{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T03:54:10Z","timestamp":1790913250224,"version":"4.1.0"},"reference-count":109,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Orthopedic disorders are still classified mainly by anatomy or end\u2010stage morphology, yet osteoporosis, osteoarthritis, fracture nonunion, spinal degeneration, and bone\u2010implant interface failure share a common mechanobiological logic: external load is filtered by hierarchical tissue architecture, converted into cell\u2010scale signals, and integrated with inflammation, metabolism, and repair capacity to determine whether adaptation or failure occurs. This structured narrative review synthesizes recent evidence on multiscale biomechanics, finite element analysis (FEA), mechanotransduction biology, tissue engineering, and emerging digital\u2010twin approaches. Rather than introducing a separate disease entity, we define the orthopedic mechanophenotype as a clinically oriented integrative framework that describes the disease\u2010relevant state generated by three interacting axes: load exposure, tissue susceptibility, and biological adaptability. We summarize how this three\u2010axis state differs across bone, articular cartilage and the osteochondral unit, the intervertebral disc, fracture repair, and bone\u2010implant interfaces. Particular emphasis is placed on evidence hierarchy, model assumptions, and persistent uncertainties, including timescale mismatch, idealized boundary conditions, incomplete cross\u2010scale validation, and overinterpretation of cell\u2010level causality from organ\u2010level surrogates. We further illustrate how mechanophenotyping can be integrated with existing clinical pathways for osteoarthritis load redistribution, fracture fixation and rehabilitation, and spinal or implant\u2010related planning. The central argument is that future progress will depend less on accumulating isolated mechanical variables and more on validated cross\u2010scale markers that connect real\u2010world loading, patient\u2010specific structure, and stage\u2010dependent biology to actionable orthopedic decisions.<\/jats:p>","DOI":"10.1111\/os.70421","type":"journal-article","created":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T01:29:06Z","timestamp":1789176546000},"page":"2045-2059","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Orthopedic Mechanophenotype: A Structured Narrative Review of Multiscale Biomechanics, Mechanotransduction, and Clinical Decision\u2010Making"],"prefix":"10.1111","volume":"18","author":[{"given":"Zihao","family":"Lan","sequence":"first","affiliation":[{"name":"The First School of Clinical Medicine, Yunnan University of Chinese Medicine  Kunming China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhipeng","family":"Mu","sequence":"additional","affiliation":[{"name":"The First School of Clinical Medicine, Yunnan University of Chinese Medicine  Kunming China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8158-1087","authenticated-orcid":false,"given":"Hongjian","family":"Li","sequence":"additional","affiliation":[{"name":"The First School of Clinical Medicine, Yunnan University of Chinese Medicine  Kunming China"},{"name":"The First People's Hospital of Yunnan Province  Kunming China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,11]]},"reference":[{"key":"e_1_2_17_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pbiomolbio.2017.09.022"},{"key":"e_1_2_17_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2021.116032"},{"key":"e_1_2_17_4_1","doi-asserted-by":"publisher","DOI":"10.1098\/rsif.2024.0361"},{"key":"e_1_2_17_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbrc.2025.152524"},{"key":"e_1_2_17_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpj.2022.01.012"},{"key":"e_1_2_17_7_1","doi-asserted-by":"publisher","DOI":"10.3390\/biom15060848"},{"key":"e_1_2_17_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/jbm.a.37478"},{"key":"e_1_2_17_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40824-023-00393-8"},{"key":"e_1_2_17_10_1","doi-asserted-by":"publisher","DOI":"10.3389\/fbioe.2022.893337"},{"key":"e_1_2_17_11_1","doi-asserted-by":"publisher","DOI":"10.22203\/eCM.v044a04"},{"key":"e_1_2_17_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2020.115328"},{"key":"e_1_2_17_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.medengphy.2025.104369"},{"key":"e_1_2_17_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/burnst\/tkaf019"},{"key":"e_1_2_17_15_1","doi-asserted-by":"publisher","DOI":"10.1039\/D0SM01106A"},{"key":"e_1_2_17_16_1","doi-asserted-by":"publisher","DOI":"10.1088\/1758-5090\/ad30c7"},{"key":"e_1_2_17_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/mabi.202300042"},{"key":"e_1_2_17_18_1","doi-asserted-by":"publisher","DOI":"10.1172\/jci.insight.178578"},{"key":"e_1_2_17_19_1","doi-asserted-by":"publisher","DOI":"10.3390\/bioengineering12030320"},{"key":"e_1_2_17_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.xinn.2026.101307"},{"key":"e_1_2_17_21_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.2509566122"},{"key":"e_1_2_17_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2023.11.015"},{"key":"e_1_2_17_23_1","doi-asserted-by":"publisher","DOI":"10.1063\/5.0085025"},{"key":"e_1_2_17_24_1","doi-asserted-by":"publisher","DOI":"10.3389\/fbioe.2020.00093"},{"issue":"1","key":"e_1_2_17_25_1","first-page":"23","article-title":"Frontiers