Background: The aim of this study was to evaluate the precision and feasibility of patient-specific instruments (PSI) in total hip arthroplasty (THA) as compared to the traditional free-hand (FRH) approach. Methods: During the period of January 1, 2021 to December 31, 2022, a randomized allocation was used for patients receiving unilateral primary THA to either the PSI or conventional operation group. The placement and size of the PSI were specifically chosen to guide femoral neck resection and prosthesis implantation. The study analyzed component positions and evaluated radiographic and clinical outcomes in 30 patients who received PSI-assisted THAs and 30 patients who received FRH THAs. This study was registered at China Clinical Trial Registry (number: ChiCTR2300072325) on June 9th, 2023. Results: The use of PSI in THA resulted in significantly higher precision in achieving the desired component position as compared to the FRH approach. The PSI group showed significantly smaller absolute errors of femoral anteversion (p < 0.001). No significant differences were found in operation time, intra-operative blood loss, hospitalization duration, or time to walk after surgery. Conclusion: In conclusion, the application of patient-specific instruments in THA provides a simple and reliable solution to enhance the precision of femoral prosthesis placement with high accuracy and feasibility. This study highlights the potential benefits of using the PSI in THA.

Background: The shared genetic etiology underlying the comorbidity of skeletal degeneration and metabolic dysregulation remains poorly understood. This study aims to decipher the pleiotropic genetic architecture of multivariate metabolic bone diseases (mvMBDs) through an integrative summary-statistics framework. Methods: We applied Genomic Structural Equation Modeling (Genomic SEM) to integrate genome-wide association study (GWAS) summary statistics for six complex traits: osteoporosis (OP), chronic kidney disease (CKD), type 2 diabetes (T2D), alkaline phosphatase (ALP), high-density lipoprotein (HDL), and C-reactive protein (CRP). Subsequent analyses incorporated robust fine-mapping (SuSiE/FINEMAP), transcriptome-wide association studies (TWAS), and partitioned heritability assessments to identify putative functional loci and regulatory mechanisms. Results: Genomic SEM revealed significant genetic covariance among the six traits, successfully deriving a latent mvMBD construct. We identified 197 genomic risk loci, including 193 lead SNPs that did not achieve genome-wide significance in the six constituent univariate GWAS, predominantly localized in non-coding cis-regulatory elements (e.g., super-enhancers and intronic regions). Fine-mapping and TWAS prioritized critical pleiotropic genes (e.g., MACF1 , CETP , SPP1 , and HNF1A ). Gene-set enrichment analyses identified enrichment for terms related to bone biology, lipid metabolism, and inflammation. Conclusion: Our findings robustly demonstrate that mvMBDs are not isolated clinical entities but rather interconnected systemic syndromes underpinned by glycolipid metabolic dysregulation and shared pleiotropic regulatory networks. This study establishes a novel theoretical paradigm for the genetic basis of metabolic bone diseases, offering promising functional targets for future precision medicine interventions.