Search Results (546)

Background: High tibial osteotomy (HTO) is an established joint-preserving treatment for medial knee osteoarthritis, but total knee arthroplasty (TKA) may be required if the disease progresses. This pilot study evaluates the radiological and functional outcomes of simultaneous limb axis correction using reverse HTO (rHTO) during TKA compared to a primary TKA control group without previous HTO. Methods: In this retrospective matched-pair study, nine patients with previous valgus HTO underwent varus correction via rHTO combined with TKA using cruciate-retaining implants. Outcomes were compared to a primary TKA control group. Radiographic parameters (MPTA, mLDFA, aHKA, JLO) and clinical scores (Oxford Knee Score, LEFS, KOOS, TAS, FIPS) were assessed pre- and postoperatively. Statistical significance was set at p < 0.05. Results: Preoperative alignment differed significantly between groups (MPTA, aHKA, JLO; all p ≤ 0.001). Postoperatively, both cohorts achieved neutral mechanical alignment showing no statistically significant differences in descriptive parameters. CPAK classification showed convergence to neutral alignment types. Functionally, mean postoperative clinical scores, including KOOS subdomains, LEFS, and Oxford Knee Score, were numerically close between groups, though confidence intervals were wide due to the limited sample size (all p > 0.05). Conclusions: This pilot study demonstrates the technical feasibility of single-stage rHTO and TKA, showing encouraging descriptive clinical and radiographic profiles in this small, highly specific cohort. Given the exploratory nature of this study, larger trials are required to definitively evaluate potential clinical differences. Full article

Osteoarthritis (OA) is a chronic degenerative joint disease characterized by persistent low-grade inflammation and progressive cartilage destruction. Macrophage-driven inflammatory responses contribute to extracellular matrix (ECM) degradation and accelerate disease progression. Here, we investigated the therapeutic potential of a DHA-derived lipid mediator mixture (LM), generated via soybean lipoxygenase and composed of 17S-hydroxydocosahexaenoic acid, resolvin D5, and protectin DX (3:47:50), in regulating macrophage–chondrocyte crosstalk and OA progression. LM significantly reduced IL-6, IL-1β, and TNF-α production in lipopolysaccharide-induced THP-1 macrophages. Conditioned medium from LM-treated macrophages attenuated ECM degradation in primary chondrocytes by suppressing MMP13 and ADAMTS5 while restoring COL2A1 and ACAN expression, indicating that LM may indirectly protects ECM by modulating the inflammatory microenvironment. In parallel, LM directly protected chondrocytes against IL-1β-induced inflammatory and catabolic responses, and restored ECM homeostasis. Mechanistically, LM significantly increased SIRT1 expression and deacetylation activity, as demonstrated by reduced NF-κB p65 acetylation. Both pharmacological inhibition by EX527 and siRNA-mediated SIRT1 knockdown abolished the protective effects of LM on ECM preservation. In vivo, LM oral administration alleviated cartilage destruction, improved joint structure and suppressed OA progression in a monosodium iodoacetate-induced OA model. Notably, micro-CT studies have demonstrated that LM significantly improved subchondral bone architecture, as evidenced by increased bone volume fraction and improved trabecular parameters. Histological analyses confirmed that LM attenuated inflammation and maintained cartilage integrity. Consistently, immunohistochemical findings showed reduced MMP13 expression, restoration of collagen II and aggrecan, and upregulation of SIRT1 in the LM-treated group compared to OA rats. Collectively, these findings suggest that LM mitigates OA progression by reducing inflammation, preserving ECM homeostasis, and attenuating subchondral bone deterioration. Full article

