To further verify the clinical application accuracy of the three-dimensional planning system assisted by artificial intelligence(AI HIP) in total hip arthroplasty (THA)by investigating the accuracy of AI HIP system for prosthesis size prediction before primary THA.

Patients who were scheduled for primary THA at PLA General Hospital First Medical Center, Peking Union Medical College Hospital, the Third Hospital of Hebei Medical University, and the Third Affiliated Hospital of Southern Medical University from August 2021 to August 2022 were included as research subjects. A total of 80 patients who needed primary THA due to hip joint diseases were included, and their preoperative imaging met the planning requirements. The patients who were pregnant or lactating and other reasons not suitable for the experiment were excluded. Finally, 75 patients completed the experiment. The experimental group used AI HIP system for pre-operative planning of THA, while the control group used the traditional X-ray template measurement method. The pre-operative planning results were compared with the actual prosthesis size used during surgery. Statistical tests such as chi square test and Fisher's exact test were used to evaluate the accuracy of the AI HIP system in planning the acetabular cup and femoral stem size.

There were 37 cases in the experimental group: 22 males and 15 females, 20 left hips and 17 right hips, median age 52 (38, 65) years. There were 38 cases in the control group: 25 males and 13 females, 18 left hips and 20 right hips, median age 56 (39, 62) years. The overall accuracy rate of the experimental group in planning the acetabular cup and femoral stem prosthesis size was 89.19% (33/37); the acetabular cup size accuracy rate was 97.30% (36/37), and the femoral stem size accuracy rate was 89.19% (33/37). The overall accuracy rate of the control group in pre-operative planning was 2.63% (1/38); the acetabular cup size accuracy rate was 42.11% (16/38), and the femoral stem size accuracy rate was 21.05% (8/38). The difference in the overall accuracy rates between the two groups was statistically significant (χ²=35.12, P<0.05).

Compared to the traditional Xray template measurement method, the AI HIP system has higher accuracy and reproducibility in planning prosthesis size for pre-operative THA. It can accurately predict the prosthesis size used in primary THA in adults.

To combine anatomic structure study of specimen and the digital subtraction angiography (DSA) on the origination of posterior-superior retinaculum artery, so as to provide guidance for the treatment of femoral head necrosis (ONFH).

The blood supply around the femoral head was dissected in 10 fresh frozen specimens without hip diseases to observe the origin and shape of the posterior-superior retinaculum artery. The patients with ONFH admitted to the department of orthopedics in 920th Hospital of the Joint Logistics Support Force from 2020 to 2024 were retrospectively analyzed, who aged from 18 to 45 years, and accepted DSA before surgery verifying posterior-superior retinaculum artery existence. Exclusion criteria: rheumatoid arthritis, ankylosing spondylitis, physical condition not suitable for surgery , poor compliance after surgery. A total of 194 cases were enrolled, 120 cases of male, female 74 cases. Eighty-four cases involved in left hip and 110 cases involved in right hip. According to Association Circulation Osseous (ARCO) staging, 128 patients were in stage Ⅱ and 66 patients were in stage Ⅲ. All the patients had axial percussion pain, Fabere test (+) and different degrees of motion limitation. After preoperative DSA for femoral head was performed to observe the origination of posterior superior retinaculum artery and to guide the choice of operation method. Harris hip function score, visual analogue scale (VAS) and range of motion of hip were evaluated before and after surgery. The data were analyzed by paired sample t test.

The superior-posterior retinaculum artery presented in all the 10 chilled specimens. Seven specimens (70%) were originated from the medial circumflex femoral artery and three specimens (30%)were from the inferior gluteal artery. The preoperative DSA examination was completed in all 194 cases, illustrating that the posterior-superior retinaculum artery in 156 cases (79.9%) were from the medial femoral circumflex artery, while it originated from inferior gluteal artery in 39 cases (20.1%). Thirty-nine patients with inferior gluteal artery type (30 cases in ARCO stage Ⅱ and nine cases in ARCO stage Ⅲ) were followed up for six to 48 months, with an average of (20.1±0.6) months. The patients in ARCO stageⅡshowed no further progress. One patient in ARCO stage Ⅲ occurred femoral head collapse, but the hip pain was remarkably relieved after the surgery compared with the preoperative condition, and the range of motion of hip also improved. The other patients had no collapse of the femoral head surface, showing good joint space, and good hip flexion and extension function. At 12 months after surgery , VAS score was (2.4±1.2), Harris score was (92.7±1.3), all obviously improved when compared with the preoperative data (t = 4.74, 33.54, both P< 0.001).

