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Objective To evaluate the implementation process of a community-based, multidisciplinary intervention (CONNACT) through a randomized controlled trial (RCT) in order to contextualize the RCT outcomes and inform implementation opportunities. Methods This study is an embedded qualitative process evaluation of the CONNACT effective-implementation hybrid RCT. Semi-structured interviews with 22 intervention patients and 14 healthcare professionals were conducted. Interviews were audio-recorded, transcribed and translated using framework analysis. Data was analysed thematically and the emergent themes were organised into the conceptual domains of RE-AIM. An explanatory sequential methods approach was used to discuss the Reach and Effectiveness domains of RE-AIM, whereby quantitative data (i.e. recruitment logs and published quantitative results) was discussed in relation to this study’s qualitative data. Results Reach : 55.4% of the patients who met the inclusion criteria participated, while work or family commitments and disinterest in physiotherapy are the primary reasons for declining participation. Effectiveness : CONNACT intervention is not superior to control hospital-based usual care in terms of pain, function, and quality of life, but superior in physical performance, knee satisfaction, global perceived effect and positive dietary change. The results and effectiveness of CONNACT are presented and discussed in a related publication. Adoption : Healthcare professionals proposed changes for long-term sustainability (transdisciplinary approach, expert patients) despite their strong support for CONNACT. Implementation (context) : A spectrum of passive-resigned and impatient-unrealistic mindsets, pain beliefs, and expectations was elucidated. Implementation (mechanism of impact) : Focus on patient education and empowerment encouraged patients to actively accept their condition and practice self-efficacy. Although group classes are a source of support, motivation, and positive peer pressure, several patients preferred personalized treatments. CONNACT’s synergistic nature benefitted patients who are more complex. Maintenance (patient-level) : Patients highlighted the importance of incorporating exercise into their regular routines, but lack of time and inertia remain as significant barriers. Conclusion The themes have allowed a better understanding of the RCT primary and secondary outcomes and informed the next phase of implementation. CONNACT and similar interventions should identify and address reasons for refusing participation [Reach]; improve group classes with initial evaluations, equal attention paid to patients, tailored exercises, and acknowledge progress [Effectiveness, Implementation]; and adopt a streamlined resource-efficient transdisciplinary design [Maintenance]. Trial registration This study, which primarily employs qualitative methods for data collection, is not a clinical trial (clinical trial number: not applicable). Ethics approval (NHG DSRB ref no: 2020/00067;) was obtained before commencement of this study.

The utility of nanotechnology in medicine, specifically within the field of orthopedics, is a topic of extensive research. Our review provides a unique comprehensive overview of the current and potential future uses of nanotechnology with respect to orthopedic sub-specialties. Nanotechnology offers an immense assortment of novel applications, most notably the use of nanomaterials as scaffolds to induce a more favorable interaction between orthopedic implants and native bone. Nanotechnology has the capability to revolutionize the diagnostics and treatment of orthopedic surgery, however the long-term health effects of nanomaterials are poorly understood and extensive research is needed regarding clinical safety.

Anterior shoulder dislocation is a common orthopedic emergency. While many reduction methods require sedation, the FARES (FAst, REliable, and Safe) and Spaso methods allow reduction without anesthesia. We conducted a single-center, prospective, randomized controlled trial comparing the FARES and Spaso methods for anterior shoulder dislocation reduction. Patients aged 20 to 90 years were enrolled. The assigned closed reduction procedures were performed without patient sedation by trained orthopedic residents. If two attempts with the assigned method failed, the alternative method was used. The primary outcome was the first-attempt success rate, while secondary outcomes included overall success rate with both methods, reduction time, and pain scores. During November 2013 and December 2015, a total of 32 patients were randomized to the FARES (n = 17) or Spaso (n = 15) method. The first-attempt success rates were 71.6% for the FARES group and 80.0% for the Spaso group ( p  = 0.691). Among patients with failed closed reduction using the first technique, all patients in the Spaso-following-FARES group achieved successful reduction, whereas none in the FARES-following-Spaso group achieved successful reduction ( p  = 0.092). Pain scores during reduction were comparable between the FARES (4.29 ± 1.69) and Spaso (3.80 ± 2.65) techniques, with no statistically significant difference ( p  = 0.542). Follow-up data were available for 28/32 patients (87.5%; mean 5.3 ± 2.2 years). Four patients were lost (3 FARES, 1 Spaso; p  = 0.726). Recurrent dislocation occurred in 3 patients (10.7%; 1 FARES, 2 Spaso; p  = 0.947), and 2 patients (1 per group; p  = 0.876) underwent surgery (arthroscopic stabilization and rotator cuff repair). Both the FARES and Spaso methods were effective for reducing anterior shoulder dislocations. Combining these methods may improve overall reduction rates. Clinical trial registration: This trial was registered at ClinicalTrials.gov (Registration number: NCT01979237) on 08/11/2013.