Background and Objectives: With contemporary blood management strategies substantially reducing transfusion rates after total knee arthroplasty (TKA), conventional endpoints such as transfusion incidence and estimated blood loss may have limited sensitivity for evaluating adjunctive hemostatic interventions. As postoperative anemia evolves dynamically over time, hemoglobin kinetics and cumulative anemia burden may offer more informative measures of treatment effect. This study evaluated whether implementation of a topical thrombin–carboxymethyl starch hemostatic agent within a standardized modern blood management protocol was associated with smaller early postoperative hemoglobin decline and lower cumulative anemia burden after TKA. Materials and Methods: In this single-center, retrospective, pre–post observational study, consecutive patients aged 50 years or older undergoing primary unilateral TKA for osteoarthritis before and after implementation of a thrombin–carboxymethyl starch topical hemostatic agent were compared. Perioperative management was otherwise standardized and unchanged. Patients were matched 1:1 using propensity scores derived from eight prespecified covariates. Co-primary endpoints were hemoglobin change from baseline to postoperative day 1 and day 2, and cumulative anemia burden quantified by the area under the hemoglobin-deficit curve from POD 0 to POD 13 was assessed as a key secondary endpoint. Results: Of 564 patients assessed for eligibility, 328 met the inclusion criteria, and 70 propensity score-matched pairs were included in the final analysis. Unless otherwise specified, the outcomes reported below were analyzed in these 70 matched pairs. In the matched cohort, the intervention group had a lesser hemoglobin decrease at postoperative day (POD) 1 than the control group (2.12 ± 0.97 vs. 2.42 ± 0.98 g/dL), corresponding to a paired mean difference of 0.30 g/dL (95% CI, 0.08–0.52; p = 0.008). The between-group difference at POD 2 was not statistically significant (paired mean difference, 0.15 g/dL; 95% CI, −0.03 to 0.33; p = 0.10). The area under the hemoglobin-deficit curve from POD 0 to POD 13 was lower in the intervention group (18.6 ± 5.2 vs. 21.3 ± 5.6 g/dL × day), with a paired mean difference of 2.7 g/dL × day (95% CI, 0.9–4.5; p = 0.004). Estimated total blood loss, formula-derived hidden blood loss, and transfusion rates did not differ significantly between groups. Conclusions: Use of a thrombin–carboxymethyl starch topical hemostatic agent was associated with modest attenuation of early postoperative hemoglobin decline and lower cumulative anemia burden after TKA, without significant differences in estimated blood loss or transfusion occurrence. Hemoglobin kinetics and cumulative anemia burden may provide complementary outcome measures in contemporary low-transfusion practice, although these findings should be interpreted cautiously given the observational design and low transfusion event rate. Full article

