Postoperative swelling following lower limb orthopedic surgery is a common complication that brings various inconveniences to patients’ rehabilitation and quality of life. The scope of swelling after lower limb surgery is broad， including procedures such as hip and knee joint replacement surgeries， trauma surgeries，and various other lower limb surgeries. These surgeries may potentially result in lymphatic reflux obstruction or vascular damage， consequently triggering swelling issues. Lower limb swelling frequently occurs during the perioperative period， causing patients pain， functional limitations， and an increased risk of complications.Currently， preventive and therapeutic measures for postoperative swelling in lower limb orthopedic surgery mainly involve drug treatment， physical therapy， and protective measures. In terms of drug treatment， diuretics，anti-inflammatory drugs， venotonic medications， etc.， are utilized to alleviate edema. Physical therapy includes methods like massage， cold compresses， and hot compresses， with the aim of promoting lymphatic and blood circulation. Protective measures emphasize postoperative patient rest and the use of specific compression stockings. However， despite the existence of some methods for preventing and treating postoperative swelling，there is still room for improvement. For example， personalized guidance and recommendations for swelling prevention and treatment strategies based on different surgical types and individual differences are currently lacking. Additionally， early prediction and intervention for swelling risks during the surgical process also need improvement. Therefore， there is an urgent need for in-depth research and development of effective preventive and therapeutic strategies for postoperative swelling after lower limb orthopedic surgery to enhance patient rehabilitation outcomes and quality of life.
To compare the efficacy of allograft acellular dermal patch enhancement repair and arthroscopic single row suture in the treatment of large rotator cuff tears.
Methods
A retrospective analysis was conducted on the data of 70 patients with giant rotator cuff tears treated in the Orthopedics Department of Guangzhou Red Cross Hospital affiliated to Jinan University from July 2019 to December 2022. All the patients had rotator cuff tears over five cetimeters or more than two tendons injuries， no local bone lesions， ineffective conservative treatment or poor results， good tolerance to patch repair and good cognitive function. Osteoarthritis，patients who needed complete resection of the distal clavicle， instability in front of the shoulder joint，unauthorized use of drugs or other treatment plans during treatment， end-stage malignant tumors were excluded.According to the treatment method used， the patients were divided into the control group of 35 cases and an observation group of 35 cases. The control group was treated with simple arthroscopic double row suturing， while the observation group was treated with arthroscopic double row suturing combined with allogeneic decellularized dermal patches for enhanced repair. The differences in shoulder joint range of motion， excellent shoulder joint function rate， and total incidence of complications between the two groups were compared by t test and chi square test.
Results
There was no statistically significant difference in shoulder joint range of motion between the two groups before treatment （P＞0.05）. After treatment， shoulder joint range of motion increased and the observation group were higher than the control group （t=6.820， 5.942， 8.082， 6.624， 7.006， all P＜0.05）. The excellent rate of shoulder joint function in the observation group was higher than that in the control group （χ2=9.875，P＜0.05）， and the total incidence of complications was lower than that in the control group （χ2=5.385， P＜0.05）.
Conclusion
In the treatment of giant rotator cuff tear， allograft acellular dermal patch can improve shoulder joint function and reduce the risk of complications， which is worthy of promotion.
To investigate and compare the precision in terms of joint prosthesis placement， early clinical efficacy and patients satisfaction of robotic-arm assisted functionally aligned total knee arthroplasty （RFA-TKA） versus mechanically aligned total knee arthroplasty with manual technique（MA-TKA）.
Methods
Retrospective analysis was conducted on data from patients who underwent total knee arthroplasty for knee osteoarthritis （OA） at the Department of Orthopedics， the First Affiliated Hospital of Chongqing Medical University between June 2022 and October 2023， with a follow-up period exceeding three months and complete follow-up information. Patients with other diagnoses， ligament laxity， and incomplete follow-up data were excluded. Patients were categorized into RFA-TKA group and MA-TKA group based on the surgical approach. General patient characteristics were documented， body mass index （BMI） was calculated，overall surgical satisfaction was assessed， and pre-and post-operative measurements including hip-knee-ankle angle （HKA）， mechanical lateral distal femur angle （mLDFA）， mechanical medial proximal tibia angle （mMPTA）were recorded. Visual analogue scale （VAS）， the Hospital for Special Surgery knee joint score （HSS）， as well as the Western Ontario and McMaster University osteoarthritis index （WOMAC） were evaluated before surgery， at three weeks， and three months after surgery. Clinical scores with repeated measurements over three times were analyzed by repeated-measures ANOVA， measurement data were analyzed by t test， and enumeration data were analyzed by chi square test.