in Mechanobiology and Mechanomedicine","volume":"3","author":"Hwang P. Y.","year":"2025","journal-title":"Med X"},{"key":"e_1_2_17_26_1","doi-asserted-by":"publisher","DOI":"10.1063\/5.0307361"},{"key":"e_1_2_17_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10439-025-03910-z"},{"key":"e_1_2_17_28_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41413-022-00222-z"},{"key":"e_1_2_17_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.medengphy.2022.103824"},{"key":"e_1_2_17_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmpb.2023.107419"},{"key":"e_1_2_17_31_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10237-022-01581-6"},{"key":"e_1_2_17_32_1","doi-asserted-by":"publisher","DOI":"10.1038\/s12276-025-01546-6"},{"key":"e_1_2_17_33_1","doi-asserted-by":"publisher","DOI":"10.1177\/0954411920936047"},{"key":"e_1_2_17_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.actbio.2020.06.008"},{"key":"e_1_2_17_35_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms23168931"},{"key":"e_1_2_17_36_1","doi-asserted-by":"publisher","DOI":"10.1177\/17534259241249287"},{"key":"e_1_2_17_37_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13036-019-0197-9"},{"key":"e_1_2_17_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.aanat.2025.152772"},{"key":"e_1_2_17_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2026.01.003"},{"key":"e_1_2_17_40_1","doi-asserted-by":"publisher","DOI":"10.1002\/jor.24292"},{"key":"e_1_2_17_41_1","doi-asserted-by":"publisher","DOI":"10.1080\/19336950.2021.1903184"},{"key":"e_1_2_17_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmbbm.2024.106628"},{"key":"e_1_2_17_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mbm.2025.100162"},{"key":"e_1_2_17_44_1","doi-asserted-by":"publisher","DOI":"10.1177\/10738584221088575"},{"key":"e_1_2_17_45_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41413-024-00375-z"},{"key":"e_1_2_17_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.actbio.2025.08.048"},{"key":"e_1_2_17_47_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2025.1595228"},{"key":"e_1_2_17_48_1","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.70062"},{"key":"e_1_2_17_49_1","doi-asserted-by":"publisher","DOI":"10.1002\/jsp2.70089"},{"key":"e_1_2_17_50_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12011-018-1322-1"},{"key":"e_1_2_17_51_1","doi-asserted-by":"publisher","DOI":"10.12659\/MSM.948290"},{"key":"e_1_2_17_52_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcell.2022.997365"},{"key":"e_1_2_17_53_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbiomech.2020.110148"},{"key":"e_1_2_17_54_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.compbiomed.2020.103937"},{"key":"e_1_2_17_55_1","doi-asserted-by":"publisher","DOI":"10.1089\/ten.teb.2023.0157"},{"key":"e_1_2_17_56_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00018-024-05331-y"},{"key":"e_1_2_17_57_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41374\u2010021\u201000668\u20105"},{"key":"e_1_2_17_58_1","doi-asserted-by":"publisher","DOI":"10.1186\/s10020-021-00360-w"},{"key":"e_1_2_17_59_1","doi-asserted-by":"publisher","DOI":"10.17305\/bb.2024.11156"},{"key":"e_1_2_17_60_1","doi-asserted-by":"publisher","DOI":"10.1109\/TBME.2024.3361893"},{"key":"e_1_2_17_61_1","doi-asserted-by":"publisher","DOI":"10.1002\/cnm.3609"},{"key":"e_1_2_17_62_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12903\u2010025\u201005586\u20102"},{"key":"e_1_2_17_63_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2026.113104"},{"key":"e_1_2_17_64_1","doi-asserted-by":"publisher","DOI":"10.1111\/os.13021"},{"key":"e_1_2_17_65_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2020.01.006"},{"key":"e_1_2_17_66_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2665\u20109913(25)00151\u20101"},{"key":"e_1_2_17_67_1","doi-asserted-by":"publisher","DOI":"10.1002\/advs.202100363"},{"key":"e_1_2_17_68_1","doi-asserted-by":"publisher","DOI":"10.1021\/jacsau.5c00669"},{"key":"e_1_2_17_69_1","doi-asserted-by":"publisher","DOI":"10.1021\/acsbiomaterials.2c01377"},{"key":"