Background and challenges Writing and publishing research is important in the fields of orthopaedic surgery, and medicine in general. In recent years, the number of orthopaedic publications has significantly increased, highlighting the value of possessing the ability to write and publish a paper. However, publishing research is not an easy task, especially if English is not a native language. Non-native English speakers have been reported to experience barriers to writing and publishing research in English, the dominant language of scientific publication. This affects not only individual researchers, but also the scientific community in general. To improve reporting in scientific manuscripts, many peer-reviewed guidelines have been published for a variety of study designs and study types. These guidelines are made available through the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network and have associated checklists that guide authors in the synthesis of their research manuscript. Purpose Whether you are a non-native English speaker or a novice research writer, these checklists can ameliorate the process of building your manuscript. The purpose of this paper is to empower orthopaedic researchers, and researchers in general, through an easy-to-follow framework for writing a research manuscript using available checklists and general research knowledge.

Background Few studies have investigated the effects of mobilization with movement (MWM) in patients with knee osteoarthritis (OA) compared to other procedures. Sham procedures are generally more appropriate control than using no or usual treatments. Moreover, studies investigating the widespread hypoalgesic effects of MWM in patients with knee OA are lacking. The aim was to investigate the effect of MWM on function and pain in patients with knee OA compared to sham MWM. Methods This is a randomized double-blind (patients and assessor) controlled trial. Forty adult patients with knee OA of grade II and above were recruited to receive either MWM treatment or sham MWM for the knee. The outcome measures included the following: a visual analogue scale (VAS) for pain, the pressure pain threshold (PPT) test, the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index, the timed up and go (TUG) test, knee strength and knee range of motion (ROM). The measurements were taken at baseline, immediately after intervention and 2 days later. Results Compared with sham MWM, MWM resulted in greater immediate improvement in pain [mean difference (95% CI): − 2.2 (− 2.8, − 1.6)], PPT at both the knee [176 (97, 254)] and shoulder [212 (136, 288)], TUG time [− 1.6 (− 2.1, − 1.1)], knee flexor strength [2.0 (1.3, 2.7)] and extensor strength [5.7 (4.1, 7.2)] and knee flexion ROM [12.8 (9.6, 15.9)] (all, p  < 0.001) but not knee extension ROM [− 0.8 (− 1.6, 0.1)] ( p  = 0.067). After 2 days of intervention, patients who received MWM also demonstrated a greater improvement in pain [− 1.0 (− 1.8, − 0.1)], PPT at the shoulder [107 (40, 175)], TUG time [− 0.9 (− 1.4, − 0.4)], knee flexor strength [0.9 (0.2, 1.7)] and extensor strength [2.9 (2.1, 3.9)] and knee flexion ROM [8.3 (4.7, 11.9)] (all, p  ≤ 0.026). However, WOMAC scores and knee extension ROM showed no evidence of change at any stage after intervention ( p  ≥ 0.067). Conclusions MWM provided superior benefits over sham MWM in terms of local and widespread pain, physical function (walking), knee flexion and extension muscle strength and knee flexion ROM for at least 2 days in patients with knee OA. Trial registration ClinicalTrials.gov ( NCT02865252 ), registered on August 12, 2016.

Orthopaedic implants have significantly improved the treatment of musculoskeletal injuries and degenerative diseases, restoring function and alleviating pain. However, long-term implant success remains challenging due to loosening, wear, and infections. Recent advancements in materials science, bioengineering, and digital technologies are driving innovations in orthopaedic implants, enhancing their performance and patient outcomes. New biomaterials, such as advanced metal alloys, polymers, ceramics, and nanocomposites, offer superior biocompatibility and mechanical durability, minimizing adverse reactions. Additive manufacturing (3D printing) allows the creation of patient-specific implants with porous architectures closely resembling natural bone, enhancing osseointegration. Additionally, surface engineering techniques, including bioactive coatings for improved bone bonding and antimicrobial layers for infection prevention, address persistent issues at the implant-tissue interface. The emergence of “smart” implants equipped with sensors and wireless connectivity enables real-time monitoring of biomechanical parameters, paving the way for personalized, data-driven orthopaedic care. This review summarizes significant developments in orthopaedic implant technology from 2020 to 2025, highlighting advances in materials, design, and functionality. We discuss how these innovations address traditional challenges and examine remaining hurdles to clinical application. Future directions, such as biodegradable implants that eliminate secondary surgeries and AI-assisted implant design, are also explored. Collectively, these breakthroughs promise a new era in orthopaedic treatments, marked by enhanced implant longevity, functionality, and patient quality of life.

