cemented unipolar hip hemiarthroplasty for FNF during a period of transition in surgical approach (2015–2023). Clinical outcomes between the straight lateral and direct anterior approach were compared. Primary outcomes were the mortality and return-to-home rates. Secondary outcomes included perioperative parameters and complications. A subgroup analysis was performed using Fracture Mobility Score (FMS) and Katz activities of daily living (ADL) index to compare functional outcomes. Results: Over a 9-year period, a total of 762 HHA were performed, of which 411 SLA and 333 DAA. Mortality at 90 days (14.1% vs. 8.7%, p = 0.029) and 1 year (26.5% vs. 17.7%, p = 0.005) were significantly higher in the SLA group. Among patients living at home preoperatively, return-to-home after surgery was lower for SLA compared to DAA (23.2% vs. 41.4%, p < 0.001). In terms of complications, SLA had significantly lower rates of periprosthetic joint infections (SLA n = 6 (1.5%) vs. DAA n = 15 (4.6%), p = 0.024). The decline in Katz ADL score at three months was significantly greater in the SLA group than in the DAA group (ΔKatz ADL −0.73 ± 1.57 vs. −0.11 ± 1.60, p = 0.036). Conclusions: Transitioning from SLA to DAA in HHA was associated with improved preservation of independent living, higher return-to-home rates and lower 90-day and 1-year mortality. However, DAA was also associated with higher rates of PJI. Full article

Impaired bone healing is a major challenge in orthopedic and trauma surgery, often causing long-term disability and high costs. While autologous bone grafting is the gold standard, it is limited by donor site morbidity, low availability, and surgical risks. As an alternative, surgical site-released tissue (SSRT) collected intraoperatively offers a readily available source of regenerative cells and bioactive factors. This study investigates the potential of SSRT-derived mesenchymal stromal cell (MSC)-like cells and their extracellular vesicles (EVs) to support bone healing in a cell-free approach. SSRT samples from 30 patients undergoing elective hip replacement were collected using a surgical vacuum filter. MSC-like cells were isolated and characterized based on International Society for Cellular Therapy (ISCT) criteria. Interestingly, many SSRT-derived MSC-like cells expressed CD34, a marker typically absent in cultured MSCs but linked to tissue-resident stromal cells, suggesting distinct regenerative properties. These cells also showed slow proliferation rates (P1: 8.7 ± 3.2 days; P2: 8.2 ± 5.4 days). EVs were isolated from osteogenically stimulated (EVs^MSC/O+) and unstimulated (EVs^MSC/O−) MSCs over three weeks. Antibody profiling revealed distinct cargo compositions, with a notable enrichment of CD13+ EVs in the stimulated group. Further in vivo and functional studies are needed to clarify underlying mechanisms and confirm therapeutic efficacy. Full article

Background: Few studies have examined changes in diet quality into old age, and related these changes to musculoskeletal outcomes. We examined this among Hertfordshire Cohort Study participants. Methods: In total, 178 individuals provided diet quality scores derived in 1998–2004, 2011 and 2017 (median age 64.0, 74.7 and 80.7) using principal component analysis of food frequency questionnaires; higher scores indicated healthier diets (more fruit and vegetables, oily fish and wholemeal bread, and less white bread, added sugar, full-fat dairy products, chips and processed meat). Pearson correlations between diet quality scores at each time-point were computed. Group-based trajectory modelling of diet quality scores was implemented; trajectory groups as predictors of musculoskeletal outcomes (history of hip/knee replacement, osteoporosis, fall in previous year, low grip strength, low gait speed) in 2017 were examined using logistic regression with age and sex included as covariates. Results: Diet quality showed moderate stability over time (0.64 < r < 0.74). Three trajectory groups were identified: low (29%), medium (51%), and high diet quality (20%). A higher diet quality group was related to greater odds (95% CI) of hip/knee replacement (1.85 (1.05, 3.26) per higher category); associations with other musculoskeletal outcomes were weak (p > 0.17). Conclusions: Weak associations were observed between diet quality trajectories and musculoskeletal outcomes. However, higher diet quality was related to increased likelihood of hip/knee joint replacement, potentially due to confounding by socioeconomic position. The stability of diet quality suggests individuals with poorer diets around age 65 are likely to maintain these patterns into old age and may benefit from targeted interventions. Full article

