Abstract: Background and Objectives: Degenerative lumbar spinal stenosis (DLSS) frequently menifests as lower leg radiating pain (LLRP), requiring selective nerve root block (SNRB). Comprehensive and integrative medical services (CIMS) – a multimodal program consisting of acupuncture, cupping, and manual therapy – have been increasingly incorporated into clinical practice in Korea. However, randomized evidence remains limited. This study evaluated the efficacy and safety of adjunctive CIMS in patients with DLSS presenting neuropathic LLRP requiring SNRB. Materials and Methods: In a single-center, parallel-group, assessor-blinded randomized controlled trial (CRIS KCT0006036), adults with DLSS (LANSS > 7; VAS > 5) were randomized 1:1 to experimental or control groups (n = 77; experimental 38, control 39). All participants received SNRB plus pharmacotherapy (limaprost, pregabalin). The experimental group additionally received CIMS, delivered 8 times over 4 weeks. The primary outcome was pain intensity (VAS) at baseline, weeks 4,8, and 12. Secondary outcomes included SF-36, ODI, and RMDQ at baseline, weeks 4,8 and 12. Repeated-measures two-factor ANOVA assessed main effects and time x group interaction. Results: Mean VAS (experimental vs. control) was 4.73±1.67 vs. 4.70±1.95 at baseline; 3.74±1.68 vs. 4.66±1.60 at week 4; 3.93±2.03 vs. 4.79±1.55 at week 8; 3.98±1.98 vs. 4.98±1.68 at week 12. The significant time x group interaction was identified (p = 0.040), indicating a greater pain reduction with CIMS. No significant time x group interactions were observed across SF-36 domains. Adherence to CIMS modalities was high, and no unexpected adverse events occurred. Conclusions: In DLSS patients receiving SNRB and pharmacotherapy, adjunctive CIMS resulted in greater pain reduction over 12 weeks compared with standard care alone, without introducing new safety concerns. These findings support the clinical utility of CIMS as an effective adjunctive treatment option for DLSS.

Abstract: Study Design: Retrospective cohort study. Objective: To evaluate the association between vertebral ankylosis and cervical paraspinal muscle health using MRI-based measures of muscle quantity and quality. Summary of Background Data: Ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis produce long-segment spinal ankylosis, altered biomechanics, and high fracture risk in the cervical spine. Paraspinal muscle degeneration (“spine-specific sarcopenia”) has been linked to pain, disability, and worse outcomes after cervical spine surgery, but the relationship between vertebral ankylosis and cervical paraspinal muscle health is unknown. Methods: Adult patients with cervical vertebral ankylosis and available cervical MRI were identified at a single academic center and propensity score-matched 1:1 to patients without ankylosing conditions based on age, sex, body mass index, American Society of Anesthesiologists class, and comorbidity index. Axial T2-weighted images at C2-3 through C7-T1 were used to manually trace bilateral deep extensor and deep flexor muscles to obtain bilateral cross-sectional areas (CSAs) at each level. Extensor fatty infiltration was graded using the Goutallier classification. CSAs and Goutallier grades were compared between the matched groups. Results: Compared with matched controls, patients with vertebral ankylosis demonstrated significantly smaller deep extensor CSA at multiple cervical levels and higher Goutallier grades in the lower cervical spine and at the cervicothoracic junction. Deep flexor CSA tended to be smaller in the ankylosis group but differences did not reach statistical significance. Conclusions: Vertebral ankylosis is associated with poorer cervical paraspinal muscle health, characterized by reduced extensor muscle bulk and increased fatty degeneration. These findings support conceptualizing ankylosing spinal conditions as disorders of both bone and muscle and highlight the cervicothoracic extensors as a potential target for risk stratification and rehabilitation strategies.

