Search Results (1,134)

Background: Frailty is a key predictor of adverse surgical outcomes in older adults. However, the prognostic utility of the 5-factor modified frailty index (mFI-5) for short- and long-term outcomes following total hip arthroplasty (THA) remains inadequately defined. This study assessed the association between frailty severity, measured by the mFI-5, and postoperative complications, implant survivorship, and mortality following primary THA in a large national cohort. Methods: This retrospective cohort study included 90,660 patients aged ≥50 years undergoing primary THA for osteoarthritis from 2003 to 2020 using the TriNetX research network. Patients were stratified by frailty severity based on mFI-5 scores: non-frail (0–1), moderately frail (2), and severely frail (≥3). Cases of fractures, polytrauma, or falls were excluded. Pairwise propensity score matching was adjusted for age, sex, race, and BMI. Outcomes included 90-day medical and surgical complications, healthcare utilization, and 2- and 5-year THA revision and mortality rates. Risk ratios (RRs) with 95% confidence intervals (CIs) and Bonferroni-corrected significance thresholds (p < 0.0167) were reported. Results: Severely frail patients had significantly increased risks of 90-day mortality (RR 4.41, 95% CI 2.22–8.74), acute kidney injury (RR 2.92), myocardial infarction (RR 3.61), and periprosthetic joint infection (RR 2.02) compared to non-frail patients. At five years, severely frail patients demonstrated a 58% higher revision risk (RR 1.58) and 23.0% mortality versus 6.9% in the non-frail cohort. A dose-dependent risk gradient was observed, with moderately frail patients exhibiting intermediate risks across all outcomes. Conclusions: Frailty severity, as measured by the mFI-5, was associated with a stepwise increase in short- and long-term complications and mortality following THA. The mFI-5 may serve as a practical, scalable tool for preoperative risk stratification, counseling, and resource planning in older adults undergoing primary THA. Full article

Background/Objectives: Hypoalbuminemia is a marker of poor nutritional status and has been associated with increased postoperative complications following total joint arthroplasty. However, its long-term implications in the revision total hip arthroplasty (THA) population are poorly characterized, and the utility of prealbumin to further risk-stratify these patients remains unclear. We aimed to study the association between preoperative hypoalbuminemia and complications after rTHA. Methods: We identified patients who underwent rTHA with preoperative albumin levels obtained within one month of surgery. Patients were divided into hypoalbuminemia (<3.5 g/dL) and normal albumin (3.5–6.0 g/dL) cohorts. A second analysis was conducted stratifying hypoalbuminemia patients by prealbumin level (<16 mg/dL vs. ≥16 mg/dL), measured within two weeks of surgery. Each cohort was 1:1 propensity score matched with a 1:1 nearest-neighbor greedy matching approach with a 0.10 standard deviation (SD) caliper, following a logistic regression to calculate patient propensity scores. Outcomes were compared at 90-day, 2-year, and 5-year intervals. Results: The matched cohorts included 4137 patients in both the hypoalbuminemia and normal-albumin groups. Hypoalbuminemia was significantly associated with increased short-term rates of any adverse event (38.9% vs. 22.5%; OR 2.195), wound dehiscence (5.4% vs. 3.1%; OR 1.808), surgical site infection (10.7% vs. 5.0%; OR: 2.271), and periprosthetic fracture (13.9% vs. 10.2%; OR: 1.414). Repeat revision THA was significantly more common within 90 days (6.6% vs. 4.5%; OR: 1.490). Periprosthetic fracture and prosthetic loosening were also more common within 2 years and 5 years (q = 0.001). There were no differences in repeat rTHA within 2 years and 5 years. Among hypoalbuminemic patients with prealbumin data, stratification by prealbumin level did not demonstrate any statistically significant differences in 90-day, 2-year, and 5-year complications. Conclusions: Hypoalbuminemia is a strong indicator of increased complication risk after rTHA, with increased risk for complications lasting to at least 5 years postoperatively. However, prealbumin stratification among hypoalbuminemic patients did not differentiate complication risk. These findings support preoperative albumin as a practical biomarker for risk stratification in rTHA patients. Full article