Results
A total of 84 patients （89 knees） were included in the study， including 47 patients （47 knees） in the RFA-TKA group and 37 patients （42 knees） in the MA-TKA group. The differences in age （t=-0.902） and BMI （t=-1.316） between the two groups were not statistically significant（both P＞0.05）.There was no statistically significant difference between the two groups in preoperative and postoperative HKA（t=0.145， -0.065）， mLDFA （t=-0.251， 0.802）， and mMPTA （t=-1.643， -0.601）（all P＞0.05）. The main effects of group and time factors on VAS score， HSS score， and WOMAC score were statistically significant（F=6.257， P=0.016； F=1076.458， P＜0.001； F=4.909， P=0.029； F=309.043； P＜0.001； F=8.856， P=0.004；F=639.542， P＜0.001）. There was an interaction effect of surgical approach and scoring time point on VAS score and WOMAC score （F=21.448， P＜0.001； F=7.504， P=0.001）. The overall surgical satisfaction of patients in the RFA-TKA group was higher （χ2=4.965， P=0.026）.
Conclusion
Both RFA-TKA and MATKA have good therapeutic effect on knee OA， while RFA-TKA has better early clinical function score and higher patient satisfaction.
To explore the curative effect of different surgical procedures on medial compartment osteoarthritis of knee joint and the effect of improving knee joint function.
Methods
A total of 106 patients with medial compartment osteoarthritis of knee joint treated in Hengshui Hospital of Traditional Chinese Medicine from January 2021 to April 2023 were selected as the research object. Inclusion criteria were as follows： the first surgical treatment of osteoarthritis in the medial compartment of the knee joint， with indications for surgery， etc. Patients with infectious diseases， traumatic fractures， osteoporosis and the history of bone and joint surgery were excluded. According to the final treatment， the patients were divided into two groups： the high tibial osteotomy group （the HTO group， 51 cases） and the single condyle replacement group（the SCR group，55 cases）. Four cases in the HTO group were lost to follow-up， and 47 cases were eventually included. Six cases in the SCR group were lost during follow-up， and 49 cases were finally included. Both groups were observed until discharge and were followed up for 12 months. The clinical efficacy （one week after operation）， peri-operative indices， knee joint range of motion （before operation and one month after operation），sitting pain， knee joint function （at different time points） ， complications （during follow-up） and observation value of knee joint （before and 12 months after operation） were compared between the two groups by t test，repeated measurement analysis of variance and chi square test.
Results
One week after operation， compared with the HTO group， the total clinical effective rate in the SCR group was higher ， the difference was statistically significant（χ2=5.752， P＜0.05）. Compared with the HTO group， the time of getting out of bed and length of hospital stay in the SCR group was shorter （t=14.461， 10.619， both P＜0.05）. Compared with the data before operation， the flexion， extension， abduction and adduction activities of the two groups all increased one month after operation （t =130.125， 113.624， 70.859， 69.402， 53.584， 51.447， 26.909， 27.901， all P＜0.05）； the difference between the two groups were not statistically significant （all P＞0.05）. There was no statistically significant difference in the sitting pain score before surgery and 12 months after the surgery in the HTO group（F=1.308， P＞0.05） nor in the SCR group （F=0.382， P＞0.05）. There was no significant difference between the two groups in the variance of repeated measurement of sitting pain score from preoperative to postoperative 12 months （F=1.556， 0.951， 1.381， 0.472， all P＞0.05）.There was no statistical significance in the University of Western Ontario and McMaster osteoarthritis index （WOMAC） in the HTO group at each time point from before operation to 12 months after operation （F=1.162， P＞0.05）， and there was no statistical significance in comparing the variance of repeated measurement of WOMAC in the SCR group at each time point from before operation to 12 months after operation （F=0.663， P＞0.05）. There was no significant difference in the variance of repeated measurement of WOMAC score between the two groups at each time point from preoperative to postoperative 12 months （F=1.442， 0.975， 0.794， 1.941， all P＞0.05）. During the follow-up period， the total incidence of complications in the SCR group was lower than that in the HTO group， the difference was statistically significant（P＜0.05）. Compared with the data before operation， the varus angle of tibial plateau decreased in both groups at 12 months after operation （t=5.457、12.047）， especially in the SCR group （t=20.602）； the ratio of internal and external space increased in both groups at 12 months after operation （t=4.060、9.726）， especially in the SCR group （t=6.196）， the differences were statistically significant（all P＜0.05）.