Abstract: Background: Two-stage revision arthroplasty remains the gold-standard treatment in the USA for patients diagnosed with periprosthetic joint infection (PJI) of the hip and knee. However, during treatment, patients have an extended interstage period between prosthesis removal and reimplantation, which is frequently characterized by substantial reductions in mobility, prolonged rehabilitation, and a high incidence of medical and psychosocial complications. This review examines the physical, psychological, and social effects of immobility during the interstage period. Methods: A comprehensive literature review was conducted to identify studies addressing mobility limitations, functional assessment tools, and associated outcomes in patients undergoing two-stage revision arthroplasty for PJI. Studies were included if they reported on clinical complications and psychosocial outcomes affected by the prolonged interstage period and mobility limitations. Results: Patients undergoing two-stage revision often experience significant immobility lasting several months, which can be influenced by pain, soft-tissue compromise, and spacer type. Prolonged inactivity can contribute to muscle atrophy, joint stiffness, and impaired range of motion (ROM) and is often associated with an increased risk of venous thromboembolism, pressure injuries, and bleeding complications related to extended thromboprophylaxis use. Psychologically, patients frequently report heightened anxiety and depression during the interstage period, compounded by uncertainty regarding infection eradication. Socially, patients have restricted independence, are dependent on caregivers, and have occupational disruption that further diminishes their overall quality of life. Current studies demonstrate wide variability in how mobility is assessed, hindering cross-study comparison and limiting targeted rehabilitation strategies. Conclusions: The interstage period of two-stage revision arthroplasty is a critical, yet understudied phase marked by significant physical, psychological, and social challenges that are not fully captured by traditional orthopedic patient reported outcome measures (PROMs). Standardized measurement of mobility is needed to assess the impact of limited mobility during the interstage period. Also, novel treatment approaches that shorten or eliminate the interstage period have the potential to mitigate complications, enhance functional recovery, and improve overall quality of life for patients undergoing staged management of PJI.

Abstract: Purpose: Revision total hip arthroplasty (RTHA) in the presence of a well-fixed femoral stem carries substantial risk and morbidity, as stem removal often leads to bone loss, prolonged operative time, and increased blood loss. This issue is particularly relevant for older implants featuring a 14/16 taper, which are no longer compatible with most modern femoral heads. The Bioball™ System (Merete Medical, Germany), a modular head–neck adapter, provides a solution that enables acetabular or head-only revision while preserving the existing femoral stem. This study aimed to evaluate the long-term clinical and radiological outcomes of revision THA procedures using the Bioball™ System in patients with 14/16 femoral tapers. Methods: This retrospective study analyzed 1039 RTHAs performed at our center between 2008 and 2020. 38 patients (23 women, 15 men; mean age 73.5 years) were finally included in the study. All procedures were performed in the presence of a well-fixed femoral stem with a 14/16 taper. Revisions were limited to exchange of the acetabular component, liner, or both using the Bioball™ System, thus avoiding femoral stem removal. The primary reason for revision surgery in the study group was acetabular cup loosening (n=29, 76.31%), while only the liner was replaced in 9 patients (23.69%). Clinical evaluation included the Merle d’Aubigné and Postel score (modified by Charnley), and radiological analysis assessed component fixation, migration, and signs of loosening. The mean follow-up period was 3082 days (8.44 years; SD 1041.5; Me 2872). Results: In 29 patients (76.3%), both the acetabular component and liner were replaced, while in 9 patients (23.7%) only the liner and head were exchanged. The most commonly used adapter lengths were 2XL (+10.5 mm, 28.95%), 5XL (+21 mm, 21.05%), 3XL (+14 mm, 18.42%), and 4XL (+17.5 mm, 15.79%); shorter sizes (M, L, XL) were applied less frequently. A 7.5° offset adapter was used in 57.9% of cases to optimize offset and anteversion, and 32 mm heads were employed in 71.05% of revisions. The modified Merle d’Aubigné and Postel (MAP) score improved by a mean of 5.7 points (p < 0.05), with good outcomes in 36.84% and fair in 63.16% of patients. Pain intensity on the VAS scale decreased from 7.4 to 2.6 (p < 0.05). Furthermore, until the final day of the follow-up period i.e. June 30, 2025, no signs of prosthesis loosening were noted in any of the patients included in the study. The Modified MAP score was distributed the same between the different procedure types (p=0.404). Conclusion: The Bioball™ System enables restoration of hip stability and offset without removing a well-fixed femoral stem, thereby reducing surgical invasiveness, blood loss, and procedure-related risks. It provides an effective solution for revisions involving older 14/16 tapers, where conventional 12/14 heads are incompatible, and demonstrates favorable long-term functional and radiological outcomes. Further studies are warranted to confirm its broader applicability in complex revision THA.

