Applied Sciences

ObjectivesA previously published biomechanical study of axial cyclic testing on a lockingtype plating system presented several failure types of the screw-plate interfaces (SPI). It was assumed that increasing micromotions of SPIs result consequently in initial failure of SPIs during cyclic loading. In conclusion, measurements of SPIs via digital image correlation (DIC) were suggested to detect potential micromotions. MethodsDIC measurements were performed using the ARAMIS Adjustable 3D measurement system to track the surface of the screw-head and bone plate during cyclic testing to determine potential micromotions. The micromotion is thereby described as the change in distance of the screw-head center to a reference point on the bone plate, providing information about the quality of interlocking of the related SPI during cyclic loading. Micromotion analysis was performed on the fracture-adjacent SPIs of the implant system, that were considered as the most relevant interfaces. ResultsMicromotion could be detected for both facture-adjacent SPIs in all test samples with increasing magnitude during cyclic testing, resulting in micromotions up to 587 {micro}m for the proximal and 321 {micro}m for the distal fracture-adjacent SPI after 50k load cycles. The strongest increase in micromotion could thereby be detected within early stages of cyclic loading. ConclusionsThe approach to determine micromotions of SPIs during axial cyclic loading was successful, indicating a reduction of the SPI s quality of interlocking as micromotions increase during cyclic loading of the tested locking-type implant system.

IntroductionDigital twins derived from 3D scanning data were developed to measure soft tissue deformation in head and neck surgery by an artificial intelligence approach. This framework was applied suggesting feasibility of soft tissue shift detection as a hitherto unsolved problem. MethodsIn a pig head cadaver model 104 soft tissue resection had been performed. The surface of the removed soft tissue (RTP) and the corresponding resection cavity (RC) was scanned (N=416) to train an artificial intelligence (AI) with two different 3D object detectors (HoloLens 2; ArtecEva). An artificial tissue shift (TS) was created by changing the tissue temperature from 7,91{+/-}4,1{degrees}C to 36,37{+/-}1,28{degrees}C. ResultsDigital twins of RTP and RC in cold and warm conditions had been generated and volumes were calculated based on 3D surface meshes. Significant differences in number of vertices created by the different 3D scanners (HoloLens2 51313 vs. ArtecEva 21694, p<0.0001) hence result in differences in volume measurement of the RTC (p=0.0015). A significant TS could be induced by changing the temperature of the tissue of RC (p=0.0027) and RTP (p=<0.0001). RC showed more correlation in TS by heating than RTP with a volume increase of 3.1 l or 9.09% (p=0.449). ConclusionsCadaver models are suitable for training a machine learning model for deformable registration through creation of a digital twin. Despite different point cloud densities, HoloLens and ArtecEva provide only slightly different estimates of volume. This means that both devices can be used for the task.TS can be simulated and measured by temperature change, in which RC and RTP react differently. This corresponds to the clinical behaviour of tumour and resection cavity during surgeries, which could be used for frozen section management and a range of other clinical applications.

Heart rate is one of the vital signs for monitoring health. Non-invasive, non-contact assessment of heart rate can lead to safe and potentially telemedicine based monitoring. Thermal videos as a modality for capturing heart rate has been underexplored. Regions with large vessels such as the face can capture the pulsatile change in temperature associated with the blood flow. The use of a machine learning-based approach to capture heart rate from continuous thermal videos is currently lacking. Our present clinical investigation comprises the continuous monitoring of heart rate from a smaller number of samples by using a combination of an efficient deep-learning-based segmentation followed by domain-knowledge-based feature calculation for estimating heart rate from 124 thermal imaging videos comprising 3,628,087 frames of 65 patients, admitted to the pediatric intensive care unit at AIIMS, New Delhi. We hypothesized that periodic fluctuations of thermal intensity over the face can capture heart rate. Frequency domain features for thermal time series were extracted followed by supervised learning using a battery of models. A random forest model yielded the best results with a root mean squared error of 24.54 and mean absolute percentage error of 16.129. Clinical profiling of the model showed a wide range of clinical conditions in the admitted children with acceptable model performance. Affordable and commercially available thermal cameras establish the feasibility and cost viability of exploring deployments for patient heart rate estimation in non-invasive and non-contact environments.

