Computer-assisted technology offers better component alignment and surgical precision than conventional TKA. However, whether robotic-assisted total knee arthroplasty (RA-TKA) shows clear benefits over navigation-assisted total knee arthroplasty (NA-TKA) is still contentious. Therefore, we aimed to perform a meta-analysis exploring the accuracy and safety of RA-TKA compared to NA-TKA in patients with knee osteoarthritis. We systematically searched PubMed, Scopus, Web of Science, and Cochrane Library for studies comparing RA-TKA with NA-TKA. We assessed radiological alignment outliers, polyethylene (PE) insert thickness, surgical time, and safety outcomes. Statistical analyses were performed using RevMan Web. Odds ratios (ORs) and mean differences (MDs) with 95 % confidence intervals (CIs) were pooled for dichotomous and continuous endpoints, respectively. A random-effects model was used due to anticipated heterogeneity and measured with the I² test. We included 19,209 patients from sixteen studies, of whom 3764 (19.6 %) were assigned to the RA-TKA. We found no statistically significant difference between RA-TKA and NA-TKA in terms of hip-knee-ankle angle outliers (OR 0.91; 95 % CI 0.56 to 1.48; p = 0.71; I² = 25 %), femoral coronal angle outliers (OR 0.46; 95 % CI 0.16 to 1.38; p = 0.17; I² = 60 %), tibial coronal angle outliers (OR 0.51; 95 % CI 0.13 to 2.08; p = 0.09; I² = 58 %), periprosthetic joint infection (OR 0.76; 95 % CI 0.27 to 2.15; p = 0.61; I² = 0 %), and length of stay MD -0.17 days; 95 % CI -1.08 to 0.74; p = 0.72; I² = 98 %). RA-TKA used 1.03 mm thinner PE inserts compared with NA-TKA (MD -1.03 mm; 95 % CI -1.60 to -0.46; p = 0.71; I² = 98 %), whereas surgical time was 9.87 min shorter with NA-TKA (MD 9.87 min; 95 % CI 0.62 to 19.11; p = 0.04; I² = 99 %). RA-TKA and NA-TKA had comparable radiological alignment. While RA-TKA allows for thinner polyethylene inserts, it requires longer surgical time than NA-TKA. These findings suggest that both techniques are adequate, with specific differences that may influence surgical decision-making.

Background/Objectives: Sodium butyrate, a short-chain fatty acid produced by gut microbial fermentation of dietary fiber, has attracted increasing interest as a potential adjunctive therapy for ulcerative colitis (UC) because of its anti-inflammatory, barrier-protective, and immunomodulatory properties. This systematic review aimed to evaluate the current clinical and preclinical evidence regarding the efficacy and mechanisms of sodium butyrate in UC. Methods: A systematic review was conducted in accordance with the PRISMA 2020 guidelines and registered in PROSPERO (CRD420261437741). PubMed/MEDLINE, Scopus, Web of Science, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform were searched from February through April 2026. Eligible clinical and experimental studies investigating oral or rectal administration of sodium butyrate in UC or experimental colitis were included. Risk of bias was assessed using RoB 2, ROBINS-I, or the SYRCLE tool according to study design. Results: Twenty-two studies were included, comprising ten clinical trials, one prospective observational study and eleven preclinical animal studies. In adults diagnosed with UC, oral sodium butyrate, particularly microencapsulated formulations, demonstrated encouraging effects as an adjunct to standard therapy by improving clinical remission rates, quality of life and reducing disease activity and inflammatory biomarkers. Evidence in pediatric inflammatory bowel disease remained inconsistent. Studies evaluating rectal sodium butyrate enemas reported variable clinical efficacy despite evidence of local biological activity. Preclinical studies consistently demonstrated reduced intestinal inflammation, improved epithelial barrier integrity, modulation of oxidative stress, favorable alterations of the gut microbiota, and regulation of several mechanistic pathways identified across individual preclinical studies, including PI3K/AKT/mTOR, WNT/ERK, ERK/STAT3, autophagy and ferroptosis. Conclusions: Current evidence suggests that sodium butyrate represents a promising adjunctive therapeutic strategy for UC, supported by consistent mechanistic findings and encouraging clinical results, particularly with oral formulations. However, the available clinical evidence remains heterogeneous, and larger, well-designed randomized controlled trials with standardized formulations and treatment protocols are required before its routine clinical implementation can be considered.

