Medische intelligence

OBJECTIVE: To explore the effects of a prior history of arthroscopic surgery on the risk of postoperative infection following knee, hip and shoulder arthroplasty. METHODS: Searched relevant literature from four major English databases up to August 10, 2025. A total of 31 observational studies were included. The generalized linear mixed model was used to pool effect sizes and calculate the odds ratios (OR) for postoperative infection after joint arthroplasty. Subgroup analyses stratified by joint type were performed, and the pooled incidence rates of infection were synthesized. RESULTS: A prior arthroscopic surgery significantly increased the risks of overall infection (OR = 1.33, 95%CI: 1.14-1.56) and deep infection (OR = 1.38, 95%CI: 1.17-1.63) after joint arthroplasty, with obvious heterogeneity among different joints. A history of knee arthroscopy was associated with elevated postoperative infection risks, and prior shoulder arthroscopy markedly increased the risk of deep infection. No significant correlation was observed between hip arthroscopy and infection risk. The pooled overall and deep postoperative infection rates were both 2% in this population. CONCLUSION: Clinicians should attach importance to this joint-specific risk when formulating treatment plans. Further studies focusing on the shoulder joint are required to validate the present findings.

OBJECTIVE: Up to 30% of patients with osteoarthritis experience suboptimal recovery after total knee arthroplasty (TKA), increasing interest in prehabilitation as a potential strategy to improve postoperative outcomes. This study compared the efficacy of individual prehabilitation modalities versus standard care for physical function, quadriceps strength, pain, and health-related quality of life (HR-QoL) at 3 months after TKA, with additional analyses at 4-8 weeks. DESIGN: We conducted a systematic review and network meta-analysis (NMA) of randomized controlled trials (RCTs) following PRISMA guidelines. Eligible studies included adults undergoing TKA for osteoarthritis who received preoperative prehabilitation targeting physical, educational, nutritional, or behavioral domains. Comparators were standard care or alternative prehabilitation interventions. Confidence in the evidence was assessed using the CINeMA framework. RESULTS: 20 RCTs (1095 patients) comparing eight prehabilitation modalities were included. At 3 months after TKA, no prehabilitation modality demonstrated statistically significant improvements in physical function, quadriceps strength, pain, or HR-QoL compared with standard care. Similar findings were observed at 4-8 weeks after TKA, except that lower-extremity strength training significantly improved quadriceps strength compared with standard care. Confidence in the evidence was predominantly low to very low, primarily because of imprecision, although three treatment comparisons were supported by moderate confidence. CONCLUSION: Current evidence does not support recommending one prehabilitation modality over another before TKA. Although lower-extremity strength training improved short-term quadriceps strength, this finding was supported by low-confidence evidence. Larger, adequately powered head-to-head trials are needed to determine whether specific prehabilitation modalities provide clinically meaningful postoperative benefits. REGISTRATION: PROSPERO (CRD42024490615).

BACKGROUND: Total knee arthroplasty (TKA) is the most effective surgical method for end-stage knee joint diseases, yet chronic postoperative pain related to pain catastrophisation remains a major cause of patient dissatisfaction, warranting evaluation of Empowered Relief (ER) in TKA patients. OBJECTIVE: This quasi-experimental study evaluated digital ER's effectiveness in reducing pain catastrophizing post-TKA. METHODS: This quasi-experimental study enrolled 70 primary unilateral TKA patients at a tertiary hospital in Lanzhou, China (March-June 2023). Participants were allocated by admission date: the intervention group (March-April, n = 35) received enhanced recovery protocols with standard pain management, while the control group (May-June, n = 35) received standard management alone. Pain outcomes were assessed at postoperative weeks 2 ( T 1), 1 month ( T 2), and 3 months ( T 3) using validated tools: Pain Catastrophizing Scale (PCS), Numerical Rating Scale (NRS), and APS-POQ-C (Chinese version) to evaluate catastrophisation, intensity, and management efficacy. Generalized Estimating Equations (GEEs) were employed for longitudinal statistical analysis. RESULTS: The ER program showed statistically significant main effects across groups ( P < 0 . 001 ), temporal effects ( P ¡ 0.001), and group-time interaction effects ( P < 0 . 001 ) on pain catastrophisation scores, pain intensity scores, and pain management outcomes, respectively. And as time went on, the intervention group showed greater improvement than the control group in pain catastrophizing (PCS: T 1 = 16, T 2 = 9, T 3 = 5 versus T 1 = 29, T 2 = 23, T 3 = 19.5), pain intensity (Pain: T 1 = 4, T 2 = 2.5, T 3 = 1 versus T 1 = 4, T 2 = 3, T 3 = 2) and pain management outcomes (APS-POQ-C: T 1 = 12.125, T 2 = 3.875, T 3 = 1.25 versus T 1 = 15.75, T 2 = 9.5, T 3 = 5). CONCLUSIONS: The ER program significantly reduced postoperative pain intensity and catastrophisation in TKA patients, enhancing pain management outcomes compared to conventional therapies. Its concentrated 2 h format demonstrates promising efficacy over standard care, offering a streamlined alternative to traditional postoperative regimens.

