Search Results (236)

Background: Depression has been identified as an important determinant of outcomes in hip and knee arthroplasty, but its impact on total ankle arthroplasty (TAA) remains unclear. Given the growing use of TAA as a treatment for end-stage ankle arthritis, understanding psychosocial risk factors is critical for optimizing surgical outcomes. This study aims to assess the effect of preoperative depression on clinical and functional outcomes following total ankle arthroplasty. Methods: A systematic review was conducted in accordance with PRISMA guidelines and prospectively registered with the Open Science Framework. PubMed, Cochrane Library, and CINAHL were searched through August 2025 for studies reporting outcomes of TAA stratified by depression status. Eligible designs included randomized trials, cohort studies and case series. Risk of bias was assessed using the Newcastle–Ottawa Scale (NOS). Given heterogeneity in study designs, depression definitions, and outcome measures, findings were synthesized narratively and summarized using a revised effect-direction plot. Results: Six unique studies involving approximately 9000 patients met inclusion criteria. Five studies were rated as good quality on the Newcastle–Ottawa Scale, while one study was judged to be of moderate quality. Four studies assessing pain outcomes consistently demonstrated worse postoperative pain or less improvement in patients with depression. Three of five studies assessing functional or disability outcomes reported reduced improvement, while two studies found no independent association. Two studies evaluating complications showed higher risks of adverse events, including prolonged hospital stay, non-home discharge, osteophytosis, and implant subsidence, among depressed patients. Revised effect-direction synthesis confirmed a consistent trend toward poorer outcomes across pain, function, and complication domains. Conclusions: Depression is associated with worse pain and higher complication rates following TAA, while its influence on functional recovery was not demonstrated uniformly. These findings support the importance of routine preoperative screening and targeted management of depression. Further prospective, multicenter studies and interventional trials are needed to clarify causality and optimize perioperative care. Full article

Non-communicable diseases (NCDs) are the leading global cause of death, causing over 43 million deaths in 2021, including 18 million premature deaths, disproportionately affecting low- and middle-income countries. NCDs also incur significant economic losses, estimated at USD 7 trillion from 2011 to 2025, despite low prevention costs. This study evaluated body mapping indicators: body mass index (BMI), waist circumference, and waist-to-hip ratio—for predicting NCD risk, including hypertension, diabetes, and cardiovascular diseases, using data from a nationally representative survey in Ghana. The study sampled 5775 participants via multistage stratified sampling, ensuring proportional representation by region, urban/rural residency, age, and gender. Ethical approval and informed consent were obtained. Anthropometric and biochemical data, including height, weight, waist and hip circumferences, blood pressure, fasting glucose, and lipid profiles, were collected using standardized protocols. Data analysis was conducted with STATA 17.0, accounting for complex survey design. Significant sex-based differences were observed: men were taller and lighter, while women had higher BMI and waist/hip circumferences. NCD prevalence increased with age, peaking at 60–69 years, and was higher in females. Lower education and marital status (widowed, divorced, separated) correlated with higher NCD prevalence. Obesity and high waist circumference strongly predicted NCD risk, but individual anthropometric measures lacked screening accuracy. Integrated screening and tailored interventions are recommended for improved NCD detection and management in resource-limited settings. Full article

