The aim of this study was to estimate whether kinematic alignment (KA) improves knee function or clinical outcomes compared with mechanical alignment (MA) in the short term after total knee arthroplasty (TKA). We searched the literature for randomized controlled trials published before January 2020 from PubMed, EMBASE, Google, Web of Science, Cochrane Library, and other databases. The observation markers included “The Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index,” “Knee Society Score (KSS),” “Oxford Knee Score (OKS),” “combined Knee Society Score (KSS),” “Knee injury and Osteoarthritis Outcome Score (KOOS),” “European Quality of Life Measure‐5 Domain‐5‐Level (EQ‐5D‐5L),” range of motion (ROM), lower limb alignment, ligament release, and complications. A total of 11 randomized controlled trial studies were included in the study. During the follow‐up of 6–24 months, the KA‐TKA group was superior to the MA‐TKA group in terms of WOMAC scores, combined KSS, KSS, knee function scores, and knee range of flexion, but there was no significant difference in EQ‐5D‐5L, KOOS, KOOS (symptoms, pain, ADL, sports, and quality of life), complications, knee range of extension, hip‐knee‐ankle (HKA) angle, tibial component slope angle, lateral distal femoral angle (LDFA) or medial proximal tibial angle (MPTA) angle between the MA‐TKA group and the MA‐TKA group ( P > 0.05). Our meta‐analysis revealed that the incidence of ligament release in the MA‐TKA group was higher than that in the KA‐TKA group. This meta‐analysis shows that the KA‐TKA group had better clinical outcomes and knee range of flexion than the MA‐TKA group at short‐term follow‐up.

Background Minimally invasive surgery is becoming increasingly common, but evidence of the advantages of the minimally invasive transpiriformis approach in total hip arthroplasty is limited. Therefore, our single-centre randomized controlled trial evaluated the benefits of this approach versus the posterolateral approach. Methods Forty-nine patients undergoing the minimally invasive transpiriformis approach and 57 patients undergoing the posterolateral approach total hip arthroplasty were analyzed. The operative time, length of hospital stay, incision length, and peri-operative data related to the surgery were recorded. In both groups, serum CRP, IL-6, HGb, Hct, MB, CK-MB, and CK levels, Harris hip scores, and VAS scores were recorded. Results Patients who underwent the minimally invasive transpiriformis approach had a smaller surgical incision (9.10 ± 0.94 vs. 15.56 ± 1.20 cm, P = 0.00) and shorter hospital stay (6.20 ± 1.54 vs. 12.26 ± 2.97 days, P = 0.00) than those who underwent the posterolateral approach. Serum levels of CRP, IL-6, MB, CK-MB, and CK were also lower. According to the Harris hip score, the minimally invasive transpiriformis group showed significant improvement at one week and one month after surgery. Conclusion Compared to the posterolateral approach, the minimally invasive transpiriformis approach for total hip arthroplasty provided rapid functional recovery, elicited a significantly reduced post-operative inflammatory response, and caused less muscle damage.

Objective Most inferior pole fractures of the patella are comminuted. Therefore, an ideal treatment method has not been determined. We have presented a modified tension band fixation technique—the Krachow suturing, Nice knot combined with tension band fixation—and reported the results of the procedure. Methods A total of 16 inferior patellar pole fractures were treated at our institution between January 2019 and October 2020, 15 of which underwent treatment with the modified tension band fixation technique consisting of Krachow suturing with Nice knots combined with tension band fixation. The primary measures: knee motion, Bostman score, anterior knee pain, fixation failure. Results Bone union occurred at a mean of 9 weeks postoperatively (range: 8–13). There were no cases of postoperative anterior knee pain, refracture of the inferior patellar pole or wire breakage. The patients regained full ROM of the knee joint without functional deficits during follow‐up; the mean ROM was 128.46° ± 7.07° (range: 113.4°–137.8°). At the last follow‐up, all patients had a mean Bostman score of 28.40 ± 1.29 (range: 26–30), with an excellent score in 11 patients and a good score in four patients. Conclusion The modified tension band fixation technique for the treatment of inferior patellar pole fractures is a simple and easy‐to‐perform surgical technique that provides stable fixation and good functional results.

