Purpose: Early onset scoliosis comprises spinal deformities in children younger than 10, creating challenges in diagnosis, risk assessment, and management. Timely intervention is vital, because untreated deformity can lead to cardiopulmonary compromise. Artificial intelligence and machine learning are reshaping orthopaedic care by improving detection, forecasting progression, and guiding treatment. This scoping review maps current use in this patient population. Methods: Following PRISMA ScR standards, we systematically searched PubMed, Embase, Web of Science, Cochrane, and Scopus for studies that developed, applied, or validated AI models to diagnose, manage, or predict outcomes in EOS. Results: After removing duplicates, 352 records were screened, 22 full texts were reviewed, and 11 studies met inclusion criteria. Most investigations (63.6%) employed convolutional neural networks (CNNs) such as Mask R CNN, EfficientNet, and U Net. Ensemble learning with gradient boosting, random forest, and logistic regression (9.1%), Gaussian Naïve Bayes (9.1%), sparse additive machines (9.1%), and unsupervised clustering (9.1%) were also used. Image analysis dominated (72.7%), automating radiographic measurements (Cobb angle, skeletal maturity) and monitoring growing-rod distraction. Predictive models (27.3%) estimated prolonged hospital stay, unplanned reoperation, or postoperative complications. Mean accuracy was 91.2% (range 86.1% to 94.0%). Common limitations were small sample sizes, single-centre data, and limited external validation. Conclusion: AI shows promise for EOS imaging and risk prediction, yet translation is hindered by methodological heterogeneity and scarce external validation. Future work should adopt standardised reporting, aggregate multicentre datasets, and test models prospectively in large cohorts.

Background: As the global prevalence of dementia rises, an increasing number of patients with cognitive impairment require Total Joint Arthroplasty (TJA). However, the specific impact of dementia on postoperative outcomes remains underreported. This systematic review evaluates the complications, mortality, and healthcare utilization associated with dementia in patients undergoing Total Hip (THA) and Total Knee Arthroplasty (TKA). Methods: A systematic search of PubMed, Scopus, Web of Science, Embase, and the Cochrane Library was conducted following PRISMA guidelines. Eligible studies included comparative cohorts of patients with and without a diagnosis of dementia undergoing primary TJA. Methodological quality was appraised using the Newcastle-Ottawa Scale (NOS). Data were synthesized regarding mortality, readmissions, implant-related complications, and discharge disposition. Results: Seven retrospective cohort studies comprising 13,816 patients with dementia and 869,061 controls were included. The mean NOS score was 8.4/9, indicating high methodological quality. Patients with dementia exhibited significantly worse outcomes across both procedures, including higher rates of postoperative delirium (OR: 4.25–6.40), mortality (HR: 1.43–3.05), and discharge to skilled nursing facilities (OR: 1.87). Stratification by procedure revealed distinct risk profiles: while both cohorts faced high readmission rates, THA patients demonstrated specific vulnerability to mechanical complications, including increased risks of dislocation, periprosthetic fracture (OR: 2.07), and revision surgery. These mechanical failures were frequently driven by falls and poor compliance with postoperative precautions rather than infection alone. Conclusion: Dementia is a robust independent predictor of adverse outcomes after TJA. While both THA and TKA carry elevated systemic risks, THA poses unique mechanical challenges that may warrant the use of high-stability implants (e.g., dual-mobility cups) to mitigate dislocation risks. Perioperative strategies should prioritize caregiver-led surveillance and strict fall prevention protocols to improve safety in this vulnerable population.

Background/Objectives: Osteoporotic vertebral fractures (OVFs) are common in older adults. While surgery is generally reserved for unstable or painful fractures, some OVFs conceal underlying malignancies, including metastatic and hematologic cancers. This study aimed to determine the pooled prevalence of unsuspected malignancy in patients initially diagnosed with OVFs. Methods: A systematic search of PubMed and Scopus was conducted from inception to September 2025 in accordance with PRISMA guidelines. Eligible studies included adults with presumed OVFs who underwent vertebral biopsy and histopathological evaluation. Prevalence estimates were pooled using a random-effects model, and study quality was assessed with the Newcastle–Ottawa Scale. Results: Thirteen studies involving 3513 patients were included. The pooled prevalence of malignancy was 8.0% (95% CI: 5.4–10.6), comprising metastatic solid tumors (4.9%; 95% CI: 2.3–7.4) and multiple myeloma (2.6%; 95% CI: 1.3–3.9). Malignancy was detected in 2.7% (95% CI: 1.8–4.1) of routine biopsy cohorts versus 36.8% (95% CI: 22.1–54.4) of clinically suspected cases. Diagnostic yield exceeded 45% in patients selected by combined history, imaging, or known malignancy. No biopsy-related complications or procedure-related mortality were reported. Moderate heterogeneity was observed, mainly in suspected cohorts. Conclusions: Vertebral biopsy is a safe and diagnostically valuable procedure in vertebral compression fractures. Its yield ranges from about one in 30 patients in routine settings to nearly one in two in high-risk groups, underscoring the importance of structured patient selection to facilitate timely cancer detection and referral.

Purpose: The posterior dynamic distraction device (PDDD) is a fusionless implant for adolescent idiopathic scoliosis (AIS). We aimed to quantify pooled major-curve Cobb correction, complication, revision, and infection rates after primary PDDD implantation for Lenke 1 or 5 curves, and to place these outcomes in context alongside posterior spinal fusion (PSF) and vertebral body tethering (VBT). Methods: Following PRISMA guidance (PROSPERO: CRD420251074442), PubMed, Embase, Scopus, and Web of Science were searched to May 2025. Random-effects meta-analyses were performed for Cobb correction, complications, and revisions, with leave-one-out sensitivity analyses. Results: Five studies (148 unique patients; mean age 13.1–16.0 years) met the inclusion criteria. Pooled mean Cobb correction was 22.8° (95% CI: 14.2–31.4°), approximately 51% of the preoperative magnitude; however, heterogeneity was extreme (I²=98%; prediction interval − 14.5° to 60.1°), and this pooled figure should not be interpreted as a reliable estimate of expected correction. The pooled complication rate was 24% (95% CI: 12–40%, I²=76%) and revision rate was 30% (95% CI: 19–45%, I²=64%), rising to 35% when elective exchanges for device outgrowth were included, with mechanical failures predominating. Primary surgical site infection occurred in 6% (95% CI: 3–12%, I²=0%). Risk of bias was moderate to serious across all studies. Conclusion: PDDD provides moderate short-term curve correction, but approximately one in four patients experiences a complication and nearly one in three requires reoperation at short-term follow-up. Reported perioperative advantages derive from only two to three uncontrolled cohorts. PDDD does not yet match PSF for reliability or percentage correction, nor VBT for reoperation rates. Pending larger comparative studies with long-term follow-up, PDDD should be considered investigational and patients counselled accordingly.

Adolescent Idiopathic Scoliosis: A Comprehensive Review of Epidemiology, Etiology, and Interventions