Background: Postoperative cognitive dysfunction (POCD) is a prevalent complication in elderly patients undergoing hip fracture surgery, often resulting in increased morbidity and prolonged rehabilitation. Biomarkers such as Neuron-Specific Enolase (NSE) and S100B protein have shown potential in detecting cerebral injury, yet their role in predicting long-term cognitive decline remains unclear. This study aimed to evaluate the association between biomarkers serum levels and the incidence of POCD in elderly patients undergoing proximal femur fracture surgery. Methods: A multicentric prospective observational study was conducted from January 2023 to February 2024, including 146 elderly patients with hip fractures treated surgically at ASL Bari and the University Orthopedic Department of Foggia. Biomarker levels of NSE and S100B were measured preoperatively (T0), at three days post-surgery (T1), and at one-year follow-up (T2). Cognitive function was assessed using the Pfeiffer Scale (PS) and the Mini-Mental State Examination (MMSE). Statistical analysis was performed using U Mann–Whitney tests and logistic regression to identify risk factors. Results: At three days post-surgery, 20.5% of patients exhibited POCD, with no significant differences in NSE and S100B levels compared to baseline. However, at one year, of the 96 patients investigated 37.9% of patients showed cognitive decline, with significantly elevated NSE (19.88 ± 4.03 μg/L) and S100B (1.86 ± 0.9 μg/L) compared to non-POCD patients (p = 0.01). Risk factors for long-term POCD included older age (OR: 1.24), diabetes mellitus (OR: 4.41), and lower baseline cognitive function (MMSE and PS scores, OR: 0.25 and 9.81, respectively). Conclusions: The study demonstrates that while early POCD is not associated with significant changes in NSE and S100B levels, their elevation at one-year follow-up suggests a possible correlation with chronic neuroinflammation and persistent neuronal damage. Preoperative cognitive impairment, advanced age, and diabetes mellitus are significant predictors of long-term cognitive decline. Incorporating biomarker evaluation and cognitive screening into perioperative management may enhance patient outcomes following hip fracture surgery. Full article

The diagnosis of early-stage osteoarthritis (eOA) is important in disease management and outcomes. Herein we report the clinical validation of a blood test for the diagnosis of eOA in a large patient cohort using trace-level glycated and oxidized amino acid analytes. Subjects were recruited and enrolled in two study groups: subjects with eOA of the hip (n = 110) and asymptomatic controls (n = 120). Their plasma was analyzed for glycated and oxidized amino acids by quantitative liquid chromatography–tandem mass spectrometry. Algorithms were developed using plasma hydroxyproline and 12 glycated and oxidized amino acid analyte features to classify the subjects with eOA and asymptomatic controls. The accuracy was defined as the percentage of the subjects correctly classified in the test set validation. The minimum number of analyte features required for the optimum accuracy was five glycated amino acid analytes: N_ω-carboxymethyl-arginine, hydroimidazolones derived from glyoxal, methylglyoxal and 3-deoxyglucosone, and glucosepane. The classification performance metrics included an accuracy of 95%, sensitivity of 96%, specificity of 94%, area under the curve of the receiver operating characteristic curve of 99%, and positive and negative predictive values of 94% and 97%. We concluded that an assay of five trace-level glycated amino acids present in plasma can provide a simple blood test for the screening of eOA. This is predicted to improve the case identification for expert referral 9-fold. Full article

Ultrasound examination using the Graf method is widely applied for early detection of developmental dysplasia of the hip (DDH), but intra- and inter-operator variability remains a limitation. This study aimed to quantify operator variability in hip ultrasound assessments and to validate an AI-assisted system for automated α-angle measurement to improve reproducibility. Thirty participants of different experience levels, including trained clinicians, residents, and medical students, each performed six ultrasound scans on a standardized infant hip phantom. Examination time, iliac margin inclination, and α-angle measurements were analyzed to assess intra- and inter-operator variability. In parallel, an AI-based system was developed to automatically detect anatomical landmarks and calculate α-angles from static images and dynamic video sequences. Validation was conducted using the phantom model with a known α-angle of 70°. Clinicians achieved shorter examination times and higher reproducibility than residents and students, with manual measurements systematically underestimating the reference α-angle. Static AI produced closer estimates with greater variability, whereas dynamic AI achieved the highest accuracy (mean 69.2°) and consistency with narrower limits of agreement than manual measurements. These findings confirm substantial operator variability and demonstrate that AI-assisted dynamic ultrasound analysis can improve reproducibility and reliability in routine DDH screening. Full article