Background/Objectives: This study aimed to evaluate the femoral rotation angle (FRA) before and after THA using a single approach and to identify its influencing factors through three-dimensional measurements. Methods: This retrospective study analyzed patients undergoing 108 primary unilateral THA via the anterolateral-supine approach (ALSA) from May to October 2023. Patients with hip contractures, femoral deformities, or other specific conditions were excluded for precise FRA measurements. Preoperative and postoperative CT scans were used for measurements of the FRA, anteversion, leg lengthening, and global offset. FRA was defined as the angle between the posterior condylar line and the line connecting the bilateral anterosuperior iliac spines, with external rotation as positive. Multiple linear regression, adjusted for age, sex, body mass index, and stem design, assessed the influence of anteversion change, leg lengthening, global offset change, and soft tissue release on the difference in FRA. Results: The mean FRA changed significantly from −2.8° preoperatively to −11.8° postoperatively (p < 0.001), demonstrating an average internal rotation of 9.0° after THA. Anteversion increased by a mean of 9.0° (p < 0.001), leg length increased by 9.0 mm (p < 0.001), and global offset decreased by 1.7 mm (p < 0.001). Multivariate analysis revealed that anteversion change (β = −0.41, p < 0.001) and global offset change (β = 0.40, p = 0.022) were significantly associated with FRA differences. Leg lengthening and ischiofemoral ligament or conjoint tendon resection were not significant (p = 0.089, p = 0.917, and p = 0.750, respectively). Conclusions: ALSA THA significantly rotates the femur internally, associated with an increase in anteversion and a decrease in global offset. Full article

Background: Surgical management of adult patients with post-dysplastic coxarthrosis using total hip arthroplasty is technically demanding and carries an increased risk of complications. In cases of high iliac dislocation classified as Crowe type IV, restoring the acetabular component to the anatomical hip centre often requires femoral shortening osteotomy to enable safe reduction in the prosthetic joint. Nevertheless, long-term evidence on functional outcomes and prosthesis survival with this approach is limited. Methods: A retrospective cohort study included 19 patients with 22 cases of Crowe type IV post-dysplastic hip osteoarthritis treated with uncemented total hip arthroplasty (Pinnacle/S-ROM, DePuy, Warsaw, IN, USA) combined with transverse subtrochanteric femoral shortening osteotomy. Patients underwent serial clinical follow-up, including assessment of range of motion, measurement of limb-length discrepancy, and functional evaluation using the Harris Hip Score and the WOMAC questionnaire. Radiological assessment included evaluation of osteotomy union, implant positioning, and osteolysis on standardized radiographs. Vertical distances of the centre of rotation (CR), the tip of the greater trochanter (GT), and the tip of the lesser trochanter (LT) from both reference lines were measured bilaterally, and inter-side differences were calculated. The reference lines consisted of the line connecting the inferior margins of the ischial bones and the teardrop (TD) line. Results: All osteotomies united at a mean of 5.57 months, with a mean follow-up of 129 months. Mean limb-length discrepancy decreased from 5.27 cm to 1.5 cm, and mean hip flexion improved from 82.9° to 106°. Functional outcomes improved significantly, with mean WOMAC increasing from 55.4 to 80.1 (p < 0.001) and mean Harris Hip Score from 49.8 to 84.66 at up to 3 years of follow-up (p < 0.001). Osteotomy length correlated strongly with lesser trochanter–teardrop distance (p = 0.00000048). Complications included distal femoral fissure (27.3%) and revision (18%), with no infection or permanent neurological deficit. Conclusions: Total hip arthroplasty combined with subtrochanteric femoral shortening osteotomy for Crowe type IV post-dysplastic hip osteoarthritis appears to be a feasible and effective procedure in an experienced centre, providing reliable osteotomy healing and significant early functional improvement that is sustained over time. Limb-length discrepancy was reduced and satisfactory biomechanical restoration was achieved, with an acceptable complication profile and implant survival of 81.3% at long-term follow-up. The LT–TD parameter was identified as a potential predictor of osteotomy length, enabling the proposal of a preoperative planning equation. However, given the limited sample size and lack of validation, these findings should be interpreted cautiously. Further studies are needed to confirm their broader applicability. Full article