Conclusion
Compared with high tibial osteotomy， the postoperative recovery time of patients with medial compartment osteoarthritis of the knee joint treated by single condyle replacement is relatively shorter， and the line and angle of knee joint can be adjusted. The incidence of complications is lower and the curative effect is more obvious， but it has the same effect on improving postoperative pain， knee joint function and knee joint mobility.
To investigate the effect of shock wave （ESW） intervention on serum tumor necrosis factor-α （TNF-α） and interleukin-1β （IL-1β） in patients with knee osteoarthritis （KOA） after arthroscopic treatment and their relationship with knee joint function.
Methods
A prospective study was conducted according to the inclusion criteria ： Kellgren-Lawrence grade I and II ； unilateral onset ； knee pain recurred in the past one month. Exclusion criteria ： osteoporosis ； arthroscopic contraindications ； severe knee varus and valgus deformity. A total of 110 patients with KOA admitted to Department of Rehabilitation Medicine，Chengdu Second People’s Hospital from June 2022 to June 2023 were selected as the research objects. They were divided into two groups according to the random number table method， 55 cases in each group. The control group was treated with arthroscopy combined with routine intervention， and the observation group was treated with ESW intervention on the basis of the cont rol group for five weeks. The patients were followed up for 24 weeks after intervention. The recovery of knee joint at different time points ［visual analogue scale （VAS）， knee joint function score （Lysholm）， knee joint range of motion （ROM）］was compared between the two groups. The levels of inflammation （TNF-α， IL -1β） were measured before and 24 weeks after intervention. The relationship between serum TNF-α， IL -1β levels and knee joint recovery in patients with KOA was analyzed by bivariate correlation Pearson.
Results
At 12 weeks and 24 weeks of treatment， the VAS scores of the two groups were lower than those before the intervention and showed a downward trend. The observation group was lower than the control group. The Lysholm score and ROM were higher than those before the intervention and showed an upward trend. The observation group was higher than the control group. The time points， groups and crosscomparisons between the two groups （VAS F=5.711， 932.505， 3.672； Lysholm score F=64.898， 664.241，20.591； ROM F=400.230， 1026.558， 77.387； all P＜0.05）. After intervention， TNF-α， IL-1β in the two groups were lower than those before intervention， and those in the observation group were lower than those in the control group （t=11.212，5.065， both P＜0.05）. The results of bivariate correlation Pearson analysis showed that the serum levels of TNF-α and IL-1β in patients with KOA were positively correlated with VAS level（r =0.356， 0.205， both P＜0.05）， and negatively correlated with Lysholm score and ROM （TNF-α r=-0.429，-0.574； IL-1β r=-0.339， -0.369； both P＜0.05）.
Conclusions
Arthroscopic intervention combined with ESW intervention in KOA patients can effectively relieve knee joint pain， improve knee joint range of motion，improve knee joint function， and reduce the body’s inflammatory response. Serum TNF-α and IL-1β levels are related to knee joint function.
To analyze the biomechanical advantages and disadvantages of posteriorlateral plates versus lateral plates in the treatment of supination-external rotaion type II fractures of the distal fibula.
