Weekly Digest

Key Takeaway: Anterior MIPO with reverse PHILOS achieved radiological union 1.8 weeks faster than posterior ORIF with EA-LCP (16.3 vs 18.1 weeks, p=0.001) with lower blood loss and operative time, but equivalent 6-month functional outcomes.

Key Takeaway: A lidocaine-bupivacaine spinal mixture achieved 0% TNS incidence with mean motor block resolution at 198 minutes and discharge readiness at 359 minutes across 208 outpatient TJA cases.

Key Takeaway: Romosozumab increased pedicle screw shear bone strength by 24.7% at 12 months versus -2.2% for placebo and 14.8% for teriparatide in postmenopausal women with low BMD, as measured by BCT-based virtual stress testing.

Key Takeaway: The triple-tapered collared (TTC) cementless stem produces minimal proximal femoral stress shielding at one year, with BMD ratios across all Gruen zones ranging 0.91–1.03 and no zone reaching statistical significance.

Key Takeaway: For 1- to 2-level DCM, ACDF produced significantly greater VAS neck pain improvement than posterior decompression (-22.6 vs. -6.1 mm, P=0.003), but both approaches yielded equivalent JOA neurological recovery at 2 years.

Key Takeaway: Oncologic rTSA patients had 22% dislocation and 52% reoperation rates versus 0% and 10% in matched nononcologic controls, yet rTSA-APC achieved superior MSTS scores over rTSA-alone (80% vs. 37%, p=0.04) despite higher axillary nerve resection rates.

Key Takeaway: Normalized rotator cuff muscle volume showed no significant correlation with functional outcomes or ROM after rTSA in either OA or CTA patients across 528 cases at mean 29.1 months follow-up.

Key Takeaway: Navigation use in pediatric posterior spinal fusion increased from 2.0% in 2016 to 15.6% in 2022, with navigated cases showing lower allogeneic transfusion rates but longer operative times.

Key Takeaway: rTSA achieved 109° abduction versus 32° with hemiarthroplasty in oncologic proximal humerus replacement, with equivalent overall implant survival despite shorter time to failure in the rTSA group (2.1 vs. 55.2 months).

Key Takeaway: In 427 presumed AIS patients undergoing PSF, only 1.9% required neurosurgical intervention for intraspinal anomalies, and all had concomitant neurological symptoms, suggesting universal preoperative MRI may be replaceable by selective screening.

Key Takeaway: In 548 patients with Grade I degenerative lumbar spondylolisthesis, decompression with instrumented fusion produced no statistically significant PROM advantage over decompression alone at 24 months (EQ-5D 0.23 vs 0.17, p=0.119) but carried a higher perioperative adverse event rate (17.1% vs 9.4%) and nearly tripled hospital stay (3.68 vs 1.25 days).

Key Takeaway: Glenoid vault CT Hounsfield units <160 HU confer a 3-fold increased risk (RR 3.00, 95% CI 1.28–7.02) of ORIF failure requiring revision to arthroplasty in displaced proximal humerus fractures.

Key Takeaway: In 1,378 primary THAs using monobloc dual-mobility cups, dislocation rate was 0% with DAA versus 0.4% with posterolateral approach, a non-significant difference (P=0.16).

Key Takeaway: SPECT/CT reliably detects acromial and scapular spine stress fractures after RSA but cannot reliably differentiate infection, heterotopic ossification, scapular notching, or aseptic loosening within the first postoperative year.

Key Takeaway: PASS thresholds for rTSA in proximal humeral fractures are higher in the Late treatment group across all three scores (ASES 60, CMS 66, SAS 67) compared to Early treatment (ASES 58, CMS 62, SAS 61), with SAS demonstrating the best discriminative ability (AUC 0.85 vs 0.74).

Key Takeaway: Triple-tapered collared cementless and collared composite-beam cemented stems yielded equivalent periprosthetic fracture rates (2.74% vs 2.97%) and 24-month revision-free survivorship (HR 0.896, P=0.916) in displaced femoral neck fracture THA, with cementless fixation producing a 6.50-point higher Harris Hip Score.

Key Takeaway: In patients ≥70 years with intact rotator cuff and glenohumeral OA, aTSA yields superior rotational ROM but carries a nearly fourfold higher revision risk compared to rTSA, with equivalent patient-reported outcomes.

Key Takeaway: Anatomic reduction reduces the hazard of adverse events by 79% (HR 0.21) after pediatric displaced femoral neck fracture, regardless of open or closed technique.