Background: Robot-assisted total knee arthroplasty (raTKA) improves the precision of component positioning and coronal alignment restoration, but it remains uncertain whether that technical accuracy modifies the clinical effect of alignment strategy in different varus phenotypes. The present report evaluates alignment strategy and correction magnitude, explicitly as a post hoc exploratory deformity-subgroup analysis within a randomized raTKA cohort. Methods: This single-center, open-label, randomized study enrolled 296 patients with varus knee osteoarthritis who underwent raTKA between 2023 and 2025 using either mechanical alignment (MA; n = 149) or limited/restricted kinematic alignment (lim.-KA; n = 147). The parent randomized comparison was conducted at the whole-cohort level; the deformity-based subgroups reported here were defined after the whole-cohort analysis and are therefore post hoc and exploratory. Patients were stratified according to preoperative varus severity into a mild-deformity subgroup (≤10°; lim.-KA-I n = 99, MA-I n = 102) and a moderate-deformity subgroup (11–20°; lim.-KA-II n = 48, MA-II n = 47). Outcomes included hip–knee–ankle angle (HKA), correction angle, range of motion (ROM), visual analog scale (VAS; 0–10 points), Knee Society Score (KSS; knee and function), Oxford Knee Score (OKS), and Forgotten Joint Score-12 (FJS-12) over 12 months. Estimates are presented with 95% confidence intervals where applicable. Because multiple post hoc subgroup comparisons were performed without formal multiplicity adjustment, p-values are interpreted descriptively and in conjunction with effect sizes and 95% confidence intervals. Results: The primary whole-cohort randomized comparison did not demonstrate an overall between-group advantage of either alignment strategy. The post hoc moderate-varus subgroup showed favorable unadjusted 12-month differences for lim.-KA versus MA in KSS-knee (+6.8 points; 95% CI 5.3 to 8.3; nominal p < 0.001), KSS-function (+4.0 points; 95% CI 2.7 to 5.2; nominal p < 0.001), OKS (+6.4 points; 95% CI 4.5 to 8.3; nominal p < 0.001), and FJS-12 (+11.3 points; 95% CI 9.4 to 13.1; nominal p < 0.001). In contrast, ROM favored MA rather than lim.-KA in the moderate-varus subgroup (−11.8°; 95% CI −16.6 to −7.0; nominal p < 0.001), indicating greater 12-month ROM after MA, and VAS pain, reported on a 0–10 scale, did not support a lim.-KA pain advantage (+0.26 points; 95% CI 0.05 to 0.48; higher scores indicate worse pain; nominal p = 0.018). Exploratory, unadjusted, post hoc 12-month alignment-by-deformity interaction terms were significant for ROM, KSS-knee, KSS-function, OKS, and FJS-12, but not for VAS. Because multiple post hoc comparisons were performed without formal multiplicity adjustment, the results are interpreted descriptively, along with effect sizes and confidence intervals. Conclusions: The primary randomized comparison did not demonstrate a clinical advantage of lim.-KA over MA in the whole cohort. In post hoc exploratory analyses, mild varus deformity was associated with outcomes broadly similar to those after both alignment strategies. In the moderate-varus subgroup, patient-level analyses suggested a possible phenotype-dependent signal for KSS-knee, KSS-function, OKS, and FJS-12 after lim.-KA, whereas ROM favored MA, and VAS pain did not support a lim.-KA pain advantage. These subgroup findings should be interpreted separately from the primary randomized result, considered hypothesis-generating only, and not used in isolation to change clinical practice without prospective confirmation. Full article

This paper presents a comprehensive augmented reality (AR)-based rehabilitation system for upper-limb recovery that integrates AR-assisted art therapy, automated markerless goniometry, and the interval mathematical modeling of rehabilitation dynamics. The proposed platform combines four interconnected subsystems: a Python-based markerless video analysis module utilizing three stationary IP cameras, MediaPipe Pose Landmarker, and Kalman filtering; an AR art-therapy application developed for the Magic Leap 2 headset using Unity/OpenXR; a server-side subsystem implemented in NestJS/TypeScript; and a physiotherapist-oriented web application developed in React. The primary objective of the study is the real-time automated assessment of shoulder joint kinematics during AR-assisted rehabilitation sessions, including flexion (160–180°), extension (50–60°), and abduction (up to 180°). To describe and forecast rehabilitation dynamics, interval mathematical models based on recurrent difference equations were developed, enabling the prediction of subsequent joint angle values using the previous 3–4 observations. Structural and parametric identification of the interval models was performed using the artificial bee colony optimization algorithm. Experimental validation was conducted on rehabilitation data collected from five patients with different clinical diagnoses, including bursitis, epicondylitis, capsulitis, osteoarthritis, and fracture-related impairments. Under the considered experimental conditions, the proposed approach demonstrated promising predictive performance, with an angular prediction error below 5° and a correlation exceeding 95% between predicted and measured rehabilitation trajectories. The developed system implements a unified rehabilitation cycle of “execution–measurement–prediction–adaptation”, enabling the continuous monitoring of recovery dynamics, adaptive adjustment of rehabilitation scenarios, and estimation of the rehabilitation duration required to achieve target motor outcomes. The proposed approach contributes to the development of intelligent AR-based rehabilitation systems by combining markerless motion analysis, predictive interval modeling, and adaptive art-therapy mechanisms within a single clinical framework. Full article

