Search Results (334)

Background: Total hip arthroplasty (THA) is a common procedure, yet instability and dislocation remain leading causes of revision. Dual mobility (DM) acetabular constructs improve stability, but comparative data across modular DM systems are limited. This study compared the safety and efficacy of three modular DM implants in primary THA, focusing on acetabular revision and functional recovery. Methods: We retrospectively reviewed 963 primary THAs performed from 2016–2024 using three modular DM systems. Patients with revision or bilateral THA, age < 18, or <2 years of follow-up were excluded. Outcomes included acetabular revision, 90-day readmission, and Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS, JR). Kaplan–Meier analysis estimated 3-year implant survivorship for each implant, and non-inferiority of Implant A was tested against a combined “Dual Mobility Control” cohort (Implants B + C) using a prespecified −10% margin. Results: A total of 297 patients met inclusion criteria (142 Implant A, 110 Implant B, 45 Implant C). Revision rates were 4.9% for Implant A, 6.4% for Implant B, and 8.9% for Implant C. HOOS, JR scores improved significantly in all cohorts with comparable 2-year outcomes. Kaplan–Meier analysis showed 3-year survivorship of 98.3% for Implant A, 98.4% for Implant B, and 96.9% for Implant C (log-rank p = 0.053). The Dual Mobility Control cohort survivorship was 98.0%, and the difference between Implant A and controls (95% CI: −2.19% to 2.69%) met the non-inferiority margin (log-rank p = 0.796). Conclusions: Implant A demonstrated non-inferior 3-year survivorship and comparable short-term patient-reported outcomes relative to two other modular DM implants. Larger, multicenter studies with longer follow-up are warranted to confirm these findings. Full article

As states within the United States respond to future grid development goals, there is a growing demand for reliable and resilient nighttime generation that can be addressed by low-cost, long-duration energy storage solutions. This report studies the potential of including concentrating solar power (CSP) in the technology mix to support California’s goals as defined in Senate Bill 100. A joint agency report study that determined potential pathways to achieve the renewable portfolio standard set by the bill did not include CSP, and our work provides information that could be used as a follow-up. This study uses a capacity expansion model configured to have nodal spatial fidelity in California and balancing-area fidelity in the Western Interconnection outside of California. The authors discovered that by applying current technology cost projections CSP fulfills nearly 15% of the annual load while representing just 6% of total installed capacity in 2045, replacing approximately 30 GWe of wind, solar PV, and standalone batteries compared to a scenario without CSP included. The deployment of CSP in the results is sensitive to the technology’s cost, which highlights the importance of meeting cost targets in 2030 and beyond to enable the technology’s potential contribution to California’s carbon reduction goals. Full article

Post-traumatic osteoarthritis (PTOA) is a distinct form of knee osteoarthritis characterized by accelerated joint degeneration following injury. It poses unique challenges in post-menopausal women due to hormonal changes and altered bone metabolism that create complex pathophysiological environments. This retrospective cohort study compared the effectiveness of different anti-osteoporotic medications in preventing total knee replacement (TKR) in 6155 postmenopausal women with PTOA treated between 2011 and 2021. We compared raloxifene and denosumab, with alendronate serving as the reference group. The primary outcome was TKR occurrence. Cox proportional hazards regression and inverse probability of treatment weighting (IPTW) were performed to estimate hazard ratios, with Kaplan–Meier survival analysis for time-to-event assessment. Participants’ mean (SD) age was 69.4 (10.0) years. Given the retrospective nature and typical delayed presentation of PTOA symptoms, cohort entry was defined as the concurrent diagnosis of PTOA and osteoporosis requiring anti-resorptive therapy. Over a mean follow-up of 5.47 years, 26 patients (0.42%) underwent TKR. Raloxifene was associated with a significantly reduced TKR risk compared to alendronate (IPTW-HR 0.81, 95% CI 0.67–0.99, p = 0.040), representing a 19% relative risk reduction. Kaplan–Meier analysis demonstrated raloxifene maintained the lowest cumulative TKR incidence compared to alendronate and denosumab over time, particularly beyond 5 years. These findings suggest that raloxifene may offer superior joint protection compared with alendronate and denosumab in postmenopausal women with PTOA, supporting its potential as a disease-modifying therapeutic option for this vulnerable population. Full article

