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: Treatment of pelvic injuries poses serious problems for surgeons due to the difficulties of the associated injuries. The objective of this research is to create a clinical workflow that integrates three-dimensional technologies in preoperative planning and performing surgery for the reduction and stabilization of associated acetabular fractures. Methods: The research methodology consisted of integrating the stages of virtual preoperative planning, physical preoperative planning, and performing the surgical intervention in a newly developed clinical workflow. The proposed model was validated in practice in a pilot surgical intervention. Results: On a complex pelvic injury case of a patient with an associated both-column acetabular fracture (AO/OTA-62C1g), we presented the results obtained in the six stages of the clinical workflow: acquisition of three-dimensional (3D) images, creation of the virtual model of the pelvis, creation of the physical model of the pelvis, preoperative physical simulation, orthopedic surgery, and imaging validation of the intervention. The life-size 3D model was fabricated based on computed tomography imagistics. To create the virtual model, the images were imported into Invesalius (version 3.1.1, CTI, Brazil), after which they were processed with MeshLab (version 2023.12, ISTI—CNR, Italy) and FreeCAD (version 0.21.2, LGPL, FSF, Boston, MA, USA). The physical model was printed in 21 h and 37 min using Ultimaker Cura software (version 5.7.2), on an Ultimaker 2+ printing machine through a Fused Deposition Modeling process. Using the physical model, osteosynthesis plate dimensions and fixation screw trajectories were tested to reduce the risk of neurovascular injury, after which they were adjusted and resterilized, which enhanced preoperative decision-making. Conclusions: The life-size physical model improved anatomical appreciation and preoperative planning, enabling accurate surgical simulation. The tools created demonstrated remarkable accuracy and cost-effectiveness that support the advancement and efficiency of clinical practice.

Background: The success of orthopaedic surgery is fundamentally biological, yet the synergistic effect of smoking and comorbidities on surgical outcomes is not well quantified. We hypothesised that active smoking multiplies the risk conferred by common comorbidities. Methods: In this retrospective cohort study, we analysed 3123 orthopaedic procedures from 2020 to 2024. Patients were stratified by comorbidity (diabetes, anemia, hepatic dysfunction, chronic venous disease) and smoking status. Primary outcomes were orthopaedic-specific complications, including non-union, periprosthetic joint infection (PJI), and revision surgery. We used multivariate logistic regression to calculate adjusted odds ratios (aORs) and formal tests for interaction to quantify synergy. Results: A significant synergistic effect was observed. In analyses adjusted for age, sex, and procedure acuity, diabetic smokers had significantly higher rates of non-union (8.6% vs. 3.3%; aOR 3.0, 95% CI 1.1–8.2), periprosthetic joint infection (8.2% vs. 2.8%; aOR 3.1, 95% CI 1.1–8.9), and revision surgery (12.2% vs. 5.0%; aOR 2.7, 95% CI 1.2–6.1). Significant interaction effects confirmed this synergy. Smokers with hepatic dysfunction had higher haematoma rates, while smoking with severe anemia was associated with markedly increased mortality (5.0%; aOR 8.9, 95% CI 1.8–43.1). Former smokers’ outcomes were consistently intermediate between active and non-smokers. For example, in the diabetic cohort, the adjusted odds of non-union were elevated for both former (aOR 2.1, 95% CI 0.8–5.5) and active smokers (aOR 3.0, 95% CI 1.1–8.2) compared to non-smokers (reference), demonstrating a gradient of risk. Conclusions: Smoking is associated with a multiplicative increase in comorbidity risk, creating a distinct high-risk phenotype that severely compromises healing. These findings strongly support that verified smoking cessation should be a foundational component of preoperative optimisation before elective orthopaedic surgery.

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.

Background/Objectives: The radiological and clinical outcomes of elastic stable intramedullary nailing (ESIN) for pediatric humeral solitary bone cysts (SBCs) were assessed, with particular attention to healing, recurrence, complications, and functional recovery. Methods: This retrospective institutional study included 25 children with humeral solitary bone cysts treated with elastic stable intramedullary nailing between January 2019 and December 2025. Patients treated exclusively with ESIN and with a minimum follow-up of 12 months were included. Radiographic healing was assessed using the Capanna classification. Clinical outcomes included pain, range of motion, complications, refracture, and recurrence. Results: The cohort consisted of 16 boys (64%) and 9 girls (36%), with a median age of 11 years. Pathological fractures were present in 56% of cases. A total of 29 surgical procedures were performed, including growth-related implant exchanges in selected patients. Cyst dimensions decreased progressively during follow-up (p < 0.001). At final evaluation, 64% of lesions demonstrated complete healing (Capanna I), 28% incomplete healing (Capanna II), and 8% recurrence (Capanna III); no cases of non-response were observed. No recurrent fractures or postoperative complications occurred. Pain resolved within one month in all patients, and a full range of motion was restored. Conclusions: Elastic stable intramedullary nailing appears to provide reliable stabilization and promotes cyst healing in pediatric humeral SBCs, with low recurrence rates and excellent functional outcomes.

Background/Objectives: This retrospective study aimed to evaluate whether PRP infiltrations improve quadriceps muscle strength recovery following anterior cruciate ligament reconstruction (ACLR), while minimizing the recovery time required to resume daily activities and sports. Numerous studies have explored the use of platelet-rich plasma (PRP) in treating ACL injuries. PRP therapy has demonstrated high efficacy in accelerating ligament healing in animal models. However, clinical trials involving human participants have reported inconsistent results regarding the effects of PRP on ACL reconstruction outcomes. Methods: Between 2020 and 2024, a total of 68 subjects who underwent ACLR were included in the study. Participants were divided into two groups, namely a treatment group that followed a standard rehabilitation protocol and received PRP infiltrations, and a control group that followed the same protocol without PRP treatment. Muscle strength was assessed using the isometric max strength balance (IMSB) test and the concentric max strength balance (CMSB) test, both performed using the Kineo Intelligent Load device (Globus Kineo 7000, Italian Excellence, Rome, Italy). Results: The results of IMSB test showed a significant difference between treatment groups according to a two-way ANOVA test (F(1, 198) = 7.345; p = 0.0073). The PRP-treated group showed significantly higher quadriceps muscle strength at 6 months (34.9 ± 9.6 vs. 30.0 ± 8.2 kg). The CMSB test also showed a significant difference at 6 months (F(1, 198) = 5.976; p = 0.00154), with the PRP-treated group having significantly higher concentric muscle strength (35.5 ± 9.5 vs. 30.7 ± 8.5 kg). Conclusions: These findings suggest that post-ligamentoplasty PRP infiltrations may have beneficial effects on muscle strength recovery. However, further prospective studies with larger sample sizes are necessary to confirm these results.