BACKGROUND: Increases in the numbers of surgical procedures for primary total hip arthroplasty (THA) inevitably lead to increases in the requirements for revision THA. The achievement of long-term stability is difficult or impossible by conventional implants in patients with severe destruction of the acetabulum. OBJECTIVE: This case report presents a successful treatment using a specific three-dimensional (3D)-printed porous titanium acetabular composite component without a flange in the management of Paprosky type IIIB acetabular defects. METHOD: A 65-year-old female diagnosed with right hip prosthetic loosening with a huge acetabular defect presented to our hospital. We designed the 3D model of the pelvis and created an individualized 3D-printed porous titanium acetabular composite component for revision THA. The procedure was performed through a posterolateral approach, and the component was implanted in the defect and fixed with cup screws using the drill guides. RESULTS: At the last follow-up at 2 years, the patient had a satisfactory hip joint function and no signs of loosening or other complications were found. CONCLUSIONS: The 3D-printed porous titanium acetabular composite component without a flange is showing promising clinical and radiological outcomes in the management of Paprosky type III acetabular defects.

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Purpose Studies have shown an average postoperative hidden blood loss (HBL) of 473.29 ml and an average Hb loss of 16.71 g/l after intramedullary nailing. Reducing HBL has become a primary consideration for orthopaedic surgeons. Methods Patients with only tibial stem fractures who visited the study clinic between December 2019 and February 2022 were randomized into two groups using a computer-generated form. Two grams of tranexamic acid (TXA) (20 ml) or 20 ml of saline was injected into the medullary cavity before implantation of the intramedullary nail. On the morning of the surgery, as well as on days one, three and five after surgery, routine blood tests and analyses of CRP and interleukin-6 were completed. The primary outcomes were total blood loss (TBL), HBL, and blood transfusion, in which the TBL and HBL were calculated according to the Gross equation and the Nadler equation. Three months after surgery, the incidence of wound complications and thrombotic events, including deep vein thrombosis and pulmonary embolism, was recorded. Results Ninety-seven patients (47 in the TXA group and 50 in the NS group) were analyzed; the TBL (252.10 ± 10.05 ml) and HBL (202.67 ± 11.86 ml) in the TXA group were significantly lower than the TBL (417.03 ± 14.60 ml) and HBL (373.85 ± 23.70 ml) in the NS group (p < 0.05). At the three month postoperative follow-up, two patients (4.25%) in the TXA group and three patients (6.00%) in the NS group developed deep vein thrombosis, with no significant difference in the incidence of thrombotic complications (p = 0.944). No postoperative deaths or wound complications occurred in either group. Conclusions The combination of intravenous and topical TXA reduces blood loss after intramedullary nailing of tibial fractures without increasing the incidence of thrombotic events.

To build a nomogram model for predicting the survival risk of teens and adults with osteosarcoma based on the TARGET database, patients with osteosarcoma were collected via the TARGET database, and the survival curves of the patients were plotted using the Kaplan-Meier method in SPSS 24.0. Least absolute shrinkage and selection operator (LASSO) univariate regression analysis was performed to identify risk factors that influence osteosarcoma survival. A model (nomogram) for predicting the survival risk of adolescent and adult patients with osteosarcoma was built or plotted using the rms26 package as implemented in R (ver. 3.5.3). The predictive accuracy and discriminating power of the nomogram were determined by the C-index and calibration curves. A total of 94 patients with osteosarcoma were included. Classification of cases based on the tumor site revealed 59 cases involving the femur (62.8%), 5 involving the fibula (5.3%), 6 humerus (6.4%), 2 radius (2.1%), 19 tibia (20.2%), and 3 ulna (3.2%). Classification of cases based on surgical method showed 81 cases involving limb sparing (86.2%), 9 cases of amputation (9.6%), and 4 without surgery (4.2%). Among the 94 cases, bone metastasis occurred in 3 cases (3.2%) and lung metastasis in 14 cases (14.9%). Among all survivors, the median rate of survival is 8.6 years (95% CI: 8.0210.92); the three-year and five-year survival rates are 64.6% and 52.6%, respectively. The LASSO regression analysis showed that metastasis site, definitive surgery, and histologic response were potential risk predictors. The C-index of the nomogram plotted was 0.729, and the C-index of the validated sample was 0.742. The nomogram used in this study allows physicians to objectively and accurately predict the prognosis and survival of osteosarcoma patients. In order to determine whether the method is applicable to other groups of patients, additional studies need to be conducted.