Search Results (100)

Introduction: Total temporomandibular joint replacement (TMJR) is a well-established surgical solution for patients with severe TMJ disorders. It aims to relieve chronic pain, restore jaw mobility, and significantly enhance quality of life. This systematic review evaluates QoL outcomes following TMJR, analyzes complication profiles, compares custom versus stock prostheses, explores pediatric applications, and highlights technological innovations shaping the future of TMJ reconstruction. Methods: A systematic search of PubMed, Embase, and the Cochrane Library was conducted throughout April 2025 in accordance with PRISMA 2020 guidelines. Sixty-four studies were included, comprising 2387 patients. Results: Primary outcomes assessed were QoL improvement, pain reduction, and functional gains such as maximum interincisal opening (MIO). Secondary outcomes included complication rates and technological integration. TMJR consistently led to significant pain reduction (75–87%), average MIO increases of 26–36 mm, and measurable QoL improvements across physical, social, and psychological domains. Custom prostheses were particularly beneficial in anatomically complex or revision cases, while stock devices generally performed well for standard anatomical conditions. Pediatric TMJR demonstrated functional and airway benefits with no clear evidence of growth inhibition over short- to medium-term follow-up. Complications such as heterotopic ossification (~20%, reduced to <5% with fat grafting), infection (3–4.9%), and chronic postoperative pain (~20–30%) were reported but were largely preventable or manageable. Recent advancements, including CAD/CAM planning, 3D-printed prostheses, augmented-reality-assisted surgery, and biofilm-resistant materials, are enhancing personalization, precision, and implant longevity. Conclusions: TMJR is a safe and transformative treatment that consistently improves QoL in patients with end-stage TMJ disease. Future directions include long-term registry tracking, growth-accommodating prosthesis design, and biologically integrated smart implants. Full article

Building extraction plays a crucial role in a variety of applications, including urban planning, high-precision 3D reconstruction, and environmental monitoring. In particular, the accurate detection of tall buildings is essential for reliable modeling and analysis. However, most existing building-detection methods are primarily trained on datasets dominated by low-rise structures, resulting in degraded performance when applied to complex urban scenes with high-rise buildings and severe occlusions. To address this limitation, we propose TBFH (Total-Building-Focused Hybrid), a novel dataset specifically designed for building detection in remote sensing imagery. TBFH comprises a diverse collection of tall buildings across various urban environments and is integrated with the publicly available WHU Building dataset to enable joint training. This hybrid strategy aims to enhance model robustness and generalization across varying urban morphologies. We also propose the KTC metric to quantitatively evaluate the structural integrity and shape fidelity of building segmentation results. We evaluated the effectiveness of TBFH on multiple state-of-the-art models, including UNet, UNetFormer, ABCNet, BANet, FCN, DeepLabV3, MANet, SegFormer, and DynamicVis. Our comparative experiments conducted on the Tall Building dataset, the WHU dataset, and TBFH demonstrated that models trained with TBFH significantly outperformed those trained on individual datasets, showing notable improvements in IoU, F1, and KTC scores as well as in the accuracy of building shape delineation. These findings underscore the critical importance of incorporating tall building-focused data to improve both detection accuracy and generalization performance. Full article

Background/Objectives: Temporomandibular joint (TMJ) ankylosis, characterized by osseous–fibrous fusion, severely impairs mandibular function. While alloplastic total joint replacement (TJR) is the gold standard, long-term outcomes remain understudied. The aim of this study is to evaluate the long-term esthetic and functional outcomes of prosthetic replacement and to retrospectively analyze our 20-year experience. Methods: A retrospective observational study (2003–2024) was conducted at a tertiary referral center in Turin and enrolled patients who underwent alloplastic total joint replacement for TMJ ankylosis. Data collected included demographic variables, etiology, characteristics of the ankylosis, prosthesis type (stock/custom), surgical details, and outcomes (maximal interincisal opening [MIO], pain, quality of life, diet consistency, Helkimo index, complications). Results: Among 28 patients (61% female, mean age 51.8 years), etiologies included post-traumatic (39%), osteoarthritis (32%), congenital (25%) and neoplastic (4%) causes. Custom prostheses were used in 57% of cases. Median follow-up was 11.5 years. Significant improvements were observed in MIO (p = 0.001), pain level (p = 0.001), quality of life (p = 0.001), diet score (p = 0.002), and Helkimo index (p = 0.001). Complications included facial nerve dysfunction (32.1%), salivary leakage (14.3%), and one recurrence (2.2%). Conclusions: Alloplstic TJR provides durable functional and esthetic restoration for TMJ ankylosis, with custom prostheses excelling in complex anatomies. Long-term stability (>10 years) supports its role as a definitive solution. Full article

