Background: The incidence and prevalence of gout have been steadily increasing globally, which has resulted in gout research attracting consistently increased attention. This study aimed to visualize the knowledge structure and research trends in gout research through bibliometrics to help understand the future development of basic and clinical research.Methods: Articles and reviews on gout from 2001 to 2021 were extracted from the Web of Science Core Collection database. CiteSpace and VOSviewer software were used to visualize the knowledge network of countries, institutions, authors, references, and keywords in this field. SPSS and Microsoft Excel software were used for curve fitting and correlation analysis.Results: A total of 3,259 articles and reviews were included. The number of publications about gout significantly increased yearly. Publications were mainly concentrated in North America, Europe, Oceania, and East Asia. The USA contributed most with 1,025 publications, followed by China and New Zealand. After adjusting for publications by population size and Gross Domestic Product (GDP), New Zealand ranked in the first place. GDP and international collaboration were significantly correlated with scientific productivity for gout research. University of Auckland and Professor Dalbeth Nicola were the most prolific institutions and influential authors, respectively. Rheumatology was the most productive journal for gout research. Gout research hotspots have shifted over time in the following order: clinical features, pathological mechanisms, complications, gouty arthritis, epidemiology, and dual-energy computed tomography to drug clinical trials, which can be observed from the keyword analysis and co-cited reference cluster analysis.Conclusions: This study found that research on gout is flourishing. The development and experimentation of drugs for the prevention and treatment of gouty arthritis would be the focus of current research and developmental trends in future research.

This study assessed the application of metagenomic next-generation sequencing in pathogen detection of periprosthetic joint infections. A total of 95 cases who previously had undergone hip and knee replacement undergoing revision from January 2018 to January 2021 were included in this study. Specimens of synovial fluid and deep-tissue were collected for culture and metagenomic next-generation sequencing, and patients were retrospectively categorized as infected or aseptic using the Musculoskeletal Infection Society criteria after revision surgery. The sensitivity, specificity, positive and negative predictive values were compared. A total of 36 cases had positive culture results and 59 cases had positive metagenomic next-generation sequencing results. Culture was positive in 34 infected cases (58.6%) and 2 aseptic cases (5.4%). Metagenomic next-generation sequencing was positive in 55 infected cases (94.8%) and 4 aseptic cases (10.8%). Five cases diagnosed with infection had other potential pathogens detected by metagenomic next-generation sequencing. Among the 24 culture-negative periprosthetic joint infections, metagenomic next-generation sequencing was able to identify potential pathogens in 21 cases (87.5%). From sampling to reporting, the average time needed for culture was 5.2 (95% CI 3.1–7.3) days, while that for metagenomic next-generation sequencing was 1.3 (95% CI 0.9–1.7) days. Metagenomic next-generation sequencing is more advantageous in pathogen detection of periprosthetic joint infection after total joint replacement, especially in patients with multiple infections or negative culture results.

Background. The number of articles of clinical and basic research for osteonecrosis of the femoral head (ONFH) is increasing, yet, to our knowledge, there is still a lack of bibliometric analysis on ONFH articles. The purpose of this study was to identify the top 100 cited (T100) articles related to ONFH research and to analyze the characteristics and qualities of these articles. Methods. The T100 articles on ONFH were retrieved from the Web of Science database. The information about each article including citations, titles, authors, journals, countries, institutions, and keywords was recorded for bibliometric analysis. Results. The T100 articles related to ONFH were mainly published from 1991 to 2010 (n = 70) and were originated from 24 countries. The USA, China, and Japan were the most productive countries in this regard. The most prolific institution was the University of Pennsylvania from the USA with 6 publications and 742 citations. The most cited article was published in 1995 by Professor Steinberg ME. The five most frequently occurring keywords were “femoral head,” “osteonecrosis,” “core decompression,” “total hip arthroplasty,” and “follow up.” The keywords like “bone tissue engineering” and “extracorporeal shock wave” have emerged in recent years. Conclusions. The USA, China, and Japan contributed greatly in terms of the T100 articles. The outcomes of core decompression and total hip arthroplasty gathered the most research interests. In recent years, bone tissue engineering and extracorporeal shock wave have become new trends. However, the mechanism of ONFH is still unclear.

Previous reviews on osteoarthritis have primarily focused on inflammation caused by cartilage destruction, often overlooking the role of synovitis in the progression of osteoarthritis (OA). Macrophages, T cells, and neutrophils play critical roles in the advancement of synovitis. Therefore, this article emphasizes the functions of macrophages, T cells, and neutrophils in OA-related synovitis, aiming to provide a deeper understanding of the interactions among damage-associated molecular patterns, immune cell activation, and signaling pathways (such as NF-κB and mTOR) in OA, thereby offering new therapeutic targets. In OA, the accumulation of macrophages within inflamed synovial fluid, along with elevated levels of RANKL, tumor necrosis factor-alpha, and interleukin-1, enhances the capacity of synovial macrophages to differentiate into osteoclasts. Furthermore, synovial macrophages can polarize into either pro-inflammatory M1 or anti-inflammatory M2 phenotypes, with a predominance of the M1 phenotype promoting cartilage destruction. T cells—particularly Th17 and regulatory T cells—disrupt immune homeostasis and exacerbate inflammation. Neutrophils contribute to tissue damage by releasing elastase and reactive oxygen species, which directly injure cartilage and bone. Current OA management primarily focuses on symptomatic relief through agents such as non-steroidal anti-inflammatory drugs and corticosteroids. In contrast, emerging therapeutic strategies aim to modulate immune pathways. Promising approaches include platelet-rich plasma, mesenchymal stem cell therapy, and photobiomodulation, which have shown potential in regulating inflammation and promoting cartilage repair. A deeper understanding of the interactions among damage-associated molecular patterns, immune cell activation, and signaling pathways—such as NF-κB and mTOR—offers new therapeutic targets. Ultimately, OA management may evolve toward a precision medicine approach that integrates immune modulation with regenerative strategies to restore joint homeostasis.

Objective. Adding vitamin E to highly cross‐linked polyethylene liners is frequently performed in clinical practice, aiming at reducing liner wear, increasing liner survival, and delaying revision surgery. This study is aimed at evaluating the revision rate, total femoral head penetration, and postoperative clinical function of highly cross‐linked polyethylene liners with and without vitamin E in total hip arthroplasty. Methods. We conducted a systematic literature search to identify the use of highly cross‐linked vitamin E liners compared to other liners in patients who received total hip arthroplasty (THA) before April 2021. The study quality assessment and data collection were conducted by two independent reviewers. Studies were artificially grouped, and vitamin E‐enhanced liners (VE‐PE) were compared with vitamin E‐free liners (non‐VE‐PE). Analyses were executed using Review Manager version 5.4.1. Results. From the preliminary screening of 568 studies, fourteen studies met the research criteria. Compared to non‐VE‐PE, using VE‐PE reduced the all‐cause revision rate (odds ratio = 0.54; 95% confidence interval (CI) 0.40, 0.73; P < 0.0001). The total femoral head penetration of the VE‐PE was lower than that of the non‐VE‐PE (mean difference = −0.10; 95% CI ‐0.17, ‐0.03; P = 0.007). However, there was no difference in clinical function, including the Harris Hip Score and EuroQol Five‐Dimension Questionnaire scores. Conclusion. Compared to the liners without vitamin E, the addition of vitamin E to liners could reduce the all‐cause revision rate by approximately 46% in the short‐term follow‐up. In addition, even though addition of vitamin E could also slow down femoral head penetration, there is no contribution to clinical function.