To evaluate the effects of adding repetitive transcranial magnetic stimulation (rTMS) to dorsolateral prefrontal cortex(DLPFC) with dual-task (DT) exercise on DT mobility, balance and cognitive performance in individuals with sub-acute stroke. Thirty sub-acute stroke patients [age, mean (SD)=59.2 (7.9) years] were randomly assigned to the experimental group (N=15), or the sham stimulation group (N=15). 5Hz rTMS (90% resting motor threshold, 1200 pulses/session) or sham stimulation was applied to the ipsilesional DLPFC, 1 session/day, 5days/week for 2weeks, followed by dual-task training. Two mobility tests [10m walking and timed-up-and-go (TUG) test] and two cognitive tasks (serial 3 subtractions and verbal fluency) were assessed separately [that is, single-task (ST) condition] and concurrently (i.e., DT condition) before and after the intervention. The experimental group had greater improvement in TUG time under both ST and DT conditions (p<0.05), while the step length of the paretic leg during the 10m walking test of the experimental group only showed better improvement under ST condition and in DT condition when performed with serial 3 subtractions task. Cadence changes did not reach significance in any DT condition. Greater increment in the DT cognitive performance was observed only when verbal fluency task performed with 10m walking test in the experimental group. The experimental group had better gain in Montreal cognitive assessment, Mini balance evaluation systems test, and Activities-specific balance confidence scores than controls. The 2-week rTMS to DLPFC combined with DT training augments DT walking performance, and improves balance and cognitive function in mild to moderate motor and cognitive impairment individuals with sub-acute stroke. This combined intervention is a feasible, effective strategy to improve real-world mobility in sub-acute stroke rehabilitation. Chinese Clinical Trial Registry platform (www.chictr.org.cn), with the registration number ChiCTR2200066237.

Enhancing prediabetes and diabetes detection through a machine learning-enabled self-assessment approach.

Total hip arthroplasty (THA) is technically challenging after curved intertrochanteric varus osteotomy (CVO) for osteonecrosis of the femoral head (ONFH) due to altered proximal femoral morphology, which might compromise clinical outcomes, implant alignment, and accurate leg length restoration. In this study, we aimed to compare the clinical outcomes and radiographic findings among patients undergoing THA after CVO and primary THA for ONFH. This retrospective case-control study included 28 hips that underwent THA after CVO (CVO group) and 56 propensity score-matched primary THA cases for ONFH (primary group). The clinical outcomes were assessed by the Harris Hip Score (HHS), complication rates, and implant survivorship. The radiographic parameters included cup inclination and anteversion, stem alignment, and postoperative leg length discrepancy (LLD). The CVO group showed longer operative time and greater blood loss than did the primary group (p < 0.01). However, no statistically significant differences were found in HHS, complication rates, or implant survival. The CVO group showed a higher rate of stem malalignment (25.0% vs. 12.5%, p < 0.01) and greater LLD (6.1 ± 5.2mm vs. 2.8 ± 3.3mm, p < 0.01). In the CVO group, cemented stems demonstrated significantly lower malalignment rates (10.5% vs. 66.7%, p < 0.01) and smaller LLD (3.8 ± 4.4mm vs. 11.0 ± 3.2mm, p < 0.01) than cementless stems. THA after CVO provided clinical outcomes and survival rates comparable to those of primary THA for ONFH. However, altered femoral morphology increased the risk of stem malalignment and LLD. Cemented stems might improve implant alignment and leg length restoration in these challenging cases.