The Sichuan Basin is a key area for shale gas energy exploration in China. However, the pore evolution mechanism and accumulation effect of the Lower Jurassic continental shale gas in the northeastern Sichuan Basin remain poorly understood. In this study, the pore structure characteristics of shale reservoirs and the dynamic accumulation and evolution of shale gas in the northern Fuling and Yuanba areas were systematically analyzed by adsorption experiments, high-pressure mercury injection joint measurement, and thermal simulation experiments. The results indicate the following: (1) The continental shale in the study area is predominantly composed of mesopores (10–50 nm), which account for approximately 55.21% of the total pore volume, followed by macropores (5–50 μm) contributing around 35.15%. Micropores exhibit the lowest proportion, typically less than 10%. Soluble minerals such as clay minerals and calcite significantly promote pore development, while soluble organic matter may block small pores during hydrocarbon generation, which facilitates the enrichment of free gas. (2) The thermal simulation experiment reveals that pore evolution can be divided into two distinct stages. Prior to 450 °C, hydrocarbon generation leads to a reduction in pore volume due to the compaction and transformation of organic matter. After 450 °C, organic matter undergoes cracking processes accompanied by the formation of shrinkage fractures, resulting in the development of new macropores and a significant increase in pore volume. This indicates that thermal energy input during the thermal evolution stage plays a key role in reservoir reconstruction. (3) The early Jurassic sedimentary environment controls the enrichment of organic matter, and the Cretaceous is the key period of hydrocarbon accumulation. Hydrocarbon generation and diagenesis synergistically promote the formation of gas reservoirs. The Cenozoic tectonic activity adjusted the distribution of gas reservoirs, and finally formed the enrichment model with the core of source–reservoir–preservation dynamic matching. For the first time, combined with dynamic thermal simulation experiments, this study clarifies the stage characteristics of pore evolution of continental shale and identifies the main controlling factors of shale gas accumulation in the Lower Jurassic in northeastern Sichuan, which provides a theoretical basis for continental shale gas exploration and energy resource development, offering important guidance for optimizing the selection of exploration target areas. Full article

Objective: The resistive knee orthosis, as a novel rehabilitation device, is designed to provide resistance to joint movement during continuous walking, thereby enhancing the postoperative recovery effect. This study aims to explore the impact of such orthoses on the joint coordination patterns of martial artists after anterior cruciate ligament (ACL) reconstruction. Methods: A total of 44 martial artists who underwent ACL reconstruction were recruited and divided into an experimental group (EG, n = 22, using resistive braces) and a control group (CG, n = 22, using conventional braces). Assessments were conducted preoperatively (T0) and at 15 days (T1), 30 days (T2), and 60 days (T3) postoperatively. The changes in joint coordination patterns during the gait cycle were analyzed, and the ACL force was estimated using a musculoskeletal model. Results: At T2 and T3, compared with the CG, the EG exhibited a significantly larger peak knee flexion angle (p < 0.05). At T3, the EG showed higher hip–ankle in-phase coordination (p < 0.05), increased proximal hip–knee coordination (p < 0.05), and decreased knee–ankle anti-phase coordination (p < 0.05). In addition, the ACL force in the EG was significantly lower. Conclusions: The resistive knee orthosis can effectively improve the joint coordination of martial artists after ACL reconstruction and reduce the ACL force. Full article

