Artificial intelligence-based orthopaedic perpetual design.

Background and aims: Integrating Artificial Intelligence (AI) methodologies in orthopaedic surgeries is becoming increasingly important as it optimises implant designs and treatment procedures. This research article introduces an innovative approach using an AI-driven algorithm, focusing on the humerus bone anatomy. The primary focus of this work is to determine implant dimensions tailored to individual patients. Methodology: We have utilised Python's DICOM library, which extracts rich information from medical images obtained through CT and MRI scans. The algorithm generates precise three-dimensional reconstructions of the bone, enabling a comprehensive understanding of its morphology. Results: Using algorithms that reconstructed 3D bone models to propose optimal implant geometries that adhere to patients' unique anatomical intricacies and cater to their functional requirements. Integrating AI techniques promotes enhanced implant designs that facilitate enhanced integration with the host bone, promoting improved patient outcomes. Conclusion: A notable breakthrough in this research is the ability of the algorithm to predict implant physical dimensions based on CT and MRI data. The algorithm can infer implant specifications that align with patient-specific bone characteristics by training the AI model on a diverse dataset. This approach could revolutionise orthopaedic surgery, reducing patient waiting times and the duration of medical interventions.

The pandemic is gone but its consequences are here to stay: avascular necrosis following corticosteroids administration for severe COVID-19.

BACKGROUND: In patients with COVID-19 infection and respiratory insufficiency, corticosteroid (CCS) administration is recommended. Among the wide range of complications and interactions, time-limited high-dose CCS administration might promote avascular necrosis (AVN) in a cumulative dose. This systematic review updated the current evidence and characterises the trend of AVN following time-limited high-dose CCS administration in patients who had severe COVID-19, discussing management strategies and outcomes. METHODS: This systematic review was conducted according to the 2020 PRISMA statement. In October 2023, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Scopus restricting the search to the years 2019 to 2023. All the clinical studies which investigated the association between time-limited high-dose CCS administration in patients with severe COVID-19 infection and AVN were accessed. RESULTS: A total of 245 patients (9 studies) who experienced AVN following COVID-19 were included in the present investigation. 26% (63 of 245 included patients) were women. The mean age of the patients was 42.9 ± 17.7 years. Four studies focused on AVN of the hip and two on the knee, and the other studies included patients with AVN from mixed areas of the body (spine, pelvis, and shoulder). The mean time elapsed from COVID-19 infection to the development of symptomatic AVN was 79.4 ± 59.2 days (range, 14 to 166 days). CONCLUSION: It is possible that even time-limited high-dose CCS administration in patients with severe COVID-19 infection increased the incidence of AVN. The mean time elapsed from COVID-19 infection to the development of symptomatic AVN was approximately 80 days. Given the high risk of bias in all the included studies, the quality of recommendations of the present investigation is low, and no reliable conclusion can be inferred.

Trends in Meniscus-Related Publications in PubMed Since 1928: A Bibliometric Study.

Background: As information on the meniscus accumulates in PubMed, it is possible to evaluate the trends in research on the topic over time. Purpose: To evaluate the major trends in meniscus-related publications in PubMed from the earliest publication to the present day. Study Design: Cross-sectional study. Methods: PubMed was searched on January 3, 2023, using the search strategy "menisc *"[All Fields] AND ("knee"[MeSH Terms] OR "knee"[All Fields] OR "knee joint"[MeSH Terms] OR ("knee"[All Fields] AND "joint"[All Fields]) OR "knee joint"[All Fields]) AND 1900/01/01:2022/12/31[Date - Publication]. This retrieved 15,569 human and animal studies. We determined the top 10 meniscus-related publications in terms of overall citations and citations per year, as well as the top 10 authors, journals, countries, and institutions of cited publications on the meniscus. In addition, we performed word-cloud analyses based on meniscus-related terms from different periods (before 1981, before 2000, after 2005, and in the past 5 years [2018-2022]), including the year of first appearance and the number of publications featured. Results: Since the first recorded publication on the meniscus in 1928, there was a steady growth in the number of articles until 2005, when there was an upsurge in publications from 254 in 2005 to 955 in 2022. Noyes was the author with the most citations (n = 3314), and a 2006 study by Caplan and Dennis had the most citations per year (n = 125). Arthroscopy published the most articles on the meniscus with 1118, whereas the Journal of Cellular Biochemistry had the most citations per article with 125.69. The most published countries and institutes were the United States and the Hospital for Special Surgery, respectively. Word-cloud analysis of article titles showed that "meniscectomy" had become less prominent, and "root,""ramp,""transplantation," and "slope" had become more prominent. Conclusion: There has been an upsurge in publications on the meniscus since 2005, with word-cloud analysis indicating shifting interests in meniscus-related research.