Although pelvic landmarks have traditionally been used to estimate the femoral head center (FC), their reliability may be limited in patients with developmental dysplasia of the hip (DDH). In contrast, femoral-based reference methods have been insufficiently investigated. This study aimed to evaluate the feasibility and clinical utility of estimating the FC location in DDH using a three-dimensional model derived from trochanteric landmarks. We retrospectively analyzed 128 femurs from 84 female patients with DDH (mean age, 36.9 years) who underwent curved periacetabular osteotomy (CPO) from April 1, 2010, to September 30, 2020, and had no symptoms involving the spine or knee. The FC was estimated using multiple regression models based on the three-dimensional coordinates (x, y, and z) of the greater and lesser trochanter tips. Differences between the estimated and actual FC positions were assessed along all three axes. Correlation coefficients between the estimated and actual FC ranged from 0.725 to 0.875 across the three directions. The mean absolute error was 2-3 mm, with greater errors observed in the anteroposterior direction than in the craniocaudal direction. An estimation error within 3 mm may be considered relatively small in the context of clinically acceptable ranges reported in previous studies for restoring femoral offset and leg length during total hip arthroplasty (THA), supporting the practical applicability of this method in preoperative planning. The accuracy of the present approach was comparable to that reported in healthy populations and exceeded that of previous pelvic landmark-based regression techniques. This trochanter-based three-dimensional method enables clinically acceptable estimation of the FC in patients with DDH and may serve as a useful adjunct for planning of the femoral component when the native FC is difficult to identify.

Changes in knee alignment takes place with the occurrence of Knee Osteoarthritis. Malalignment of knee is evident when Hip knee ankle angle of an individual changes from its neutral position. The aim of the research is to study the lower-extremity using deep learning for detection of changes in joint alignment. In this study, a dataset of 340 images of scanograms was created. A deep learning model based on Renet-18 with transfer learning is implemented for analysis of left leg and right leg separately. Hip knee ankle angle is measured using landmarks on centre of Femur, centre of knee and centre of ankle. Depending on the HKA angle, knee alignment is decided as Varus, Valgus or Neutral. Results obtained by our deep learning model differed from radiologist’s predictions by ±2° for right leg and ±3° for left leg. The model could achieve Intra Class Correlation Coefficient (ICC) of 0.92 and Pearson Correlation Coefficient (r) of 0.94 in HKA analysis. Along with HKA angle analysis, model is trained to evaluate leg length and discrepancy between left and right leg. This deep learning technique enables precise predictions of HKA and leg length enabling the healthcare providers for early and fast decision making.

The number of total hip arthroplasties (THAs) performed worldwide is steadily increasing, and, consequently, the demand for revision procedures is expected to rise as well. two-stage revision procedure continues to be considered the gold standard in many clinical scenarios. During the first step, failure to restore femoral offset has been implicated as a contributor to instability and mechanical failure, although a clear consensus is still lacking. The primary aim of this study is to evaluate the restoration of biomechanical parameters of the hip-specifically leg length discrepancy (LLD), femoral offset (FO), acetabular offset (AO), and global offset (GO)-following implantation of a specific type of articulating hip spacer during the first stage of a two-stage revision for PJI. A secondary objective is to assess the correlation between variations in offset parameters and the rate of interstage mechanical complications. We retrospectively reviewed all patients undergoing staged revision with a specific articulating spacer between 2020 and 2022 at a single institution. Harris Hip Scores, Oxford Hip Scores, and Visual Analogue Scales for pain were obtained at different time points. Radiographic analysis included LLD, FO, AO and GO measurements on the affected (spacer and post-reimplantation) and the contralateral side. Complications were recorded during the interstage and post-reimplantation period. Forty-seven patients (47 hips), were enrolled. The mean follow-up was 25.3 months. Clinical outcomes showed significant improvement from pre-operative visit to interim period and at the last follow-up (p < 0.01). No statistically significant differences for FO, AO and GO between contralateral and spacer side were observed. LLD before reimplantation was 10.1 ± 7.5mm. GO increased of 4 ± 3.2mm at final follow-up (p < 0.05) with a final LLD of 5.6 ± 4.9mm. Six complications (12.8%) occurred during the interstage period: 4 spacer dislocations (8.5%) and 2 intraoperative femoral peri-spacer fractures (4.3%). Comparison between stable and dislocated spacers showed statistically significant differences for mean ΔFO (p = 0.02) and ΔGO (p = 0.04). The articulated spacer assessed in this study, especially when used in combination with a custom-made acetabular component, allowed approximation of the main biomechanical parameters, with small, non-significant differences compared to the contralateral side. Offset parameters reduction may be associated with spacer dislocation rate.

