Osteonecrosis of the femoral head (ONFH) is a complex and challenging condition in orthopedic practice. Its pathogenesis is centered on the closely linked pathological processes of femoral head blood supply, bone necrosis progression, and bone repair. Interventional vascular therapy has emerged as a minimally invasive and hip-preserving treatment modality aimed at improving intraosseous blood circulation and the microenvironment within the necrotic region. This approach is gaining increasing recognition among orthopedic surgeons. Despite its extensive clinical application, there is currently a lack of expert consensus or guidelines to standardize the implementation of interventional vascular therapy for ONFH. To address this gap, this research group employed methodologies including bibliometric analysis, consensus conferences, and the Nominal Group Technique to comprehensively review and analyze the current state of research on interventional vascular therapy for osteonecrosis of the femoral head. By integrating expert recommendations, we have thus developed the China expert consensus on interventional vascular therapy of osteonecrosis of the femoral head. This consensus formalizes key aspects of the procedure, including indications, contraindications, pharmacological selection, interventional techniques, and complication management, with the ultimate goals of enhancing clinical efficacy and preventing and reducing adverse effects.

To explore the association between critical shoulder angle (CSA) and calcific supraspinatus tendinitis (CST) in the rotator cuff, analyzing the possibility of CSA enlargement as a potential high-risk factor for CST from both clinical and imaging perspectives, and provide theoretical basis for early diagnosis and precise treatment of CST.

All CST patients who received treatment at the First Affiliated Hospital of the University of Science and Technology of China from June 2017 to January 2024 were included. The patients with no other shoulder joint diseases before surgery and undergoing arthroscopic shoulder surgery were enrolled in the CST group, while the patients with rotator cuff tears and history of shoulder surgery were excluded. An equal number of patients admitted to the hospital during the same period due to clavicle fractures were matched and included in the control group. The shoulder joint X-rays of all the patients before operation were extracted, and CSA was measured twice by the same researcher at one month interval. Independent sample t test was used to compare the CSA values of CST group and control group. The patients in CST group were divided into different subgroups according to CSA size, and the associations between visual analog scale (VAS) for shoulder pain and American Society of Shoulder and Elbow Surgeons (ASES), University of California shoulder score (UCLA) and other functional scoring systems scores before operation and at one year after operation were analyzed.

A total of 100 patients were enrolled, with 50 cases in the CST group and 50 cases in the control group available for analysis. The average CSA in CST group (39.6±3.7) ° was higher than that of the control group (34.5±1.5) ° (t=8.97, P<0.001). Patients with larger CSA in the CST group had higher pain scores and poorer functional scores before surgery (t=3.81, P<0.05). After surgery, the pain and functional scores in the CST group were improved, and there were no statistically significant differences in the pain and functional scores among the different CSA subgroups (all P>0.05). The proportion of typeⅢ acromion (hook type) in the CST group was 56% (28/50), while only 12% (6/50) in the control group, the difference was statistically significant (χ²=21.58, P<0.001). There was no statistically significant difference in VAS, ASES, and UCLA scores between the two groups after surgery (all P>0.05).There was no statistically significant difference in VAS, ASES, and UCLA scores (all P>0.05) between the patients whether underwent rotator cuff repair.

There is a correlation between CST and increased CSA, suggesting that increased CSA may be a high-risk factor for CST occurrence. Although CST patients with larger CSA may have poorer shoulder joint function before surgery, pain and functional scores after surgery could still show similar improvements as the small CSA patients.

To analyze the effect of orthopedic robot-assisted femoral neck system (FNS) fixation in the treatment of unstable femoral neck fractures.

A total of 81 patients with unstable femoral neck fractures admitted to department of trauma orthopedics of No.215 Hospital of Shaanxi Nuclear Industry were selected from June 2021 to June 2024. According to the surgical methods, the enrolled patients were divided into robot group (orthopedic robot + FNS fixation, n=46) and control group (artificial surgery + FNS fixation, n=35). Inculusion criteria: unilateral unstable femoral neck fractures, age 18 to 75 years, normal hip before the fracture, patient accepted robot assisted or traditional FNS fixation with complete information. Exclusion criteria: hip fracture history, pathologic fractures or multi-fractures, follow-up duration less than six months, vital organ dysfunction, severe osteoporosis, etc. The surgical indicators, numerical rating scale (NRS), Harris hip score (HHS), pain factors and postoperative complications were compared between the two groups by t test, analysis of variance, and chi square test.