Most of the posterior-superior retinaculum arteries originate from the medial circumflex femoral artery, and a small part are from the inferior gluteal artery. Compared with the medial circumflex femoral artery type, the inferior gluteal artery type has a higher anatomical position, more alternative surgical methods of hip preservation may be applied with lower risk of trauma and iatrogenic vascular injury, but further observation of more cases are needed.

To explore the effects of different surgical timing on the operative efficacy and postoperative complications of elderly hip fractures, and to provide evidence for the establishment of the green channel for the treatment of hip fractures in China.

A retrospective analysis was conducted on hip fracture patients admitted to the Third Affiliated Hospital of Guangzhou Medical University and Liwan Central Hospital of Guangzhou from January 2019 to June 2022. Inclusion criteria: first-time hip fracture, injury time <24 h, receiving surgical treatment. Exclusion criteria: age <80 years, open fractures, pathological fractures, and multiple fractures. A total of 150 patients were included in the study, divided into the early surgery group (75 cases) and the delayed surgery group (75 cases). The early surgery group underwent surgery within five days of admission, while the delayed surgery group underwent surgery after five days of admission. Comparisons between the two groups were made using t test and chi square tests for surgical timing, intraoperative blood loss, and postoperative complication rates during hospitalization.

There was no statistically significant difference in operation time ［(94±15) min vs(93±18) min］ or intraoperative blood loss ［100(80, 200) ml vs 100(95, 200) ml］ between the two groups (both P>0.05). The length of hospital stay(18±7) d in the early group was lower than that in the delayed group(21±5) d, and the difference was statistically significant (t=0.001, P<0.05). In the early group, incision infection rate was 4.0% (3/75), urinary tract infection 1.3% (1/75), cerebrovascular accident 1.3% (1/75), myocardial infarction zero(0/75), and lower limb venous thrombosis 1.3% (1/75). Compared with the delay group, of which these incidences were 5.3% (4/75), 2.6% (2/75), 2.6% (2/75), 1.3% (1/75), 1.3% (1/75) respectively, the differences were not statistically significant (all P>0.05). The incidences of postoperative pulmonary infection and bedsore were 1.3% (1/75) and 1.3% (1/75) respectively in the early group, which were lower than those in the delayed group ［13.3% (10/75) and 10.6% (8/75)］; the differences were statistically significant (χ²=0.012, 0.039, both P<0.05).

In elderly patients with hip fracture, surgery within 5 days can reduce the incidence of postoperative pulmonary infection and bedsore.

To investigate the influencing factors of osteonecrosis of the femoral head (ONFH) in patients with hematologic malignancies after allogeneic hematopoietic stem cell transplantation (allo-HSCT).

Data of leukemia patients who underwent allo-HSCT in the Department of Hematology at the First Affiliated Hospital of Sun Yat-sen University between January 2016 and December 2021 were retrospectively collected. The patients with complete clinical data were enrolled, while the patients with incomplete data or short-term follow-up time were excluded. A total of 40 patients were included, and 18 potential influencing factors were analyzed using logistic regression with 1:3 matched design based on gender, age, and disease status during the same period.

In the univariate logistic regression analysis, statistically significant factors for ONFH included cystitis ［odds ratio (OR)= 5.967, 95% confidence interval (CI) (1.209, 29.443), P = 0.028］, methylprednisolone dosage at six months after transplantation ［OR = 2.108, 95%CI(1.008, 4.408), P=0.048］, and extreme difference in serum calcium after transplantation (i.e., the difference between the maximum and minimum values of blood calcium after transplantation) ［OR=2.377, 95%CI(1.127, 5.014), P=0.023］. In the multivariate logistic regression analysis, only the extreme difference in blood calcium levels after transplantation remained statistically significant［OR=2.377, 95%CI(1.127, 5.014), P=0.023］.

A large difference in blood calcium levels after transplantation is a risk factor for ONFH in leukemia patients undergoing allo-HSCT.

To investigate the effect of ultrasound-guided peripheral nerve block (PNB) on postoperative recovery after total hip arthroplasty (THA) or total knee arthroplasty (TKA).