Background/Objectives: Arthroplasty registries provide a broad database that constitutes evidence for discussions about cemented versus uncemented fixations. The objective of this study is to determine the current trend in fixation of total hip arthroplasties. Methods: From the Romanian Arthroplasty Register we extracted data regarding primary hip replacement surgery and revisions. We established evaluation variables and methodologies that contain volumes, variation trends, and gradients for surgical procedures, fixations and revision burdens. Results: In the period 2001–2024, the share of uncemented fixations was 56.8%, and that of cemented ones was 43.13%. The uncemented fixation gradient showed an increase from 0.32 in 2001 to 3.43 in 2024. We found an annual increase in the share of uncemented fixations (2.08%), to the detriment of cemented fixations, which decreased (−6.97%). We found that there is an obvious trend towards uncemented fixation, which is also evident in the elderly age group of 80+ years. The results regarding revision burdens remain within a relatively narrow range of 5.09–7.23%. The revision burdens of uncemented fixations are lower, ranging between 4.82% and 5.36%, compared to cemented fixations. Also, the revision burdens of cemented fixations have a decreasing trend of 0.54%. Conclusions: The variation trend of total uncemented implants is almost double compared to the variation trend of all primary hip joint surgeries. This indicates a trend towards uncemented fixation, and its share is increasing in all age groups. The increase in the proportion of uncemented fixations was associated with a small, non-significant decrease in revision burden. Full article

Introduction: The use of modular components provides several advantages in total knee arthroplasty (TKA), including exchange of the polyethylene insert while retaining the stable components in the revision TKA. Compared to full, non-modular component revision TKA, isolated polyethylene exchange (IPE) has the advantage of decreased morbidity, faster rehabilitation, and acceptable outcomes. Methods: A review of published literature on revision TKA was conducted, with a specific focus on studies evaluating the use of IPE for managing complications such as stiffness, instability, and periprosthetic joint infection (PJI). Results: IPE with downsizing may be considered for patients with mild stiffness and stable, well-positioned implants that have increased polyethylene thickness, though expectations for motion gain should be cautious. There is no clear consensus on IPE for instability. Some studies report high re-revision rates, while others show clinical and functional improvement when the TKA is well-aligned, well-fixed, and intraoperative gap balance is achieved. Additionally, irrigation and debridement with polyethylene exchange (IDPE) may be effective for acute TKA PJI management, particularly within the first two weeks of symptom onset. Conclusions: Based on current literature, IPE in aseptic TKA revisions may be effective for stiffness or instability when implants are well-fixed and well-aligned—particularly if polyethylene constraint can be adjusted for instability or downsized for stiffness. The role of IDPE in acute TKA PJI is better defined in the literature, with strong emphasis on its time-sensitive effectiveness—most notably within the first two weeks of symptom onset. Full article

In total joint replacement, early aseptic loosening of implants caused by inadequate initial fixation and late aseptic loosening due to stress shielding-related periprosthetic bone remodeling are the main causes of failure. Over the last two decades, additive manufacturing has been revolutionizing the design of cementless orthopaedic implants by enabling biomimetic, highly porous titanium structures that enhance bone ingrowth and osseointegration while reducing stress shielding. The synergy between optimized selective laser-melted highly porous titanium bearing components, ceramic-coated titanium articular surfaces, and vitamin E-stabilized polyethylene liners delivers several benefits essential for implant longevity: reliable initial fixation, improved biological fixation, reduced bone resorption caused by stress shielding, and lower osteolytic reactivity. These benefits have encouraged the synergetic use of these technologies in joint replacement in novel clinical applications. In recent years, novel off-the-shelf, 3D-printed, highly porous titanium implants have been introduced into hip and knee arthroplasty. These newly introduced implants appear to offer an innovative and promising solution, and are particularly indicated for young active patients, elderly patients with osteoporotic bones, and in complex cases. Future clinical research should confirm these novel implants’ superior results in comparison to the current state of the art in cementless joint replacement. The possibility of extending these technologies in the future to other clinical applications such as partial knee prosthesis is discussed. Full article

Background/Objectives: This study investigates the impact of Disease-Specific Care Certification (DSCC) on total medical costs associated with joint replacement surgeries in Taiwan. Methods: Using retrospective inpatient data from a regional hospital, we analyzed 660 cases of primary total knee replacement (DRG20903), total hip replacement (DRG20904), and unicompartmental knee replacement (DRG20905) classified under Taiwan’s Tw-DRG system. The dataset covered a 24-month period before certification and a 17-month period after certification, allowing for a comparison of cost changes associated with DSCC implementation. Results: While total medical costs increased slightly following certification, the differences across DRG categories were not statistically significant. However, significant increases were observed in rehabilitation costs (all DRGs), surgical costs (DRG20904 and DRG20905), anesthesia costs (DRG20904), and injection-related costs (DRG20905), indicating increased investment in standardized postoperative care. In contrast, blood transfusion and special materials costs significantly decreased in DRG20905, possibly reflecting improved care coordination and resource optimization. Additionally, the proportion of patients with prolonged hospital stays (≥11 days) declined significantly, suggesting potential efficiency gains. Conclusions: These findings imply that DSCC may facilitate better resource allocation and clinical standardization without substantially increasing overall medical expenditures, offering valuable insights for hospital administrators and policymakers operating under global budgeting systems. Full article

