Exploring the clinical efficacy of proprioceptive neuromuscular facilitation (PNF) combined with dry needling in the treatment of subacromial impingement syndrome (SIS).

Sixty SIS patients admitted to the Rehabilitation Medicine Department of the 904th Hospital of the Joint Protection Force from May 2023 to July 2024 were selected as the study subjects. The patients with shoulder radiation pain caused by cervical spondylosis, scapular tumors, congenital developmental abnormalities, combined nerve injuries, and history of surgery or fracture of the affected shoulder joint were excluded. Utilizing the random number table method, the participants were classified into a control group (n=30) and an observation group (n=30). The control group received conventional exercise combined with dry needle therapy,while the observation group received a combination of PNF and dry needle therapy. Before and after eight weeks of treatment, visual analogue scale (VAS) scores, active range of motion (AROM) of the shoulder joint, and disabilities of the arm, shoulder, and hand (DASH) were used for evaluation. Statistical analysis was conducted using t test, non parametric test and chi square test.

After treatment, both groups showed a significant reduction in VAS scores (Z=-4.879, -4.890, both P<0.05), but there was no statistically significant difference between the groups (Z=-1.34, P>0.05). The observation group exhibited greater increases in AROM across all directions compared to the control group (P<0.05), and the DASH scores were lower in the observation group, with a statistically significant difference (Z=-2.441, P<0.05).

The combination of PNF and dry needling therapy can effectively alleviate pain in SIS patients and significantly improve the active range of motion of the shoulder joint and upper limb function. This approach is beneficial for patients’ early return to normal life and is worthy of promotion and application.

To investigate the application strategy of robot-assisted navigation technology in anterior approach total hip arthroplasty (THA) for severe hip dislocations and to evaluate its clinical safety and effectiveness.

Eighteen patients with severe hip dislocations (Crowe type IV), including three males and 15 females, age range was 23 to 72 years, were enrolled in the department of sports medcine and adult reconstruction, Nanjing Drum Tower Hospital from October 2022 to October 2023. The patients with joint infection on the involved side and those who were intolerant to surgery were excluded. Before surgery, the MAKO robot was used to plan the acetabular position, prosthesis type and size, and implantation angle. The prosthesis type and size were also planned based on the morphology of the proximal femur. The anterior approach was used to expose the hip in the supine position, with the acetabular cup prepared and installed under robotic arm assistance, while manual reaming and femoral prosthesis installation were performed. Data were collected on preoperative and postoperative (three and six months, one year) Harris hip function scores and evaluated by repeated measurement of variance analysis. The data of operative duration, leg length discrepancy, acetabular cup anteversion and abduction angles, preoperative and postoperative hematocrit and hemoglobin levels were analyzed by paired t test; postoperative complications were recorded.

The average operative duration was (162.5±36.3) min. Hemoglobin levels decreased from (126.2±12.9) g/L to (109.0±10.9) g/L after surgery, and hematocrit decreased from (41.2±12.0) % to (33.1±3.1) %, with statistically significant differences (t=5.241, 2.791, both P<0.01). Leg length discrepancy was corrected from an average of (35.4±20.4) mm preoperatively to (9.6±6.2) mm postoperatively. Postoperative measurements showed an average acetabular cup anteversion angle of (19.6±4.1)°, which was larger than the preoperative plan of (14.4±1.6)°, and an average abduction angle of (40.3±5.1)°, which was smaller than the preoperative plan of (43.8±2.6)°, with statistically significant differences (t=5.130, 4.940, 2.591, all P<0.05). There was no statistically significant difference in the eccentricity before and after surgery (t=0.897, P=0.130). The preoperative planning for femoral stem and acetabular cup sizes matched the intraoperative use with 100% consistency. The Harris hip function score increased from an average of (58.2±10.8) preoperatively to (79.9±15.9) at six months postoperatively and (89.5±8.3) at one year postoperatively, indicating significant improvement in hip function. Two patients (11.1%) experienced proximal femoral fractures, and two patients (11.1%) had postoperative prosthesis dislocations. One case of postoperative femoral nerve palsy was treated with hip flexion fixation combined with neurotrophic therapy. The symptoms were relieved three months after the operation. After open reduction and fixation with braces, no recurrences occurred. No patients experienced complications such as wound infection or poor wound healing.