Osteoarthritis is a chronic degenerative joint disease characterized by inflammation and cartilage degradation, for which current treatments are mainly symptomatic and unable to halt disease progression. Adipose-derived mesenchymal stem cells (ASCs) represent a promising therapeutic option due to their regenerative and immunomodulatory properties, which may be further enhanced through specific priming strategies. In this study, primary human ASCs were exposed to interleukin-1 beta (IL1β), interferon-gamma (IFNγ), or hypoxic priming, and subsequently analyzed using a multi-omics approach integrating RNA sequencing, proteomics of secretome, and exosomal miRNA profiling. Differential gene expression, protein abundance, and miRNA signatures were assessed together with functional enrichment and network analyses. IL1β priming induced marked transcriptional reprogramming of ASCs, while hypoxia and IFNγ priming produced limited changes. IL1β also profoundly reshaped the ASC secretome and exosomal miRNA cargo, revealing coordinated regulation of pathways involved in immune modulation and cartilage remodeling. In contrast, the other priming conditions showed minimal and less integrated molecular effects. Overall, IL1β priming consistently generated a multi-layered molecular signature linking immunoregulatory and regenerative pathways. These findings suggest that IL1β priming enhances the functional properties of ASCs and provides mechanistic insight supporting their potential use in osteoarthritis therapy. Full article

Background: Total knee arthroplasty (TKA) is widely used to treat advanced knee osteoarthritis, yet the optimal timing for initiating postoperative rehabilitation remains unclear, particularly regarding its impact on short- and long-term functional outcomes. Objective: This study aimed to systematically review and compare earlier versus later initiation of structured postoperative rehabilitation following primary TKA according to the timing definitions used in the available literature of structured postoperative rehabilitation after primary TKA and its effects on functional recovery. Methods: Electronic searches were performed in PubMed, Scopus, Web of Science, and ScienceDirect between January and February 2025. Studies were limited to human participants, published in English or Spanish from 2010 onwards. Eligible studies compared early versus delayed rehabilitation following primary TKA and reported at least one predefined outcome related to pain, patient-reported functional measures, range of motion, muscle strength, performance-based functional tests, or hospital length of stay. Study selection was performed independently by two reviewers, and methodological quality was assessed using the Joanna Briggs Institute critical appraisal tools. Results: A total of 662 records were identified, of which five studies (three randomized controlled trials, one prospective observational study, and one retrospective cohort study), including 185 participants, met the inclusion criteria. Early rehabilitation (typically initiated within the first postoperative hours to days) was associated with reductions in hospital length of stay ranging from approximately 1 to 2 days, lower early postoperative pain scores, greater short-term knee flexion gains, and improved early muscle strength compared with delayed rehabilitation protocols. However, no consistent differences were observed in medium- and long-term patient-reported functional outcomes across studies. No increase in postoperative complications was reported. Conclusions: Early initiation of rehabilitation after TKA appears safe and may enhance short-term recovery outcomes. However, no consistent long-term functional differences were observed between earlier and later rehabilitation initiation across the included studies. Further high-quality research with standardized definitions and long-term follow-up is required. Full article

Background: A previous short-term retrospective analysis from our center suggested early improvement in pain, function, and sleep outcomes after fixed-dose tramadol/paracetamol therapy in patients with early-stage symptomatic knee osteoarthritis (KOA). However, the durability of these outcomes beyond the initial treatment phase remains insufficiently described in routine clinical practice. Objective: To describe short- and mid-term patient-reported outcomes and safety during extended follow-up in adults with symptomatic KOA treated with fixed-dose tramadol/paracetamol in routine outpatient care. Methods: This single-center retrospective observational extension study analyzed a fixed cohort of 30 adults with symptomatic knee osteoarthritis and Kellgren–Lawrence grade I–II treated with fixed-dose tramadol/paracetamol in routine outpatient care. Patients were evaluated at baseline (T0), 15 days (D15), 3 months (M3), and 6 months (M6), where evaluable follow-up data were available. The primary outcome was change in pain intensity measured by the Numeric Rating Scale (NRS). Secondary outcomes included WOMAC total and subscale scores, Pittsburgh Sleep Quality Index (PSQI) score, adverse events, and treatment discontinuation. Results: Patients had a mean age of 64.8 ± 9.6 years and a mean BMI of 27.3 ± 5.0 kg/m². NRS pain improved from a median of 6.0 (5.0–7.0) at baseline to 4.0 (2.0–5.3) at D15 and 3.0 (2.0–5.0) at both M3 and M6. WOMAC total score improved from 47.8 ± 12.8 at baseline to 35.6 ± 13.8 at D15, 33.8 ± 13.6 at M3, and 33.9 ± 13.5 at M6. Sleep score improved from 9.5 (7.0–15.0) at baseline to 7.0 (5.0–9.0) at D15 and remained improved at M3 and M6. Mild adverse events were reported in 10.0% of patients, and discontinuation occurred in 6.7%. Conclusions: In this small, uncontrolled, single-center retrospective cohort of adults with early-stage symptomatic KOA, fixed-dose tramadol/paracetamol was associated with early improvement in pain, WOMAC outcomes, and sleep, with group-level benefits remaining evident through 6 months. These findings should be considered exploratory and hypothesis-generating rather than comparative evidence of effectiveness. Larger controlled studies are needed to confirm durability, comparative benefit, and long-term safety. Full article