Hand grip strength as a proposed new vital sign of health: a narrative review of evidences.

Hand grip strength (HGS) serves as a fundamental metric in assessing muscle function and overall physical capability and is particularly relevant to the ageing population. HGS holds an important connection to the concept of sarcopenia, which encompasses the age-related decline in muscle mass, strength, and function. It has also been reported to indicate the health of an individual. We reviewed the interplay between HGS and various health parameters, including morbidity and mortality, by carrying out a literature search on PubMed, Scopus and Google Scholar between 10 and 30 August 2023, to identify the relevant papers on the relationship between health and HGS. We used several keywords like 'hand grip strength', 'muscle strength, 'sarcopenia', 'osteosarcopenia', 'health biomarker', 'osteoporosis', and 'frailty', to derive the appropriate literature for this review. This review has shown that the HGS can be measured reliably with a hand-held dynamometer. The cut-off values are different in various populations. It is lower in Asians, women, less educated and privileged, and those involved in sedentary work. Several diseases have shown a correlation with low HGS, e.g., Type 2 diabetes, cardiovascular disease, stroke, chronic kidney and liver disease, some cancers, sarcopenia and fragility fractures. The low HSG is also associated with increased hospitalization, nutritional status, overall mortality and quality of life. We believe that there is adequate evidence to show that HGS stands as an important biomarker of health. Its utility extends to the identification of diverse health issues and its potential as a new vital sign throughout the lifespan.

Management of chondral and osteochondral lesions of the hip : A comprehensive review.

Chondral and osteochondral lesions encompass several acute or chronic defects of the articular cartilage and/or subchondral bone. These lesions can result from several different diseases and injuries, including osteochondritis dissecans, osteochondral defects, osteochondral fractures, subchondral bone osteonecrosis, and insufficiency fractures. As the cartilage has a low capacity for regeneration and self-repair, these lesions can progress to osteoarthritis. This study provides a comprehensive overview of the subject matter that it covers. PubMed, Scopus and Google Scholar were accessed using the following keywords: "chondral lesions/defects of the femoral head", "chondral/cartilage lesions/defects of the acetabulum", "chondral/cartilage lesions/defects of the hip", "osteochondral lesions of the femoral head", "osteochondral lesions of the acetabulum", "osteochondral lesions of the hip", "osteochondritis dissecans," "early osteoarthritis of the hip," and "early stage avascular necrosis". Hip osteochondral injuries can cause significant damage to the articular surface and diminish the quality of life. It can be difficult to treat such injuries, especially in patients who are young and active. Several methods are used to treat chondral and osteochondral injuries of the hip, such as mesenchymal stem cells and cell-based treatment, surgical repair, and microfractures. Realignment of bony anatomy may also be necessary for optimal outcomes. Despite several treatments being successful, there is a lack of head-to-head comparisons and large sample size studies in the current literature. Additional research will be required to provide appropriate clinical recommendations for treating chondral/osteochondral injuries of the hip joint.

Journal metrics of the top-ranked Orthopaedic, Medical, and Surgical journals - A cross-sectional, comparative study.

PURPOSE: In academic publishing, research metrics play a crucial role in assessing the scientific impact and performance of the published literature, as well as of the journals in which they are published. Several journal-level metrics (JLM) such as the h-index of the analysed journals, total citations, total documents, citable documents, references and external citations per document are considered crucial indicators of the importance and reputation of the journals. We hypothesize that journals in the field of Medicine receive more citations than those in Surgical journals like Orthopaedic surgery, and hence have better JLM. This study aims to to assess and compare the JLM of Medical and Surgical journals between two time zones 2017-2019 vs. 2020-2022, i.e., pre and post-COVID-19 pandemic period. METHODS: A cross-sectional bibliometric analysis of the top-ranked Orthopaedic, Medical, and Surgical journals was undertaken based on traditional JLM, using the SCImago database from 2017 to 2022. Our analysis focused on identifying trends in the h-index of the analysed journals, total citations, total documents, citable documents, references and external citations per document. RESULTS: Overall Medical journals were found to have higher JLM than the Surgical and Orthopaedic journals. The h-index of Surgical journals, Medical journals and Orthopaedic journals were comparable between the two periods (pre and -post-COVID-19 pandemic); Total Cites (3 years), total documents (2017), total documents (3 years), total references, and citable documents (3 years) of Surgical journals, Medical journals and Orthopaedic journals were significantly higher in the period 2020-2022. CONCLUSION: There has been a steady increase in the number of publications from post COVID-19 period. Medical journals have higher JLM than Surgical and Orthopaedic journals. Journal of Bone and Joint Surgery (Am), Annals of Surgery and Diabetes Care were the most published journals in Orthopaedics, General Surgery and Medicine-related topics respectively.