Methods
The ankle fracture model and two plate models were created by using computer finite element software such as Medical 21.0， Geomagic and Solidworks. Ansys software was used to simulate the stress and fracture displacement of the ankle joint and plate models under two motion states， and to compare the biomechanical differences of the two plates in the treatment of ankle fractures.
Results
Under both loading conditions， the posterior-lateral plate exhibited superior performance compared to the lateral plate， as evidenced by lower stress values in the internal fixation model， overall stress in the fracture model， and stress distribution in the fibula model， along with improved displacement contour maps.
Conclusion
The posterior-lateral plate demonstrates superior biomechanical properties in terms of compressive strength and rotational stability compared to the lateral plate in the treatment of lateral malleolus fractures； coupled with its favorable soft tissue compatibility， the clinical application value of the new posterior-lateral plate is significantly greater than that of the lateral plate.
To compare the clinical efficacy of the antegrade intramedullary nailing with different retrograde techniques in the treatment of fifth metacarpal neck fractures.
Methods
The databases of PubMed， Excerpta Medica Database（Embase）， Cochrane Library， Web of Science， China Knowledge Network， China Science and Technology Journal Database （VIP） and Wanfang were searched for clinical studies on the treatment of fifth metacarpal neck fracture （FMNF） by the antegrade intramedullary pins technique versus different retrograde techniques. Ten high-quality articles were included， including randomized controlled studies， prospective and retrospective cohort studies. A total of 563 patients had FMNFs， of which 277 patients underwent fixation with antegrade intramedullary pins and 286 patients underwent fixation with different retrograde techniques. The main observations were visual analogue scale （VAS）， quick disability of arm， shoulder and hand （Quick DASH）， flexion， dorsal extension and complications.
Results
At three month after surgery，the VAS score of the antegrade intramedullary pin group ［mean difference （MD）=-0.88， 95% confidence interval （CI） （-1.56， -0.19）， P=0.01］was superior to those of different retrograde techniques groups， but at six months after surgery， the VAS score of the antegrade intramedullary pin group was not statistically different from that of the different retrograde techniques［MD=-0.65，95% CI （ -1.93，0.62）， P=0.32］. The Quick DASH score for the antegrade intramedullary pins was superior to the retrograde technique at three months ［MD=-4.63，95% CI （-7.86， -1.41）， P=0.005］and at six months ［MD=-1.46， 95% CI（-2.78，-0.13）， P=0.03］after the procedure. There was no difference between the two groups in flexion and dorsal extension（both P＞0.05）. In addition， the overall complication rate was low in both groups.
Conclusions
Antegrade intramedullary pins fixation was superior to retrograde technique fixation in terms of early postoperative pain and recovery of upper extremity mobility， but both complication rates were comparable. The antegrade intramedullary pin technique results in faster restoration of hand function， therefore， antegrade intramedullary pin fixation is recommend.
Joint cartilage is a crucial tissue for bearing weight in the human body. Its lack of blood vessels， nerves， and lymphatic tissue significantly limits its ability to self-repair. Damage to cartilage can lead to a range of symptoms and potentially impact the quality of life. Current clinical methods for cartilage repair have not achieved satisfactory results due to their inability to form natural hyaline cartilage， highlighting the urgent need for exploring new treatment approaches. In recent years， the deepening research into exosomes has revealed their significant potential in cartilage repair. This article focused on the biological characteristics of exosomes and the promising application of exosomes derived from cartilage cells in repairing cartilage damage，aiming to provide theoretical support for further studies on the use of exosomes from cartilage cells for cartilage repair.
Osteoarthritis is one of the common orthopedic diseases in the middle-aged and elderly people， which has a serious effect on the quality of life of the patient， the pathogenesis of the disease is not clear，there is no effective cure measures， so further study of the pathogenesis of osteoarthritis is of great significance.phosphatidylinositol 3-kinase （PI3K）/protein kinase B （AKT） signaling pathway， an important signaling pathway of cellular activity impacts a variety of downstream factors through AKT， which is involved in the cell metabolism， growth， autophagy， apoptosis， and angiogenesis in normal and tumor cells. Recent studies have found that PI3K/AKT signaling pathway is closely related to the occurrence and development of OA. Therefore，it is necessary to review the relationship between PI3K/AKT signaling pathway and OA， and explore the significance of this signaling pathway in OA treatment.
