Osteoarthritis (OA) is a complex disease of whole joints with progressive cartilage matrix degradation and chondrocyte transformation. The inflammatory features of OA are reflected in increased synovial levels of IL-1β, IL-6 and VEGF, higher levels of TLR-4 binding plasma proteins and increased expression of IL-15, IL-18, IL-10 and Cox2, in cartilage. Chondrocytes in OA undergo hypertrophic and senescent transition; in these states, the expression of Sox-9, Acan and Col2a1 is suppressed, whereas the expression of RunX2, HIF-2α and MMP-13 is significantly increased. NF-kB, which triggers many pro-inflammatory cytokines, works with BMP, Wnt and HIF-2α to link hypertrophy and inflammation. Altered carbohydrate metabolism and the upregulation of GLUT-1 contribute to the formation of end-glycation products that trigger inflammation via the RAGE pathway. In addition, a glycolytic shift, increased rates of oxidative phosphorylation and mitochondrial dysfunction generate reactive oxygen species with deleterious effects. An important surveyor mechanism, the YAP/TAZ signaling system, controls chondrocyte differentiation, inhibits ageing by protecting the nuclear envelope and suppressing NF-kB, MMP-13 and aggrecanases. The inflammatory microenvironment and synthesis of key matrix components are also controlled by SIRT1 and mTORc. Senescent chondrocytes represent the functional end stage of hypertrophic differentiation and characteristically upregulate p16 and p21, but also a variety of inflammatory cytokines, chemokines and metalloproteinases, developing the senescence-associated secretory phenotype. Senolysis with dendrobin, miR29b-5p and other agents has been shown to be efficient under experimental conditions, and appears to be a promising tool for the treatment of OA, as it restores COL2A1 and aggrecan synthesis, suppressing NF-kB and destructive metalloproteinases.

Background/Objectives: Neurogenic heterotopic ossification (HO) is an abnormal formation of lamellar bone in soft tissues, frequently developing near major joints in patients with spinal cord injury. While imaging provides valuable diagnostic insights, large and anatomically complex HO often requires advanced preoperative planning to minimize surgical risks. This study presents the development and clinical application of a structured six-stage workflow integrating three-dimensional (3D) technologies for the preoperative planning and surgical resection of giant iliofemoral HO. Materials and Methods: A workflow was developed comprising: (1) 3D imaging acquisition, (2) creation of a virtual model, (3) production of a life-size physical model, (4) preoperative simulation, (5) surgical resection, and (6) postoperative imaging validation. The workflow was applied to a 50-year-old male with paraplegia after a T12 fracture who developed a 26 cm iliofemoral bony bridge, confirmed by computed tomography and 3D reconstruction. Results: The physical model provided a precise anatomical reference, enabling detailed surgical rehearsal and safe planning of neurovascular dissection. Resection was performed using combined orthopedic and vascular techniques. The hip joint was preserved, and postoperative rehabilitation achieved improved range of motion and patient handling without major complications. Conclusions: This structured 3D-assisted workflow enhanced anatomical understanding and surgical precision in this complex case. The framework is applicable to other extensive ossifications with intricate anatomical relationships and warrants further evaluation in larger series.

Introduction: Neurogenic heterotopic ossification (HO) is the abnormal formation of bone in non-skeletal tissues, typically near major joints, following traumatic or nontraumatic spinal cord or brain injuries. This condition significantly affects the patients’ quality of life, often leading to joint ankylosis and severe limitations of mobility. Case presentation: In June 2023, a 50-year-old construction worker fell from a height of 3 m and suffered multiple severe injuries, including an occipito-parietal cranium fracture with subsequent epidural and subarachnoid hematomas, a myelic fracture of the T11 and T12 vertebrae, traumatic anterolisthesis of the T11 vertebral body, and paraplegia. Following prehospital stabilization, he underwent lifesaving procedures, including a craniectomy for evacuation of the epidural hematoma and posterior stabilization of the thoracolumbar spine with decompressive laminectomy, at a trauma center in Budapest. By October 2023, rehabilitation efforts were hampered by extensive HO in the right hip, as confirmed by plain radiography. The patient was discharged in December 2023, with rehabilitation impossible due to the ankylosis of the right hip. At this advanced stage, surgical resection was identified as the only viable therapeutic option. Conclusion: Mature HO can only be effectively treated through surgical excision. Early diagnosis, prevention, and medical management of immature lesions are essential to avoid severe complications and preserve joint function.