BackgroundThe acetabular pathomorphology in patients with Crowe type II and III developmental dysplasia of the hip(DDH)often present complicated changes, which bring challenges to the anatomical reconstruction of acetabulum in total hip arthroplasty (THA). The objective of this study was to develope a novel 3D printed integral customized acetabular prosthesis, which provides a promising way to reconstruct the acetabulum with higher accuracy and efficiency by digital softwares, compared with previous 3D printing model method. Methods15 patients (18 hips) with end-stage hip osteoarthritis due to Crowe type II/III DDH who underwent primary cementless THA from January 2015 to November 2021 were included. The 15 patients consisted of 3 men (3 hips) and 12 women (15 hips) with an average age of 53.89 {+/-} 8.48 years (range from 32 to 69 years). The novel 3D printed integral customized acetabular prosthesis was designed by the model method and software method respectively. The indicators of the cup size, the volume and superficial area of bone defect, the inclination and anteversion of acetabular cup, the horizontal and vertical distance of hip center and working time were compared between two methods. ResultsThere were statistically significant difference between the software group and model group on the volume and superficial area of bone defect as well as working time (t = 2.397, 2.707,138.509, P < 0.05). The mean anteversion and inclination of acetabular cup in the software group and model group were(15.17{+/-}0.52){degrees},(40.24{+/-}0.58){degrees}and (33.79 {+/-}13.43){degrees}, (30.50 {+/-}11.03){degrees}respectively, the difference was statistically significant (t = 5.859, 3.767, P < 0.05).There were no statistically significant difference between the software group and model group on cup size, the horizontal and vertical distance of hip center(t =1.458,0.114, 1.712, P > 0.05) ConclusionsThe application of digital softwares could design and develope the novel 3D printed integral customized anatomical acetabular prosthesis in THA for {square}Crowe type II and III DDH with high accuracy and efficiency.

IntroductionOsteoporosis (OP) is a bone disease caused by a decrease in bone mineral density (BMD). OP is common in women because BMD gradually decreases after age 35. OP due to decreased BMD is highly likely to cause fatal traumatic injuries such as hip fracture. The purpose of this study was developed and evaluated a multi-layer perceptron neural network model that predicts OP using physical characteristics and activity factors of adult women over the age of 35 whose BMD begins to decline. Materials and MethodsData from KNHANES were used to develop a multi-layer perceptron model for predicting OP. Data preprocessing included variable selection and sample balancing, and LASSO was used for feature selection. The model used 5 hidden layers, dropout and batch normalization and was evaluated using evaluation scores such as accuracy and recall score calculated from a confusion matrix. ResultsModels were trained and evaluated to predict OP using selected features including age, quality of life index, weight, grip strength and average working hours per week. The model achieved 76.8% accuracy, 74.5% precision, 80.5% recall, 77.4% F1 score, and 74.8% ROC AUC. ConclusionA multi-layer perceptron neural network for predicting OP diagnosis using physical characteristics and activity factors in women aged 35 years or older showed relatively good performance. Since the selected variables can be easily measured through surveys, assessment tool, and digital hand dynamometer, this model will be useful for screening elderly women with OP or not in areas with poor medical facilities or difficult access.

BackgroundChronic lateral ankle instability stems from laxity in the anterior talofibular (ATFL) and calcaneofibular (CFL) ligaments. While suture repair is standard, added reinforcement is often needed to restore native strength. This study evaluates the biomechanics bio-inductive implant augmentation (Bio-Aug) of suture repair. MethodsEight fresh-frozen human ankle specimens were tested under three ATFL and CFL conditions, including: (1) Intact, (2) Suture-Repair, and (3) Bio-Aug, (BioBrace(R), CONMED Co, Largo, FL). Biomechanical testing included a 500-cycle loading protocol, with creep, primary stiffness, and final stiffness as outcomes. ResultsOnly 32% of Suture-Repair specimens completed all 500 cycles, compared to full completion in other groups (P = .04). Bio-Aug results were comparable to Intact, while Suture-Repair showed lower final stiffness than Bio-Aug (P = .049). The Intact group had the least creep, although Suture-Repair showed high variability. ConclusionBio-inductive implant appears to provide comparable stiffness to native ligaments by reinforcing suture repair.