Objectives: Some following up patients have poor clinical outcomes when they experience anterior cruciate ligament reconstruction. The patient will undergo progression of knee joint osteoarthritis or several secondary knee procedures such as high tibial osteotomy, total knee arthroplasty, menisectomy, meniscus repair, or meniscus transplantation on their knees after anterior cruciate ligament reconstruction. This may be related to the remaining instability of the knee joint, changes in the knee joint biomechanics, and progression of osteoarthritis. This study aims to determine which secondary knee procedures are performed over time after anterior cruciate ligament reconstruction. Methods: The National Health Insurance Service-Health Screening database analyzed 146,122 patients who underwent ACL reconstruction surgery between 1 January 2002 and 31 December 2021. Secondary knee procedures were investigated by categorizing them into revisional reconstruction, high tibial osteotomy, total knee arthroplasty, menisectomy, meniscus repair, and meniscus transplantation, respectively. Multivariable Cox Proportional Hazard model analysis was used. The significant predictors for complications (p < 0.05) were as follows. Results: Among a total of 146,122 patients with anterior cruciate ligament reconstruction, 1073 (0.7%) patients underwent HTO, 908 (0.6%) patients underwent TKA, 15,218 (10.4%) patients underwent meniscectomy, 7169 (4.9%) patients underwent meniscus repair, and 938 (0.6%) patients underwent meniscus transplantation. The hazard ratio differed according to graft type, gender, and age group. Conclusions: Patients who undergo ACL reconstruction may experience poor clinical outcomes, such as progression of osteoarthritis and undergoing secondary knee procedures several years after ACL reconstruction. It is important for decision-making, ongoing monitoring, and follow-up care for patients undergoing ACL reconstruction. Full article

Introduction: Many orthopedic surgeons recommend ischemic tourniquets during arthroscopic anterior cruciate ligament (ACL) repair to reduce blood loss and improve visibility. However, their use remains controversial due to potential complications. Similarly, the practice of postoperative drainage is debated. While its proponents argue it reduces limb swelling, DVT, adhesions, and stiffness, others contend that it may increase infection risk or harm the ACL graft and joint surfaces. Materials and Methods: A total of 456 patients underwent anterior cruciate ligament reconstruction between September 2015 and December 2024, without the use of a tourniquet or drainage. The patients were 334 men with a mean age of 34.7 years and 122 women with a mean age of 32.3 years. In 389 cases the graft type was a hamstring autograft, in 55 cases a patellar tendon autograft (BPTB) was used, and in 12 cases a quadriceps tendon autograft was used. Results: The mean operative time was 61 min (range 52–79). No cases experienced visual impairment or required ischemia to enhance visibility. Bleeding sites were successfully cauterized during arthroscopy. Postoperative complications included knee hematoma in three patients (0.7%), resolved after drainage on day one, and two infections (0.4%), treated successfully with arthroscopic drainage and implant removal. No further complications were reported. Conclusion: Although many orthopedic surgeons prefer arthroscopic ACL repair with a tourniquet for better visibility and reduced intraoperative blood loss, this approach carries risks such as nerve palsy, joint swelling, stiffness, muscle weakness, and vascular changes. Not using a tourniquet can help to identify bleeding sites and allows for a more thorough procedure. The literature suggests that avoiding a tourniquet also reduces postoperative pain and accelerates recovery. The mean operative time for ACL reconstruction was consistent with the literature, indicating that avoiding a tourniquet did not cause delays. Additionally, the absence of postoperative drainage did not lead to complications, with most patients showing no issues like bleeding, hematoma, ischemia, or poor wound healing. Full article