Data were collected from the patients who underwent primary THA or TKA from January2012 to December 2021 in Fujian Provincial Hospital. The patients who were not primary THA or TKA and those who were lost during follow-up or refused to follow up after surgery were excluded. The enrolled patients were divided into PNB and non-PNB groups based on whether they accepted ultrasound-guided peripheral nerve block (PNB). Propensity score matching (PSM) was performed to account for the baseline differences between two groups that were accepted to PNB or not, and postoperativeall-cause mortality at 90 d and one year of the two groups after PSM was also analyzed using Kaplan-Meier survival curve, and the difference in postoperative complications of the two groups after PSM was analyzed using chi square test. In addition, the associations of PNB and the complications were assessed by logistic regression models.

A total of 1 328 patients with THA or TKA were included in this study, of which 197 patients had ultrasound-guided PNB. After 1:1 PSM, 197 matches were successfully completed. Compared with the non-PNB group, patients who accepted PNB had significantly lower all-cause mortality at 90 d after surgery (0% vs 2.5%, χ²=5.046, P=0.025). In addition, the PNB group were associated with a reduced risk of pulmonary complications ［odds ratio (OR)=0.430, 95%confidence interval (95%CI) ( 0.216, 0.857), P=0.033］ and lower extremity deep vein thrombosis ［OR=0.103, 95% CI (0.011, 0.954), P=0.042］.

Ultrasound-guided peripheral nerve block significantly reduces the risk of postoperative pulmonary complications and lower limb deep vein thrombosis in patients with THA or TKA, and is associated with a lower 90-day all-cause mortality.

To investigate the clinical efficacy of robot-assisted total knee replacement (RTKA) versus conventional total knee replacement (TKA).

A retrospective study was conducted to collect 156 patients in RTKA group and TKA group at 920th Hospital of PLA Joint Logistic Support Force from January 2021 to August 2022. Inclusion criteria were patients aged 40 to 80 years with knee osteoarthritis of Kellgren-Lawrence (K-L) scale Ⅲ to Ⅳ who received unilateral TKA or RTKA. Exclusion criteria were pregnancy, severe flexion deformity (deformity >20°) and severe inversion deformity (deformity >20°), presence of other metal implants in the surgical area, active infection, and severe systemic disease. Chi square test, independent sample t test or independent sample rank sum test were used to compare the data between the two groups, including gender, age, body mass index (BMI), duration of osteoarthritis, surgical side, resting and exercise scores of visual analogue scale ( VAS) before and after surgery, Hospital for Special Surgery(HSS)osteoarthritis score, American Knee Society score (KSS), pain, stiffness and function scores of Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and shifting of hip-knee-ankle angle (HKA).

The operation time of the RTKA group was (101±13) min longer than (67±10) min of the TKA group. The intraoperative blood loss of the RTKA group was (261±49) ml less than (371±81) ml of the TKA group, the length of hospital stay after operation in the RTKA group were 3(3, 3)d, which were shorter than 4(3, 5) d of the TKA group. The differences were statistically significant (t=18.251, -10.543, Z=-6.036, all P<0.05). Preoperative functional indicators of RTKA group ［HSS score (52.4±2.6), KSS score (57.3±4.5) and WOMAC score (50.0±5.0)］ and TKA group ［HSS score (52.2±3.5), KSS score (56.5±4.4) and WOMAC score (50.5±4.4)］ showed no statistically significant difference (t=-0.433, 1.170, -0.768, all P>0.05). The functional evaluation indices of RTKA group ［HSS score (88.0±2.3), KSS score (83.3±6.8) and WOMAC score (84.1±4.8)］ at six months after operation were higher than those of TKA group ［HSS score(85.0±3.0), KSS score(80.4±6.4)and WOMAC score(80.3±5.0)］. The differences were statistically significant (t=6.940, 2.682 , 4.729, all P<0.05). Six months after operation, mechanical lateral distal femoral angle (mLDFA) (86.0±1.8) °, medial proximal tibial angle (MPTA) (87.1±2.1) °, joint line convergence angle (JLCA) (2.0±0.5) ° and HKA deviation (1.9±0.6) ° in RTKA group were better than those in the TKA group ［mLDFA (85.2±3.2)°, MPTA (85.5±3.4)°, JLCA(2.7±0.7)° and HKA deviation (2.9±0.7)°］. The differences were statistically significant (t=2.098, 4.163, -7.082, -9.335, all P<0.05).

RTKA is a safe, effective and feasible new technique, which is worth popularizing and applying in clinic.