Background: The incorporation of biosensors into orthopedic implants, particularly tibial components in total knee arthroplasty (TKA), marks a new era in personalized joint replacement. These smart systems aim to provide real-time physiological and mechanical data, enabling dynamic postoperative monitoring and enhanced surgical precision. Objective: This narrative review synthesizes the current landscape of electrochemical biosensor-embedded tibial implants in TKA, exploring technical mechanisms, clinical applications, challenges, and future directions for translation into clinical practice. Methods: A comprehensive literature review was conducted across PubMed and Google Scholar. Articles were thematically categorized into technology design, integration strategies, preclinical and clinical evidence, regulatory frameworks, ethical considerations, and strategic recommendations. Findings were synthesized narratively and organized to support forward-looking system design. Results: Smart tibial implants have demonstrated feasibility in both bench and early clinical settings. Key advances include pressure-sensing intraoperative tools, inertial measurement units for remote gait tracking, and chemical biosensors for infection surveillance. However, the field remains limited by biological encapsulation, signal degradation, regulatory uncertainty, and data privacy challenges. Interdisciplinary design, standardized testing, translational funding, and ethical oversight are essential to scaling these innovations. Conclusions: Biosensor-enabled tibial components represent a promising convergence of orthopedics, electronics, and data science. By addressing the technological, biological, regulatory, and ethical gaps outlined herein, this field can transition from prototype to widespread clinical reality—offering new precision in arthroplasty care. Full article

Three-dimensional human pose estimation from monocular video remains challenging for clinical gait analysis due to high computational cost and the need for temporal consistency. We present Pose3DM, a bidirectional Mamba-based state-space framework that models intra-frame joint relations and inter-frame dynamics with linear computational complexity. Replacing transformer self-attention with state-space modeling improves efficiency without sacrificing accuracy. We further incorporate fractional-order total-variation regularization to capture long-range dependencies and memory effects, enhancing temporal and spatial coherence in gait dynamics. On Human3.6M, Pose3DM-L achieves 37.9 mm MPJPE under Protocol 1 (P1) and 32.1 mm P-MPJPE under Protocol 2 (P2), with 127 M MACs per frame and 30.8 G MACs in total. Relative to MotionBERT, P1 and P2 errors decrease by 3.3% and 2.4%, respectively, with 82.5% fewer parameters and 82.3% fewer MACs per frame. Compared with MotionAGFormer-L, Pose3DM-L improves P1 by 0.5 mm and P2 by 0.4 mm while using 60.6% less computation: 30.8 G vs. 78.3 G total MACs and 127 M vs. 322 M per frame. On AUST-VisGait across six gait patterns, Pose3DM consistently yields lower MPJPE, standard error, and maximum error, enabling reliable extraction of key gait parameters from monocular video. These results highlight state-space models as a cost-effective route to real-time gait assessment using a single RGB camera. Full article

Background: Total hip (THR) and knee replacement (TKR) effectively treat end-stage osteoarthritis, but many patients continue to experience functional limitations and reduced quality of life (QoL) after rehabilitation. The aim of this pilot study was to assess the changes in terms of QoL in people with THR and TKR after a specifically designed PA intervention. The secondary aim was to evaluate changes in physical function through strength and mobility tests. Methods: Eighteen participants (mean age 65.8 ± 7.1 years) were enrolled at the Rizzoli Orthopedic Institute and were randomly assigned to an intervention group (IG), which completed a six-month supervised PA program (6 months after surgery), or a control group (CG), which received standard care. Assessments were conducted at four time points: before surgery, after rehabilitation, and at 9- and 12-month post-surgery. Repeated measures ANOVA was used to assess within- and between-group differences over time, with post hoc pairwise comparisons conducted using independent t-tests with Sidak correction. The level of statistical significance was set at p < 0.05 for all analyses. Results: Both groups showed significant improvements in QoL over time, with greater gains in physical functioning observed in the IG. Lower limb strength increased more in the IG; however, the differences between groups were not statistically significant. The Timed Up and Go and 30-Second Chair Stand Test improved in both groups. No adverse events were reported. Conclusions: These findings support the feasibility and potential benefits of adapted PA programs after rehabilitation. Although no significant differences emerged between groups, clinically relevant improvements were observed in the IG. Larger studies are warranted to confirm these results and explore long-term outcomes across multiple domains. Full article