Thermoelectric generators (TEGs) can harvest waste heat for small electronics. However, printed planar TEGs are often limited by low thermocouple density within a given footprint. Here, we present a paper-based rolled thermoelectric generator (Rolled TEG) that autonomously transforms from a planar sheet into a cylindrical geometry via paper self-folding using a fully printed fabrication process. Silver nanoparticle ink is inkjet printed to form electrodes and interconnects, while PEDOT:PSS is screen printed to form p-type thermoelectric legs, enabling series-connected architectures on paper substrates. The self-folding transformation rearranges thermocouples onto the inner cylindrical surface, increasing thermocouple density per projected installation area while preserving leg length and electrical connectivity. By systematically examining printing conditions and electrode pattern design, we clarify how internal resistance and output characteristics are governed and demonstrate that the rolled geometry enhances footprint-normalized power generation by achieving a footprint-normalized power density of 18.9nW cm-2, which is 28.1 times higher than that of the Planar TEG. This work establishes autonomous paper self-folding as an effective design strategy for compact, fully printed thermoelectric devices.

Systematic review, PROSPERO ID: (CRD42023112392). We aim to provide physicians with an evidence-based stepwise approach to distinguishing the primary cause of plane pelvic obliquity (PO) to guide treatment. PO is a frequent clinical finding in both spinal deformity (SD) and leg length discrepancy (LLD) but distinguishing between these etiologies remains challenging due to overlapping clinical and radiographic features and potential multifactorial origins. Misdiagnosis may delay care and worsen patient outcomes. PubMed, Embase, Scopus, and Web of Science were searched from inception to July 2025 for English-language studies evaluating coronal PO in the context of LLD and/or SD that explicitly compared or differentiated limb-origin from spine-origin obliquity using radiographic, advanced imaging, or validated clinical assessments and reported diagnostic accuracy, discriminative features, or management impact. Two reviewers independently screened studies, extracted data, and performed ROBINS-I risk assessment and Newcastle-Ottawa Scale quality assessment. Owing to marked heterogeneity in populations, measurement protocols, and thresholds, findings were synthesized qualitatively with stratification by age group where possible. Of 436 records, 24 cohort studies met the inclusion criteria. Standing anteroposterior (AP) radiographs reliably quantified both LLD and PO, while advanced imaging provided high reproducibility for subtle or ambiguous cases. Radiographic block or shoe lift correction tests distinguished limb-origin and spine-origin PO through immediate postural correction. Key discriminators included a lumbar curve or PO resolving with block/lift correction suggesting LLD, versus persistent deformity despite correction suggesting spinal etiology. Difficulty remains in diagnosing and treating mixed etiology patients. Accurate differentiation of spinal versus limb-driven PO begins with a structured diagnostic approach. AP radiographs, followed by functional block tests, and advanced imaging, may increase diagnostic confidence and decrease unnecessary interventions. Particularly in patients with both LLD and coronal plane SD, prospective studies are required to standardize measurement protocols and improve long-term outcomes. Level IV.

Total hip arthroplasty (THA) is commonly performed for Crowe I developmental dysplasia of the hip (DDH) and primary osteoarthritis (OA), but comparative survivorship and patient-reported outcome measure (PROM) data remain limited with mixed findings. This study aimed to compare PROMs, revision rates, and implant survivorship between propensity-matched THA patients who had Crowe I DDH and OA. A retrospective review of a single surgeon's case log was performed to identify patients who had a diagnosis of DDH or OA who underwent THA. Propensity-score matching was utilized, yielding 105 DDH hips and 105 OA hips. Primary outcomes were modified Harris Hip Score (mHHS), Hip disability and Osteoarthritis Outcome Score - Joint Replacement (HOOS-JR), Visual Analog Scale (VAS) for pain, and University of California, Los Angeles Activity Scale (UCLA) collected preoperatively, at one year, and at minimum 2-year final follow-up. The secondary outcomes included implant survivorship via Kaplan-Meier analysis, multivariable logistic regression for minimal clinically important difference (MCID) and substantial clinical benefit (SCB) achievement, revision rates, and radiographic assessment of leg length discrepancy and acetabular inclination. There were no significant between-group differences in any PROM at any time point (all P > 0.05). Analysis of covariance (ANCOVA) confirmed equivalent adjusted final scores across all four PROMs (all P > 0.14). MCID was achieved in over 92% of both cohorts for mHHS, HOOS-JR, and VAS. There were four revisions in the DDH group (three instability, one periprosthetic joint infection) and three in the OA group; revision rates did not differ significantly (P = 1.0). Kaplan-Meier survivorship analysis showed no significant difference between groups (log-rank P = 0.83). In this propensity-matched series, Crowe I DDH and OA patients achieved comparable midterm PROMs, revision rates, and implant survivorship after THA. Furthermore, preoperative functional status, rather than underlying diagnosis, was the primary predictor of achieving minimal clinically important difference (MCID). These findings suggest that contemporary THA provides similar clinical benefits across both diagnoses.