Abstract:

Tendon disorders are common and have a major socio-economic impact. Current treatments (drugs, physiotherapy, surgery) do not provide lasting relief, leading to chronicity and recurrence. In this context, studies on regenerative therapies, such as stem cells, platelet-rich plasma and natural and synthetic membranes, have shown promising results in the treatment of tendon lesions. The present study analyzes the tissue response to a combination of bone marrow mononuclear cells BMMCs) and human decellularized amniotic membrane for treatment of Achilles tendon lesions in rats. Forty male Wistar rats were randomized into four treatment groups: SC (stem cells), AM (amniotic membrane), SC + AM (stem cells + amniotic membrane) and C (control). All underwent Achilles tendon sectioning and tenorrhaphy. In the AM and SC + AM groups, amniotic membrane was sutured over the lesion after the tendon was sutured; in the SC and SC + AM groups, 2 ml of autologous blood from the iliac crest containing BMMCs was applied around the lesion. Group C animals received only 2 ml of 0.9% saline around the lesion. After four weeks, the animals were euthanized, and the tendons were sent for histological analysis (Picrosirius Red) and immunohistochemistry (IL-6, IL-4 and IL-13). Analysis of type I and type III collagen fibers showed no differences between groups. However, the SC + AM group showed a better immunohistochemical profile, with greater expression of IL-4 and IL-13. In this experiment, animals treated with amniotic membrane and autologous stem cells had a better immunohistochemical profile than controls, with increased expression of cytokines associated with tissue repair and organization.

Abstract: A fixed-bearing medial unicompartmental knee arthroplasty (UKA) is a well-established option for the treatment of unicompartmental knee osteoarthritis. Several cohorts, meta-analyses and joint registry studies have shown comparable results to mobile-bearing medial UKA. What is less clear is whether the fixed-bearing all-polyethylene tibia implants provide comparable results to metal-backed versions. It has been suggested that fixed-bearing all-polyethylene tibia UKAs may show early failure due to the loosening of the all-polyethylene tibial component. A historical and narrative review was performed to answer the question: are all-polyethylene tibia implants safe to use and are the postoperative outcomes as good as when using a fixed-bearing metal-back implant? After a thorough review of the all-polyethylene and metal-back UKA philosophy, including the most recent scientific evidence available, we can conclude that all-polyethylene tibia UKA implants achieve similar results to metal back-implants both in terms of survival rates and patient-reported outcomes (PROMS). Both versions, all-polyethylene and metal-back tibia implants are valid treatment options when dealing with a patient presenting with unicompartmental knee osteoarthritis, and the final decision between using one over the other will rely on the surgeon's experience and preference.

Abstract: A promising alternative to traditional metal hardware in pediatric surgical care has been on the rise. Avoiding the need for hardware removal is particularly beneficial in children, who would otherwise face a second surgery with attendant risks. This brief review discusses the use of biodegradable implants, with a focus on poly(lactic-co-glycolic acid) (PLGA) devices, for fracture fixation in the growing skeleton, as well as outlines the challenges of managing pediatric fractures with traditional fixation and how bioabsorbable implants address some of these issues. The mechanism of PLGA implant degradation is summarised, highlighting how controlled hydrolysis allows implants to provide support during healing and then safely resorb. Clinical applications are reviewed through recent studies and case examples, including forearm, distal radius, ankle, and elbow fractures, which demonstrate effective healing and outcomes comparable to metal hardware. The benefits and limitations of presently used resorbable instruments are also discussed, together with future directions in research and material innovation, including newer biodegradable polymers and alloys.

Abstract:

Background. Dynamic anterior stabilization (DAS) is a novel surgical technique for treating chronic anteroinferior glenohumeral instability. It presents an alternative to the currently used Bankart and Latarjet procedures, aiming to reduce associated complications and revision surgeries. However, the value of histopathological and clinical characteristics for the assessment of prognosis and the efficacy of shoulder instability surgical treatment is still poorly understood. Objectives. The aim of this study was to evaluate the clinical effectiveness of DAS for anterior shoulder instability by analyzing clinical and histopathological characteristics. Methods. 20 patients with anterior shoulder instability were included in the study. The patients underwent clinical assessments before the surgery, and 1, 3, and 6 months after surgery. The tissue specimens from the anterior glenoid bone surface and a segment of the long head of the biceps tendon were evaluated after the surgery. Results. Our results demonstrated that the first three months postoperatively were characterized by worse functional outcomes, however six months after the surgery the patients demonstrated functional recovery. The extent of preoperative bone osteonecrosis was associated with functional outcomes after 6 months of surgical treatment (P= 0.044; Rho= - 0.56), whereas the extent of lymphocyte infiltration was associated with the pain severity (P=0.027; Rho = -0.567)). Conclusions. To conclude, our study showed that dynamic anterior stabilization is clinically effective method with functional recovery in 6 months. Furthermore, the associations of clinical and histopathological characteristics for the prognosis and assessment of anterior shoulder instability surgical treatment were observed.