Wear of the inlay in total knee arthroplasty (TKA) contributes to implant failure and the need for revision surgery. In vivo wear assessment is challenging owing to the radiolucency of the inlay in standard radiographs. This study aimed to investigate the basic feasibility of integrating radiopaque X-ray markers on standard inlays to enhance their radiographic visibility and enable wear evaluation. Preliminary experiments identified optimal process parameters for micro-milling cavities on ultra-high molecular weight polyethylene (UHMWPE). A total of 450 parameter combinations were evaluated, with burr formation serving as the quality criterion. A process chain, comprising pre-contouring, micro-milling, filling cavities with radiopaque composite, and final contouring, was developed for inlay production. Eleven inlays with varying marker alignments, orientations, and geometries were manufactured, featuring grooves ([&le;]0.8 mm wide) and holes (diameter = 1.6 mm), both 1 mm deep. Three HDPE + BaSO composites (10, 20, and 30 wt.% BaSO) were formulated and assessed for radiopacity per ASTM F640-20. Final marker cavities were filled with HDPE + 20 wt.% BaSO via pellet extrusion. The inlays were positioned in a phantom knee setup and radiographed in the anteroposterior view. Projected markers were evaluated based on edge visibility, measurability, homogeneity, and obscuration by the implant. None of the parameter combinations resulted in burr-free cavities, indicating an unstable five-axis process. X-ray images revealed that grooves aligned in the X-ray direction and drilled holes exhibited the best visibility for wear markers. Pin-on-plate tribological experiments revealed that BaSO addition to pure HDPE reduced its CoF from 0.25 to 0.1, reaching a value comparable to UHMWPE (0.15), while also enhancing wear resistance. This study demonstrated the feasibility of integrating wear markers on standard TKA inlays by micro-milling cavities at different positions and orientations on the inlay surface and filling them with a radiopaque composite. Further research is required to optimise process parameters and investigate marker wear.

Osteoarthritis (OA) is a progressive degenerative joint disease that significantly impairs mobility and quality of life, particularly in aging populations. Current therapeutic approaches primarily focus on symptom relief, but fail to address the underlying mechanisms of cartilage degeneration. In recent years, epigenetic reprogramming has emerged as a promising strategy for cellular rejuvenation, offering new perspectives for regenerative medicine. This study investigates the potential of a selected set of small chemical molecules (SCM) to induce epigenetic reprogramming of chondrocytes and promote cartilage regeneration in an in vivo model of chemically induced OA. The experiments were conducted on aging female rats, a translational model chosen for its relevance to human age-related OA and postmenopausal cartilage deterioration. OA was induced via intra-articular administration of trypsin, and a subset of animals was further subjected to estrogen receptor blockade using clomiphene citrate to simulate postmenopausal conditions. The SCM cocktail was administered intra-articularly to evaluate its effects on cartilage repair. Chondroitin sulfate was used as a comparative treatment control. The results demonstrated that SCM administration led to significant improvements in joint tissue integrity, including increased cartilage thickness, enhanced synthesis of mucopolysaccharides, and restoration of chondrocyte metabolic activity. Histological analysis revealed that SCM-treated groups exhibited reduced cartilage erosion, lower inflammatory marker expression, and improved nuclear-cytoplasmic index (NCI) values, suggesting enhanced chondrocyte function. Notably, the group with estrogen receptor blockade responded more favorably to SCM treatment than the non-blocked OA group, highlighting the potential interaction between hormonal status and epigenetic reprogramming. These findings provide strong evidence for the feasibility of epigenetic modulation as a therapeutic strategy for OA. The ability of SCMs to restore cartilage structure and function suggests a novel approach to treating age-related degenerative diseases. Further research is required to elucidate the precise molecular mechanisms underlying this rejuvenation process and optimize therapeutic protocols for clinical applications.