Osteoarthritis is the most common musculoskeletal disorder. It primarily affects people in their mid-40s and older. As the disease progresses, degenerative changes occur in the synovial membrane, subchondral bone, and cartilage. Ultimately, the entire joint and its surrounding tissues become structurally and functionally impaired. Several sets of biochemical markers have been proposed to enable timely diagnosis and anticipate disease progression. However, only a few of these markers are routinely used to evaluate disease activity in subgroups. We conducted a cross-sectional, single-center cohort study of 72 patients with knee osteoarthritis. Diagnoses were established based on clinical data and radiological findings. We examined two Wnt/β-catenin signaling inhibitors, serum DKK-1 and sclerostin, and two bone/cartilage metabolic regulatory factors, RANKL and OPG, correlating these with disease activity and pain scores (WOMAC, VAS, and KOFUS), radiographic stage, inflammatory molecules and indices, and bone mineral density. DKK-1 levels were higher in the intensive pain group (VAS > 5) and positively correlated with the KOFUS throughout the study. This correlation was stronger in individuals with a BMI < 30. Serum DKK-1 levels were higher in patients with lower bone mineral density. No significant modifications in SOST, RANKL, or OPG levels were found in any of the above settings. In our patient cohort with mild-to-moderate knee osteoarthritis (OA), sclerostin, osteoprotegerin (OPG), and receptor activator of nuclear factor kappa-B ligand (RANKL) were not related to pain or disease activity. In contrast, DKK-1 was an indicator of pain and low-grade flare-ups. Furthermore, DKK-1 was associated with the KOFUS and impaired bone turnover in non-obese subgroups. Confirming these relationships in larger groups of patients would contribute to more efficient use of DKK-1 in disease stratification algorithms.

Background: The open Latarjet procedure is widely used for the treatment of recurrent anterior shoulder instability associated with bipolar bone defects. Preoperative imaging parameters may be associated with short-term functional outcomes following the open Latarjet procedure for recurrent anterior shoulder instability. Materials and Methods: This retrospective study included 16 patients treated with the modified open Latarjet procedure. Preoperative CT or MRI measurements included glenoid bone loss, Hill–Sachs interval (HSI), glenoid track (GT), HSI/GT ratio and glenoid index. At 6 months, patients were evaluated using the auto-Rowe and auto-Walch–Duplay scores, range of motion, recovery time, residual symptoms, and return to activity. Results: The median Rowe and Walch–Duplay scores were 95 (90–95) and 75 (70–90), respectively. Fifteen patients resumed physical activity, including seven who returned to their previous level. No procedure-related complications were reported. Among the imaging parameters analysed, a higher HSI/GT ratio was associated with lower Walch–Duplay (p = 0.007, q = 0.043) and Rowe scores (p = 0.014, q = 0.043). Higher glenoid bone loss was associated with a lower Rowe score (p = 0.015, q = 0.043), while a higher glenoid index was associated with a lower Walch–Duplay score (p = 0.017, q = 0.043). Glenoid track showed a positive nominal association with the Walch–Duplay score (p = 0.036), which did not remain significant after FDR adjustment (q = 0.072). Discussion: Preoperative assessment of bipolar bone loss, particularly the HSI/GT ratio, may provide complementary information for surgical planning and for exploring associations with short-term functional outcomes. The formula proposed by Boden may help determine whether the coracoid graft is sufficient to convert an off-track lesion into an on-track lesion. In patients with larger Hill–Sachs defects, additional remplissage or humeral head bone grafting may be considered, although these techniques carry risks of external rotation restriction and graft resorption or osteonecrosis, respectively. Conclusions: The open Latarjet procedure is a widely used surgical option for anterior shoulder instability. These exploratory findings require validation in larger cohorts with longer follow-up.

The management of comminuted, severely displaced proximal humerus fractures in elderly patients with osteoporosis poses a significant challenge in trauma surgery, due to both their frequency and complexity, both in initial management and in the treatment of complications. The patient’s condition, motivation, expectations, and anatomical conditions are all determining factors in the choice of treatment. In cases requiring surgical intervention, we must choose between different osteosynthesis methods (locking plates, intramedullary nail), hemiarthroplasty, and reverse shoulder prosthesis implantation, based on individual assessment. Complications of osteosynthesis are not uncommon. Implant displacement, screw cutout, secondary displacement of the fracture, and non- and malunions can raise serious problems in terms of treatment. Aggravating factors include pre-existing osteoporosis, altered local conditions resulting from previous surgery, scarring, possible bone defects, and pre-existing pathology of the shoulder joint. We would like to present the “forced” solution we chose in the case of a 77-year-old female patient, which we performed on a twice re-operated humeral pseudarthrosis, in this case with a satisfactory outcome. After analyzing the available imaging procedures, we decided on intramedullary nailing, taking into account the patient’s medical history, multiple surgeries, and inclination towards the simplest solution. Due to the patient’s personal preference, we rejected the option of implanting a reverse-type, long-stemmed prosthesis that would allow for faster rehabilitation. Due to local factors observed during surgery, we performed a long Philos type plate osteosynthesis.