Michael Tanzer

Three-dimensional gait analysis (3DGA) in patients undergoing total hip and knee arthroplasty (THA and TKA, respectively) is impractical for widespread clinical use. This study evaluated the Azure Kinect, combined with the Motognosis AMSA software (AK-M), for the assessment of selected clinically relevant gait parameters in THA and TKA patients compared with reference 3DGA. Twenty participants (10 THA, 10 TKA) were simultaneously assessed using AK-M and Qualisys 3DGA while walking along an 8 m walkway. Discrete peaks of sixteen bilateral gait parameters were compared using Bland–Altman mean bias and 95% limits of agreement (LOAs), with ICC(3,1) as a complementary measure of relative consistency. Maximum hip kinematics and knee extension demonstrated low mean bias. In contrast, maximum knee flexion, knee range of motion, and step length demonstrated larger mean bias and wider LOAs. Cadence and gait speed demonstrated the lowest bias and narrowest LOAs. ICC(3,1) values ranged from 0.84 to 0.95. AK-M showed parameter-specific agreement with 3DGA, supporting preliminary concurrent validity for simplified assessment of selected discrete gait outcomes. Wider LOAs for other parameters identify areas requiring further technical refinement and clinical interpretation. These findings apply to the combined arthroplasty cohort and should not be interpreted as separate THA and TKA cohorts.

Several gait parameters have demonstrated associations with PROMs in THA and TKA. However, existing gait‐PROMs studies are longitudinal and relied on lab‐based or wearable systems. This pilot study aimed to assess cross‐sectional associations between gait parameters measured using a portable, markerless gait analysis system and PROMs 12 months following THA and TKA. In this prospective cross‐sectional study, 58 patients (32 THA, 26 TKA) were assessed at 12 months postoperatively. PROMs consisted of the Oxford Hip/Knee Scores (OHS/OKS), EQ‐5D‐5L, and EQ‐VAS. Gait analysis was conducted using a Kinect‐based markerless motion capture system, and kinematic and spatiotemporal parameters were recorded. Univariate and multivariable linear regressions, subgroup regressions, and correlations analyses were used for the analysis. Greater operated hip flexion in THA patients was significantly associated with better pain and function (OHS; β = 0.335, p = 0.0049) and higher quality of life (EQ‐5D‐5L; β = 0.006, p = 0.0154). In TKA patients, worse knee extension in both the operated (β = –0.453, p = 0.0231) and non‐operated (β = –0.354, p = 0.0134) limbs was associated with lower quality of life (EQ‐VAS). Spatiotemporal parameters including operated step length (β = 0.002, p = 0.0447) and non‐operated stride length (β = 0.126, p = 0.0492) in THA were associated with higher EQ‐5D‐5L. This pilot study provides preliminary evidence supporting the clinical relevance, of specific gait parameters as cross‐sectional measures at 12 months, adding to longitudinal evidence. In addition, this is the first study to demonstrate these associations using a portable, markerless system well‐suited for widespread clinical use. Together, portable markerless gait analysis may serve as a promising objective complement to PROMs for routine postoperative assessment.

Bone healing is a complex regenerative process regulated by interactions between skeletal and host biologic responses, and failure of bone repair remains a major challenge in orthopedic surgery. Using a murine model, this study investigated whether a preemptive priming stimulus could enhance healing of a subsequent contralateral cortical bone defect and whether the type and timing of the stimulus influenced this response. Skeletally mature male mice were randomized into six groups (n = 6/group) receiving either no stimulus, a skin incision, skin and muscle incisions, or a unicortical femoral drill hole stimulus. A subcritical-sized 1 mm × 2 mm unicortical defect was subsequently created in the contralateral femur after intervals of 2, 6, or 12 weeks, depending on group allocation. Femora were harvested 8 weeks later for micro-computed tomography, histology, and immunofluorescence analyses. Mice undergoing muscle elevation 2 weeks prior to defect creation and mice receiving drill hole stimulus 12 weeks prior demonstrated the greatest degree of cortical regeneration and healing of the contralateral subcritical-sized defect, with normalized cortical thicknesses reaching 104% and 109% of adjacent native cortex, respectively. Histologic analysis confirmed restoration of mature cortical architecture in these groups. Immunofluorescence analysis demonstrated a relative shift toward an Arg1-associated reparative macrophage profile with reduced iNOS-associated inflammatory signaling, suggesting that modulation of the innate immune response contributed to the enhanced regenerative healing observed. These findings demonstrate that priming stimuli can enhance subsequent bone healing in a timing- and stimulus-dependent manner and may represent a novel strategy to optimize bone regeneration.

Bacterial infection remains a primary cause of delayed wound healing. It is one of the leading causes of post‐surgical hospital readmission and is a major burden on global health systems. In light of the growing threat of antibiotic resistance, improving efficacy of traditional antimicrobials, such as the broad‑spectrum oxidizing biocide hydrogen peroxide, is of growing importance. In particular, solid peroxy‐compounds can offer prolonged action and sustained delivery of both oxygen and reactive oxygen species, offering both infection control and microenvironmental modulation. This review presents the current progress on antimicrobial dressings, comprehensively covering the application of solid peroxide‐releasing compounds in the treatment of infected wounds for antimicrobial control and acceleration of wound healing. Calcium peroxide (CaO ₂ ) loaded biomaterials are found to be the most studied solid peroxide in the literature (90%; 30 studies), and the average improvement in healing of these reports was 26 ± 14%. However, biomaterial formulations are often complex with multiple ingredients, and an analysis of 17 studies that included peroxide‐free but otherwise complete formulations identified that the improvements in wound healing attributable to peroxide loading itself were significant, P < 0.05, in 8 of 17 studies. Additionally, infected wound healing, the potential biological roles of metal ions, strategies to control ROS/O ₂ release, and the translational outlook/market readiness of peroxide materials are discussed.