Total joint arthroplasty (TJA) and total joint replacement (TJR) are effective treatments for end-stage osteoarthritis, but prosthetic joint infections (PJIs) remain a significant complication. These infections are often associated with bacteria that form biofilms, which contribute to their persistence and resistance to treatment. The aim of this study was to investigate the biofilm-forming ability, cyclic diguanylic acid (c-di-GMP) production, and the presence of biofilm-associated genes in Staphylococcus aureus and coagulase-negative Staphylococci (CoNS) isolates obtained from synovial fluid samples of patients with PJIs following TJA and TJR. A total of 198 samples were analyzed, with bacterial growth detected in 33 samples (16.7%). Among these, 10 strains of S. aureus and 22 strains of CoNS were identified. Biofilm formation was evaluated using the crystal violet assay, and c-di-GMP levels were measured. A statistically significant linear regression was found between biofilm formation and c-di-GMP production (p = 0.016, R² = 0.18). Genetic analysis revealed the presence of biofilm-associated genes, including icaA, clfA, fnbA in S. aureus, and atlE, fbe in CoNS. Furthermore, there was a statistically significant difference in c-di-GMP production between strains harboring the icaA gene and strains without icaA (p = 0.016), while oxacillin resistance was detected more frequently in strains carrying fbe gene (p = 0.031). The study emphasizes the variability in antibiotic resistance profiles among staphylococcal isolates, underscoring the complexity of managing these infections. Full article

Background/Objectives: Resection arthroplasty is well established in treating bone defects following tumor resection, with the distal femur and proximal tibia being its most common localizations. The aim of this study was to analyze the functional outcomes and quality of life following endoprosthetic reconstruction for malignant bone tumors of the knee joint. Methods: We retrospectively included all patients treated with an endoprosthetic reconstruction following resection of a malignant bone tumor of the knee at our institution. Functional outcomes (KOOS, OKS, MSTS, and KSS) and health-related quality of life scores [QoL] (SF-36, Karnofsky Index) were evaluated. Chi-square and Fisher’s exact test was used for categorical variables, T-test and Whitney U-Mann tests for continuous variables. Survival was calculated using the Kaplan–Meier curves. Results: 32 patients were included. A total of 12 patients had died at the time of follow-up. Among the remaining 20 patients (m:w 17:3), mean follow-up was 8.1 years (range, 8.12 ± 6.8). Mean age at the time of tumor diagnosis was 50 ± 23.3 (10–83) years. According to age, patients were divided into two groups (group C1: <29 years, group C2: >29 years). Group C1 showed significantly better results regarding functional outcome (p < 0.05). The anatomic location of the replacement and a revision surgery did not influence the functional outcome (p > 0.05). QoL showed no significant differences in subgroup analysis (p > 0.05). Primary bone tumors had a significantly better survival (primary tumor: 216.90 months [168.42–265.83]; secondary tumor: 37.03 months [11.71–62.35] p = 0.01). Furthermore, pathologic fractures were associated with significantly worse survival (pathologic fracture: 50.24 months [0.00–102.43]; pathologic fracture 190.63 moths [139.28–241.45]; p = 0.007). Conclusions: Knee resection arthroplasty can offer meaningful long-term functional outcomes and acceptable quality of life in selected patients with musculoskeletal tumors. While the rarity and heterogeneity of such cases remain a challenge, our findings contribute to the growing evidence supporting this complex but limb-sparing surgical option. Full article

