Field Of Orthopedics Research Articles

Evolution in the Use of Statistical Testing in the Field of Orthopedics From 1993 to 2023

Evolution in the Use of Statistical Testing in the Field of Orthopedics From 1993 to 2023

Organic-Inorganic Biocompatible Coatings for Temporary and Permanent Metal Implants

The general trend of increasing life expectancy will consistently drive the demand for orthopedic prostheses. In addition to the elderly, the younger population is also in urgent need of orthopedic devices, as bone fractures are a relatively common injury type; it is important to treat the patient quickly, painlessly, and eliminate further health complications. In the field of traumatology and orthopedics, metals and their alloys are currently the most commonly used materials. In this context, numerous scientists are engaged in the search for new implant materials and coatings. Among the various coating techniques, plasma electrolytic oxidation (PEO) (or micro-arc oxidation—MAO) occupy a distinct position. This method offers a cost-effective and environmentally friendly approach to modification of metal surfaces. PEO can effectively form porous, corrosion-resistant, and bioactive coatings on light alloys. The porous oxide surface structure welcomes organic molecules that can significantly enhance the corrosion resistance of the implant and improve the biological response of the body. The review considers the most crucial aspects of new combined PEO-organic coatings on metal implants, in terms of their potential for implantation, corrosion resistance, and biological activity in vitro and in vivo.

Developing high elongation of Ca-containing Zn alloys with superior osteogenic and antibacterial properties

The development of high-strength zinc (Zn) alloys significantly contributes to the field of orthopedics by enhancing their osteogenic properties. Calcium (Ca) is pivotal for bone composition; however, its incorporation into the Zn matrix often hampers elongation due to the formation of large-sized CaZn13 phases. In this study, two Zn alloys with different Ca contents were prepared, and their microstructures, mechanical properties, corrosion behavior and biocompatibility were investigated. Results indicate that the Zn alloy with high Ca content exhibits large-sized and high-volume-fraction CaZn13 phases, which do not significantly change during equal channel angular pressing (ECAP). The grain sizes of ECAPed Zn alloys decreased from 36.75 μm and 35.81 μm of as-cast state to 4.32 μm and 1.71 μm, respectively. Refined microstructures contributed to the improvement of mechanical properties of Zn alloys, which have elongation over 15 % higher than that of all Zn-Mg-Ca alloys reported so far. The high elongation of Zn alloys originates from the inhibition of the propagation of microcracks which generated from the Zn/CaZn13 interphase. Moreover, the formation of large-sized CaZn13 phases leads to the severe local corrosion through enhancing galvanic effect, finally increasing corrosion rate. During degradation, the release of metallic ions, such as Zn2+, Mg2+, and Ca2+, are beneficial to the cell viability and osteogenic properties. And the accelerated release of Zn2+ plays a role in antibacterial performance. These results are very helpful for promoting the application of biodegradable Zn alloys in the field of orthopedics.

TiO2 nanotube enhance osteogenesis through Kindlin-2/Integrin β1/YAP pathway-mediated mechanotransduction

Titanium has been widely employed in the fields of orthopaedics and dentistry, attributed to its superior mechanical and biological properties. The mechanical stimulation induced by the titanium dioxide (TiO2) nanotubes (TNTs) morphology resulting from surface modification has been demonstrated to enhance the osteogenic differentiation of bone marrow-derived mesenchymal stem cells (BMSCs). Kindlin-2, a pivotal focal adhesion protein, is involved in mechanical signaling processes through the regulation of stress fibril filament assembly. Additional research is needed to clarify the involvement of Kindlin-2 in the mechanism of TNTs-induced osteogenic differentiation. This study systematically investigated the impact of Kindlin-2 on TNTs-induced osteogenesis and mechanotransduction. TiO2 nanotubes with diameters of approximately 30 nm (TNT-30) and 100 nm (TNT-100) were fabricated and characterized using anodic oxidation. The results showed that TNT-100 significantly increased the expression of Kindlin-2 and enhanced osteogenic differentiation compared to polished titanium (PT) and TNT-30. Additionally, Kindlin-2 promotes cytoskeleton assembly by regulating the integrin β1/FAK/RhoA signaling pathway, impacting osteogenic gene expression and BMSC differentiation in a Yes-Associated Protein (YAP)-dependent manner. Therefore, these findings contribute to a more comprehensive understanding of the fate of BMSCs on TNTs morphologies and provide a novel theoretical foundation for the development of advanced bone repair biomaterials.