Background: Early research involvement during medical training may influence several dimensions of future academic development of which scholarly productivity is one measurable component. This study evaluates whether publication activity during residency, including authorship role, journal impact, and mentor H-index, predicts long-term scholarly productivity among orthopaedic surgery trainees. Methods: A retrospective cohort study of 112 orthopaedic surgery residents at a single academic institution was conducted. Resident publication metrics, including total publications, first-author contributions, and senior author H-index, were collected and correlated with postresidency academic output using bibliometric databases. Pearson and Spearman correlations, analysis of variance, and multivariable linear regression analyses were performed to identify independent predictors of long-term scholarly productivity. Results: Research productivity during residency significantly predicted future scholarly output. Residents with more publications during training had higher postresidency publication counts (r = 0.483, p < 0.001) and H-indices (r = 0.470, p = 0.0004). First-author publications during residency independently predicted postresidency productivity (B = 11.21, p < 0.001), as did coauthorship (B = 9.60, p < 0.001), together explaining 67.4% of the variance in total publications (R ² = 0.674). In addition, mentorship by senior authors with higher H-indices was moderately correlated with future output (r = 0.368, p < 0.001). Conclusion: First-author publication experience during residency and mentorship by academically productive faculty are predictors of long-term scholarly success. These findings underscore the importance of structured research opportunities, with an emphasis on meaningful authorship, and high-impact academic mentorship in training programs to foster future productive orthopaedic surgeons. Level of Evidence: Level III . See Instructions for Authors for a complete description of levels of evidence.

Background: Despite the success of total joint arthroplasty for end-stage hip and knee osteoarthritis, periprosthetic joint infection (PJI) remains a devastating complication and leading cause of revision surgery. Antiseptic irrigation solutions and topical antibiotics are promising and cost-effective strategies for the prevention of PJIs, though high-quality evidence assessing their efficacy is lacking. Therefore, this study investigates the feasibility of conducting a definitive trial to determine the optimal prophylactic treatment of PJIs using various irrigation solutions and topical antibiotics. Methods: Using a simple randomized 3 × 2 factorial trial, patients were randomized across 5 centers to 1 of 6 possible treatments (povidone-iodine, chlorhexidine-gluconate, or saline, with or without vancomycin). Nine criteria were assessed to evaluate feasibility including participant enrollment, administration of treatments, data collection methods, and protocol compliance. Adverse event rates were used to assess trial safety. Secondary outcomes included rates of PJI requiring reoperation and persistent wound drainage (PWD). Results: Four hundred and ninety-five participants were included in the pilot trial. Study participants were 56% female with a mean age of 67 years. Seven of the 9 criteria assessing feasibility indicated the trial was successful and no modifications needed. Two criteria, treatment contamination (8.5%) and completeness of patient follow-up (93.8%), were graded as requiring minor adjustment before conducting the definitive trial. There were 114 serious adverse events; none of which were deemed associated with the treatments. Overall, 9 (1.84%) presented with PJIs requiring reoperation, and 6 patients (1.12%) presented with PWD. Conclusion: This study demonstrates the feasibility and safety of prophylactic irrigation solutions and topical antibiotics. PREVENT-IT has received funding from the Canadian Institutes of Health Research toward the definitive, large, multicenter randomized controlled trial (NCT06126614).Ultimately, findings will directly affect clinical practice with the potential to positively influence global rates of PJI. Level of Evidence: NA.

Background: While many patients report that their symptoms are influenced by weather conditions prior to their knee arthroplasty (TKA), how weather-related pain (WRP) evolves following surgery remains poorly understood. This study investigated the prevalence of WRP prior to and after TKA, assessed whether TKA resolves preoperative WRP, evaluated the incidence of new-onset WRP postoperatively, and identified associated risk factors. Methods: We prospectively surveyed 87 patients (121 TKAs) at a mean follow-up of 9 years (range: 1–26 years). Patients completed a standardized questionnaire assessing WRP before and after surgery, along with patient-reported outcome measures (WOMAC, UCLA activity score, and SF-12). Statistical analysis was performed to assess the associations between WRP and clinical or demographic variables, as well as patient-reported outcome measures (PROMs) in patients with and without WRP. Results: Preoperatively, 31% of patients (37/121 knees) reported WRP. Following TKA, WRP resolved in 48% of these cases (18/37 knees), persisted in 16% (19/121 knees), and developed de novo in 16% of patients (20 knees). Postoperative WRP was significantly associated with the presence of WRP in other joints (p < 0.0001), and with female sex (p < 0.0008). Preoperatively, patients with WRP had worse WOMAC scores for pain (p = 0.046), stiffness (p = 0.012), and physical function (p = 0.024). Despite these differences, all groups demonstrated significant improvement in PROMs postoperatively, with no differences between groups at final follow-up (p > 0.125). Conclusions: TKA leads to the resolution of WRP in nearly half of affected patients; however, a subset develops new or persistent WRP. Female sex, and multi-joint involvement are associated with WRP after TKA. These findings underscore the importance of preoperative counseling regarding expectations for pain relief, particularly in relation to weather sensitivity.