Lumbar shear forces are increasingly recognized as critical contributors to lower-back injury risk, yet most ergonomic assessment tools—most notably the Revised NIOSH Lifting Equation (RNLE)—do not directly estimate shear loading. This study develops and evaluates a family of linear mixed-effects regression models that statistically predict L4/L5 lumbar shear force exposure using traditional NIOSH lifting parameters combined with posture descriptors extracted from digital human models. A harmonized dataset of 106 peak-shear lifting postures was compiled from five controlled laboratory studies, with lumbar shear forces obtained from validated biomechanical simulations implemented in the Siemens JACK (Siemens software, Plano, TX, USA) platform. Twelve model formulations were examined, varying in fixed-effect structure and hierarchical random effects, to quantify how load magnitude, hand location, sex, and joint posture relate to simulated task-level anterior–posterior shear exposure at the lumbar spine. Across all models, load magnitude and horizontal reach emerged as the strongest and most stable predictors of shear exposure, reflecting their direct mechanical influence on anterior spinal loading. Hip and knee flexion provided substantial additional explanatory power, highlighting the role of whole-body posture strategy in modulating shear demand. Upper-limb posture and coupling quality exhibited minimal or inconsistent effects once load geometry and lower-body posture were accounted for. Random-effects analyses demonstrated that meaningful variability arises from individual movement strategies and task conditions, underscoring the necessity of mixed-effects modeling for representing hierarchical structure in lifting data. Parsimonious models incorporating subject-level random intercepts produced the most stable and interpretable coefficients while maintaining strong goodness-of-fit. Overall, the findings extend the NIOSH framework by identifying posture-dependent determinants of lumbar shear exposure and by demonstrating that simulated shear loading can be reliably predicted using ergonomically accessible task descriptors. The proposed models are intended as statistical predictors of task-level shear exposure that complement—rather than replace—comprehensive biomechanical simulations. This work provides a quantitative foundation for integrating shear-aware metrics into ergonomic risk assessment practices, supporting posture-informed screening of manual material-handling tasks in field and sensor-based applications. Full article

Background: The relationship between comorbidity burden, as measured by the American Society of Anesthesiologists (ASA) classification, and functional recovery after total hip replacement (THR) remains uncertain. This study aimed to clarify whether ASA grade independently predicts postoperative patient-reported outcomes. Methods: We conducted a retrospective analysis of 218 consecutive patients from a prospectively maintained institutional registry who underwent primary unilateral THR between March 2021 and March 2024 in a single center. Patients were stratified into ASA 1–2 and ASA 3 groups. The Oxford Hip Score (OHS, 0–48) was collected preoperatively and at 1 week, 3 months, and 6 months postoperatively. Between-group differences were assessed, and multivariable linear regression was used to identify predictors of 6-month OHS. Results: Compared with ASA 1–2 patients, ASA 3 patients had lower preoperative OHS and longer hospital stay, but both groups showed substantial improvement over time and achieved excellent mean OHS at 6 months. In the adjusted model, higher ASA grade remained an independent negative predictor of 6-month OHS, whereas higher preoperative OHS and BMI were positive predictors. Conclusions: Despite presenting with worse baseline function and requiring longer hospitalization, ASA 3 patients experienced clinically meaningful recovery and achieved favorable 6-month outcomes after THR. Higher ASA status should therefore inform perioperative optimization rather than preclude surgery. Full article