Developmental dysplasia of the hip (DDH) is a common neonatal musculoskeletal disorder. In Germany, sonographic screening is recommended at 1–10 days of life for neonates with specific risk factors. This study aims to determine reference values for early sonographic screening and to evaluate associated risk factors. Between 2007 and 2022, 3383 neonates (6766 hips) underwent hip ultrasound according to Graf. Of these, 967 neonates were screened universally (2007–2015) and 1900 based on predefined risk factors (2015–2022). DDH was defined as ≥type IIc, according to Graf. A subgroup of 20 neonates with borderline alpha angles (51–52°) was followed up after 3–6 weeks. The mean alpha angle was 61.2° ± 5.3° (range 50.5–71.9°), and beta angle 70.8° ± 8.6° (range 53.6–88.0°). DDH prevalence was 2.5% in the universal and 3.2% in the risk-based cohort (p = 0.350). Logistic regression revealed associations with abnormal birth presentation (OR = 3.09, p < 0.001) and female sex (OR = 3.77, p < 0.001), not with Cesarean section or familial predisposition. In the follow-up subgroup, all hips showed a sufficient maturation to an alpha angle of 61.0° (range 57–66°). This study provides reference values for early DDH screening and confirms abnormal birth presentation and female sex as relevant risk factors. Full article

Background/Objectives: Back pain is increasingly prevalent during childhood and adolescence, often predicting adult spinal disorders. This study aimed to describe sex-specific anthropometric and “Postural Fitness” characteristics in school-aged children and adolescents and to introduce a standardized, field-based assessment protocol for early screening of postural and functional deficits. Methods: This cross-sectional study included a total of 494 students (8–17 years; 50% girls) from 14 schools in Murcia (Spain). Exclusion criteria included diagnosed spinal pathology or major physical injury, lack of signed informed consent, absence on the testing day, and incomplete Postural Fitness assessment. The “Postural Fitness” protocol included assessments of sagittal spinal alignment (inclinometer), hip range of motion (ROM) (inclinometer with an extendable telescopic arm), pelvic tilt (goniometer with a spirit level system), and trunk muscle endurance (chronometer). Tests were conducted in physical education sessions by trained sports scientists. Results: Significant sex-based differences were observed. Boys exhibited greater thoracic kyphosis (40.3 ± 9.6° vs. 36.7 ± 9.2°), reduced hip ROM (passive hip extension (PHE): 16.8 ± 8.1°, passive hip flexion with knee extension (PHFKE): 68.9 ± 8.6°), and more posterior pelvic tilt (104.9 ± 8.4° vs. 99.7 ± 8.1°), whereas girls demonstrated increased lumbar lordosis (35.7 ± 8.6° vs. 31.5 ± 8.5°), greater hip ROM (PHE: 18.5 ± 9°, PHFKE: 77.9 ± 13°), and superior trunk extensor endurance (123.2 ± 74.7 s vs. 106.2 ± 69.8 s). Lateral trunk muscle endurance was higher in boys (48.7 ± 31 s vs. 41.4 ± 24.9 s). Conclusions: The “Postural Fitness” protocol proved feasible in school settings and revealed key sex-based disparities in spinal and neuromuscular profiles. These findings highlight the need for individualized, sex-specific screening and preventive programs to enhance back health during growth. Implementing this protocol may support early identification of modifiable risk factors linked to spinal dysfunction and pain in youth. Full article

