Weekly Digest

Key Takeaway: At 7.3-year median follow-up, 125mm and 150mm cemented polished taper slip stems showed equivalent Oxford Hip Scores (mean difference 0.5, 95% CI -2.1 to 4.4) and equivalent survival (98.1% vs 98.2%), but the short stem demonstrated 0.7mm less subsidence.

Key Takeaway: A non-opioid multimodal protocol achieved equivalent 10-day pain scores (VAS 2.4 vs. 2.3, p=0.52) while reducing morphine milligram equivalent consumption by 89% (0.4 vs. 3.7 MME, p<0.001) compared to an opioid-based regimen after TSA.

Key Takeaway: Tourniquet use in primary TKA increases DVT risk by 60% (RR 1.60, 95% CI 1.25–2.05) without reducing calculated blood loss or transfusion requirements.

Key Takeaway: Home-based exercise improves aerobic capacity (SMD 0.53, 95% CI 0.32–0.74) in children and adolescents with chronic diseases, but confers no significant benefit over controls for functional capacity or quality of life.

Key Takeaway: Gluteus maximus tendon release during THA reduces muscle density (11.5 to 9.0 HU, p=0.022) but does not impair isokinetic extensor strength or clinical outcomes compared to preservation or release-with-repair at short-term follow-up.

Key Takeaway: Current public LLMs achieved 91.5% accuracy for CPT coding but only 23.9% for ICD-10 coding in hand surgery notes, with laterality errors as the dominant failure mode.

Key Takeaway: At 2 years, minimally invasive SI joint fusion maintained superiority over sham surgery with a mean VAS pain improvement of 41.5 vs. 13.5 points (p<0.001) and 73% of fusion patients achieving ≥20-point improvement versus 26% of sham patients.

Key Takeaway: At 6 weeks post-THA, piriformis-preserving STAR approach achieved step-length symmetry ratio of 1.03 versus 1.02 for DAA (P=0.15), with >96.8% of patients in both groups meeting symmetry thresholds.

Key Takeaway: In revision shoulder arthroplasty, synovial neutrophil percentage is the strongest preoperative diagnostic marker for PJI, with an optimal cutoff of 71.9–76.7% yielding an AUC of 0.707–0.714 for ICM Definite PJI.

Key Takeaway: GM and TA activation during gait remained significantly below healthy controls at 12 months post-TKA (GM: P<0.001; TA: P=0.01), with higher GM activation strongly associated with reduced pain and improved function.

Key Takeaway: Young THA patients (<40 years) at mean 10-year follow-up demonstrated significantly worse TUG, 5TSTS, HHS, OHS, and SF-12 physical scores compared to asymptomatic age-matched controls (all P<0.001), despite satisfactory pain relief.

Key Takeaway: Latent class growth modeling identified three distinct fear-of-falling trajectories after TKA, with 26.7% of patients following a persistently high slow-declining course predicted by older age, lower positive psychology scores, lower distress disclosure, and higher VAS pain.

Key Takeaway: Cefazolin reduces PJI risk by 45% versus vancomycin ± clindamycin and 34% versus non-cephalosporin antibiotics, with no significant difference against higher-generation cephalosporins across 2,303,501 TJA patients.

Key Takeaway: Perioperative touchpoints per TJA patient more than doubled from 2016 to 2022, reaching a mean of 17.8 for TKA and 16.1 for THA by 2022.

Key Takeaway: Outerbridge grade I–II lateral femoral condyle cartilage damage does not affect Oxford Knee Score, Forgotten Joint Score, or Kujala score at mean 70.8 months after medial UKA, with 0% conversion to TKA across all groups.

Key Takeaway: Among satisfied TKA patients with a baseline KOOS JR ≥60, CMS criteria deemed only 39% of surgeries successful, revealing profound discordance between patient satisfaction and a fixed 20-point improvement threshold.

Key Takeaway: Clopidogrel monotherapy for VTE prophylaxis after TJA increases transfusion risk by 69% (aOR 1.69) compared to aspirin without reducing DVT, PE, stroke, or MI rates.

Key Takeaway: Carbon fiber and titanium intramedullary nails for pathologic femoral fractures show equivalent total inpatient and 30-day costs with comparable 30-day complication rates (25% vs. 20%, P=0.50) in propensity-matched cohorts.