Objective: This study aimed to evaluate the effects of 12 weeks of Astragalus membranaceus saponins (AMS) supplementation on functional performance, knee joint mobility, self-reported outcomes, and biomarkers of inflammation and cartilage in healthy subjects with knee discomfort. Methods: A randomized, double-blind, placebo-controlled trial was conducted in healthy subjects aged 20–70 years with knee discomfort but without clinically diagnosed knee osteoarthritis. Participants were assigned to receive one capsule of AMS or a placebo once daily for 12 weeks. The pre-specified primary endpoints were the SLSD step count and knee ROM; KOOS total score was a key secondary endpoint; serum biomarkers were exploratory. The results included functional performance assessed by the Single Leg Step Down (SLSD) test, knee range of motion (ROM), and self-reported outcomes using the Knee injury and Osteoarthritis Outcome Score (KOOS). Knee ROM was measured with a goniometer and recorded as both active ROM and passive ROM for knee flexion and extension. Serum biomarkers of inflammation (IL-8, IL-1β, MIP-1α), cartilage degradation (CTX-II, COMP, MMP-13, COL2A1), and cartilage synthesis (PIINP) were evaluated at baseline and Week 12. Results: Within the AMS group, SLSD step count increased significantly by 16.83% (Δ = +12.78 steps; p < 0.05) and recovery time decreased significantly by 19.12% (Δ = −108.91 s; p < 0.05) compared with baseline, whereas the placebo group showed smaller, non-significant changes (+4.48 steps and −56.48 s, respectively); however, neither between-group difference in change scores reached statistical significance. Significant improvements in active and passive knee ROM were observed in both flexion and extension (all p < 0.05) within the AMS group, whereas the placebo group showed no significant changes. KOOSs improved significantly in all domains within the AMS group, with the largest gains observed in sport/recreation (+22.23%) and quality of life (+18.38%). In the exploratory biomarker analysis, several inflammation and cartilage-related biomarkers changed after AMS supplementation showed within-group reductions (IL-8, COMP, MMP-13) and PIINP increased. Conclusions: 12 weeks of AMS supplementation was associated with improvements in selected functional, mobility, and outcomes in generally healthy adults with self-reported knee discomfort. AMS was also associated with changes in selected circulating biomarkers related to inflammation and cartilage metabolism. These findings should be interpreted as a preliminary, safe, complementary strategy to support joint health in healthy subjects with knee discomfort. Full article