Purpose: Revision total hip arthroplasty (RTHA) in the presence of a well-fixed femoral stem is associated with increased risk, as stem removal often results in bone loss, prolonged operative time, and greater blood loss. This problem is particularly relevant for older implants with a 14/16 taper, which is incompatible with most modern femoral heads. The Bioball™ System, a modular head–neck adapter, allows for acetabular or head-only revision while preserving the femoral stem. This study aimed to evaluate long-term clinical and radiological outcomes of RTHA using the Bioball™ System in patients with 14/16 tapers. Methods: A total of 38 patients (23 women, 15 men; mean age 73.5 years) met the inclusion criteria. All procedures were carried out with a well-fixed femoral stem and a 14/16 taper. Revisions were limited to exchange of the acetabular component, liner, or both, avoiding stem removal. The primary indication was acetabular cup loosening (n = 29, 76.3%); liner-only exchange was performed in 9 patients (23.7%). Clinical outcomes were assessed using the modified Merle d’Aubigné and Postel (MAP) score, and radiological evaluation focused on fixation, migration, and loosening. Mean follow-up was 8.44 years. Results: Both the acetabular component and liner were replaced in 76.3% of patients, while 23.7% underwent liner and head exchange only. Longer adapter sizes were most frequently used, and a 7.5° offset adapter was applied in 57.9% of cases. The modified MAP score improved by a mean of 5.7 points (p < 0.05), and VAS pain scores decreased from 7.4 to 2.6 (p < 0.05). No radiological signs of loosening were observed at final follow-up. Conclusions: The Bioball™ System enables effective restoration of hip stability and offset without femoral stem removal, offering favorable long-term clinical and radiological outcomes in revisions involving older 14/16 tapers. Full article

Background and Objectives: Short femoral stems are increasingly used in total hip arthroplasty (THA), yet evidence regarding their performance in elderly femoral neck fracture (FNF) patients is limited. In this study, we compared clinical and radiographic outcomes of the use of a short femoral stem (SFS) versus a conventional standard stem (CSS) in cementless THA. Materials and Methods: This prospective, single-center case–control study (1:2) included patients ≥ 65 years of age with displaced FNF (Garden 3–4) treated with cementless THA. Follow-up lasted a minimum of 2 years. Clinical evaluations included the Harris Hip Score (HHS), Roles and Maudsley satisfaction score, and thigh pain assessment. Radiographic evaluations assessed cup position, osseointegration (Moore signs), radiolucencies (DeLee–Charnley and Gruen zones), subsidence, leg length discrepancy (LLD), and heterotopic ossification. Results: A total of 114 patients were analyzed (38 with SFS versus 76 with CSS). The final follow-up HHS was 87 ± 2.7 (SFS) and 88 ± 2.5 (CSS) (p = 0.231), and satisfaction was excellent in nearly all patients in both groups. Thigh pain was rare and resolved by final follow-up in all SFS patients, and no radiographic loosening was observed. Early subsidence (≤3 mm) occurred in two SFSs and three CSSs without progression, while LLD < 1 cm was present in three SFS and eight CSS cases. No implant-related revisions occurred, and complication rates were low and comparable. Conclusions: Short femoral stems provided clinical and radiographic outcomes equivalent to those of conventional stems in elderly FNF patients treated with cementless THA. Short stems appear to be a safe and effective option in this population, and further studies with longer follow-up are needed to confirm their durability. Full article

Background/Objectives: To analyze the financial impact of the ERAS program in two major surgical procedures (colon resection for cancer and hip replacement) in two second-level healthcare centers. Methods: A cost–benefit analysis was carried out on four hypothetical scenarios, based on the rate of compliance with the ERAS program, focusing on the additional costs and the additional benefits deriving from the decrease in hospital stay caused by the application of the ERAS protocol, with particular regard to the interventions envisaged by the National Waiting List Management Plan (PNGLA). Results: In the most optimistic scenario, with a coefficient of application of ERAS of 100% and a number of 800 days of hospitalization gained per year, the revenue–cost ratio was equal to 2.92. In the least favorable scenario, with a coefficient of application of ERAS of 50% and a number of 400 days of hospitalization gained per year, the revenue–cost ratio was equal to 1.11. Conclusions: In all the scenarios, the revenue–cost ratio was higher than 1. Implementation of the ERAS program is feasible also in second-level centers with the costs for additional healthcare professionals. Application of the ERAS program leads to a more sustainable health policy with an improvement in the number of treated patients per year and an advantage in the waiting list. Full article