Key Takeaway: GLP-1 receptor agonist use in diabetic/obese ACDF patients reduced 90-day DVT/PE (0.44% vs 0.94%) and acute kidney injury (0.94% vs 1.69%) without increasing pulmonary aspiration risk (0.81% vs 1.25%).

Key Takeaway: Metaphyseal stems yielded superior abduction (74.6° vs. 57.9°) and external rotation (32.1° vs. 14.8°) after RSA for 3- and 4-part PHF, while diaphyseal stems produced higher ASES scores (76.4 vs. 65.6), with no difference in revision rates.

Key Takeaway: Uncemented monoblock cups in primary THA achieved 10-year survivorship of 98.8% for any cup revision and 99.2% for aseptic loosening, with a dislocation rate of only 0.1% across 2,292 hips.

Key Takeaway: Lateralized glenoid baseplates in rTSA for proximal humerus fractures produced a 6.8-point higher Constant-Murley Score (70.8 vs. 64.0) and 7° greater external rotation (30° vs. 23°) compared to medialized baseplates at minimum 18-month follow-up.

Key Takeaway: Postoperative PI-LL overcorrection (PI-LL < -10°) after lumbar fusion carries an OR of 17.05 for developing osteonecrosis of the femoral head and a hazard ratio of 9.67 for THA at five years.

Key Takeaway: Serum Ti, Co, and Cr concentrations remain elevated for at least 48 months after posterior spinal fusion in AIS patients, with Ti levels 5.5-fold higher than controls at 4 years (1.1 vs 0.2 μg/L), and implant removal normalizes levels to control values within 12 months.

Key Takeaway: Robotic assistance reduced early-career surgeon PA-THA dislocation rate from 4.5% to 0.3% (OR 0.08, 95% CI 0.004–0.42), matching experienced-career manual technique (1.2%) and DAA rates (0.5%).

Key Takeaway: Revision total elbow arthroplasty carries a pooled nerve injury incidence of 22.3% (95% CI 16.3–29.6%), with the ulnar nerve involved in 66.7% and radial nerve in 31.7% of cases.

Key Takeaway: DAIR success rates were similar for THA (66.4%) and TKA (68.7%), but risk factors for failure differed by joint, with only elevated preoperative CRP shared between both cohorts.

Key Takeaway: In 950 pediatric femoral neck fractures across 31 studies, plate fixation reduced AVN and premature physeal closure compared to screw fixation, with the greatest benefit in Delbet III/IV and displaced fractures.

Key Takeaway: Pyrocarbon humeral resurfacing hemiarthroplasty achieves 10-year cumulative revision rate of 7.7% versus 9.0% for best-in-class anatomic TSA in patients under 65, with no statistically significant difference in revision risk.

Key Takeaway: Preoperative metal hypersensitivity diagnosis is associated with a 3.63-fold increased risk of all-cause TKA revision at 5 years (13.1% vs 3.8%), but confers no significant revision risk increase after THA (4.8% vs 3.0%).

Key Takeaway: Humeral implant subsidence occurred in 25% of stemless rTSA cases at mean 43 months, driven by varus cut angle <140°, non-parallel implant seating, and superior glenosphere positioning, yet subsidence did not correlate with worse Constant scores or revision rates.

Key Takeaway: One-component single-stage revision TKA for PJI carries 5.3× higher odds of 90-day infection-related readmission versus two-component exchange, while two-component exchange has 3.7× higher odds of aseptic loosening-driven failure at five years.

Key Takeaway: In 43,189 patients with idiopathic cubital tunnel syndrome, 18% required surgery, with CTS (highest OR), elbow arthritis, RA, and metabolic comorbidities as independent risk factors for both disease development and surgical intervention, while regular exercise was protective for both outcomes.

Key Takeaway: Motor nerve palsy occurred in 0.4% of 10,604 primary THAs, with only 20% achieving complete recovery, and lumbar spine disease conferred a 21-fold increased odds of palsy (OR 21.3).

Key Takeaway: Cemented THA yielded the highest net monetary benefit ($790,784 CAD) and was cost-effective versus internal fixation at an ICER of $127.50 per QALM for non-displaced femoral neck fractures in 65-year-old Canadians.

Key Takeaway: Unplanned conversion from outpatient to inpatient TSA occurs in 7.2% of cases, with older age, ASA ≥3, COPD, diabetes, female sex, Hispanic ethnicity, and operative time >127 minutes as independent predictors on multivariable analysis.