The intraoperative blood loss volume and intraoperative fluoroscopy frequency in the robot group were 25 (22, 31) ml and (14±3) times, which were less than 31 (26, 38) ml and (15±3) times in the control group (Z=4.631, t=2.455, both P<0.05). The success rate of one-time nail placement was 100.0% in the robot group which was higher than 80.0% in the control group (Fisher’s exact test P=0.002). There were no statistical differences in surgical time and hospitalization time between groups (Z=1.639, t=1.693, both P>0.05). Repeated measures analysis of variance revealed that the NRS score in the two groups showed a decreasing trend (time-point F=227.30, P<0.001; between groups F=8.83, interaction F=3.75, both P<0.05), and the NRS scores were 5.7±1.1 and 4.1±1.0 in the robot group at one day and three days after surgery, which were lower than 6.5±1.3 and 4.8±1.1 in the control group (t=2.715, 2.878, both P<0.05). HHS score in both groups showed an increasing trend (time-point F=483.43, P<0.001, between-group F=5.31, P=0.022, interaction F=1.49, P>0.05), and HHS score in the robot group were 82±9 at three months after surgery, which was higher than 76±7 in the control group (t=3.311, P<0.05), while there was no statistical significance in HHS score at six months after surgery between groups (t=1.548, P>0.05). Prostaglandin E₂ (PGE₂) and neuropeptide Y (NPY) in the two groups increased first and then decreased, and no statistical differences were exhibited in PGE₂ and NPY between groups at one day after surgery (t=1.664, 1.717, both P>0.05). PGE₂ and NPY in the robot group at three days after surgery were lower than those in the control group (t=2.155, 2.586, both P<0.05). There was no statistical difference in total incidence rate of postoperative complications between the robot group (10.9%) and the control group (17.1%) (χ²=0.667, P>0.05).

Orthopedic robot-assisted FNS fixation for unstable femoral neck fractures can effectively relieve the postoperative pain, and promote the short-term hip joint recovery, and it has small trauma to patients and is conducive to postoperative rehabilitation.

To investigate the correlation between the degree of lower limb alignment correction (neutral alignment vs. residual valgus) and clinical outcomes after total knee arthroplasty (TKA) in patients with varying degrees of valgus knee deformity.

A retrospective study analyzed patients who underwent primary TKA at Affiliated Hospital of Nantong University from March 2019 to November 2022 due to unilateral knee valgus deformity. Patients with extra-articular deformities and those using restrictive prostheses were excluded. A total of 157 patients were enrolled. According to preoperative femorotibial angle (FTA) measured on Ximages, the patients were divided into three groups: mild valgus group (7°< FTA < 15°, n=80), moderate valgus group (15°≤FTA ≤ 30°, n=56), and severe valgus group (FTA > 30°, n=21). FTA, range of motion (ROM), Hospital for Special Surgery score (HSS), Western Ontario and McMaster University osteoarthritis index (WOMAC) and patient satisfaction were recorded and analyzed statistically. Data were analyzed using one-way analysis of variance, independent samples t test, and chi square or Fisher’s exact test.

The mean follow-up was (34.2±5.8) months. In the preoperative mild valgus group, patients with postoperative neutral alignment showed significantly higher satisfaction (χ²=10.02), HSS (F=3.78), and WOMAC (F=3.44) compared to those with postoperative valgus alignment (all P<0.05). In the preoperative moderate and severe valgus group, the patients with postoperative valgus alignment showed significantly higher satisfaction (χ²=8.97, 6.24, both P<0.05) and greater improvement of HSS (F=4.85, t=4.91, both P<0.05), WOMAC (F=3.53, t=6.54, both P<0.05), and SF-36 score (F=3.52, t=2.18, both P<0.05) than thepatients with postoperative neutral alignment. Deep vein thrombosis occurred in one case in moderate group, artificial prosthesis aseptic loosening occurred in two cases in severe group. No infection, anchylosis or recurrent dislocation of knee-cap occurred during follow-up.