Background: Arthropathies are a substantial source of global morbidity and healthcare costs, and there is a clinical need for accessible tools capable of detecting inflammatory and metabolic changes beyond conventional structural imaging. This review consolidates the recent evidence on infrared thermography (IRT) as a diagnostic and monitoring adjunct in the major arthropathies. Methods: A structured narrative review was conducted. A literature search of PubMed, Web of Science Core Collection, and Scopus was performed to identify relevant studies published between January 2016 and December 2025 using thermography- and arthropathy-related keywords and controlled-vocabulary terms combined with Boolean operators; only original full-text studies in English published within the previous decade were eligible. The structured search yielded 53 primary studies. Additional sources, including narrative and systematic reviews, methodological references, and book chapters, were drawn upon to inform the Introduction, Discussion, and interpretation but were not included in the primary evidence synthesis. Results: Across the included studies, IRT detected clinically meaningful thermal changes in most cases of osteoarthritis, rheumatoid arthritis, juvenile idiopathic arthritis, Charcot neuroarthropathy, and post-arthroplasty states, with thermal signals correlating moderately with ultrasound-detected synovitis, inflammatory biomarkers, and symptom distribution. Discussion: The evidence base is heterogeneous, however: temperature distributions overlap substantially between patients and controls, well-conducted negative results exist for hand thermography in low-activity rheumatoid arthritis, and reported effect sizes vary widely across devices and protocols. Quantitative thermographic metrics and machine-learning approaches may further refine diagnostic performance and enable remote monitoring. Conclusions: IRT is a promising rapid, non-invasive, radiation-free adjunctive imaging modality, but its clinical adoption is constrained by methodological variability, environmental and vascular confounders, and the absence of prospective validation. Standardised acquisition protocols and prospective multi-site validation are required before routine clinical use. Full article

Background/Objectives: Despite its beneficial effect on the healing of bone fractures and in the treatment of osteoporosis, there is still a lack of evidence on the impact of clinical outcomes after a total joint arthroplasty (TJA). This review aims to establish the role of vitamin D in clinical outcomes after a total knee arthroplasty (TKA). Methods: In this review, PubMed, Scopus and Web of Science databases were cross-checked by two reviewers independently. The inclusion criteria were original human studies published in English from 2014 to 2024. For identification-relevant studies, the search terms used were as follows: “Vitamin D” and “total knee arthroplasty” or “total knee replacement” or “total joint arthroplasty” or “total joint replacement”. Case reports, letters and expert consensuses were excluded from the analysis. Finally, 19 studies were included in this review. Results: A literature review shows that vitamin D may have an impact on patients treated for osteoarthritis (OA) of the knee with a significant prevalence of hypovitaminosis in orthopedic patients. The influence was observed for periprosthetic joint infections: PJI patients have significantly lower vitamin D levels than primary ones. Also, a greater incidence of revision knee surgery due to PJIs in the deficient group compared to the non-deficient group at a one-year follow-up was found, of up to a 2-fold increase. This affects the clinical outcome with a lower Knee Society Score (KSS) functional score in the vitamin D-deficient group. Conclusions: The current data suggest that the vitamin D metabolism pathway and its implications in orthopedic patients, especially those treated with TKA surgery, may be a significant factor that improves clinical and functional outcomes. A possible relation between a low preoperative concentration of vitamin D and its impact on the outcomes, such as the length of the hospital stay, implant survival, and risk of complications, is needed to support these findings in multicenter, prospective studies and randomized controlled trials. Full article