Abstract: BACKGROUND The success of orthopaedic surgery is fundamentally biological, yet the synergistic effect of smoking and comorbidities on surgical outcomes is not well quantified. We hypothesised that active smoking multiplies the risk conferred by common comorbidities. METHODS In this retrospective cohort study, we analysed 3,123 orthopaedic procedures from 2020–2024. Patients were stratified by comorbidity (diabetes, anemia, hepatic dysfunction, chronic venous disease) and smoking status. Primary outcomes were a complex of orthopaedic-specific complications. We used multivariate logistic regression to calculate adjusted odds ratios (aORs) and formal tests for interac-tion to quantify synergy. RESULTS A powerful synergistic effect was observed. Diabetic smokers had significantly higher rates of non-union (9.2% vs 3.3%; aOR 3.0), periprosthetic joint infection (8.2% vs 2.8%; aOR 3.1), and revision surgery (12.2% vs 5.0%; aOR 2.7). Significant interaction effects confirmed this synergy. Smokers with hepatic dysfunction had higher haematoma rates, while smoking with severe anemia was associated with dramatically increased mortality (5.0%; aOR 8.9). Former smokers' outcomes were consistently intermediate. CONCLUSIONS Smoking multiplies comorbidity risk, creating a distinct high-risk phenotype that severely compromises healing. These findings mandate that verified smoking cessation is a non-negotiable, foundational component of preoperative optimisation before elective orthopaedic surgery.

Abstract: Introduction: Reverse total shoulder arthroplasty (RTSA) is increasingly common, but large-scale studies on age-related differences in outcomes are limited. This study aims to evaluate epidemiological trends, clinical indications, and postoperative outcomes in patients under 65 undergoing RTSA. Methods: We analyzed data from the Nationwide Inpatient Sample (NIS) from 2016-2021, including 48,460 patients aged 35-64 undergoing shoulder arthroplasty. Patients were stratified into three age groups: 35-45, 46-55, and 56-65 years. We assessed trends, clinical indications, comorbidities, hospital stay metrics, and postoperative complications using chi-square tests, ANOVA, and multivariate logistic regression. Results: Procedure volumes increased from 2016 to 2019, peaking at 2,007 cases, but declined in 2020 and 2021 (924 cases). The 56-65 age group consistently comprised the majority of procedures (81.7% in 2016 to 88.3% in 2021). Comorbidities like type 2 diabetes (5.9% to 22.8%), hypertension (27.9% to 55.3%), and dyslipidemia (10.3% to 40.5%) increased with age (p<0.001). Rotator cuff tears were more prevalent in older patients (25% to 48.5%, p<0.001), while instability was higher in the youngest group (8.8%, p<0.001). Osteoarthritis was the most common indication, increasing with age (56.6% to 62.5%, p<0.001). Cardiac complications increased with age (2.2% to 5.1%, p=0.04). Female gender (OR=1.548, p<0.001), private insurance (OR=1.570, p<0.001), and small hospital size were associated with higher odds of cardiac complications. Native American race showed lower odds (OR=0.308, p=0.009) compared to White patients. Conclusion: Significant age-related differences exist in comorbidities, clinical indications, and postoperative complications following RTSA. Older patients had higher rates of comorbidities and cardiac complications, while younger patients presented with instability. These findings highlight the importance of age-specific perioperative management to optimize outcomes.

Abstract: (1) Background: Articular cartilage has limited self-repair capacity. While thermoresponsive pNIPAAm-based Cell Sheet Engineering (CSE) is a promising scaffold-free strategy, its inherent material properties pose limitations. This study developed and validated a novel, non-thermoresponsive CSE platform for functional cartilage regeneration. (2) Methods: A culture platform was fabricated by grafting the biocompatible polymer γ-PGA and a disulfide-containing amino acid onto porous PET membranes. This design enables intact cell sheet detachment with its native extracellular matrix (ECM) via specific cleavage of the disulfide bonds by a mild reducing agent. (3) Results: The hydrated substrate exhibited a biomimetic stiffness (~16.2 MPa) that closely mimics native cartilage. The platform showed superior biocompatibility and supported the cultivation of multi-layered rabbit chondrocyte sheets rich in Collagen II and Glycosaminoglycans. Critically, in a rabbit full-thickness defect model, transplanted autologous cell sheets successfully regenerated integrated, hyaline-like cartilage at 12 weeks, as confirmed by MRI, CT, and histological analyses. (4) Conclusions: This novel CSE platform, featuring highly biomimetic stiffness and a gentle, chemically specific detachment mechanism, represents a highly promising clinical strategy for repairing articular cartilage defects.