For mild valgus before operation, correction to neutral alignment achieved better outcomes than leaving residual valgus. For preoperative moderate and severe valgus, retaining residual valgus postoperatively ensured satisfactory clinical outcomes too.

To verify the effect of bone morphogenetic protein 2 (BMP2) secreted by the previously constructed microcapsule cell complex on osteogenic differentiation of surrounding bone mesenchymal stem cells (rBMSCs).

Enzyme-linked immunosorbent assay (ELISA) was used to detect BMP2 release from the microcapsule cell complex in the induction group (using medium containing doxycycline inducer) and the control group (using medium without doxycycline inducer). Real-time quantitative polymerase chain reaction (qRT-qPCR) and western blot experiments were used to verify the effect of the microcapsule cell complex in the BMSC(-), BMSC7 d, and BMSC14 d groups on the osteogenic gene and protein expression of surrounding rBMSCs. Immunohistochemistry was used to verify the osteogenic induction ability of the microcapsule cell complex in the control group, untransfected group, uninduced group, and induced group on surrounding rBMSCs. Alizarin staining and von Kossa staining were used to verify the effect of the microcapsule cell complex in the blank group, control group, and induced group on the osteogenic differentiation of surrounding rBMSCs. All experiments in this study were repeated three times; quantitative data were discribed as ±s. Repeated measurement analysis of variance (ANOVA) and one-way ANOVA were used to statistically analyze differences between groups.

After doxycycline (DOX) induction, hBMP2 protein secretion gradually increased in the induced group (F=234.6, R²=0.9902, P<0.05, Tukey multiple test among groups: all P<0.05). After DOX induction stopped on day 21, hBMP2 protein secretion decreased compared with the previous data (Tukey multiple test among groups: all P<0.05). qRT-PCR experiments confirmed that after DOX induction, the expression of BMP2 (F=26.7, P<0.05), runt-related transcription factor 2 (RUNX2) (F=115.9, P<0.05), and osteocalcin (OCN) (F=1652, P<0.05) in rBMSCs surrounding the microcapsule cell complex was upregulated over time. Western blot results indicated that at the protein level, hBMP2 secretion in rBMSCs surrounding the microcapsule cell complex after DOX induction.BMP2 and RUNX2 proteins were detected. Immunohistochemistry confirmed that the complex enhanced the expression of RUNX2 (F=110.3, P<0.05), OCN (F=125.6, P<0.05), and type I collagen (COL1) in surrounding rBMSCs (F=157.2, P<0.05). Staining experiments further confirmed that the complex enhanced calcium nodules and calcium salt deposition in peripheral rBMSCs.

This microcapsule cell complex can achieve on-demand release of BMP2, effectively inducing osteogenic differentiation of peripheral BMSCs, providing a new strategy for gene-enhanced bone tissue engineering, and has potential clinical application value.

To investigate whether smartphone photo screening can be used as a more simple, efficient and widely available method for rapid screening of flatfoot.

A screening was conducted on October 15, 2024, in a middle school in Guangzhou, and informations such as gender and age of students were collected. Inclusion criteria: age from 12 to 14 years, the students could standing on one foot for at least five seconds without other supporting. Exclusion criteria: abnormality of foot or ankle, student was incompetent to cooperate, incomplete data, etc. Orthopedic surgeons used smartphones to photograph the inside position of feet while standing on one foot and were screened by the pictures. Plantar pressure screening was performed using pressure plate measurements (ZKBF-D1E, JOINCA), measuring foot width and length, plantar contact areas of forefoot, midfoot and heel, pressures on ground of forefoot, midfoot and heel, loads of forefoot, midfoot and heel, and arch types. The screening outcomes of smartphone-based photo and plantar-pressure were compared using the McNemar test, and differences in their data characteristics were evaluated with independent-samples t test.

A total of 596 students (332 males and 264 females) were photo-screened, and 85 students (49 males and 36 females, 170 feet) completed both screenings. The positive detection rate for plantar pressure (62.9%) was higher than that for smartphone photography (41.8%) (χ²=22.34, P<0.001), and the characteristics with statistically significant differences between the two screening methods were in line.