Musculoskeletal disorders (MSDs) among orthopaedic surgeons are associated with sustained, constrained postures during demanding intraoperative tasks. Total hip arthroplasty (THA) comprises sequential steps that may impose different postural loads on both the surgeon and assistant, yet team-level ergonomic design interventions remain underexplored. This study compared ergonomic risk during primary THA performed through the direct lateral (modified Hardinge) and posterolateral (Moore) approaches and assessed a simple workflow redesign: swapping surgeon and assistant positions during acetabular cup preparation (bottom reaming, perimeter reaming, and cup impaction). In a controlled Sawbones-based simulation using standard THA instruments, eight standardised surgical steps were recorded with 360° photographs. Forty-two postural instances (22 for the surgeon, 20 for the assistant) were analysed. Joint angles were measured with Kinovea and converted to Rapid Entire Body Assessment (REBA) scores; intra- and inter-rater reliability (ICC) and minimum detectable change (MDC95) were calculated. Surgeon REBA scores were in the medium-risk range and slightly lower with the posterolateral approach (mean 5.5) than with the direct lateral approach (mean 5.88), whereas assistant scores were in the low-risk range (means 3.43 and 3.29, respectively). The position-swap intervention successfully lowered the surgeon’s REBA action level, most notably during cup impaction, where ergonomic risk dropped from 10 (high risk) to 4 (medium risk) in the posterolateral approach, and from 7 (medium risk) to 3 (low risk) in the direct lateral approach, without increasing assistant risk. These findings provide controlled simulation-based evidence that this simple, zero-cost positional change can reduce the surgeon’s ergonomic action level during THA, although confirmation under real operative conditions is needed before broad generalization. Full article

Background and Objectives: Medial unicompartmental knee arthroplasty (UKA) has emerged as an effective surgical option for isolated medial compartment osteoarthritis (OA), offering advantages in bone preservation, knee kinematics, and postoperative recovery compared with total knee arthroplasty (TKA). Although numerous studies have evaluated the mid- to long-term outcomes of UKA, reports focusing on cohorts with follow-up periods exceeding 10 years remain relatively limited. The purpose of this study was to analyze the long-term clinical and radiological results of medial fixed-bearing UKA using the Miller-Galante prosthesis. Methods: Sixty-eight patients who underwent UKA at a single institution with at least 10 years of follow-up were retrospectively reviewed. Clinical outcomes were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and knee range of motion (ROM). Radiological parameters including the hip-knee-ankle axis angle (HKA) and osteoarthritis (OA) grade using the Kellgren-Lawrence (K-L) grading system were evaluated. Implant survivorship was evaluated using Kaplan–Meier survival analysis. Results: A total of 68 patients were included with a mean age of 56.8 ± 7.5 years at surgery and a mean follow-up of 170.9 ± 37.3 months. Significant improvement in the WOMAC score was observed from 48.9 ± 17.2 preoperatively to 23.8 ± 27.7 at final follow-up (p = 0.002). The cumulative survival rates were 97.1% at 10 years and 84.8% at 15 years with conversion to total knee arthroplasty as the endpoint. Significant improvement in the HKA was observed from 172.5° ± 4.4° to 174.3° ± 4.8° postoperatively (p = 0.002), though residual varus alignment persisted. Progressive OA was observed in the lateral tibiofemoral and patellofemoral compartments (both p < 0.001) but showed no correlation with the WOMAC score. The failure group showed trends toward higher body mass index (BMI) and smaller preoperative HKA angle compared to the non-failure group. Conclusions: The long-term outcomes of medial fixed-bearing UKA using the Miller–Galante prosthesis were generally favorable, with significant functional improvement and acceptable implant survivorship. Although overall varus alignment was corrected, some residual varus deformity remained, and OA progression was observed in the lateral tibiofemoral and patellofemoral compartments over time. However, given the retrospective design and limited sample size, these findings should be interpreted with caution. Full article