Preoperative robotic planning aids in personalized prosthesis selection for severe hip dislocations, ensuring precise installation. The anterior approach helps release the tensor fascia lata for limb length correction. However, hip deformities and muscle atrophy may delay recovery and increase dislocation risks, necessitating detailed perioperative soft tissue management beyond robotic capabilities.

To observe the effects of Tri-Lock bone preservation stem (BPS) and Corail femoral stem prosthesis on perioperative indicators, joint function scores and postoperative complications in patients undergoing total hip arthroplasty (THA).

A total of 243 patients with developmental dysplasia of the hip who underwent primary THA in the First People’s Hospital of Guangyuan were enrolled, while the patients with hip surgical history, American Society of Anesthesiologists (ASA) classification ≥Ⅲ, bone density T value <-5 and other severe diseases were excluded. The patients were assigned to the Corail group (123 cases, 167 hips) and the Tri-Lock BPS group (120 cases, 151 hips) according to different femoral stem prostheses used. T test and chi-squared test were performed to compare perioperative indicators, joint function, initial stability of femoral stem, imaging parameters, gait parameter and postoperative complications between the two groups.

Blood loss of the Tri-Lock BPS group was less than that of the Corail group, and length of postoperative hospital stay was significantly shorter than that of the Corail group (t=3.148, P<0.05). Harris scores of the two groups at one, three, six and twelve months after surgery showed statistically significant differences in terms of time effect (F=1295.358, P<0.05). The femur offset, bone mass retention area of the widest part of the lesser trochanter and bone mass retention volume between the greater and lesser trochanters in the Tri-Lock BPS group were larger than those in the Corail group (t=9.701, 4.941, 46.493, all P<0.05). The stride length and step length of Tri-lock BPS group were significantly larger than that of Corail group (t=4.113, 5.083, both P<0.05). The stride frequency and gait asymmetry index were significantly smaller than that of Corail group (t=3.458, 4.911, both P<0.05). The postoperative complication rate in the Tri-Lock BPS group was lower than that in the Corail group (χ²=4.074, P<0.05).

Applying Tri-Lock BPS femoral stem in THA can reduce blood loss, shorten the length of hospital stay, increase offset value, retain more bone mass in the broadest part of the lesser trochanter and the intertrochanteric bone mass, improve gait, and reduce postoperative complication risk.

To prospectively investigate gait-related risk factors associated with downslope walking concerning sport-related lower limb injuries.

The inclusion criteria comprised healthy college students, and the exclusion criteria were lower limb trauma or ligament injury in the last year, history of surgery, neuromuscular disorders, and conditions impairing athletic performance or quality of life. Demographics and anthropometric data of participants were collected, and a three-dimensional gait analysis system was employed to obtainsix degreeoffreedom (6 DOF) kinematic parameters of the knee during down-slope walking on a treadmill. Over 18 months, lower limb injuries were documented. Independent samples t tests and Wilcoxon Mann-Whitney tests were used to compare variable differences. Binary analysis identified risk factors, with variables showing P<0.05 included in multivariate logistic regression analysis.

A total of 518 subjects were recruited, of whom 399 were ultimately included, including 190 males and 209 females, average age were (20.3±3.7) years, resulting in a follow-up rate of 80.7%. A total of 36 injuries (9.0%) were reported. Multivariate logistic regression analysis indicated that subjects who sustained injuries exhibited significantly greater anterior tibia translation (ATT) during the loading response [odds ratio (OR) =2.563, 95% confidence interval (CI) (1.439, 4.565)]while walking down-slope. The uninjured subjects exhibited a greater maximum knee flexion angle (KFA) during down-slope walking[OR=0.969, 95%CI (0.953, 1.014)].

Greater ATT may serve as a gait-related risk factor for lower limb injuries, whereas greater KFA may act as a protective factor. Other gait-related factors assessed under downs-lope conditions, especially muscle mass, gender, and BMI, do not demonstrate significant etiological relevance among college students.