Background: Total hip arthroplasty (THA) is a well-tolerated and effective procedure that can improve a patient’s mobility and quality of life. A main concern, however, is the release of metal ions into the body due to wear and corrosion. Commonly reported ions are Co and Cr, while others, such as Ti, Mo, and Ni, are less frequently studied. The objective of this study was to characterize compartmentalization and time-dependent ion behaviors across serum, whole blood, and urine after hip prosthetic implantation. The goal of using Random Forest (RF) was to determine whether machine learning modeling could support temporal trends across data. Methods: Data was gathered from the literature of clinical studies, and we conducted a pooled analysis of the temporal kinetics from cohorts of patients who received hip prosthetics. Mean ion concentrations were normalized to µg/L across each fluid and weighted by cohort sample size. RF was used as a study-level test of predictive accuracy across ions. Results: For serum and whole blood, Co and Cr displayed one-phase association models, while Ti showed an exponential rise and decay. Ions typically rose quickly within the first 24 months postoperatively. Serum Co and whole blood had similar patterns, tapering off just under 2 µg/L, but serum Cr (~2.02 µg/L) was generally higher than that of whole blood (~0.99 µg/L). Mean urinary Co levels were greater than those of Cr, suggesting a larger, freely filterable fraction for Co. RF was implemented to determine predictive accuracy for each ion, showing a stronger fit for Co (R² = 0.86, RMSE = 0.57) compared to Cr (R² = 0.52, RMSE = 0.50). Conclusions: Sub-threshold exposure was prevalent across cohorts. Serum and whole blood Co and Cr displayed distinct kinetic profiles and, if validated, could support fluid-specific monitoring strategies. We present a methodology for interpreting ion kinetics and show potential for machine learning applications in postoperative monitoring. Full article

Walking ability is crucial for maintaining independence and healthy aging. Although joint angle measurement is important for detailed gait assessment, it is rarely performed in clinical practice due to the complexity of motion capture systems. This study investigates individual variability and cross-population generalizability of deep learning-based joint angle estimation from a single inertial measurement unit (IMU) attached to the pelvis. Gait data from three distinct populations were collected: 17 young adults, 20 healthy older adults (aged 65+), and 14 pre-operative patients scheduled for hip replacement surgery due to hip osteoarthritis (also aged 65+). A 1D ResNet-based convolutional neural network was trained to estimate bilateral hip, knee, and ankle joint angles from IMU signals. We systematically compared within-population training (trained and tested on the same population) with cross-population training (trained on combined data from all populations) using nested 5-fold cross-validation. Cross-population training showed population-specific effectiveness: older adults demonstrated consistent improvement, while young adults showed minimal change due to already high baseline performance, and pre-operative patients exhibited highly variable responses. These findings suggest that the effectiveness of cross-population learning depends on within-population gait heterogeneity, with important implications for developing clinically applicable gait analysis systems across diverse patient populations. Full article

Introduction: Total hip replacements and total knee replacements are among the most frequently performed operations worldwide, and the demand for such procedures is ever-growing. It is essential to focus on preventable medical complications that can arise from these procedures, specifically postoperative hyponatraemia. Postoperative hyponatraemia has an incidence of 20–40% in total hip and knee replacement patient cohorts. Even mild postoperative hyponatraemia is clinically relevant, as it is associated with cognitive impairment and gait disturbance and may undermine the aims of enhanced recovery protocols. Severe postoperative hyponatraemia can lead to seizures, coma, intensive care admission, and death. Although uncommon, the high volume of patients treated in busy orthopaedic centres means such cases will inevitably be encountered. This narrative review summarises the current evidence on incidence, risk factors and consequences of postoperative hyponatraemia in total hip and knee replacement populations. Methods: A literature review was performed through the EBSCO and PubMed databases to identify relevant studies. Key search terms included were “hyponatraemia”, “total hip replacement”, and “total knee replacement”. Results: The incidence of postoperative hyponatraemia is largely between 20% and 40%; however, there are some outliers to this. Multiple risk factors have been identified through observational studies, including age, preoperative hyponatraemia, female sex and certain medications, which signal a need for a risk stratification strategy that can assist in preoperative assessment and the early identification of patients at higher risk of developing postoperative hyponatraemia. Evidence is scarce regarding interventional studies for the prevention and management of postoperative hyponatraemia, despite multiple studies highlighting the issue. Conclusion: Future work should focus on testable, quality improvement interventions, such as automatic sodium checks on postoperative day one, weight-based oral fluid protocols, oral salt supplementation, and escalation pathways for high-risk patients. Incorporating these into enhanced recovery frameworks has the potential not only to optimise safe early discharge for the majority but also to prevent rare but significant complications. Full article