Knee osteoarthritis (KOA) is a chronic, disabling disease with multiple etiologies and a complex pathophysiology. Conservative treatment is the cornerstone of KOA management, and when it proves insufficient, extracorporeal shock wave therapy (ESWT) has emerged as a practical non‑invasive alternative. The present narrative review systematically summarizes current preclinical and clinical evidence on ESWT for KOA through a structured literature search, aiming to integrate its therapeutic effects and identify knowledge gaps. Accumulating evidence indicates that ESWT can slow KOA progression through multiple biological pathways, encompassing anti‑inflammatory, anti‑apoptotic, pro‑proliferative and cartilage‑protective effects, while also relieving pain and improving function clinically. Summarizing the available data, this review finds that ESWT exhibits a favorable safety profile for articular tissues and disease‑modifying potential in preclinical models, although treatment outcomes depend critically on energy flux density and protocol selection. In human studies, the current evidence primarily supports symptomatic relief, including pain reduction and functional improvement; high‑quality trials with structural endpoints to verify cartilage regeneration or joint space preservation remain scarce. Given its non‑invasive nature, safety and growing clinical support, ESWT merits consideration as an adjunctive therapy. However, heterogeneity in treatment parameters and limited long‑term data preclude standardized guidelines. Despite these limitations, ESWT remains a promising adjunctive therapy for patients who are unresponsive to conventional conservative treatments. Future research should prioritize parameter optimization, extended follow‑up and translational studies to bridge the gap between preclinical structural findings and clinical application. Addressing these gaps will strengthen the therapeutic role and scientific foundation of ESWT.

Ferroptosis is closely associated with the pathogenesis of osteoarthritis (OA), though the underlying molecular mechanisms remain unclear. This study aims at exploring the role of CDO1 in chondrocyte ferroptosis. In this study, cell viability was assessed using the CCK8 assay. ROS levels were measured via flow cytometry. Lipid peroxidation was evaluated using the C11 BODIPY 581/591 fluorescent probe, and mitochondrial morphology was examined by transmission electron microscopy. Our results demonstrated that CDO1 was upregulated in cartilage tissues from patients with severe knee OA. IL-1β stimulation elevated ferroptosis levels in SW1353 cells, as indicated by reduced cell viability, extracellular matrix (ECM) accumulation and GSH levels, increased oxidative stress, lipid peroxidation and MDA content, and impaired mitochondrial morphology. These effects were reversed by the ferroptosis inhibitor Fer-1. Overexpression of CDO1 reduced intracellular cysteine levels and enhanced ferroptosis, whereas CDO1 knockdown produced the opposite effects. We further identified VHL as a binding partner of CDO1 and showed that VHL promoted CDO1 protein degradation. The ferroptosis and ECM degradation induced by CDO1 overexpression were rescued by VHL co-overexpression. Importantly, cysteine deficiency enhanced VHL activity, promoted CDO1-VHL interaction, and accelerated CDO1 degradation, thereby may form a VHL/CDO1/cysteine negative feedback loop. The function of CDO1/VHL axis was further validated in a rat OA model, where CDO1 exacerbated OA progression and VHL alleviated it. In summary, our findings reveal that the VHL/CDO1 axis regulates intracellular cysteine levels, mediates chondrocyte ferroptosis and OA progression.