The principal aim of this study was to present a novel approach to manipulative repositioning for the management of anterior shoulder dislocation. This was evaluated in comparison with the established repositioning method to ascertain its clinical efficacy. Seventy-six patients with anterior dislocation of the shoulder joint were randomly assigned to one of two groups. Each group underwent reducing using either Tang’s method or Hippocrates’ method, respectively. The patients were then monitored for six months. The researchers analyzed and compared the general condition, reduction time, reduction success rate, VAS score, and ASES score of the patients in the two groups. No statistically significant difference was observed in the general condition of the patients prior to the reduction between the two groups. The mean reduction time for the Tang’s method group (70.9 ± 11.88) was found to be significantly shorter than that observed for the Hippocrates method group (411.6 ± 50.41). The reduction success rate was significantly higher in the Tang’s method group (100.00%) than in the Hippocrates method group (80.56%). No statistically significant difference was observed in VAS scores between the two groups prior to the reduction. However, the Tang’s method group demonstrated superior outcomes compared to the Hippocrates method group during and following the reduction. No statistically significant difference was observed in ASES scores between the two groups prior to the reduction. However, at one, three, and six months post-reduction, the Tang’s method group exhibited significantly superior outcomes compared to the Hippocrates method group. The Tang’s method is a safe and effective method of reducing for anterior dislocation of the shoulder. It is significantly superior to the traditional Hippocrates method.

Background The past century has witnessed the rapid development of operation technique, surgical instruments, and knowledge of the diseases in orthopedics. In the academic history, a number of classic papers boosted the advancement for surgery. In this paper, we performed a bibliometric analysis, aiming to determine the most influential studies within the field. Methods Articles were searched from the publication year of 1900 to 2016 according to the Science Citation Index Expanded database of the Clarivate Analytics Web of Science Core Collection database. Two citation indicators TC year and C year were employed to characterize the classic articles and the articles were identified and analyzed. Results A total of 30 classic articles with TC 2016  ≥ 1000 in Web of Science category of orthopedics were identified, all written in English between 1961 and 2007 by nine countries. The minimal value of TC 2016 was 1010; the maximum 3570; and the average 1591. Thirty classic articles were published in eight journals that were listed in the Web of Science category of orthopedics in 2016, and in two other orthopedics journals that were no longer tracked by Web of Science category of orthopedics as of 2016. Among the top 10 cited articles in both TC 2016 and C 2016 , five articles barely received attention in the first few years after their publication, while they became cited more and more frequently in the last decade. Conclusion This study evaluated the development and trend of orthopedics research by adopting bibliometric analysis. It serves as a guide for investigators in the future research.

Surgical education videos currently all use a single point of view (POV) with the trainee locked onto a fixed viewpoint, which may not deliver sufficient information for complex procedures. We developed a novel multiple POV video system and evaluated its training outcome compared with traditional single POV. We filmed a hip resurfacing procedure performed by an expert attending using 8 cameras in theatre. 30 medical students were randomly and equally allocated to learn the procedure using the multiple POV (experiment group [EG]) versus single POV system (control group [CG]). Participants advanced a pin into the femoral head as demonstrated in the video. We measured the drilling trajectories and compared it with pre-operative plan to evaluate distance of the pin insertion and angular deviations. Two orthopedic attendings expertly evaluated the participants' performance using a modified global rating scale (GRS). There was a pre-video knowledge test that was repeated post-simulation alongside a Likert-scale questionnaire. The angular deviation of the pin in EG was significantly less by 29% compared to CG (p = 0.037), with no significant difference in the entry point's distance between groups (p = 0.204). The GRS scores for EG were 3.5% higher than CG (p = 0.046). There was a 32% higher overall knowledge test score (p<0.001) and 21% improved Likert-scale questionnaire score (p = 0.002) after video-learning in EG than CG, albeit no significant difference in the knowledge test score before video-learning (p = 0.721). The novel multiple POV provided significant objective and subjective advantages over single POV for acquisition of technical skills in hip surgery.

Nanotechnology has made significant progress in various fields, including medicine, in recent times. The application of nanotechnology in drug delivery has sparked a lot of research interest, especially due to its potential to revolutionize the field. Researchers have been working on developing nanomaterials with distinctive characteristics that can be utilized in the improvement of drug delivery systems (DDS) for the local, targeted, and sustained release of drugs. This approach has shown great potential in managing diseases more effectively with reduced toxicity. In the medical field of orthopedics, the use of nanotechnology is also being explored, and there is extensive research being conducted to determine its potential benefits in treatment, diagnostics, and research. Specifically, nanophase drug delivery is a promising technique that has demonstrated the capability of delivering medications on a nanoscale for various orthopedic applications. In this article, we will explore current advancements in the area of nanostructured DDS for orthopedic use.