High tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are widely used surgical options for the treatment of medial compartment knee oste

Aim: Acetabular liner orientation has been widely studied in the context of instability and impingement after total hip arthroplasty (THA), yet its impact on postoperative hip range of motion (ROM) remains unclear. ROM may be influenced by multiple confounding factors, including limb length discrepancy (LLD), femoral offset, body mass index (BMI), smoking status, and soft-tissue procedures. Methods: This retrospective study included 92 hips that underwent primary THA with either a posterosuperior or posterior liner orientation. Demographic, radiographic, and surgical variables—including LLD, femoral offset, bursal repair, and postoperative drain output—were recorded. Hip ROM (flexion, abduction, internal and external rotation) was measured goniometrically at final follow-up. Correlation analyses and multivariable linear regression models were used to evaluate independent predictors of ROM. Results:Mean ROM did not differ significantly between the posterosuperior (n = 61) and posterior (n = 31) liner groups. LLD was independently associated with reduced flexion and external rotation. Abduction and internal rotation were positively associated with bursal repair and greater drain output, whereas higher BMI showed a trend toward reduced abduction. Smoking demonstrated a statistical association with higher abduction values, although this was likely confounded by patient characteristics. Overall, ROM variation was more strongly related to LLD and soft-tissue–related surgical factors than to liner orientation. Conclusion:Liner orientation (posterosuperior vs. posterior) did not significantly influence postoperative ROM after THA. Postoperative mobility was primarily determined by LLD and soft-tissue management. Surgical planning should prioritize correction of LLD and optimization of soft-tissue balance rather than relying on liner orientation to improve ROM.

Background/Objectives: Septic arthritis of native joints is an orthopedic emergency in which rapid discrimination from non-infectious arthritis is crucial. Because cartilage damage can occur within hours, urgent irrigation and debridement are often pursued on an emergency basis (ideally within the first 6–8 h) of presentation, underscoring the need for rapidly available biomarkers. The delta neutrophil index (DNI) quantifies circulating immature granulocytes and may complement conventional inflammatory biomarkers such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell count (WBC), and procalcitonin (PCT). We evaluated the diagnostic performance of DNI for native-joint septic arthritis against both microbiologic and clinical reference standards. Methods: We retrospectively analyzed 85 adults who underwent surgical irrigation and debridement for suspected native joint septic arthritis at a tertiary center. Serum CRP, ESR, WBC, DNI, and PCT (available in 67 patients) were recorded together with synovial leukocyte counts. Infection status was defined using either positive synovial culture (microbiologic reference) or clinical adjudication according to the Guideline for management of septic arthritis in native joints (SANJO). Diagnostic performance was assessed using receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC); exploratory cut-offs were identified by the Youden index, and pairwise AUCs were compared using DeLong’s test. Results: Synovial leukocyte analysis was highly sensitive but poorly specific (sensitivity 92.9%, specificity 10.3%). Against culture, DNI showed the highest discrimination (AUC = 0.914), exceeding CRP (0.687), ESR (0.643), WBC (0.648), and PCT (0.697); DeLong ΔAUC vs. CRP 0.227 (p < 0.001), ESR 0.270 (p < 0.001), WBC 0.266 (p < 0.001), PCT 0.227 (p = 0.001). At pre-specified cut-offs, DNI showed the most balanced sensitivity/specificity (94.3%/84.0%), corresponding to a negative predictive value (NPV) of 95.5% (42/44) and a positive predictive value (PPV) of 80.5% (33/41) against culture in this cohort. Against clinical infection, DNI outperformed others (AUC:0.921; ΔAUC vs. CRP = 0.204, ESR = 0.343, WBC = 0.244, PCT = 0.295; all p < 0.001). As a rule-in threshold, DNI ≥ 0.6 yielded a specificity of 100% with a sensitivity of 73.2%. In culture-negative patients (infected n = 21, uninfected n = 29), DNI remained discriminatory (AUC 0.80, p < 0.001), whereas other biomarkers were not. Conclusions: DNI demonstrated superior diagnostic accuracy compared with conventional inflammatory biomarkers. As a rapid parameter available with the initial complete blood count, DNI may support early risk stratification and rule-in decisions within the first hours of presentation; however, it should be used as a supplementary indicator alongside synovial fluid analysis and clinical assessment rather than as a stand-alone diagnostic tool.

Background/aim: The changes in proximal femoral blood flow occurring after reconstructive surgery for Crowe types III– IV developmental dysplasia of the hip (DDH) and their impact on healing remain unclear. In the present study, blood flow around the osteotomy site is evaluated with particular focus on the proximal segment in patients who underwent subtrochanteric shortening osteotomy and hip arthroplasty. To this end, single-photon emission computed tomography (SPECT/CT) scans were conducted to evaluate changes in proximal blood flow and to assess the impact on union rates and potential complications. Materials and methods: A retrospective analysis was conducted of 26 hips from a total of 20 patients with Crowe types III or IV DDH who underwent hip arthroplasty with subtrochanteric shortening osteotomy between July 2017 and September 2022. Planar, wholebody, and SPECT/CT images were reviewed by two nuclear medicine physicians, and the tracer uptake between the greater and lesser trochanters was assessed visually and quantitatively. Results: Assessed in the study were 26 hips of 20 patients (mean age 51.5 ± 8.8 years; 80.8% female) with a mean follow-up of 20.1 ± 10.1 months. Of the total, 14 hips were right-sided and 12 were left-sided; five and 21 were Crowe types III and IV, respectively. The union was timely (≤6 months) in 16 hips (61.5%), delayed in nine hips (34.6%), and nonunion in one hip (3.8%). After one year, 25 hips (96.2%) had achieved union. The mean femoral shortening was 3.8 ± 1.2 cm. SPECT/CT analysis revealed a mean SUVmean of 3.5 ± 1.2 on the operated side versus 3.3 ± 1.2 on the contralateral side (p = 0.350). The tracer uptake ratios for greater trochanter/sacrum and greater trochanter/distal femur were similar between sides (p = 0.425 and 0.674, respectively). Conclusion: In patients with Crowe types III–IV DDH undergoing total hip arthroplasty, shortening osteotomies and soft tissue releases do not appear to significantly reduce vascularity or perfusion of the proximal osteotomy fragment. In our cohort, high union rates were observed.

Aim: To evaluate the impact of factors such as fracture type, initial displacement, reduction method, associated fibular fractures, and trauma mechanism on the occurrence of premature physeal arrest in pediatric distal tibial physeal fractures. Methods: This retrospective study included 83 pediatric patients who underwent surgical treatment for distal tibial physeal fractures between 2019 and 2024 at two centers. Data on fracture type (Salter-Harris classification, Mc.Farland, tillaux, triplanar), reduction method (open/closed), fixation technique, and mechanism of injury were analyzed. Angular deformities were assessed using lateral distal tibial angle (LDTA) and anterior distal tibial angle (ADTA). Statistical analysis was performed using SPSS software, with significance set at p