To improve the equilibrium and mobility function in ankle fracture patients by using Proprioceptive training.

A total of 32 patients with peri-ankle fractures who were treated in Suzhou Ruisheng Rehabilitation Hospital two months after surgery were collected. The included patients had good fracture alignment and could stand and walk independently, while the patients with severe neuromuscular injury, traumatic arthritis and foot mutilation were exluded. The patients were divided into observation group and control group (n=16 for each group) by random number method. Balance training with proprioceptive training (once or twice a day, five to seven days a week) and comprehensive rehabilitation therapy were used in observation group, and control group were treated only with comprehensive rehabilitation therapy. The patients were assessed using 10-meter walking test and balance assessment system in length of gravity center (LNG) after training for one month. The therapeutic effect difference was analyzed by t test.

After one month of treatment, comparing between observation group and control group, the balance and mobility function of the patients in observation group had more significant improvements than the control group (t=-3.561, P=0.008; t=2.85, P=0.001).

Proprioceptive training can promote the recovery of the balance and mobility function of the patients with ankle fracture and accelerate the recovery process.

To systematically evaluate the difference of therapeutic effects of different Glucocorticoid (GC) combined with or without sodium hyaluronate (HA) on knee osteoarthritis (KOA).

PubMed, Cochrane Library, Web of Science, Sciencedirect, China National Knowledge Infrastructure (CNKI), Wanfang , China Science and Technology Journal Database(VIP), and China Biology Medicine disc (CBM) were searched by computer, and the literatures about randomized controlled trial (RCT) of intra-articular injection of glucocorticoid in the treatment of knee arthritis were searched. The retrieval time ranged from establishment of the database to May 2023. The repetitive publication, lack of access to the full text and incomplete or incorrect research data were excluded, and two researchers screened the literature independently from the literature type, research object, intervention measures and outcome indicators.The data were extracted and the risk of bias was evaluated. Software ReviewManager5.4 and Stata17 were used for network meta-analysis.

A total of 2098 related literatures were searched, and 49 RCTs were finally included, including 13 drug regimens, specifically HA, compound betamethasone (CB), dexamethasone (DXM), methylprednisolone acetate (MPA), triamcinolone acetonide (TA), placebo (PLA) with water for injection or normal saline as the main component, HA+CB, HA+PLA, HA+DXM, HA+MPA, HA+TA, CB+PLA, TA+PLA. In the process of the treatment of KOA, network meta-analysis showed results as follows :(1)for improving the effective rate, the top three drug regimens were HA+CB ［compared with TA, odds ratio (OR)=22.13, 95% (confidence interval) CI (6.32, 77.47)］, HA+TA ［compared with TA, OR=20.39,95%CI (5.49, 75.73)］, HA+DXM ［compared with TA, OR=19.30,95%CI (4.77, 78.20)］; 95%CI does not contain 1, indicating that the difference is statistically significant.(2)For reducing the scores of Western Ontario and McMaster Universities osteoarthritis index (WOMAC), the top three drug regimens were DXM ［compared with CB, the mean difference (MD) =-22.46% CI (- 38.01, -6.90)］, HA+TA ［compared with CB, MD=-13.87,95%CI (- 27.38, -0.36)］, HA+CB ［compared with CB, MD=-11.03,95%CI (- 21.47, -0.60)］; 95%CI does not contain 0 to indicate that the difference is statistically significant.(3)In terms of reducing the score of visual analogue scale (VAS), the top three medication schemes were HA+TA［compared with MPA, MD=-4.65, 95%CI (-6.78, -2.51)］, CB+PLA［compared with MPA, MD=-2.60, 95%CI (-4.69, -0.51)］, HA+CB［compared with MPA, MD=-2.50, 95%CI (-4.06, -0.94)］.(4)In terms of reducing Lequesne index, the top three drug regimens were HA+TA［compared with PLA, MD=-6.72, 95%CI (-9.33, -4.12)］, DXM［compared with PLA, MD=-5.60, 95%CI (-8.80, -2.40)］, HA［compared with PLA, MD=-4.63,95%CI (-6.77,-2.49)］.

HA combined with GC is preferred in the effectiveness of intra-articular injection of glucocorticoid in the treatment of knee osteoarthritis, among which HA+TA has a higher curative effect in the overall evaluation of KOA. Limited by the quantity and quality of RCTs, this conclusion still needs further verification by more high-quality clinical RCTs.