Trends of Publications on Single- and Double-Bundle ACL Reconstructions over the Last 20 Years: A Bibliometric Analysis of the PubMed Literature.

Purpose: To improve the clinical outcomes of anterior cruciate ligament reconstruction (ACLR), there have been attempts to reproduce anatomic reconstruction by modifying the single-bundle (SB) and double-bundle (DB) techniques. Although DB ACLR restores better rotational control compared to SB ACLR, it is still debatable whether there are higher clinical outcomes in favor of DB ACLR. We aimed to study the trends of publications on SB and DB ACLR techniques over the last 20 years. Methods: For this bibliometric study, we performed a PubMed search on 31/05/2022 with a well-defined search strategy. The articles were downloaded into Excel software, and citations were determined from the iCite website for PubMed. The analysis was performed using SPSS software version 28.0.1. Data mining was performed using Orange software, Mac version 3.32.0, from the titles of all articles and each group of SB and DB ACLR. The output is presented as word clouds. Results: A total of 10,530 publications were identified, of which 9699 publications (92.1%) pertained to SB-ACLR and 831 publications (7.9%) to DB-ACLR. There was a steady increase in the publications on SB-ACLR until 2012, followed by a steep increase that peaked in 2021. The highest number of publications on DB-ACLR was in 2012 (n = 76; 9.1%). The mean citations per year for SB-ACLR and DB-ACLR were 2.87 ± 4.31 and 2.74 ± 3.17, respectively. The most prolific journals publishing on this topic were Knee Surgery Sports Traumatology Arthroscopy, American Journal of Sports Medicine, and Arthroscopy. The top three articles that received the maximum number of citations were from Japanese authors. Conclusion: The number of publications related to SB-ACLR was significantly higher than that related to DB-ACLR in the last 20 years. The publications related to DB-ACLR have decreased in the recent past, after reaching a peak in 2012. The citations per year of SB-ACLR and DB-ACLR were similar.

Artificial intelligence in foot and ankle surgery: current concepts.

The twenty-first century has proven that data are the new gold. Artificial intelligence (AI) driven technologies might potentially change the clinical practice in all medical specialities, including orthopedic surgery. AI has a broad spectrum of subcomponents, including machine learning, which consists of a subdivision called deep learning. AI has the potential to increase healthcare delivery, improve indications and interventions, and minimize errors. In orthopedic surgery. AI supports the surgeon in the evaluation of radiological images, training of surgical residents, and excellent performance of machine-assisted surgery. The AI algorithms improve the administrative and management processes of hospitals and clinics, electronic healthcare databases, monitoring the outcomes, and safety controls. AI models are being developed in nearly all orthopedic subspecialties, including arthroscopy, arthroplasty, tumor, spinal and pediatric surgery. The present study discusses current applications, limitations, and future prospective of AI in foot and ankle surgery.

Scientometric analysis of highly cited papers on avascular necrosis of the femoral head from 1991 to 2022.

INTRODUCTION: A highly cited paper (HCP) is considered a landmark that can influence both research and clinical practice. The characteristics of HCPs in avascular necrosis of the femoral head (AVNFH) were identified and the research status was explored in a scientometric analysis. METHODS: The present bibliometric analysis were based on the Scopus database from 1991 to 2021. Microsoft Excel and VOSviewer were used for co-authorship, co-citation, and co-occurrence analysis. From 8496 papers, only 2.9% (244) were HCPs, with 200.8 citations registered per article. RESULTS: Of the HCPs, 11.9% and 12.3% were externally funded and had international collaboration, respectively. These were published in 84 journals by 1625 authors from 425 organizations of 33 countries. The USA, Japan, Switzerland, and Israel were the leading countries.The lead research organizations were Sinai Hospital and John Hopkins University (USA). The most impactful organizations were University of Arkansas for Medical Science, and Good Samaritan Hospital (USA). R.A. Mont (USA) and K.H. Koo (South Korea) were the most prolific contributing authors, while R. Ganz (Switzerland) and R.S. Weinstein (USA) registered the most impactful contributions. The most prolific publishing journal was the Journal of Bone and Joint Surgery. CONCLUSION: The HCPs contributed to the knowledge of AVNFH by examining research perspectives and identifying important subareas through keyword analysis. LEVEL OF EVIDENCE: Not applicable. TRIAL REGISTRATION: Not applicable.