Enhancing Orthopedic Knowledge Assessments: The Performance of Specialized Generative Language Model Optimization.

This study aimed to evaluate and compare the effectiveness of knowledge base-optimized and unoptimized large language models (LLMs) in the field of orthopedics to explore optimization strategies for the application of LLMs in specific fields. This research constructed a specialized knowledge base using clinical guidelines from the American Academy of Orthopaedic Surgeons (AAOS) and authoritative orthopedic publications. A total of 30 orthopedic-related questions covering aspects such as anatomical knowledge, disease diagnosis, fracture classification, treatment options, and surgical techniques were input into both the knowledge base-optimized and unoptimized versions of the GPT-4, ChatGLM, and Spark LLM, with their generated responses recorded. The overall quality, accuracy, and comprehensiveness of these responses were evaluated by 3 experienced orthopedic surgeons. Compared with their unoptimized LLMs, the optimized version of GPT-4 showed improvements of 15.3% in overall quality, 12.5% in accuracy, and 12.8% in comprehensiveness; ChatGLM showed improvements of 24.8%, 16.1%, and 19.6%, respectively; and Spark LLM showed improvements of 6.5%, 14.5%, and 24.7%, respectively. The optimization of knowledge bases significantly enhances the quality, accuracy, and comprehensiveness of the responses provided by the 3 models in the orthopedic field. Therefore, knowledge base optimization is an effective method for improving the performance of LLMs in specific fields.

Enhanced wear resistance of in-situ nanoscale TiC reinforced Ti composites fabricated by additive manufacturing

The poor wear resistance of Ti alloys limits its application in the orthopedic and dental surgery field. TiC as an ideal reinforcement phase can improve wear resistance due to its high hardness, low coefficient of friction, and good bio-compatibility. However, the wettability of the interface between the TiC and Ti matrix is poor, which leads to low mechanical properties and wear resistance. In situ TiC formed through the addition of a C source can enhance interfacial bonding. In this work, the Ti-graphite composites are prepared by Laser powder bed fusion (LPBF). On the one hand, the LPBF can prepare various complex porous shapes according to the personalized customized demand. On the other hand, the LPBF can provide a high cooling rate, suppressing grain growth and refining grains, and also can obtain equally distributed nanoscale TiC particles. The results show that the composites are mainly composed of Ti, TiC, and residual graphite. With the increase of graphite content, the amount of TiC increases and the grain becomes smaller, and the microhardness increases from 317 HV0.2 to 408 HV0.2. Meanwhile, the Ti-1.5 wt%Gr composite has a low friction coefficient, volume of wear, and wear rate, which is attributed to the high hardness of TiC particles and lubrication of graphite. The oxide on the surface of the wear mark is mainly composed of TiO2 and TiO. The main wear mechanisms of the composites are oxidation wear and adhesive wear.

Trace element selenium–augmented Kirschner wire with enhanced osteogenetic and antibacterial properties

The Kirschner wire (K-wire) is widely used in orthopedic external fixation due to its versatility and clinical effectiveness. However, a significant challenge associated with its use is the potential for bacterial migration, subsequent infection, and dislodgement as the wire penetrates the skin and bone. This study introduces a novel bioactive material, selenium/calcium silicate (Se/β-CS), achieved by integrating selenium—an essential trace element in the human body—into bioceramic calcium silicate. This integration was accomplished using a combined chemical co-deposition method and redox reaction. Furthermore, a uniform and controllable Se/β-CS coating was applied to the K-wire's surface using the Langmuir-Blodgett technique. This coating gradually releases active components—Si, Ca, and Se—that effectively eliminate bacterial infections and promote osteointegration. The findings of this study offer promising opportunities for the use of robust and multifunctional coating materials on implantable devices, particularly within the fields of orthopedics, transplantation, and surgery.