Background/Objectives: Osteoporosis and osteoarthritis are age-related musculoskeletal disorders with a high socio-health burden, affecting both healthcare systems and individuals’ quality of life. Both conditions are generally accompanied by a concomitant decline in muscle mass and strength, referred to as sarcopenia. In this context, tensiomyography emerges as a novel, non-invasive potential diagnostic strategy for assessing muscle quality, as this parameter influences the progression of both conditions. Methods: Histomorphometric and immunohistochemical analyses were performed on vastus lateralis muscle tissue obtained from patients undergoing surgery for femoral fracture affected by osteoporosis or osteopenia, patients operated for hip osteoarthritis, and patients undergoing hip arthroplasty for osteoarthritis, concomitantly affected by osteoporosis or osteopenia. In addition, muscle function was assessed in these patients using tensiomyographic analysis. Results: In osteoarthritic, osteoporotic, and osteopenic patients, a reduction in muscle quality and function was observed compared with the other two experimental groups, indicating an unfavorable effect of the coexistence of the two conditions on the muscular component. Furthermore, contraction time (Tc) measured by tensiomyography was negatively correlated with lumbar spine bone mineral density values and positively correlated with the percentage of type II muscle fibers. Conclusions: This study highlights how tensiomyography may represent a valuable non-invasive diagnostic strategy for assessing muscle status in osteoporotic and osteoarthritic patients, as it is able to detect muscle alterations that parallel the worsening of bone status and that cannot be inferred from simple biopsy analysis. Thus, tensiomyography could be considered a practical adjunct tool in the clinical assessment of musculoskeletal frailty. Full article

Osteoarthritis (OA) represents a degenerative joint disease which advances through cartilage breakdown, synovial inflammation, and subchondral bone transformation until it causes persistent pain and mobility loss. The scientific community lacks complete knowledge about OA disease mechanisms and post-operative healing processes despite arthroplasty surgery providing effective symptom relief. This study investigated plasma proteomic changes in OA patients before and after arthroplasty. The cohort included eight OA patients undergoing knee or hip arthroplasty and ten age-, sex-, and body mass index-matched healthy controls. Plasma proteins were analyzed using liquid chromatography–tandem mass spectrometry following enzymatic digestion and depletion of high-abundance components. The bioinformatic analysis together with quantitative methods showed that OA patients experienced changes in inflammatory pathways, extracellular matrix remodeling, immune system regulation and coagulation processes. A total of 93 proteins were differentially abundant in the pre-operative comparison. Among these, 63 proteins were consistently up-regulated and 23 were consistently down-regulated across both pre- and post-operative time points. In addition, 20 proteins exhibited post-operative-specific changes. These findings highlight both persistent disease-associated alterations and transient proteomic shifts linked to post-operative recovery. Overall, this study identifies candidate plasma proteomic signatures associated with OA and surgical intervention, providing exploratory insights into disease monitoring and potential personalized therapeutic strategies. Full article

Birmingham hip resurfacing (BHR) is an alternative to bone-sparing total hip arthroplasty; however, failures may be associated with the cementing technique. This study aimed to evaluate the characteristics of the cement layer and potential failure mechanisms. BHR explants were analyzed using radiographic evaluation, stereomicroscopy, scanning electron microscopy (SEM), and histopathology. The cement layer was nonuniform, with excessive thickness in the dome regions and insufficient lateral coverage. Increased cement penetration values exceeded recommended thresholds. SEM analysis revealed inhomogeneous cement with cracks, air inclusions, and loosening at the cement–prosthesis interface. BHR failure may be associated with a complex interplay between cementation parameters, cement mantle morphology, and the biological response at the bone–cement interface, as well as interactions at the cement–prosthesis interface. Microscopic evaluation may provide valuable insights into the mechanisms potentially contributing to BHR prosthesis failure. Full article

Background and Objectives: Hip and knee replacement joint surgeries are experiencing constant growth, and anticipating future needs allows decision-makers and stakeholders involved in the healthcare system to allocate the necessary resources for safe and effective services. The objective of this study is to estimate the volumes of primary and revision hip and knee surgeries expected to be performed in Romania by 2060. Materials and Methods: We used data from the Romanian Arthroplasty Register regarding the total volume of primary hip replacement surgery (cumulative n = 51,252 across five years), hip revision surgery (cumulative n = 3579), primary knee replacement surgery (cumulative n = 32,283), and knee revision surgery (cumulative n = 943) performed in 2017–2019, 2023 and 2024—the last five years of complete registrations, excluding the pandemic period. We projected future numbers of hip and knee primary and revision surgeries using the arithmetic mean of annual procedure rates observed during the study period, combined with the average annual trend in these rates. Projections were stratified by age group (0–39, 40–49, 50–59, 60–69, 70–79, and ≥80 years) and sex and were applied to population forecasts from the National Institute of Statistics of Romania up to 2060. Results: By 2060, primary hip replacement surgery volumes will increase by 40.14% relative to 2024 levels (from 13,526 in 2024 to 18,965 in 2060), and primary knee replacement surgery volumes will increase by 79.78% (from 9003 in 2024 to 16,186 in 2060). Revision hip surgery volumes will increase by 42.02% (from 759 in 2024 to 1078 in 2060), and revision knee surgery volumes will increase by 109.25% (from 227 in 2024 to 475 in 2060). The largest relative increases are concentrated in patients aged ≥80 years, with projected growth substantially exceeding those in younger age groups across all procedure types and both sexes. These percentages represent the projected growth in procedure volumes for this age group compared with 2024 baseline volumes. Conclusions: By 2060, we project substantial increases in all arthroplasty procedure types in Romania, with the most pronounced growth among patients aged ≥80 years. Given that resource utilization and morbidity are higher in this population, the increased demand for medical interventions requires advance planning, which will have significant implications for the healthcare system. Full article