Abstract: Background/Objectives: The COVID-19 pandemic limited access to in-person physiotherapy, raising concerns about post-operative rehabilitation outcomes. This study evaluated whether a self-rehabilitation protocol with virtual consultations after a mini-open Latarjet procedure affected short-term clinical outcomes in active military personnel. Materials and Methods: We prospectively enrolled 18 patients (19 shoulders) undergoing mini-open Latarjet between May and October 2020. Patients performed a standardized self-rehabilitation protocol starting on the first post-operative day, with progressive range-of-motion (ROM) exercises added at two weeks. Pain was assessed using the Visual Analog Scale (VAS), ROM was recorded at each follow-up, complications were noted, and patient satisfaction was evaluated at 12 weeks. Results: A total of eighteen patients were prospectively enrolled in the study. At 12 weeks, mean VAS decreased from 1.2 ± 0.6 at week 1 to 0 at week 4 onward. The mean drug consumption was 2.5 ± 0.7 tablets/day only for the first week. Mean assisted forward flexion improved from 155°± 10° at week 1 to 180° in all patients by week 4. External rotation reached 60°± 5°at 4 weeks, 75°± 4° at 8 weeks, and 80°± 3°at 12 weeks, with no deficits compared to the contralateral side. Internal rotation improved to T7 level by week 8 and remained stable at week 12. No complications, recurrent instability, or graft displacements were reported. Patient satisfaction exceeded 9.5/10 in all cases. Conclusions: A self-rehabilitation protocol after mini-open Latarjet surgery yielded excellent short-term outcomes in young military patients, with full ROM recovery, high satisfaction, and no complications. Further validation of these results requires larger, rigorously controlled studies.

Abstract:

Background/Objectives: Evaluating osteoarthritis (OA) care quality is increasingly relevant for service improvement and benchmarking purposes. The Osteoarthritis Quality Indicator questionnaire (OA-QI) measures patient-reported guideline-concordant care; however, no version has been tested in Italian primary care or bilingual contexts. This study aimed to introduce the OA-QI version 3 (OA-QI v3) in German and Italian, assess its applicability in practice, and examine its acceptability and reliability. Methods: A survey was conducted using the South Tyrolean General Practice Research Network. Thirty-eight general practitioners recruited 266 patients with hip or knee OA. Patients completed the OA-QI v3 in German or Italian, with subsamples for comprehensibility testing (n = 38) and retest reliability after 14 days (n = 36). Test–retest reliability was analyzed using percent agreement, Cohen’s κ, intraclass correlation coefficients (ICC), standard error of measurement. The smallest detectable change was analyzed to estimate factual change. Results: Response rate reached 95% of the targeted patients. Patient feedback showed good comprehensibility and ease of use in both languages. Adherence to recommended quality indicators varied, with strengths in physical activity advice, NSAID prescription, and pain assessment, but gaps in weight management, occupational counseling, and assistive devices. Test–retest reliability ranged from fair to substantial at the item level (κ = 0.33–0.69) and was moderate for the total score (ICC = 0.55, 95% CI 0.28–0.74). While measurement error restricted individual-level interpretation, reliability at the practice or institutional level supports application for benchmarking and quality monitoring. Conclusions: The OA-QI v3 was feasible, acceptable, and reliable for group-level assessments in South Tyrol. These findings position OA-QI v3 as a practical tool for identifying care gaps and guiding quality improvement, while providing important lessons for the full validation of the German and Italian versions in larger cross-national samples.