BackgroundMusculoskeletal diseases are a leading cause of global disability and healthcare burden, yet traditional orthopaedic procedures often fail to address molecular drivers of degenerative and genetic conditions. CRISPR-Cas Systems, a precise and programmable genome-editing technology, show promise in preclinical musculoskeletal models, ranging from gene knockouts in osteoarthritis to mutation correction in skeletal dysplasia. Despite growing interest, no comprehensive synthesis exists to map how CRISPR-Cas Systems are being applied in orthopaedic research. This scoping review aims to fill that gap. MethodsThis protocol will be registered with the Open Science Framework and follows PRISMA-ScR guidelines and the Arksey & OMalley framework. MEDLINE, Embase, Scopus, Web of Science, and grey literature sources from 2005 onward will be searched. Inclusion criteria encompass original research using CRISPR-Cas Systems in human, animal, or in vitro musculoskeletal models. Two reviewers will independently screen titles, abstracts, and full texts using Covidence software. Data extraction will be standardized and performed in duplicate. Extracted variables include study design, model system, target tissue, gene-editing approach, delivery system, and reported outcomes. Results will be synthesized descriptively and thematically. Expected ResultsWe anticipate mapping the evolution and diversity of CRISPR-Cas Systems applications across musculoskeletal tissues (bone, cartilage, tendon, muscle), highlighting domains such as tissue regeneration, gene correction, and disease modeling. Delivery strategies (viral vectors, nanoparticles) and translational challenges, including off-target effects and delivery barriers, will be summarized. ConclusionsThis will be the first scoping review to systematically characterize the role of CRISPR-Cas Systems in musculoskeletal medicine. Findings will inform researchers, clinicians, and policymakers, helping to guide future translational research and accelerating the integration of gene editing into clinical practice.

BackgroundOsteoarthritis (OA) is a common degenerative disease affecting people and animals, resulting in persistent pain and joint deformities. Its growing prevalence presents considerable difficulties to public health and veterinary care systems worldwide. Despite substantial research, the molecular pathways underlying OA pathogenesis remain poorly understood, limiting the development of effective treatment strategies. Exosomes, or small endosomal membrane microvesicles, have emerged as intriguing vehicles for intercellular communication and medicinal administration in a variety of illnesses, including OA. However, their efficacy and action methods in preclinical OA models require additional exploration. MethodsWe analyzed several databases from 2016 to 2023 for original studies on exosome treatment in preclinical OA models. The inclusion criteria included studies that used exosomes generated from mesenchymal stem cells (MSCs) in both human and animal models of OA. Thematic synthesis and data extraction were used to examine research features, dosage administration techniques, and efficacy results. The quality of included studies was assessed using recognized criteria, and statistical analysis was performed to determine the efficacy of exosome treatment in decreasing Osteoarthritis Research Society International (OARSI) scores. ResultsOur study comprised thirteen peer-reviewed articles that included both human and animal models of OA. Most trials used bone marrow MSC-derived exosomes administered intra-articularly. The analysis of OARSI scores revealed a considerable reduction in joint deterioration following exosome therapy. Source analysis demonstrated that exosome treatment originating from human and animal MSCs was consistently effective. However, an assessment of study quality revealed potential biases and limitations, emphasizing the need for more research to validate these findings and refine therapy options for OA management. O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=141 SRC="FIGDIR/small/24313971v1_ufig1.gif" ALT="Figure 1"> View larger version (42K): org.highwire.dtl.DTLVardef@df242corg.highwire.dtl.DTLVardef@1bfd06forg.highwire.dtl.DTLVardef@d318aorg.highwire.dtl.DTLVardef@2f6655_HPS_FORMAT_FIGEXP M_FIG O_FLOATNOGraphical AbstractC_FLOATNO C_FIG