Fluoroscopy has become an increasingly valuable adjunct in performing total hip arthroplasty (THA) through the direct anterior approach (DAA). Its intraoperative use allows surgeons to confirm acetabular cup inclination and anteversion, optimize femoral offset and leg length, and recognize potential sources of malposition or complications intraoperatively. This review outlines the principles of fluoroscopic imaging during DAA THA, including optimal C-arm positioning, image orientation, and techniques to minimize parallax and distortion. Emphasis is placed on radiation safety and workflow integration to maintain surgical efficiency. Current evidence supports fluoroscopy as a reliable tool for improving component accuracy and reducing leg length discrepancies without compromising surgical time or increasing complication rates. Understanding common pitfalls such as magnification error and inconsistent limb positioning remains critical to accurate interpretation. When properly applied, fluoroscopy enhances intraoperative decision making and allows surgeons to achieve consistent, reproducible outcomes. This review provides practical guidance and evidence-based insights to help orthopaedic surgeons safely and effectively incorporate fluoroscopy into DAA THA practice.

In sprint running, the starting block distance (SBD) directly influences an athlete's start performance, yet there is a lack of research exploring how block distance affects internal tibial load. Therefore, this study examined internal tibial loading in 28 elite sprinters using finite element analysis. Maximum principal stress, shear stress, total deformation, and bending moments were assessed under 3 front block distances (50%, 60%, and 70% of leg length). A 2-way analysis of variance evaluated the effects of gender, SBD, and their interaction. The results showed a significant main effect of gender on maximum principal stress (P < .001), tibial bending moment (P < .001), maximum shear stress (P < .001), and total deformation (P < .001). Furthermore, significant gender-by-SBD interactions for maximum principal stress (P = .001, ηp2=.16) and maximum shear stress (P = .02, ηp2=.05) indicated distinct mechanical responses between male and female athletes in response to SBD settings. This finding suggests that adopting block settings previously reported to optimize start performance (eg,front block distance [FB]/interblock spacing length [SL] 50/45) may inevitably increase internal tibial loading, potentially elevating the risk of cumulative injuries such as medial tibial stress syndrome.

ABSTRACT The aim of this study was to model the relationship between segmental lower limb parameters and stature in a Turkish adult sample and to develop population-specific regression formulae. The study included 115 adults, 47 males and 68 females, with known stature. Pelvic segment height, thigh length, leg length, foot segment height, trochanteric segment length, and total lower limb segment length were measured on anteroposterior orthoroentgenography images. Sex differences were assessed using independent samples t-test, and associations with stature were evaluated using Pearson correlation and linear regression analyses. In males, pelvic segment height and thigh segment length were identified as the most significant predictors of stature in multiple regression analyses; in females, thigh segment length, leg segment length, and foot segment height were the most significant predictors. Total lower limb segment length and trochanteric segment length showed strong associations with stature in both sexes. In this adult Turkish sample, the contribution of lower limb segments to stature estimation varied according to sex and anatomical region. The proposed equations reflect radiograph-based, population-specific models, while the combined evaluation of multiple segments within an anatomically continuous framework carries potential forensic value, particularly for stature estimation from selected fragmented body parts.