The features of reduced heel load and increased midfoot load in photo-screened positive feet are consistent with the results of plantar pressure screening, but smartphone photography cannot be directly used for rapid screening of adolescent flatfoot yet.

To evaluate operative timeand postoperative efficacy between cementless and cemented prostheses for media knee osteoarthritis.

Randomized controlled trials (RCTs) and clinical controlled trials (CCTs) were searched in medical electronic databases, including PubMed, Excerpt Medica Database (Embase), Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, and China Science and Technology Journal Database (VIP), from the establishment of the databases up to September 2024. Exclusion criteria:duplicates, low-quality studies, non-compliant outcome measures, and unavailable full texts. The quality and risk of bias of the included studies were assessed using the Cochrane Risk of Bias Tools and Newcastle-Ottawa scale (NOS). Meta-analysis was performed using RevMan 5.4.

A total of 17 studies (five RCTs, 12 CCTs) were included, involving 39 464 cases (20 405 cementless vs. 19 059 cemented unicompartmental knee arthroplasties demonstrated that cementless prostheses had shorter operative time [mean difference (MD) =9.08, 95% confidence interval (CI) (6.89, 11.28), P<0.001], slightly lower one-year survival rates[OR=1.28, 95% CI (1.02, 1.61), P=0.03], higher 5-year survival rates [odds ratio (OR) =0.73, 95% CI (0.63, 0.84), P<0.0001]. No statistically significant difference was found in postoperative range of motion [MD= -1.22, 95% CI (-4.83, 2.38), P=0.51] and complication rates[OR=0.83, 95% CI (0.68, 1.02), P=0.08]between the two groups during follow-up.

Cementless prosthesis presents many advantages such as shorter operative time, lower revision rates during follow-up, and higher five-year survival rates, while postoperative range of motion and complication rates during follow-up between cementless and cemented prostheses may not be very different .

Rheumatoid arthritis (RA) is an autoimmune disease that involves the small peripheral joints, and the main lesions include inflammatory reaction, synovial cell proliferation and synovial neovascularization. According to Chinese medicine, "dampness, heat and stasis" are the main theories of RA’s pathogenesis. Chinese medicine compound preparation and its main active ingredients can inhibit the inflammatory reaction, the proliferation of fibroblast-like synoviocytes (FLS), and synovial blood vessel neovascularization, thus preventing the deterioration of RA. Therefore, it is promising to explore the pharmacodynamic mechanism of Chinese medicine compound preparation and its main active ingredients on RA angiogenesis. This article aimed to investigate traditional Chinese medicine compound formulations with "warming the meridians and dispelling cold" and "dispelling wind and dampness" effects, along with their primary active components, to provide a theoretical basis for their therapeutic application in RA through anti-inflammatory, anti-FLS proliferation, and anti-angiogenic pathways.

Artificial joint replacement is an effective treatment for end-stage osteoarthritic diseases, but periprostheticosteolysis, as its major complication, seriously affects the service life of the prosthesis and the prognosis of patients. Autophagy plays an important role in the development of periprosthetic osteolysis. This paper reviewed the theories of periprosthetic osteolysis and autophagy, elaborated the role of autophagy in the development of periprosthetic osteolysis, including the induction of autophagy by wear and tear particles, the removal of wear and tear particles by autophagy, and introduced the latest research results and breakthroughs, pointing out the limitations of the current study and the future outlook, with the aim of providing references for unraveling the pathogenesis of periprosthetic osteolysis and searching for the effective therapeutic targets.

Rotator cuff tear is a common shoulder disease and one of the main causes of shoulder joint dysfunction and pain.Large epidemiological studies have identified a higher prevalence of rotator cuff tears in the general population.Rotator cuff tears can be divided into full tear and partial tear according to tear thickness.Partial rotator cuff tear is partial tears of rotator cuff thickness.Conservative treatment is usually preferred.Drug injection in conservative therapy is an important way to treat this kind of tendon disease.Among the most commonly used drug injections in clinic are corticosteroids,sodium hyaluronate and platelet-rich plasma(PRP).PRP is a platelet concentrate extracted from fresh whole blood after centrifugation.It is a commonly used biological agent at present.It has been widely used in clinical repair of various tissues and has achieved certain effects,especially in tendon diseases.However,the efficacy,safety and tear type of PRP in the treatment of partial rotator cuff tear remain to be explored. This review synthesized evidence from recent literature on PRP for partial-thickness rotator cuff tears (PTRCTs). It delineated the efficacy of PRP in pain and functional recovery, its safety profile, indications stratified by tear characteristics (location and grade), and its long-term benefits benchmarked against corticosteroids and other injectables. The analysis may provide critical insights to guide the rational clinical application of PRP.