AbstractO_ST_ABSSignificanceC_ST_ABSCurrent systems for diffuse optical tomography (DOT) are unsuitable for clinical applications on acute traumatic brain injury (TBI) patients while in the intensive care unit (ICU). AimTo develop and test a method for DOT recordings suitable for TBI patients in the ICU. This method is based on measurements and co-registration using 3-D optical scans, and the acquisition of optical data using a custom-made helmet which would enable a multimodal (invasive and non-invasive) neuromonitoring. ApproachProbe displacements compared to electromagnetic digitization co-registrations were assessed. The capacity to isolate and monitor, using functional near-infrared spectroscopy (fNIRS), the optical signal in the intracranial (ICT) and extracranial tissues (ECT) was tested on 23 healthy volunteers. Participants were scanned with a frequency-domain NIRS device (690 and 830 nm) during 5 Valsalva maneuvers (VM) in a simulated ICU environment. ResultsThe results showed an average error in probe displacement of 5.5 mm, a sufficient capacity to isolate oxyhemoglobin O2Hb (p=6.4{middle dot}10-6) and total hemoglobin HbT (p=2.8{middle dot}10-5) in the ICT from the ECT, and to follow the changes of hemoglobin in the ICT during the VM (O2Hb, p=9.2{middle dot}10-4; HbT, p=1.0{middle dot}10-3). ConclusionsThe developed approach appears to be suitable for use on TBI patients in the ICU.

Cobbs traditional method for measuring the angle of scoliosis is complicated and error-prone in application. Angles measured with this method are inaccurate and it therefore stands to reason to search for improved procedures. We propose Cobbs angle to be determined by two novel methods: the distance method and the two-angle method. Using mathematical error analysis and experimental test measurings we demonstrate that the two proposed methods offer significant advantages over the current standard. They simplify the measurement process and increase outcome accuracy. For Cobbs angles larger than 30 degrees, the two-angle method reduces the error-variation by approx. 25%. For Cobbs angles below 30 degrees the distance method reduces the error-variation by approx. 50%.

In a major health crisis, demand for mechanical ventilators may exceed supply. This scenario has led to the idea of connecting ventilation circuits in parallel to ventilate multiple patients simultaneously with the same machine. However, simple parallel connection may be harmful when the patients respiratory system mechanics differ. The aim of this work was to develop and test a low-cost, multi-patient, pressure-controlled ventilation system in which parameter settings could be individualized. Two types of circuits were built from polyvinyl chloride plumbing tubes and connectors, with ball valves and water columns used to control pressures. The circuits were connected to test lungs of differing compliances, ventilated in parallel at 20 cycles per minute and assessed for control error, variability and interdependency during peak inspiratory (20 to 35 cmH2O, in 5 cmH2O steps) and positive end-expiratory (5 to 20 to 5 cmH2O, in 5 cmH2O steps) pressure changes in one of the circuits. Results showed control errors lower than 1 cmH2O, a maximum standard deviation in pressure of 1.4 cmH2O and no dependency between the parallel circuits during the pressure maneuvers or a controlled disconnection/reconnection. This pressure-control system might be used to expand a commercial ventilator or, with constant gas inflow and an automated outlet valve, as a stand-alone ventilator with individually-controlled settings for multiple patients. In conclusion, the proposed solution is presented as a potentially reliable strategy for safely individualizing pressure-control parameters in a multi-patient ventilation system during a major health crisis.

Spatial transcriptomics is undergoing rapid advancements and iterations. It is a beneficial tool to significantly enhance our understanding of tissue organization and relationships between cells. Recent technological advancements have achieved subcellular resolution, providing much denser spot placement for downstream analysis. A key challenge for this following analysis is accurate cell segmentation and the assignment of spots to individual cells. The primary objective of this study was to evaluate the effectiveness of a new cell segmentation approach based on subcellular level spatial transcriptomic data by confirming nuclei positions and using Voronoi diagrams, compared to direct clustering with cellbin data. Our findings demonstrate that the Voronoi method not only outperforms traditional methods in providing clearer boundaries and better separation of cell types but also excels in preserving the most transcripts, addressing the issue of low capture efficiency. This integrative methodology presents a substantial advancement in spatial transcriptomics, offering improved cell type classification and spatial pattern recognition. All codes in the paper are available at the GitHub repository: https://github.com/Charlottttttte/Cell_Segmentation_Voronoi