Key Takeaway: Subscapularis repair reduces instability risk by 74% overall (OR=0.26) in rTSA, but this benefit is largely confined to medialized implants (OR=0.06), with no IR improvement advantage demonstrated in lateralized designs.

Key Takeaway: After meta-regression adjustment for defect severity, cup-cage and custom triflange constructs show equivalent re-revision, PJI, instability, and aseptic loosening rates across 808 revision THAs at mean follow-up of 5.8–6.2 years.

Key Takeaway: Statin use after arthroscopic rotator cuff repair was not associated with increased retear risk (RR=1.14; 95% CI 0.54–2.42) and was associated with a significantly lower revision surgery rate (RR=0.83; 95% CI 0.70–1.00) compared to non-users across 14,483 patients.

Key Takeaway: DAIR for PJI after UKA yields 72% infection-free survival and 67% all-cause implant survival, with a 34% conversion-to-TKA rate across 165 patients.

Key Takeaway: Ultrasound-assisted CRPP for Song Type V lateral condyle fractures achieved a 98.96% excellent/good rate versus 97.80% with ORIF, with operative time 16 minutes shorter (37 vs. 53 min), supporting equivalent outcomes with less surgical exposure.

Key Takeaway: Among 3,479 patients ≥65 undergoing cemented THA for femoral neck fracture, taper-slip and composite beam stems showed no statistically significant difference in all-cause revision (1.8% vs. 3.2%; HR 1.81, 95% CI 0.96–3.40, P=0.06).

Key Takeaway: In 305 revision rotator cuff repairs, preoperative mental health status (VR-12 MCS) was the strongest predictor of baseline pain, function, and satisfaction, while tear size and type showed no association with baseline PROMs.

Key Takeaway: One-stage revision TKA with gastrocnemius flap reconstruction achieved 72.5% reinfection-free survival at two years, statistically equivalent to one-stage revision without flap coverage (P=0.56).

Key Takeaway: Applying ODEP benchmarking criteria to 25,495 Kaiser Permanente shoulder arthroplasties, 74.6% of patients received rated implants, but 15.1% received constructs that never met minimum volume thresholds for any rating.

Key Takeaway: Relative fibrinogen trajectory after explantation predicts early two-stage revision failure with an AUC of 0.75 (sensitivity 0.81, specificity 0.70), outperforming CRP.

Key Takeaway: Greulich and Pyle bone age overestimates chronological age by a mean of 2.9 months cohort-wide, with ~2-year 95% limits of agreement, but shows no systematic bias across race, ethnicity, or socioeconomic status in 472 pediatric ACL patients.

Key Takeaway: Tibial metal block augments in primary and aseptic revision TKA achieved 98.8% reoperation-free survival at mean 8-year follow-up with PROM improvements equivalent to standard primary TKA.

Key Takeaway: In full-thickness rotator cuff tears, shoulder flexor strength (r=0.485) and lower trapezius strength (r=0.376) correlate with functional outcome more strongly than structural parameters such as tear size (r=0.317), which correlates only with pain.

Key Takeaway: In 1.62 million adults, spinal fusion carried a 2.32x higher hazard of progressing to THA once hip OA developed, exceeding the 1.51x hazard seen with degenerative spine disease alone.

Key Takeaway: Posterior LHBT glenoid origin is independently associated with increased odds of full-thickness rotator cuff tears (OR ~3.6 vs. supraglenoid tubercle origin, OR 0.27) in patients aged 45–70 undergoing shoulder MRI.

Key Takeaway: At minimum 5-year follow-up after DAA THA, 90% of patients returned to sport within one year, but high-impact activity participation dropped from 24% to 10% postoperatively, driven largely by surgeon counseling (34%) rather than implant failure.

Key Takeaway: Preoperative anti-remodeling therapy (bisphosphonates) is independently associated with a 25% increased odds of one-year periprosthetic humeral fracture after shoulder arthroplasty (OR 1.25, 95% CI 1.06–1.46), with the effect driven primarily by the aTSA subgroup (OR 1.85).

Key Takeaway: LFIT cobalt-chromium and stainless-steel femoral heads yield equivalent 10-year revision-free survival (96.3% vs 96.5%, HR 1.17, p=0.32) when used with a polished tapered SS stem and XLPE liner.

Key Takeaway: Sickle cell disease patients undergoing TSA face a 4.82-fold increased risk of DVT and wound dehiscence and a 4.36-fold increased risk of acute kidney injury within 90 days, without a corresponding increase in 2-year implant-related complications.

