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The immune system plays a critical role in the union process after arthrodesis; however, the systemic osteoimmunological response has not been clearly defined. In this study, we investigated immune cell dynamics in patients who underwent SA using single\u2010cell RNA sequencing (scRNA\u2010seq). Peripheral blood mononuclear cells (PBMCs) were collected before surgery and 3\u2009months after the operation. The degree of bone fusion was assessed using computed tomography (CT) scans at 3\u2009months, and patients were categorised into early union (EU) and delayed union (DU) groups. scRNA\u2010seq analysis was performed to examine immune cell composition, gene expression and functional pathways. Monocytes in the EU group showed enhanced antigen processing and presentation, whereas those in the DU group demonstrated increased phagocytic activity. NK cells in the DU group exhibited stronger cytotoxicity through Fc\u2010gamma receptor signalling and antibody\u2010dependent cellular cytotoxicity (ADCC) pathways, while NK cells in the EU group showed higher chemokine and cytokine activity. These immune differences persisted postoperatively, suggesting that variations in the systemic immune environment may influence bone healing outcomes. Our findings emphasise the important roles of monocytes and NK cells in bone union and suggest that immunomodulatory approaches could help improve bone repair.<\/jats:p>","DOI":"10.1111\/jcmm.70980","type":"journal-article","created":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T03:55:05Z","timestamp":1765511705000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Deciphering the Osteoimmune Landscape in Subtalar Arthrodesis: A Single\u2010Cell RNA Sequencing Approach"],"prefix":"10.1111","volume":"29","author":[{"given":"Hansong","family":"Lee","sequence":"first","affiliation":[{"name":"Medical Research Institute Pusan National University  Yangsan Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kihun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Occupational and Environmental Medicine Pusan National University Yangsan Hospital  Yangsan 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