Background: To our knowledge, the effect of Goreisan on edema following total hip arthroplasty (THA) has not been investigated, and its clinical efficacy in this context remains unclear. Methods: To elucidate these issues, we conducted a retrospective comparative study of 149 patients who underwent primary THA at our institutions, with group allocation based on treatment period. Patients were divided into control (n = 77, mean ± standard deviation age: 66.8 ± 9.8 years; 56 females) and Goreisan (n = 72, age: 65.6 ± 9.7 years; 53 females) groups, based on whether Goreisan was administered postoperatively for 7 days (2.5 g, three times daily). The primary outcome was CT-based postoperative swelling, assessed by thigh circumference and cross-sectional area, whereas pain and blood loss were evaluated as secondary outcomes. Correlation and multiple regression analyses were also conducted. Results: The postoperative blood loss was lower in the Goreisan group (451.2 ± 256.8 mL vs. 553.6 ± 301.9 mL, p = 0.036). The differences in thigh circumference and area were larger in the control group (+13.5 ± 12.6 mm vs. +1.9 ± 12.7 mm, p < 0.001; +11.1 ± 9.5 cm² vs. +2.7 ± 9.3 cm², p < 0.001). The enlargement ratios of thigh circumference and area were higher in the control group (+3.0 ± 2.96% vs. +0.41 ± 2.86%, p < 0.001; +6.96 ± 6.95% vs. +1.63 ± 5.70%, p < 0.001). Motion pain on postoperative day 7 was lower in the Goreisan group (1.71 vs. 2.18, p = 0.037). The differences and enlargement ratios of both the thigh circumference and area were associated with motion pain on postoperative days 1 and 7. In both cases, the correlations were stronger for circumference-related parameters than those for area-related parameters. Conclusions: These findings suggest that Goreisan may be associated with reduced postoperative swelling and pain after THA, although the results are observational and hypothesis-generating. Full article

Background: Gait re-education is one of the key elements of comprehensive rehabilitation after total hip replacement. Recent technological advancements allow patients to benefit from increasingly sophisticated training solutions based on biofeedback. The aim of this study was to assess the impact of a treadmill training protocol with a digital biofeedback component on the gait parameters of patients after an uncomplicated total hip replacement and on their functional status. Methods: The study included 137 patients after total hip replacement. In the control group, traditional walking training with biofeedback in the form of a mirror was used. In the study group, the Biodex Gait Trainer 3 treadmill was used for this purpose, which also served as a diagnostic tool for both groups. The following parameters were assessed: distance, average walking speed, average step cycle, step length, coefficient of variability and time on each foot. Additionally, the study included the Timed Up & Go (TUG) test and the use of orthopedic supplies. Results were considered statistically significant at p < 0.05. Results: Significant statistical differences were found between the groups in terms of distance, average walking speed, and step length. Additionally, significantly shorter TUG times were observed and a higher rate of discontinuation of orthopedic supplies in the study group. However, the therapy method did not have a significant effect on the average step cycle, coefficient of variability or time on each foot. These parameters showed comparable improvement in both groups. Conclusions: Treadmill training with visual biofeedback has a positive effect on certain gait parameters. The greatest benefits from this type of training can be gained by patients with deficits in stability and mobility in space. Full article