Key Takeaway: A 7-day postoperative oral antibiotic course did not reduce PJI rates at 90 days or 1 year compared to no extended prophylaxis in 2,935 primary THA/TKA patients (P=0.254 at 1 year).

Key Takeaway: Prefabricated functional bracing reduced mean hospital charges by $22,520 per patient and LOS by 9.8 hours compared to spica casting, with 77% of brace patients requiring no sedation.

Key Takeaway: OSA patients undergoing primary TKA had no significant difference in 90-day medical or 1-2 year surgical complications versus matched controls, and achieved similar MCID rates across all PROMIS and KOOS-PS domains despite lower absolute postoperative scores.

Key Takeaway: In multiple revision ACLR, allograft use carries a threefold higher re-revision hazard versus BPTB autograft (HR 3.06), and fixed suspensory femoral fixation triples re-revision risk compared to adjustable suspensory devices (HR 0.30 favoring adjustable).

Key Takeaway: Femoral revision THA without ETO achieved 99% 10-year survivorship free of aseptic femoral loosening in 624 carefully selected cases, with dislocation (46% of re-revisions) as the dominant failure mode.

Key Takeaway: All-inside meniscal repair during ACLR fails in 12.3% of cases at 3 years, with medial repairs (17.7%) and bucket-handle tears (18.6%) carrying the highest risk and a medial repair HR of 3.08 versus lateral.

Key Takeaway: Medicaid and self-pay patients undergoing primary THA face 36% and 50% higher adjusted odds of in-hospital complications, respectively, compared to privately insured patients across 2.28 million weighted procedures.

Key Takeaway: Prior ACLR patients undergoing robotic functionally aligned TKA achieved equivalent KSS and FJS scores but had 10° less active knee flexion (120° vs. 130°, p=0.048) compared to controls at minimum 24-month follow-up.

Key Takeaway: Complete revision TKA using both femoral and tibial stems with cones or sleeves had the lowest cumulative percent second-revision rate for all-cause failure and aseptic loosening compared to all 13 other construct permutations across 22,238 aseptic revision TKAs.

Key Takeaway: Reverse coronal deformity (10.8% prevalence) managed with functional alignment robotic TKA achieved equivalent KSS and FJS scores at median 39 months with 0% aseptic revision rate versus 1.1% in controls.

Key Takeaway: After posterior-approach THA, posterior dislocation recurs in 68.4% of cases versus 28.6% for anterior dislocation (P=0.006), while concordance direction has no predictive value after anterior-approach THA (42.3% vs 41.2%, P=0.94).

Key Takeaway: Combining lower trapezius transfer with RSA using an allograft-prosthetic composite restored active external rotation past neutral in 80% of surviving shoulders at mean 2.7 years, up from 15% preoperatively.

Key Takeaway: RAO combined with FVWO achieved 85.9% THA-free survival at 20 years, with Tönnis grade 2 preoperatively and larger postoperative acetabular roof angle independently predicting failure.

Key Takeaway: 3D-printed custom-made acetabular implants achieved 96.3% implant survival at 9 years with 90% bone ingrowth and Oxford Hip Score improvement from 8 to 32 in complex revision THA.

Key Takeaway: Preoperative cryoneurolysis of four anterior knee nerves reduced cumulative postoperative opioid consumption by 27% (362 vs 497 MME, p=0.016) without affecting ROM recovery at 2 weeks, 6 weeks, or 3 months.

Key Takeaway: MCL injury occurs in 28.4% of PCL tibial avulsion fractures, and a fracture anteroposterior diameter ≥50.2% independently predicts concomitant MCL injury with an OR of 13.74.

Key Takeaway: In revision THA with Paprosky Grade II+ femoral bone loss, proximal femoral replacement demonstrated significantly lower 4-year survivorship (69.8%) compared to monoblock (84.5%) and modular tapered fluted stems (85.8%, P=0.030).

Key Takeaway: Abstract not available — see the original article for details.

Key Takeaway: A 2.5D deep learning model fused with radiomic and clinical features achieved micro-AUC 0.918 for detecting bone-on-bone medial compartment OA on MRI, matching senior surgeon accuracy and outperforming junior surgeons (P=0.027).