Biofilm formation on prosthetic joint surfaces is a key mechanism causing treatment failure in prosthetic joint infection, and intraoperative irrigation is routinely used during debridement, antibiotics, and implant retention and revision surgery. Clinical evidence directly supporting biofilm-disrupting irrigation solutions in established PJI is limited and unclear. This scoping review mapped clinical evidence evaluating defined biofilm-disrupting irrigation strategies used during surgery for established hip and knee prosthetic joint infection and identified existing evidence gaps. A scoping review was structured in accordance with PRISMA-ScR guidance. PubMed, Scopus and Embase were searched. Clinical studies in adults undergoing surgery for established PJI that reported clinical outcomes associated with a defined irrigation solution with intended biofilm-disrupting activity beyond normal saline were eligible. Prevention-only arthroplasty studies were charted separately for context. Data were recorded on study design, population, causative organisms, surgical procedure, irrigant protocol, comparators, follow-up, outcome definitions and adverse events. Semi-quantitative descriptive analysis and MINORS risk of bias assessment was undertaken. Four clinical studies met inclusion criteria, all retrospective observational or comparative cohorts. The available evidence primarily involved povidone-iodine & hydrogen peroxide sequences, vancomycin-povidone iodine protocolised irrigation, and Bactisure® based irrigation during debridement, antibiotics and implant retention. Comparative studies reported variable findings: protocolised povidone-iodine/hydrogen peroxide and vancomycin-povidone iodine approaches were associated with lower failure in selected cohorts, whereas Bactisure® did not significantly reduce DAIR failure compared with standard DAIR in the largest comparative cohort. Interpretation is limited by small study numbers, retrospective design, heterogeneous infection timing, organism profiles, host factors, component exchange practices, antimicrobial regimens, and inconsistent outcome definitions. Prevention-only arthroplasty lavage studies were considered contextual evidence only and should not be extrapolated directly to established PJI. Current evidence does not identify a superior irrigant or justify treatment recommendations. Future multicentre prospective trials should evaluate standardised irrigation protocols within standardised treatment bundles, use musculoskeletal infection society definitions, report adverse events and cytotoxicity, and include patient-reported outcomes and cost-effectiveness analysis.

PURPOSE: To preliminarily evaluate whether routine knee MRI demonstrates reproducible patterns of combined patellar cartilage and subchondral bone involvement using an exploratory three-tier patella-focused osteochondral MRI framework. METHODS: This retrospective single-center lesion-based study included 200 knee MRI examinations performed between January 1, 2024 and January 1, 2026. Patellar cartilage damage was graded as Amax (0-4), and subchondral bone abnormalities were graded as Bmax (0-3). Examinations were categorized as Tier 1 low-burden involvement, Tier 2 discordant involvement, or Tier 3 concordant advanced involvement. Field-strength subgroup analyses were performed to assess potential differences between 1.5-T and 3-T examinations. RESULTS: Interobserver agreement was high for Amax (weighted kappa = 0.82) and Bmax (weighted kappa = 0.85), and excellent for the composite score (ICC = 0.91). Cartilage and bone grades were positively correlated (Spearman's rho = 0.637, p < 0.001). Tier 1, Tier 2, and Tier 3 patterns were observed in 43.5%, 23.5%, and 33.0% of examinations, respectively. Within Tier 2, cartilage-predominant and bone-predominant patterns accounted for 38/47 (80.9%) and 9/47 (19.1%) cases, respectively. Field-strength analysis showed a difference in detailed Amax grade distribution (p = 0.021), whereas high-grade cartilage involvement, Bmax distribution, framework category, and composite score did not differ significantly between 1.5-T and 3-T examinations. CONCLUSION: Routine knee MRI may reveal low-burden, discordant, and concordant advanced patterns of patellar osteochondral involvement. The proposed framework provides an exploratory structural description of combined cartilage-bone involvement rather than a validated staging system or a proven replacement for conventional grading.