To delineate and segment the lower limb muscle distribution in patients with varus knee osteoarthritis (KOA) using full-length anteroposterior digital radiographs (DR), quantitatively assess muscle abundance in different lower limb regions, and to explore its associations with KOA progression and the risk of sarcopenia (SP).

A total of 57 patients (80 lower limbs) diagnosed with KOA and hospitalized in the Joint Center of the Third Affiliated Hospital of Guangzhou University of Chinese Medicine between January 2023 and July 2023 were enrolled based on inclusion and exclusion criteria. Inclusion criteria were: knee pain within the past month, age ≥ 50 years, morning stiffness lasting <30 min, and radiographic evidence of joint space narrowing, subchondral sclerosis and/or cysts, and osteophyte formation. Exclusion criteria: valgus KOA or other types of arthritis, comorbidities affecting lower limb function, limb deformities of non-KOA origin, or inability to cooperate with data collection. Demographic data such as gender, age, height, weight, body mass index (BMI), and presence of diabetes or hypertension were collected. Muscle area indices were extracted from five anatomical regions-lateral femur, medial femur, medial tibia, crural interosseous region, and lateral fibula-based on full-length DR images. KOA-related radiographic parameters such as hip-knee-ankle angle (HKA), joint line convergence angle (JLCA), medial joint space width (MJSW), and lateral joint space width (LJSW) were also recorded. Appendicular skeletal muscle mass index (ASMI) was assessed using dual-energy X-ray absorptiometry (DXA). Patients were classified into SP-KOA and KOA groups according to the diagnostic criteria for sarcopenia proposed by the Asian Working Group for Sarcopenia (AWGS), and further categorized into mild KOA [Kellgren & Lawrence (K-L) grade one to two] and severe KOA (grade three to four) groups for comparative analysis. Group comparisons were conducted using Mann-Whitney U test, independent samples t test, and chi square test as appropriate. Binary logistic regression was used to assess the associations between regional muscle area indices and KOA severity or SP risk. Linear regression was employed to evaluate the relationship between muscle distribution ratios and the degree of varus deformity. Receiver operating characteristic (ROC) curves were constructed to determine predictive value.

Binary logistic regression analysis indicated that the tibial medial muscle area index was significantly associated with SP risk [odds ratio (OR)=0.068, 95% confidence interval (CI) (0.011, 0.407)], with area under the curve (AUC) of 0.732 [95% CI (0.625, 0.843), P<0.001], optimal cut-off value of 1.457, sensitivity of 85.3%, and specificity of 52.2%. Age [OR=1.11, 95% CI (1.024, 1.203)] and femoral lateral muscle area index [OR=0.321, 95% CI (0.127, 0.806)] were significantly associated with KOA progression [AUC=0.782, 95% CI (0.682, 0.881), P<0.001], with optimal thresholds of 68 years for age and 2.760 for femoral lateral muscle area index, respectively, yielding a sensitivity of 87.5% and specificity of 55.0%. Moreover, the medial-to-lateral femoral muscle area index ratio was significantly correlated with the degree of varus deformity: negatively correlated with HKA (t=-2.64, P<0.05), positively correlated with JLCA (t=2.38, P<0.05), and negatively correlated with MJSW (t=-3.07, P<0.05).

In patients with varus KOA, atrophy of the lateral femoral muscle and imbalance in medial-to-lateral femoral muscle distribution may contribute to disease progression, while medial tibial muscle atrophy may be associated with increased SP risk. Tailored rehabilitation strategies targeting specific muscle groups may help mitigate KOA progression and reduce the incidence of sarcopenia.

To explore the early rehabilitation effects of the health action process approach (HAPA)-based prehabilitation in robot-assisted total knee arthroplasty (rTKA).