Periprosthetic acetabular fractures: classifications, treatment and challenges

Periprosthetic acetabular fractures (PPAF) are fractures of the acetabulum with ahip endoprosthesis in place. They are arare complication, although they are occurring more frequently due to the increase in patients being fitted with total hip arthroplasty (THA) and the long service life of the implants. At present, only asmall amount of scientific literature exists, particularly regarding the surgical treatment of these fracture types.The aim of this paper is to provide an overview of the topic of PPAF with acritical review of the current literature and to present the necessary surgical treatment.An evaluation of the current literature on the topic of PPAF with afocus on the surgical treatment of fractures is carried out.Surgical treatment is technically demanding due to the pelvic ring instability with removal of the bone tension for secure acetabular cup fixation and should lead to the recovery of the biomechanical stability of the pelvis and thus the secure anchoring of the acetabular cup. An interdisciplinary approach requiring both trauma surgery and orthopaedic expertise is certainly recommended, as older and comorbid patients with poor bone quality are particularly frequently affected.The treatment of periprosthetic acetabular fractures, especially in older patients, requires not only the individual expertise of surgeon involved in the operation but also agoal-oriented and consistent interdisciplinary approach by the surgeons involved from the fields of orthopaedics and trauma surgery in view of the patients' frequent comorbidities. By working together, the optimal and individualized operation can be performed for the patient.

Academic impact of French Hip & Knee Surgery Society (SFHG): A bibliometric analysis

IntroductionThe French Hip & Knee Surgery Society (SFHG) brings together French-speaking hip and knee expert surgeons. There has been an exponential growth of orthopaedic surgical activity over the last decade and hip and knee surgery clinical research has had a similar growth. Despite this, the SFHG's contribution to the orthopaedic literature remains poorly known. To answer this question, we conducted a bibliometric study using data from the national SIGAPS database between 2013 and 2022 to determine: (1) the number of publications produced by SFHG members, (2) the proportion of articles produced by SFHG members in relation to French orthopaedic production, (3) impact markers for articles produced by SFHG member surgeons, (4) collaboration networks between SFHG member surgeons. HypothesisThe number of articles produced by SFHG member surgeons will represent a significant proportion of French scientific output in orthopaedics. Material and methodThe analysis was carried out by cross-referencing the SFHG membership list with the French database of the “Système d'interrogation, de gestion, d'analyse des publications scientifiques” (SIGAPS) and the InCites platform. Among the 189 SFHG members, we identified a list of 183 SIGAPS identifiers in the national database, corresponding to 127 distinct individuals with publications over the period 2013–2022. Several indicators were studied: number of publications; SIGAPS score for the different WoS categories; number and percentage of publications in the top1% and top10%. ResultsOf SFHG's 189 members, 127 have been identified by the SIGAPS database as “publishers”. Over the last decade, 2306 articles have been published by SFHG members. The number of publications has risen steadily, from 203 publications in 2013 to 261 publications in 2022. All SIGAPS categories were represented. Most articles were published in rank D (n = 719; 31.2%) C (n = 552; 23.9%) and B (n = 549; 23.8%) journals. Authors were in first (n = 624) or last position (n = 730) in 58.7% of publications. Orthopaedics (1,639; 71.1%), Surgery (1,124; 48.7%) and Sports surgery (335; 14.5%) were the most frequently observed topics. Orthopaedics & Traumatology: Surgery & Research is the most popular journal for SFHG members' articles, with 655/2306 articles published over the last decade, representing a 32.2% market share. Of the 2160 publications indexed on the Web of Science, 1807 (83.7%) had a French corresponding author. 31 articles (1.4%) were in the Top 1% of most-cited articles worldwide, and 310 were in the Top 10% of most-cited articles worldwide (14.5%). DiscussionSFHG is a major player in orthopaedic research in France. In 2022, it accounted for 19% of the annual volume of French scientific publications in the field of orthopaedics and traumatology. Level of evidenceIV; Retrospective study without control group.

