Background: Use of 3-dimensional (3D) computed tomography (CT) preoperative planning and patient-specific instrumentation has been demonstrated to improve the accuracy of glenoid implant placement in total shoulder arthroplasty (TSA). The purpose of this study was to compare the accuracy of glenoid implant placement in primary TSA among different types of instrumentation used with the 3D CT preoperative planning. Methods: One hundred and seventy-three patients with end-stage glenohumeral arthritis were enrolled in 3 prospective studies evaluating patient-specific instrumentation and 3D preoperative planning. All patients underwent preoperative 3D CT planning to determine optimal glenoid component and guide pin position based on surgeon preference. Patients were placed into 1 of 5 instrument groups used for intraoperative guide pin placement: (1) standard instrumentation, (2) standard instrumentation combined with use of a 3D glenoid bone model containing the guide pin, (3) use of the 3D glenoid bone model combined with single-use patient-specific instrumentation, (4) use of the 3D glenoid bone model combined with reusable patient-specific instrumentation, and (5) use of reusable patient-specific instrumentation with an adjustable, reusable base. Postoperatively, all patients underwent 3D CT to compare actual versus planned glenoid component position. Deviation from the plan (in terms of orientation and location) was compared across groups on the basis of absolute differences and outlier analysis. Univariable and multivariable comparisons were performed. As the initial analyses showed no significant differences in preoperative factors or in deviation from the plan between Groups 1 and 2 or between Groups 4 and 5 across studies, the final analysis was across 3 major treatment groups: standard instrumentation (Groups 1 and 2), single-use patient-specific instrumentation (Group 3), and reusable patient-specific instrumentation (Groups 4 and 5). Results: In nearly all comparisons, there were no significant differences in the deviation from the plan (absolute differences or outlier frequency) for glenoid implant orientation or location across the 3 major treatment groups. Conclusions: This study did not demonstrate that any type of patient-specific instrumentation resulted in consistent differences in accuracy of glenoid implant placement in primary TSA with 3D CT preoperative planning. Surgeons have multiple patient-specific instrumentation options available for improving accuracy of glenoid implant placement when compared with 2D imaging without patient-specific instrumentation. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

In this comprehensive review, we explore the full spectrum of the most common incidentally found bone lesions in children and adolescents. Non-ossifying fibromas (NOFs) are benign, self-limiting bone lesions that represent a significant proportion of skeletal abnormalities in this population. Beginning with their first description by Sontag and Pyle and the subsequent histological characterization by Jaffe and Lichtenstein, we trace the historical evolution of understanding NOFs, including early theories on etiology, while outlining key epidemiologic, histopathologic, and advanced imaging findings. Furthermore, we discuss diagnostic criteria, management strategies, and emerging molecular insights for NOFs, emphasizing their clinical significance. By integrating historical perspectives, current diagnostic protocols, and emerging discoveries, this paper seeks to assist clinicians in optimizing diagnostic and treatment protocols to prevent unnecessary interventions through a comprehensive understanding of NOFs.

Total hip arthroplasty (THA) is a widely performed procedure to restore hip function in patients with degenerative joint diseases. Traditional “press-fit” fixation methods rely on sufficient bone quality for stability, but additional screw fixation is often necessary for patients with suboptimal bone conditions. However, comprehensive studies utilizing predictive modeling to optimize screw placement strategies in THA remain limited. This study integrates finite element analysis (FEA) with deep learning (DL) to optimize screw fixation strategies, enhancing implant stability and reducing revision rates. The design optimization process was conducted to refine key implant parameters before training the deep learning surrogate model. By utilizing advanced simulation techniques—including Goodness of Fit analysis, Response Graphs, Local Sensitivity Analysis, and Spider Charts—critical factors influencing stress distribution and fixation stability were identified. The optimization process ensured that the dataset used for deep learning training consisted of well-validated simulations, thereby improving the predictive accuracy of stress–strain responses. The findings indicate that optimized screw placement significantly improves load distribution, reducing stress concentrations and enhancing long-term implant stability. The comparative analysis of FEA and DL results showed that the DL-FEA surrogate model successfully replicated deformation patterns, though with a mean squared error (MSE) of 24.06%. While this suggests room for improvement, the model demonstrates potential for streamlining surgical planning. A comparative assessment with traditional methods highlights the advantages of DL-FEA in reducing computational time while maintaining precision. Future improvements will focus on refining the DL model, increasing the dataset size, and incorporating clinical validation. These findings contribute to developing a computational protocol for personalized acetabular cup fixation, with implications for reducing revision rates and improving surgical outcomes.

Introduction: Cryoablation can be used to palliatively and/or definitively treat bone tumors. In transpedicular cryoablation of spine tumors, hydrodissection is frequently used in attempts to protect local anatomy, like nerves. No studies have investigated the direct clinical benefits of hydrodissection in spinal tumor cryoablation. Methods: To assess for any meaningful rise in temperature around the pedicle when using hydrodissection, cryoprobes were placed through the pedicles bilaterally at six vertebral levels, and a 10-minute freeze cycle was initiated. At each level, one pedicle served as a control and the other received hydrodissection. Temperature measurements were taken every minute at the inferior pedicular cortex, medial pedicular cortex, and at midline of the spinal canal. Distance measurements between the thermometers and cryoprobe were obtained with the aid of three-dimensional reconstruction software. Results: In a time-temperature regression model, the distance from the cryoprobe demonstrated a polynomial relationship with an overtly positive effect on temperature. Time, predictably, resulted in more negative temperatures. The positive polynomial relationship was maintained when looking at the final time point in isolation. Interestingly, no statistically significant change in temperature was demonstrated with use of hydrodissection. Analysis revealed an average temperature difference of 1.89°C (95% confidence interval, −2.26 to 6.05°C) throughout a 10-minute freeze cycle and −1.40°C (95% confidence interval, −8.03°C to 5.24°C) at the final. Conclusion: These results suggest that hydrodissection with saline during transpedicular cryoablation may not result in clinically relevant increases in local temperatures. As such, the time devoted to hydrodissection may be better devoted to attaining a well-placed cryoprobe.