Sensation seeking represents a significant risk factor for various mental health disorders and maladaptive behaviors, highlighting the need for objective assessment methods that circumvent the limitations of traditional self-report measures. This study introduces an innovative digital phenotyping approach that combines computational gait analysis with machine learning (ML) to quantify sensation-seeking traits and examines its validity. Natural gait sequences (using a Sony camera at 25 FPS) and self-report measures (Brief Sensation-Seeking Scale for Chinese, BSSS-C) were collected from 233 healthy adults. Computer vision processing through OpenPose extracted 25 skeletal keypoints, which were subsequently transformed into a hip-centered coordinate system and denoised using Gaussian filtering. From these kinematic data, 300 temporospatial gait features capturing various aspects of movement dynamics were derived. Using a supervised ML approach with feature selection, three ML models (SMO Regression, Multilayer Perceptron, and Bagging) were developed and compared through 10-fold cross-validation. The SMO Regression model demonstrated superior performance (r = 0.60, MAE = 3.50, RMSE = 4.59, R² = 0.26), outperforming the other approaches. These results establish proof-of-concept for gait-based digital phenotyping of sensation seeking, offering a scalable, objective assessment paradigm with potential applications in clinical screening and behavioral research. The methodological framework presented here advances the field of behavioral biometrics by demonstrating how computer vision and ML can transform basic movement patterns into meaningful psychological indicators. Full article

Purpose: We aimed to systematically review the current literature on the bond strength between custom tray materials and impression materials, including the various parameters affecting the strength. Methods: Four electronic databases were used: Ovid, Web of Science, PubMed, and Scopus. Relevant studies were chosen based on their eligibility, determined through inclusion and exclusion criteria. This review followed the PRISMA strategy. A risk of bias assessment was produced to evaluate the validity of each study. Results: There were 173 initial relevant studies identified, and after the screening process, this was reduced to seven. Two additional studies were also included from hand searching, resulting in total nine studies to be included in the review. Four of the nine evaluated studies concerned additively manufactured (AM) materials, including acrylonitrile butadiene styrene (ABS), polyethylene terephthalate glycol polyester (PETG), high-impact polystyrene (HIPS), and polylactic acid (PLA). Five studies evaluated an auto-polymerizing resin and one a thermoplastic material. All studies used polyvinyl siloxane impression materials and an adhesive selection following manufacturers’ recommendations. Three studies used scanning electron microscopy (SEM) to analyze their specimens. All studies reported a low risk of bias. Conclusions: Surface roughening was shown to reduce the strength of the bonding interface, whereas combining chemical and mechanical retention was shown to increase the bond strength. Inconsistent results exist in determining if AMed (3D-printed) tray materials are comparable or perform better than the conventional tray materials, highlighting the need for further study. Clinical Significance: The bond strength of the custom tray to the dental impression material is critical as it affects the model produced and therefore the final prosthesis. It is therefore invaluable to use materials with high bond strength for the construction of custom trays. Full article

Background: Developmental dysplasia of the hip (DDH), if not treated, can lead to osteoarthritis and disability. Ultrasound (US) is a primary screening method for the detection of DDH, but its interpretation remains highly operator-dependent. We propose a supervised machine learning (ML) image segmentation model for the automated recognition of anatomical structures in hip US images. Methods: We conducted a retrospective observational analysis based on a dataset of 10,767 hip US images from 311 patients. All images were annotated for eight key structures according to the Graf method and split into training (75.0%), validation (9.5%), and test (15.5%) sets. Model performance was assessed using the Intersection over Union (IoU) and Dice Similarity Coefficient (DSC). Results: The best-performing model was based on the SegNeXt architecture with an MSCAN_L backbone. The model achieved high segmentation accuracy (IoU; DSC) for chondro-osseous border (0.632; 0.774), femoral head (0.916; 0.956), labrum (0.625; 0.769), cartilaginous (0.672; 0.804), and bony roof (0.725; 0.841). The average Euclidean distance for point-based landmarks (bony rim and lower limb) was 4.8 and 4.5 pixels, respectively, and the baseline deflection angle was 1.7 degrees. Conclusions: This ML-based approach demonstrates promising accuracy and may enhance the reliability and accessibility of US-based DDH screening. Future applications could integrate real-time angle measurement and automated classification to support clinical decision-making. Full article