PurposeFES-Cycling can be used to assess neuromuscular performance, however the safety and feasibility of this evaluation method has never been investigated. Materials and methodsan observational prospective study was carried out. The FES-Cycling equipment was set in the evaluation mode. For safety determination, hemodynamic parameters and peripheral oxygen saturation were measured before and immediately after the evaluation protocol, as well as venous oxygen saturation and blood lactate. The creatine phosphokinase level (CPK) was measured before and 24, 48 and 72 hours after the test. The time spent to carry out the entire evaluation protocol and the number of patients with visible muscle contraction were recorded to assess feasibility. ResultsHeart rate, systolic and diastolic blood pressure did not change after protocol evaluation, as well as peripheral and venous oxygen saturation (p > 0.05). Moreover, blood lactate did not change (p > 0.05). CPK did not change up to 72 hours after the test (p > 0.05). The time for evaluation was 11.3 (SD = 1.1) minutes. Furthermore, 75% of the patients presented very visible muscle contraction, 25% of the patients presented barely visible and no patients presented non-visible muscle contraction. ConclusionsFES-Cycling based neuromuscular evaluation method is safe and feasible.

Ovarian aging is closely associated with low female fertility. Excessive oxidative stress can induce ovarian senescence and follicular atresia, thereby reducing reproductive performance. In this study, intact antral follicles of pigs were treated with tert-butyl hydroperoxide (t-BHP) to simulate aging stimulation conditions. The results showed that 200 M t-BHP induced the senescence-related phenotype of antral follicles, which was time-dependent and changed significantly after 6 h of treatment. t-BHP can induce an increase in reactive oxygen species (ROS) and senescence mediated by Caspase-3, P53, Foxo1, and SOD. Senescence-associated {beta}-galactosidase (SA-{beta}-Gal) staining revealed an increase in the number of positive cells. Enzyme-linked immunosorbent assays (ELISA) showed that the level of reactive oxygen species increased, and that the ratio of progesterone (P4) to estradiol (E2) increased. Finally, the findings of this study showed that the relative expression levels of Caspase-3, P53, Foxo1 mRNA, and protein increased, while the relative expression levels of SOD decreased. In conclusion, treatment with 200 M of t-BHP effectively induced follicular senescence at 6 h. Therefore, the in vitro treatment of follicles with 200 M t-BHP for 6 h may be a feasible in vitro culture model to simulate ovarian senescence in gilts.

Laser therapeutic applications, such as the use of high energy lasers (HILT), are widely used in physical therapy, but basic studies on the mechanisms of action of HILT on tendinous/ligamentous tissue are largely lacking. The aim of this study was to investigate microcirculatory changes of the patellar tendon by HILT. 21 healthy volunteers were treated with HILT. Before and after the intervention, as well as 10 minutes later, the microcirculation was measured by noninvasive laser spectroscopy (O2C device). Tissue temperature was recorded at the measurement time points using thermography. Blood flow increased significantly by 86.38 AU (p < 0.001) after the intervention and by 25.76 AU (p < 0.001) at follow-up. Oxygen saturation increased by 20.14% (p < 0.001) and 13.48%, respectively (p < 0.001), whereas relative hemoglobin decreased by 6.67 AU and 7.90 AU, respectively. Tendon temperature increased by 9.45{degrees} and 1.94{degrees} Celsius, respectively. Acceleration of blood flow by improving the flow properties of erythrocytes and platelets may have caused the results.

