Bone and Arthrosurgery Science

Clinical Guideline for Perioperative Pain Management in Diabetic Foot Ulcers

Junwei Zong — 2025-12-31

This guideline outlines the pathophysiology and classification of neuropathic, ischemic, inflammatory, and procedural pain, and proposes a risk-stratified assessment using NRS/VAS combined with ulcer severity and comorbidities. Core recommendations emphasize preventive multimodal analgesia, prioritization of regional anesthesia, systematic management of neuropathic pain, protocolized procedural analgesia, and multidisciplinary collaboration.

Trends in the Burden of Osteoarthritis in China Compared with G20 Countries, 1990–2023: An Analysis of the Global Burden of Disease Study

Qixuan Song — 2025-12-31

Background: Osteoarthritis (OA) is a leading cause of disability worldwide. China is undergoing rapid population ageing, yet how its OA burden compares with that of other G20 countries over time has not been fully quantified. Methods: Using data from the Global Burden of Disease 1990–2023 study, we described OA incidence, prevalence, and disability-adjusted life years (DALYs) for China and the aggregated G20. We analyzed age-standardized rates (ASRs) and absolute numbers for adults ≥ 30 years by year, age group, and anatomical site (knee, hip, hand, other). Temporal trends were summarized by estimated annual percentage change. We visualized overall time trends in incidence, age-specific rates, and case numbers in 2023, and the distribution of OA subtypes in China versus the G20. Results: From 1990 to 2023, China’s age-standardized incidence rate (ASIR) increased from 487.1 to 550.2 per 100,000, while annual incident cases rose from 4.68 to 11.90 million. Age-standardized prevalence and DALY rates also rose modestly, but absolute numbers of prevalent cases and DALYs more than doubled. Compared with the G20 aggregate, China showed steeper increases in both incidence and case numbers. In 2023, incidence, prevalence, and DALY rates climbed steadily with age in both China and the G20, with incidence peaking at 55–64 years, prevalence at 85–94 years, and DALY rates at 70–79 years; the bulk of cases occurred between 50 and 74 years. Across anatomical sites, knee OA contributed the largest share of burden, followed by hand, other sites, and hip OA, with a broadly similar ranking in China and the G20. Conclusion: From 1990 to 2023, China experienced a marked rise in OA burden, driven mainly by population growth and ageing. Older adults, especially those with knee and hand OA, carry the greatest share of the disease. Healthcare planning should prioritize age-friendly prevention, early diagnosis, and long-term rehabilitation.

The Effect of Intra-Articular Injection of PRP Combined with Sodium Hyaluronate and TCM Hot Compress Pack on Serum IL-1β and IL-6 in Patients with Knee Osteoarthritis

Hua Pan — 2025-12-31

Objective: This study aims to investigate the impact of a combined intervention of intra-articular injections of platelet-rich plasma (PRP) and sodium hyaluronate, followed by traditional Chinese medicine (TCM) hot compress therapy, on serum levels of interleukin-1β (IL-1β) and interleukin-6 (IL-6) in patients with knee osteoarthritis (KOA). Additionally, it seeks to assess the clinical effectiveness and elucidate the potential mechanisms of this integrated treatment approach. Methods: A total of 86 KOA patients admitted to our hospital between August 2024 and July 2025 were randomly assigned to a study group and a control group, each with 43 patients. The control group was treated with intra-articular injection of PRP combined with sodium hyaluronate, while the study group received additional application of a TCM hot compress pack. Clinical efficacy, pain intensity (assessed using the numerical rating scale, NRS), joint function (evaluated using the WOMAC index), serum levels of IL-1β and IL-6, and quality of life (measured using the SF-36 scale) were compared between the two groups before and after the intervention. Results: The study group demonstrated a significantly greater total effective rate compared to the control group (P < 0.05). Following treatment, the study group exhibited markedly reduced NRS and WOMAC scores, along with lower serum levels of IL-1β and IL-6, all significantly superior to the control group (P < 0.05). Conversely, SF-36 scores in the study group were significantly elevated compared to the control group (P < 0.05). Conclusion: Intra-articular injection of PRP combined with sodium hyaluronate, supplemented by TCM hot compress pack, can effectively regulate serum IL-1β and IL-6 levels in KOA patients, alleviate pain, improve joint function and quality of life, and has good clinical application value.

The Impact of Preemptive Analgesia Combined with Multimodal Analgesia on Perioperative Pain and Postoperative Fracture Healing in Elderly Patients with Hip Fractures

Haihang Wang — 2025-12-31

Objective: To investigate the impact of preemptive analgesia combined with multimodal analgesia on perioperative pain and postoperative fracture healing in elderly patients with hip fractures. Methods: A total of 202 patients who underwent total hip arthroplasty from January 2024 to December 2024 were selected and divided into two groups based on different analgesic methods: a control group receiving routine postoperative multimodal analgesia and a study group receiving preemptive analgesia combined with multimodal analgesia, each with 101 cases. The analgesic effects were compared between the two groups. Results: The pain scores of the study group at all postoperative time points were significantly lower than those of the control group (P < 0.05); the number of patient-controlled intravenous analgesia pumps and the frequency of rescue analgesia in the study group were significantly lower than those in the control group (P < 0.05); the levels of stress response indicators in the study group were significantly lower than those in the control group after surgery (P < 0.05); the fracture healing time in the study group was significantly shorter than that in the control group (P < 0.05). Conclusion: The application of preemptive analgesia combined with multimodal analgesia in elderly patients with hip fractures can provide superior perioperative analgesic effects, effectively reduce surgical stress responses, promote early functional rehabilitation, and have a positive effect on postoperative fracture healing.