Trochanteric fractures are common in geriatric patients, and cephalomedullary nailing is widely used. However, its ability to restore and maintain native hip geometry over time remains unclear. In this retrospective single-center study, patients aged ≥ 75years treated with cephalomedullary nailing between June 2022 and August 2024 were included. Centrum-collum-diaphyseal (CCD) angle, femoral offset, and leg length discrepancy (LLD) were assessed on the operated and contralateral sides postoperatively and at final follow-up (minimum 6weeks). Changes over time and correlations with the cortical thickness index (CTI) and AO/OTA classification were analyzed. Implant-related complications were systematically recorded in the overall cohort and analyzed descriptively. Sixty-six patients (mean age 86.2 ± 6.4years, 76% female) were included. Postoperatively, CCD angle and femoral offset were restored close to the contralateral side without significant differences (p > 0.05). At final follow-up (mean 142days), both parameters decreased significantly on the operated side (p ≤ 0.005) but remained comparable to the contralateral side (p > 0.05). LLD increased significantly over time (- 3.0 ± 3.3mm to - 4.2 ± 4.0mm, p < 0.001). No correlation was found between CTI, fracture classification, and geometric changes. In the overall study cohort, implant-related complications occurred in 13 of 150 patients (8.7%), with no significant independent predictors identified in exploratory multivariable regression analysis. Cephalomedullary nailing was associated with near-anatomical restoration of the proximal femoral geometry in geriatric trochanteric fractures in the short term, despite the nail's dynamic compression mechanism. However, reductions in CCD angle, femoral offset, and leg length occur during the healing phase, underscoring the importance of achieving an optimal initial fracture reduction. These findings are exploratory, and prospective studies are needed to clarify their clinical relevance. Level III, Therapeutic study.

This study primarily aimed to compare the accuracy of acetabular cup positioning between the portable inertial navigation system (INS) Navbit Sprint and the manual method during total hip arthroplasty (THA) using the same cup in the supine position. The second aim was to investigate patient factors associated with cup positioning accuracy for THA with a portable INS. This study included 105 consecutive patients who underwent THA using a portable INS (n = 54) or manual methods (n = 51). The absolute difference between the target and postoperative angles, as determined by postoperative computed tomography data (placement error), was compared between the portable INS and manual method groups. The absolute value of the difference between the navigation and postoperative angles (measurement error) was also evaluated, and related factors were analyzed using multiple regression analysis. The average placement error with the portable INS group was 3.6 ± 2.7° and 2.6 ± 2.5° for inclination and anteversion, respectively. For the manual method group, the absolute difference was 6.0 ± 4.0° and 4.5 ± 3.5° for inclination and anteversion, respectively. Significant differences were observed between groups. The average measurement error of the portable INS group was 2.5 ± 1.9° and 2.7 ± 2.2° for inclination and anteversion, respectively. The measurement error for inclination significantly correlated with the leg length discrepancy. Cup positioning with the Navbit Sprint was significantly more accurate than the manual method during THA using the same cup in the anterolateral supine position. However, a significant leg length discrepancy could negatively impact the accuracy of cup positioning inclination.

This study evaluates the survivorship and clinical outcomes of revision total hip arthroplasty (THA) to treat symptomatic leg length discrepancy (LLD) via limb shortening. A total of ten patients were included who underwent revision THA to treat LLD via limb shortening at a single arthroplasty center from January 1, 2000, to December 31, 2022, representing 0.4% (ten of 2763) of all revision THA during this period. Among these cases, six of ten (60.0%) were men, mean age at index surgery was 62years (range, 39 to 81), and mean follow-up was 7.63years (range, 3.51 to 15.73). Kaplan-Meier survivorship analysis was conducted with failure defined as revision surgery for any reason. Kaplan-Meier survivorship for failure due to any cause was 100.0% at five years, with nine hips at risk and 80.0% at ten and 15years with one hip at risk. One patient failed due to dislocation. The mean LLD significantly improved from a pre-operative value of 24.5mm (SD 7.25) to a post-operative value of 1.25mm (SD 3.17) (P < 0.001). There was a significant increase in Harris hip scores from 50.44 (SD 11.11) pre-operatively to 75.4 (SD 19.35) at one year (P = 0.0172) and 84.6 (SD 12.44) at three years post-operatively (P = 0.011). Revision total hip arthroplasty to treat LLD via limb shortening provides favourable 5- to 10-year survivorship and clinical outcomes.