Abstract: Introduction – aim: There is a lack of studies focusing on the thoracic and spinal condition in mild to moderate idiopathic scoliosis (IS) patients prior to the initiation treatment. This report aims to address the above issue in children who are about to begin nonoperative treatment, whether through Physiotheraputic Scoliosis Specific Exercises PSSE, bracing, or a combination of both. The outcomes may also enhance our understanding of scoliogenesis. Method and Materials. N = 252 scoliotic children in total were studied. Two groups were formed, a) Group 1 with curves of 10 -25 Cobb angle, n= 34 males (24%) and 110 females (76%) and b) Group 2 with curves of 26 – 40 Cobb angle, n= 18 males (17%) and 90 females (83%). The assessment included age, sex, body height, scoliometry, Cobb angle, apical vertebra, apical vertebra rotation (AVR), and segmental Rib Index (SRI) in the lateral spinal radiographs. Moreover, the Rib index (RI) was assessed at the level of the maximum Double Rib Contour Sign (DRCS) distance, the average SRI value across T1-T12, the average difference between these two variables and RI at the apical vertebra of the primary curvature, (rib apical vertebra - RIAV). It is considered that in RI equal or more than 1,45-1,50 express a significant thoracic deformity in the transverse plane. In statistical analysis the following tools were included to examine distributional properties, predictive relationships, and subgroup differences relevant to the study’s objectives. These were histograms, Q–Q plots, Kolmogorov–Smirnov and Shapiro–Wilk, descriptive statistics, including measures of central tendency and dispersion, linear regression analysis, model adequacy using coefficient of determination (R²), standardized beta coefficients and residual diagnostics, a multifactorial General Linear Model (GLM) , including all two-way and three-way interactions on Cobb angle and vertebra rotation (VR), a correlation analysis applying Pearson’s correlation coefficient, one-way analysis of variance (ANOVA) and Bonferroni correction. Statistical significance was determined at the conventional threshold of p < 0.05. Results yielding p-values between 0.05 and 0.10 were interpreted as borderline significant, warranting cautious consideration in the context of effect size and theoretical relevance. All analyses were performed using IBM SPSS Statistics for Windows, Version 30.0 (IBM Corp., released 2023, Armonk, NY, USA). Results. For all groups rib asymmetry, as measured by SRI showed level- and severity-dependent associations with VR and Cobb angle. In mild scoliosis (Cobb 10°–25°), significant effects of SRI were mainly observed at lower thoracic levels (T10–T12) for VR, while associations with Cobb angle were weak and largely non-significant. In moderate scoliosis (Cobb 26°–40°), SRI effects were stronger, particularly at T10–T12, with VR and Cobb angle showing significant associations. Age contributed modestly to VR in mild scoliosis, whereas gender effects were mostly weak, occasionally reaching borderline significance. Curve type significantly influenced VR in moderate scoliosis, highlighting structural differences in thoracic anatomy. Adjusted R² values indicate that RI alone accounts for a moderate proportion of variance in VR (up to ~24%) and a smaller proportion in Cobb angle (up to ~8–10%), consistent with scoliosis being a multifactorial condition. Rib asymmetry is a better predictor of VR than Cobb angle, particularly in moderate scoliosis. Significant effects are concentrated in the mid- and lower thoracic spine (T7–T12), suggesting regional vulnerability. SRI measures may provide additional clinical insight into three-dimensional deformity beyond standard Cobb assessment. Discussion. The findings of this research highlight the important role of thoracic deformity in cases of mild and moderate IS. The observed correlation in mild IS between the SRI and mainly rotation not to the Cobb angle suggests that asymmetric rib growth, exerting unequal pressure/force on the vertebrae, may initiate spinal rotation. Within the context of the pathoremodeling sequence in IS, these results align with earlier studies which proposed that spinal deformity in the frontal plane originates at the level of the intervertebral discs than the vertebral bodies (Grivas et al., 2006; Will et al., 2009). Furthermore, this study supports the view that scoliotic deformity likely come first in the thoracic cage and then the spine. The diurnal "accordion-like" phenomenon observed in the intervertebral discs may then contribute to vertebral deformation and subsequent progression of IS. In conclusion, this study demonstrates that the use of RI and SRI methods provides valuable insight into scoliogeny of mild and moderate IS and emphasizes the critical role of the thoracic cage in its development.

Abstract: Background: Orthopedic implants are increasingly used in both trauma and reconstruc-tive surgery. Fractures occurring in the presence of implants are currently described with multiple terms (periprosthetic, peri-implant, hardware-related, implant-associated), lea-ding to inconsistent communication. Objective: To systematically review the existing terminology, quantify its heterogeneity, and evaluate the rationale for a unified umbrella concept. Methods: A systematic literature search was performed across PubMed, Scopus, and Web of Science (2000–2023) using predefined keywords. Inclusion criteria were clinical studies, reviews, or consensus papers that used or discussed terminology for fractures related to orthopedic implants. Data on terminology, anatomical site, and year of publication were extracted. A bibliometric frequency analysis was conducted. Results: Of 1,142 records screened, 184 met inclusion criteria. The terms “periprosthetic fracture” (68%), “implant-related fracture” (14%), “peri-implant fracture” (9%), and “hardware-related fracture” (7%) were most frequent, with substantial variation by ana-tomical site (hip: 52%, knee: 19%, shoulder: 11%, spine: 8%, trauma fixation devices: 10%). Historical consensus groups (AO/OTA, ISFR, ICS) have debated umbrella terms but re-jected them due to concerns about ambiguity. Discussion: Current terminology is fragmented, site-specific, and inconsistently applied. We propose the descriptive label “artificial fracture” to denote any fracture in which the biomechanics, morphology, or management are significantly influenced by the presence of an implant. This concept is intended as a transversal descriptor to complement, not re-place, existing classification systems. Conclusion: Standardized terminology may improve interdisciplinary communication, research comparability, and registry documentation. Future validation should include Delphi surveys, stakeholder engagement, and consensus endorsement.