Background/Objectives: Microfracture remains the most widely used first-line procedure for focal chondral defects of the knee, but its fibrocartilaginous repair deteriorates over time. This review asked whether adding an orthobiologic or scaffold to marrow stimulation changes clinical, structural or safety outcomes compared with isolated marrow stimulation, by augmentation type. Methods: PubMed, Scopus and the Cochrane Library (January 2016 to July 2026) and ClinicalTrials.gov were searched for randomized and non-randomized comparative studies with at least 12 months of follow-up (PROSPERO CRD420261484998, registered retrospectively). Risk of bias was assessed with RoB 2 and ROBINS-I; findings were synthesized without meta-analysis (SWiM) by effect direction, exploratory sign tests and unpooled standardized mean differences, and certainty was rated with GRADE. Results: Fifteen studies (six randomized; 630 patients; follow-up 12 months to 10 years) were included. Across augmentation types, the point estimate for function favored augmentation in eight out of nine independent evidence sources (p = 0.039) but not when the four unclassifiable studies were counted as unfavorable (8 of 13; p = 0.58), and clinically important IKDC differences occurred only in non-randomized cohorts. A structural advantage was statistically supported in two out of ten studies, in one only on a group-by-time interaction. Further surgery occurred mainly after isolated marrow stimulation, but events were few, and harms were inconsistently reported. Conclusions: Effects differ by augment and should not be generalized to augmentation as a class. Type I/III collagen membranes may improve patient-reported function, and cellular or autologous tissue products, chiefly adipose-derived, may improve pain and symptoms (low certainty); effects on structure, reoperation and safety are very uncertain. Adequately powered randomized trials of each augment are needed.

Background: Osteoporosis is a major skeletal disorder, particularly affecting postmenopausal women. Young ovariectomized rat models are commonly used to investigate estrogen deficiency-related skeletal changes, although they do not fully reproduce osteoporosis in a mature postmenopausal skeleton. Established pharmacological therapies remain the cornerstone of osteoporosis management, while nutritional factors continue to be investigated for their potential supportive role in bone metabolism. Menaquinone-7 (MK-7), a form of vitamin K2, has been investigated for potential skeletal effects through vitamin k-dependent mechanisms, particularly osteocalcin carboxylation. The aim of this study was to evaluate the dose-dependent effects of MK-7 on bone turnover markers, femoral mechanical resistance, qualitative histological findings, and hepatic safety in a young ovariectomized rat model. Methods: Forty female Wistar rats that were 8 weeks old, and thus still undergoing skeletal maturation, were assigned to four groups: sham-operated controls, ovariectomized controls, ovariectomized rats treated with low-dose MK-7, and ovariectomized rats treated with high-dose MK-7. Treatment was administered every 48 h for 12 weeks. At study completion, 35 rats survived; standardized analysis included eight animals per group. Plasma bone turnover markers (BTMs) and alanine aminotransferase were measured, femoral strength was assessed by the three-point bending test, and bone and liver histology was analyzed. Results: Biomechanical testing showed that high-dose MK-7 was associated with greater femoral mechanical resistance compared with untreated ovariectomized rats, while qualitative histology suggested differences in cortical architecture among groups. Biochemically, MK-7 treatment reduced undercarboxylated osteocalcin, suggesting vitamin K-dependent target engagement, whereas conventional turnover markers showed discordant findings. Overall, hepatic architecture was preserved, although mild hepatocellular apoptosis was observed. Conclusions: In this young OVX rat model, high-dose MK-7 was associated with improved femoral mechanical resistance compared with untreated OVX controls. However, because ovariectomy was performed during skeletal maturation, these findings should be interpreted as preliminary and cannot be directly extrapolated to established postmenopausal osteoporosis in a mature skeleton, and further studies are needed to clarify its activity pathways and safety profile.