Volumetric Classification: Unveiling the True Extent of Rotator Cuff Tears

Rotator cuff injury diagnosis involves comprehensive clinical, physical, and imaging assessments, with MRI being pivotal for detecting and classifying these injuries. However, the absence of a universally accepted classification system necessitates a more precise approach, advocating for the use of three-dimensional (3D) modeling to better understand and categorize rotator cuff tears. This research was conducted as a prospective, single-institution study on 62 patients exhibiting full-thickness rotator cuff tears. Utilizing preoperative 1.5T MRI, the study aimed to create a more detailed classification system based on volumetric and surface area measurements. Advanced 3D modeling software was employed to transform MRI data into precise 3D representations, facilitating a more accurate analysis of the lesions. The study unveiled a novel classification system rooted in volumetric and surface area assessments, revealing significant discrepancies in the existing two-dimensional classifications. Approximately 45% of the cases demonstrated inconsistencies between traditional classifications and 3D measurements. Notably, medium-sized lesions were often overestimated, while small and large lesions were consistently underestimated in their severity. The volumetric and surface area-based classifications provided a more accurate depiction, highlighting the limitations of relying solely on coronal plane assessments in MRI. Comparative analysis confirmed the improved accuracy of the 3D method. The integration of 3D imaging and volumetric analysis offers novel advancement in diagnosing and classifying rotator cuff injuries. This study's findings challenge the conventional reliance on 2D MRI, proposing a more detailed and accurate classification system that enhances the precision of surgical planning and potentially improves patient outcomes. The incorporation of comprehensive 3D assessments into the diagnostic process represents a significant step forward in the orthopedic imaging field.

Higher Grit Scores Are Associated With Greater Scholarly Productivity Among Orthopaedic Surgery Residents

Introduction: Scholarly research is a core component of resident education, designed to advance the orthopaedic field while facilitating an evidence-based approach to patient care. Grit, defined as trait-level perseverance, has been shown in prior studies to predict clinical performance, burnout rates, and residency match rates. No previous study has investigated the relationship between grit and research productivity. Study Description: This study is a cross-sectional survey of orthopaedic surgery residents from the American Academy of Orthopaedic Surgeons. Residents were assessed via online survey of scholarly productivity and the 12-item grit scale. Methods: Surveys distributed to the Academy of Orthopaedic Surgeons residents assessed the number of peer-reviewed publications, presentations, first author publications, book chapters, and articles. Respondents were also evaluated through the 12-item grit scale, with scores ranging from 1 (minimum grit) to 5 (maximum grit). Residents were divided into low (score ≤3.4), medium (score: 3.5 to 3.9), and high grit (score ≥4.0) cohorts. Analysis of variance analysis compared the cohorts regarding the scholarly productivity metrics. Linear regression models analyzed grit score as a continuous variable. Findings were statistically significant at P < 0.05. Results: The mean grit score was 3.8. The high grit cohort was more likely to have increased publications, presentations, articles, and first authorship (P < 0.0001). Analyzed as a continuous variable, increased grit positively correlated with increased publications, presentations, articles, first authorship, and book chapters (P < 0.0001). Conclusions: The results suggest that higher grit scores are associated with scholarly productivity.

Trends in the Use of Weightbearing Computed Tomography.

Background: This review aimed to critically appraise the most recent orthopedic literature around cone beam weightbearing computed tomography (WBCT), summarizing what evidence has been provided so far and identifying the main research trends in the area. Methods: This scoping review was performed on studies published between January 2013 and December 2023 on the Pubmed database. All studies (both clinical and nonclinical) in which WBCT had been used were critically analyzed to extract the aim (or aims) of the study, and the main findings related to the role of this imaging modality in the diagnostic pathway. Results: Out of 1759 studies, 129 were selected. One hundred five manuscripts (81%) dealt with elective orthopedic conditions. The majority of the analyses (88 studies; 84%) were performed on foot and ankle conditions, while 13 (12%) studies looked at knee pathologies. There was a progressive increase in the number of studies published over the years. Progressive Collapsing Foot Deformity (22 studies; 25%) and Hallux Valgus (19 studies; 21%) were frequent subjects. Twenty-four (19%) manuscripts dealt with traumatic conditions. A particular interest in syndesmotic injuries was documented (12 studies; 60%). Conclusions: In this review, we documented an increasing interest in clinical applications of weightbearing CT in the orthopedic field between 2013 and 2023. The majority of the analyses focused on conditions related to the foot and the ankle; however, we found several works investigating the value of WBCT on other joints (in particular, the knee).