Joint and muscle function are essential for normal human movement， and sarcopenia can compromise post-joint replacement rehabilitation. This study conducted a scoping review of sarcopenia in patients undergoing total joint arthroplasty. Guided by scoping review methodology， the following data bases were searched：the China National Knowledge Infrastructure， Wanfang Database， Chinese Biomedical Literature Database， Web of Science， PubMed， Cumulative Index to Nursing and Allied Health Literature（CINAHL），and Cochrane Library from inception to April first， 2024. Two graduate students screened， summarized， and systematically analyzed the literature， ultimately including 19 studies. The prevalence of sarcopenia in preoperative total joint arthroplasty patients ranged from 1.3% to 35.5%， primarily assessed using SARC-F and calf circumference. Influencing factors included sociodemographic， physical status， biomarkers， and comorbidities. Interventions involved exercise， nutritional supplements， traditional Chinese medicine， and multidisciplinary approaches. The varying prevalence and influence of multiple factors highlight the need for further validation of sarcopenia prediction models and the development of culturally appropriate screening tools for timely identification of sarcopenia in total joint arthroplasty patients.
Necrosis of the femoral head is a common and difficult-to-treat hip disease in orthopedics，with the main clinical manifestations of claudication， limitation of hip flexion and extension activities， and hip pain. If left untreated once the femoral head collapses or secondary osteoarthritis occurs， total hip replacement is eventually required. Currently， the clinical treatment of femoral head necrosis is mainly based on Association Research Circulation Osseous （ARCO） staging to choose different treatment modalities. Early-stage patients are usually treated with "hip preservation"， and the commonly used surgical methods include medullary decompression， autologous bone grafting， stem cell therapy， etc.， while total hip arthroplasty is often used for advanced patients. However， prevention of collapse has always been the key point in the treatment of femoral head necrosis. In recent years， platelet-rich plasma （PRP） has been effective in promoting cartilage repair and vascular regeneration of the femoral head. Therefore， this paper summarized the mechanism of PRP in the treatment of femoral head necrosis and its clinical application， with a view to providing reference and direction for subsequent research.
Femoral anteversion （FA） is an angle that describes the rotation or torsionof the proximal femur relative to posterior condyle line. Abnormal FA has a great influence on the kinematics and dynamics of the joints of the lower limbs.There are great differences in FA among individuals， and the measurement methods have not yet been unified. At present， the most commonly adopted normal value of FA ranges from 5°to 20°. Abnormal FA， including excessive anteversion and relative retroversion， could change the mechanical environment of the hip joint， and contribute to the occurrence and development of developmental dysplasia of hip and femoroacetabular impingement. Abnormal FA leads to alteration of the movement pattern， which could subsequently cause damage of the acetabular cartilage， labrum and even bone. Accurate measurement and meticulous evaluation of FA are helpful to formulate personalized preoperative planning， thereby further improving the efficacy of hip joint preserving operation.
Knee dysfunction associated with Knee Osteoarthritis（KOA） is characterized by knee pain， knee stiffness， reduced muscle mass and knee flexion and extension strength. The causes of pain in KOA includes peripheral damaging pain mechanisms as well as pain by osteopathic regulation or central sensitization mechanisms， which is associated with changes in activity in the somatosensory cortex and emotion regulation regions of the brain. Changes in knee motor control in KOA patients include changes in gait and muscle activation patterns， quadriceps muscle weakness， proprioceptive impairment， and limited joint movement， which are closely related to central neuroregulation.
Total knee arthroplasty （TKA） has a wide audience， individualized and tiered rehabilitation treatment after surgery is particularly crucial. Therefore， postoperative follow-up and knee joint function evaluation should be conducted for TKA patients. At present， postoperative TKA mainly relies on outpatient follow-up， which squeezes medical resources. Remote follow-up after TKA surgery is gradually emerging，but there are still some drawbacks. This article aimed to introduce the progress of remote TKA follow-up and evaluation of knee joint function through artificial intelligence （AI） technology.