BACKGROUND: This study determined the prevalence of glucagon-like peptide-1 (GLP-1) use before total joint arthroplasty (TJA), measured weight loss of patients on GLP-1s, and evaluated if GLP-1s were associated with outcomes. METHODS: We identified 6482 patients (2990 hips; 3492 knees) who had primary TJAs between 2019 and February 2023. The mean age was 67 years, 50% were female, and 12% had a body mass index ≥40 kg/m 2 . Univariable and multivariable models evaluated outcomes. Mean follow-up was 3 years. RESULTS: The prevalence of GLP-1s before TJA was 3%, increasing from 2% in 2019 to 5% in 2022. The mean preoperative weight change on GLP-1s was -9 pounds (range, -110 to +36 pounds). Among patients taking GLP-1s, 19% lost ≥20 pounds prior to surgery, and the mean body mass index change was -1.4 kg/m 2 (range, -16.3 to 6.2 kg/m 2 ). In univariable analyses, GLP-1 use was not associated with revisions ( P = .35), reoperations ( P = .09), or complications ( P = .23). In multivariable analyses, GLP-1s were not associated with revisions ( P = .66), reoperations ( P = .34), or complications ( P = .85). There was no difference in the risk of a 90-day postoperative emergency department visit between those on GLP-1s vs not on those medications (odds ratio, 1.5; P = .07). CONCLUSIONS: The prevalence of preoperative GLP-1s before TJA increased from 2% in 2019 to 5% in 2022, and preoperative weight change on GLP-1s varied considerably. GLP-1s were not associated with decreased postoperative risks but investigational GLP-1s before TJA require further study. LEVEL OF EVIDENCE: Level III.

INTRODUCTION: Total knee arthroplasty (TKA) generally provides substantial and durable relief in end-stage knee osteoarthritis, yet a proportion of patients develops chronic postsurgical pain (CPSP). Conventional analgesics often fail to adequately address this condition. Cooled radiofrequency ablation (CRFA) has shown effectiveness in knee osteoarthritis, but its utility for patients with CPSP after TKA has not been investigated. This study aimed to report a phase I/IIa clinical trial regarding CRFA for patients with CPSP after TKA. MATERIALS AND METHODS: This prospective pilot study (jRCTs052230123) enrolled consecutive patients with CPSP between November 2023 and August 2025. Inclusion criteria included persistent pain ≥6 months after TKA, inadequate response to standard analgesics (NRS ≥5), and ≥50% pain reduction after diagnostic genicular nerve block. Following informed consent, participants underwent CRFA using the Coolief® system. The primary endpoint was the change in Numeric Rating Scale (NRS) pain score from baseline to 6 months. 2011 Knee Society Score (KSS) was also used for the efficacy evaluation. As for the safety evaluation, the occurrence and outcomes of any severe adverse events between the day of treatment and 6 months post-treatment were recorded. RESULTS: Of 15 screened patients, 5 met all criteria and completed the study. CRFA resulted in a consistent reduction in pain intensity; however, the change in NRS scores did not reach statistical significance at 6 months. Responder analyses demonstrated that a substantial proportion of patients achieved clinically meaningful improvements at 6 months. Although the 2011 KSS showed a trend toward improvement, the change was not statistically significant. No adverse events or complications occurred. CONCLUSIONS: CRFA provided clinically meaningful pain relief without adverse events in patients with CPSP after TKA. These findings suggest that CRFA is a safe and potentially effective therapeutic option. Larger studies are needed to verify its clinical value.

Knee osteoarthritis is a progressive condition with limited disease-modifying treatments. Platelet-rich plasma (PRP) has emerged as a biologically plausible option due to its anti-inflammatory and anabolic effects, including modulation of the nuclear factor kappa light chain enhancer of activated B cells pathway and support of cartilage cell activity. Structural imaging outcomes remain inconclusive, reflecting heterogeneity in PRP formulations and short follow-up periods. Given uncertain efficacy, high cost, and lack of standardization, major orthopedic societies do not recommend routine PRP use, suggesting it be considered only as an adjunct for selected patients seeking to delay surgery.