Conservative nonsurgical knowledge of German orthopedic and trauma surgeons-Present state of affairs.

After the fusion of the fields of orthopedics and trauma surgery in 2006 the educational content significantly increased. The acquisition of non-surgical diagnostic and treatment skills seems to fall behind in the classical operatively focused residency programs. This study presents astatus quo of the non-surgical education and knowledge in the field of orthopedics and traumatology in Germany. An online-based voluntary and anonymous questionnaire was conducted between June and August 2023. The questionnaire was distributed through the email lists of the German Society for Orthopedics and Traumatology (DGOU) and the German Professional Association for Orthopedics and Traumatology (BVOU). Atotal of 486 German orthopedic and trauma surgeons answered the online questionnaire (77.9% male; mean age50.2 ± 11.8 years) and 11.5% were residents. Only 27.1% spent part of the residency training in the outpatient sector. In total 84.2% wish for an increased focus on non-operative treatment options during further education, 81.1% agreed that they have agood general understanding of non-operative treatment options and 81.0% felt confident to apply them in the daily clinical routine (residents 35.4% and 41.7%, respectively). The highest self-assessed competences were knowledge on the application of splints and casts and physiotherapy, ergotherapy and sports therapy, the lowest were knowledge on acupuncture, magnetic field therapy and nutritional aspects after trauma. In total, 77.7% stated non-surgical research projects are not supported at their institution. Orthopedic and trauma surgeons in Germany subjectively have solid knowledge on treatment options while resident physicians still need to strengthen their skills. Rotation into the outpatient sector and rehabilitation facilities as well as supporting research in the field could further improve the non-surgical skills.

The role of collagen in joint disorders: Applications in orthopedics, rheumatology, and sports medicine

Joint diseases are prevalent in orthopedic, rheumatological, and sports medicine fields, significantly impacting patients' quality of life. Collagen, a primary component of connective tissues, has emerged as a therapeutic agent for these conditions. This article explores the applications of collagen in joint diseases, comparing oral and intra-articular administration, evaluating optimal dosages, assessing single versus long-term therapies, discussing side effects, and examining the benefits of hydrolyzed versus non-hydrolyzed collagen. Additionally, explore various sources of collagen and their respective advantages for patient care.

Achieving Health Equity: Combatting the Disparities in American Access to Musculoskeletal Care : Disparities Exist in Every Aspect of Orthopaedic Care in the United States - Access to Outpatient Visits, Discretionary and Unplanned Surgical Care, and Postoperative Outcomes. What Can We Do?

Healthcare disparities influence multiple dimensions of orthopaedic care including access, burden and incidence of disease, and outcome in varying populations. These disparities impact healthcare at both the micro and macro scale of the healthcare experience from individual patient-physician relationships to reimbursement rates across the United States. This article provides a review of how healthcare disparities contribute to the landscape of orthopaedic care and specifically highlights how disparities affect outpatient visits, discretionary and unplanned surgical care, and postoperative outcomes. Current research demonstrates the widespread presence of healthcare disparities in the field of orthopaedics and gives both objective and subjective evidence confirming disparities' measurable influence. The disparities most highlighted by our review include differences in orthopaedic care based on insurance type and race. Currently disparities in orthopaedic care are deeply connected to patient insurance status and race. In the outpatient setting insurance significantly impacts access to care, travel burden, and utilization of services. The emergent setting is similarly influenced with measurable differences in lack of access to acute care, rates of inappropriate triage, and timeliness of care based on insurance status and race. Additionally, the postoperative period is not immune to disparities with likelihood of follow up, experience of catastrophic medical expenses, and postoperative outcomes also being affected. Addressing these disparities is a pressing need and may include solutions like wider expansion and acceptance of publicly funded insurance and the development of readily available and easily measurable metrics for healthcare equity and quality in vulnerable populations.