To discuss the early efficacy of the intelligent minimally invasive reduction robot system for pelvic fractures in the treatment of unstable pelvic fractures， and to analyze its clinical advantages， limitations and precautions.
Methods
A retrospective evaluation was conducted on 25 patients with unstable pelvic fractures treated by the robot system at the trauma orthopedics department of Foshan Traditional Chinese Medicine Hospital between June 2022 and November 2023. According to the Tile classification， there were 20 cases of type C and five cases of type B fractures. Minimally invasive closed reduction of pelvic fractures were performed with the assistance of the robot system. Pelvic CT scans and X-ray images at anteroposterior， outlet， and inlet positions were taken before and after surgery. The maximum displacement of the anterior and posterior pelvic rings before reduction and the maximum residual displacement of anterior and posterior pelvic rings after reduction were measured according to X-ray and CT images， and the quality of fracture reduction was evaluated by Matta criteria. The maximum displacement of the anterior and posterior pelvic rings before reduction， fluoroscopy frequency and time， reduction time， operation time，intraoperative blood loss， and maximum residual displacement of anterior and posterior pelvic rings after reduction were documented， and the distance required for the robotic arm to reduce the anterior and posterior pelvic rings was calculated. The fracture healing time and postoperative monitoring period were recorded， and the Majeed scoring system was used for functional evaluation.
Results
With the assistance of the robot system， 25 patients were all successfully treated with minimally invasive closed reduction for pelvic fractures. The average maximum displacement before reduction of the anterior pelvic ring was （16±7） mm. The average maximum displacement before reduction of the posterior pelvic ring was （9±6） mm. The intraoperative fluoroscopy frequency was 31 （19，58） times. The average fluoroscopy time was （31±16） s. The average reduction time was （59±4） min. The surgery time was 206 （200，213） min. The intraoperative blood loss was 100 （50，160） ml . The maximum residual displacement after reduction of the anterior and posterior pelvic rings were 2.1 （0， 7.6） mm， 3.8 （1.4，7.9）respectively. The distance required for the robotic arm to reduce the anterior and posterior pelvic rings were 14 （4，18） mm， 4.0 （1.8，6.6） mm respectively. According to Matta criteria， the reduction quality of both the anterior and posterior pelvic ring was excellent in 15 cases， good in seven cases， and fair in two cases， with a good-toexcellent rate of 91.7%. The fracture healing time was 3 （3， 4） months. Follow-up time for the 24 cases was 16 （14，19） months， with the Majeed functional score （85±8） on average. Nine cases scored excellent， and 16 cases were good， with a good-to-excellent rate of 100%.
Conclusion
In this study， the robot system can facilitate precise and minimally invasive closed reduction for the majority of patients with unstable pelvic fractures， achieving satisfactory fracture reduction quality and early efficacy.
To explore the arthroscopic binding fixation through single bone tunnel using wire versus open fixation for tibial insertion of the posterior cruciate ligament in adults.
Methods
From June 2018 to June 2023， 40 patients with acute adult posterior cruciate ligament tibial insertion fractures admitted to Jianhu Clinical Medical College of Yangzhou University were randomly divided into two groups： arthroscopic group （n=20） and incision group （n=20）. Follow-up assessment included visual analogue scale （VAS）， Lysholm knee score， International Knee Documentation Committee （IKDC）， range of motion（ROM） for knee， posterior drawer test， Lachman test and radiological evaluation before surgery and three days， one month and six months after surgery. Overall differences in VAS， Lysholm score， IKDC， ROM were analyzed by variance for repeated measurement data， differences at each time point were analyzed by independent samples t test. The categorical data were analyzed by rank sum test.