Abstract:

The purpose of this study was to examine the convergent validity and reliability of the session rating of perceived exertion (sRPE) in complete CrossFit® sessions, comparing it with a weighted RPE measure (RPEW) obtained from different session phases. Twenty-four recreational practitioners (13 men and 11 women) completed 28 standardized sessions of approximately 60 minutes, consisting of warm-up, strength/skill, WOD, and cooldown. RPE was collected after each phase, and sRPE was recorded 30 minutes post-session. Results showed that RPEW (5.8 ± 1.5) was significantly lower than sRPE (6.8 ± 1.4; p < 0.001, d = 0.69), resulting in a higher training load estimated by sRPE (+15.5%). Bland–Altman analysis revealed a positive bias and wide limits of agreement, while relative reliability was moderate-to-good (ICC = 0.73–0.77). Multiple regression analysis indicated that WOD RPE explained 70% of the variance in sRPE (R2 = 0.70, p < 0.001), confirming its role as the primary perceptual determinant. In conclusion, sRPE represents a valid, simple, and cost-effective tool for monitoring internal load in CrossFit®. However, it tends to overestimate weighted RPE and is strongly influenced by the final phase of the session, which should be taken into account by coaches and practitioners when interpreting its values.

Abstract:

Converting a medial unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA) presents challenges in bone preservation, alignment, and soft-tissue balance. Robotic assistance enables three-dimensional CT-based planning, precise bone preparation, and real-time ligament balance assessment, thereby supporting a bone-preserving approach. We describe a stepwise workflow using the Mako system (Stryker) to convert a failed medial UKA to a condylar-stabilizing (CS) Triathlon TKA within a functional alignment framework. Pre-explantation registration on the in-situ components maintains accuracy despite potential metallic artifacts. The polyethylene insert is briefly removed for reference surface acquisition, then reinserted for intraoperative balance evaluation. After component removal, small medial tibial or femoral defect can be filled with autologous cancellous bone graft from the resected bone surfaces. Definitive cementless components are implanted without stems or augments, and the patella is resurfaced. This technique provides a reproducible robotic workflow for UKA-to-TKA conversion in selected cases with preserved bone stock and stable soft-tissue balance, and facilitates accurate and reproducible conversion with optimal bone preservation.

Abstract: Acute Systemic Antimicrobial Prophylaxis (ASAP) is the standard of care for managing open fractures. There is concern that protocols do not address the modern open fracture bioburden. Online databases were searched to estimate the effect size in reducing the risk of postoperative infections in open fracture management stratified by regimen and fracture classification. 2,031 patients from 17 studies were analyzed. Meta-analysis of Type III open fractures suggested that Flucloxacillin + Benzylpenicillin had a lower infection rate than Cefazolin + Gentamicin; furthermore, the duration of hospitalization was extended by four days with Cefazolin + Gentamicin in Type II/III open fractures. No one antibiotic prophylactic regimen can be recommended over another in the management of open fractures with the current available data. We offer methodological guidelines for future trials that will allow robust evidence for future studies.