e_1_2_17_70_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0271301"},{"key":"e_1_2_17_71_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bonr.2019.100216"},{"key":"e_1_2_17_72_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2023.1232698"},{"key":"e_1_2_17_73_1","doi-asserted-by":"publisher","DOI":"10.3389\/fbioe.2021.603444"},{"key":"e_1_2_17_74_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ultrasmedbio.2024.07.003"},{"key":"e_1_2_17_75_1","doi-asserted-by":"publisher","DOI":"10.3892\/mmr.2017.6327"},{"key":"e_1_2_17_76_1","doi-asserted-by":"publisher","DOI":"10.1002\/advs.202518788"},{"key":"e_1_2_17_77_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms24129814"},{"key":"e_1_2_17_78_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13018-025-05484-x"},{"key":"e_1_2_17_79_1","doi-asserted-by":"publisher","DOI":"10.3389\/fbioe.2025.1600020"},{"key":"e_1_2_17_80_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmbbm.2020.104292"},{"key":"e_1_2_17_81_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bioactmat.2025.02.021"},{"key":"e_1_2_17_82_1","doi-asserted-by":"publisher","DOI":"10.1115\/1.4054439"},{"key":"e_1_2_17_83_1","doi-asserted-by":"publisher","DOI":"10.1177\/03913988241259969"},{"key":"e_1_2_17_84_1","doi-asserted-by":"publisher","DOI":"10.21037\/qims-20-1156"},{"key":"e_1_2_17_85_1","doi-asserted-by":"publisher","DOI":"10.3390\/jpm15070298"},{"key":"e_1_2_17_86_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.xnsj.2025.100598"},{"key":"e_1_2_17_87_1","doi-asserted-by":"publisher","DOI":"10.1515\/bmt-2024-0158"},{"issue":"6","key":"e_1_2_17_88_1","article-title":"An Outline on the Advancements in Surgical Management of Osteoporosis\u2010Associated Fractures","volume":"16","author":"Hakami I. A.","year":"2024","journal-title":"Cureus"},{"key":"e_1_2_17_89_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41413-019-0066-7"},{"key":"e_1_2_17_90_1","doi-asserted-by":"publisher","DOI":"10.3390\/bioengineering12060580"},{"key":"e_1_2_17_91_1","doi-asserted-by":"publisher","DOI":"10.33594\/000000818"},{"key":"e_1_2_17_92_1","doi-asserted-by":"publisher","DOI":"10.1111\/os.13980"},{"key":"e_1_2_17_93_1","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics15222918"},{"key":"e_1_2_17_94_1","doi-asserted-by":"publisher","DOI":"10.4274\/MMJ.galenos.2026.48733"},{"key":"e_1_2_17_95_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13018-022-03299-8"},{"key":"e_1_2_17_96_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-025-07385-0"},{"key":"e_1_2_17_97_1","doi-asserted-by":"publisher","DOI":"10.1093\/bmb\/ldag012"},{"key":"e_1_2_17_98_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.actbio.2021.08.007"},{"key":"e_1_2_17_99_1","doi-asserted-by":"publisher","DOI":"10.3390\/ma16113946"},{"key":"e_1_2_17_100_1","doi-asserted-by":"publisher","DOI":"10.3390\/ma14226833"},{"key":"e_1_2_17_101_1","doi-asserted-by":"publisher","DOI":"10.1177\/0022034518778033"},{"key":"e_1_2_17_102_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.medengphy.2019.03.006"},{"key":"e_1_2_17_103_1","doi-asserted-by":"publisher","DOI":"10.3390\/ma18235421"},{"key":"e_1_2_17_104_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms24010208"},{"key":"e_1_2_17_105_1","doi-asserted-by":"publisher","DOI":"10.3390\/antiox11081571"},{"key":"e_1_2_17_106_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4939-9095-5_11"},{"key":"e_1_2_17_107_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361-6560\/ab453d"},{"key":"e_1_2_17_108_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semcdb.2017.06.019"},{"key":"e_1_2_17_109_1","doi-asserted-by":"publisher","DOI":"10.3390\/children11010090"},{"key":"e_1_2_17_110_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinbiomech.2021.105405"}],"container-title":["Orthopaedic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/os.70421","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/os.70421","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/os.70421","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T02:58:48Z","timestamp":1790909928000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/os.70421"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,11]]},"references-count":109,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1111\/os.70421"],"URL":"https:\/\/doi.org\/10.1111\/os.70421","archive":["Portico"],"relation":{},"ISSN":["1757-7853","1757-7861"],"issn-type":[{"value":"1757-7853","type":"print"},{"value":"1757-7861","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,11]]},"assertion":[{"value":"2026-05-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-26","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-11","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}