Key Takeaway: Metaphyseal cementless and standard cemented stems achieved equivalent 90-day complication rates compared to diaphyseal-engaging stems in conversion THA after intramedullary nailing, with zero periprosthetic fractures across all 80 patients.

Key Takeaway: In patients under 50, aTSA achieves 95–100% implant survivorship at 0–10 years, but survivorship drops to 61–64% beyond 15 years, with revision rates ranging from 3.8% to 41.2% across included studies.

Key Takeaway: Lower-limb wearables detected significant improvements in Oxford Hip Score (p<0.001), Oxford Knee Score (p=0.020), and UCLA Activity Index (p<0.001) post-arthroplasty, but daily step counts did not significantly increase until beyond six months postoperatively.

Key Takeaway: In 80 AIS patients after PSF, PJK occurred in 13% and a postoperative PJA ≥12° (not the standard ≥10° threshold) best predicted clinically meaningful increases in pain interference and mobility decline on PROMIS.

Key Takeaway: Revision and modular TKA produce significantly higher whole blood cobalt and chromium concentrations than primary and monobloc TKA (P<0.05), with median whole blood levels of 1.42 ppb cobalt and 1.44 ppb chromium across all primary TKA studies.

Key Takeaway: Among ambulatory EOS patients treated with MCGR, UPROR rates were statistically equivalent between idiopathic (12.3%) and non-idiopathic etiologies (13.9%), with a risk difference of +1.5% (95% CI: -6.7% to +9.7%) falling within the pre-specified ±20% equivalence threshold.

Key Takeaway: Cemented THA reduced periprosthetic fracture risk by 60% (OR 0.40) and transfusion need by 24% (OR 0.76) versus uncemented fixation in propensity-matched elderly Japanese patients.

Key Takeaway: Incisional VAC following neuromuscular posterior spinal fusion reduced unplanned return to OR for infection from 21.0% to 7.3% (2.9x reduction, NNT=7.3, p=0.023), with patients discharged home with iVAC having only a 2.2% infection rate.

Key Takeaway: ORIF for adolescent supracondylar humerus fractures achieved 100% union across T-type and extraarticular patterns, but the overall complication rate was 64%, driven primarily by hardware pain (32%).

Key Takeaway: Vitamin D-deficient AIS patients undergoing PSFI had lower preoperative SRS-22r function scores (4.4 vs 4.6, P=0.020) but achieved equivalent 2-year postoperative scores after perioperative repletion.

Key Takeaway: Active 3D self-correction in AIS adolescents produced immediate improvements in trunk inclination, lateral deviation, and surface rotation, with baseline alignment parameters explaining up to 72% of correction magnitude variance (R²=0.720).

Key Takeaway: Over 17 years, age at definitive fusion for EOS remained unchanged overall (mean 12.1 years), with significant increases only in congenital EOS (10.6→12.3 years) and females (11.4→12.1 years).

Key Takeaway: Rotating-hinge TKA in neuromuscular genu recurvatum (mean preoperative hyperextension 33.4°) achieved a mean KSS of 72.4 and 7.7% failure rate at mean 4-year follow-up.

Key Takeaway: Femoral neck fractures in OI carry a 72.2% complication rate, 33.3% nonunion rate, and 55.6% revision rate, with Pauwels type 3 morphology in 72.2% of cases driving the majority of failures.

Key Takeaway: Patient-specific BIO-RSA for Walch type C glenoid dysplasia achieved 95% bone graft healing and 0% revision rate at mean 6.5-year follow-up, with mean retroversion correction of 30°.

Key Takeaway: Spinal anesthesia completed 23 DDH reduction procedures in infants (mean age 6.4 months) with zero anesthetic or surgical complications and 100% concentric reduction maintained at cast removal.

Key Takeaway: Acute THA for select acetabular fractures reduces revision surgery risk compared to ORIF alone, though available data remain heterogeneous and short-term.

Key Takeaway: Intraoperative duplex ultrasonography confirmed brachial artery flow in 8 of 10 pink pulseless hands after CRPP, guiding selective open exploration in only 2 cases with arterial spasm or kinking, with 100% neurovascular recovery by 6 weeks.

Key Takeaway: Distal humerus hemiarthroplasty yields comparable MEPS (86 acute vs. 83 salvage) and DASH scores (16.7 vs. 17.3) with no significant difference in complication rates (26.5% vs. 19.3%) between acute and salvage settings.