Research Progress on the Role of Exosomes and the PI3K/Akt Pathway in Osteoporosis

Xing Dai — 2025-12-31

Osteoporosis (OP) is a metabolic bone disease characterized by decreased bone mineral density and microstructural deterioration, leading to an elevated risk of fragility fractures. Bone remodeling relies on the dynamic balance between osteoblast-mediated bone formation and osteoclast-mediated bone resorption. Exosomes, as key mediators of intercellular communication, regulate the differentiation and function of bone marrow mesenchymal stem cells (BMSCs), osteoblasts, and osteoclasts by delivering bioactive molecules (e.g., miRNAs), thereby playing a pivotal role in OP pathogenesis. Recent studies have revealed that the PI3K/Akt signaling pathway not only serves as a central regulator of BMSC osteogenic differentiation but also synergizes with exosomes to promote bone formation by activating downstream targets (e.g., RUNX2, BMP2). This review systematically summarizes the synergistic mechanisms of exosomes and the PI3K/Akt pathway in osteogenesis, focusing on how specific miRNAs (e.g., miR-19a-3p, miR-935) modulate key molecules (e.g., PTEN, STAT1) to restore bone metabolic homeostasis. These findings provide novel insights into the molecular mechanisms of OP and lay a theoretical foundation for developing targeted therapeutic strategies.

Ferroptosis Mechanism in the “Secondary Injury” Phase of Osteoporotic Fractures: From Laboratory to Perioperative Intervention

Jun Lei — 2025-12-31

Delayed healing of osteoporotic fractures is a common and challenging clinical problem, traditionally attributed to insufficient local blood supply. However, recent years have seen increasing attention on the critical role of ferroptosis during the “secondary injury” phase of osteoporotic fractures. Ferroptosis damages chondrocytes through iron overload and lipid peroxidation, having a significant impact on bone repair. This article explores the molecular mechanisms of ferroptosis, focusing on the role of osteoclasts in secreting free iron and the impact of changes in GPX4 and FSP1 expression on ferroptosis regulation, highlighting the significance of ferroptosis chondrocyte subpopulations in fracture healing. It also evaluates the application potential and existing controversies of perioperative intervention strategies such as iron chelators and vitamin K2, discussing the development trends of bone-targeted iron chelating nanoparticles and rapid detection technologies for ferroptosis evaluation. This review aims to provide new theoretical bases and intervention ideas for the treatment of clinical osteoporotic fractures, promoting solutions to delayed fracture healing.

Application of Joint Line Incision + Precise Pre-Bent Plate via Three-Dimensional Reconstruction of the Proximal Tibia In Vitro + Transparent Retractor in Tibial Plateau Fractures

Aixiang Pan — 2025-12-31

Objective: To analyze the combined application effects of the joint line incision approach, precise pre-bent plates via three-dimensional reconstruction of the proximal tibia in vitro, and transparent retractors in the clinical treatment of Schatzker types III to VI tibial plateau fractures, and their impact on the functional recovery of the knee joint. Methods: A retrospective analysis was conducted on the surgical treatment outcomes of 28 patients with tibial plateau fractures admitted from January 2023 to January 2025. All patients underwent internal fixation surgery via the joint line incision approach after admission, with the combined use of precise pre-bent plates via three-dimensional reconstruction of the proximal tibia in vitro and transparent retractors for auxiliary treatment during surgery. Surgical treatment indicators, treatment outcomes, and the occurrence of complications were analyzed. Knee joint range of motion and knee joint function scores [New York Special Surgery Hospital Score (HSS), International Knee Documentation Committee Score (IKDC)] were compared before and after surgery. Results: At six months post-surgery, the overall excellent and good reduction rate of tibial plateau fractures in 28 patients was 89.29%. The overall incidence of surgical complications within six months post-surgery was 14.29%, with no cases of severe complications observed. The average surgical duration was 145.32 ± 15.07 minutes, the average intraoperative blood loss was 53.52 ± 6.71 ml, and the average time to fracture healing post-surgery was 14.65 ± 2.21 weeks. Compared to pre-surgery, the range of motion of the knee joint, as well as the HSS and IKDC scores of the knee joint, significantly increased at three and six months post-surgery, with statistically significant differences (P < 0.05). Conclusion: The application of three-dimensional reconstruction-based precise pre-bent plates for the proximal tibia and fluoroscopically visible retractors in internal fixation surgery via a joint line incision approach for patients with Schatzker type III–VI tibial plateau fractures can actively enhance surgical efficiency and the effectiveness of internal fixation. Additionally, it can assist in optimizing postoperative fracture reduction and the rehabilitation of knee joint function in patients.