Cyclists present with a broad range of musculoskeletal and neurologic injuries, both traumatic and overuse. The Spaulding Cycling Medicine Clinic is a cycling-specific multidisciplinary sports medicine clinic, employing a collaborative approach to management of cycling injury. This paper outlines the clinic structure and the demographics, training habits, injuries, and biomechanics of 323 adult patients across the first 9 years. The most common areas of chronic discomfort in this group were the knee, hip, and lumbar spine, and knee pain was the most frequent complaint that motivated patients to seek care. Neck pain was noted as an area of discomfort more frequently than as a chief complaint. Patients with a chief complaint of low back pain were more likely to demonstrate posterior pelvic tilt and lumbopelvic asymmetry on the bicycle. This is the first work we know of to comprehensively evaluate demographics, clinical presentation, and bicycle fit for a large sample of cyclists.

Developmental dysplasia of the hip (DDH) is a common congenital pediatric orthopedic malformation that often requires open reduction combined with pelvic osteotomy, resulting in severe postoperative pain. Pediatric patients under 2 years old have immature anatomical and physiological characteristics, high sensitivity to opioid analgesics, and an inability to subjectively express pain, which makes perioperative analgesia and anesthesia management a major clinical challenge. Traditional opioid-based analgesic regimens carry a high risk of adverse reactions such as respiratory depression and restlessness, which hinder postoperative recovery. This case reports the optimized perioperative anesthesia and analgesia management strategy for a 19-month-old female infant (12 kg, ASA Ⅰ) with right DDH undergoing open hip reduction and pelvic osteotomy, and preliminarily explores the clinical application value, efficacy and safety of ultrasound-guided type Ⅱ QLB in infant DDH surgery. A composite anesthesia strategy of general anesthesia combined with ultrasound-guided type Ⅱ QLB (0.2% ropivacaine, 0.5 mL/kg, total 6 mL) was adopted, with optimized perioperative management including precise airway selection, targeted vital sign monitoring, and multimodal postoperative analgesia (PCIA+on-demand oral acetaminophen). Pain was evaluated using the FLACC behavioral scale, and vital signs and adverse reactions were closely monitored postoperatively. The infant's 24-hour postoperative FLACC scores were all ≤2 points without the need for rescue analgesics, with significantly reduced opioid consumption (intraoperative sufentanil 6 μg, 24-hour PCIA tramadol 70 mg) compared with traditional regimens. Vital signs remained stable postoperatively, with no adverse reactions such as restlessness, nausea/vomiting, urinary retention, or local hematoma. The infant achieved independent turning and sitting at 48 h postoperatively and was discharged uneventfully at 14 days with no long-term complications, and parental analgesia satisfaction was 9/10. Ultrasound-guided type Ⅱ QLB combined with general anesthesia is a safe and effective perioperative management strategy for infant DDH surgery, which addresses pediatric-specific perioperative analgesia challenges, reduces opioid-related adverse reactions, and improves postoperative comfort. Strict control of local anesthetic dosage, proficient ultrasound localization for immature pediatric anatomy, and multimodal analgesia are the key to successful perioperative management, which provides a valuable clinical reference for pediatric orthopedic anesthesia practice.

Knee osteoarthritis (KOA) causes pain, functional impairments, and sleep disturbances. This study aimed to assess differences in pain pattern, insomnia, function, and muscle strength across Kellgren-Lawrence grades in patients with KOA. In this cross-sectional study, 82 patients (65.8 ± 7.8 years) were categorized into Kellgren-Lawrence Grade 2 (n = 20), Grade 3 (n = 20), and Grade 4 (n = 42). Pain (VAS, ICOAP), insomnia (ISI), knee function (KOS-ADLS), functional performance (Timed-Up and Go [TUG], Five Times Sit-to-Stand [FTSST]), and isometric muscle strength were evaluated. Comparisons were performed using ANCOVA, adjusting for age and BMI. Groups differed significantly in age and BMI (p < 0.001 and p = 0.024), with higher values in Grade 4. Significant between-group differences were observed in VAS (p = 0.006), ICOAP-constant pain (p = 0.037), ICOAP-total pain (p = 0.035), TUG (p = 0.021), KOS-ADLS (p = 0.015), and quadriceps strength of the affected knee (p < 0.001) and hip adductor strength (p = 0.046). No significant differences were found for ICOAP-intermittent pain, ISI, or non-affected knee quadriceps strength (p > 0.05). Pairwise comparisons showed that Grade 4 patients had significantly worse outcomes than Grade 2 in VAS (p = 0.013), ICOAP-constant pain (p = 0.041), and total pain (p = 0.047), and TUG (p = 0.025), as well as reduced quadriceps strength of both affected (p < 0.001) and non-affected (p = 0.019) knees. Differences between Grades 2 and 3 were limited to VAS (p = 0.026), while Grades 3 and 4 differed only in KOS-ADLS (p = 0.022). Higher Kellgren-Lawrence grades were associated with greater pain, poorer function, and reduced quadriceps strength, particularly in Grade 4, emphasizing the clinical relevance of radiographic grading in characterizing symptom burden in KOA.

Inflammatory pseudotumor (IP) is an increasingly recognized etiological factor in the failure of total hip arthroplasty (THA). It is a non-neoplastic, non-infectious mass encircling a hip prosthesis following arthroplasty and may appear as cystic, solid, or mixed tissue. Although initially associated with metal-on-metal (MoM) bearing surfaces, IP formation can also occur with other bearing types. Recognized risk factors include female sex, specific genetic predispositions, MoM bearings, large femoral head size, modular femoral stem designs, elevated metal ion levels, and wear debris from polyethylene components. IP contributes to THA failure through both mechanical and inflammatory mechanisms, often leading to pain, instability, or implant loosening. Diagnosis relies heavily on imaging modalities, including plain radiographs, ultrasound, CT, and MRI with metal artifact reduction sequences (MARS-MRI), which help delineate the extent and characteristics of IP lesions. A multimodal imaging approach is essential for accurate assessment and surgical planning. Management strategies are guided by clinical presentation and radiographic findings, such as IP size and anatomical location, ranging from close observation in asymptomatic cases to revision surgery in symptomatic or progressive disease. IP is therefore an important, imaging-detectable cause of THA failure, and awareness of its presentation and diagnostic features is critical for timely intervention and improved patient outcomes.