Background: Facial features are the first basic sign of medical knowledge of children and adults with congenital malformations. Children born with multiple contractures almost always receive the misdiagnosis of arthrogryposis multiplex. Larsen syndrome can easily be diagnosed at birth via the proper interpretations of its characteristic facial features and multiple dislocations. Comprehensive clinical diagnosis can facilitate an orthopedic strategy for early treatment and can enhance the recognition of unreported craniocervical malformation complexes. Material and Methods: Six children (four boys and two girls, with ages ranging from a few months to 7 years old) were referred to our department for diagnosis and treatment. All children received their first misdiagnosis by the pediatricians as manifesting arthrogryposis multiplex congenita. The clinical phenotype was our first decisive tool for diagnosis. All children exhibited the classical phenotype of dish-like facies associated with multiple joint dislocations. Radiological phenotypic characteristics confirmed our clinical diagnosis of Larsen syndrome. Three children out of six showed unpleasant cervical spine deformities. The first child, a 2-year-old, became tetraplegic after minor trauma. One child presented with progressive rigid cervical kyphosis. The third child was a product of a first-relative marriage and was born with congenital tetraplegia. A genotype was carried out for confirmation. Results: Three children underwent open reduction for congenital hip and knee dislocations. One child underwent spinal fusion CO-C7 because of tetraplegia. A 3D-reformatted and reconstruction CT scan of the craniocervical junction showed two forms of unusual dys-segmentation, firstly along C2-3 effectively causing the development of acute-angle cervical kyphosis. Secondly, an infant with congenital tetraplegia showed a serious previously undescribed atlanto–axial malformation complex. Namely, atlanto–axial maldevelopment (dys-segmentation) of (C1/C2) was associated with hypoplasia of the anterior and the posterior rings of the atlas. Genetic tests of these children were compatible with the autosomal dominant type of Larsen syndrome and manifested a heterozygous mutation in FLNB mapped 3p14.3, encoding an actin-binding protein, filamin B. The child with congenital tetraplegia showed no mutations in FLNB, though his clinical and radiological phenotype and his family history of first-relative marriage were totally compatible with the diagnosis of the autosomal recessive type of Larsen syndrome. Conclusions: Our strategy was and still is based on a coherent clinical and radiological diagnosis, which is based on comprehensive clinical and radiological phenotypic characterizations. We implemented a 3D-reformatted CT scan to further understand the craniocervical junction pathology in three children. Strikingly, prenatal onset of lethal maldevelopment (dys-segmentation) of the atlanto–axial spine segments has been diagnosed in an infant with congenital tetraplagia. A less serious cervical spine malformation was detected in two children who presented with progressive acute-angle cervico and cervico-thoracic kyphosis. Our clinical strategy can form the basis for a thorough clinical assessment for infants and children born with multiple malformation complexes and can lead to recognition of novel understandings. Full article

The anatomic characteristics of the graft and tunnel, i.e., the tunnel position, angle, length, and the graft bending angle, influence knee joint stability and postoperative functional recovery. The purpose of this study was to evaluate the tunnel position, length and angle, as well as graft bending angle after ACL reconstruction assisted by a surgical robot. A total of 70 patients were randomized into two groups: the surgical robot group (robot group, n = 35) and the traditional handheld locator group (control group, n = 35). Postoperative computed tomography (CT) was employed to assess the positions and lengths of the tunnels, as well as the tunnel angle and the graft bending angle. Additionally, the posterior wall distance was measured by determining the minimum vertical distance from the long axis of the tunnel to the posterior wall region. There were no significant differences between the two groups in the mean position or length of the femoral and tibial tunnel (p > 0.05). However, the femoral tunnel angle was significantly larger in the robot group compared to the handheld locator group (p = 0.012). The graft bending angle was significantly less acute in the robot group than in the control group (p = 0.008). Additionally, the posterior wall distance was significantly greater in the robot group compared to the control group (p < 0.001). The results suggest that surgical robot-assisted ACL reconstruction enhances safety in the inclination of the tunnel and graft, helping to avoid potential biomechanical issues such as the wiper effect and the bungee effect, which may lead to tunnel widening and surgical failure. Full article

Background: Rupture of the ACL is a common injury among men and women athletes. While planning the surgical ACL reconstruction procedure, the eventual graft’s diameter is extremely important. Many parameters are therefore evaluated pre-surgery to ensure access to reliable data for estimating the graft diameter. Considering this, magnetic resonance imaging (MRI), particularly qualitative analyses of the hamstring tendons, offers a promising approach. Methods: In a retrospective analysis, we carried out 3D segmentation of the gracilis (GT) and semitendinosus tendon (ST) utilizing MRI with varying slice thicknesses and field strengths. The cross-sectional area (CSA) was calculated on different levels (by relying on the models we had thus created) to generate a mean of CSA with six specific segments. We then correlated the mean CSA with the diameter of the graft measured during surgery. Results: A total of 32 patients were included (12 female, 20 male) in this retrospective analysis. We observed the largest CSA in segment 10 mm–0 (16.8 ± 6.1) with differences between men and women. The graft size and tendon diameter correlated significantly in all segments throughout our study cohort. The strongest correlation was apparent in the segment 10 mm–0 (r = 0.552). Conclusions: MRI-based 3D segmentation and the STGT CSA represent a reliable method for estimating preoperatively a quadrupled hamstring graft diameter. The 10 mm–0 mm segment above the joint line showed a strong correlation, making it an ideal reference for graft planning. Full article