Total hip arthroplasty (THA) is among the most effective orthopedic interventions for osteoarthritis, yet post-operative rehabilitation is frequently delayed due to informational and organizational barriers. Geographic information system (GIS) technology offers a promising approach to improving rehabilitation access coordination, though its integration into patient-facing mobile platforms remains insufficiently studied. This two-arm, parallel-group, superiority randomized controlled trial enrolled 142 adult patients (≥18 years) within seven days of primary THA at the National Research Oncology Center LLC, Astana, Kazakhstan. Participants were randomized 1:1 to the GIS-integrated Health-GIS mobile coordination platform (experimental group) or standard general practitioner (GP)-mediated referral (control group). Key exclusion criteria included severe cognitive or visual impairment, absence of smartphone access or digital literacy, and medical contraindications to rehabilitation. The primary outcomes were time to second-stage rehabilitation initiation and health-related quality of life assessed by the SF-12 (Physical and Mental Component Summaries). Secondary outcomes included the Harris Hip Score (HHS), Visual Analogue Scale (VAS) for pain, System Usability Scale (SUS), and quality-adjusted life years (QALYs) over a 12-month follow-up. Of 142 randomized participants (61% male, 39% female), 131 completed follow-up and were included in the modified intention-to-treat analysis (experimental: n = 66; control: n = 65). The experimental group initiated second-stage rehabilitation significantly earlier (median 43 vs. 59 days; p = 0.021). At 12 months, the experimental group demonstrated superior SF-12 Physical Component Summary scores (48.21 vs. 42.84; p < 0.001), while Mental Component Summary scores did not differ significantly between groups (46.96 vs. 47.05; p = 0.669). Quality-adjusted life years were significantly higher in the experimental group (0.74 ± 0.04 vs. 0.72 ± 0.04; p = 0.008). Harris Hip Scores were significantly better in the experimental group at 6 weeks (p < 0.001) and 6 months (p = 0.009), converging by 12 months (p = 0.068). No statistically significant between-group differences in pain intensity (VAS) were observed at any time point (baseline: p = 0.814; 6 weeks: p = 0.336; 6 months: p = 0.066; 12 months: p = 0.105). Platform usability was rated as good-to-excellent by clinicians (SUS: 86.9 at 6 months) and acceptable by patients (mean SUS: 71.4). A GIS-integrated mobile coordination platform significantly reduced time to rehabilitation initiation and improved physical health-related quality of life and health utility following THA compared to standard referral practice. These findings support platform-based care coordination as an effective complement to surgical care, with important implications for rehabilitation access policy. Future multi-center studies and formal cost-effectiveness analyses are warranted to establish generalizability. Trial Registration: ClinicalTrials.gov, NCT07201116, registered 23 September 2025. Full article

Background/Objectives: Total hip arthroplasty (THA) is a common orthopedic procedure, and with projected growth in both primary and revision surgical volumes, robust implant performance data is necessary to inform surgical decision-making. To ensure successful outcomes in primary THA (pTHA) and revision THA (rTHA), surgeons need versatile implant systems that can address patient-specific surgical challenges. This study aimed to evaluate the outcomes of a next-generation acetabular system used for various indications in both pTHA and rTHA. Methods: We retrospectively reviewed 319 patients who underwent either pTHA or rTHA using a modern acetabular system at a single urban academic center between 2014 and 2023 with at least 18 months of follow-up. Baseline characteristics and the patient-reported Hip Disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS, JR) were collected. A total of 284 patients who underwent pTHA and 35 patients who underwent rTHA were included. Median follow-up was 2.6 years (range: 1.5–8.4 years). Results: The most common indication was osteoarthritis (90%) for pTHA and instability (46%) for rTHA. Most rTHAs utilized a dual-mobility construct (74%), compared to pTHAs (22%). There were ten all-cause acetabular revisions in the entire cohort (eight in pTHA, two in rTHA), four of which were aseptic (three in pTHA, one in rTHA). All-cause and aseptic acetabular survivorship of the pTHA cohort was 97.2% and 98.7%, respectively, and of the rTHA cohort was 94.3% and 97.1%, respectively. Improvement in the median HOOS, JR score was 21.5 points at one year and 25.5 points at two years among pTHAs. Conclusions: The findings with this system support adequate mid-term acetabular component survivorship in pTHA and rTHA, along with clinically meaningful functional improvement following pTHA. Given the retrospective, observational nature of this study, further prospective research with extended follow-up and larger sample sizes, particularly in the rTHA cohort, is needed to better assess long-term outcomes. Full article