Scientometric analysis of Indian Orthopaedic Research in the last two decades.

PURPOSE: This study aimed to examine India's orthopaedic research output during 2002-2021 to analyze the research characteristics and publication performances of leading organizations, authors, and cities, the core journals publishing research, broad subject areas, sub-specialties, and the classification by anatomical location, the subject areas of research using major keywords and the sources of funding and the extent of international collaboration. METHODS: India's orthopaedic publications data was identified and downloaded from the Scopus database ( https://www.scopus.com ) using a well-defined search strategy and keywords. RESULTS: India's 4606 publications grew at a 20.8% annual growth rate and averaged 11.3 citations per paper. The 10.4% and 16.3% share of India's papers received external funded support and were involved in international collaboration. The USA and UK (31.8% and 21.3%) represent the highest collaborative share in India's international collaborative publications. AIIMS-New Delhi and PGIMER-Chandigarh produced a larger proportion of articles (5.2% and 4.3%) among contributing organizations. In terms of authors, R. Vaishya and S. Rajasekaran are the most productive ones, contributing 1.6% and 1.1% share respectively. Clinical studies, paediatric sub-specialty, and knee & leg anatomical location accounted for the largest share of papers (32.2%, 10.8%, and 7.5%).The most frequent keywords co-occurrences were "Orthopaedic Surgery," "Hydroxyapatite," "Biocompatibility," "Orthopaedic Procedures," "Bone," "Surgical Techniques," "Biomaterials," and "Osteosynthesis." CONCLUSION: This study revealed the characteristics and trends of research and core publications from Indian authors and organizations identified in the last two decades. This research should provide useful insights into the research hotspots of India in the present, past, and future.

Aggressive giant cell tumour (GCT) of the distal humerus in a young pregnant woman.

A 25-year-old pregnant woman reported suffering from an aggressive giant cell tumour of the distal humerus extending into the elbow joint. The successful management required a careful evaluation of the various treatment options due to her pregnancy. Surgical excision of the mass was performed. The residual bone defect was reconstructed with an elbow mega-prosthesis. The patient made a pain-free recovery with a good range of motion and delivered the baby at term with no complications.

Fracture in an arthrodesed Charcot's knee joint.

Charcot's joint is a type of neuro-arthropathy, where asymmetrical damage of the involved joint happens haphazardly, without following any described pattern. We present a rare case of Charcot's joint involving the knee joint in an adult male following spina bifida. His knee joint was successfully fused after two surgeries. Later, he sustained a fracture through the arthrodesis after a fall, which we managed surgically. The fracture through the knee arthrodesis was managed surgically by an open reduction and internal fixation, using a 14-hole broad low contact dynamic compression locking plate with bone grafting. Union was achieved at the knee arthrodesis site in 6 months. Fracture through a fused knee requires surgical management. Re-arthrodesis was done using a stable fixation. Postoperative rehabilitation should include protected weight bearing with braces and splints until a sound bony union is achieved.

Single-stage surgical correction of a bilateral acquired coxa vara deformity in a young woman.

A 23-year-old female-treated patient of osteomalacia and secondary hyperparathyroidism with hypophosphatemia presented with a 5-year history of bilateral groin pain and stiffness of both hips and difficulty in walking. Plain radiographs of the pelvis showed bilateral coxa vara deformity. She was managed surgically by a single-stage bilateral subtrochanteric corrective osteotomy with the internal fixation. After the osteotomy healing at 3 months, the patient was pain free and walked comfortably with an increased range of hip motion.

Pubic Osteolysis in an Elderly Masquerading as Malignancy: A Case Report and Review of Literature.