Return to activity and return to sports after total knee replacement

Total knee arthroplasty (TKA) is one of the most common and successful operations in the field of orthopaedics, with asteadily increasing number of patients. However, as the patient population becomes younger, expectations regarding the outcome of the surgery are also changing. In addition to pain reduction and improved mobility, the longevity of the implant and the recovery of (everyday) activity in general (return-to-activity, RtA) and sporting activity in particular (return-to-sports, RtS) are becoming increasingly important. RtS with atendency towards low-impact sports seems generally possible but is highly dependent on the individual characteristics of the patient. Despite comprehensive studies on treatment with TKA, there are no systematic studies and reliable conclusions on the key factors that enable patients to return to sports after TKA. Any recommendation by the responsible surgeons remains dependent on their subjective experience due to the lack of standardized implementation of an RtA/RtS assessment and the necessary long-term follow-up observation under control of patient-related confounding factors.

3D-printed porous polyether-ether-ketone composite scaffolds for better osteogenic activity

Due to excellent biocompatibility and favorable mechanical properties, polyether-ether-ketone (PEEK) scaffolds are becoming the next-generational orthopaedic implants, but the bioinertness limits their application. In this study, to improve the osteogenic activity of PEEK scaffolds, porous composite scaffolds containing PEEK and biphasic calcium phosphate (BCP) were achieved by 3D printing, which exhibited equilateral triangular profile with the porosity of 69.4 ± 6.3 % and elastic modulus of 186.2 ± 10.9 MPa. The EDS mapping images and XPS spectra indicated increased P and Ca elements in PEEK-BCP scaffolds. The results of in vitro and in vivo evaluations demonstrated that the introduction of BCP significantly increased the osteogenic capacity of PEEK scaffolds and the obvious bone ingrowth could be observed. In conclusion, compared with pure PEEK scaffolds, PEEK-BCP scaffolds with better osteogenic activity are more promising in the orthopaedic and craniofacial field.

High-Precision Implant Cavity Fabrication Using Femtosecond Lasers.

Objective: This study aims to enhance the precision of implant cavity preparation, addressing a notable challenge in the current state of the field by utilizing femtosecond lasers. Background: The application of femtosecond lasers in implant cavity preparation heralds a noninvasive and efficient technique, characterized by diminished thermal damage and high biocompatibility. Despite these promising attributes, the realization of precise cavity preparation remains a significant challenge in the contemporary domain. Materials and Methods: Our research group devised a specialized femtosecond laser microsurgery robotic system tailored for sophisticated implant cavity preparation. This system facilitated the meticulous analysis of sheep shank bone samples, enabling precise three-dimensional cutting. The analysis included an extensive examination of ablation effects, using a laser scanning microscope and VK Analyzer software. This investigation spanned the phases of laser flux calibration and experimental validation, offering a critical evaluation of the automated preparation process. Results: The study delineated that at the focus position of our custom-made oral clinical femtosecond laser microsurgery robotic system, the laser spot diameter is 75.69 μm, and ascertained the ablation threshold for sheep shank cortical bone to be 1.47 J/cm2. Utilizing low laser flux with minimal ablation craters overlap compromised the sidewall precision of the implant cavity, whereas employing high laser flux with extensive ablation craters overlap resulted in an enlarged ablation angle. At a laser energy setting of 2.2362 J/cm2 and a 50% ablation crater overlap, an implant cavity was successfully crafted featuring a top diameter of 4.41 mm, a bottom diameter of 3.98 mm, and a depth of 3 mm, devoid of any adverse thermal effects such as cracking or carbonization. Conclusions: The oral clinical femtosecond laser microsurgery robotic system can achieve automated and precise implant cavity preparation. This advancement promotes the broader application of femtosecond lasers in the field of orthopedics.