The treatment of leg length discrepancies, bone defects and deformities is highly complex. Distraction osteogenesis (callus distraction) is often used for this purpose. Nowadays, the previously used external fixators have increasingly been replaced by intramedullary, fully implantable motorized systems. These are used in combination with innovative planning methods and minimally invasive surgical techniques. This enables reliable and safe treatment with improved patient comfort. In contrast to external fixation, particularly modern external hexapod systems, intramedullary devices once implanted fix the bone fragments in both axial alignment and rotation. Thus,meticulous analysis and planning as well as exact intraoperative execution, are essential for successful treatment outcomes. This article summarizes the relevant intramedullary techniques and indications as well as the practical implementation, taking the current publishedevidence into account.

The aim of the investigators was to conduct a kinematic analysis of the crossover block stepping technique in elite female volleyball players based on acceleration and time data from each phase, and to compare the performances of players in different positions. The secondary aim of this study was to conduct a correlation analysis between the anthropometric and explosive strength characteristics of the participants and their crossover block stepping performance. Twenty-nine elite female volleyball players (20±4.4 years; 1.80±0.07 m; 68.7±7.84 kg) participated in this study. Athletes were divided into two groups according to their playing positions as middle blockers (MB; N.=8) and wing players (WP; N.=21). WPs included setters, opposite and outside hitters. In addition, each playing position was analyzed separately. Players were significantly faster toward the left direction compared to the right during the total movement. The highest rate of force development was observed during Phase 3 in both directions. MBs exhibited higher mean acceleration in both directions during all phases compared to WPs. Both countermovement jump (CMJ) and squat jump (SJ) had weak-to-moderate correlations with Phase 1 acceleration toward the left (r: 0.30-0.32). Height (r: 0.36-0.46) and leg length (r: 0.38-0.55) were moderately correlated with mean acceleration during the overall movement in each direction. Strength and conditioning coaches may utilize exercises aimed at improving triple extension performance to enhance push-off during the initiation of the crossover step. Taller players with longer legs have an advantage in crossover block stepping.

Direct anterior approach for total hip arthroplasty with patients in the lateral decubitus vs supine position: A systematic review and meta-analysis.

Walking locomotion in Triatoma infestans: An approach that explores the relationships between leg morphometry and locomotor activity.

Total hip arthroplasty (THA) presents unique technical challenges in patients who have morbid obesity, and benefits of imageless navigation in this population remain unclear. This study compared complications, thromboembolic events, and emergency department utilization between imageless navigation-assisted and manual THA in patients who have morbid obesity. A retrospective cohort study was performed using the PearlDiver database. Patients who have morbid obesity (BMI ≥ 40) undergoing elective primary THA between 2010 and 2021 were identified. Cases performed with robotic assistance or image-based navigation were excluded. Patients were stratified by intraoperative technique into manual and imageless navigation cohorts and matched 1:3 on age, sex, year of procedure, and comorbidities. Surgical complications, thromboembolic events, revision procedures, and emergency department visits were evaluated at multiple postoperative time points and compared using univariable regression. After matching, 4,499 patients who have morbid obesity were included, comprising 3,367 manual (74.8%) and 1,132 imageless navigation (25.2%) cases. No significant differences were observed between cohorts in rates of surgical complications, including infection, dislocation, periprosthetic fracture, mechanical loosening, chronic pain, or leg length discrepancy at any evaluated time point (P > 0.05). Thromboembolic events were uncommon and did not differ between groups at 30 or 90days. Emergency department visits and revision rates were also similar at all time points. Among patients who have morbid obesity undergoing primary THA, imageless navigation was not associated with improved outcomes compared with manual techniques, suggesting postoperative risk is driven primarily by obesity-related factors. Surgeons should weigh resource utilization and patient characteristics when selecting operative technique.