Results
All the patients were followed up for eight to 12 months， with an average of （9.91.0） months. All the incisions achieved healing by first intention after operation. There was no incision infection， popliteal neurovascular injury or thrombosis in deep veins of lower limbs. X-ray films at six months after operation showed the fractures obtained bone union. The back drawer test and Lachman test were both negative. The total differences of VAS （F=18.364）， Lysholm score （F=49.371）， IKDC score （F=14.094）， and ROM （F=174.708） between the two groups were statistically significant （all P＜0.001）， which showed that the arthroscopic group were better than the incision group. In terms of grouping， the differences of VAS （t=-3.048、2.1250）， Lysholm （t=6.725、6.280， both）， IKDC （t=4.127、5.872）， ROM （t=4.875、4.500） between the two groups were statistically significant on three days and one month after surgery （all P＜0.05）. The differences of VAS， Lysholm， IKDC， ROM between the two groups were not statistically significant at six months after surgery（t=0.438、1.792、1.999、1.433， all P＞0.05）. In terms of time，the VAS of the two groups decreased from preoperation to six months after operation，and Lysholm， IKDC， ROM of the two groups increased from pre-operation to six months after operation.
Conclusions
Arthroscopic binding fixation of avulsion fractures of the tibial insertion of the posterior cruciate ligament through single bone tunnel using wire in adults has satisfactory early results and better efficacy than open fixation surgery， which is minimally invasive， benefit for rehabilitation. It can achieve satisfactory recovery and is worthy of clinical application.
To analyze lessons and experiences of the failed cases of the recurrent bone cyst（BC）and aneurysmal bone cyst （BCA） by evaluations of the clinical efficacy and long-term follow-up results of local intralesional injection， as well as the therapeutic effect of subcutaneous injection of denosumab.
Methods
Retrospective analysis was performed on 10 patients with postoperative recurrence of BC and BCA in The First Affiliated Hospital of Guangzhou University of Chinese Medicine from 2013 to 2021. Five patients were treated with multiple intralesional injections after recurrence. Among these five patients， two patients were treated with denosumab， one patient was treated with epiphyseal plate block， and one patient finally underwent artificial hip replacement. These 10 patients were followed up for a long time to evaluate the clinical efficacy，oncological outcome and postoperative function.
Results
Some BCA and BC patients had no obvious clinical symptoms after recurrence. After at least 24 months of follow-up， all the patients treated with intralesional injection and desumumab achieved partial or complete healing， Musculoskeletal Tumor Society （MSTS） score of 29 or 30， good functional activity， high psychological acceptance， and no complication.
Conclusion
Regular follow-up is very important to detect recurrence of BCA and BC， and multiple intralesional injections are recommended for recurrent patients.
To analyze the effect of the quality improvement tool of the supply tube on the very early ambulating activity of the elderly after total knee arthroplasty.
Methods
A total of 122 elderly patients receiving RA-TKA from the Department of Orthopedics of the 920th Hospital of the Joint Logistics Support Force of PLA from March 2022 to April 2023 were conveniently sampled. Among them， 61 patients from March 2022 to September 2022 were not treated with the intervention of the supply circle quality improvement tool as the control group， and were given routine nursing and related health education.The observation group included 61 patients who used the tool intervention from October 2022 to April 2023.T test， Chi-square test and repeated analysis of variance were used to compare the rate of getting out of bed and the time of first ambulation time. Visual anaolgue scale （VAS） and Knee Society score （KSS） were performed at rest， during and after activity.
Results
The compliance rate of getting out of bed after surgery， the time of getting out of bed for the first time and the compliance rate of all types of getting out of bed were higher in the observation group than in the control group， with statistical significance （χ2=21.058， t=16.611， walking on ground≥10m χ2=8.396， bed to chair transfer χ2=11.517， standing at the bedside over five minutes χ2=9.210， all P＜0.05）. VAS score showed statistically significant differences in inter-group effect， intra-group effect and interaction effect（F=5041.267， 317.856， 10.749， all P＜0.001）.Simple effect analysis showed that VAS scores in the observation group were lower than those in the control group （F=10.680， 28.846， both P＜0.05）. KSS， KSS function scores，and range of motion of knee in observation group were significantly higher than those in control group （t=2.150，2.530， 14.489， all P＜0.05）.
Conclusion
The quality control circle quality improvement tool can improve the ultra-early ambulation rate of elderly patients after robot-assisted total knee arthroplasty， improve the active pain，shorten the first ambulation time after surgery， improve the joint range of motion， and promote the recovery of joint function.