Utility of Machine Learning, Natural Language Processing, and Artificial Intelligence in Predicting Hospital Readmissions After Orthopaedic Surgery: A Systematic Review and Meta-Analysis.

Numerous applications and strategies have been utilized to help assess the trends and patterns of readmissions after orthopaedic surgery in an attempt to extrapolate possible risk factors and causative agents. The aim of this work is to systematically summarize the available literature on the extent to which natural language processing, machine learning, and artificial intelligence (AI) can help improve the predictability of hospital readmissions after orthopaedic and spine surgeries. This is a systematic review and meta-analysis. PubMed, Embase and Google Scholar were searched, up until August 30, 2023, for studies that explore the use of AI, natural language processing, and machine learning tools for the prediction of readmission rates after orthopedic procedures. Data regarding surgery type, patient population, readmission outcomes, advanced models utilized, comparison methods, predictor sets, the inclusion of perioperative predictors, validation method, size of training and testing sample, accuracy, and receiver operating characteristics (C-statistic), among other factors, were extracted and assessed. A total of 26 studies were included in our final dataset. The overall summary C-statistic showed a mean of 0.71 across all models, indicating a reasonable level of predictiveness. A total of 15 articles (57%) were attributed to the spine, making it the most commonly explored orthopaedic field in our study. When comparing accuracy of prediction models between different fields, models predicting readmissions after hip/knee arthroplasty procedures had a higher prediction accuracy (mean C-statistic = 0.79) than spine (mean C-statistic = 0.7) and shoulder (mean C-statistic = 0.67). In addition, models that used single institution data, and those that included intraoperative and/or postoperative outcomes, had a higher mean C-statistic than those utilizing other data sources, and that include only preoperative predictors. According to the Prediction model Risk of Bias Assessment Tool, the majority of the articles in our study had a high risk of bias. AI tools perform reasonably well in predicting readmissions after orthopaedic procedures. Future work should focus on standardizing study methodologies and designs, and improving the data analysis process, in an attempt to produce more reliable and tangible results. Level III. See Instructions for Authors for a complete description of levels of evidence.

Enhancing Bioactivity and Mechanical Properties of Nano-Hydroxyapatite Derived from Oyster Shells through Hydrothermal Synthesis.

Nano-hydroxyapatite (nHA) demonstrates favorable biological activity, cell adhesion, cell proliferation, and osteoconductivity, making it highly valuable in biomedicine. It is extensively used as a bone substitute and in bone transplantation within the dental and orthopedic fields. This study employed oyster shells as a calcium source to synthesize nHA at 150 °C with various hydrothermal reaction durations (10 min, 1 h, 6 h, and 12 h). As a control, HA synthesized via a wet precipitation method for 1 h at room temperature was utilized. Subsequent material analyses, including XRD, FE-SEM, FTIR, and ICP-MS, were conducted, followed by comprehensive evaluations of the bioactivity, cell attachment, cell proliferation, and sintering properties of the synthesized nHA. The results indicated that nHA synthesized through the hydrothermal reaction produced nanoscale crystals, with the aspect ratio of nHA particles increasing with the duration of hydrothermal treatment. Notably, rod-like nHA particles became prominent with hydrothermal durations exceeding 6 h. nHA particles derived from oyster shells contained carbonate and trace elements (Na, Mg, K, and Sr), similar to constituents found in human hard tissue such as bone and teeth. The immersion of nHA synthesized at 150 °C for 1 h (HT2) in simulated body fluid (SBF) for 28 d led to the formation of a bone-like apatite layer on the surface, indicating the excellent bioactivity of the synthesized nHA. The cell culture results revealed superior cell attachment and proliferation for nHA (HT2). Following the sequential formation and sintering at 1200 °C for 4 h, HT2 ceramics exhibited enhanced microhardness (5.65 GPa) and fracture toughness (1.23 MPa·m0.5), surpassing those of human tooth enamel.