INTRODUCTION: A rapidly progressive destructive lesion characterizes pubic osteolysis (PO) in the pubic bone due to an inadequate fracture healing response. It may be seen in pelvic insufficiency fractures (IF) secondary to radiation therapy (RT) of pelvic malignancies, occurring even in the absence of significant trauma. Such a radiological picture may distract the clinician towards a malignant etiology and may affect the management. CASE REPORT: A 79- year- old female, known case of carcinoma of the urinary bladder, underwent contrast-enhanced computed tomography (CT) (CECT) of the abdomen and pelvis as a routine follow- up and was found to have an osteolytic lesion in the right pubic bone, suggesting a malignant pathology. CT- guided biopsy did not reveal any malignant or infective etiology. The patient showed recovery with conservative management. CONCLUSION: Osteolytic lesions of the pubic bone can often occur following radiation for pelvic malignancies. It occurs due to impaired fracture reparative response by a bone afflicted by radiation therapy RT. It can be managed effectively with conservative analgesics, bisphosphonates, calcium, and Vitamin D supplementation. The radiographic picture can imitate malignant or infective lesions and provoke invasive testing for confirmation. The clinicians need to be conscious of this clinical entity to initiate proper treatment and avoid unnecessary investigations.

Successful Salvage of a Mangled Injury of the Ankle in a Young Male.

INTRODUCTION: The salvage of a mangled limb is quite challenging, but can be rewarding especially for younger individuals. CASE REPORT: We present a case of mangled injury of the ankles in a young male, which was salvaged successfully, using Orthopaedic and Plastic Surgery procedures. CONCLUSION: The GHSS is helpful for decision-making and to predict the ultimate outcome of the open injuries. Younger patients with intact vascularity of the limb should be considered for limb salvage with a multidisciplinary stepwise approach.

Etiopathology and Management of Stiff Knees: A Current Concept Review.

BACKGROUND: Knee stiffness after trauma, fracture fixation, arthroscopic surgery, infection, and knee arthroplasty is a known complication, which is challenging to manage and causes significant disability to the patients. METHODS: We did a comprehensive search on the stiff knees, in the last week of May 2020, from the search engines of PubMed, SCOPUS, Google Scholar, and Research Gates using the appropriate keywords. RESULTS: We found two types of articles related to knees stiffness: (a) following trauma, internal and external fixation of fractures and arthroscopic surgery, and (b) following total knee arthroplasty. Arthroscopic surgery was found to be a favored mode of management of stiff knees in both of the above groups. The Manipulation under Anesthesia (MUA) was also found effective if done carefully and in the early course of the stiffness. CONCLUSION: Knee stiffness due to any cause is a trouble proposition to both patients and treating surgeons. Various methods of management have been described to deal with knee stiffness. Amongst the operative treatment, MUA and arthroscopic surgery were found to be the most effective. Arthroscopic surgery offers a good option of release stiff knees in the majority of cases, and it is most valuable and effective if done earlier in the course of the stiffness (preferably between 3 and 6 months).

Trends of arthroscopy publications in PubMed and Scopus.

PURPOSE: Arthroscopy is an established sub-speciality in orthopaedics. With advancing technology, instrumentation and implants, this sub-speciality has seen an explosion of knowledge and techniques since its inception. The indications for arthroscopic management are increasing and, hence, the number of publications on this topic. There has been no study looking into the bibliometrics of all publications within this speciality. The purpose of this study was to look into the trends of published articles on arthroscopy from PubMed and Scopus including studying their citation numbers. MATERIALS AND METHODS: We set out to look into the number of publications from the earliest up to 2019 and their trends and citation numbers in PubMed and Scopus. We also performed a VOS viewer analysis of MeSH terms and titles of publications to look at research trends over time. RESULTS: There were 41,149 articles published on PubMed since 1955 and 50,373 articles on Scopus since 1939. The total number of citations were 912,630 for 38,338 cited articles. With 2864 publications in 2019, there was a more than four-fold increase from the number published in the year 2000. The knee joint was the most frequently published joint with an increasing trend in hip arthroscopy. Cohort studies were the most common with 13,180 articles followed by Reviews with 5746 articles. The top 10 authors, universities and journals were listed along with citation numbers. We analysed the trends of publications for each joint and compared them. Yearly citations have progressively increased to reach a maximum of 45,407 in 2007. Arthroscopy was the most published and cited journal on this topic. The Journal of Bone and Joint Surgery (JBJS) (Am) had the most citations per article. The USA and Hospital for Special Surgery, New York were the most published country and university, respectively. CONCLUSIONS: There is a healthy growth of publications on the subject of arthroscopy with a steep increase in the number of publications and citations in recent years. VOS Viewer analysis showed an evolution of research and practice in the field of arthroscopy. Recommendations were made for databases and search engines to improve on the search and analysis of such studies in the future. LEVEL OF EVIDENCE: 4.