Key Takeaway: Tönnis grade 2 hips undergoing arthroscopy for FAI achieve similar mHHS improvement to Tönnis 0 and 1 hips but carry a significantly higher rate of conversion to THA (OR 5.27 vs Tönnis 0, though Tönnis 2 vs 3 did not reach significance at OR 5.27, 95% CI 0.91–30.51).

Key Takeaway: In valgus CPAK phenotypes (III and VI), neutralizing joint line obliquity after mechanical alignment TKA was associated with a 4.19-point higher 6-week Oxford Knee Score in CPAK III and 1.10-point improvement per degree of delta JLO in CPAK VI, while CPAK V knees lost 1.13 OKS points per degree of apex-proximal JLO shift at one year.

Key Takeaway: Contemporary arthroscopic Bankart repair achieves instability and functional outcomes equivalent to open repair, but carries a 2.15x higher reoperation rate (RR 2.15, P=0.0004) and preserves 1.67° more external rotation in abduction.

Key Takeaway: In robotic cruciate-retaining rKA TKA, LDFA change <2.3° and ELG ≥3.0 mm were the strongest predictors of superior 2-year KSKS and FJS, respectively.

Key Takeaway: Contralateral ACL injury rates are equivalent across HT (10.8%), BPTB (10.5%), and QT (12.2%) autografts in patients ≤25 years, but males have a significantly lower CL injury risk after BPTB specifically (RR 0.439) — a sex-graft interaction not seen with HT or QT.

Key Takeaway: Monoblock fluted tapered stems were associated with a 40% lower risk of re-revision for dislocation compared to modular stems (aHR 0.6, P=0.045), with no significant difference in all-cause re-revision (8.5% overall) between designs.

Key Takeaway: Slope-reducing ACWHTO combined with revision ACLR reduces posterior tibial slope by a mean of 8.40° and significantly improves anterior tibial translation, pivot shift, IKDC, and Lysholm scores at minimum 24-month follow-up.

Key Takeaway: An institutional preoperative anemia optimization protocol achieved a mean hemoglobin increase of 1.3 g/dL in anemic THA patients, with 69% reaching MCID, but ACD patients gained only 0.8 g/dL despite similar optimization duration (~83 days).

Key Takeaway: Cartilage fenestration with calcium sulfur-phosphorus composite implantation for chondroblastoma of the capital femoral epiphysis achieved 4% recurrence and 0% AVN in 25 pediatric patients at mean 67.5-month follow-up.

Key Takeaway: Revision THA consolidated dramatically (HHI 42.4 to 132.8) while primary THA and TKA decentralized over 2013–2023 in the Medicare population.

Key Takeaway: ORIF of posterior distal humeral shear fractures achieved 100% excellent-to-good MEPS outcomes (mean 95±5 points) at mean 25-month follow-up in 13 patients.

Key Takeaway: T2DM patients undergoing THA who received celecoxib developed new-onset postoperative heart failure at nearly double the rate of those receiving meloxicam (7.1% vs. 4.0%, p=0.013).

Key Takeaway: Sarcopenic obesity and central adiposity independently predict wound complications, mechanical failure, and delayed recovery in spine surgery patients beyond what BMI alone captures.

Key Takeaway: No single interbody cage material or surface technology has demonstrated consistent clinical superiority across titanium, PEEK, silicon nitride, or porous tantalum constructs.

Key Takeaway: Lateral robotic-assisted UKA achieves 98.8% survivorship at mean 53.4 months with 95.4% patient satisfaction across 971 procedures in 15 studies.

Key Takeaway: Compensatory loading by residual rotator cuff subregions reduces superior humeral head translation by 34–44% and posterior translation by 60–68%, restoring head center to within 0.1–1.7 mm of intact position, but contact pressure remains elevated in massive tear models.

Key Takeaway: Remnant-preserving footprint preparation yields 209.6 N ultimate failure load for 2.8-mm all-suture anchors, significantly exceeding decortication (137.2 N) and bone marrow stimulation (151.6 N) by approximately 35–38%.

Key Takeaway: Hip and Knee articles from the 2018 ICM on Musculoskeletal Infection captured 50.2% of 2,881 total citations, while Foot and Ankle articles captured only 0.2%, demonstrating extreme subspecialty disparity in knowledge translation.

Key Takeaway: Across 15 studies (13 RCTs), high protein intake improved muscle mass retention and functional recovery after ACLR, but only 1 trial addressed return-to-sport outcomes, leaving the clinical endpoint most relevant to surgeons essentially unstudied.