A total of 74 patients undergoing revision total knee arthroplasty (rTKA) at the 920th Hospital of the Joint Logistics Support Force between August 2021 and March 2024 were enrolled. Inclusion criteria: meeting the diagnostic criteria for end-stage knee osteoarthritis and providing informed consent for rTKA; knee flexion contracture< 15°; absence of systemic or local infectious diseases; and the ability of the patient or accompanying family member to use WeChat on a mobile phone. Exclusion criteria: knee revision surgery; presence of neurological disorders affecting the knee joint; and severe chronic comorbidities. Patients were randomly assigned to either the control group or the intervention group (37 cases per group) by random number table. The control group received routine preoperative rehabilitation training, while the observation group received additional HAPA-based prehabilitation interventions alongside routine preoperative rehabilitation. Independent samples t tests and repeated-measures analysis of variance (ANOVA) were employed to compare knee range of motion (ROM), quadriceps muscle strength, and balance ability assessed before operation, one and three months after operation. Additionally, the Knee Society score (KSS) knee score, KSS function score, and hemoglobin decline were compared between the groups before operation and three months after operation.

Repeated measures ANOVA revealed significant between-group, time, and interaction effects for ROM, quadriceps strength, and balance ability (inter-group effect: F=9.045, 6.088, 4.255, time effect: F=319.597, 164.419, 114.488, interaction effect: F=4.712, 7.065, 4.434, all P<0.05). Simple effect analysis demonstrated superior ROM, quadriceps strength, and balance ability in the intervention group at one and three months postoperatively (P<0.05). No significant inter-group differences were observed in hemoglobin decline (t=0.538, P>0.05) or KSS knee and function scores at three months (t=0.320, 0.262, both P>0.05).

HAPA-based prehabilitation can effectively improve joint mobility, enhance core muscle strength around the knee, and promote balance recovery in rTKA patients, facilitating early postoperative rehabilitation.

To investigate the effect of femoropopliteal combined nerve block and local periarticular infiltration anesthesia on pain control after total knee arthroplasty.

A total of 102 patients who underwent unilateral total knee arthroplasty in Jianyang People’s Hospital from June 2020 to August 2022 were selected; patients with severe osteoporosis, coagulation disorders, reumatoids, malignant tumors, chronic pain and patients on long-term analgesic therapy were excluded. They were divided into the observation group (given combined femoral-popliteal nerve block) and the control group (given local periarticular infiltration anesthesia) according to the random number table method, with 51 cases in each group. Repeated measures analysis of variance was used to compare the visual analogue scale (VAS) scores for pain, adrenocorticotropic hormone (ACTH), cortisol (COR), and the number of compressions for patient-controlled intravenous analgesia (PCIA) at different time points between the two groups in the resting state and the passive movement state. Independent sample t tests were used to compare the time of the first compression between the two groups.

The differences in VAS score, ACTH, COR, postoperative PCIA compression times were statistically significant between the two groups ( inter-group F=150.034, 150.539, 121.930, 157.205, time F=564.883, 19.802, 1554.104, 1586、661, interaction F=10.579, 29.889, 154.069, 201.473, all P<0.001). VAS scores at rest and passive exercise at six, 12, 24, 48 h and 72 h in observation group were lower than those in control group (t=4.029, 5.222, 8.886, 6.232, 7.172, 7.737, 8.198, 8.818, 10.752, 11.799, all P<0.05). At one and three days after operation, ACTH and COR in observation group were lower than those in control group (t=9.713, 14.607, 15.099, 12.394, all P<0.05). The number of PCIA compressions six, 12 h and 24 h after operation in the observation group was lower than that in the control group, and the first PCIA compression time was longer than that in the control group (t=12.541, 15.290, 14.761, 5.650, all P<0.05).

Femoropopliteal nerve block has an ideal analgesic effect in total knee arthroplasty, which is conducive to reducing stress response and PCIA compression times.

To evaluate the position of the talus and fibula on axial magnetic resonance imaging (MRI) images of patients with chronic ankle instability (CAI).

Fifty patients who were hospitalized in the Department of Orthopedics of Renhe Hospital Affiliated to China Three Gorges University from January 2019 to July 2023 were enrolled as as the experimental group (the included patients were diagnosed with CAI with anterior talofibular ligament injury; patients with a history of previous lower limb joint surgery or deformity were excluded). The other 50 patients who visited this hospital for other diseases were enrolled as control group (excluded those with ankle joint-related bony or ligamentous injuries). A retrospective analysis was performed on the data of the enrolled patients. The axial malleolar index (AMI), inter malleolar index (IMI), malleolar talus index (MTI), central malleolar index (CMI), and midpoint inter malleolar index (MIMI) were measured using the measurement tools within the Picture Archiving and Communication System (PACS) of the hospital. The distance (d) between the center of the fibula and the axis line of the proximal tibia was measured at the level of the axial image layers near the joint; t test and Wilcoxon rank sum test were applied for statistical analysis.