Background: Periprosthetic joint infection and native hip infections often require staged surgical intervention due to extensive bone and soft tissue destruction. This study evaluates the clinical feasibility and mechanical reliability of a modified functional articulating hip spacer (FAHS) incorporating a cemented dual-mobility-bearing (DMB) metal liner. Methods: We retrospectively reviewed the cases of 20 patients who underwent a DMB-incorporated FAHS between March 2018 and December 2019. The technique involved cementing a DMB metal liner directly into the prepared acetabulum without a standard outer shell. Successful clinical outcome was defined as either transition to second-stage total hip arthroplasty (THA) or stable spacer retention, the latter including cases with definitive eradication or symptom-controlled chronic suppression therapy. Infection eradication required the clinical absence of infection for at least twelve months following the cessation of antimicrobial therapy. Construct-related mechanical complications and radiographic parameters were also analyzed. Results: The mean follow-up was 23.5 months, ranging from 6.0 to 62.6 months. Successful clinical outcome was achieved in 17 patients (85%), with seven (35%) transitioning to second-stage THA and ten (50%) opting for spacer retention. Within the retention group, seven achieved definitive eradication while three were maintained under chronic suppression therapy. Construct integrity was maintained in 80% of the cohort. Mechanical complications included two dislocations (10%) and two implant failures (10%). Radiographic analysis showed higher inclination and anteversion angles of the metal liner in the dislocation cases. Conclusions: The off-label use of DMB-incorporated FAHS represents a feasible option with acceptable mechanical performance in selected cases of PJI and native hip joint infection. However, as mechanical complications cannot be fully prevented, meticulous surgical techniques and careful patient selection remain essential. Full article

Background: Medical progress and sustainability pressures have made reducing hospital Length Of Stay (LOS) for total joint arthroplasty increasingly feasible and necessary. Monitoring rehabilitation duration and outcomes after surgical ward discharge needs equal attention. The aim of this retrospective, cohort study is to evaluate perioperative predictors of Inpatient Rehabilitation LOS (IRLOS), Discharge Destination (DD) (home versus residential care unit) and Need for Assistance at Discharge (NAD), in patients undergoing inpatient rehabilitation after total hip or knee arthroplasty in a high-volume, specialized research hospital. Methods: Electronic hospital datasets were employed to identify all adults with hip or knee osteoarthritis who received specialistic inpatient rehabilitation after total joint replacement between January and December 2019. Associations between demographic, clinical, surgical and functional variables and postoperative outcomes were examined using binary logistic regression for dichotomous outcomes (DD, NAD) and linear regression for continuous outcomes (IRLOS). Results: Based on a cohort of 1679 patients, we found various patient-related (age, working status, living alone, pre-existing comorbidities, osteoarthritic characteristics), surgical (duration of intervention, LOS, joint approach) and postoperative (hemoglobin levels, functional status) predictors. Overall, the regression models explained a modest but meaningful proportion of the variability in rehabilitation duration and post-discharge outcomes (R² ranging from 0.12 to 0.34), resulting in marginal changes compared to a preliminary version of the same study on a smaller dataset. Conclusions: External validation on another cohort from the same hospital could be used to test the model’s predictivity at the local level, supporting the continuity of care between an orthopedic hospital hub and outpatient care and rehabilitation. Gains in predictive capacity may follow from including local factors like the operating surgeon and team. Although these factors could significantly improve the model performance at the local level, they would not be generalizable in different settings. Full article

Total hip arthroplasty (THA) reliably restores function, yet instability remains a clinically relevant complication. Increasing evidence indicates that postoperative stability is strongly influenced by the dynamic spine–pelvis–hip interaction, which modulates functional acetabular orientation across postures. This narrative review summarizes current evidence on postoperative spinopelvic alignment changes after THA with emphasis on temporal patterns, underlying mechanisms, and predictive factors. Early after THA, restoration of hip motion can partially normalize hip-driven compensatory patterns, however substantial interindividual variability persists. Mid- to long-term follow-up shows that pelvic orientation continues to evolve, particularly progressive posterior pelvic tilt in standing, largely driven by aging and spinal degeneration, with acceleration in older patients and those with spinal pathology. Prediction of postoperative pelvic behavior requires integrated assessment of pelvic orientation, spinal alignment and mobility, contralateral hip status, and whether imbalance is hip-driven versus spine-driven. Although classification- and model-based approaches can estimate postoperative pelvic tilt, clinically meaningful prediction uncertainty remains, supporting a strategy focused on risk stratification and adaptive preoperative planning. Full article