Bacterial infection and infection-induced immune response have been a life-threatening risk for patients having orthopedic implant surgeries. Conventional biomaterials are vulnerable to biocontamination, which causes bacterial invasion in wounded areas, leading to postoperative infection. Therefore, development of anti-infection and immune-evasive coating for orthopedic implants is urgently needed. Here, we developed an advanced surface modification technique for orthopedic implants termed lubricated orthopedic implant surface (LOIS), which was inspired by slippery surface of Nepenthes pitcher plant. LOIS presents a long-lasting, extreme liquid repellency against diverse liquids and biosubstances including cells, proteins, calcium, and bacteria. In addition, we confirmed mechanical durability against scratches and fixation force by simulating inevitable damages during surgical procedure ex vivo. The antibiofouling and anti-infection capability of LOIS were thoroughly investigated using an osteomyelitis femoral fracture model of rabbits. We envision that the LOIS with antibiofouling properties and mechanical durability is a step forward in infection-free orthopedic surgeries.

Hip joint ultrasonographic (US) imaging is the golden standard for developmental dysplasia of the hip (DDH) screening. However, the effectiveness of this technique is subject to interoperator and intraobserver variability. Thus, a multi-detection deep learning artificial intelligence (AI)-based computer-aided diagnosis (CAD) system was developed and evaluated. The deep learning model used a two-stage training process to segment the four key anatomical structures and extract their respective key points. In addition, the check angle of the ilium body balancing level was set to evaluate the system’s cognitive ability. Hence, only images with visible key anatomical points and a check angle within ±5° were used in the analysis. Of the original 921 images, 320 (34.7%) were deemed appropriate for screening by both the system and human observer. Moderate agreement (80.9%) was seen in the check angles of the appropriate group (Cohen’s κ = 0.525). Similarly, there was excellent agreement in the intraclass correlation coefficient (ICC) value between the measurers of the alpha angle (ICC = 0.764) and a good agreement in beta angle (ICC = 0.743). The developed system performed similarly to experienced medical experts; thus, it could further aid the effectiveness and speed of DDH diagnosis.

Hip fracture in elderly patients is a serious health concern due to the associated morbidity and mortality. Although acute kidney injury after hip fracture is known to be a significantly poor prognostic factor for morbidity and mortality, the literature regarding the risk factors for acute kidney injury after hip fracture is insufficient. This study aimed to investigate the incidence and associated risk factors for acute kidney injury in patients with femoral neck fracture. A total of 248 patients who underwent an operation for femoral neck fracture between January 2011 and January 2015 were retrospectively analyzed. Acute kidney injury was defined according to the Kidney Disease: Improving Global Outcomes guidelines. The incidence of acute kidney injury was 17.7% (n = 44). Risk factors for acute kidney injury included diabetes mellitus, pre-existing renal disease, preoperative blood urea nitrogen (BUN), preoperative estimated glomerular filtration rate (eGFR), preoperative haemoglobin (Hb) level, type of operation, postoperative creatinine level and intraoperative hypotension (P < 0.05). After controlling for confounding variables, intraoperative hypotension was only the independent risk factor for acute kidney injury (P = 0.012). Acute kidney injury was found to occur frequently after surgery for femur neck fracture. Surgeons should be aware of acute kidney injury when planning the management of patients with femoral neck fracture and consider that the duration of intraoperative hypotension is a risk factor for acute kidney injury.