Background and Objectives: To date, the gold standard of care for bone sarcomas is limb salvage surgical resection. In cases where the tumor arises in the distal femur or proximal tibia near the joint line, knee-sacrificing surgery is typically performed, followed by reconstruction with oncological megaprostheses. This study aims to evaluate the effectiveness of a precise 3D-based surgical approach for knee-sparing tumor resections, assessing its feasibility and its impact on surgical, oncological, and functional outcomes. Materials and Methods: This single-center retrospective study presents the surgical and oncological outcomes of knee-sparing surgeries following bone sarcoma resections. All patients underwent either intercalary or geographic resection, and reconstruction was tailored to each patient, using either an allograft or a titanium alloy Ti64 implant, depending on the specific requirements of the case. Results: A total of 23 patients (average age 21.04 years, 14 males) were included, with an average postoperative follow-up of 58 months (range: 12–102 months). Clear surgical margins were achieved in all patients, with 16 patients (69.5%) showing wide negative margins (R0) and the rest showing close negative margins (R1). Resections were primarily intercalary (17 patients, 73.9%), with 6 patients (26.1%) undergoing geographic resections. Reconstruction methods included allografts (9 patients, 39.3%), vascularized fibula and allograft (8 patients, 34.7%), and printed Ti64 cage reconstructions (6 patients, 26.0%). At the last follow-up, 19 patients (82.6%) were disease-free, 3 patients (13.4%) were alive with evidence of disease, and 1 patient (4%) was dead of disease. Complications included four cases of non-union that required revision surgery, as well as two local recurrences, which necessitated revision surgery to a modular endoprosthesis and above-knee amputation. The average MSTS at the final follow-up was 23.16 ± 5.91. Conclusions: The use of 3D-printed PSIs for knee-sparing bone tumor resections has emerged as the gold standard, enhancing both surgical and oncological outcomes. A future challenge lies in improving reconstruction techniques, shifting from traditional allografts to customized Ti64 printed lattice implants. As personalized healthcare and additive manufacturing continue to advance, the future of orthopedic oncology will likely see more precise, durable, and biologically integrated implants, further improving patient outcomes. Full article

Background: Patients with a triad of severe temporomandibular joint (TMJ) pathologies, obstructive sleep apnea (OSA), and dentofacial deformities often experience significant functional and aesthetic impairments. A combination of total TMJ reconstruction and maxillomandibular advancement (MMA) has emerged as a promising treatment option, which can address the complexity of these conditions simultaneously. Methods: This paper presents a practical protocol for TMJ reconstruction using patient-specific alloplastic total joint prosthesis in conjunction with additional splintless osteotomies. This approach integrates the recent advancements in virtual surgical planning (VSP), custom TMJ prostheses, and three-dimensional (3D) custom osteotomy guide and implant manufacturing, allowing for precise anatomical correction and enhanced treatment outcomes. Three patients were treated with the present protocol. Postoperative assessments mainly included maximum inter-incisal opening, apnea–hypopnea index (AHI), and patient satisfaction with facial aesthetics. Results: All surgeries were performed without complications. The follow-up period ranged from 7 to 12 months. For the two patients with TMJ ankylosis, the postoperative maximum inter-incisal opening (MIO) increased from 3–5 to 35 mm and from 12 to 32 mm, respectively. Additionally, all three cases demonstrated that the protocol could significantly decrease AHI (with improvements of 57.5, 49, and 66.4 events/h, respectively) and achieve satisfactory aesthetics. Conclusions: These findings suggest that this protocol is a viable option for addressing complex cases involving severe TMJ pathologies, OSA, and dentofacial deformities. Future studies with larger cohorts and long-term follow-up are needed to further validate these findings. Full article