Background: Vitamin D deficiency represents a global health problem of enormous extent. It is estimated that around one billion people worldwide have inadequate vitamin D levels. This phenomenon is directly associated with negative impact on a variety of orthopaedic conditions. Further, there is now robust evidence that perioperative vitamin D levels in patients scheduled for total joint replacement (TJA) affect outcome and the healing process. To date, only few studies focus on vitamin D levels of patients scheduled for total arthroplasty of the upper extremity (shoulder and elbow). For this reason, the objective of this study is to determine the prevalence of vitamin D deficiency in this patient collective. Methods: In a monocentric cohort study, serum levels of 25-hydroxyvitamin D (25OHD) were measured preoperatively in all patients undergoing total shoulder or elbow arthroplasty. Demographic and perioperative data as well as comorbidities were recorded from medical records to assess for potential risk factors for hypovitaminosis D. Multivariate regression analyses were used to identify risk factors for vitamin D insufficiency and deficiency. Results: Collectively, 108 patients with total joint replacement of the upper extremity were included over a period of twelve months. Notably, 28.7% (31/108) of patients reported a regular intake of vitamin D supplements. 62.3% (19/31) of those had sufficient vitamin D levels, while 38.7% (12/31) had insufficient and further 6% (2/31) deficient vitamin D levels (<20 ng/mL). Remarkably, 87% of patients that did not report a regular vitamin D intake (n = 77) showed low serum vitamin D levels. In particular, 63.6% (49/77) were vitamin D deficient, 23.4% (18/77) vitamin D insufficient and only 13% of patients had vitamin D serum levels above or equal to 30 ng/mL that are considered sufficient (mean serum 25(OH)D = 36.4 ng/mL for vitamin D substitution vs. 18.4 ng/mL for no substitution; p < 0.0001). Moreover, vitamin D levels varied between seasons, with the lowest levels recorded in spring (OR = 4.32, p = 0.044) and the highest levels in summer (p = 0.005 vs. spring). Conclusion: Patients undergoing total shoulder or elbow arthroplasty have an increased risk profile for hypovitaminosis D (vitamin D supplementation had 94% lower odds of being deficient; OR = 0.06, p = 0.001). Seasonal circumstances at the point of arthroplasty seem to be a key risk factor for low vitamin D levels. For this reason, it would be advisable to consider preoperative serum vitamin D level measurement as an integral part of the regularly performed preoperative care. Full article

Background/Objectives: Avascular necrosis of the femoral head is a debilitating condition that, if left untreated, leads to progressive arthritis necessitating total hip replacement (THR). In the younger adult population, there is a drive towards joint-preserving procedures, particularly where alternative techniques such as core decompression or vascularised bone grafting are anticipated to fail. Proximal femoral osteotomy is a technique that aims to remove the necrotic segment from the weight bearing area. The presented review aims to examine the efficacy of this technique in the management of avascular necrosis of the femoral head, reporting both rates of conversion to total hip replacement and patient reported outcomes. Methods: This systematic review was conducted according to PRISMA guidelines. A search was conducted of PubMed, Ovid Medline, EMBASE, and the Cochrane Library using pre-defined search terms. Data were extracted, and descriptive data presented. Quality of each study was assessed using the NIH quality assessment tool for case series studies. Results: Fifty-three studies with data for 2686 osteotomies are presented. Progression of radiological arthrosis was present in 40% of cases, with 20.3% of patients having undergone conversion to THR at a mean of 75.4 months (range 20–132 months). Patient-reported outcome measures were recorded in 1416 patients, of which the Harris Hip Score was the most commonly utilised. This score improved from a mean of 58.3 to 84.4 at a mean follow-up of 102 months. Conclusions: Osteotomy represented a valid head-preserving technique in the armamentarium against avascular necrosis of the femoral head, with conversion to THR required in 20.3% of patients at 7 years. In those patients who did not require THR, PROMS were similar to the arthroplasty population. Full article

Total knee replacement (TKR) is a common procedure for pain relief and restoration of the mobility of the knee joint in patients with severe knee joint problems. Despite this, some patients still suffer from stiffness, instability, or pain caused by soft tissue imbalance, malalignment, or implant-related issues. Previously, surgeons have had to use their experience and visual judgment to balance the knee, which has resulted in variability of outcomes. Smart knee implants are addressing these issues by using sensor technology to provide real-time feedback on joint motion, pressure distribution, and loading forces. This enables more accurate intra-operative adjustment, enhancing implant positioning and soft tissue balance and eliminating post-operative adjustment. These implants also enable post-operative monitoring, simplifying the ability to have more effective individualized rehabilitation programs directed at optimizing patient mobility and minimizing complications. While the patient pool for smart knee implantation remains not commonly documented, it was found in a study that 83.6% of the patients would opt to have the monitoring device implemented, and nearly 90% find reassurance in monitoring their healing indicators. As the number of knee replacements is likely to rise due to aging populations and the rising prevalence of joint disease, smart implants are a welcome development in orthopedics, optimizing long-term success and patient satisfaction. Smart knee implants are built with embedded sensors such as force, motion, temperature, and pressure detectors placed within the implant structure. These sensors provide real-time data during surgery and recovery, allowing earlier detection of complications and supporting tailored rehabilitation. The design aims to improve outcomes through better monitoring and personalized care. Full article