Background: Osteoarthritis has a large and growing burden in an ageing population. Controversy exists in current management, particularly regarding opioid use due to increasing negative effects. Clinicians need guidance on the individual mortality associations for common osteoarthritis treatments when compared to a control. Aims: The aim is to undertake a structured narrative literature review comparing mortality associations for common osteoarthritis management options. Methods: A search strategy (Web of Science 23 September 2024) was performed to identify observational studies which reported all-cause mortality in a treatment group compared to a control. The control group could be either the general population or those with osteoarthritis who were treated with the following: NSAIDs (non-steroidal anti-inflammatory drugs), opioids, paracetamol, GLP-1 RAs (Glucagon-like peptide-1 receptor agonists), hip or knee arthroplasty, or exercise. Articles were screened by two authors, and each included article was assessed for adequate quality using the strengthening the reporting of observational studies in epidemiology (STROBE) framework. Results: Of 2362 studies retrieved, 39 cohort studies met the inclusion requirements. Exercise, compared to no or lower levels of exercise, had ten studies reporting substantially reduced all-cause mortality. GLP-1 RA agonists had two related studies showing all-cause mortality reduction up to 5 years. Mortality following joint arthroplasty followed a multi-phasic response. There was a short-term post-surgical increase in mortality. However, from 90 days post-surgery to 8–11 years, there were significant reductions in mortality. After 9–12 years post arthroplasty, mortality increased and became significantly higher. Opioids were associated with an increase in mortality in 6 out of 7 studies. Inconsistent trends were found for NSAIDs and paracetamol. Conclusions: Exercise and GLP-1 RA prescription are associated with reduced all-cause mortality. Arthroplasty was found to have survival benefit until 9–11 years post-operatively, whereafter mortality then increased. Opioids were found to consistently increase mortality when used for non-cancer pain at all time points. The other common osteoarthritis treatments assessed were not consistently associated with changes in mortality. Full article

Background/Objectives: Surgical site infections (SSIs) are serious complications in orthopedic implant-associated procedures, increasing morbidity, mortality, and hospital costs. The purpose of this study was to evaluate the impact of a structured infection prevention and control (IPC) service on SSI incidence and cost savings across hip arthroplasty (HA), knee arthroplasty (KA), and open reduction and internal fixation (ORIF). Methods: A retrospective analysis included 6930 patients treated between 2019 and 2024, divided into pre-intervention (2019–2022) and post-intervention (2023–2024) cohorts. Preventive methods (PMs) comprised enhanced antibiotic prophylaxis, Staphylococcus aureus screening, chlorhexidine bathing, intraoperative audits, and behavioral interventions. Economic evaluation used literature-based costs, standardized to 2024 US dollars (USD 2024), with sensitivity analyses performed. Results: SSI incidence decreased from 5.6% to 1.1% overall (p < 0.001), with consistent reductions across procedures: ORIF (5.2%→1.0%), HA (9.2%→2.4%), and KA (4.8%→1.2%). In 2023, approximately 31 SSIs and one infection-related death were prevented, avoiding 308 hospital days. Cost savings ranged from USD 209,188 to USD 376,898, with cost saving confirmed in 93% of simulations. Conclusions: Comprehensive infection-prevention protocols, delivered through a structured IPC service, significantly reduced SSIs and generated substantial cost savings. These findings support wider use of these PMs in orthopedic surgery. Full article

Background/Objectives: Developmental dysplasia of the hip (DDH) is one of the most common pediatric orthopedic disorders and warrants timely diagnosis and treatment to prevent long-term disability. This review identified, summarized, and assessed the quality of current European national guidelines for DDH screening and treatment. Methods: Guidelines were identified by contacting the national orthopedic societies from 46 European countries and retrieving the guidelines from a recent systematic review. Two researchers independently extracted data and assessed guideline quality using the AGREE II checklist. Interrater agreement was assessed using Cohen’s $\kappa$. Results: Nine European national DDH guidelines were identified, of which four were published in peer-reviewed scientific journals. All guidelines advised clinical examination and imaging as part of the DDH screening program, though screening approach and timing varied considerably. Four guidelines included treatment recommendations. The type of treatment (abduction treatment vs. active monitoring) and duration of long-term follow-up showed great variation. Guideline quality ranged from 16 to 92% (Cohen’s $\kappa$ = 0.62), with two out of nine guidelines rated “good quality” (>70%). Conclusions: European national DDH guidelines appear scarce and of varying quality and content. A coordinated European initiative is warranted to urge countries to develop evidence-based DDH guidelines using validated tools and to publish these guidelines in peer-reviewed journals, thereby advancing equal diagnosis and treatment for children with DDH. Full article