Non-traumatic avascular necrosis of the femoral head (ONFH) is a difficult-to-treat disease that significantly impacts patients’ quality of life. Due to its complex pathogenesis and limited treatment options, pharmacotherapy has shown unique advantages in the treatment of ONFH. Angiostatin, as a bioactive substance with angiogenic-promoting effects, has gradually gained attention in the research on the treatment of ONFH. This article reviewed the research progress of angiostatin in treating ONFH, pointing out that angiostatin may help restore blood supply to the femoral head by promoting angiogenesis and improving blood supply, thereby alleviating clinical symptoms. Therefore, angiostatin plays a positive role in the expression of related factors in vascular intervention and provides a new perspective for the treatment of ONFH.

Recently, machine learning (ML) models have made significant progress in predicting postoperative outcomes after joint replacement. Particularly in predicting postoperative functional recovery and complications, their accuracy far surpasses that of traditional statistical methods. ML models can integrate diverse data sources (such as demographic, clinical, and imaging data) and capture complex nonlinear relationships, thereby providing more precise individualized risk predictions. However, the clinical application of ML models still faces multiple challenges, including difficulties in data integration due to the lack of standardized medical data, trust issues arising from the "black box" nature of high-performance models, as well as constraints related to model generalization, legal regulations and compliance, and data security. This review aimed to explore the research progress of ML models in predicting postoperative outcomes after joint replacement.

Gait analysis, a multidisciplinary technology integrating dynamics, kinematics, and physiology, has become an important assessment tool in the field of orthopedics. Total hip arthroplasty (THA) is a core treatment for end-stage hip joint diseases. Although it can effectively improve joint function, there are still challenges in accurately assessing the timing of surgery, prosthesis matching, and postoperative rehabilitation. Gait analysis can provide objective evidence for THA from preoperative planning to postoperative rehabilitation monitoring by quantifying movement patterns and mechanical parameters. This article aimed to systematically explore the application value of this technology in the entire cycle management of THA, to provide theoretical support for building a precise and individualized diagnosis and treatment system, and it might be of great clinical significance for improving the effect of hip joint replacement surgery.

Knee osteoarthritis (KOA) is a chronic degenerative disease characterized by impaired knee joint function and structural damage, with an increasing incidence. Currently, conservative treatment is often used for early to mid-stage KOA, while surgical intervention is considered for advanced stages. However, these treatments have certain limitations. Genicular artery embolization (GAE) has emerged as a promising treatment for KOA, offering significant pain relief, minimal invasiveness, and a low incidence of severe complications. As research on GAE continues to grow, this article reviewed the mechanisms, procedural details, clinical efficacy, and safety of GAE in treating KOA, providing a reference for clinical practice.

Steroid-induced osteonecrosis of the femoral head (SONFH) is an ischemic necrotic bone disease caused by long-term use of glucocorticoids, characterized by a high incidence rate and severe disability risk. Its pathogenesis is complex, and early diagnosis remains challenging. Circular RNA (circRNA), a novel class of non-coding RNA, has been shown to play a significant role in the occurrence, progression, and clinical management of SONFH. With ongoing research, circRNAs have been found to regulate gene expression through the competing endogenous RNA (ceRNA) mechanism, affecting the differentiation of osteoblasts and osteoclasts, thereby modulating bone metabolism. Abnormal expression of specific circRNAs has been identified in the blood or bone tissue of SONFH patients, providing a basis for their potential use as diagnostic biomarkers and therapeutic targets. This review summarized the recent research progress on circRNAs in SONFH, focusing on their regulatory mechanisms, biological functions, and potential as diagnostic markers and therapeutic targets, offering new insights into the early diagnosis and treatment of SONFH.