Key Takeaway: Crossed-screw subtalar arthrodesis achieved a 96.9% radiographic union rate (96/99) with a 7.1% symptomatic hardware removal rate at mean 26-month follow-up.

Key Takeaway: The Medacta cementless humeral stem demonstrated 67% stress shielding rates versus 19% (DJO Altivate) and 6.5% (Zimmer TM), with an odds ratio of 28.667 for stress shielding compared to the Zimmer TM stem.

Key Takeaway: In 505 patients undergoing combined ACWO with ACLR, the overall complication rate was 9.7%, with symptomatic hardware comprising 6.1% of cases and postoperative ACL graft rupture occurring in only 1.7%.

Key Takeaway: rTSA in Japan increased 8.9-fold from 630 to 5,601 procedures over 2014–2023, with the PHF indication share rising from 5.4% to 21.2% of all rTSA cases.

Key Takeaway: Onlay humeral stems increase acromial/scapular spine cortical bone regions exceeding yield stress threshold by 23–30% compared to inlay configurations, despite superior joint compressive stability gains after rTSA.

Key Takeaway: In CLEER patients undergoing rTSA, combining onlay (lateralized) humeral component with LD/TM transfer produced the greatest external rotation improvement and was the only strategy to exceed MCID for both rotation planes simultaneously at mean 38 months.

Key Takeaway: Wide laminectomy produced significantly greater posterior spinal cord displacement and longer deltoid MEP latency than limited laminectomy at postoperative days 10 and 14 in a rat model, supporting root tethering as the primary mechanism of C5 palsy.

Key Takeaway: Osteoporosis increases risk of frozen shoulder (4.8% vs. 4.0%), proximal humerus fracture (1.0% vs. 0.7%), and TSA conversion (2.2% vs. 1.9%) at 3 years after arthroscopic rotator cuff repair.

Key Takeaway: rTSA after failed rotator cuff repair yields a mean Constant score of 61 at 60 months, with infraspinatus involvement (Collin type D), absence of glenohumeral OA, and younger age each independently predicting inferior outcomes.

Key Takeaway: aTSA achieves a SANE ≥95 ('normal') rate of 51.0% vs. 37.3% for rTSA, with both designs reaching that threshold by 1 year in most patients and improvement plateauing at 3 years.

Key Takeaway: Bilateral Bernageau views quantify glenoid bone loss with accuracy equivalent to arthro-CT (mean difference 1.92%, Spearman r=0.80, p<0.001) in chronic anterior shoulder instability.

Key Takeaway: Arthroscopic ECM-BMAC grafting for OLTs in patients ≤18 years achieved 88% return-to-sport at mean 6.2 months and 6% reoperation rate at mean 32.8 months follow-up.

Key Takeaway: Monoblock dual-mobility THA for Crowe I–II DDH achieved 100% implant survival and zero dislocations at mean 10-year follow-up with HHS improving from 48 to 98.

Key Takeaway: In 21,863 TSA preoperative CT scans, arm position significantly affects PHHS measurement, but the effect is clinically small: a 10° change in flexion or internal rotation shifts subluxation by only ~2%, and abduction by ~1%.

Key Takeaway: Coracoid autograft for contained glenoid defects in revision shoulder arthroplasty yielded 0% baseplate failure and 11.1% overall revision rate at mean 5.0 months follow-up in 27 patients.

Key Takeaway: Telescoping intramedullary rods demonstrate lower reoperation rates than static rods for OI deformity correction, and bisphosphonates remain first-line pharmacotherapy though they delay osteotomy healing.

Key Takeaway: rTSA for failed proximal humerus fracture treatment achieved significant ASES improvement (45.8 to 69.6) with only 6.3% complication and 6.3% failure rates at mean 100.8-month follow-up.

Key Takeaway: Subscapularis repair significantly recenters glenohumeral contact loads in rTSA at 6 mm humeral lateralization, reducing load centroid radial distance to 0.2 mm versus 0.9 mm without repair (p<0.001) in abduction, behind-back, and overhead-reach positions.

Key Takeaway: In lateralized rTSA, teres minor demonstrates a universal biphasic length-tension pattern with a median circle angle at 50° of forward elevation, occurring 26.9° earlier than the infraspinatus, supporting its unique role in external rotation at elevation.

Key Takeaway: Humeral head size correlates with required graft thickness for near-anatomic lateralization in rTSA at r=0.93, with the Frankle-type configuration best reproducing native posterosuperior cuff muscle length.