No statistically significant differences were found in age, gender ratio, affected side ratio, height, weight, or body mass index (BMI) between the experimental group and the control group. There were no significant differences in angular measurements between the two groups ( all P>0.05), the data were as follows: AMI (-10.8±4.8)°vs. (-10.4±5.5)°, IMI (-9.3±3.7)° vs. (-9.4±3.9)°, CMI (-15.8±6.5)° vs. (-13.9±5.8)°, MIMI (-8.4±3.7)° vs. (-8.3±3.6)°, MTI 86.00 (84.00, 88.00)°vs.85.00 (83.00, 87.00)°. The experimental group showed a more posterior position of the fibular center relative to the distal tibial axis compared to the control group (Z=2.562, P<0.05).

In CAI patients, the position of the fibula relative to the tibia is displaced posteriorly on MRI axial images, with no significant change in the position of the talus.

Osteoarthritis is a degenerative disease marked by articular cartilage degradation, osteophyte hyperplasia, subchondral bone remodeling, and synovial inflammation, primarily manifesting as pain. Notably, normal articular cartilage is devoid of nerve innervation; however, as osteoarthritis advances, innervation emerges in previously uninnervated regions. Axon guidance cues serve as pivotal regulators of nociceptive nerve growth, playing a dual role. On one hand, nerve innervation facilitates injury repair, subchondral bone remodeling, and mitigatessynovial inflammation. Conversely, it heightens pain sensitivity or exacerbates pain symptoms. This intricate interplay is orchestrated by four primary axon guidance cues: netrin-1, slit guidance ligand(SLIT), Eph receptor-interacting proteins (ephrin), and semaphorin3A (Sema3A). This review delved into the intricate role of these cues in the progression of osteoarthritis and elucidates the mechanisms underlying nerve innervation in areas previously lacking innervation.

Osteoarthritis (OA) is one of the common orthopaedic diseases in the middle-aged and elderly population, which has a serious impact on the quality of life of patients. The etiological and pathological mechanisms of OA are still unclear, and there is currently no effective preventive and curative measure, so in-depth study of the pathogenesis of osteoarthritis is of great significance. Primary cilia are microtubule-based organelles that play important roles in mechanosensation, mechanotransduction, polarity maintenance, and cellular behaviour during organ development and pathological changes. The hedgehog pathway, as a highly conserved signaling pathway for cellular activities, plays an important role in regulating the formation and development of the skeleton of tissues and organs, as well as in disease processes. In recent years, with the further development of precision medicine and extensive research in cell and molecular biology, it has been found that primary cilia mediate the hedgehog signaling pathway, which can affect the function and degeneration of chondrocytes. The relationship between primary cilia and hedgehog signaling pathway and OA is now reviewed, with the aim of providing precise targets and new ideas for the clinical treatment of articular cartilage injury and OA.

Steroid induced osteonecrosis of the femoral head (SONFH) is a common metabolic disease in clinical practice. However, there are multiple theoretical theories on its pathogenesis, but it is currently believed that microcirculation disorders are the main pathological mechanism causing osteonecrosis of the femoral head. As an immune cell, macrophages play an important role in regulating the balance of tissue microenvironment under normal circumstances. However, the changes in physiological environment after microcirculatory disorders affect the transformation of their metabolic status, resulting in high heterogeneity and plasticity. Especially in the early stages of onset, the impact of vascular growth factor interference on macrophage metabolism on bone resorption and remodeling remains largely elusive. Therefore, investigating the vascular growth factors secreted following microcirculatory disturbances has potential significance in elucidating their role in mediating the pathogenesis of steroid-induced femoral head necrosis via bone immune cells.