The calcitonin gene-related peptide (CGRP) is a 37-amino acid neuropeptide belonging to the calcitonin family, discovered as a product of alternative splicing of the calcitonin gene. CGRP has emerged as a pleiotropic signaling molecule with widespread distribution in the central and peripheral nervous systems, particularly within primary sensory neurons. This narrative review synthesizes current knowledge on the CGRP system, integrating recent advances in its molecular structure, gene organization, and post-translational processing with high-resolution structural insights into its heterodimeric receptor complex (CLR-RAMP1) obtained through cryo-electron microscopy. We also include long-term safety data on anti-CGRP monoclonal antibodies, emerging cardiovascular risk signals, and novel therapeutic applications in vestibular migraine and pediatric populations. The intracellular signaling cascades activated by CGRP, including the canonical cAMP-PKA pathway, MAP kinase activation, and context-dependent calcium signaling, are discussed in relation to its diverse physiological functions. These encompass vasodilation, nociception modulation, neurogenic inflammation, gastrointestinal motility, bone metabolism, tissue regeneration, and energy homeostasis. The central role of CGRP in migraine pathophysiology is examined to understand the development of targeted therapies. The current pharmacological landscape is reviewed, including the evolution of small-molecule CGRP receptor antagonists (gepants) through three generations and the four approved monoclonal antibodies targeting CGRP or its receptor, with comparative analysis of their efficacy, safety profiles, and clinical positioning. Beyond migraine, emerging and predominantly preclinical roles of the CGRP system are discussed in chronic pain, osteoarthritis, cardiovascular diseases, sepsis, cancer (particularly bone metastases and tumor microenvironment immunomodulation), and neurodegenerative disorders such as Alzheimer’s disease. In these areas, the available evidence remains heterogeneous and, in most cases, is not yet sufficient to support clinical translation. Finally, future directions are discussed, including the development of stable CGRP analogs, allosteric modulators, and the potential expansion of therapeutic applications into oncology, intensive care medicine, and neuroprotection. Full article

Purpose: Posterior tibial slope (PTS) is an important anatomical parameter that influences knee kinematics and clinical outcomes following total knee arthroplasty (TKA). Recent advances in CT-based robotic-assisted TKA (RA-TKA) have enabled accurate three-dimensional (3D) evaluation of knee morphology. However, limited data are available regarding PTS and its associated coronal and sagittal alignment factors in Asian patients with knee osteoarthritis. The purpose of this study was to quantify medial and lateral PTS and to identify alignment factors associated with PTS, thereby clarifying the relevance of individualized 3D assessment for TKA planning. Methods: This retrospective study evaluated 236 knees from 236 Asian patients with knee OA undergoing primary RA-TKA (MAKO^®, Stryker, Kalamazoo, MI, USA). Radiological parameters, including medial posterior tibial slope (MPTS), lateral posterior tibial slope (LPTS), medial proximal tibial angle (MPTA), lateral distal femoral angle, mechanical hip–knee–ankle angle, arithmetic hip–knee–ankle angle, and femur flexion angle were automatically calculated by MAKO planning software based on predefined anatomical landmarks and reference axes. Correlation and multivariate regression analyses were performed to assess the relationships between PTS and other coronal, sagittal alignment parameters. Results: The cohort showed an overall varus tendency, with a mean mechanical HKA angle of −8.3° ± 5.21°, while coronal alignment itself was not used as an exclusion criterion. PTS demonstrated substantial variability among individuals as well as between the medial and lateral sides within the same knee. The distribution of PTS values showed a wide range, with MPTS ranging from −4.8° to 24.5° and LPTS ranging from −1.4° to 17.4°. The MPTS was significantly greater than the LPTS (7.85° ± 4.72° vs. 6.33° ± 4.04°, p < 0.001). No statistically significant association was observed between MPTS and MPTA. Multivariate linear regression demonstrated that LPTS was the strongest positive predictor of MPTS (β = 0.365, p < 0.001), while height (β = −0.169, p = 0.006) and femoral flexion angle (β = −0.195, p < 0.001) were significant negative predictors. Conclusions: In Asian patients with knee OA, PTS showed substantial inter-individual variability and significant medial–lateral asymmetry on 3D CT analysis. These findings suggest that a fixed PTS target may not fully reflect patient-specific native morphology, and further outcome-based studies are needed to define the optimal compartment-specific PTS reference for TKA planning. Full article