Abstract: Background and Objectives: Great efforts in orthopaedic surgery have been devoted to the ad-vancement in prosthetics, with a focus on various materials with enhanced mechanical, physical, and chemical properties, geometries of implants, and their surface morphology. A considerable in-terest relates to interfaces with the bone tissues, and their surroundings, e.g., body fluids, building interaction with the living body. Organ dysfunctions effect the quality of bone. The objective of the study is to find interconnections between the underlying conditions of patients, the quality of their bones, and their orthopaedic implants, on different time spans. We refer to femoral stems only. Materials and Methods: We report on three cases, two women (F1 aged over 35, and F2 aged over 80), and one man (M aged over 65), with diabetes, dyslipidaemia, and kidney dysfunction, under-going HA with uncemented Ti-alloy implants. The samples examined were: a segment of a broken Ti-alloy stem (7 years old), biological remnants on it (bone with a metallic layer, 1.75 cm2 and 2.53 g, and soft tissue, 1.50cm2 and 1.098 g), segments of two spare stems, and synthetic plasma enriched with glucose, urea, and cholesterol (according to the biochemistry tests of the respective patients). The stem pieces, 20 x 11 x 6.56 mm3, were immersed in the corresponding synthetic plasma at 38 C and ultrasonicated for 7h. Scanning electron microscopy and energy dispersive X-ray spectroscopy were employed to investigate the Ti-alloy stem samples, and electrochemistry - to adequately explore the plasma left after sonication (50µL/sample) of each sample. Histopatho-logical examination was performed on the soft tissue remnants on the broken stem. Results: EDX spectra have shown that all femoral stem samples are of Ti-6Al-4V, with various additions of C, Fe, Si, Zr, coated with hydroxyapatite. The electrochemistry study shows that the metallic layer on the bone fragment was caused by migration of vanadium during the 6 months since fracture to re-vision for M. That finding agrees with analysis of prosthetic vanadium concentration in se-rum/plasma after 6 months, as recently reported by other authors. Conclusions: The reactivity of the stems in altered synthetic plasma is given by the presence of glucose and urea, whereas choles-terol influences on bone quality only. The histopathological analysis shows severe panniculitis and myositis. Numerous neutrophils intermixed by macrophages, and a few lymphocytes, are present, supporting the abundance of small new capillaries (granulation tissue). Metal migration from the prostheses can occur through the chemical interactions between body fluids with abnor-mal biochemistry and the compounds building the orthopaedic prostheses, having however in mind that chemical corrosion, and wear resulting from friction during usual movements of the body, are competing mechanisms, especially through effects like surface cracks. Even though Ti-alloys are fully biocompatible, diabetes, dyslipidaemia, and renal dysfunction alter the bone-implant interface because of dramatically weakened and frail bones, no matter the age, and sex. Therefore, for those patients with complex conditions, it can be anticipated a shorter lifetime of implants till revision than in healthier ones. A brief review supports our experimental findings.

Abstract: Background: Hamstring strain injuries (HSI) are common in soccer and difficult to predict. Machine learning and regression approaches may identify novel strength-related predictors, but model development requires transparent reporting. Objective: To develop and internally validate a prediction model for hamstring strain injuries in amateur soccer players using preseason strength and clinical measures. Study Design: Prospective cohort study. Methods: This prospective cohort study included 120 amateur male soccer players monitored across one competitive season (30 weeks). Baseline predictors were age, body mass index, prior injury, and bilateral isometric hip and knee strength variables measured with a handheld dynamometer. The outcome was player-level hamstring injury status (≥1 HSI vs none). Twenty candidate predictors were reduced to 10 via symmetrical uncertainty feature ranking. A logistic regression model was trained (n=83 players) with nested four-fold cross-validation and tested on an independent hold-out set (n=37 players). Model performance was evaluated using the area under the ROC curve (AUC), calibration slope and intercept, and confusion matrices. Results: Twenty-one players sustained ≥1 HSI (32 events; 28% reinjuries). With 10 predictors and 21 events, the events-per-variable ratio was 2.1, below recommended thresholds, indicating risk of overfitting. On the test set (5 injured, 32 uninjured), the model achieved an accuracy 64.9%, AUC 0.68 (95% CI 0.52–0.84), calibration slope 0.85, and intercept –0.12. Sensitivity was 60% and specificity 65.6%. Dominant-leg hip abduction strength was the only statistically significant predictor (OR=0.82, 95% CI 0.70–0.96), though stability analyses identified previous hamstring injury as the most consistent contribution despite significance in regression due to limited events. Conclusion: Previous hamstring injury remained the strongest predictor of future injury risk, while reduced dominant-leg hip abduction strength emerged as a candidate risk factor but demonstrated instability under resampling. Neither age nor hamstring isometric strength were significant predictors in this cohort. Model discrimination was modest, calibration indicated mild overfitting, and overall risk of bias was high. This study represents a TRIPOD Category 2 prediction model development without external validation. Findings should therefore be considered exploratory and hypothesis-generating, requiring confirmation in larger, methodologically robust cohorts.