Periprosthetic joint infection (PJI) caused by Streptococcus bovis (S. bovis) is rare but clinically significant due to its established association with colorectal neoplasia. Early recognition and interdisciplinary management are essential to ensure favorable outcomes. We report the case of a 68-year-old woman who presented with a chronic fistula and signs of active infection 20 years after uncemented total hip arthroplasty. Cultures from the wound identified S. bovis, prompting further evaluation. Imaging and laboratory tests supported a diagnosis of chronic PJI. A two-stage revision was performed, beginning with implant removal, debridement, and placement of a vancomycin/gentamicin-loaded spacer. Given the pathogen’s known link to gastrointestinal malignancy, the patient underwent colonoscopy, which revealed a tubulovillous adenoma with carcinoma in situ. Surgical resection was performed with curative intent. Six months later, the patient underwent successful reimplantation. At three-month follow-up, clinical and radiographic assessments showed favorable recovery. This case reinforces the importance of gastrointestinal screening in patients with S. bovis PJI, as early detection of associated colorectal lesions may impact treatment strategies and prognosis. Full article

Background and objectives: Patient-specific components (PSC) represent an innovative option for total knee arthroplasty (TKA) in advanced osteoarthritis. Their effectiveness, however, closely relies on accurate positioning. Our study investigates the accuracy achieved by means of an inertial-based extramedullary cutting guide and the postoperative clinical and radiographic outcomes. Methods and materials: This was a prospective, single-arm, pilot study involving patients undergoing primary TKA with YourKnee^TM PSC. Femoral and tibial bone resections were performed using the Perseus inertial-based extramedullary cutting guide. Postoperative mechanical alignment and component positioning were assessed by computed tomography. Clinical outcomes were evaluated preoperatively and at 1, 3, 6, and 12 months postoperatively by main knee function and clinical outcome measures. Results: The study population included a small cohort (n= 12, four females/eight males, mean age 69 ± 5.65 years, mean BMI 25.7 ± 3.8 kg/m², KL grade > 3) with no control group. The mean absolute error between the planned and obtained Hip–Knee–Ankle angle was 1.36° ± 1.06 and within ±3° of all cases. Mean coronal alignment error was 1.87° ± 0.87 and 1.67° ± 0.75 for the femoral and tibial components, respectively. The mean sagittal alignment error was 1.89° ± 1.24 and 2.45° ± 0.87 for the femoral and the tibial components, respectively. Patients showed significant improvement in clinical and functional scores within the first 6 months: OKS increased from 20.64 ± 2.77 at the preoperative screening to 42.27 ± 4.34 (p < 0.0001), total KSS rose from 90.64 ± 17.25 to 169.36 ± 23.57 (p < 0.0001), and FJS reached 85.09 ± 17.14 at 6 months (p = 0.0031), indicating excellent functional recovery and forgotten joint effect. Knee ROM improved from 90.91° ± 11.14 to 110.36° ± 8.44 (p < 0.0001). After 6 months, outcome scores plateaued, suggesting an early stabilization of clinical benefits. No signs of radiolucency were detected on X-rays at 3- and 12-month follow-ups. Conclusions: The Perseus inertial-based extramedullary cutting guide used in combination with the YourKnee^TM PSCs resulted in accurate intraoperative prosthesis positioning and significant improvements in clinical and functional outcomes at 6 months after surgery. Despite the small sample size and absence of a control group, the results suggest that such combination represents a viable option to conventional surgical instrumentation and current off-the-shelf prosthetic designs. Full article