To explore the efficacy of three dimentional (3D) -printed porous titanium trabecular acetabular cups and traditional biological fixation acetabular cups in total hip arthroplasty (THA) for patients with type Ⅰ/Ⅱ acetabular dysplasia.

This retrospective cohort study included 70 patients with type I/II acetabular dysplasia who underwent THA at Guigang People's Hospital from September 2021 to September 2023. Patients were divided into two groups based on the type of prosthesis: the control group (n=35) received THA with a biological acetabular prosthesis, and the observation group (n=35) received THA with a 3D-printed porous titanium trabecular acetabular cup. The follow-up time, prosthesis survival rate, visual analogue scale (VAS) pain score, Harris hip score, prosthesis fixation effect, and safety were observed in both groups. The results of the above indicators were compared between the two groups. Independent sample t test was used for comparisons between groups for measurement data, paired ttest was used for comparisons within groups, and repeated measures ANOVA for the data at multiple time points. Chi square test or Fisher’s exact probability method were used for comparisons between groups for count data. The Mann-Whitney U test (non-parametric test) was used to compare the follow-up time between the two groups, and the log-rank test was used for comparison of survival curves between groups.

There was no statistically significant difference in VAS between the two groups (F=0.547, P>0.05), and there were statistically significant differences in both groups at three time points(control group F=386.724, observation group F=412.159, both P<0.001), while the difference in interaction effect of VAS score was also statistically significant ( interaction F=4.316, P=0.014). As for Harris scores, there was a statistically significant difference between the two groups (F=14.582, P<0.05), and statistically significant differences within both groups among the three time points (control group F=387.624, observation group F=425.817, both P<0.05). There was a statistically significant difference in interaction effect of the two groups (F=5.217, P<0.05). Multivariate analysis showed no statistically significant difference in Harris scores before operation between the two groups (t=0.403, P>0.05), but the observation group had higher Harris scores than the control group at three and six months after surgery (t=3.809, 4.521, both P<0.05). There was no statistically significant difference in follow-up duration between the two groups (P>0.05). The prosthesis survival rate of the observation group (100.0%) was better than the control group (97.1%) [ log-rank test hazard ratio (HR)=0.314, 95% confidence interval (CI) (0.013, 7.892), P<0.05].

3D-printed porous titanium trabecular acetabular cups can improve the clinical outcomes of THA in patients with type Ⅰ/Ⅱ acetabular dysplasia to a certain extent and are worthy of clinical promotion and application.

To study the early efficacy of total hip arthroplasty in the treatment of traumatic femoral neck factures.

One hundred patients with traumatic femoral neck fractures in Jixi People's Hospital from January 2021 to June 2022 were selected and randomly divided into the observation group and the control group, with 50 cases in each group. The perioperative indicators, inflammatory factors, stress hormones, hip joint score, balance ability and the incidence of lower extremity venous thrombosis were compared between the two groups. The analyses of measurement data were performed using independent sample t test for comparison between groups, paired t test for comparison within groups, and repeated measures analysis of variance for comparison at multiple time points. Count data were analyzed by chi square test was used. P<0.05 indicated statistically significant difference.

Compared with the control group, the intraoperative blood loss, postoperative drainage volume, operation time and hospital stay in the observation group increased (t=3.985, 4.487, 3.915, 3.242, all P<0.05). Compared with the control group, interleukin (IL) -1β, tumor necrosis factor (TNF) -α, stress hormone adrenocorticotropic hormone (ACTH), and catecholamine (CA) in the observation group decreased (t=2.201, 11.770, 6.540, 6.551, all P<0.05). After one month of treatment, there was no statistically significant difference in the Berg balance scale (BBS) scores between the two groups (P>0.05). Compared with the control group, BBS score in the observation group increased at three and six months of treatment (t=4.080, 4.241, both P<0.05). Compared with the control group, the excellent and good rate of Harris score in the observation group increased (χ²=4.396, P<0.05). There was no statistically significant difference in the incidence of lower extremity venous thrombosis between the two groups (P>0.05).

Total hip arthroplasty is an effective treatment option for traumatic femoral neck fractures and can offer patients a better choice.