Femoral head fractures are serious and rare injuries of the proximal femur, often associated with acetabular fractures and hip dislocations, which are complex and difficult to treat with unsatisfactory results, and the current literature in the UK and abroad is dominated by small studies and case report series. In recent years, due to the increase in the number of motor vehicle accidents and the improved safety performance of modern vehicles, the survival rate of patients with multiple trauma has increased significantly, resulting in a steady increase in the incidence of femoral head fractures, which are usually high-energy intra-articular injuries and therefore pose a challenge to orthopaedic surgeons. This article presents a narrative review of the mechanism of injury, typing and treatment of this fracture in recent years, both nationally and internationally.

This artical summarized the development trend of rehabilitation nursing research hotspots for ankle joint injuries in China, presentedresearch hotspots and trends, and providedreference for ankle joint injury rehabilitation nursing research. Based on 660 articles on ankle joint injuries indexed by China National Knowledge Infrastructure (CNKI) from the year 2024, co-word analysis and burst word graph analysis were conducted to explore the cutting-edge hotspots and evolutionary paths of rehabilitation nursing research for ankle joint injuries.In recent years, the annual publication curve of ankle joint injury rehabilitation nursing research literature has decreased, and research institutions are relatively scattered, without forming a core author group and core research institutions.The research on ankle joint injury rehabilitation nursing has received continuous attention in China since 2015, and there is still significant research space. Relevant departments need to increase their attention and investment in order to deepen the development of ankle joint injury rehabilitation nursing research.

To investigate the early clinical effect of delayed intraarticular injection of platelet-rich plasma (PRP) for the treatment of rotator cuff tears after repair.

Ninety patients with rotator cuff tears were selected from May 2021 to December 2022 in Yancheng NO.1 People’s Hospital. According to random number table, the patients were divided into three groups: the delayed single-injection group (single-injection group), the delayed multiple-injection group (multiple-injection group) and the control group, 30 cases in each group. All the patients underwent single-row rotator cuff repair with small to large full-thickness rotator cuff tears. All three groups of patients took the same rehabilitation program after surgery. The single-injection group received a single dose intra-articular injection of PRP one month after arthroscopic surgery. The multiple-injection group received intra-articular injection of PRP once a week for three consecutive weeks at one month postoperatively, while the control group received a single dose intraarticular injection of PRP at the end of arthroscopic surgery. Visual analogue scale (VAS), Constant-Murley score (CMS) and University of California Los Angeles shoulder score (UCLA) were recorded before and three, six,12 months after arthroscopic surgery. The results were statistically analyzed by repeated measurement variance analysis. Any adverse event during follow-up was record. The rotator cuff retear rates were evaluated 12 months after surgery by MRI.

All the patients were followed up. There were no statistically significant differences in VAS, CMS or UCLA scores among the three groups before surgery (F=0.077, 0.185, 1.269, all P>0.05). The VAS scores of the three groups after surgery were lower than those before surgery, and the CMS and UCLA scores after surgery were higher than those before surgery; VAS scores at three, six and 12 months after surgery in the multiple-injection group were significantly lower than those in the control group (I-J=-0.933, -0.700, -0.833, all P<0.05); the CMS and UCLA scores at three, six and 12 months after surgery in the multiple-injection group were significantly higher than those in the control group (I-J=5.100, 4.367, 3.600, all P<0.05; I-J=4.367, 1.600, 3.300, all P<0.05). The CMS scores at six and 12 months and the UCLA scores at six and 12 months after surgery in the multiple-injection group were significantly higher than those in the single-injection group (I-J=2.533, 2.267, both P<0.05; I-J=2.933, 1.600, both P<0.05). No wound swelling, exudation, blood vessel and nerve injury occurred in the three groups. There was no statistically significant difference in the rate of rotator cuff retear among the three groups (P>0.05).

Delayed injection of PRP after rotator cuff repair is a safe and effective method in treatment of rotator cuff tears, which could relieve the postoperative pain and improve shoulder function.

To compare the early to mid-term outcomes and functional results of neutral alignment versus mild residual valgus following primary total knee arthroplasty (TKA) in patients with valgus knee deformity.