Introduction and ObjectiveNear-infrared (NIR) fluorescence is used to visualize anatomical structures and physiological activities in real time. The objective is to synthesize the advantages and disadvantages of the PTeye system in the identification of parathyroid glands during thyroid and parathyroid surgery. MethodA literature review of the scope of primary research articles in databases such as PubMed, WoS and Cochrane was carried out, using the search strategy "(autofluorescence AND (parathyroid glands)) AND PTeye" until January 27, 2025. We included studies with any methodology that evaluated the identification of parathyroid glands with autofluorescence in thyroid or parathyroid surgery with PTeye technology. Review articles, editorials, and individual clinical cases were excluded. ResultsWe included 8 studies that met the inclusion criteria. The results showed that PTeye has high accuracy in identifying parathyroid glands, with identification rates above 90%. The use of PTeye reduced the need for additional tests such as freeze biopsies and increased the surgeons confidence in identifying parathyroid tissue. However, some false positives were identified, including thyroid nodules and lymph nodes. The device proved to be easy to use and provided real-time feedback. ConclusionsPTeye is a useful tool to improve the identification of parathyroid glands during surgery, increasing surgeon confidence and reducing the rate of postoperative hypocalcemia. Although it has some disadvantages, such as the possibility of false positives and the need for a learning curve, its benefits outweigh these limitations. More studies are needed to confirm these findings and assess their long-term impact.

IntroductionThis study aimed to examine the effects of body mass index (BMI) on functional recovery after total hip arthroplasty (THA). Materials and methodsThis prospective case-control study included 269 patients who underwent primary THA. Participants were categorized into normal weight, overweight, and obese groups based on the World Health Organization criteria. Recovery outcomes were assessed across BMI groups using gait measurements and the Japanese Orthopaedic Association (JOA) hip scores. ResultsPatients with obesity exhibited slower recovery in walking speed and stride length at 6 months and 1 year than did their less-obese counterparts. At 1 year post-surgery, the JOA hip scores showed no significant differences among the BMI groups, thereby indicating similar satisfaction levels despite initial functional recovery differences. ConclusionsAlthough patients with obesity faced early recovery challenges, particularly regarding gait, satisfaction with THA outcomes was comparable across all BMI groups at 1 year. These findings highlight the need for personalized management and rehabilitation strategies for optimizing THA outcomes for patients with obesity.

BackgroundBone healing after internal fixation of intertrochanteric hip fractures is difficult to monitor with radiography, particularly with internal fixation implants such as the sliding hip screw (SHS). In this study, we evaluate a robust, user-friendly device to non-invasively determine the loading on the screw implant. This will allow clinicians to better monitor the status of bone healing and take preventative steps if complications occur. MethodsA novel strain-sensing sliding hip screw (SS-SHS) was designed and refined using a finite element model of a simple intertrochanteric fracture and a standard SHS implant. The SS-SHS houses an internally fixed indicator rod, whose position relative to the screw body can be viewed on plain film radiographs to measure screw bending. Screw bending was assessed in an intact femur and an unstable A1 intertrochanteric fracture using a finite element computational model and compared with experimental axial loading of a femoral Sawbones composite and human cadaveric femur specimens. Indicator rod position relative to the screw was visually tracked using plain radiographs at each load state. ResultsThe indicator rod was found to displace linearly in response to implant strain in the unstable fracture. This movement was consistently visible and measurable using radiography throughout loading cycles across the mechanical and cadaveric fracture models. Sensor movement was not detected in healed fracture models. The slope of the curve was approximately equal in the computations, composite and cadaveric models (0.08 {micro}m/N, 1.0 {micro}m/N, 0.08 {micro}m/N, respectively). The noise level was approximately 25 N in the composite model and 63 N in the cadaveric specimen and this was sufficient to see 1/10th of body weight or more for an 80 kg patient which is likely good enough to track fracture healing. ConclusionsIn current practice, clinicians must carefully monitor their patients for signs of implant failure after surgery. However, by the time signs of failure are apparent, it is often too late to avoid revision surgery. This device enables clinicians to quantitatively track fracture healing, and better communicate the process to the patient. Clinicians can also take preventive measures with at-risk patients before revision surgery is needed, thus reducing mortality risks. Clinical RelevanceBy augmenting an existing SHS system with an indicator rod, crucial information on the status of fracture healing can be ascertained from follow-up radiographs already taken with no additional risk to the patient.