Background: Restoration of the joint line is important for an optimal outcome after total knee arthroplasty (TKA). The goal of this study was to analyze the accuracy of joint line reconstruction in conventionally performed TKA. The study evaluates the potential influences of mechanical deformity on joint line restoration. Methods: A total of 115 patients (58.3% female, mean age 72.4 years (52–89)) with 43 valgus and 72 varus knees were reviewed. A total of 36 patients underwent CR-TKA, and 79 underwent PS-TKA. The joint line was measured from the adductor tubercle to the joint line. Results: A total of 106 patients (92.2%) had the joint line restored within four millimeters. The distance increased significantly from preoperative (48.30 ± 6.35 mm) to postoperative 49.03 ± 6.29 mm (p = 0.003). Varus knees showed no significant change (p = 0.313), while valgus knees had a significant elevation (p = 0.0004). Conclusions: In conventional total knee arthroplasty (TKA), the distance from the adductor tubercle to the joint line slightly increased. However, in most patients, the joint line was restored within four millimeters. Valgus knees in particular are at risk for postoperative joint line elevation. Full article

Background/Objectives: Developmental dysplasia of the hip (DDH), defined by the malalignment of the femoral head and acetabulum, is a major precursor to coxarthrosis, posing substantial challenges during total hip arthroplasty (THA). Patients with coxarthrosis secondary to DDH often exhibit acetabular bone insufficiency, which makes challenging surgical reconstruction difficult. This study aimed to compare the radiologic and functional outcomes of robotically assisted and conventional manual THA techniques in patients with coxarthrosis secondary to Crowe type III–IV DDH. Methods: This prospective study included 40 patients divided into robotically assisted (n = 20) and conventional manual (n = 20) THA groups. Evaluations encompassed hip pain (Visual Analogue Scale, VAS), function (Harris hip score and University of California, Los Angeles, activity scale), quality of life (Short Form-12), and prosthesis sensation (Forgotten Joint Score-12). Radiologic outcomes included acetabular inclination and anteversion angles. Femoral shortening, operative duration, and follow-up times were also analyzed. Results: Demographic characteristics did not differ between groups (p > 0.05). Robotically assisted THA exhibited a significantly longer operative time (171.40 ± 11.96 vs. 150.30 ± 14.67 min; p = 0.001) but a shorter follow-up (29.3 ± 8.51 vs. 52.95 ± 18.96 months; p = 0.001), without a difference in the amount of femoral shortening (p = 0.947). Despite the extended surgical duration, the two techniques achieved comparable radiologic outcomes, with no significant differences in acetabular inclination or anteversion angles (p > 0.05). Functional assessments, including Harris hip scores (73.85 vs. 73.95; p = 0.978), UCLA activity scores, and VAS, indicated similar efficacy between groups. SF-12 physical and mental quality of life and Forgotten Joint Score-12 prosthesis sensation did not differ between groups (p > 0.05). Conclusions: This study concludes that robotically assisted and conventional manual THA present similar radiologic and functional outcomes in patients with coxarthrosis secondary to Crowe type III–IV DDH, as displayed by comparable acetabular anteversion and inclination alignment, femoral shortening, hip function, pain, quality of life, and prosthesis sensation scores. While robotically assisted THA requires a longer operative time, its precision in implant placement may hold potential advantages for long-term outcomes, demanding further investigation in extended follow-up studies. Full article

Abnormal trochlear morphology is one of the most important factors for patellar luxation occurrence in dogs, yet no studies have investigated its prevalence in the general population. This retrospective computed tomography study was designed to evaluate the trochlear groove morphology in four small dog breeds and the prevalence of trochlear dysplasia types according to Déjour’s classification depending on the breed, sex, and medial patellar luxation (MPL) presence and grade. A total of 174 joints (68 healthy, 96 grade II MPL, and 10 grade III MPL) from Mini-Pinschers, Yorkshire Terriers, Pomeranians, and Chihuahuas were included in the study. The morphological type of trochlear dysplasia (TD) was evaluated on axial scans and 3D reconstruction images according to the four-type classification of Déjour, sulcus angle, trochlear depth, and lateral/medial inclination angles. Of all 174 joints, 140 had trochlear dysplasia—all joints with MPL (n = 106) and 50% of healthy joints (n = 34). The classification of Déjour for trochlear dysplasia types (A, B, C, and D) corresponds to the morphology of the femoral trochlea in the studied small breeds of dogs. The results demonstrated three types of trochlear dysplasia according to Déjour: most commonly, type A, followed by type C, and most infrequently, type D. The Déjour type B was an incidental finding. The large proportion of clinically healthy joints with TD (50%) emphasises the significance of early trochlear morphology evaluation for the orthopaedical health of dogs from susceptible breeds, especially in female breeders. Full article