A retrospective analysis was conducted on 55 patients with valgus knees (57 knees) who met the inclusion criteria between January 2015 and August 2020. The follow-up duration were 2.8 to 8.5 years. Based on the hip-knee-ankle angle (HKA) measured on the first postoperative weight-bearing lower-limb X-ray, patients were divided into two groups: the neutral group (–3°≤HKA≤3°, n=33) and the mild valgus group (3°<HKA≤6°, n=24). The groups were compared using the American Knee Society score (KSS), the Western Ontario and McMaster Universities osteoarthritis index (WOMAC), and the forgotten joint score-12 (FJS-12) were compared between the two groups using paired t tests or Wilcoxon signed-rank test. No case needs prosthetic knee revision during the follow-up period.

At the final follow-up, the neutral group demonstrated significantly better clinical and functional outcomes compared to the mild valgus group, including higher KSS knee scores (t=2.043, P<0.05), knee function scores (Z=-2.766, P<0.05), lower WOMAC scores (t=-3.327, P<0.05), and higher FJS-12 scores (t=2.485, P<0.05). Additionally, among preoperative valgus patients, those with a valgus angle of 9° to 15° achieved significantly higher KSS knee function scores compared to those with angles of 3° to 9°or >15° (H=6.189, P<0.05).

In patients with valgus-type OA undergoing TKA, adjusting the HKA alignment to a neutral position (±3°) significantly improves clinical and functional outcomes compared to mild residual valgus and enhances patient satisfaction. There may be an optimal range of postoperative alignment for different degrees of valgus, within which patients experience the most significant symptom relief and functional recovery. This finding provides valuable insights for optimizing personalized treatment strategies.

To explore the clinical study and efficacy of three dimentional (3D) printed osteotomy plate combined with Scarf osteotomy in the treatment of moderate to severe hallux valgus deformity.

Twenty-four patients (30 feet) with moderate to severe valgus admitted to the Department of Joint Surgery, 940th Hospital of the Joint Logistics Support Force from October 2018 to December 2023 were divided into two groups: the observation group adopted Scarf osteotomy assisted by 3D printing osteotomy guide plate and the control group adopted conventional Scarf osteotomy, 12 patients with 15 feet in each group. In the observation group, the patients were from 43 to 49 years old, the preoperative hallux valgus angle (HVA) was 30° to 46°, and intermetatarsal angle (IMA) was 11° to 25°. In the control group, the patients were from 44 to 49 years old, the preoperative HVA was 30° to 45°, and IMA was11° to 23°. The following parameters were compared: operative time, intraoperative blood loss, hospital stay, postoperative complications, visual analog scale (VAS) pain score at one week after surgery, American Orthopaedic Foot & Ankle Society (AOFAS) functional scores, and radiographic parameters immediate after surgery and at final follow-up, including HVA, IMA, distal metatarsal articular angle (DMAA), relative length of the first metatarsal (RLFM). Statistical analysis included repeated-measures ANOVA for multi-timepoint quantitative data, t tests for continuous variables, and chi square test for categorical variables.

All the incisions were healed by first intention without complications. No significant differences were observed between groups in follow-up duration (t=0.820), intraoperative blood loss (t=1.430), length of hospital stay (t=0.990), or VAS scores one week after surgery (t=1.099) (all P>0.05). The observation group exhibited significantly shorter operative time than the control group (t=-1.430, P<0.001). The immediate data of HVA, IMA, DMAA, and AOFAS after surgery and the data at final follow-up compared to the data before surgery in both the observation and control groups showed statistically significant differences (observation group: F=225.1, 54.93, 139.3, 1103, control group: F=165.5, 33.65, 88.3, 818.5, all P<0.001). Between-group comparisons of the HVA, IMA, DMAA, and AOFAS scores immediately postoperatively and at final follow-up revealed statistically significant differences (observation vs. control group: t=-2.733, -2.662, -3.138, 2.083, -2.890, -3.081, -2.727, 4.108, all P<0.05). No statistically significant difference was observed in RLFM between the two groups at immediate time point after surgery or at final follow-up (t=-0.419, -0.455, both P>0.05).

The 3D-printed osteotomy guide-assisted Scarf osteotomy improves surgical precision, enhances alignment correction, and optimizes functional recovery in moderate-to-severe hallux valgus.